Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic.

OBJECTIVES: Examine physical function change and physical therapy (PT) use in short-stay and long-stay residents not infected by CoVID-19 within Veterans Affairs (VA) Community Living Centers (CLCs). DESIGN: Retrospective cohort study using Minimum Data Set (MDS) 3.0 assessments. SETTINGS AND PARTICIPANTS: 12,606 Veterans in 133 VA CLCs between September 2019 and September 2020. METHODS: Difference in physical function [MDS Activities of Daily Living Score (MDS-ADL)] and PT use (minutes in past 7 days) from admission to last assessment in a period were compared between the pre-CoVID-19 (September 2019 to February 2020) and early CoVID-19 (April 2020 to September 2020) period using mixed effects regression with multivariable adjustment. Assessments after a positive CoVID-19 test were excluded. Differences were examined in the sample and repeated after stratifying into short- and long-stay stratums. RESULTS: Veterans admitted during early CoVID-19 had more comorbidities, worse MDS-ADL scores, and were more often long-stay residents compared with those admitted during pre-CoVID-19. In comparison to pre-CoVID-19, Veterans in VA CLCs during early CoVID-19 experienced greater improvements in their MDS-ADL (-0.49 points, 95% CI -0.27, -0.71) and received similar minutes of therapy (2.6 minutes, 95% CI -0.8, 6.0). Stratification revealed short-stay residents had relative improvements in their function (-0.69 points, 95% CI -0.44, -0.94) and higher minutes of PT (5.1 minutes, 95% CI 0.9, 9.2) during early CoVID-19 whereas long-stay residents did not see differences in functional change (0.08 points, 95% CI -0.36, 0.51) or PT use (-0.6 minutes, 95% CI -6.1, 4.9). CONCLUSIONS AND IMPLICATIONS: During early CoVID-19, physical function improved while the amount of PT received was maintained compared with pre-CoVID-19 for Veterans in VA CLCs. Short-stay residents experienced greater improvements in physical function and increases in PT use. These findings may be partly due to selection bias relating to Veterans admitted to CLCs during early CoVID-19.

Long-Term Career Earnings in Academia Might Offset the Opportunity Cost of Full-Time PhD and Postdoctoral Education for Physical Therapists Who Hold a Doctor of Physical Therapy Degree.

OBJECTIVE: Rigorously trained physical therapy researchers are essential for the generation of knowledge that guides the profession. However, there is a current and projected dearth of physical therapy researchers capable of sustaining research programs in part due to perceived financial barriers associated with pursuit of a doctor of philosophy (PhD) degree, with and without postdoctoral training, following doctor of physical therapy (DPT) degree completion. This study aimed to evaluate the financial impact of PhD and postdoctoral training, including opportunity cost, years to break even, and long-term earnings. METHODS: Clinical and academic salaries were obtained via the 2016 APTA Median Income of Physical Therapist Summary Report and 2019 CAPTE Annual Accreditation Report. Salaries were adjusted to total compensation to account for benefits and compared over a 30-year period starting after DPT education. Total compensations were also adjusted to the present value, placing greater weight on early career earnings due to inflation and potential investments. RESULTS: Relative to work as a clinical physical therapist, 4 years of PhD training result in an earnings deficit of $264,854 rising to $357,065 after 2 years of additional postdoctoral training. These deficits do not persist as evidenced by a clinical physical therapist career earning $449,372 less than a nonmajority scholarship academic career (DPT to PhD to academia pathway) and $698,704 less than a majority scholarship academic career (DPT to PhD to postdoctoral training to academia pathway) over a 30-year period. Greater long-term earnings for PhD careers persist when adjusting to present value. CONCLUSIONS: Although there is an initial opportunity cost of PhD and postdoctoral training represented by a relative earnings deficit, advanced research training results in greater long-term earnings. IMPACT: The findings of this study allow physical therapists interested in pursuing PhD and postdoctoral training to be better informed about the associated financial ramifications.

The Interplay Between Fear of Falling, Balance Performance, and Future Falls: Data From the National Health and Aging Trends Study.

BACKGROUND AND PURPOSE: Fear of falling is common in older adults and greatly increases their risk for falls. Interventions aimed at reducing fall risk in older adults with a fear of falling typically aim to improve balance. However, this approach has limited success, and the idea that balance performance impacts fall risk in this population is largely based on research in the general older adult population. The aim of this study was to assess whether presence of fear of falling modifies the relationship between balance performance and future falls in a sample of nationally representative older adults. METHODS: We analyzed data from 5151 community-dwelling Medicare beneficiaries (65 years or older) from waves 1 and 2 of the National Health and Aging Trends Study. In this prospective cohort study, balance performance and fear of falling were recorded during wave 1, while a report of a fall was recorded during wave 2 (1-year follow-up). The interplay between fear of falling, balance performance, and fall risk was analyzed using logistic regression with fear of falling as a moderating variable while controlling for common confounding variables. RESULTS: Twenty-seven percent of participants reported a fear of falling at wave 1 while 32.7% reported a fall at wave 2. Reduced balance performance was significantly associated with increased future fall likelihood in individuals with and without a fear of falling ( P = .008). Further, the presence of fear of falling did not modify the association between balance and future falls ( P = .749). Fear of falling was associated with increased future fall likelihood independent of balance performance ( P < .001). CONCLUSION: These findings demonstrate that fear of falling did not modify the relationship between balance performance and future fall risk, thus suggesting that balance training is appropriate to reduce falls in older adults with a fear of falling. However, balance training alone may be insufficient to optimally reduce falls in older adults with a fear of falling, as the presence of this fear increased future fall risk independent of balance performance.