Post on 24-Jul-2020
Running Head: VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY
SELF-REPORTED USE OF VITAL SIGNS IN THE ADULT OUTPATIENT
PHYSICAL THERAPY SETTING
______________________________________________________________________________
An Independent Research Project
Presented to
The Faculty of the College of Health Professions and Social Work
Florida Gulf Coast University
In Partial Fulfillment
of the Requirement for the Degree of
Doctorate of Physical Therapy
______________________________________________________________________________
By
Joshua J. Peters
2014
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY
APPROVAL SHEET
This Independent Research Project is submitted in partial fulfillment of
the requirements for the degree of
Doctorate of Physical Therapy
____________________________
Joshua J. Peters
Approved: May 2014
____________________________
Ellen Donald, MS, PT
Committee Chair
____________________________
Kathleen Swanick, DPT, MS, OCS
Committee Member
The final copy of this independent research project has been examined by the signatories, and we find that both the
content and the form meet acceptable presentation standards of scholarly work in the above mentioned discipline.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY
Acknowledgements
First and foremost, I would like to thank my wife Kim and our two sons Jordan and Jaden
for always supporting me in everything I do. This project would not have been possible without
your love, patience, and the sacrifices you’ve made along the way. You are the light of my life
and I love you all so dearly.
I would like to thank my father, David Peters, for inspiring me to learn more about
cardiovascular disease. You’ve approached your own “battle with the beast” with unwavering
determination and “grit.” You’re example has inspired many to join the fight and stand up to
cardiovascular disease.
I would like to thank my committee chair, Ellen Donald, MS, PT, and committee
member, Kathleen Swanick, DPT, MS, OCS. This study would not have been possible if it
wasn't for your affirmation during the early stages and your patience, expertise, and guidance
throughout the process. You are the epitome of excellence as professionals and I feel blessed to
have worked with you on this project. I would also like to thank professor Arie van Duijn, EdD,
PT, OCS for sharing his knowledge regarding statistics and data analysis. Thank you for your
time and guidance during that part of the process.
I would like to thank the Florida Physical Therapy Association (FPTA) for their support.
Without the FPTA’s co-operation, this project would not have been possible. Finally, I am
especially grateful for the time and thoughtful responses given by the individuals who responded
to the survey.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY
Abstract
Physical Therapists (PTs) are responsible for ensuring the safety of each patient being treated.
Measuring vital signs allows clinicians to screen for undiagnosed conditions, monitor existing
conditions, and facilitate patient safety through prevention. The purpose of this study was to
survey PTs regarding their use of vital signs in the clinical setting. Participants (N=45) included
licensed PTs currently practicing in adult outpatient clinics in the state of Florida. Participants
were recruited via the Florida Physical Therapy Association’s (FPTA) website. The survey
assessed the frequency of heart rate (HR), blood pressure (BP), and pulse oximetry (SpO2)
measurement in the six months prior to taking the survey; beliefs about the importance of
measuring vitals, reasons for not measuring vitals, and information pertaining to the
demographics of the respondents. Only 28.9% (n=13) of respondents (N=45) reported that their
clinic had a policy regarding the measurement of vital signs and few believed it was important to
measure vitals on each patient at every visit (“Extremely Important”; HR n=4, BP n=4, SpO2
n=3). When asked the reasons for not measuring vitals, the most frequently chosen responses
were “not important for my patient population” (40.0%; n=18) and “lack of time” (22.2%; n=10).
This study provides useful information about the gaps between the American Physical Therapy
Association’s (APTA) recommendations for measuring vitals and current clinical practices.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 5
Table of Contents
Introduction ................................................................................................................................7
Purpose............................................................................................................................7
Research Questions and Hypotheses ................................................................................7
Review of the Literature ..............................................................................................................8
The Global Burden of CVD .............................................................................................8
Current PT Practices ........................................................................................................8
The Silent Killer ..............................................................................................................9
PT Interventions and the Cardiovascular System ........................................................... 10
Underutilization of Secondary Prevention Services ........................................................ 11
Use of Vitals .................................................................................................................. 13
Justification/Need for this Study .................................................................................... 16
Method ..................................................................................................................................... 16
Study Design ................................................................................................................. 16
Participants and Sampling.............................................................................................. 17
Survey Instrument ......................................................................................................... 17
Data Collection .............................................................................................................. 18
Data Analysis ................................................................................................................ 18
Results ...................................................................................................................................... 19
Characteristics of Respondents ...................................................................................... 19
Self-Reported Behaviors and Beliefs ............................................................................. 20
Analysis of Relationships: Beliefs, Behaviors, and Demographic Factors ...................... 22
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 6
Differences Based on ABPTS Certification and APTA Membership.............................. 23
Discussion ................................................................................................................................. 25
Summary of Findings .................................................................................................... 25
Future Research ............................................................................................................. 27
Conclusions ................................................................................................................... 28
References ................................................................................................................................ 29
Appendix A: Explanation of Study and Link to Survey on FPTA’s Website ............................. 32
Appendix B: Online Survey Consent Form ............................................................................... 33
Appendix C: Survey Instrument ............................................................................................... 36
Appendix D: Q3 Reasons for Not Measuring Vitals ................................................................. 39
Appendix E: Q4 Estimated Time it Takes to Measure Vitals .................................................... 42
Appendix F: Q5 Area of Practice.............................................................................................. 44
Appendix G: Q6 Primary Problems of Patients Treated During Last 6 Months ......................... 46
Appendix H: Q7 Current Practice Setting ................................................................................. 47
Appendix I: Q8 & Q9 Clinic Policies ....................................................................................... 48
Appendix J: Q10 Entry Level Degree & Q11 Highest Degree Earned ....................................... 50
Appendix K: Q12 & Q13 ABPTS Certification ........................................................................ 52
Appendix L: Q14 Years of Practice .......................................................................................... 54
Appendix M: Q15 & Q16 APTA Membership ......................................................................... 55
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 7
Introduction
The prevalence of cardiovascular disease (CVD) and the emergence of physical therapists
(PTs) as autonomous practitioners demand that therapists regularly measure vital signs. Vital
signs (vitals) have been operationally defined to include heart rate (HR), blood pressure (BP),
and pulse oximetry (SpO2). Measuring vitals allows therapists to screen for medical red flags,
incorporate relevant information into the plan of care, and monitor a patient’s cardiovascular
response to PT interventions. Currently, very few studies have examined PT’s engagement in
regularly measuring vital signs (Frese, Richter, & Burlis, 2002; Jette & Jewell, 2012). Likewise,
it is not known if factors such as entry level degree, American Board of Physical Therapy
Specialties (ABPTS) certification, American Physical Therapy Association (APTA)
membership, years of experience, clinic policies, or beliefs of the therapist influence clinical
practice.
Purpose
The purpose of this study is to examine information regarding the measurement of HR,
BP, and SpO2 performed by PTs in adult outpatient physical therapy clinics.
Research Questions and Hypotheses
This study seeks to answer the questions, (1) do PTs, practicing in adult outpatient
settings, routinely measure the HR, BP, and SpO2 of new and existing patients (routinely
measure = 80-100% of the time for their current caseload, in the 6 months prior to participating
in the study)? (2) Is there a relationship between factors such as highest degree earned, ABPTS
specialty, APTA membership, years of experience, clinic policies, beliefs about the importance
of measuring vitals, and the frequency of measuring HR, BP, and SpO2?
