A Cardiopulmonary Instructor's Perspective on a Standardized Patient Experience: Implications for Cardiopulmonary Physical Therapy Education

Purpose: Standardized patients (SP) in Doctor of Physical Therapy (DPT) curricula are increasingly used for students to practice developing clinical reasoning, communication, and professional skills in an authentic learning environment. The purposes of this article are to: (1) describe an instructional model that synthesized SPs, Internet-based communities of practice, and reflection to teach clinical reasoning in DPT students; and (2) a cardiovascular and pulmonary physical therapy (CPPT) instructor''s perspective on the educational process and student clinical skill development. Summary of Key Points: The model, employed in a course: “Integrative Physical Therapy Practice,” enabled the instructor to document student clinical performance and reasoning during an SP interaction. For students, clinical reasoning was illuminated through the model''s assessment process. Data collected through the assessment process provided important feedback to the instructor on classroom instructional effectiveness. Conclusions: Examination of student learning experiences enabled the instructor to consider: (1) key aspects of examination and management for persons with cardiovascular or pulmonary disorders, (2) methods for visualizing clinical reasoning, (3) the impact of teaching on student learning, and (4) strategies for teaching CPPT. More research is indicated to investigate pedagogy for the development of clinical reasoning in DPT students.Key Words: standardized patient, clinical reasoning, reflection, physical therapy education, cardiovascular, pulmonary     

The Use of Health Related Quality of Life Measurement in Cardiovascular and Pulmonary Physical Therapy Practice: An Exploratory Study

Background: The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends health related quality of life (HRQL) measurement with all cardiovascular and pulmonary patients. The current pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists is unknown. Objective: The purpose of this study was to evaluate the pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists. Design: The study used a semi-structured interview format within the context of 3 focus groups. Methods: Eleven physical therapists participated in this study and all were members of the Cardiovascular and Pulmonary Section of the American Physical Therapy Association (APTA). Participants participated in a conference call and were provided a question tree to guide discussion. Results: Several primary themes emerged, including decreased knowledge, barriers, and poor indicators of patient status. In addition, several subthemes developed including lack of familiarity, lack of use, administrative and cost limitations, inappropriateness of tool for patient population, correlation between function and quality of life, and suggestions for future outcome measures. Conclusions: A lack of familiarity and use of HRQL measurement and barriers to their use were established. In addition, ideas for future research on HRQL measurements with specific patient populations in physical therapy practice were defined.Key Words: health related quality of life, outcomes measurement     

The BASES expert statement on exercise therapy for people with chronic kidney disease

Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease, which is the leading cause of morbidity and mortality in this patient population. Physical inactivity has emerged as a significant and independent risk factor for accelerated deterioration of kidney function, physical function, cardiovascular function and quality of life in people in all stages of CKD. CKD specific research evidence, combined with the strong evidence on the multiple health benefits of regular and adequate amounts of PA in other cardiometabolic conditions, has resulted in physical inactivity being identified by national and international CKD clinical practice guidelines as one of the multiple risk factors that require simultaneous and early intervention for optimum prevention/management of CKD. Despite this realisation, physical inactivity is not systematically addressed by renal care teams. The purpose of this expert statement is therefore to inform exercise and renal care specialists about the clinical value of exercise therapy in CKD, as well as to provide some practical recommendations on how to more effectively translate the existing evidence into effective clinical practice.     

Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention

Purpose

The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention.

Methods

A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed.

Results

Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health.

Conclusions

Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors.Key Words: cardiovascular disease, primary disease prevention, secondary disease prevention     

Cardiovascular Regulation after Stroke: Evidence of Impairment,Trainability, and Implications for Rehabilitation

Purpose: To discuss the role of the vascular system and regulation of blood flow delivery in individuals with chronic stroke. This paper will discuss mechanisms of blood flow, vascular remodeling in chronic stroke, exercise as an intervention to improve blood flow delivery, and the role of physical therapy practice in promoting exercise. Key Points: Evidence suggests that people with chronic stroke may experience reduced blood flow and decreased arterial diameter in the hemiparetic limb. These arterial changes may influence exercise performance and functional ambulation. However, exercise training can be an effective intervention for improving blood flow delivery in the hemiparetic limb. Statement of Recommendations: Physical therapists working with people post-stroke should routinely prescribe aerobic exercise training within the plan of care during stroke rehabilitation. This may minimize declines in the cardiorespiratory and vascular systems and provide greater functional capacity to perform functional activities during and after discharge from physical therapy services.Key Words: blood flow, stroke, cardiovascular, exercise     

