Agile Journal 2008 Autumn

7/27/2019 Agile Journal 2008 Autumn

1/36AGILITY

Autumn/Winter issue

A study to explore the predictive validity ofPerformance-oriented Assessment ofMobility (POAM) for falls in older people

National Clinical Guidelines for Stroke 2008Research Proposal: A Survey to investigatethe range of and indications for specificoutcome measures used in therehabilitation of the older person

Chartered Physiotherapistsworking with Older People

2008 No 2


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AGILITYAutumn/Winter 2009 1

Editorial 1

Contact details of Agiles Executive Committee 3

Contact details of Agiles Regional Representatives 3An update on the Agile Standards revision 4

A study to explore the predictive validity ofPerformance-oriented Assessment ofMobility (POAM) for falls inolder people 5

Impact report 2007-8 10

An update to the AGILE continence exercises 11

Agile Conference 2008 Report 12

National Clinical Guidelines for Stroke 2008 14

Research Proposal: A Survey to investigatethe range of and indications for specificoutcome measures used in therehabilitation of the older person 16

List of articles of interest 32

Guidelines for authors 33

Items for sale 34

Membership Form 35

Welcome to AGILITY, Winter 2008! Thisbeing my first edition as the editor, itmay be a little rough around the edges,but please bear with me as I settle into

my new role... and any feedback will be welcomed.This is your journal, so let me know what youd liketo see done with it.

This time around, were lucky enough to have an

editorial written by Amanda Squires, a co-founder ofAgiles predecessor and some interesting reading. Firstup, a study exploring the predictive validity of thePOAM and some details on the National StrokeGuidelines 2008, and also a research proposal fromlast year that some of you will hopefully have takenpart in and maybe we can see the results in the nextedition (if youre like me, roll on summer!!). Theresfeedback from conference 2008 as well as a reportwritten by our former chair, Vicki Goodwin, on theimpact of Agile.

Enjoy the reading, if you can fit it in with Christmasshopping, and why not make a contribution(article/report/critique) to AGILITY one of your NewYears Resolutions?!

Carrie-Ann Reynolds

GUEST EDITORIAL

Prior to the second World War, people who reachedold age and had no relatives or funds were largelylooked after by fitter inmates in the infirmariesattached to parish workhouses. The demand for acutebeds during the war led to evacuation of chronicallyill patients from hospitals to infirmaries, accompaniedby qualified junior staff. One such junior doctor,

Marjorie Warren, realised that specialisation,surroundings, assessment, diagnosis, prioritisation,foot wear and clothing, treatment and discharge werepossible. This start to rehabilitation coincided with thedischarge of PT instructors from the Army being takenon by innovative units.

By the 1970s, an increasing number of people wereliving into old and very old age as a direct result ofVictorian public health improvements. More of themwere living alone as a result of war bereavement,social mobility and the changing expectations of theirfamilies. This was coupled with pressure on health

service funding as a result of an oil crisis. Anincreasing number of older people, through age andabsence of carers, were taking up hospital beds, andrehabilitation and discharge of older people wasbeing seen as an opportunity to free up beds. Thespecialty of geriatrics was, however, low in thesocial and funding hierarchy, and most of us workedsingle handed with assistants with poor equipmentand in poor premises (many still the originalworkhouse infirmaries). Despite this, teamwork with

Editorial

CopyrightThe material in this Journal is copyright to AGILITY and may not be published in another journal without the permission of theeditor. Authors will be advised of any requests to reprint their articles in other journals. Opinions expressed in this Journal are notnecessarily those of the Editor of AGILITY, AGILE or the publisher.

Contents


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2 AGILITYAutumn/Winter 2009

other disciplines was excellent as we fought againstall manner of odds as a team.

The Health Advisory Service, set up by thegovernment following scandals in the vulnerableareas of mental health, learning disabilities,paediatrics and elderly care, sent teams to every such

unit around the country on rotation. It was at such avisit that Margot Hawker, the physiotherapist on theteam and the first to promote the opportunities ofphysiotherapy in elderly care, and myself as a nervousphysiotherapist being visited met, and discussed theissue of isolation from colleagues battling with similarchallenges. We subsequently set up the forerunner ofAGILE to promote high standards of physiotherapywith older people through education, communicationand support.

AGILEs membership, past and present, have beencrusaders in the cause of improving elderly care. We

have largely focussed at a local, national and single

discipline level in hospitals based on the originalprinciples. As we mature as an organisation, we needto ratchet up our focus to a political and moreinterdisciplinary, interagency and internationalinfluence. By 2025 there will be an estimated 800million older people in the world, with the fastestgrowth in developing countries. In developed

countries more older people are in care than inhospital and we need to consider how we reach themmore effectively. Sharing information based oninternational interdisciplinary interagency experienceshould be our future.

Amanda Squires PhD, MSc, FCSP

Co founder and former secretary and president ofAGILE

Ref. Physiotherapy with older people. AGILITY

Commemorative 21st Anniversary Issue April 1999

Data Protection ActMembers details are held on a computer database. Questionnaires may be sent by students undertaking dissertations this willbe via the membership secretary. The database address list may also be provided to a third party if the National Executive believeit would be beneficial to members interest in older people. Please write to the membership secretary if you do not want yourdetails disclosed in either of these circumstances.

Do you need financial support to attend a courseor do some research?

The AGILE Education and Research Fund can help you.

A research fund for AGILE members was established in early2005 and a total of 600 per year is available with the idea thatup to three awards will be made each year.

The funding is available towards research that relates tophysiotherapy and the older person including that beingundertaken as part of a higher degree or as part of a localresearch project. Other potential uses are purchasing

equipment, transcribing costs or producing conference postersto disseminate research findings. You may be surprised to findsome support for attending a course overseas and you wontknow until you apply!

More information about the Research Fund can be found on theAGILE website or contact Lynne Bakewell, Treasurer.