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 8
The following hypotheses have been formulated: (1) PTs, practicing in adult outpatient
settings, do not routinely measure the HR, BP, or SpO2 of new and existing patients (routinely
measure = 80-100% of the time for their current caseload, in the 6 months prior to participating
in the study). (2) Factors such as highest degree earned, ABPTS specialty, APTA membership,
years of experience, clinic policies, and beliefs about the importance of measuring vitals will
correlate with reported frequencies of measuring HR, BP, and SpO2.
Review of the Literature
The Global Burden of CVD
Cardiovascular disease is an umbrella term referring to a group of disorders primarily
affecting the heart and blood vessels (World Health Organization [WHO], 2011). In 2006, over
600,000 people died from CVD in the United States, accounting for more than one in every four
deaths (Center for Disease Control [CDC], 2010). CVD is the leading cause of death in both
men and women in the United States (CDC, 2010) and globally, more people die each year from
CVD than from any other cause. In 2008, roughly 17.3 million people died from CVD. The
WHO (2011) predicts the number of annual deaths will increase to 23.6 million by 2030 (WHO,
2011).
Current PT Practices
The Guide to Physical Therapist Practice (Guide) lists HR, BP, and SpO2 as tools for
assessing aerobic capacity/ endurance levels and performing cardiovascular and pulmonary
screening. The Guide specifically recommends HR and BP measurements be included in the
examination of each new patient (American Physical Therapy Association [APTA], 2003). It is
unknown whether current practices are in alignment with the APTA’s recommendations. Recent
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 9
evidence suggests discrepancies may exist between the APTA’s recommendations and clinical
practice.
Frese et al. (2002) surveyed 387 clinical instructors regarding the importance of
measuring baseline heart rate and blood pressure in the outpatient setting. Only 45% of
respondents agreed (strongly agreed or agreed) that obtaining baseline vitals was essential.
Similarly 43% of respondents reported never measuring baseline vitals in the week prior to
taking the survey. When given a list of why HR and BP were not measured, the most frequently
chosen response was that it was not important for the patient population being treated (Frese et
al., 2002). Jette and Jewell (2012) found that physical therapists may not view themselves as
providers of primary or secondary prevention services. Even more concerning, were the findings
that patient management strategies associated with prevention services may be perceived as
unimportant or burdensome (Jette & Jewell, 2012). Such findings are alarming, especially
considering PT’s roles as autonomous practitioners.
It is increasingly common for PT’s to serve as the first point-of-entry for many people
into the health care system. This responsibility requires screening for undiagnosed CVD.
Although PT’s are not able to diagnose CVD they are equipped to recognize and respond to
patients requiring physician referral or emergency medical attention.
The Silent Killer
The American Heart Association ([AHA], 2012) identifies high blood pressure (HBP) as
a precursor for many other serious cardiovascular conditions including heart failure and stroke.
One in three adults in the United States has HBP (systolic BP ≥ 140 mm Hg/diastolic BP ≥ 90
mm Hg; or taking antihypertensive medication; or being told twice by a physician or other health
care provider that one has HBP) and roughly one in five are totally unaware that they have the
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 10
condition (AHA, 2011). Meissner et al. (1999) randomly measured the blood pressures of 636
men and women (age ≥45 years). Roughly 337 participants (53%) were found to be
hypertensive. One hundred thirty-one (39%) were reported to have been totally unaware they
had the condition. The remaining 206 (61%) reported already knowing about their HTN
(Meissner et al., 1999). The decreased awareness and sub-optimal management of HBP reported
among participants in this study, illustrate the need for routine vitals assessment. A strong
relationship exists between BP and increased risk for other cardiovascular related events
(American College of Sports Medicine [ACSM], 2010). This becomes especially relevant to
PT’s due to the volume of evidence found in the literature that suggests many PT interventions
illicit physiological responses by the cardiovascular system.
PT Interventions and the Cardiovascular System
Commonly prescribed therapeutic exercises have been shown to induce a cardiovascular
response. One example is the response to McKenzie exercises for low back pain. The results of
one study suggest that HR and BP increase with increasing repetitions. Participants included 59
men and 41 women with no history of CVD and mean ages of 31 years and 30.6 years
respectively (Al-Obaidi, Joseph, Dean, & Al-Shuwai, 2001). Peel and Alland (1990) examined
cardiovascular responses to isokinetic trunk exercises. Participants performed 30s of trunk
flexion and extension exercises at a moderate speed, followed by 60s of rest. After completing
five intervals, average peak HR increased to 148 bpm (SD ± 21 bpm) or 77% of average HRmax
(Peel & Alland, 1990). Even the most basic interventions, such as simple gait training with an
assistive device, have been shown to increase the demands being placed on the cardiovascular/
pulmonary system. Holder et al. (1993) reported finding assisted ambulation (using, axillary
crutches, standard walker, or rolling walker) caused greater increases in HR and O2 consumption
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 11
than unassisted ambulation in healthy participants. Another study found that a sustained passive
stretch, applied to the gastrocnemius and soleus muscles for 60s, prompted a HR increase of
approximately 5 bpm (Gladwell & Coote, 2002). This small increase can be attributed to a
physiological chain of events known as the muscle mechanoreflex. Type III (Aδ), sensory
afferent neurons depolarize in response to mechanical stimuli (i.e. isometric contraction or
passive stretching) and synapse in the cardiovascular control centers of the medulla. The
brainstem nuclei respond by simultaneously increasing sympathetic output and decreasing
parasympathetic output. These changes in autonomic activity result in increased HR and BP. At
first, the clinical significance of the changes in HR reported by Gladwell and Coote (2002) may
seem minimal. However, other studies have reported that the muscle mechanoreflex is
exaggerated in the presence of HBP (Middlekauff et al., 2001; Pickering, 1987). This adds to the
relevance of the findings reported by Gladwell and Coote (2002) and further illustrates the
importance of regularly measuring vitals.
Collectively, these studies demonstrate the wide range of cardiovascular responses to PT
interventions. In patients with CVD, these interventions may elicit an unexpected response that
could potentially be life-threatening. Additional evidence demonstrates the need to continuously
improve prevention services due to a growing number of patients with poorly managed CVD.
Underutilization of Secondary Prevention Services
Following a serious incident, individuals with CVD may participate in a cardiac
rehabilitation (CR) program. A current definition for CR comes from the U.S. Public Health
Service stating:
Cardiac rehabilitation services are comprehensive, long-term programs involving medical
evaluation, prescribed exercise, cardiac risk factor modification, education, and counseling.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 12
These programs are designed to limit the physiologic and psychological effects of cardiac illness,
reduce the risk for sudden death or re-infarction, control symptoms, stabilize or reverse the
atherosclerotic process, and enhance the psychosocial and vocational status of selected patients
(as cited in Thomas et al., 2007, p. 1404)
There is a large body of evidence supporting the efficacy of exercised-based cardiac
rehabilitation programs.
After analyzing the results of 47 studies where a total of 10,794 patients were randomized
to either an exercise based CR program or usual care, Heran et al. (2011) reported that the
exercise based group reported “significantly improved health related quality of life.” This
analysis also established the effectiveness of exercise based CR in reducing the rate of
cardiovascular mortality (Heran et al. 2011). Koovor et al. (2006) conducted a randomized trial
of 142 patients and reported that exercise based CR significantly decreased several risk factors
associated with CVD. In the same study, patients who returned to work with no CR did not
experience the same decrease (Koovor et al., 2006). Studies have also shown that exercise based
CR improves the quality of life in patients with CVD by reducing risk factors such as anxiety
and depression (Yohannes, Doherty, Bundy, & Yalfanni, 2010; Zwisler et al., 2008). After
conducting a multivariate analysis of 441 patients, Barth et al. (2009) reported men and women
benefit equally from physical and psychological responses to exercise based CR. Although there
is strong evidence supporting the efficacy of exercise based CR programs, many are widely
underutilized.
The AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for
Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services found that
referral to CR programs occurs in less than 30% of patients who are eligible (Thomas et al.,
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 13
2007). Suaya et al. (2007) reported that only 50,000 of 267,427 or 18.7% of Medicare-eligible
patients over the age of 65 were referred to a CR program following a cardiac related event.
These findings suggest an increase in the number of people with diagnosed, yet poorly managed
CVD. This presents an opportunity for adult outpatient PT clinics to play an important role in
secondary prevention.
Consider the example of a patient with poorly managed CVD being treated for LBP at an
outpatient clinic. As suggested earlier, many PT interventions illicit a response from the
cardiovascular system. Regularly measuring vitals during therapy sessions may help prevent
another major cardivascular incident. Alternately, failure to properly measure vitals
compromises the health and safety of the patient. The increased incidence of CVD, physiological
demands of PT interventions, and underutilization of CR programs all demonstrate the
importance of patient management strategies for the prevention of CVD. Obtaining a thorough
past medical history, regularly measuring vital signs, and assessing the risk stratification for each
patient are effective practices for ensuring patient safety.
Use of Vitals
Risk stratification is the process of categorizing individuals as low, moderate, or high risk
for CVD. Assessment of risk stratification can enable PTs to make appropriate
recommendations for physical activity, select safe parameters for exercise, and determine when
further medical examination is warranted. HR and BP measurements should be included when
determining risk stratification. The ACSM (2010) suggests a risk stratification based on the
criteria outlined in Table 1. Asymptomatic men and women who have ≤ 1 risk factor are
considered low risk while asymptomatic men and women who have ≥ 2 risk factors are
considered moderate risk. Individuals are considered high risk if they have major signs and
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 14
symptoms suggestive of cardiovascular, pulmonary, or metabolic disease; or if they have been
previously diagnosed with any of those conditions.
Table 1
Risk Factors for CVD
Positive Risk Factors Defining Criteria
Age M ≥ 45 years, F ≥ 55 years
Family History Myocardial infarction
Coronary revascularization
Sudden death before 55 years of age in male first-degree relative
or 65 years of age in female first-degree relative
Cigarette Smoking Current smoker or quit within previous 6 months or
exposure to environmental tobacco smoke
Sedentary Lifestyle < 30 minutes of moderate intensity exercise (40-60% VO2R) on at
least 3 days of the week for at least 3 months
Obesity BMI ≥ 30 kg∙m2 or
Waist girth M > 102 cm; F > 88 cm
Hypertension *Systolic blood pressure (SBP) ≥ 140 mm Hg and/or diastolic
blood pressure (DBP) ≥ 90 mm Hg or
Currently prescribed antihypertensive medications
Dyslipidemia LDL-C ≥ 130 mg∙dL-1 or HDL-C < 40 mg∙dL-1 or
Currently prescribed lipid-lowering medication
Pre-diabetes *Fasting plasma glucose ≥ 100 mg∙dL-1 but < 126 mg∙dL-1 or
*2-hour oral glucose tolerance test ≥ 140 mg∙dL-1 but < 200
mg∙dL-1
* Confirmed on at least two separate occasions.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 15
The AHA recommends that M ≥ 45 yrs. of age and F ≥ 55 yrs. of age, having 2 or more
risk factors, undergo medical examination and a medically supervised exercise test before
engaging in vigorous exercise. The AHA also proposes that men and women with moderate to
high risk for cardiac complications during exercise undergo constant ECG and BP monitoring
during training (as cited in ACSM, 2010). Both the AHA (2012) and ACSM (2010) recommend
measuring HR and BP before, during, and after exercise to monitor for abnormal responses.
The normal BP response to exercise includes a progressive increase in SBP, little change
in DBP, or possibly a slight decrease in DBP. For low-risk adults, exercise should be terminated
if SBP > 250 mmHg, DBP >115 mmHg, or SBP drops > 10 mmHg. Post-exercise HR and BP
should return to near resting levels before discontinuing monitoring. The ACSM and AHA
recommendations were developed to “reduce the incidence and severity of complications during
exercise” (as cited in Scherer, Noteboom, & Flynn, 2005, p. 731). It can be seen then, that there
is a consensus among the APTA, ACSM, and AHA of the importance of measuring vitals before,
during, and after exercise.
It is the therapist’s responsibility to ensure that each patient qualifies as an appropriate
candidate for physical therapy. A proper evaluation should include a thorough medical history
questionnaire, risk stratification, and measurement of vital signs. Additional measurements
should be made to monitor HR and BP during PT interventions. A decision not to measure vitals
is a decision to ignore critical information that should be incorporated into each plan of care.
Patient centered care involves active participation by the patient/patient’s family members in the
decision making process. Measurement of vitals is essential for providing patients with sound
information regarding their health status and empowering them to make informed health care
decisions.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 16
Justification/Need for this Study
A large body of evidence suggests that many physical therapy interventions impact the
cardiovascular system to some extent. It is imperative that PTs ensure proper services are being
provided to each patient. The profession as a whole could benefit from this study by raising
awareness of the possible discrepancies between the APTA’s recommendations and current
practice behaviors. Understanding these behaviors is the first step towards improving the
standard of care and ensuring patient safety.
Method
Study Design
This a non-experimental quantitative survey study, designed to evaluate practice
behaviors, beliefs of the therapist, and demographic data related to the use of vitals in the adult
outpatient physical therapy setting. Participant recruitment coincided with the start of data
collection. Convenience sampling was utilized. Once IRB Approval was obtained, a brief
description of the study and a link to the informed consent form were placed on FPTA's
Research Support Page. A link to the survey was embedded in the online consent form. Survey
information and all links remained available on the FPTA’s Research Support Page for 21 days
(see Appendix A). The FPTA's Research Support Page was regularly promoted through FPTA
weekly updates, an e-newsletter sent to 3,500 members, the FPTA Facebook page and Twitter
account as per the FPTA's Policies and Procedures for the Research Support Page. A link
allowed potential respondents to access an on-line survey service, Survey Monkey. Information
provided on Survey Monkey included a detailed description of the nature and purposes of the
study, an on-line consent form (see Appendix B), a link for eligible participants to access the
survey, and instructions for individuals who did not want to participate in the study. No other
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 17
solicitation materials were used during this study. The link was deleted after three weeks of data
collection and individual responses were downloaded onto a flash drive and placed in a secure
location on campus.
Participants and Sampling
Participants (N=45) included PTs from the state of Florida practicing in the adult
outpatient setting for at least 6 months. Three questions to verify inclusion criteria were included
in the online survey consent form (1. Are you currently employed at an adult outpatient clinic?
2. Do you currently practice in the state of Florida? 3. Have you been practicing at an adult
outpatient clinic for at least 6 months?). These questions were designed to help ensure quality
and accuracy during data collection by verifying eligibility to participate in the study.
Candidates who answered "no" to any of the above questions did not meet the inclusion criteria
and were instructed to disregard the link to the survey. Candidates who answered "yes" to each
of these questions were asked to consider participating in the study and instructed to continue
reading the consent form.
Survey Instrument
The survey instrument (see Appendix C) was designed to evaluate clinical practice,
beliefs of the therapist, and demographic data. The 16 item survey questionnaire was developed
after a thorough review of current literature, with the help and expertise of the committee chair.
