Association Between Performance on an Interdisciplinary Stroke Assessment Battery and Falls in Patients With Acute Stroke in an Inpatient Rehabilitation Facility: A Retrospective Cohort Study.

OBJECTIVE: To explore the association between demographic factors and functional performance measures of patients with acute stroke in an inpatient rehabilitation facility (IRF) and falls during the IRF stay and to quantify the diagnostic accuracy of functional outcome measures in identifying fallers. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: Individuals with acute stroke admitted to hospital-based IRF (N=139). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Odds ratios were used to examine the relationship between fall frequency and functional outcome measures (National Institute of Stroke Scale, neglect [Item #11], Berg Balance Scale, Stroke Rehabilitation Assessment of Movement mobility and Stroke Rehabilitation Assessment of Movement lower extremity subscales [STREAM-LE], Montreal Cognitive Assessment, Dynamic Gait Index, and Stroke Impact Scale). Receiver operator characteristic analysis with area under the curve, sensitivity, specificity, and diagnostic odds ratio were used to assess the diagnostic accuracy of each functional outcome measure to distinguish patients who fell vs those who did not fall in the IRF. RESULTS: A total of 23 patients (16.2%) fell during the IRF hospitalization. Patients who did and did not fall did not differ in terms of age, sex, stroke type, or stroke location. Only the STREAM-LE was associated with falls (odds ratio, 0.93; 95% CI, 0.86-0.99). Area under the curve was 0.67 (95% CI, 0.51-0.82). With a positivity cutoff point of 12, sensitivity and specificity were 73.3% (95% CI, 54.6%-92.2%) and 50.0% (95% CI, 39.9%-59.2%), respectively. The diagnostic odds ratio was 3.4. CONCLUSIONS: The STREAM-LE score at admission to IRF may identify patients with acute stroke who are more likely to fall during their stay. However, the search for measures with greater diagnostic accuracy should continue.

Examining the Early Academic Performance of Doctor of Physical Therapy Students After Holistic Review: A Retrospective Cohort Study.

INTRODUCTION: A diverse health care workforce can help to address systemic health disparities. Holistic review and use of an expanded definition of underrepresented minority (URM) that includes factors beyond race and ethnicity are suggested methods to promote diversity in the physical therapist (PT) workforce and ultimately address societal health disparities. REVIEW OF LITERATURE: Evidence suggests that holistic review can promote PT student diversity; however, limited evidence exists that describes the academic outcomes of holistic review that consider social determinants of learning (SDOL) factors in the review process. The purpose of this study was to examine the early academic outcomes of students after a holistic review and to examine relationships between SDOL factors and academic performance. SUBJECTS: A convenience sample of 160 students admitted to a doctor of physical therapy (DPT) program from June 2020 to June 2022 was used. METHODS: A secondary analysis of students' self-reported responses from their admissions application was used to categorize response data into SDOL groups. An independent-sample t-test was used to test group differences in academic performance, and regression modeling was used to test relationships between SDOL factors and academic performance. RESULTS: The mean 6-month DPT program grade point average (GPA) of the sample was 3.32 ± .43. Nonstatistically significant differences appeared in early DPT GPA between URM and non-URM student groups. However, after controlling for undergraduate GPA, a history of educational disadvantage was the only SDOL factor that contributed to early DPT GPA variance (2.6%), P < .05. DISCUSSION AND CONCLUSION: The similar academic performance of URM and non-URM students provides support for using an expanded URM definition in holistic review. Most of the educationally disadvantaged group were first-generation college students, which was associated with lower early GPA. These results provide emerging evidence that first-generation students in DPT programs may benefit from additional academic support.

A backward cycling programme for people with Parkinson's disease: a feasibility and preliminary results study.

OBJECTIVE: To assess the feasibility of backward cycling for people with Parkinson's disease. Secondary objectives were to assess changes in gait and balance following a 6-week program. DESIGN: A single-group prospective pre-test, post-test study with 1-month follow-up. SUBJECTS/PATIENTS: Twenty-six people with Parkinson's disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years). METHODS: Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test. RESULTS: There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest. CONCLUSION: Backward cycling was a feasible intervention for people with Parkinson's disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.

Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization.

BACKGROUND: As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG. METHODS: To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG. RESULTS: Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication. CONCLUSIONS: This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines. TRIAL REGISTRATION: N/A.

Comparing the use of mathematical calculation to a measuring wheel to determine distance walked in three different course configurations of the 6 minute Walk Test in healthy adults.

INTRODUCTION: A recent clinical practice guideline set forth recommendations for the administration of the 6 Minute Walk Test, including course set-up and using mathematical calculation to obtain the distance walked. In clinical practice and research, however, deviations from these protocols exist. PURPOSE: To assess for differences in total distance walked between use of mathematical calculation and a measuring wheel during three different course configurations of the 6 Minute Walk Test. METHODS: Fifty healthy adults (18 males, 32 females) completed this study. The mean age was 37.04 (13.76) years ranging from 23 to 61 years. Each participant completed three course configurations of the 6 Minute Walk Test: a 12-meter straight walkway representing the Academy of Neurologic Physical Therapy Core Set of Outcome Measures Clinical Practice Guideline protocol, a 30-meter straight walkway, representing the American Thoracic Society's recommended protocol, and a 1.2-meter by 12-meter rectangular walkway, of which the Core Set of Outcome Measures Clinical Practice Guideline was derived. For mathematical calculation, the total number of laps counted, and this total number was multiplied by the distance of one lap with any partial lap added. Additionally, a research assistant followed behind each participant with a measuring wheel to capture distance walked. RESULTS: For all configurations, there were statistically significant differences between mathematical calculation and a measuring wheel, with mathematical calculation producing significantly less total distance. Additionally, there were statistically significant differences between all course configurations, despite the method of measurement. CONCLUSION: Adhering to 6 Minute Walk Test protocols, including the method of measuring the distance, is imperative to accurately interpret results and compare to existing data.Key messagesDespite recommendations for standardized administration of the 6 Minute Walk Test, deviations exist, including the method of which to obtain the total distance walked; either by use of mathematical calculation or a measuring wheel.In three different 6 minute walk test course configurations, including the American Thoracic Society's recommended protocol and the Academy of Neurologic Physical Therapy recommended protocol, the measuring wheel resulted in significantly larger distances than use of the mathematical calculation.Despite the measuring wheel able to account for the turns during the 6 Minute Walk Test, it is imperative for clinicians to utilize standardized procedures such as using mathematical calculation, in order to accurately track progress and compare to existing data, of which mathematical calculation was used to derive.

The Effects of Dog Walking on Gait and Mobility in People with Parkinson Disease: A Pilot Study.

The objective of this study was to assess the effects of dog walking on gait and mobility in people with Parkinson disease (PD). This single-group, single-session, observational pilot study included nineteen participants with PD in Hoehn and Yahr stages II (n = 9) and III (n = 10). Primary measures were a gait analysis and the Timed Up and Go (TUG). Three trials of two conditions (walking with and without a dog) were completed. Walking with a dog resulted in slower gait velocity (mean difference = 0.11 m/s, p = 0.003, d = 0.77), shorter step length (left: mean difference = 7.11 cm, p = 0.000; right: mean difference = 3.05, p = 0.01), and stride length (left: mean difference = 7.52, p = 0.003; right: mean difference = 8.74, p = 0.001). The base of support was more narrowed (Z = -2.13, p = 0.03), with increased double limb stance time (left: Z = -2.89, p = 0.004; right: Z = -2.59, p = 0.01). Walking with a dog caused slower TUG times (mean difference = -1.67, p = 0.000) and increased number of steps (Z = -3.73, p = 0.000). No significant change shown in step time (left: mean difference = -0.001, p = 0.81; right: mean difference = 0.002, p = 0.77) or cadence (Z = -1.67, p = 0.10). In conclusion, there was an overall decline of gait parameters in people with PD when walking with a dog.