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PRESIDENT

Bob Laventure Email: [email protected]

CHAIR

Mandy TylerEmail: [email protected]

VICE CHAIR

Lynn Sutcliffe Email: [email protected]

SECRETARY

Janet Thomas Email: [email protected]

MEMBERSHIP SECRETARY

Julie George Email: [email protected]

NOTES SECRETARY

Vacant

TREASURER

Lynne Bakewell

Email: [email protected]

JOURNAL EDITOR

Carrie ReynoldsEmail: [email protected]

RESEARCH OFFICER

Vivien AstburyEmail: [email protected]

iCSP REP

Vicky JohnstonEmail: [email protected]

PRO

Jo HurfordEmail:[email protected]

EDUCATION OFFICER

Ursula Martindale Email: [email protected]

AGILE NationalExecutiveOfficers

November 2008

NORTHLYNN SUTCLIFFEEmail: [email protected]

VIVIEN ASTBURYEmail:[email protected]

EASTLOUISE BRIGGSEmail: [email protected]

LYNNE BAKEWELLEmail: [email protected]

WESTJUDE DOUCHEmail: [email protected]

CATHERINE SAUNDERSEmail: [email protected]

SCOTLANDJANET THOMASEmail: [email protected]

NORTHERN IRELANDGAIL MCMILLANEmail: [email protected]

WALESMANDY TYLEREmail: [email protected]

AGILE RegionalRepresentatives


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With this edition of Agility you shouldhave received your copy of the AGILERevised Standards of PhysiotherapyPractice Supplementary Paper.

AGILE published the Standards of Physiotherapy

Practice Supplementary Paper in 2004 and whilstmuch of the information in that document is stillcurrent and relevant, the Executive Committee felt thatthere were aspects of the standards which requiredrevising and updating.

As with the 2004 edition, this revised supplementarypaper has been mapped against the standardscontained in the CSP documents, the Core Standardsof Physiotherapy Practice and Service Standards of

Physiotherapy Practice. As such, it should be read inconjunction with both CSP standards documents; it is

not a stand-alone paper. Additional guidance has onlybeen added where essential, and has been focussed

on areas pertinent to physiotherapy practice witholder people.

One particular point to note is that the section onstaffing does not consist of AGILE recommendedstaffing levels. Rather, we have tried to reflect how

some current teams and departments have managedtheir case loads with regard to staffing levels, skill mixand caseload mix.

All AGILE members are urged to ensure that theirphysiotherapy practice follows the good practicehighlighted in this revised standards paper.

AGILE would welcome feedback on this revisedstandards paper please send any comments to theSecretary at [email protected]

On behalf of the Agile Standards working group

Agile StandardsRevisionBy Janet Thomas

Using AGILITY for your announcements/vacancies etc

AGILE Study Days / Events : no charge

Staff vacancies: 75.00 per half page for AGILE members

150.00 per full page for AGILE members

Commercial advertisements: 100.00 per half page

200.00 per full page

Closing date for publication in Spring/Summer 2009 issue, availablebeginning of June 2009, is 30th April 2009

Please send in any queries to the Journal Editor

[email protected]


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INTRODUCTIONAlthough there are many therapy outcome toolsavailable, choosing the most appropriate one provesto be difficult, given either the limited availableresearch evidence base or the practical difficulties inadministering them. However, POAM is an outcometool that is believed to be valid and reliable, and at thesame time easy to administer (Thomas and Lane,2005). This study, which was of single blind type,aimed to establish its predictive validity in identifyingolder people at high risk of falling by administeringPOAM, on a sample of 50 participants, all aged above65 years.

This study also aimed to test the hypothesis that therewill be a significant difference in falls status betweenolder people scoring less than and greater than 19 out

of a possible total of 28 on POAM. In other words, itwas hypothesised that the participants scoring lessthan 19 on POAM will be the individuals with historyof persistent falling and also with a high risk of futurefalling.

The key issue of concern is not merely that of falls inolder people, as young people sustain frequent fallstoo, but rather the unique co-presentation of a highincidence and a high susceptibility by older people toserious injuries. Although only a small percentage offalls result in fractures, the annual cost of these

fractures to the NHS is staggering. Apart fromeconomical fallout, fractures and subsequent eventsmight force individuals to lose independence andexperience a poor quality of life. In a study done to

evaluate the psychological state of the older people, itwas observed that the individuals preferred death tofracturing their hips and subsequent transfer to anursing home (Salkeld et al. 2000).

Rationale & Development of the ResearchQuestionPOAM was developed for several reasons by M. E.Tinetti, viz. to identify components of mobility thatcould be problematic whilst performing the activitiesof daily living; to explore potential reasons for troublein carrying out certain manoeuvres; an individualssusceptibility to falling; and to aid in diagnosis,prevention and management of problems having apotential to interfere with functional mobility (Tinetti,1986).

POAM combines both balance and gait componentsfor a thorough evaluation of the functional mobility. Itis scored out of a possible 28 points, with higher thescore the better the balance and gait parameters. Acut-off point of 19 is considered to be unsafe asregards to functional mobility, and those individualsscoring less than 19 are deemed to be at high risk ofpotential falling.

POAM is divided into balance and gait sub-sections,and all the activities within are scored on a cardinalscale of 0 for being unable to do, 1 for able to do with

help or on more than one attempt, and 2 forindependent completion of the activity beingassessed. However, the gait parameters are scoredonly 0 and 1 for inability and ability respectively to do

A study to explore thepredictive validity ofPerformance-oriented

Assessment ofMobility (POAM) for

falls in older peopleBy Kiran Katikaneni, Dr Alexander Nowicky


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an activity. Balance and gait activities are scoredindependently for a total of 16 and 12 respectively;and the final total is 28. However, despite extensiveliterature review, only one study was found whichtested the validity of POAM with 3 other balance andmobility tools (Thomas and Lane, 2005).

To sum up the known risk factors in falls, and aid ahealth care professional in identifying individuals atrisk, De Moraes Barros (2006) suggests use of amnemonic- I HATE FALLING- by all those who areinvolved in falls management or come across olderpeople in their practice. Table 1 illustrates themnemonic.

I Inflammation of joints (or joint deformity)

H Hypotension (orthostatic blood pressurechanges)

AAuditory and visual abnormalities

T Tremor (Parkinsons Disease or other cause)E Equilibrium (balance) problem

F Foot problemsAArrhythmia, heart block, or valvular diseaseL Leg length discrepancyL Lack of conditioning (generalised weakness)I IllnessN Nutrition (poor; weight loss)GGait disturbance

Table 1: A mnemonic for key physical findings inelderly people who fall or nearly fall (De Moraes

Barros GDV (2006) Falls in elderly people. The Lancet367: 729-730.)

DEVELOPMENT OF METHODResearch QuestionThis study aimed to test the hypothesis that there is adifference in falls status depending on the POAMscores. The null hypothesis of the study being thatthere will be no difference in falls status based onPOAM scores.