The survey was peer reviewed by two Florida Gulf Coast University (FGCU) DPT faculty
members, three student physical therapists, and three unbiased lay persons. Feedback from the
peer reviewers was incorporated. Multiple edits were made to improve the overall content,
readability, and efficiency of the final instrument. All questions were carefully reviewed to
minimize bias and ensure ease of use. Question 1 (Q1) assessed the frequency of HR, BP, and
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 18
SpO2 measurement in the six months prior to taking the survey. Question 2 (Q2) assessed beliefs
about the importance of measuring vitals. The remaining questions asked about reasons for not
measuring, and an estimate of how long it takes to measure HR, BP, and SpO2; primary area of
practice within the adult outpatient setting, ownership of the clinic, clinic policies, characteristics
of patients treated in the six months prior to taking the survey, entry level degree, highest degree
earned, ABPTS certification, years in practice, and APTA membership (see Appendix A).
Data Collection
Ordinal and nominal data were collected via Survey Monkey and stored on a flash drive.
The data was then coded and transferred in an Excel spreadsheet.
Data Analysis
Data analysis was performed using SPSS, Release 21.0. Frequencies, means, medians,
and modes were used to describe the data. Responses to demographic questions were used to
describe the characteristics of the participants (see Appendices D-M for data summaries).
Data related to behaviors (Q1) were coded so that,”0-20% of visits” = 1,”21-40% of visits” =
2,”41-60% of visits” = 3,”61-80% of visits” = 4, and ”81-100% of visits” = 5 (see Table 2). Data
related to beliefs (Q2) were coded so that “Not at all important” = 1;”Somewhat unimportant” =
2; ”Neutral” = 3; ”Somewhat important” = 4, and ”Extremely important” = 5, (see Table 3). The
coded categorical data from Q1 and Q2 were analyzed for correlations. Categorical data related
to demographic questions about entry level degree, highest degree earned, years of practice, and
years of APTA membership were also coded. Non-parametric Spearman rho (rs) tests were used
to analyze for relationships between beliefs, behaviors, and demographic characteristics.
Questions about ABPTS certification (see Appendix K) and APTA membership (see
Appendix M) only provided “yes” or “no” answer options. Responses were coded so that “no” =
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 19
1 and “yes” = 2. ABPTS certification and APTA membership were used as independent
grouping variables to subdivide respondents. For example, all responses were divided into 2
groups. Group 1 (n=39) included all respondents who answered “no” to the question, “Do you
have an American Board of Physical Therapy Specialties (ABPTS) certification?” Group 2
(n=6) included all respondents who answered “yes”. A Mann-Whitney test (U) was used to
analyze differences between the 2 groups in their reported behaviors (Q1) and beliefs (Q2)
regarding measuring vitals. The same process was repeated using APTA membership as the
grouping variable.
Results
Characteristics of Respondents
While the majority of respondents (n=22, 48.9%) reported entering the profession with a
Bachelor’s Degree, 11 of the 22 had gone on to earn either a Master’s Degree or Doctorate. The
majority of respondents (n=28, 62.2%) were current members of the APTA and 6 (13.6%)
reported having an American Board of Physical Therapy Specialties (ABPTS) Certification
(“Orthopedics” n=5; “Pediatrics” n=1). The average range chosen for “years of clinical practice”
was 16-20 years (SD± 10 years) but a wide variety of experience levels were reported by
respondents. Most respondents (n=25; 55.6%) worked in outpatient clinics that were part of a
hospital system and the remaining 20 worked either in a PT owned clinic (n=14; 31.1%) or for a
corporation (n=6; 13.3%). Surprisingly only 28.9% (n=13) of respondents said their clinic had a
policy regarding the measurement/recording of vital signs. The most commonly reported area of
clinical practice was “outpatient orthopedics” (see Appendix H) and 66.7% reported that 81-
100% of their case load over the last 6 months involved patients whose primary problems were
musculoskeletal in nature. When asked reasons for not measuring vital signs, the most
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 20
frequently chosen responses were “not important for my patient population” (40.0%; n=18) and
“lack of time” (22.2%; n=10). None of the respondents selected “lack of skill in taking these
measurements” as a reason for not measuring vital signs.
Self-Reported Behaviors and Beliefs
Most participants reported measuring vitals 0-20% of the time during initial evaluations
and regularly scheduled visits, as shown in Table 2 and Figure 1. A summary of responses
indicating routine measurement of vitals (routine measurement = 0-80% of the time during
initial evaluations and regular visits) is presented in Table 3.
Table 2
Reported Vitals Measurement During Initial Evaluation and Regularly Scheduled Visits
Initial Evaluation Regular Visits
HR BP SpO2 HR BP SpO2
Mean a
2.47
2.47 2.13 2.13 2.04 1.84
Median b
1.00 1.00 1.00 1.00 1.00 1.00
Mode c
1.00 1.00 1.00 1.00 1.00 1.00
SD (±) 1.78 1.74 1.54 1.46 1.40 1.24
Note. 1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-60% of visits”; 4=”61-80% of visits”; 5=”81-100% of
visits.”
a,b,c All participants (N=45) provided answers for each of the 6 items (HR, BP, and SpO2 during initial evaluation
and HR,BP, and SpO2 during regularly scheduled visits).
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 21
Figure 1. Distribution of Responses for Q1.
Table 3
Summary of Responses Indicating Routine Measurement (80-100% of the time) of Vitals
Initial Evaluation Regular Visits
HR BP SpO2 HR BP SpO2
Responses Indicating Routine Measurement (n) 11
11 6 6 3 3
Percentage (% ) of Total Responses a
24.4 24.4 13.4 13.4 6.7 6.7
Note. 1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-60% of visits”; 4=”61-80% of visits”; 5=”81-100% of
visits.”
a All participants (N=45) provided answers for each of the 6 items (HR, BP, and SpO2 during initial evaluation and
HR,BP, and SpO2 during regularly scheduled visits).
The majority of respondents believed it was important to measure vitals (“Extremely
important”; HR n=20; BP n=21; SpO2 n=18) for patients with a cardiovascular condition but few
believed it was important to measure vitals for each patient at every visit (“Extremely
important”; HR n=4, BP n=4, SpO2 n=3). As seen in Table 4, mean responses related to beliefs
about measuring vitals for certain patients some of the time and patients with medical history of
05
101520253035404550
Heart rate
(HR) during an
initial
evaluation?
Blood pressure
(BP)during an
initial
evaluation?
Oxygen
saturation
(SpO2) during
an initial
evaluation?
HR during
regularly
scheduled
visits (not
including the
initial
evaluation)?
BP during
regularly
scheduled
visits (not
including the
initial
evaluation)?
SpO2 during
regularly
scheduled
visits (not
including the
initial
evaluation)?
In the LAST 6 MONTHS, what PERCENTAGE of the VISITS did you
measure...
0-20%
21-40%
41-60%
61-80%
81-100%
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 22
a cardiovascular condition each visit, were greater than mean responses for measuring vitals on
all patients, each visit.
Table 4
Summary of Self-Reported Beliefs-Importance of Vitals Measurement
Certain Patients/Some of the Time Patients with Medical History of CVD All Patients/Each Visit
HR BP SpO2 HR BP SpO2 HR BP SpO2
Mean a 4.44 4.49 4.27 4.15 4.18 3.96 2.42 2.42 2.27
Median b 4.00 5.00 4.00 4.00 4.00 4.00 2.00 2.00 2.00
Mode c 5.00 5.00 5.00 5.00 5.00 5.00 2.00 2.00 2.00 SD ( ±) 0.59 0.59 0.84 0.93 0.94 1.06 1.20 1.20 1.08 Note. 1=Not at all important; 2=”Somewhat unimportant”; 3=”Neutral”; 4=”Somewhat important”; 5=”Extremely
important.”
a,b,c All participants (n=45) provided answers for each of the 9 items (HR, BP, and SpO2 for certain patients some of
the time, patients with medical history of CVD, and all patients each visit).
