Tanya Kinney LaPier

The First Physical Therapy Summit on Global Health: Implications and Recommendations for the 21st century

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Abstract Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n = 32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization’s non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

Analysis of Activities of Daily Living Performance in Patients Recovering from Coronary Artery Bypass Surgery

The purpose of this study was to investigate the impact of coronary artery bypass grafting surgery (CABG) on the ability to perform activities of daily living. Patients who had recently undergone CABG surgery (n = 40) participated in this study. They completed the Functional Status Index, a self-report instrument, at two weeks and two months postsurgery. We calculated the response frequency for each item of the Functional Status Index and used chi-square for data analysis. A significant loss of function occurs immediately following surgery. The number of patients who experienced limitations or difficulty with opening containers, dressing, and rising from a chair increased two weeks after CABG surgery. Depressed physical function immediately following surgery may be related to surgeon-determined activity restrictions, fear of activity, and/or exacerbation of symptoms.

Indicators of functional deficits after coronary artery bypass surgery.

The purposes of this study were to determine if ratings of difficulty or pain were more likely to detect deficits in activities of daily living (ADL) than degree of dependency and to longitudinally examine ADL in patients recovering from coronary artery bypass (CAB) surgery. This study included 40 patients who had recently undergone CAB surgery. We evaluated ADL performance using 3 subcategories of the Functional Status Index: mobility, personal care, and hand activities. Subjects completed the Functional Index before, 2 weeks after, and 2 months after CAB surgery. The percent of participants reporting difficulty or pain on the FSI was greater than the percent needing assistance except for hand activities preoperatively. Up to 65% of study participants reported deficits in ADL performance. In conclusion, assessments of ADL abilities that rely only on need for assistance may underestimate the presence of functional deficits in patients recovering from CAB surgery. Understanding functional level will assist in determining patients need for rehabilitation services after CAB surgery.

Perceptions of exercise and quality of life in older patients in the United States during the first year following coronary artery bypass surgery

Abstract Background and purpose: It is important for patients recovering from coronary artery bypass (CAB) surgery to initiate and maintain recommended exercise guidelines. The purpose of this qualitative study was to describe factors that influence adherence to exercise, and perceptions of activity limitations and health-related quality of life (QoL) in older patients recovering from CAB surgery. Subjects: Participants were 28 people aged 65 and older, prospectively recruited from a U.S. hospital following CAB surgery. Procedures: A qualitative description methodology was used to identify factors that influenced participants’ feelings about exercise and QoL. Data were collected using phone interviews 3, 6, and 12 months after surgery. Data were coded by identifying significant statements, grouping them into meaningful units or “themes”, and generating descriptions of participants’ experiences and understandings. Results: Across time points, participants’ most commonly described motivators were that it feels good to exercise, and belief that it improves physical health. The most commonly cited barriers to exercise were other time commitments, inclement weather, and pain/injury/illness related or unrelated to CAB surgery. Discussion and conclusion: Motivating themes remained consistent across the time intervals but the number of responses regarding barriers to exercise increased over time. A better understanding of the patient experience may help to promote exercise initiation and adherence following CAB surgery.

Upper Extremity Forces Generated During Activities of Daily Living: Implications for Patients Following Sternotomy

Purpose:Activity restrictions are typically imposed on patients following median sternotomy. Among common sternal precautions (SP) are limitations in upper extremity (UE) force production. The purpose of this study was to measure peak forces during UE activities of daily living and to examine the effect of force production by varying the temporal components of task completion. Methods:Fifteen participants between 22 and 59 years of age performed 19 lifting, pushing, or pulling tasks. For each task, participants performed 3 trials at their preferred speed and 3 trials at a slow speed. Peak forces were measured using a digital dynamometer. Mean percentage change in force produced during preferred and slow movements was recorded for each task. Descriptive statistics were calculated, and paired Student t tests were used to determine differences in force between preferred and slow speeds. Results:Mean peak force generated during preferred speed was less than 10 pounds (a common SP weight limit) for only 6 of the 19 tasks. Peak force exceeded 20 pounds for 5 tasks. Forces were less for all tasks performed at a slow speed as compared with a preferred speed, except 1; the percentage reduction in force ranged from 8% to 61%. Conclusions:Many daily tasks generate UE peak forces in excess of 10 pounds. Performing UE movements at slower than normal speeds reduces peak forces. Optimally, SP should be individualized and functionally based, with consideration for the UE forces produced during activities patients are likely to perform.

Assessment of Kinesiophobia and Use of Music Therapy in the Acute Care Setting: A Case Report

Background and Purpose:Rehabilitation of patients with low function, multisystems involvement, and concomitant fear of activity (kinesiophobia) is challenging in acute care. The purpose of this case report was to describe the physical therapy (PT) management of a patient admitted to an acute care hospital with an uncommon diagnosis and employment of a unique assessment and intervention component. Case Description:A 48-year-old woman with mixed connective tissue disease–associated pulmonary artery hypertension was hospitalized after rapid decline in function and medical status. Because the patient presented with extreme fear of activity, PT management included the use of the Tampa Scale for Kinesiophobia and music therapy. Outcomes:The patient made modest improvements in her impairments and functional limitations despite a poor medical prognosis. The use of music during PT increased her participation in therapeutic exercise and, therefore, activity tolerance. Objective assessment of the patients level of kinesiophobia allowed clear identification of this barrier and the use of strategies to minimize it. Discussion:This case describes the PT management of a complex patient using strategies that are not frequently used in acute care settings. The use of nontraditional PT outcome measures and interventions can be feasible, especially for patients with long hospital stays like the patient described in this case.

Exercise Adherence Issues, Behavior Change Readiness, and Self-Motivation in Hospitalized Patients with Coronary Heart Disease

Purpose: Exercise and increased physical activity are important lifestyle modifications for patients with coronary heart disease (CHD). The purpose of this study was to identify factors that influence patient adoption of exercise as part of a healthy lifestyle in hospitalized patients with CHD. Methods: Fifty‐one patients hospitalized for a CHD‐related diagnosis were prospectively recruited from a regional medical center. Participants completed 3 self‐report survey instruments during their inpatient hospitalization—Exercise Adherence Questionnaire, Change Readiness Assessment, and Self‐Motivation Scale for Compliance. Results: Thirty‐two men (64%) and 18 women (36%) with a mean age of 65 years (±11.5) participated in this study. Using the Exercise Adherence Questionnaire, participants identified more motivators than barriers to exercise. Based on Change Readiness Assessment responses, only one‐third of participants (33%) were exercising regularly. The mean Self‐Motivation Scale for Compliance score was below the instrument threshold score, indicating low self‐motivation and compliance, and a high likelihood of quitting exercise. Conclusion: Study findings describe current attitudes toward exercise, factors that encourage and limit exercise participation as well as likelihood of maintaining an exercise program in a group of hospitalized patients with CHD. For many patients with CHD, the acute care hospital stay may be the only opportunity to receive education about exercise, adoption of positive health behaviors, and self‐management skills. Also, the medical event and the resulting hospitalization itself can be a powerful motivator for positive health behavior changes.