Secondly, based on results, it was proposed torecommend implementation of POAM, the outcometool under study, as a standardised objective assessmentfor falls in the older people in Physiotherapydepartments. Therefore, this study aimed to recommendthe use of POAM as a specific outcome tool in olderpeople referred for falls management.

Research DesignSensitivity and specificity of the POAM wasdetermined following the construction of a 2x2 table;and ROC was subsequently plotted to determine thevalidity of POAM.

SampleParticipants were recruited from the Day Hospital. Aconvenience sample of 50 older people, aged 65 years

or above was used in this study. All the participantswere referred to, and attending the day hospital aspart of their ongoing rehabilitation programme.

Recruitment CriteriaThe inclusion criteria to participate in the study were;participants aged 65 years of above, to have a score

of 13 and above on MMSE, and with good vision. Asthe study aimed to explore the validity of a fallsmeasurement tool, it is imperative that the participantsare from the population that are at high risk of falls.

The exclusion criteria were; the participants aged lessthan 65 years; with blindness and those with a scoreof less than 13 on the MMSE. Intact vision is anessential prerequisite for completion of this test.

Information & Consent Forms

Research participant consent and information formswere designed as per the Central Office for ResearchEthics Committees (COREC) recommendations.

Data Collection & AnalysisPOAM was administered on the participant by theresearcher on one-to-one basis. For balance activities,the participant was seated in a hard, armless chairwhilst all the manoeuvres were tested. In case of gaitrelated tasks, the participant was asked to walk acrossthe room at his/her usual pace with the researcherfollowing him/her closely behind for safety of theparticipant. Collected data were analysed forsensitivity and specificity using a 2x2 table to identify

the number of participants with true positives andnegatives, and false positives and negatives. A 2x2table (Table 2) was helpful in clear separation of theparticipants based on their true falls status and theirPOAM scores. For the purpose of the study,participants scoring less than 19 who were alsopersistent fallers were considered to be true-positives, whilst those persistent fallers scoring morethan 19 were considered as false-negatives.Participants who were non-fallers but scoring lessthan 19 were considered as false-positives, and thosenon-fallers scoring more than 19 were identified as

true-negatives.

POAM Persistent-Fallers Non-Fallers

(Cut-off=19)

Number of A B

participants True False

with Test-Positives Test-Positives

POAM 19Number of C D

participants False True

with Test-Negatives Test-Negatives

POAM 18 A+C B+D

Table 2: 2x2 Table for POAM Study



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RESULTSThe mean SD age of the participants was 79.1 8.4years. The mean age of the female participants was80.2 9.3 years, whilst that of the male participantsbeing 78 7 years. There were 24 (48%) participantswith score of less than 19 on POAM, whilst the meanPOAM score being 18 5.3. There were 24 (48%)

participants who have had persistent falls, whilst theremaining 28 (56%) have had either no or just 1 fall inthe preceding 1 year duration. As identified by thePOAM, there were 24 (48%) individuals with truepositive on the test, 3 (6%) with false positive; and 15(30%) with true negative whilst 8 (16%) individualstested false negative on the tool.

Of 50 participants, 12 (24%) were diagnosed withParkinsons disease whilst 2 (4%) were suspected tohave the disease, 9 (18%) have had Stroke, 17 (34%)were under treatment for a cardio-respiratorycondition, and 10 (20%) have sustained a fracture onfalling. 1(2%) participant with a history of persistentfalls was diagnosed to have Mnires disease, and 6(12%) have had joint replacement surgeries, eitherknee or hip. It was significant to observe that 5 (10%)individuals of them were found to be persistent fallers,and 4 (8%) of them tested positive on the tool. Table3 shows the participant characteristics.

Analysing the data for determining its distribution byhistogram showed the frequency distribution withsuperimposed normal curve. The Figure 1 belowillustrates histogram plotting the frequency

distribution of POAM and the superimposed normal

curve. The histogram shows the mean POAM to be18.12 5.

Figure 1: Histogram for frequency distribution ofPOAM

T-test for falls status versus POAM proved to besignificant (p=0.0001, 95% CIE of 3.919 and 9.075.This T-test was done to determine significance ofPOAM on predicting falls status but without separatinggender of the participants. Mean POAM in olderpeople with persistent falls was 15.78 4.668 wheren=32. In Table 4, 0 denotes the number of non-fallers, whilst 1 denotes the number of participants

with history of persistent falls.

Age: Mean

Sex: FemaleMale

Domiciliary Status: Spouse/ CarerIndependent

Diagnosis: Cardio-respiratory conditionParkinsons diseaseFractureStroke

Joint Replacement SurgeryMnires disease

Falls History: Persistent Fallers

POAM: Mean

True PositiveTrue NegativeFalse NegativeFalse Positive

79.1 8.4 years

28 (mean age- 80.2 9.3 years (56%)22 (mean age- 78 7 years (44%)

32 (64%)18 (36%)

17 (34%)12 (24%)10 (20%)9 (18%)6 (12%)1 (2%)

32 (64%)

18 (36%) 5.3

24 (48%)15 (30%)8 (16%)3 (6%)

Table 3: Participant Characteristics

Table 4: Group Statistics for POAM versus Falls Status

POAM Falls Status N Mean Std. Deviation Std. Error Mean0 18 22.28 3.707 .8741 32 15.78 4.668 .825


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2x2 table was constructed to identify the number ofparticipants testing true and false positive; and trueand false negative on POAM; and furthermore tocalculate its sensitivity and specificity. Table 5 showsthe 2x2 table.

POAM Persistent-Fallers Non-Fallers(Cut-off=19)

Number of A Bparticipants True Test-Positives False Test-Positives

with 24 3POAM 19Number of C Dparticipants False Test-Negatives True Test-Negatives

with 8 15POAM 18

A+C=32 B+D=18

Table 5: 2x2 Table for calculating Sensitivity and

Specificity of POAM

Sensitivity = AA + C

i.e. number of true test-positives/ number of true test-positives + number of false test-negatives

Specificity = DB + D

i.e. number of true test-negatives/ number of false

test-positives + number of true test-negatives

Sensitivity, was found to be 0.75; and specificity was0.83. POAM could identify 75% of persistent fallingparticipants who tested true positive on the test; and83% of participants without history of persistent fallswho all tested true negative.