Analysis of Relationships: Beliefs, Behaviors, and Demographic Factors
A strong correlation was observed between behaviors of measuring vitals during initial
evaluations and measuring vitals during regularly scheduled visits (rs = 0.798, p < .01).
Moderate correlations between behaviors and beliefs for patients with a history of cardiovascular
disease are described in Table 5. Weak to moderate correlations, also shown in Table 5, were
found between frequency of measuring vitals (during the initial evaluation and during regular
visit) and beliefs about measuring vitals for all patients each visit and for certain patients some of
the time (Cohen, 1988).
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 23
Table 5
Relationships Among Beliefs and Behaviors for Measuring Vitals
Measured During Importance of Measuring
All Patients, Each Visit b Certain Patients, Some Visits b Patients With CVD b
Initial Evaluations a
Moderate Relationship
(rs = .39, p < .01)
Weak Relationship
(rs = .25, p < .01)
Moderate Relationship
(rs = .45, p < .01)
Regular Visits a
Moderate Relationship
(rs = .47, p < .01)
Weak Relationship
(rs = .28, p < .01)
Moderate Relationship
(rs = .50, p < .01)
Note. The abbreviation rs denotes Spearman rho test for correlation between variables using non-parametric data. a Q1 responses are related to behaviors, b Q2 responses are related to beliefs.
No statistically significant correlations existed between the demographic variables being
examined and either the frequency of measuring vitals or beliefs about the importance of
measuring vitals.
Differences Based on ABPTS Certification and APTA Membership
Responses about ABPTS specialty certification (“Yes” = 2, n = 6 “No” = 1, n = 39 ) and
APTA membership (“Yes” = 2, n = 28 ; “No” = 1, n = 17 ) were used as independent grouping
variables. A Mann-Whitney (U) test for differences between groups was used to analyze each
grouping variable for differences regarding behaviors and beliefs. No significant between group
differences were present regarding behaviors (Table 6 and Table 7) or beliefs (Table 8 and Table
9).
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 24
Table 6
Behaviors and ABPTS Certification
Initial Evaluations a
Regular Visits a
Mann-Whitney U 97.500 104.500
Probability (p) 0.549 0.730
Note. Q12 responses, regarding ABPTS certification, were used as the grouping variable. Group 1 included
respondents who did not have ABPTS certification (n = 39, responded “no” to Q12). Group 2 included
respondents who had ABPTS certification (n = 6, responded “yes” to Q12). a Q1 coded responses were pooled on an individual basis (1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-
60% of visits”; 4=”61-80% of visits”; 5=”81-100% of visits”). The sum of the coded responses for the
frequency of HR, BP, and SpO2 measurements performed during initial evaluations was calculated as a single
score for each respondent. This score was used to represent the reported frequency of all vitals measured during
initial evaluations for each respondent. This process was repeated for Q1 coded responses regarding regularly
scheduled visits.
Table 7
Behaviors and APTA Membership
Initial Evaluations a
Regular Visits a
Mann-Whitney U 210.000 188.500
Probability (p) 0.485 0.217
Note. Q14 responses, regarding APTA membership, were used as the grouping variable. Group 1 included non-members (n = 17, responded “no” to Q14). Group 2 included APTA members (n = 28, responded “yes” to
Q14).
a Q1 coded responses were pooled on an individual basis (1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-
60% of visits”; 4=”61-80% of visits”; 5=”81-100% of visits”). The sum of the coded responses for the
frequency of HR, BP, and SpO2 measurements performed during initial evaluations was calculated as a single
score for each respondent. This score was used to represent the reported frequency of all vitals measured during
initial evaluations for each respondent. This process was repeated for Q1 coded responses regarding regularly
scheduled visits.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 25
Table 8
Beliefs and ABPTS Certification
Certain Patients Some Time a Patients with CVD a All Patients Each Visit a
Mann-Whitney U 85.000 106.500 107.000
Probability (p) 0.287 0.790 0.802
Note. Q12 responses, regarding ABPTS certification, were used as the grouping variable. Group 1 included
respondents who did not have ABPTS certification (n = 39, responded “no” to Q12). Group 2 included
respondents who had ABPTS certification (n = 6, responded “yes” to Q12). a Q2 coded responses were pooled on an individual basis (1=”Not at all important”; 2=”Somewhat
unimportant”; 3=”Neutral”; 4=”Somewhat important”; 5=”Extremely important.”). The sum of the coded
responses regarding beliefs about the importance of measuring HR, BP, and SpO2 for “certain patients, some of
the time” was calculated as a single score for each respondent. This score was used to represent beliefs about
the level of importance for measuring all vitals with “certain patients, some of the time.” This process was
repeated for Q2 coded responses for “patients with a known history of CVD” and “all patients, each visit.”
Table 9
Beliefs and APTA Membership
Certain Patients Some Time a Patients with CVD a All Patients Each Visit a
Mann-Whitney U 237.000 199.500 230.500
Probability (p) 0.980 0.351 0.853
Note. Q14 responses, regarding APTA membership, were used as the grouping variable. Group 1 included non-members (n = 17, responded “no” to Q14). Group 2 included APTA members (n = 28, responded “yes” to
Q14).
a Q2 coded responses were pooled on an individual basis (1=”Not at all important”; 2=”Somewhat
unimportant”; 3=”Neutral”; 4=”Somewhat important”; 5=”Extremely important.”). The sum of the coded
responses regarding beliefs about the importance of measuring HR, BP, and SpO2 for “certain patients, some of
the time” was calculated as a single score for each respondent. This score was used to represent beliefs about
the level of importance for measuring all vitals with “certain patients, some of the time.” This process was
repeated for Q2 coded responses for “patients with a known history of CVD” and “all patients, each visit.”
Discussion
Summary of Findings
This survey study seems to be one of the first research efforts to report information on the
use of vitals in adult outpatient PT clinics. The study attempted to answer the questions, (1) do
PTs, practicing in adult outpatient settings, routinely measure the HR, BP, and SpO2 of new and
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 26
existing patients (routinely measure = 80-100% of the time for their current caseload, in the 6
months prior to participating in the study)? (2) Is there a relationship between factors such as
highest degree earned, ABPTS specialty, APTA membership, years of experience, clinic
policies, beliefs about the importance of measuring vitals, and the frequency of measuring HR,
BP, and SpO2?
The evidence suggests that the majority of respondents did not routinely measure the HR,
BP, and SpO2 of the patients on their current caseload, as discussed in Table 3. The results of
this study also highlight the discrepancies between beliefs about what is considered important in
clinical practice and what is actually taking place in the clinic. For example, the majority of
respondents believed it was “extremely important” to measure vitals for patients with CVD, each
visit (HR n = 20, BP n = 21, SpO2 n = 18). However very few respondents reported routinely
measuring vitals during initial evaluations (“80-100% of the time”; HR n = 11, BP n = 11, SpO2
n = 6) and even fewer reported routinely measuring vitals (“80-100% of the time) during regular
visits (HR n = 6, BP n = 3, SpO2 n = 3). Although many clinicians believe it’s extremely
important to measure vitals each time they treat someone with known CVD, a small portion are
actually routinely measuring vitals.
