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Geriatric Rehabilitation
As the aging population continues to increase, so does the need for a text specific to the specialized care of the elderly patient as it applies to the physical therapist assistant student, faculty, and clinician.
Geriatric Rehabilitation: A Textbook for the Physical Therapist Assistant
, recognizes the growing role of the PTA in a variety of heath care settings from acute to home to long-term care settings, to name a few.
Inside
Geriatric Rehabilitation
, Dr. Jennifer Bottomley, along with her contributors, focuses on the clinically relevant assessment, treatment, and management of the geriatric population. Pathological manifestations commonly seen in the elderly patient are addressed from a systems perspective, as well as a focus on what is seen clinically and how it affects function.
Each pathological area covered includes:
Screening, assessment, and evaluation
Treatment prescription
Goal setting
Modification of treatment
Anticipated outcomes
Psychosocial, pharmacological, and nutritional elements
The organization and presentation of the practical, hands-on components of interventions, assessments, and decision-making skills make this a go-to text for the PTA to administer comprehensive geriatric care at each point along the continuum of care.
Some of the features inside include:
Emphasis on treatment interventions-techniques, tips, and options
Focus on how assessment tools and treatments are applied and modified to benefit the geriatric population, and what the expected outcomes are
Clear and outlined chapter objectives
User-friendly summary tables in the nutritional and pharmacology chapters
Pearls that highlight important chapter information
Appendices and study aids
Geriatric Rehabilitation: A Textbook for the Physical Therapist Assistant
answers the call for a text that focuses on the management of geriatric patients across the spectrum of care for the PTA, from students to those practicing in geriatric populations.
eBook
Promoting Physical Activity and Fitness
Exercise and physical activity in all forms are an important part of life, and can have lasting mental and physical health benefits. Promoting Physical Activity and Fitness provides critical insights in the field through clear and evidence-based information on how to evaluate, train, and foster physical activity and fitness in individuals with childhood-onset disabilities safely across the lifespan. The authors respond to specific needs to enable many people to lead more physically active lives. Themes include physical fitness and activity assessment and training, safe engagement, measurement of activity levels and progress, responses to pain, and information relevant to specific diagnostic groups. Diverse, complex subjects are presented in an accessible and engaging way.
eBook
Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation
AbstractObjectiveTo evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery.DesignMulticentre, pragmatic, superiority, randomised controlled trial with economic evaluation.Setting17 UK National Health Service cancer centres.Participants392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196).InterventionsUsual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months.Main outcome measuresDisability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective.ResultsBetween 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale −0.68, −1.23 to −0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) −2.02, −3.11 to −0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average −£387 (€457; $533) (95% confidence interval −£2491 to £1718; 2015 pricing) and was cost effective compared with usual care.ConclusionsThe PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications.Trial registrationISRCTN Registry ISRCTN35358984.
Journal Article
Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial
Background
Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.
Methods
An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson’s χ
2
test and approximative z-test.
Results
168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.
Conclusions
A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.
Journal Article
Muscle energy techniques : a practical guide for physical therapists
\"This concise guide explains the theory behind muscle energy techniques (METs), demonstrates functional assessment testing for chronically tight and dysfunctional muscles, and shows how to apply specific METs to restore normality\"--Provided by publisher.
Book
Early Active Mobilization during Mechanical Ventilation in the ICU
Intensive care unit (ICU)-acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability.
We randomly assigned 750 adult patients in the ICU who were undergoing invasive mechanical ventilation to receive increased early mobilization (sedation minimization and daily physiotherapy) or usual care (the level of mobilization that was normally provided in each ICU). The primary outcome was the number of days that the patients were alive and out of the hospital at 180 days after randomization.
The median number of days that patients were alive and out of the hospital was 143 (interquartile range, 21 to 161) in the early-mobilization group and 145 days (interquartile range, 51 to 164) in the usual-care group (absolute difference, -2.0 days; 95% confidence interval [CI], -10 to 6; P = 0.62). The mean (±SD) daily duration of active mobilization was 20.8±14.6 minutes and 8.8±9.0 minutes in the two groups, respectively (difference, 12.0 minutes per day; 95% CI, 10.4 to 13.6). A total of 77% of the patients in both groups were able to stand by a median interval of 3 days and 5 days, respectively (difference, -2 days; 95% CI, -3.4 to -0.6). By day 180, death had occurred in 22.5% of the patients in the early-mobilization group and in 19.5% of those in the usual-care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Among survivors, quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in the two groups. Serious adverse events were reported in 7 patients in the early-mobilization group and in 1 patient in the usual-care group. Adverse events that were potentially due to mobilization (arrhythmias, altered blood pressure, and desaturation) were reported in 34 of 371 patients (9.2%) in the early-mobilization group and in 15 of 370 patients (4.1%) in the usual-care group (P = 0.005).
Among adults undergoing mechanical ventilation in the ICU, an increase in early active mobilization did not result in a significantly greater number of days that patients were alive and out of the hospital than did the usual level of mobilization in the ICU. The intervention was associated with increased adverse events. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; TEAM ClinicalTrials.gov number, NCT03133377.).
Journal Article