An Otago-based strengthening, balance, and walking home exercise program can potentially be used to decrease the number of falls and the risk of falling among older adults residing in an assisted living facility.
Objectives: The purpose of this retrospective study is to further the limited body of evidence regarding the effects of a group-based boxing intervention for those with Parkinson’s disease (PD). Design: A retrospective cohort study was performed analyzing data collected on outcome measures at 6-month intervals up to 2 years. Individuals participated in the standardized “Rock Steady Boxing” (RSB) program for up to 24 months. Every 6 months, measures were taken of balance (Fullerton Advanced Balance [FAB] Scale), functional mobility (Timed-Up and Go [TUG]), lower extremity strength (30-second Chair Stand [30CST]), and gait speed (10 Meter Walk Test [10MWT]). Methods: Statistical significance ( P < .05) was determined by a two-tailed t test. Data were collected from RSB-affiliated programs at 4 locations across the southeastern United States. Current and/or past participants in RSB with baseline and at least one subsequent outcome measure were included, resulting in 68 participants (54 male, 14 female, and mean age of 71.2 years ± 8.56 standard deviation). Results: Statistically significant improvements in FAB scale, TUG, and 30CST over time were found at both 6- and 12-month time points. Significant changes continued through 18 months for FAB and 30CST. No significant changes in 10MWT were observed; however, a moderate effect size was observed at the 1-year point. Conclusions: Participants with PD were able to achieve statistically significant improvements in standard measures of functional mobility, balance, and strength within the timeline of this study. Limitations include the retrospective nature, an inability to monitor adherence, and lack of control over pharmaceutical or other interventions.
Background and Purpose: Falls are a leading cause of morbidity, mortality, loss of independence, and significant functional decline in aging populations. Effective interventions aimed at reducing the risk of falls, and preventing associated disability and functional decline, are needed to promote the health and wellness of older adults. Recent literature has found that an Otago-based exercise program (OBEP), which incorporates strengthening, balance, and walking, may not only decrease falls and fall risk among community-dwelling older adults but may also be effective among older adults residing in assisted living facilities (ALFs). The purpose of this study is to expand upon current research by comparing the outcomes of an OBEP and traditional physical therapy (TPT) in decreasing falls and the risk of falls among older adults living in an ALF. The authors hypothesized that traditional physical therapy would reduce fall risk and the number of falls in older adults residing in ALFs more than an OBEP. Methods: This study conducted a 2-group retrospective chart review of 59 older adults living in an ALF from January 2013 to October 2018 who received either TPT (n = 29) or the OBEP (n = 30). Participants were a mean of 87 years old and were classified at risk for falls by the Tinetti Performance-Oriented Mobility Assessment (POMA). Primary variables included the number of falls prior to intervention, during intervention, and 1 year following intervention, as well as pre- and posttreatment Tinetti POMA scores. Efficacy was examined using multiple linear regression analysis. Results and Discussion: Both groups achieved reduced falls and increased POMA scores. Group assignment did not significantly predict performance in key outcome measures, namely the number of falls (P = .199) and Tinetti POMA scores (P = .063) following treatment. Conclusions: These findings indicated that both an OBEP and tpt may be effective interventions for reducing falls and fall risk in the ALF setting.
Purpose: Early predictors of the degree of walking ability poststroke are vital considering the decreased length of stay in most inpatient rehabilitation facilities (IRFs). Prediction of functional walking capability upon discharge from IRFs requires more investigation. This study aimed to (1) determine whether the Postural Assessment Scale for Stroke (PASS) and the Berg Balance Scale (BBS) can predict an individual's IRF discharge poststroke gait category and (2) establish cut-off scores for these assessments to better forecast gait category upon discharge. Methods: A total of 180 individuals with an admitting stroke diagnosis were assessed with both balance measures and the 10-m walking test at admission and discharge from inpatient rehabilitation. Participants were stratified by gait speed into 4 groups (nonambulators: 0 m/s; household ambulators: <0.4 m/s; limited community ambulators: 0.4-0.8 m/s; and community ambulators: >0.8 m/s). Results: Both the admission PASS and the BBS scores may predict patients who will be ambulatory and performed similarly in differentiating between gait classifications upon discharge from inpatient rehabilitation (P < .01). Cut-off scores of 6 or less on the BBS (sensitivity 96%; specificity 83%) and 17 on the PASS (sensitivity 92%; specificity 90%) were established to predict nonambulators, and cut-off scores of 29 or more on the BBS (sensitivity 92%; specificity 86%) and 30 on the PASS (sensitivity 80%; specificity 87%) were established to predict community ambulators. Conclusions: These results can inform clinicians of poststroke patients' walking prognosis and advise discharge needs early in a patient's IRF stay.
imulation-based learning is a well-established learning activity in health professions education. [1][2][3][4][5] Simulation has been used in physical therapist (PT) education to provide students with opportunities to advance psychomotor skills, engage in clinical decision making, apply feedback from mentors, and navigate patient interactions in a low-risk setting to prepare for patient care as entry-level clinicians. 4,5 Health care simulation consists of using high-fidelity simulation, 1,6-8 standardized patients (SPs), 2,4,9-13 volunteer patients (VPs), 11 and peer role-playing. 2,13 These models of simulation have demonstrated an increase in PT students' confidence in clinical skills and decision-making abilities. 1,8 High-fidelity simulation, which consists of the use of a computerized manikin, has been shown to be an effective teaching tool among health care professions. 6 In addition, research supports the use of SPs, individuals trained to depict medical conditions, to teach clinical skills in health care education. 2,4,[9][10][11][12][13] Because of the high costs of high-fidelity simulation and SPs, VPs and peer role-playing are often used to improve student performance. Dalwood et al 2 demonstrated that although peer-role-playing lacked the realism of using a SP, PT students demonstrated increased confidence,
Hospice has been associated with improved outcomes for terminally-ill patients and families, including in pain management, care satisfaction, and rates of hospitalizations. In 2016, 1/3 of Medicare hospice beneficiaries died in nursing homes (NH). The responsibilities for meeting the needs of the NH resident receiving hospice are shared by the NH staff and hospice team, making good communication and coordination of services between providers critical to the successful delivery of services. This exploratory study surveyed NH direct care and administrative staff about their perceptions of hospice, and barriers to collaboration. A total of 66 NH staff completed the online survey. The sample was 62.1% direct care staff (e.g., social work, nursing) and 37.8% administrators, predominately female (75%), non-Hispanic-white (43.9%), and employed full-time (87.8%). Over half of the NHs were non-profit organizations (56.1%). Respondents had on average 33.8 hours of hospice education and held positive hospice attitudes, with 76% strongly agreeing that hospice should be an option regardless of setting, and 87.8% believing they could collaborate with hospice toward the goal of a “good death.” Although participants cited barriers to hospice related to COVID-19, this was not associated with overall hospice attitudes. Respondents cited resistance from family as the primary barrier to hospice, indicating lack of knowledge and a need for family education. They also cited concerns surrounding duplication of roles. Family members in previous studies have identified care allocation as a challenge, based on expectations that hospice would bring additional contact/services instead of replacing NH services. Implications will be discussed.
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