Most respondents (40%, n = 18) selected “not important for my patient population” as
their primary reason for not measuring vitals. Roughly 2 out of every 3 respondents reported 81-
100% of their case load over the last 6 months involved patients whose primary problems were
musculoskeletal in nature. Solid research suggests that a percentage of those patients whose
primary problems are “musculoskeletal in nature” are also likely to have some form of CVD
(AHA, 2011 & Meissner et al., 1999).
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 27
No significant correlations were found between many of the variables being examined.
Weak to moderate relationships exist between beliefs about the importance of measuring vitals
and the frequency of measuring HR, BP, and SpO2. Although we didn’t observe any strong
correlations between these variables, our findings provide enough information to warrant further
study in this area. Other useful information related to reasons for not measuring vitals, estimated
time to measure vitals, area of clinical practice, current practice setting, and clinic policies we
reported (see Appendices B, C, D, F, and G). Such information may be useful to future studies.
Limitations
The important limitations of this study were lack of a random sample and the small
sample size. Our design included the use of convenience sampling and participant recruitment
using the FPTA’s website. Because the survey was distributed through the FPTA’s website, the
responses gathered may be skewed. Unfortunately we were unable to calculate a response rate
for this study. It should be noted that the findings of this study are limited to describing our
sample (n = 45) and the results should not be generalized to a larger population.
Future Research
Future studies are needed to continue examining the use of vitals in the outpatient setting.
The survey instrument used in this study could be modified and used to gather data in a sample
that is more representative of all PTs. Improvements could be made to the survey itself to
facilitate a more efficient data analysis and strengthen the data analysis. Future research should
examine the disconnect between beliefs and behaviors to determine the reasons why PTs with
strong beliefs may not practice according to those beliefs. Another area for future study has to
do with lack of clinical resources that are specific to PT profession. Current information about
evidence based practice and resources, such as criteria for risk stratification (Table 1) and
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 28
exercise guidelines, were developed by the ACSM and the AHA. Future research should address
this issue in some way. For example it would be feasible for the APTA to create a risk
stratification for CVD and set guidelines for measuring vitals based on the number of
characteristics a patient presents with. This could help guide clinical decision making and would
be a wonderful resource to clinicians.
Conclusions
Although our findings are based on non-parametric data, they do provide useful
information regarding an area of clinical practice that has not been well studied. It seems fitting
that the strongest correlation determined by this research was related to the behaviors reported by
respondents. PTs who measured vitals during the initial evaluation were significantly more
likely to also measure vitals during regular visits (rs = .798, p < .01). Therapists are ultimately
responsible for ensuring the safety of each patient being treated. Measuring vitals allows
clinicians to screen for undiagnosed conditions, monitor existing conditions, and facilitate safety
through prevention.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 29
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VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 32
Appendix A: Explanation of Study and Link to Survey on FPTA’s Website
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 33
Appendix B: Online Survey Consent Form
Online Survey Consent Form
Study Title: Self-Reported Use of Vital Signs in the Adult Outpatient Setting
Principal Researcher: Joshua J. Peters, SPT
Faculty Sponsor: Ellen Donald MS, PT
You are being asked to participate in an online survey for a research project conducted
through Florida Gulf Coast University. This research is being conducted as a program
requirement for successful completion of the Doctor of Physical Therapy degree. The University
requires that you give your approval to participate in this project. You must be at least 18 years
old to take this survey.
Your participation in the study is completely voluntary. If you decide to participate now
you may change your mind and stop at any time, for any reason, without penalty or loss of any
future services you may be eligible to receive from the University or the Florida Physical
Therapy Association. You can choose to not answer an individual question or you may skip any
section of the survey by clicking “Next” at the bottom of the survey page to move to the next
question.
The purpose of the study is to examine information regarding the measurement of vital
signs performed by PTs in the adult outpatient setting. This research is important because little
is known about PTs behaviors, beliefs, or the demographic factors related to this topic. I am
asking you to take part in the study because you are currently employed as a licensed PT
practicing at an adult outpatient clinic in the state of Florida. As a quality measure, please
answer yes or no to each of the following questions:
1. Are you currently a licensed physical therapist practicing at an adult outpatient clinic?
2. Do you currently practice in the state of Florida?
3. Have you practiced at an adult outpatient clinic for at least 6 months prior to this date?
If you answered “no” to any of the above questions, you do not meet the eligibility requirements
for participation in this study. Please delete this email and thank you for your consideration.
If you answered “yes” to each of the questions, you are eligible to participate in this study.
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 34
If you agree to be part of the research study, you will be asked to complete an online
survey about your practice behaviors and beliefs regarding measuring heart rate (HR), blood
pressure (BP), and pulse oximetry (SpO2). The survey also includes questions about your
demographic data. We expect the survey will take a maximum of 10-15 minutes to complete.
The survey will remain available for 21 days and can be completed in more than one session.
Your participation will be kept anonymous. However, working with email or the internet
has the risk of compromising privacy, confidentiality, and/or anonymity. Despite this possibility,
the risks to your physical, emotional, social, professional, or financial well-being are considered
to be 'less than minimal’ by completing the survey.
Although your participation in this research may not benefit you personally, it will help
us understand current practices, beliefs, and demographic factors related to measuring vital signs.
We believe this study will provide valuable information about what is actually occurring in
clinical practice. This knowledge will serve as a foundation for understanding the factors
influencing clinical decision making. It is our sincere hope that the data collected from this
study will be used to help guide clinical practice and ensure patient safety.
If you join the study, we will make every effort keep your information confidential and
secure by taking the following steps. Your name and email address will remain confidential and
will be stored on an account through SurveyMonkey.com. We will not have access to your name
or email address at any time and all completed surveys will be assigned a number. All data,
including the data analysis, will be transmitted via a secure browser. Once the data analysis is
complete, the SurveyMonkey.com account will be deleted. However, despite these safeguards,
there is the possibility of hacking or other security breaches that could compromise the
confidentiality of the information you provide. Thus, it is important to remember that you are
free to decline to answer any question that makes you uncomfortable for any reason. Click here
http://www.surveymonkey.com/mp/policy/privacy-policy/ for SurveyMonkey’s privacy policy
or here http://www.surveymonkey.com/mp/policy/security/ for SurveyMonkey’s security
statement.
We will not release information about you unless you authorize us to do so or unless we
are required to do so by law. If results of this study are published or presented at a professional
meeting, no information will be included that would make it possible to identify you as a study
participant.
You will not be paid to take part in this study. If you have any questions about this study,
you may contact Professor Ellen Donald MS, PT at 239-590-7531. If you have any questions
about your rights as a participant in this research, or if you feel you have been placed at risk, you
can contact the Chair of the Human Subjects' Institutional Review Board through Sandra
Terranova, Office of Research and Sponsored Programs, at 239-590-7522.
Statement: I have read the preceding information describing this study. I am 18 years of age or
older and freely consent to participate in the study. My decision to participate or to decline
participating in this study is completely voluntary. I understand that I am free to withdraw from
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 35
the study at any time. I am aware of my option to not answer to any questions I choose. I am
currently a licensed physical therapist practicing at an adult outpatient clinic located in the state
of Florida, and have been practicing in this setting for at least 6 months prior to participating in
this study. I understand that it is not possible to identify all potential risks. I believe that
reasonable steps have been taken to minimize both the known and potential but unknown risks.
The submission of the completed survey is my informed consent to participate in the study.
If you would like a copy of the consent form, print a copy before continuing.
By clicking the survey link below you are consenting to participate in this research survey. If
you do not wish to participate please delete this email.
(Link to survey)
Thank you for your time.
Josh Peters, SPT
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 36
Appendix C: Survey Instrument
Part I – Practice Behaviors & Beliefs
Q1. In the last 6 MONTHS, what PERCENTAGE of the VISITS did you measure…
0-20% 21-40% 41-60% 61-80% 81-100%
HR during an initial evaluation?
