Rehab & Wellness: Creating an Innovative, Evidence-Based, … · 2019. 12. 18. · volunteer basis;...
Transcript of Rehab & Wellness: Creating an Innovative, Evidence-Based, … · 2019. 12. 18. · volunteer basis;...
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Rehab & Wellness:Creating an Innovative, Evidence-Based, Person-Centered
Wellness Model of Care Beyond TherapyCasey Shotts, PT, DPT, Senior Rehab Solutions, Dallas, TX
Julie Kirkwood, PT, Midland PACE, Topeka, KS Heidi Pickerell, Midland PACE, Topeka, KS
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Overview
SRS & Midland PACE - how it all started
Rehab-Driven Wellness Model ApproachSenior Fitness Testing – 0-6 risk factors identifiedDetermine appropriate movement through rehab continuum/tracksTargeted wellness initiatives based on SFT outcomesOvercoming challenges, obstacles; enhancing participant engagement and satisfaction; scheduling
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Zoom Login Instructions
Join polling via smart phoneDownload the free Zoom Cloud Meetings appGo to Join a MeetingEnter Meeting ID 184-143-560Join options – Don’t connect to audio; Turn off my videoEnter your name or nicknameAnswer polling questions when prompted
First round of Zoom Polling Introductions – Let’s Go!
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Senior Fitness Test
Adults 60-90+ with broad range of abilitiesFocus on function – tests physical capacity to perform normal everyday activities safelySimple and economical; minimal equipmentComprehensive with normative valuesGood test-retest reliabilityCriterion-referenced test – predetermined standard of performance tied to physical independence
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Senior Fitness Test Items
Test Purpose Functional Risk Areas30 Second Sit to Stand LE strength Transfers, Toileting, GaitArm Curl Test UE strength UB dressing, grooming,
hygiene; lifting/carrying6 minute walk test or 2 minute step test
Aerobic endurance Gait, endurance for prolonged tasks
8 Foot Up & Go Gait speed, agility, balance
Gait, standing balance, transfers
Chair sit and reach LE Flexibility LB dressing, functional reaching
Back Scratch test UE Flexibility UB dressing, toileting hygiene, home skills
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SFT Normal Ranges - Women
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SFT Normal Ranges - Men
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Zoom Polling Senior Fitness Test
Join polling via smart phoneDownload the free Zoom Cloud Meetings appGo to Join a MeetingEnter Meeting ID 184-143-560Join options – Don’t connect to audio; Turn off my videoEnter your name or nicknameAnswer polling questions when prompted
30 Second Sit to Stand – Ready, Set, GO!
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Rehab-Driven Wellness Model
• SFT data collection launched December 2017 on volunteer basis; ppt retested every 3 months
• New enrollment baseline assessments added June 2018 – new ppts tested during 1st month on PACE
• Use SFT data & PT/OT clinical judgment to determine appropriate rehab continuum track
• Use SFT data, outcome trending, PT/OT clinical judgment to modify programs and select targeted exercises for specificity
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Rehab Continuum Tracks
• Continuous, multi-directional movement b/w tracks as needed & clinically appropriate
• Clinical judgement, IDT, and SFT assist with appropriate tier level
Skilled Rehab
WellnessIndependent
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Skilled Rehab Track
Based on individual needs & change in condition –primary goal to improve functionAutomatic inclusion criteria > 4 SFT risk items identifiedNew or worsening SFT risk items triggeredSkilled level of care focused on addressing underlying impairments impacting functional abilities – PT, OT, ST 1:1 services
Skilled Rehab
WellnessIndependent
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Wellness Track
Primary goal to maintain level of function; prevent decline when ableInclusion criteria </= 4 SFT risk items identifiedFocus on health promotion & education; engagement Group and individual exercise programmingOversight & training provided by PT/OT; carried out by trained team member –Wellness Technician
Skilled Rehab
WellnessIndependent
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Independent Track
Future initiative – goal of ppt ownership & adoption of Wellness for quality of lifeHigh focus on ppt/caregiver training and educationUse satisfaction surveys and ppt report to create programs of interestEngagement & compliance are challenges
Skilled Rehab
WellnessIndependent
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Zoom Polling SFT Trends
Join polling via smart phoneDownload the free Zoom Cloud Meetings appGo to Join a MeetingEnter Meeting ID 184-143-560Join options – Don’t connect to audio; Turn off my videoEnter your name or nicknameAnswer polling questions when prompted
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SFT Initial Findings & Plan
Initial score findings (Volunteer round 1 and new ppt)• Scores in normal range for Arm Curl Test and Chair
Sit & Reach• Low physical functioning scores for: 30SST, 6MWT,
Back Scratch, 8 Foot Up & GooWellness exercise specificity for 30SST while also
addressing individual risk areas with each pptoSkilled OT focus on Back Scratch test when this item
was triggered and OT interventions deemed appropriate
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Exercise Specificity
• Principle of specificity predicts that the closer the training routine is to the requirements of the desired outcome (i.e. a specific exercise task or performance criteria), the better will be the outcome
• Wellness exercises specific to 30 SST with anticipation of strength adaptations impacting other components of SFT
• Weekly meeting with Wellness Technician to review weekly trends, barriers, ppt response to targeted exercises
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30-Second Chair Stand - Women
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30-Second Chair Stand - Men
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Exercises for 30 Second Sit to Stand
TARGETED EXERCISES GENERAL EXERCISES
Eccentric Chair SquatsUE Assisted Chair StandsChair Stand Speed DrillsChair Squats with Forward ReachEyes Open/Eyes ClosedCompliant SurfacesUnilateral Chair Squats with/without UEChair Squats with Free Weights
Seated/Standing MarchingResistance Ball SqueezesResistance bands for ABD/ADD Resistance bands ham curlsLungesWall SitsAnkle weight resisted LAQHeel Raises/Toe Taps
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SFT Retest Findings & Plan
• Improvements noted round 2 (3 months after initial) of testing but then plateau with round 3 &4
• Improved initial vs. round 2 30SST scores & 6MWT scores – correlation?