DISCUSSIONThe results obtained on data analysis prove that forour sample (n=50) the hypothesis that the persistentfallers scored significantly lower then the cut-off 19 onPOAM. The most important finding of this study is thatthe POAM could be effectively used as a validassessment tool in predicting falls risk and incidenceof future falls in older people. As hypothesised, thescore on POAM for the older people with a history ofpersistent falls was found to be lower than 19, and insome instances it was significantly lower than this cut-off point.

The most important finding, being that evidence forthe use of POAM as a valid tool in falls assessment isshown by having high rates of true positives and true

negatives. As detected by the 2x2 table and furtheranalysis of sensitivity and specificity, there were 24(75%) fallers with true positive out of the total 32fallers, and 15 (83%) of non-fallers tested true negative

out of the total 18 non-fallers. To be deemed to besignificant, a diagnostic tool should have highsensitivity and specificity levels. Therefore, the studypresented is the first to provide strong supportingevidence to recommend the use of POAM as a validfalls assessment tool in older people.

This study also showed that for patients withParkinsons disease, POAM reliably detected thoseindividuals with falls history. 57% of them had a fallshistory with all of them testing positive on POAM.This puts forth a strong case for use of POAM as avalid falls assessment tool in Parkinsons disease overthe use of other mobility and balance tests. POAM wasalso successful in identifying persistent fallers whohave had co-morbid conditions like stroke, cardio-respiratory diseases etc.

POAM was shown to have best sensitivity in a studythat compared it with three other balance and gait

outcome tools (Thomas and Lane, 2005). This couldbe explained based on its inclusion of multifunctionalmanoeuvres and also both predictive and reactiveequilibrium adjustments. In addition, POAM tests thestrength in lower limb muscles by sit-to-standmanoeuvre and also the impact of visual input onbalance mechanisms. As POAM incorporates all theseaspects in its balance sub-section, and based on thefindings of the present study, it can be stronglyrecommended for use as a routine clinical assessment.

Limitations of the Study

The sample size was n=50 therefore the results couldbe generalised, though with caution, to thepopulation. However, given the existing and projectedchanges in demographics of older people, largersample size would have substantiated the findings andhelped in making stronger assertions.

The present study did not test any other balance andgait tests, thereby providing no opportunity tocompare the efficacy of POAM with that of the othertests.

There was no provision made in the design of thestudy for testing intra-rater reliability in administeringthe POAM. Thomas and Lane (2005) in their study onvarious balance and gait outcome tools have reportedfare to excellent intra-rater reliability.

Areas of Further ResearchFurther research in the field of falls prevention andmanagement could be in the areas of testing validityand reliability of various assessment tools in generaland POAM in particular as pre and post interventionoutcome measures.

CONCLUSIONThis study aimed to establish the predictive validity ofPOAM as a falls assessment tool by establishing itssensitivity and specificity.


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The present study was successful in establishing thepredictive validity of POAM in identifying therecurrent fallers and also predicting the risk of theirfuture falling by rejecting the null hypothesis.Alternatively, it can be stated that the findings of thecurrent study have indicated that there is a differencein falls status between the participants scoring less

than and greater than 19 on POAM.

The POAM is one such tool, and its efficacy and easeof use warrants its widespread use by the cliniciansand researchers alike in the field of elderlyrehabilitation.

This dissertation was submitted as a part fulfilment forthe MSc Neurorehabilitation, Brunel University,Uxbridge, Middx. UB8 3PH

Acknowledgements: Staff of the Physiotherapy Department & The

Pendre Day Hospital, Princess of WalesHospital, Bridgend, Mid Glam, Wales

Dr Louise Marston, Brunel University,Uxbridge, Middx.

Address for CommunicationContact the author for a full reference list.

Kiran Katikaneni, Senior Physiotherapist, St RichardsHospital, Chichester, West Sussex PO19 6SE,[email protected]

Dr Alexander Nowicky, Course Leader, MScNeurorehabilitation, Brunel University, Uxbridge,Middx. UB8 3PH

REFERENCES

Cumming RG, Salkeld G, Thomas M, Szonyi G (2000).

Prospective study of the impact of fear of falling

on activities of daily living, SF-36 scores, and

nursing home admission. Journals of Gerontology.

Series A, Biological Sciences and Medical Sciences

55 (5): 299-305.

De Moraes Barros GDV (2006). Falls in elderly people.Lancet 367: 729-730.

Salkeld G, Cameron ID, Cumming RG et al (2000).

Quality of life related to fear of falling and hip

fracture in older women: a time trade off study.

British Medical Journal 320: 341-345.

Salkeld G, Cumming RG, ONeil E, Thomas M, Szonyi

G, Westbury C (2000). The cost effectiveness of a

home hazard reduction programme to reduce falls

among older persons. Australia and New Zealand

Journal Public Health 24 (3): 265-271.

Thomas JI, Lane JV (2005). A pilot study to explore the

predictive validity of 4 measures of falls risk in

frail elderly patients. Archives of Physical

Medicine and Rehabilitation 86: 1636-1640.

Tinetti ME (1986). Performance-Oriented Assessment

of Mobility Problems in Elderly Patients. Journal of

the American Geriatrics Society 34:119-126.

Tinetti ME, Baker DI, Gottschalk M, Williams CS,

Pollack D, Garrett P et al (1999). Home-based

multicomponent rehabilitation program for older

persons after a hip fracture: a randomised trial.

Archives of Physical Medicine and Rehabilitation

80: 916-922.


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This is a summary of achievements, activitiesand forward planning during the year 2007-8that you would have enjoyed if you attendedthe conference in October 2008. We look

forward to a similarly busy and successful 2008-9, andthank the NEC for all their hard work.

National Executive Committee President Chair Vice Chair Secretary Membership Secretary Treasurer Journal Editor Research Officer Minutes Secretary Diversity Officer iCSP Officer PRO

+ Regional representatives+ Project officers

Education 10 Regional study days 1 National conference 4 study days cancelled due to lack of interest

Publications Agility (2) Newsletters (3)

Standards 2008 Undergraduate pack review Supplements

Outcome measures (TUAG) National falls and bone health audit papers

Responses to national documents andpublications Falls clinics Stroke guidelines

Rehabilitation framework (Scotland) NHS Wales restructuring OA guidelines Intermediate care strategy Dementia Strategy Older peoples system reform

Committee membership/working groups RCP Falls and Bone Health Steering group RCP Stroke working group BGS Falls and Bone Health Section National Coalition for Active Ageing Older Peoples Specialist Forum

Parkinsons Disease Society IPTOP EUNAAPA DoH falls and fracture commissioning expert

panel

CSP related work Scrutinising of post-graduate courses for CSP

accreditation Workforce development ARC CIGLC Pebblepad pilot Icsp Media enquiries and interviews

2008-9 Streamlining Website Outcome supplement

Exercise supplement Study days Conference 2009

Impact Report 2007-8By Victoria Goodwin (Outgoing Chair)


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In 2006 AGILE published their Incontinence andPelvic Floor Muscle exercises supplement inconjunction with Jeanette Haslam on behalf ofCPPC and ACPWH. The information was also

replicated in the Autumn/Winter edition of Agility(2006).