BP during an initial evaluation?
SpO2 during an initial evaluation?
HR during regularly scheduled visits
(not including the initial evaluation)?
BP during regularly scheduled visits (not including the initial evaluation)?
SpO2 during regularly scheduled visits
(not including the initial evaluation)?
Q2. I believe it is important to measure…
Not at all
Important
Somewhat
Unimportant
Neutral Somewhat
Important
Extremely
Important
HR on certain patients some of the time
BP on certain patients some of the time
SpO2 on certain patients some of the time
HR on patients with known history of CVD each
visit
BP on patients with known history of CVD each
visit
SpO2 on patients with known history of CVD
each visit
HR on all patients each visit
BP on all patients each visit
Spo2 on all patients each visit
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 37
Q3. What are your reasons for not measuring vital signs - HR, BP, and/or SpO2? (CHECK ALL THAT APPLY)
____ Not important for my patient population
____ Vitals are measured by other staff members at my clinic
____ Lack of time
____ Equipment not available
____ Lack of skill in taking these measurements ____ Other (please explain):
Q4. If you have full access to the appropriate equipment, how long would you say - on average - it would take to
measure a patient’s HR, BP and SpO2? (Average length of time in MINUTES) ____________minutes
Part II – Demographic Information
Q5. Which of the following BEST describes the areas of practice covered at your clinic? (CHECK ALL THAT
APPLY)
____ Aquatic Physical Therapy
____ Cardiovascular & Pulmonary Physical Therapy ____Wound Care
____ Geriatric Physical Therapy
____ Hand Rehabilitation
____ Neurologic Rehabilitation
____ Orthopedic Physical Therapy
____Sports Physical Therapy
____ Women’s Health Physical Therapy
____ Other (please explain):
Q6. Which classification BEST describes the PRIMARY PROBLEMS (reasons for seeking PT services) of the
patients you’ve treated over the LAST 6 MONTHS? (PERCENTAGE of YOUR caseload over the LAST 6
MONTHS)
Percentage of caseload over the last 6 months
0% 1-25% 26-50% 51-75% 81-99% 100%
Musculoskeletal
Neurologic
Cardiovascular
Pulmonary
Integumentary
Lymphatic
Metabolic
Q7. Which of the following BEST describes your current practice setting? (CHECK ALL THAT APPLY)
____ PT Owned
____ Physician Owned
____ Hospital System
____ Corporation
____ Other (please explain):
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 38
Q8. Does your clinic have a policy regarding the measurement/recording of vital signs?
____ YES ____NO
Q9. If you answered YES to question 8, please describe the policy.
Q10. Which of the following BEST describes your ENTRY LEVEL degree?
____ Certificate
____ Bachelor’s Degree
____ Master’s Degree
____ DPT
Q11. Which of the following BEST describes the HIGHEST degree you’ve earned?
____ Bachelor’s Degree
____ Master’s Degree
____ Doctorate
Q12. Do you have an American Board of Physical Therapy Specialties (ABPTS) certification?
____YES ____ NO
Q13. If you answered YES to question 12, please indicate the area(s) of your specialist certification. (CHECK ALL
THAT APPLY):
____ Cardiovascular & Pulmonary
____ Clinical Electrophysiology
____ Geriatrics
____ Neurology
____ Orthopedics
____ Pediatrics
____ Sports
____ Women’s Health
Q14. How many YEARS have you been practicing as a licensed physical therapist?
0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40+
Q15. Are you CURRENTLY a member of the American Physical Therapy Association (APTA)?
____ YES ____ NO
Q16. If you answered YES to question 15, how many YEARS have you been a member?
0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40+
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 39
Appendix D: Q3 Reasons for Not Measuring Vitals
Q3. What are your reasons for not measuring vital signs - HR, BP, and/or SpO2?
(CHECK ALL THAT APPLY)
Table D1
Frequency of Responses Q3
Response
Percent
Response
Count
Not important for my patient population
62.1% 18
Vitals are measured by other staff members at my clinic
13.8% 4
Lack of time
34.5% 10
Equipment not available
10.3% 3
Lack of skill in taking these measurements
0.0% 0
Other (please specify)
23
Note. Responses for “Other (please specify)” included in Table B2.
Figure D1. Frequency of Responses for Q3.
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Not important for
my patient
population
Vitals are
measured by other
staff members at
my clinic
Lack of time Equipment not
available
Lack of skill in
taking these
measurements
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 40
Responses (n = 23) to Q3, “Other (please specify)”
“If pt's don't have abnormal symptoms than usually don't take during tx visits.”
“patient is stable and having no observable signs or symptoms of having any issues”
“straight forward younger patients without history of cardiovascular disease may not need
monitoring as this takes time and if visit is only 30 minutes, it takes time away from their
treatment”
“Vitals do not always have a bearing based upon Dx and tretament being given.”
“My patient population is pediatrics”
“pt not appropriate for vitals due to condition”
“We only see pt for 30 mins. We have only 1 BP cuff. Not practical.”
“taking HR, BP every visit, take SpO2 for pts with cardiopulmonary insufficiency”
“unclear parameters / protocol for what is too high/ low for individual patients
clinical assessments done ongoing to assess response to exercise in all pts; vitals taken for
targeted pts with active cardiac concerns that have been acute”
“non-compliance”
“All visits”
“All patients regardless of age and diagnosis are tested at the initial evaluation. After that, those
with normal measurements and no history or medications for heart, BP or lung conditions are not
measured. Others are measured at each visit.”
“WE MEASURE THEM WHEN WE FEEL THE SITUATION WARRENTS”
“Patient has proven to be stable in previous treatments “
“Not clinically indicated”
“No indication”
“forget to do”
“none, I usually always check initially especially if HTN or cardiac hx”
“we are required to assess vital signs at each treatment session.“
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 41
“Make the clinical decision after the initial evaluation if these examination measures are
important to monitor”
“I only take vitals if I am concerned about stability of vitals or if I need to determine level of
exertion”
“Healthy, asymptomatic outpatients are less likely to be monitored after initial. Those with no
S&S's are also less likely. Usually always monitor/check inpatients or pts who are symptomatic
or with recent event (MI, cardiomyopathy, angina, etc)”
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 42
Appendix E: Q4 Estimated Time it Takes to Measure Vitals
Q4. If you had full access to the appropriate equipment, how long would you say - on average -
it would take to measure a patient's HR, BP, and SpO2? (Average length of time in MINUTES)
Responses (n = 45) to Q4
3
3-5 minutes
2 mins
5
2
the equipment is shared by 15 other therapists; if available and returned to the correct place to be
found by the next theraist, it takes approx 5 minutes--I have to adjust the cuff at times if it says
error which takes extra time as well as you must wait at least 2 minutes per studies between
consecutive measurements
<5
2
2 mins
1-2 minutes
10
8
4
5 mins
4 mins
3-5 minutes
10 mins with documentation, if normal- longer if abnormal and physicians needs notifying!
5
5 min
5 minutes
5 minutes hr and Bo. Not sore spo2
8 mins
5 mins
less than 5 minutes
5
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 43
2 minutes
10
5
5 minutes
2
4
2
4
5-7 min
3 minutes
2 minutes
7 minutes
10
1
3 minutes
3
2
3
2
3 minutes
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 44
Appendix F: Q5 Area of Practice
Q5. Which of the following BEST describes the areas of practice covered at your clinic?