Overview of Telehealth and Its Application to Cardiopulmonary Physical Therapy

Advances in telecommunication technology provide unique opportunities for the provision of medical services to underserved and geographically displaced patients. Health care professionals currently use voice and video systems to communicate with patients and colleagues in a variety of clinical venues. Unfortunately, such systems have limited presence in physical therapy settings. A variety of factors, including lack of familiarity with existing devices and perceived system purchase and operation costs, appear to be limiting its use. Even the terminology is confusing with such terms as telehealth, telemedicine, and telerehabilitation often used interchangeably. The purpose of this paper is to present an overview of this technology and to provide a clinical perspective regarding the use of telehealth in cardiopulmonary physical therapy practice.Key Words: technology and health care, physical therapy

“The future has a habit of suddenly and dramatically becoming the present.”Roger A. Babson

     

Bewegungsverhältnisse in der Gesundheitsförderung

Improving environments for physical activity is a fundamental goal of health sports. Both considerations in sport science as well as practical guidelines by sport associations and sickness funds build upon that. However, currently there is neither a theory-based concept nor a systematic operationalisation of that concept. In the first part, this article therefore aims to define and conceptualise the term “environments for physical activity”. It refers to the term “setting” to underline the multidimensionality of environments with regard to physical activity as part of health promotion. The article indicates potential links of the concept to theories of sociology and political science by looking at the interdependency of structure (Verhältnisse) and agency (Verhalten). The second part of the article analyses a case study from physical activity promotion to demonstrate the explanatory power of the concept to intervention practice. The focus of the analysis is on an approach to structural change, i.e. the potential of changing environments for physical activity.     

田径运动消减与我国青少年体质下降的关系及对策

我国青少年体质20年持续下降是一个严重的问题,心肺血管功能差是致命的弱点,学校的应试教育是主要原因.因学生体质差怕出伤害事故而消减田径运动,因田径运动消减而造成学生心肺血管功能差,两者互为因果,形成恶性循环.将男生1 000m跑、女生800m跑直接列入中考和高考,从根本上冲破传统观念的束缚,以扭转青少年体质持续下降的状...     

Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions

Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports. One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies. This paper explains the process that is used to conduct systematic reviews, which includes the establishment of a protocol, comprehensive searching, appraisal of the quality of the included studies, data extraction and metaanalysis, and consideration of the clinical and research implications of the findings. We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased (believable) estimate of the treatment effect. A systematic review of randomized trials of a cardiopulmonary physical therapy intervention is used as an example. The issue of appraisal of quality is then discussed further, with a demonstration of how one validated tool for quality appraisal–the PEDro scale–can be used to evaluate a randomized trial in cardiopulmonary physical therapy.Key Words: systematic review, physical therapy     

Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults

BackgroundDelirium is a neurocognitive disorder characterized by an abrupt decline in attention, awareness, and cognition after surgical/illness-induced stressors on the brain. There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality. One common indicator for cardiovascular health is the heart rate response/recovery (HRR) to exercise, but how this relates to future delirium is unknown.MethodsElectrocardiogram data were examined in 38,740 middle- to older-aged UK Biobank participants (mean age = 58.1 years, range: 40–72 years; 47.3% males) who completed a standardized submaximal exercise stress test (15-s baseline, 6-min exercise, and 1-min recovery) and required hospitalization during follow-up. An HRR index was derived as the product of the heart rate (HR) responses during exercise (peak/resting HRs) and recovery (peak/recovery HRs) and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile, respectively. Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a 2-year landmark analysis to minimize reverse causation. Sociodemographic factors, lifestyle factors/physical activity, cardiovascular risk, comorbidities, cognition, and maximal workload achieved were included as covariates.ResultsDuring a median follow-up period of 11 years, 348 participants (9/1000) newly developed delirium. Compared with the high HRR group (16/1000), the risk for delirium was almost doubled in those with low HRR (hazard ratio = 1.90, 95% confidence interval (95%CI): 1.30–2.79, p = 0.001) and average HRR (hazard ratio = 1.54, 95%CI: 1.07–2.22, p = 0.020)). Low HRR was equivalent to being 6 years older, a current smoker, or ≥3 additional cardiovascular disease risks. Results were robust in sensitivity analysis, but the risk appeared larger in those with better cognition and when only postoperative delirium was considered (n = 147; hazard ratio = 2.66, 95%CI: 1.46–4.85, p = 0.001).ConclusionHRR during submaximal exercise is associated with future risk for delirium. Given that HRR is potentially modifiable, it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.     