Following this, the AGILE committee have received

some requests for clarification about using theexercises, and in particular about the need forassessment of the pelvic floor prior to prescribingpelvic floor muscle exercises (PFME). AGILE haveconsulted with Jeanette Haslam and the following is aclarification of the need for assessment prior to usingPFME.

The guidelines state that Routine digitalassessment of pelvic floor muscle contractionshould be undertaken before the use of

supervised pelvic floor muscle training for thetreatment of Urinary incontinence [NICE Clinicalguideline 40 Page 26].

In other words, if incorporating PFMEs into classwork or general healthy living advice then digitalassessment is not deemed necessary. However if aperson with urinary incontinence is referred fortreatment of their incontinence then a digital

assessment is necessary to ensure a patient specificexercise programme. This would also ensure they arecapable of doing the exercises. Any other form ofintervention such as electrical stimulation would alsoneed a digital examination. You may also assess aPFM contraction using real time ultrasound if youhave the appropriate machine and training. Youwould also need to digitally examine before using anyvaginal or anal device.

AGILE ContinenceExercises

Got anything interesting to share?

Have you recently undertaken some research, and audit or been on anamazing course?

Are you prepared to share your results with your colleagues?

Why not prepare your report for publication and send it to me forsubmitting.

Details of the latest guidelines for authors can be found within this issue.

Your report could be published as early as June 2009.

Any research or relevant topics will be considered.

Please contact the AGILITY editor:

[email protected]


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with the wider elderly population who developcontractures that are often extremely uncomfortableand painful.

Dr Ruth Greenhalgh, Consultant Clinical Psychologistwho lectured at last years Agile Conference returnedthis year to present on Psychological aspects of

stroke and strategies for management. In clinicalpractice it is always interesting to link the personsfunctional deficits to the areas of the brain that areaffected and in the same way it is interesting to linka persons behaviour. From this presentation I learntthat consistency within the multi-disciplinary team isvery important from a psychological viewpoint andthings may get worse before they get better but it isworthwhile persevering. It is also important thatpsychology has an impact on the persons physicalrecovery and it is useful to be aware of psychologicalstrategies that can be incorporated into our clinicalpractice by working alongside a Clinical Psychologist.

The final two presentations were very innovative:Training reaching following severe stroke using theSMARTArm by Dr Sandra Brauer from Queensland,

Australia demonstrated following research that itwas a useful rehabilitation tool and that upper limbfunction could be improved with the use of thisdevice but further research is needed.

Robot-aided neuro-rehabilitation: science fictionor innovation by Mr Rui Loureiro, Senior Research

Fellow. This research is in its infancy and may bemost useful in the early stages of StrokeRehabilitation when it can have the greatestinfluence on neural plasticity and brain recovery. Amore comprehensive clinical trial is planned togather further evidence.

Overall this was a very successful conferenceincluding the Gala Dinner on the Saturday eveningwith an entertaining after dinner speaker. Thank youto the organising committee for putting on theconference which is also a great place to network aswell as gaining knowledge and ideas from the

presentations, workshops, posters and the sponsors.


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BACKGROUND TO THE PROCESSThe third edition of the U.K national clinical guideline

on the management of stroke collated by the ClinicalEffectiveness and Evaluation Unit Stroke Programmeat the Royal College of Physicians together with theIntercollegiate Stroke Working Party (ISWP) aims toimprove the quality of care for stroke patients. TheISWP is made up of representatives from allorganisations involved in stroke management.Physiotherapists are key members of themultidisciplinary team, led by Sheila Lennonrepresenting the CSP supported by Nicola HancockACPIN and Christine FitzPatrick AGILE. Theseupdated guidelines have 300 recommendations

interpreted by the ISWP from systematic searching ofcomputerised databases and the use of qualitativeevidence from 2002 up until September 2007 as wellas the members expertise.

ContentThe guideline consists of seven chapters covering allaspects of stroke management. For the first time thescope of the guidelines incorporate the NICErecommendations on acute diagnosis and initialmanagement of acute stroke for the first 48 hours andTIA treatment; specific guidance on commissioningstroke services (Chapter 2 pages 21 -26) and also asection on mental capacity and consent.

The chapters of particular interest to physiotherapistsare Chapters 6 and 7 (pages 71 110) that focus onrehabilitation from a few days to 6 months, thenprogressing to the longer-term management of strokepatients

Profession specific guidelines, including thePhysiotherapy Concise Guidelines for Stroke (pages134 139) have been compiled by extractingrecommendations from the full guidelines.

Members should consider the document to be aworking tool and consider whether new evidence ona topic may alter existing recommendations.

Examples of Key Recommendations Relevant toPhysiotherapists

3.13.1 A Treatment Intensity. Patients shouldundergo as much therapy appropriate to their

needs as they are willing and able to tolerate and

in the early stages they should receive a minimum

of 45 minutes daily of any therapy that is required.

(NICE): Early InterventionA People with acute stroke should be mobilisedas soon as possible (when their clinical conditionpermits) as part of an active managementprogramme of a specialist stroke unit

C People with acute stroke should be helped to situp as soon as possible (when their conditionpermits)

5.3.1 Lifestyle MeasuresB All patents should be advised to take regularexercise as far as they are able: The aim shouldbe to achieve moderate physical activity(sufficient to become slightly breathless) for 2530 minutes each day.

6.13.1 Self Efficacy TrainingA All patients should be offered training in self-management skills, to include active problemsolving and individual goal- setting

B any patient whose recovery is delayed orlimited should be assessed for changes in selfidentity, self -esteem, and self- efficacy as well aschanges in mood.

6.2.1 Evaluating and Stopping TreatmentsA Every patient should have progress measuredagainst goals set at regular intervals determinedby the patients rate of change, for example using

goal attainment scaling.