(CHECK ALL THAT APPLY)
Table F1
Frequency of Responses Q5
Response Percent Response Count
Aquatic Physical Therapy 15.9% 7
Cardiovascular and Pulmonary Physical Therapy 9.1% 4
Wound Care 2.3% 1
Geriatric Physical Therapy 47.7% 21
Hand Rehabilitation 11.4% 5
Neurologic Rehabilitation 31.8% 14
Orthopedic Physical Therapy 93.2% 41
Sports Physical Therapy 50.0% 22
Women's Health Physical Therapy 20.5% 9
Other (please specify) 6
Note. Responses for “Other (please specify) included in Table D2.
Figure F1. Frequency of Responses to Q5.
0.0%10.0%
20.0%
30.0%
40.0%
50.0%60.0%
70.0%
80.0%
90.0%
100.0%
Aq
uat
ic P
hysi
cal
Ther
apy
Car
dio
vas
cula
r
and
Pulm
onar
y
Physi
cal…
Wound C
are
Ger
iatr
ic
Physi
cal
Ther
apy
Han
d
Reh
abil
itat
ion
Neu
rolo
gic
Reh
abil
itat
ion
Ort
hoped
ic
Physi
cal
Ther
apy
Sp
ort
s P
hysi
cal
Ther
apy
Wo
men
's H
ealt
h
Physi
cal
Ther
apy
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 45
Responses to Q5 (n = 6), “Other (please specify)”
“oncology, lymphedema”
“pediatrics”
“Pediatric”
“Pediatrics, Wheelchair assessment”
“home health”
“outpatient and inpatient”
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 46
Appendix G: Q6 Primary Problems of Patients Treated During Last 6 Months
Q6. Which classification BEST describes the PRIMARY PROBLEMS (reasons for seeking PT
services) of the patients you've treated over the LAST 6 MONTHS? (PERCENTAGE of
YOUR caseload over the LAST 6 MONTHS)
Table G1
Frequency of Responses to Q6
0% 1-25% 26-50% 51-75% 81-99% 100% Response Count
Musculoskeletal 0 0 5 9 21 9 44
Neurologic 3 21 8 3 3 0 38
Cardiovascular 12 16 1 2 1 0 32
Pulmonary 18 7 3 1 0 0 29
Integumentary 23 4 0 0 0 0 27
Lymphatic 21 4 0 2 0 0 27
Metabolic 21 8 0 0 1 0 30
Figure G1. Frequency of Responses to Q6.
05
101520253035404550
0%
1-25%
26-50%
51-75%
81-99%
100%
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 47
Appendix H: Q7 Current Practice Setting
Q7. Which of the following BEST describes your current practice setting?
(CHECK ALL THAT APPLY)
Table H1
Frequency of Responses (n = 45) to Q7
Response Percent Response Count
PT Owned 31.1% 14
Physician Owned 0.0% 0
Hospital System 55.6% 25
Corporation 13.3% 6
Other (please specify) 0
Figure H1. Frequency of Responses to Q7.
PT Owned
Physician Owned
Hospital System
Corporation
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 48
Appendix I: Q8 & Q9 Clinic Policies
Q8. Does your clinic have a policy regarding the measurement/recording of vital signs?
Table I1
Frequency of Responses (n = 45) to Q8
Response Percent Response Count
Yes 28.9% 13
No 71.1% 32
Figure I1. Frequency of Responses to Q8.
Yes
No
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 49
Q9. If you answered YES to question 8, please describe the policy.
Responses (n = 13) to Q9
“Patients with CV conditions should have VS measurements”
“Take BP/HR/Sats when appropriate”
“BP, HR taken beginning of every visit”
“take vital signs when warranted.”
“All vital signs has be done every visit.”
“Policy is to monitor HR, BP on individuals with history of CVD and SPO2 on patients with pulmonary disease.”
“All patients have their VS- HR, BP and oxygen sat measured at the evaluation. Any patient with history of medical
conditions of the heart, lungs, kidney, and HTN are measured at follow up visits.”
“Measure vitals at every encounter”
“Vitals are taken prior to therapy start by MA”
“Measure at each visit as indicated”
“required to assess BP, HR, respirations, SpO2 (if cardiopulm patient), and temperature at eval and each treatment
session.”
“BP and HR at every patient encounter”
“competency and scope of practice in place”
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 50
Appendix J: Q10 Entry Level Degree & Q11 Highest Degree Earned
Q10. Which of the following BEST describes your ENTRY LEVEL degree?
Table J1
Frequency of Responses to Q10
Response Percent Response Count
Certificate 2.2% 1
Bachelor's Degree 48.9% 22
Master's Degree 26.7% 12
DPT 22.2% 10
Note. (n=45).
Figure J1. Frequency of Responses to Q10.
Certificate
Bachelor's Degree
Master's Degree
DPT
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 51
Q11. Which of the following BEST describes the HIGHEST degree you've earned?
Figure J2. Frequency of Responses to Q11.
Bachelor's Degree
Master's Degree
Doctorate
Table J2
Frequency of Responses to Q11
Response Percent Response Count
Bachelor's Degree 24.4% 11
Master's Degree 28.9% 13
Doctorate 46.7% 21
Note. (n=45).
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 52
Appendix K: Q12 & Q13 ABPTS Certification
Q12. Do you have an American Board of Physical Therapy Specialties (ABPTS) certification?
Figure K1. Frequency of Responses to Q12.
Yes No
Table K1
Frequency of Responses to Q12.
Response Percent Response Count
Yes 13.6 % 6
No 86.4 % 38 Note. (n=44).
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 53
Q13. If you answered YES to question 12, please indicate the area(s) of your specialist
certification. (CHECK ALL THAT APPLY)
Table K2
Frequency of Responses to Q13
Response Percent Response Count
Cardiovascular & Pulmonary 0.0% 0
Clinical Electrophysiology 0.0% 0
Geriatrics 0.0% 0
Neurology 0.0% 0
Orthopedics 83.3% 5
Pediatrics 16.7% 1
Sports 0.0% 0
Women's Health 0.0% 0
Note. (n=6).
Figure K2. Frequency of Responses to Q13.
Cardiovascular & Pulmonary
Clinical Electrophysiology
Geriatrics
Neurology
Orthopedics
Pediatrics
Sports
Women's Health
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 54
Appendix L: Q14 Years of Practice
Q14. How many YEARS have you been practicing as a licensed physical therapist?
Table L1
Frequency of Responses to Q14
Years Response Percent Response Count
0-5 13.3% 6
6-10 15.6% 7
11-15 13.3% 6
16-20 15.6% 7
21-25 11.1% 5
26-30 15.6% 7
31-35 8.9% 4
36-40 4.4% 2
40+ 2.2% 1
Note. (n=45)
Figure L1. Frequency of Responses to Q14.
0-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
40+
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 55
Appendix M: Q15 & Q16 APTA Membership
Q15. Are you CURRENTLY a member of the American Physical Therapy Association
(APTA)?
Table M1
Frequency of Responses to Q15
Response Percent Response Count
Yes 62.2% 28
No 37.8% 17
Note. (n=45).
Figure M1. Frequency of Responses to Q15.
Yes No
VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 56
Q16. If you answered YES to question 15, how many YEARS have you been a member?
Table M2
Frequency of Responses to Q16
Years Response Percent Response Count
0-5 6.7% 2
6-10 33.3% 10
11-15 23.3% 7
16-20 3.3% 1
21-25 3.3% 1
26-30 13.3% 4
31-35 10.0% 3
36-40 3.3% 1
40+ 3.3% 1
Note. (n=30).
Figure M2. Frequency of Responses to Q16.
0-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
40+