Ellen Costello

Motivators, Barriers, and Beliefs Regarding Physical Activity in an Older Adult Population

Background and Purpose:Regular physical activity (PA) plays an important role in improving and maintaining ones health, especially as one ages. Although many older Americans are aware of the benefits of regular PA, the majority do not participate in regular PA that meets recommended guidelines. The purpose of this study was to gain insight into the motivators, barriers, and beliefs regarding PA of independent-living older adults with easy access to fitness facilities. Methods:In this qualitative design, focus group interviews were used to explore the individual perceptions of physically active and inactive older adults regarding PA and exercise. Thirty-one older adults, over age 60 participated in focus group discussions regarding PA beliefs and behaviors. Groups were homogenous based on current PA behaviors. Demographic information was collected. Discussions were audiotaped and transcribed verbatim and deidentified. Two researchers independently coded for emergent themes. Interrater reliability was established (&kgr; = 0.89). Peer review was used to further ensure trustworthiness and credibility. Results:No significant differences were noted in age, body mass index, or educational levels between the physically active and inactive groups. Differences in perceptions were noted between the groups regarding the construct of PA, barriers to participation in regular PA, and the components of an ideal PA program. Physically inactive persons had much lower fitness expectations of a physically active older adult, more perceived barriers to regular PA, and required individual tailoring of a PA program if they were going to participate. In addition, inactive persons were intimidated by the fitness facilities and concerned about slowing others down in a group exercise setting. Both groups shared similar motivators to participate in PA, such as maintaining health and socialization; however, inactive persons also described PA as needing to be purposeful and fun. Discussion and Conclusion:Physically inactive persons perceived themselves to be physically active, as their perception of PA was grounded in a social context. Although both groups shared some barriers to regular PA participation, physically active individuals developed strategies to overcome them. Issues relating to self-efficacy and stages of change need to be explored to address the individual perceptions and needs of inactive older adults if initiation or long-term adherence to a PA program is to be achieved.

Validating Functional Measures of Physical Ability for Aging People with Intellectual Developmental Disability.

Unlike the aging population without intellectual and developmental disabilities (IDD), few standardized performance measures exist to assess physical function and risk for adverse outcomes such as nonfatal, unintentional injuries. We modified 3 selected standardized performance tools in the areas of general fitness (2-Minute Walk Test), balance and gait (Performance-Oriented Mobility Assessment I), and functional independence (Modified Barthel Index) for administration with people with IDD. The modified tools were piloted with 30 participants. Results indicated the measures are strongly associated and successfully distinguished between participants with an adverse health event in the previous year. The modified tools have potential to provide clinicians with quantitative measures that track physical performance changes associated with aging in people with IDD.

Education Program and Student Characteristics Associated With Pass Rates on the National Physical Therapy Examination for Physical Therapist Assistants

Background and Purpose. An important program outcome for physical therapist assistant (PTA) education programs is the pass rates of PTA graduates on the National Physical Therapy Examination (NPTE). The purposes of this study were to: (1) examine the relationship between PTA student education program characteristics and PTA graduate pass rates on the NPTE; and (2) develop a model which includes student and programmatic characteristics to predict success on the NPTE. Subjects. Program directors from 50 accredited PTA education programs completed surveys about their program. Methods. Program survey responses were coded and matched with first time and ultimate pass rates on the NPTE obtained from the Federation of State Boards of Physical Therapy (FSBPT). Correlation analyses and regression analyses were performed examining the relationships between NPTE pass rates and survey variables describing student and program characteristics and the role of the variables in predicting program pass rates. Results. Pass rates of PTA graduates were positively correlated with newer, public programs, more clinical education credits, and less general education credits as a percentage of the total credits required for program completion. The model best predicting first time pass rates included the year of program inception, and clinical education credits expressed as a percentage of the total credits. The model best predicting ultimate pass rates included the year of program inception, and whether the institution was public or private. Discussion and Conclusion. Updated curricula that include adequate time for required PTA competencies and the recruitment of qualified students are some factors that may contribute to PTA graduate success on the NPTE. All factors examined in this study need further investigation with a larger sample size.

Clinical Decision Making in the Acute Care Environment: A Survey of Practicing Clinicians

Purpose: To investigate current practice trends in the acute care setting using a case‐based clinical decision‐making survey to clarify when exercise or ADL training would be contraindicated. Methods: Acute care and cardiovascular and pulmonary section members participated in an 8‐question clinical decision‐making survey. Choices included decisions “to treat” or “not to treat” based on information provided. Additional comments were analyzed. Demographic information was also collected. Results: 356 PTs responded to the survey (18% response rate). Number of correct responses was calculated per case. Responses were also analyzed by educational training and years of experience. Respondents chose the optimal treatment choice more than 80% of the time in five of eight cases. Mean scores ranged from 4.85 for bachelors‐trained therapists with less experience, to 6.76 for doctorally‐trained therapists with greater experience. A two‐way ANOVA indicated a significant main effect for educational training and years of experience and also a significant interaction (p=.017). Incorrect responses in one of the eight cases appeared to be related to therapists using outdated information or institutional guidelines. Conclusions: Section members appear to be utilizing current evidence to support their clinical decision making process. Respondents with more experience, and those who continued their professional education were more likely to choose the optimal treatment strategy.

Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis

Background Persons with multiple sclerosis (MS) commonly have difficulty walking. The 6-Minute Walk Test (6MWT) assesses functional capacity but may be considered burdensome for persons with MS, especially those with higher disability levels. The 2-Minute Walk Test (2MWT) may be an alternative measure to the 6MWT. The purpose of this study was to investigate the validity of the 2MWT in persons with MS. Methods Twenty-eight ambulatory persons with MS aged 18 to 64 years participated in this cross-sectional study. Participants completed five measures of walking performance (2MWT, 6MWT, usual and fast gait speed, and Timed Up and Go test) and two functional measures (Berg Balance Scale and five-times sit-to-stand test) during a testing session. Participants were classified into two subgroups based on Disease Steps scale classification. Results The 2MWT was significantly correlated with the 6MWT (r = 0.947), usual gait speed (r = 0.920), fast gait speed (r = 0.942), the Timed Up and Go test (r = -0.911), and other functional measures. The 2MWT explained 89% of the variance seen during the 6MWT. The distances completed on the 2MWT and 6MWT accurately distinguished the subgroups. Conclusions This study demonstrated good construct and discriminant validity of the 2MWT in persons with MS, providing an efficient and practical alternative to the 6MWT. Validation of the 2MWT with other functional measures further supports these findings.