• Decline 6MWT round 3, 4 or refusal to completeo Plan - Replace 6MWT with 2MSTo Better ppt response to 2MST; scores = low functioning
• Arm Curl Test decline initial vs. round 2 – possibly related to LE strength focus and UE ROM focus?o Plan - Increase UE resistance training; no change noted yet
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30-Second Arm Curl - Women
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30-Second Arm Curl - Men
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Exercises for Arm Curl Test
TARGETED EXERCISES GENERAL EXERCISESSingle/Double Arm CurlsSingle/Double Hammer CurlsAlternating CurlsIsometric HoldsEccentric Curls
Boxing with or without dumbbellsWall push upsResistance band rows, lat pull downsTriceps kickbacksUpright rowOverhead pressFunctional tasks – carrying large items, bags, etc.
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Lessons & Challenges
• SRS learning PACE• Volunteer vs. Enrollment standard• Day Center challenges• Ppt satisfaction/engagement
o 6MWT vs. 2MSTo Pedometerso Competition, games, prizes, FOOD
• Data collectiono Flexibility testing o Behavioral?o Non-ambulatory options
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Future Wellness Opportunities
• Possible assessment additions/modificationso Non-ambulatory testingo Quality of Life and depression scaleso Cognition, memoryo Fall risk assessment o New test entirely?
• Routine survey and polling for satisfaction & engagement – working well with CCRC campuses
• Increase service offerings for health promotion and education – monthly topics/challenges (mirror current programming in CCRC campuses?)
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Zoom Polling Conclusion
Join polling via smart phoneDownload the free Zoom Cloud Meetings appGo to Join a MeetingEnter Meeting ID 184-143-560Join options – Don’t connect to audio; Turn off my videoEnter your name or nicknameAnswer polling questions when prompted
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Thank You!
• Questions? Please contact:
Casey Shotts, PT, DPT Clinical Support SpecialistSenior Rehab [email protected]
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References
• Reliability of the Senior Fitness Test in Community‐dwelling Older People with Cognitive Impairment Karin Hesseberg Hege Bentzen Astrid Bergland13 June 2014; https://doi.org/10.1002/pri.1594
• The Intensity and Effects of Strength Training in the Elderly Frank Mayer, Friederike Scharhag-Rosenberger, Anja Carlsohn, Michael Cassel, Steffen Müller, Jürgen Scharhag; Deutsches Ärzteblatt International | Dtsch Arztebl Int 2011; 108(21): 359–64
• Steib S, Schoene D, Pfeifer K: Dose-response relationship of resistance training in older adults: a meta-analysis. Med SciSports Exercise 2010; 42: 902–14.
• Orr R, Raymond J, Fiatarone Singh M: Efficacy of progressive resistance training on balance performance in older adults. A systematic review of randomized controlled trials. Sports Med 2008; 38: 317–43.
• Jordan M. Glenn, Michelle Gray and Ashley Binns, Relationship of Sit-to-Stand Lower-Body Power With Functional Fitness Measures Among Older Adults With and Without Sarcopenia, Journal of Geriatric Physical Therapy, 40, 1, (42), (2017).
• Megan D Salvatore, Alexandra M Colacino, Meghan E Hess, Samuel W Todd and Nathan W Saunders, Concurrent validity and minimum detectable change of Senior Fitness Test components: instrumented vs. manual assessment, Physical Therapy and Rehabilitation, 4, 1, (13), (2017).