B When the goal is not achieved the reasonshould be established and: the goal should be

National ClinicalGuidelines for Stroke2008By Christine FitzPatrickAGILE Project Officer for RCP Stroke


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adjusted; the intervention should be adjusted orno further intervention should be given towardsthat goal.

C When the therapist or team stops giving goalsthe therapist should: discuss the reasons with thepatient; ensure that continuing support that the

patient needs to maintain and/ or improve healthis provided; teach the patients and if necessarycarers and family how to maintain health;provide clear instructions how to contact theservice for re-assessment and outline whatspecific events or changes should trigger furthercontact.

7.1.1 Further RehabilitationB Any patient with residual impairment shouldbe offered formal review at least every sixmonths, to consider whether furtherinterventions are warranted and should be

referred for specialist intervention if: newproblems, not present when last seen by thespecialist service are present the patientsphysical or social environment has changed.

7.5.1 CarersB The carer of every patient with stroke shouldbe involved in the management process from theoutset, specifically: as an additional source ofimportant information about the patient bothclinically and socially; being given accurateinformation about the stroke, its nature and

prognosis and what to do in the event of afurther stroke, being given emotional andpractical support as required.

CONCLUSIONEveryone should be aware of the most importantrecommendations relevant to their practice. This is thefirst time that the intensity of treatment a minimum of45 minutes daily (Recommendation 3.1.13) has beenspecified. Comparative studies in Europe suggest thatU.K face-to- face therapist contact time is lower than

other countries. There is strong evidence for the linkbetween the intensity of rehabilitation and recovery inparticular for gait and ADL, and this will provide achallenge for commissioners, managers and therapiststo provide adequate resources in order to fulfil thiscommitment to rehabilitation.

The guideline focuses on stroke-specific matters.However, because rehabilitation is essential to providea high quality, effective service somerecommendations are based on general principles ofrehabilitation and are a useful source of evidence.

Useful Links for Stroke InformationNational Clinical Guideline for Stroke- ThirdEditionavailable at:http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=250

Profession Specific Audit of Stroke: AMultidisciplinary Pilot Study:Profession Specific Audit of Stroke Organisationaland Clinical Audit Version 2 available atwww.csp.org.uk

Spring/Summer AGILITY 2009

Submissions for the Spring/Summer issue of AGILITY shouldreach the editor, by 30th April 2009 at the latest


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INTRODUCTIONPhysiotherapy has prided itself on the scientific basis

of its practice without asking whether treatments workover the past number of years (Wyatt & Gully, 2002).This realisation has resulted in a focus on evidence-based therapy (Wyatt & Gully, 2002; Sackett et al,1997; Sackett et al, 1996), and in the rehabilitation ofthe older person, many objective measures are used(Morris et al, 2007; Chartered Society ofPhysiotherapists (CSP), 2006; Nitz et al, 2006; Scott etal, 2007). This proposal aims to:

Develop a comprehensive research proposalon objective measures used in the rehab of the

older person, including full research protocol. Demonstrate selection of appropriate research

methods including exclusion and inclusioncriteria.

Suggest a data collection strategy and identifysuitable approach for data analysis.

Demonstrate critical evaluation skills and theability to apply a problem solving approach toa research question by means of aquestionnaire.

Background

In the rehabilitation of the older person, the main aimof physiotherapy is to prevent a fall (Street et al,2007). Identifying and managing the risk factors hasbeen shown to reduce fall rates in the older

population (Hill & Schwarz, 2004). 30% of peopleover the age of 65 fall within a twelve-month period

Increasing to over 50% for those aged 80 years,and10% of all falls result in serious injuries.. Falls inthe elderly population cost the NHS and social caresector more than 1.7 billion per year (Street et al,2007; Nandy et al, 2004; Bogle-Thorbahn & Newton,1996). They have an adverse affect on the patient andthere is often a loss of confidence, resulting indecreased mobility and further deconditioning, whichputs the patient at a higher risk of falls and thereforein need of more care (Street et al 2006).Physiotherapists use objective measures as part of therehabilitation programme, and play a key role in

preventing falls in the elderly (Scott et al, 2007; Bogle-Thorbahn & Newton, 1996). When a persons risk offalling is assessed and appropriate action taken, fallsare reduced by 50% (AGILE, 2006). Physiotherapyaims to screen people and give necessary treatmentbefore a fall becomes a reality. Currently there is nodata that informs what measures are used, and why,by physiotherapists and therefore, best evidencebased practice is limited (Scott et al, 2007).

Literature reviewFigure one highlights the key words and databases

used by the author. The literature found no previoussurveys identifying which objective measures are usedin the rehabilitation of the older person. Based onthis, the author chose to highlight the objective

A Survey to investigatethe range of andindications for specificoutcome measures usedin the rehabilitation of

the older person.ProposalBy Stephanie Grace


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PLAN OF INVESTIGATION

Methodology

The study will take the form of a qualitative research

design and the project timetable is outlined in

Appendix E. A qualitative study explores the beliefs

and understanding needed to find out why the results

of research are not implemented in practice (Haines

Jones, 1994). However, this type of research is

controversial and not recognised by many members

(Denzin & Lincoln, 1998).

In addition, in qualitative research there tends to be a

lack of agreement on criteria of assessment (Pope &

Mays, 1995).

The research will be in the form of a mail survey using

questionnaires. The advantages of this method are the

low cost and elimination of bias (often as much as 75

percent) compared with interviews (Brambilla &McKinlay 1987). The disadvantages are a potentially

low response rate, the time taken to return the

questionnaire and potential bias (Harrison et al, 2002;

Siemiatycki et al, 1984).

Ethical ConsiderationsThe author will seek approval from AGILE to attendand distribute questionnaire packs at the Novemberconference in Newcastle from the committee board.

PopulationThe study will target physiotherapists in the United

Kingdom (UK) through an AGILE conference. AGILEare a clinical interest group of the CSP for therapistsworking with older people. The mission statement is,

To deliver the highest possible physiotherapy practicewith older people(AGILE, 2006)

The regions included are the UK, Wales and Scotland.The group produce a journal twice a year and holdtwo conferences annually. Inclusion and exclusioncriteria of physiotherapists are outlined in table formin Figure 2.

TOOLS OF INVESTIGATIONQuestionnaireTo collect relevant data for the research proposal, theauthor will use a questionnaire system (Appendix C).

Figure 2: Population Inclusion/Exclusion criteria


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While this is cost effective (Edwards et al, 2002; Subar

et al, 2001), some authors suggest this method hassome negative points: Lower response rates and therefore high risk of

nonresponse bias due to differential responserates in different social groups.

