Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Debra Stern

Date of original Performance / Presentation

January 2023

Publication Date / Copyright Date

1-1-2023

Abstract

Background There is an increased risk of falls with advancing age. Individuals aged 65 and older represent the fastest growing population segment in much of the world. The United States Census Bureau predicts that by the year 2030 one out of five Americans will be at least 65 years old. Therefore, over the next 20 years the number of falls affecting this population and their related costs are expected to continue to rise exponentially. It is the physical therapist’s responsibility and duty to reduce fall risk and fall related injuries when presented with the opportunity as in home care. Purposes To determine: 1) the clinical reasoning and other factors that influence decision-making of home care physical therapists in selection and use of fall assessment/screening tools when providing care to individual patients, and 2) how clinical reasoning and other factors are integrated into patient management once risk is identified. Methods This was an exploratory two-phase research study. Phase 1 included semi-structured interviews of five home care physical therapy experts. Phase 2 included a 40-question internet-based survey with two case studies to collect data from home care physical therapists. Results: A total of 179 responses were analyzed. Participants were given a choice of thirteen of the most common balance and fall assessment measures. The Timed Up and Go Test (TUG) was the most selected measure followed by the Berg Balance Scale (BERG), and Single Leg Stance measure (SLS). Specific prompts to warrant fall and balance screening included a history of falls (10.45%), a reported fear of falling (9.49%), general history (8.92%), and age (8.66%). Respondents’ utilization of current guidelines of fall CPGs (37.85%) and the STEADI program (20.9%) were exceptionally low. Conclusions: Identifying the factors, including the physical therapist's education, background, clinical experience and patient characteristics, which influence the selection and utilization of fall and balance assessment tools by the physical therapist and the decision to implement an appropriate plan of care are of paramount importance. The analysis and interpretation of these factors should provide a framework for physical therapy clinicians to utilize to improve current best practice.

Disciplines

Physical Therapy

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