Heart Rate and Blood Pressure Assessment by Physical Therapists in the Outpatient Setting—An Observational Study

Millar, A. Lynn; Village, David; King, Tiffany; McKenzie, Germyn; Lee, Jody; Lopez, Coronel

doi:10.1097/cpt.0000000000000033

Cited by 15 publications

(8 citation statements)

References 19 publications

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“…28 In addition, an observational analysis of 74 outpatient sessions, including 15 initial evaluations, noted that HR and BP were taken during only 2 sessions, despite 26% of patients having a history of CVD. 29 Similar findings have been identified in acute care practice where a recent study showed PTs are only taking vital signs 56% of the time in acute care settings. 30…”

Section: Introductionsupporting

confidence: 76%

Self-reported Vital Sign Assessment Practices of Neurologic Physical Therapists

O’Brien¹,

Wallmann²,

Karaffa

et al. 2022

Cardiopulm Phys Ther J

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Purpose:This study's purpose was to describe the vital sign assessment (VSA) practices of physical therapists (PTs) during evaluation and treatment of patients with neurologic conditions.Methods:A survey was distributed to clinicians from a clinical site database and the Academy of Neurologic Physical Therapy's list serve. Respondents included US licensed PTs who treat patients with neurologic conditions.Results:Usable surveys included 133 US PTs with 69.2% doctorally prepared and 79.7% American Physical Therapy Association (APTA) members. Although 58.6% of survey respondents indicated that VSA is an essential part of the PT evaluation, at evaluation, only 37.6% and 39.1% of respondents always take heart rate (HR) and blood pressure (BP), and only 8.3% of respondents always take respiratory rate (RR). During treatment, only 14.3% of respondents report taking HR or BP at each session, while only 5.3% always take RR. Board certification was correlated with an increased frequency of HR assessment (P = .0027) and BP (P = 0.038) at evaluation, while importance of VSA strongly correlated with increased assessment of HR (P = 0.000), BP (P = 0.000), and RR (P = 0.003) at evaluation and with HR (P = 0.000) and BP (0.000) during treatment.Conclusions:Although VSA by neurologic PTs is higher than other identified PT groups, it is still below-recommended assessment guidelines.

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Section: Introductionsupporting

confidence: 76%

Self-reported Vital Sign Assessment Practices of Neurologic Physical Therapists

O’Brien¹,

Wallmann²,

Karaffa

et al. 2022

Cardiopulm Phys Ther J

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“…Studies have identified that 75% of home health care patients and 62% of outpatients under the care of physiotherapists were identified as having either pre-hypertensive or hypertensive blood pressure measures [ 21 , 23 ]. Therefore, availability of an automatic blood pressure unit in the home would offer another level of screening in that the older adult could be trained to self-identify factors which may predispose them to a fall (e.g., orthostatic hypotension) as well as hypertensive measures which may warrant further workup by a medical professional.…”

Section: Hop-up-pt As a Case Examplementioning

confidence: 99%

“…However, given the variety of serious health sequalae associated with HTN (e.g., cerebral vascular accident, coronary heart disease, renal disease), a physiotherapist's inclusion of blood pressure (BP) measures in routine care is essential [19,20]. This assertion is further supported by reports that nearly two thirds of adult patients under the care of physiotherapists present with elevated BP readings [21][22][23]. Recommendations for best practices in prevention, detection, evaluation, and management of Fig.…”