Lower quality response. Biased comparisons due to different quality

responses in different population subgroups(Siemiatycki et al, 1984).

The author was unsure of a number of pointsconcerning the questionnaire: What questions should be included? How long should the questionnaire be? Do I include a cover note? Will I publish a copy in a medical journal for

other physiotherapists? Do I give a financial or gift incentive? Do I include a stamped addressed envelope?

Following a literature search Figure 3 and a ThoughtShower session, it was decided on the currentquestionnaire (Appendix C).

Reliability and Validity

Response rates of a survey are very important (Smeeth& Fletcher 2002; Siemiatycki et al, 1984) a moreaccurate result is found when there is a large responsefrom the population (Edwards et al, 2002; Sahar et al,

1993). There are a number of reasons why people

dont respond to questionnaires, including time-limitations and lack of motivation (Edwards at al,2002; Smeeth & Fletcher 2002).

The type of survey questions included are open-ended (Appendix C) to facilitate open and honestanswers from the participants (Edwards et al, 2002). Inorder to fulfil the aims of the research, the questionsare clear, precise and short (Subar et al, 2001). To

minimise response bias the author has omitteddouble-barrelled questions, double negatives andloaded questions (Smeeth & Fletcher 2002). The

length of the questionnaire is two pages. Whilelength of questionnaire does have effect on responserates, quality of responses is not affected. (Iglesias &

Torgerson, 2000) The inclusion of a cover note(Appendix B) and the option of receiving the resultsof the study can increase response rates. (Edwards etal, 2002) Instructions on filling out the questionnaireare also included (Appendix D) in order to minimisemisunderstanding of the questions. Mail surveyspublished in medical journals have a high response

rate (68%) from non-physicians. The survey will beadvertised in AGILE monthly magazine for its

members. To offer any kind of incentive raises majorethical issues and involves bias. (Smeeth & Fletcher,2002) The author will include a first class stampedaddressed envelope for return of questionnaire as

Figure 3: Literature search for questionnaire.


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demonstrated selection of appropriate researchmethod and data collection strategy and identified

suitable approach for data analysis. The author hasalso demonstrated critical evaluation skills and theability to apply a problem solving approach to aresearch question.

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Brambilla, D. & McKinlay, S. (1987) A comparison ofresponses to mailed questionnaires and telephoneinterviews in a mixed mode health survey.American Journal of Epidemiology, 126 (5),pp.962-971.

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Pratrap, S. & Wentz, R. (2002) Increasing responserates to postal questionnaires: systematic review.British Medical Journal, 324, pp.1183-1185.

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Harrison, R., Holt, D. & Elton, P. (2002) Do postage-stamps increase response rates to postal surveys?A randomized controlled trial. InternationalJournal of Epidemiology, 31, pp.872-874.

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Hill, K. & Schwarz, J. (2004) Clinical perspectives-assessment and management of falls in olderpeople. Intern Medical Journal, 34, pp.557-64.

Iglesias, C. & Torgerson, D. (2000) Does length ofquestionnaire matter? A randomised trial of

response rates to a mailed questionnaire. JournalHealth Service Response Policy, 5 (4), pp.219-21.

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Gait Index: a pilot study. NeurologicalRehabilitation, 26 (8), pp.8-14.

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archiving and revisiting qualitative data.Sociology, 32, pp.733-45.

McMeeken, J., Stillman, B., Story, I. & Kent, P. (1999)The effects of knee extensor and flexor muscletraining on the timed-up-and-go test in individualswith rheumatoid arthritis. PhysiotherapyResources International, 4 (1), pp.55-67.

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Morris, R., Harwood, R., Baker, R., Sahota, O.,

Armstrong, S. & Maud, T. (2006) A comparison ofdifferent balance tests in the prediction of falls inolder women with vertebral fractures: a cohortstudy. Age and Ageing, 36, pp.78-83.

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population-based studies. Archive InternalMedicine, 149, pp.1628-33.

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the functional reach and the timed up and go testsin the Canadian study of health and aging. Journalof Gerontology Archives Biological Science, 55,pp.70-3.

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Shumway-Cook, A., Gruber, W., Baldwin, M. & Liao,S. (1997) The effect of multidimensional exerciseson balance, mobility, and fall risk in community-dwelling older adults. Physical Therapy, 77,

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D. (1984) Quality of response in differentpopulation groups in mail and telephone surveys.American journal of Epidemiology, 120 (2),pp.302-314.

Smeeth, L. & Fletcher, A. (2002) Improving theresponse rates to questionnaires. British MedicalJournal, 324, pp.1168-1169.

Steffen, T., Hacker, T. & Mollinger, L. (2002) Age- andgender-related test performance in community-dwelling elderly people: Six-Minute Walk Test,

Berg Balance Scale, Timed Up & Go Test, and gaitspeeds. Physical Therapy, 82, pp.128-37.

Stevenson, T. (2001) Detecting change in patients withstroke using the Berg Balance Scale. AustralianJournal of Physiotherapy, 47, pp.29-38.

Street, A., Hill, K., Sussex, M., Warners, M. & Scully, M.(2006) Haemophilia and aging. Haemophilia, 12(3), pp.8-12.

Subar, A., Zieglar, R., Thompson, F., Johnson, C.,Weissfeld, J., Reding, D., Kavounis, K. & Hayes, R.(2001) Is shorter always better? Relativeimportance of Questionnaire length and cognitive

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Thapa, P., Gideon, P., Brockman, K., Fought, R. & Ray,W. Clinical and biomechanical measures ofbalance as fall predictors in ambulatory nursinghome residents. Journal Gerontology ArchivesBiological Science Medical Science, 51, pp.239-46.

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Tinetti, M. & Ginter, S. (1988) Identifying mobility

dysfunctions in elderly patients: standardneuromuscular examination or direct assessment?Journal of American Medical Archives, 259,pp.1190-3.


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BergBalance

SupportiveHousing

Toe

xaminestatic

>60yearsofage

Highinter-/intrarater

Asanindicatorof

Lim

itedevidenceof

Scale

Community(265)

and

dynamicbalance

andpoststroke

reliability.

balance.

clinicalmeaningful

(113)

cont

rol.

andposthip

Sensitivityto

ch

ange.Changes

Long-termc

are

fracture.

fallsmoderate.

in

scoreswith

setting(60)

interventionstudies.