Relationship between abdominal adiposity,cardiovascular fitness,and biomarkers of cardiovascular risk in British adolescents

BackgroundPuberty is a critical time in the development of overweight and obesity. The aim of this study was to examine relationships between measures of adiposity, cardiovascular fitness, and biomarkers of cardiovascular disease risk in adolescents.MethodsIn a cross-sectional study design, 129 girls and 95 boys aged 12.9–14.4 years at various stages of puberty were included, along with their mothers (n = 217) and fathers (n = 207). Anthropometric assessments of adiposity were made, along with cardiovascular physical fitness, using the 20-m shuttle run test, and biomarkers associated with cardiovascular risk, including glucose, insulin, triglyceride, fibrinogen, and C-reactive protein (CRP) concentrations.ResultsWaist-to-height ratio values were similar in boys and girls and correlated positively with diastolic blood pressure, insulin, triglyceride, fibrinogen, and CRP concentrations, and inversely with cardiovascular fitness scores. Skinfold thickness measurements were higher in girls. High-molecular-weight adiponectin concentrations were lower in boys than girls, particularly in late puberty, and CRP levels were higher. Cardiovascular fitness, maternal body mass index (BMI), and paternal BMI contributed independently to the variance in waist measurements in girls and boys. Gender, triceps skinfold thickness, and weight-to-height ratio, but not parental BMI, contributed independently to the variance in cardiovascular fitness.ConclusionThere is a relationship between measures of adolescent adiposity and parental weight that involves factors other than cardiovascular fitness. Adolescent boys have relatively more abdominal fat than girls and a tendency to have a proinflammatory profile of biomarkers. These observations suggest that family and social environmental interventions are best undertaken earlier in childhood, particularly among boys.     

A Comparison of the Effects of Physical and Mental Practice in Learning a Motor Skill

Abstract

This study sought to determine the relative effectiveness of mental and physical practice upon the learning of a selected motor skill, and the possible differential effects of mental practice during different stages of the learning period.

Ninety-three male volunteers were used as subjects. They were randomly assigned to the following five treatment conditions: control, mental practice, physical practice, mental-physical practice, and physical-mental practice. Practice consisted of throwing rubber balls at a target from a distance of 15 ft. The practice periods lasted for 18 days.

Initial and final tests were administered to determine the increase in skill. Data, which consisted of gain scores, were analyzed using analysis of variance. The results indicated that the only significant improvement occurred in the combination-type treatment conditons. Trend analysis was used to evaluate the changes in the daily practice scores. The results showed that either mental or physical practice was equally effective during the first half of the skill development period.     

Safety and Efficacy of Mobility Interventions in Patients with Femoral Catheters in the ICU: A Prospective Observational Study

Introduction

There are limited data describing mobility interventions provided to patients with femoral catheters. The purpose of this study was to examine the incidence of femoral catheter related adverse effects during physical therapy (PT) sessions in a cardiovascular intensive care unit (ICU).

Methods

This was a prospective, observational study and included patients with at least one femoral catheter. Data were collected after each PT session.

Results

There were 77 subjects with a total of 92 femoral catheters (50 arterial, 15 central venous, and 27 dialysis) treated. A total of 210 separate PT sessions occurred with 630 mobility activities including sitting on side of bed, standing at the bedside, transfers to stretcher chair or regular chair, and walking. There were no catheter related mechanical or thrombotic complications during any of the PT sessions.

Conclusions

Physical therapy sessions, including standing and walking were feasible and safe in cardiovascular ICU patients with femoral catheters who met the criteria for mobility interventions. The results from this study support the hypothesis that early mobilization in patients with femoral catheters is important to minimize functional decline and provide evidence that the presence of femoral catheters alone should not be a reason to limit progressive mobility interventions.Key Words: physical therapy, ICU, early mobilization, femoral catheter     

关于《学生体质健康标准》中身体机能指标研究

通过实验法和数理统计法对《学生体质健康标准》中身体机能指标进行分析研究。结果表明,反映心血管功能的台阶试验评定指数与反映肺功能的肺活量指数,两者无明显关联。两项指标在身体机能评价中应分别进行检测。     

Physical activity, nutrition, screen time and sleep associated with body weight and physical condition in young children