Section: Comorbiditiesmentioning

confidence: 99%

State of the Art Physiotherapist-Led Approaches to Safe Aging in Place

2022

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Introduction Safe aging in place (SAIP) is when an older adult can successfully and comfortably remain in their home despite increasing barriers, including falls. Various physical, medical, psychological, and psychosocial factors may individually or cumulatively impact an older adult’s ability to safely age in place. Physiotherapists should assess not only items traditionally considered within their scope of practice but should select efficient and effective outcome measures to quantify other domains of health. A comprehensive geriatric assessment (CGA) is an evidence-based clinical assessment which identifies medical, psychosocial, and functional limitations of an older person. The CGA is useful to dictate individualized exercise/intervention prescription to address identified areas of increased risk. Purpose and importance to practice The purpose of this Masterclass is to describe key screening, assessments, and interventions to facilitate SAIP and to provide overviews of currently available programming and care delivery models applicable to physiotherapist practice. There are a wide variety of outcome measures and interventions that vary in depth, validity, and reliability. Measures selected for inclusion in this Masterclass were chosen based upon their clinical utility with respect to time and resource constraints and ease of administration during a comprehensive assessment for SAIP in community-dwelling older adults. Measures recommended for assessing physical function were the Short Physical Performance Battery, the Timed-Up-and-Go, the 30 second chair rise test, and the Four Test Balance Scale. Additionally, measures from the heath domain (e.g., Functional Comorbidity Index) and the environmental domain (e.g., Home FAST) are recommended. Relative to interventions, the Otago Exercise Program, motivational interviewing, home modifications, and leveraging technology are recommended. Partnerships with community-facing organizations facilitate utilization of resources for sustainable SAIP. The Home-based Older Person Upstreaming Prevention Physical Therapy (HOP-UP-PT) program is one approach led by physiotherapists framed in the screening, assessments, and interventions discussed in this Masterclass with strong scientific grounding. Conclusion Programs integrating both community and healthcare approaches have the strongest evidence for their utility; however, implementation for these preventative approaches are lagging behind the increased need due to the substantial population growth of those over 65 years.

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“…Recent data show that initial heart rates and blood pressures are measured in less than 3% of initial visits in outpatient physical therapy clinics while recommendations state that blood pressure should be measured on all new physical therapy patients. 7,11,15 Severin has recently stated that routine blood pressure screening in outpatient physical therapy practice is an ethical duty of care. 9 This is important because 62% of an outpatient physical therapy population and 68% of a fitness program population have presented for exercise with prehypertension or hypertension.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Elevated Pulse Pressure and Hypertension in Adults Participating in Outpatient Physical Therapy

O’Connell

Jumper

Hicks³

et al. 2023

Cardiopulm Phys Ther J

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Purpose: To examine pulse pressure (PP), systolic (SBP), and diastolic (DBP) pressure in outpatient physical therapy or maintenance fitness subjects by age (5 age groups) and in those younger than versus those who were 65 years and older. To test for differences in SBP, DBP, and PP in those with and without a hypertension (HTN) diagnosis. Methods: Ninety-eight physical therapy and maintenance fitness subjects in 1 urban outpatient clinic had PP and SBP/DBP measured and classified (ACC/AHA 2017 guidelines) using two different age classifications: (1) 20 to 44, 45 to 54, 55 to 64, 65 to 74, or ≥75 and (2) ≤64 or ≥65. Comparisons were also made in SBP, DBP, and PP based on a known hypertension diagnosis. Results: Forty male and 58 female subjects (height: 65.98 inches [SD = 4.19]; weight: 180.91 pounds [SD = 39.62]; body mass index: 29.11 [SD = 5.86]; age: 64.34 years [SD = 15.92]) participated in this investigation. Systolic blood pressure, DBP, and PP were significantly higher in those older than 65 years. Systolic blood pressure significantly increases across 5 age groups. Systolic blood pressure, DBP, and PP were significantly higher in those older than 65 years. Pulse pressure was significantly greater in those with hypertension. Pulse pressure was abnormal in 36.2% of the sample. Conclusions: Thirty-six percent of subjects receiving physical therapy treatment or participating in maintenance fitness had elevated PP while 78.9% and 47.3% had abnormal SBP and DBP, respectively. Both PP and blood pressure were significantly influenced by age. Therapists should measure resting BP and PP before treatment and refer as needed to achieve improved control.

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Heart Rate and Blood Pressure Assessment by Physical Therapists in the Outpatient Setting—An Observational Study

Cited by 15 publications

References 19 publications

Self-reported Vital Sign Assessment Practices of Neurologic Physical Therapists

Self-reported Vital Sign Assessment Practices of Neurologic Physical Therapists

State of the Art Physiotherapist-Led Approaches to Safe Aging in Place

Prevalence of Elevated Pulse Pressure and Hypertension in Adults Participating in Outpatient Physical Therapy

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