Dynamic

Gait

99Community

Measurebalance

Olderadultsand

Highinteran

d

Validasan

No

formalstudies.

Index

impairmentthrough

patientswith

intraraterreli

ability

indicatorofgait

Ch

angesin

mod

ificationofgait

vestibular

fortotalscore.

adaptability.

responseto

duringtask

disorders.

Lackofevide

nce

Canpredictthe

intervention.

commands.

forindividualitems.

riskoffalling.

TimedUp

Community(1135)

Testsbasic

Frailolderpeople

Highinteran

d

Validasan

No

evidenceof

andGo

Long-termc

are

mob

ilityof

andcommunity

intrarelaterre

liability.

indicatorof

clinicalmeaningful

(TUG)

setting(323)

elderlypatients.

dwellingadults.

balanceandlower

ch

ange.

Rise

froma

Patientswith

extremityfunction.

standardarm

stroke,Arthritis,

Highsensitivity

chair,walk

andVertigo.

andspecificity

3metres,turn,

predictfalls.

walk

backto

chair,situsing

regu

larfootwear

and

walkingaid.

Tinetti

Community(225)

Measuresbalance

OlderAdults

Moderateinterrater

Validasan

No

evidenceof

Performa

nce

Long-term

and

Gaitin

bothfrailand

reliabilityfor

the

indicatorof

clinicalmeaningful

Orientate

d

caresetting

olde

rpersons

community

balancecomponent.

balanceand

ch

ange.

Mobility

(118)

throughbalance

dwelling.

function.Can

Assessme

nt

and

Gaittasks.

predictifpatients

(POMA)

willbenefitfrom

intervention.

Appendix

A:SummaryofLiterature

Responsiveness

Validity

Reliability

Validatedpopulations

Time foradministration

Method ofadministration

Content

Sample size &Population

Measure/Scale


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Appendix B: Cover Letter for Questionnaires

School of Health Studies,University of Bradford25 Trinity Rd.BradfordUnited Kingdom

BD5 OBB

Tel. +44 01274 236367Fax. +44 01274 236302

1 November 2007

To Whom It May Concern,

You will find enclosed a questionnaire concerning older people and assessment tools. Thepurpose of this questionnaire is to address the attitudes and beliefs held by physiotherapistsin this specific client group with reference to assessment tools.

The changing face of physiotherapy now requires a more evidence-based practice. With thisin mind, there is a need to identify current reasoning behind the choice of assessment tool.

The Author of this Qualitative study will identify common themes from the data collected.This information will then go on to inform a Quantitative study in the future.

This study heavily relies in your participation in the form of filling out the questionnaire. The

information will be to advise physiotherapy in the future of best practice.

Thanking You,

Stephanie GracePhysiotherapist


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Appendix C: Questionnaire for population.

Questionnaire CODE 001

This questionnaire is part of an audit to assess what assessment tools physiotherapists use and why. Theinformation you give on this page will inform evidence-based practice and a further study of an assessment

tool. Please fill in thoroughly and carefully in black ink pen and capital letters.

Position held:

Trust:

Department:

1. Do you use an assessment tool/objective measure in the treatment of your patient group? (Circle answer)

YES NO

If NO, Why? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. If the answer to question one is yes, what tool(s) do you use?

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. Why do you use this tool(s)?

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. What are the Advantages/Disadvantages in using this particular type of tool(s)?

Advantages Disadvantages

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. How often do you use this tool(s)?

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. How can this tool(s) be improved?

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Does this tool(s) inform your practice?

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Appendix D: Additional Information on Questionnaire Code 001

Question 1May include the following assessment tools: Berg Balance Scale TUG test Dynamic Gait index

Gait velocity Physical Performance test Timed chair stand Tinetti performance orientated mobility

You may answer No if you are not aware of or do not use any Tools/Measurements in the rehabilitation ofthe older person. You must say why.

Question 2Outline what tool(s) you use in the rehabilitation of the older person.

Question 3

This may be because you find one tool easier to use or understand compared with another. The tool mayalso yield better results or you may simply not know any other tools.

Question 4More specific reasons for using the tool.

Question 5For example is the tool used: Each separate treatment session Admission and discharge only Once only Other

Question 6 Can the tool(s) be improved? How, what are the limiting factors? Are the tool(s) only suited to a particular patient or environment?

Question 7Does the tool(s) add to your treatment and assessment?

Question 8 If so, Why? If not, why havent you?

Question 9 Do you use the tool in accordance with the specific guidelines or do you adapt it to suit you and your

patients?

Question 10 Do you record fully and clearly how the testing of the tool was carried out? Including equipment and patient compliance on the day.


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AGILEPHYSIOTHERAPY WITH OLDER PEOPLE

Members Application Form (1st

January 2009 31st

December 2009)A form should be completed annually and sent with the membership fee to ensure that details are up to date

PLEASE COMPLETE ALL APPROPRIATE FIELDS

CSP No. AGILE No.

Title First Name Surname

Group Name (where applicable)

E-mail addressFor distribution of information

Preferred Mailing Address including postcode

New Member Membership Renewal Lapsed Member Honorary Member

REGIONAL GROUP

North West East

Northern Ireland Wales Scotland* Overseas Members please choose a region for regular updates on activities Overseas *

AREA OF WORK (CHOOSE MORE THAN ONE IF APPROPRIATE)

Community Hospital Wards Intermediate Care

Outpatients / Day Hospital Care Home Hospice / Respite

Education Research Retired

AREA OF INTEREST(S)

GRADE

AfC Band / Whitley Grade

Role

Student Other (please state)

MEMBERSHIP FEES

Group 30 Individual 25 Associate 25 Assistant / Student 5

Cheques should be made payable to AGILE and sent with this application form toJulie George, Project Manager-Flexible Workforce, Workforce Planning, NHS Eastern &

Coastal Kent, Brook House, John Wilson Business Park, Reeves Way, Chestfield, CT53DD

Cheque

Enclosed

If you have problems paying by cheque please contact the national treasurer

OFFICE USE ONLY

Membership Secretary National Treasurer

Stage Form sent to Membership Sec. Payment Processed

Date

Initials

DATA PROTECTION ACTMembers details are held on a computer database. Questionnaires may be sent by students undertaking dissertations this will be

via the membership secretary. The database address list may also be provided to a third party if the National Executive believe itwould be beneficial to members interest in older people Please write to the membership secretary if you do not want your details

Agile Journal 2008 Autumn

Documents

Transcript of Agile Journal 2008 Autumn