A Knowledge Translation Framework for Optimizing Physical Therapy in Patients With Heart Failure

Frontloading Home Physical Therapy Visits for Patients With Heart Failure: A Multi-center Randomized Controlled Trial

Frontloading home care visits has been found to be effective in the nursing profession but has not been investigated in physical therapy (PT) practice. This study aimed to examine the impact of frontloading home PT visits on function in persons with heart failure (HF). This was a prospective multi-center randomized controlled trial with blinded raters. A total of 82 ambulatory patients with a primary diagnosis of HF discharged from an acute care facility to home care participated in the study. Subjects were randomly allocated to an experimental frontloaded group (FLG) or control group (CG) for 4 weeks. FLG visit frequencies were five sessions per week for 2 weeks, and three sessions per week for 2 weeks. The CG received two sessions per week for 4 weeks. Functional measures including the 2-minute step test (2MST), 2-minute walk test (2MWT), gait speed (GS), Timed Up and Go (TUG), and 30-second chair rise test (30-CRT) were collected at the onset of care, at the end of 2 weeks and 4 weeks. The groups were statistically similar at baseline for all measures. All subjects significantly improved scores in all functional measures over time, within-subject main effect (p < .01). Significant between-subject effects were noted for 30-CRT (p = .04). Interaction effects were noted for GS (p = .03) and TUG test (p = .02). This is the first study to report meaningful improvements in function in individuals with HF. Significant treatment effect differences between the FLG and CG were found for GS, TUG, and 30-CRT. Future studies should examine the use of a standardized intervention to validate the effectiveness of frontloading home visits on quality of life and readmission rates.

Incorporating Physical Activity Assessments and Behavior Change Techniques Into Geriatrics

Ninety-one percent of adults 65 years and older do not perform the recommended levels of physical activity (PA), resulting in increased risk of disability, morbidity, and mortality. Despite knowing the benefits of PA and acknowledging the importance of assessing and addressing inadequate PA levels, 50%-75% of health care providers do not incorporate behavior change techniques into clinical practice. This clinical gap can be explained by a lack of knowledge or confidence in (1) assessing PA levels; (2) addressing inadequate PA levels; and (3) justifying the time needed to use these techniques in clinical practice. In this special communication, we address this gap by providing a 3-step theoretical-based clinical decision pathway that guides health care providers on how to identify older adults with inadequate PA levels, determine readiness to increase PA, and empower patents to develop an action plan that will increase their PA levels. We also provide a conceptual model that supports the use of techniques that assess and address inadequate PA by tying PA to the Age-Friendly Health System's 4Ms (ie, What Matters to the older adult, Mentation, Mobility, and Medications).

A health and lifestyle framework: An evidence-informed basis for contemporary physical therapist clinical practice guidelines with special reference to individuals with heart failure

BACKGROUND AND PURPOSE

This study proposes contemporary physical therapist clinical practice guidelines (CPGs) with special reference to heart failure (HF) be grounded in an evidence-informed integrative health and lifestyle framework to not only better reflect the totality and weighting of the literature, but also in the interest of superior patient, clinical, and economic outcomes.

METHODS

As an illustration, a health and lifestyle framework is described to underpin, thereby complement, recently published physical therapist CPGs for individuals with HF.

RESULTS

The case for the framework, an alternative to a single-disease biomedical perspective, is consistent with 21st century professional and epidemiologic indicators. Four themes that emerged from the HF CPGs and further support such a framework, emerged that is, limitations of conventionally constructed CPGs; physical therapists' scope of practice as "health" professionals; "best" practice in an era of NCDs including HF; and superior economic benefit.

DISCUSSION

A health and lifestyle framework underpinning contemporary physical therapist CPGs will enable clinicians to better appreciate the power of lifestyle change in maximizing the health of the heart, its healing and repair, and in mitigating and reversing signs and symptoms of cardiac dysfunction. Further, a focus on health and lifestyle will augment the benefits of the core, evidence-based, key action statements related to exercise in the HF CPGs.

Using knowledge translation to establish a model of hospital-based early supported community reintegration for stroke patients in South Korea

Background

In 2019, the South Korean government started designating rehabilitation medical institutions to facilitate the early return of patients with stroke (PWS) to their communities after discharge. However, a detailed operating model has not yet been suggested. We aimed to develop a hospital-based early supported community reintegration model for PWS that is suitable for South Korea based on knowledge translation in cooperation with clinical experts and PWS.

Methods

Clinical experts (n = 13) and PWS (n = 20) collaboratively participated in the process of developing the early supported community reintegration model at a national hospital in South Korea, using the following phases of the knowledge-to-action cycle: (1) identifying knowledge, (2) adapting the knowledge to the local situation, (3) assessing barriers and facilitators to local use of knowledge, and (4) tailoring and developing the program. Barriers and facilitators to local use of knowledge were assessed multidimensionally at the individual, interpersonal, organizational, and community level based on the social-ecological model. Literature reviews, workshops, individual and group interviews, and group meetings using nominal group technique were conducted in each phase of the knowledge-to-action cycle.

Results

Each phase of the knowledge-to-action cycle for developing the early supported community reintegration model and a newly developed model including the following components were reported: (1) revision of strategies of organizations related to community reintegration support, (2) establishment of a multidepartmental and multidisciplinary community reintegration support system, (3) standardization of patient-centered multidisciplinary goal setting, (4) multidimensional classification of community reintegration support areas, and (5) development of guidelines for a tailored community reintegration support program.

Conclusions

We designed a hospital-based multidimensional and multidisciplinary early supported community reintegration model that comprehensively included several elements of community rehabilitation in connection with hospitals and communities, taking into account the South Korean situation of lacking community rehabilitation infrastructure. In developing a guideline for a tailored community reintegration support program, we attempted to take into consideration various situations faced by PWS in South Korea, which is in a transitional stage for community rehabilitation. It is expected that this early supported community reintegration model can be referenced in other countries that are in a transitional stage of community rehabilitation.