Michael J. Shoemaker

Direct Consumer Access to Physical Therapy in Michigan: Challenges to Policy Adoption

Background Despite the ability of consumers to receive treatment from a physical therapist without a physician referral or prescription in 45 states, Michigan continues to require a physician prescription. Given the impending primary care provider shortage, direct access should be considered as a potential solution to barriers that prevent patients from accessing timely musculoskeletal care. Objective The purpose of the present policy analysis was to analyze why an attempt in 2006 to remove the prescription requirement in Michigan was not adopted. Methods The Policy Analysis Triangle approach, which considers the relevant actors, processes, and context in which a policy must be considered, was used to analyze why Michigan House Bill 5618 was not passed. Data sources included position statements from relevant stakeholders, state government documents, stakeholder analysis, and a systematic review of the literature. Results Multiple data sources, including a systematic review of the literature, revealed that direct access does not pose a risk to public safety and may result in better outcomes with regard to cost and quality of care. Failure of Michigan to adopt direct access in 2006 was due to scope of practice conflicts and various political contexts and processes. Conclusions Direct consumer access to physical therapy services appears to be sound health policy that should be reconsidered by Michigans legislature to alleviate the primary care provider shortage for those with musculoskeletal disorders.

Grip strength values stratified by age, gender, and chronic disease status in adults aged 50 years and older.

Background and Purpose:Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases. Methods:A cross-sectional analysis was conducted using data collected from adults aged 50 years or older (n = 5877) from the Health and Retirement Study survey administered in 2008. Grip strength values (in kilograms) were determined and stratified on the basis of the number of self-reported chronic diseases (0, 1, 2, ≥3) and stratified by age (decades) and gender. Results:Consistent with previously published values, males demonstrated higher mean hand grip strength than females and grip strength values decreased with age. Adults with multimorbidity demonstrated decreased grip strength as compared with those without chronic conditions (males/females with 0 chronic diseases right grip strength = 44.2/26.8 kg as compared with males/females with 3 or more chronic disease right grip strength = 36.1/21.7 kg). Conclusions:The grip strength values presented can serve as a standard of comparison for the large proportion of adults who have multimorbidity. Clinicians should consider grip strength as a component of a comprehensive physical assessment to identify decreased grip strength and recommend increased physical activity as an appropriate intervention.

A virtual patient educational activity to improve interprofessional competencies: A randomized trial

Abstract The purpose of the present study was to determine whether an interprofessional virtual patient educational activity improved interprofessional competencies in pharmacy, physician assistant, and physical therapy graduate students. Seventy-two fifth semester pharmacy (n = 33), fourth semester physician assistant (n = 27) and fourth semester physical therapy (n = 12) graduate students participated in the study. Participants were stratified by discipline and randomized into control (n = 38) and experimental groups (n = 34). At baseline and at study completion, all participants completed an original, investigator-developed survey that measured improvement in selected Interprofessional Education Collaborative (IPEC) competencies and the Readiness for Interprofessional Learning Scale (RIPLS). The experimental group had statistically significantly greater odds of improving on a variety of IPEC competencies and RIPLS items. The use of a single, interprofessional educational activity resulted in having a greater awareness of other professions’ scopes of practice, what other professions have to offer a given patient and how different professions can collaborate in patient care.

Predicting response to rehabilitation in elderly patients with stroke using the Orpington Prognostic Scale and selected clinical variables.

Purpose: Prediction of outcome and response to rehabilitation in patients with stroke can be difficult, especially in the elderly. The purpose of this study was to determine the ability of the Orpington Prognostic Scale (OPS) to predict outcome and response to subacute rehabilitation in older patients with stroke. Methods: Twenty‐two subjects in the subacute care setting diagnosed with acute stroke were prospectively studied. The OPS was scored within 2 weeks of stroke, and the Functional Independence Measure (FIM) motor subscale was scored at admission and discharge. Results: Strong Spearman correlations with OPS scores were found for improvement in FIM score [rs = −.74, 95% CI: (−.88, −.45), p = .0007] and discharge FIM score [rs = −.81, 95% CI: (−.92, −.58), p = .0002]. Conclusions: The OPS scores were strong predictors of response to subacute rehabilitation and discharge FIM motor subscale scores. The OPS may warrant a broader application as a prognostic indicator for patients with stroke.

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)☆

BACKGROUND Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. METHODS A cross-sectional analysis was conducted of 5877 respondents (2744=male, 3103=female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). RESULTS As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b=3.1, 95% CI=2.3-3.9, p<0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. CONCLUSION Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.

Exercise- and Psychosocial-Based Interventions to Improve Daily Activity in Heart Failure: A Pilot Study

In individuals with heart failure (HF), low daily activity is associated with a poorer prognosis. The purpose of this pilot study was to investigate the effects of two home-based interventions on the primary HF-related outcome of daily activity and secondary outcomes of exercise tolerance, HF-related health status, and lower extremity functional strength in 16 patients with HF and implanted Medtronic implantable cardioverter defibrillator and cardiac resynchronization devices using a single-blind, randomized controlled pilot trial. Interventions were either daily activity feedback and encouragement or health coaching and home-based exercise. There were no significant differences in primary or secondary outcomes either between or within groups. Three subjects in each treatment group improved in two or more secondary outcomes, and only one improved in daily activity. Although the present pilot study incorporated both exercise and psychosocial components in the intervention, there was no effect on daily activity, perhaps because readiness for behavioral change was not accounted for either in group stratification/allocation or inclusion criteria.

Seasonal variation of daily physical activity in individuals with heart failure

Background Previous studies indicate that seasonal variation affects daily physical activity (PA), but none have investigated this relationship in individuals with heart failure (HF) who also have implanted cardioverter defibrillators and cardiac resynchronization therapy (ICD/CRT) devices. The purpose of the present study was to determine if seasonal variation in temperature affects daily PA in patients with HF and ICD/CRTs. Patients and methods Secondary analysis of data from 16 subjects with HF and Medtronic® ICD/CRT devices enrolled in a randomized trial investigating interventions to improve daily PA. Due to the rolling study enrollment, daily PA data for all subjects were not available for the entire time frame and were divided into two groups. Determination of seasonal variation of daily PA was determined using visual analysis of daily PA plotted with average temperature, autocorrelation, visual analysis of seasonal subseries plots and boxplot analysis, as well as Wilcoxon signed-rank tests. Results Subjects 1-8 demonstrated the greatest differences in daily PA during periods of seasonal transition whereas subjects 9-16 demonstrated the greatest variation in daily PA with greatest seasonal temperature difference. Wilcoxon signed-rank testing of the lowest and highest months for daily PA revealed median differences of 0.30 (p = 0.050) and 0.36 hours (p = 0.036) for subjects 1-8 and 9-16, with effect sizes of 0.69 and 0.74, respectively. Conclusions Seasonal variation in mean temperature appears to affect daily PA in individuals with HF and ICD/CRT devices by a magnitude of 0.30-0.36 hours, which may need to be accounted for in future research investigating interventions to improve daily PA.