The aim of this cross-sectional study was to explore the possible relationship between (un)healthy behaviour and (over)weight and physical condition in families with young children (4–7 years), in a village (30,000 inhabitants) in the eastern part of the Netherlands, close to Germany. It is one of two pilot studies as a precursor of a cross-border project including six Dutch and six German villages, to counteract physical inactivity and possible future metabolic problems. In total, 459 children of five elementary schools and their parents were included. Parents were requested to fill in a questionnaire on the nutritional, physical, sedentary, and sleeping behaviour of their child. Relevant background characteristics were obtained and lifestyle classifications were made. At school, the children's height and weight (body mass index (BMI)) were measured, as well as their physical condition (two tests) and basic motor abilities (four physical exercise tests). The relationship between the standardized BMI z-scores and physical condition test scores, and nutritional, physical, sedentary and sleeping habits was analysed using independent sample t-test, bivariate correlation analysis and multiple regression analysis. Latent class analysis was used to identify clusters of people based on their nutritional, physical and sleep habits. Of the parents, 376 (82?%) were willing to fill out the questionnaire. High birth weight and a high BMI of the mother and/or father correlated with a higher BMI of the child (ρ?=?0.28, p?<?0.001; ρ?=?0.13, p?=?0.016; and ρ?=?0.23, p?<?0.001, respectively). Daily playing outside, eating small cookies (compared with large cookies) and no sleeping problems (no waking up during the night) were related to low BMI levels (no overweight) [ρ?=???0.14, p?=?0.005; ρ?=???0.12, p?=?.020; t(364)?=?1.81, p?=?0.072 (trend), respectively]. Daily playing outside (frequency and duration) and being a member of a sports club were related to positive scores on the physical condition tests [ρ?=?0.20, p?<?0.001; t(365)?=???2.99, p?=?0.003, respectively]. High levels of television (TV) watching and general sleeping problems were related to a less optimal physical condition [ρ?=???0.09, p?=?0.076 (trend); and ρ?=???0.10, p?=?0.059 (trend), respectively]. A latent class analysis revealed three clusters: 46?% of the sample belonged to the ‘healthy group’ concerning nutrition, sedentary lifestyle and TV/personal computer (PC) use; 17?% to the ‘less healthy’ group and 37?% to a group with nutrition and physical activity habits close to the healthy group, but with low conditional probabilities for the sleeping items. Conducting a pilot study before the start of a binational intervention study gives a blueprint for the final questionnaire, and clues for tailored interventions in the schools, as proposed in the approach of ‘Gesunde Kinder in gesunden Kommunen’ (GKGK). The results of a latent class analysis underscore that interventions should exist of a multi-component strategy, focusing on promoting physical activity, healthy nutrition habits and appropriate sleep.     

Physical activity estimated by the bone-specific physical activity questionnaire is also associated with cardiovascular risk

The nature of physical activity that benefits bone is traditionally thought to differ from that benefiting cardiovascular health. Accordingly, exercise recommendations for improving bone health and cardiovascular health are largely incongruent. Our aim was to determine the associations between high-impact physical activity participation and both cardiovascular disease risk factors and bone mass. We recruited 94 men and women (age 34.0?±?13.3 years) to undergo measures of cardiovascular disease risk (BMI, total cholesterol, fasting blood glucose, waist-to-hip ratio, and mean arterial pressure) and dual-energy X-ray absorptiometry (DXA XR-800, Norland) measures of bone mass (femoral neck, lumbar spine, and whole body BMD) and body composition (whole body lean mass and fat mass). Physical activity participation was estimated using the bone-specific physical activity questionnaire (BPAQ). Those in the upper tertile for current BPAQ score exhibited lower total cholesterol, waist-to-hip ratio, and mean arterial pressure than those in the lower tertiles (P?r?=??0.49 to 0.29, P?P?=?0.008), with BPAQ score predicting 6% of the variance in BMD (P?=?0.02). We conclude that high-impact physical activity as captured by the BPAQ may be beneficial for both bone health and for attenuating cardiovascular disease risk.     

Football practice with youth players in the “Footbonaut”

In today’s leading football training centres, state-of-the-art performance diagnostic systems such as the “Footbonaut” allow controlled and standardized assessments of physical and mental components of agility, e.g. speed of action and ball control, that are considered to be decisive for talent identification and development. However, effects of induced physical and mental strain on performing football-specific practice patterns remain to be elucidated, particularly in youth players, and, thus, characterize the purpose of this study. 33 randomly assigned competitive football players (U14 to U16) performed a standardized Footbonaut practice pattern (i.e. 20 balls randomly drawn at 50?km/h each), prior to and immediately after either mentally demanding tasks (MDT; n?=?11; continuous Vienna Test System’s Stroop task and determination test), physically demanding tasks (PDT; n?=?11; consisted of 4?×?4?min of football-specific high-intensity intervals with 3?min of active recovery in between) or a control condition (CON; n?=?11). Continuous heart rates (HR) as well as self-perceptions of fatigue were assessed. Main findings revealed performances for speed of action (p?=?0.44; f?=?0.01) and ball control (p?=?0.15; f?=?0.03) that were not modulated in the face of induced physical and mental strain as indicated by increased HR following PDT (p?<?0.001; d?>?0.8), or in the face of increased self-perceptions of fatigue following PDT and MDT (both p?<?0.001; both d?>?0.8) compared to CON. This is in line with a suggested talent factor and previous reports on motivational trade-off aspects in youth players. However, the present study’s short-timed practice patterns make it difficult to reliably compare a measuring sensitivity to complex football-specific movement behavioural and technical proficiencies with respect to mental and physical strain of longer-lasting football games and, thus, need further investigation in favour of improving talent identification and development using the Footbonaut.