Reach Out!
Step Up Your Community Outreach Efforts.
By Carole Lewis, PT, DPT, GCS, GTC, MPA, MSG, FSOAE, PhD, FAPTA*
“Why do people get total knee replacements?” “Because they have fractured kneecaps.” Or “What is a good exercise for the quadriceps?” “A great exercise for your quads is standing up and bringing your knee up toward your hip.” We know there isn’t a therapist reading this who would give these answers. But I recently attended a presentation sponsored by a nationally known and very well-respected hospital chain in which an exercise physiologist, who works in a cardiac rehab unit, addressed a group of older adults on the topic “A Better Body at Any Age.” The outline was as follows:
1. What happens to our bodies as we age?
2. Exercise is the most effective medicine that can be prescribed.
3. What are the major components of a balanced exercise program?
4.What are the risks of a sedentary lifestyle and sitting time?
5. Barriers/setbacks: how to overcome and find motivation to exercise.
In the 50 minutes that followed, the exercise physiologist vaguely covered these topics and never referenced a single research study to support her “facts.” At the end, she fielded questions for 10 minutes, generally providing incorrect information to the participants and never once deferring to actual experts when the questions were outside her area of expertise.
This is a travesty and it has been going on for too long. Enough is enough. We are not fulfilling our community outreach role and therefore others who do not have adequate training are filling the void. Because we’ve been careless/inattentive/neglectful (choose one) in our commitment to proving and promoting our worth, hospitals and rehab centers across the country have quietly been replacing physical therapists (PTs) with exercise physiologists and rehab techs. PTs and occupational therapists (OTs) are far more qualified than our more economical replacements, but not innovating, not practicing at the top of our license, and not reaching out to the community have made our situation precarious.
In 2004, Dale Avers made a motion to the American Physical Therapy Association’s Section on Geriatrics to take steps to make physical therapists the exercise experts for older adults. I was on that task force. Many goals evolved, most notably the development of a certification to help therapists become exercise experts. Many have received that certification and we applaud this success; however, more must be done.
Because of the strides made in educating therapists about exercise and aging, we believe the focus must now shift to (1) the development of an easy to use, predictive, and normed screening tool for our clients/patients who are 50 years old and older, (2) understanding ways to motivate older persons to exercise not just aerobically, but also in ways that will improve their quality of life and reduce their risk of falls, (3) learning techniques for presenting information and advice in the community, and most importantly, (4) figuring out ways to gain support for annual physical therapy checkups from medical venues and community centers.
To that end, the Moving Target Screen (MTS) was created. The MTS is a performance-based functional assessment tool for 50-plus adults designed to be used by physical therapists to evaluate the key aspects of fitness central to optimal aging: posture, flexibility, balance, endurance, and strength. The tool is available for free along with a YouTube video demonstrating its use. Check it out at www.movingtargetscreen.com.
The Moving Target Screen has 15 items and can be completed by a physical therapist in as little as 30 minutes. The components of the Moving Target Screen and how they are measured are as follows:
1. Posture: Wall Occiput Distance and Ribs to Iliac Crest
2. Flexibility: Ankle Dorsiflexion and Back Scratch
3. Balance: Vestibular Hypofunction, One-Leg Stand, Timed Up and Go, Tandem Walk
4. Endurance: The 2-Minute Step Test
5. Strength: Grip, Shoulder Rotators, Plantarflexors, Sit to Stand, Abdominals, Back Extensors
These measures were selected because all of them have predictive analytics that impact function, and most of them include normative data as well. All of them are based on research.
Prior to launching the Moving Target Screen, beta tests were conducted with both therapists and physicians. My favorite feedback was from the group of geriatricians. One physician raised her hand and said, “I love this. Just like I order blood work, I can order the MTS for each annual visit. This will provide me with vital information on my patient’s functional status.”
I am not saying that therapists must use this tool, but I am saying we need to do something. I don’t want to see us using non-evidence-based tools or measuring impairments that have no direct effect on function. Feel free to use this screen or develop your own, but get out there and use evidence that is specific to our expertise.
Carole Lewis, PT, DPT, GCS, GTC, MPA, MSG, FSOAE, PhD, FAPTA, is a PPS member and president of GREAT Seminars and Books and Great Seminars Online. She can be reached at clewis@greatseminarsonline.com.