Citation

Haas R, Maloney S, Pausenberger E, Keating JL, Sims J, Molloy E, Jolly B, Morgan P, Haines T. Phys. Ther. 2012; 92(5): 666-679.

Affiliation

R. Haas, Allied Health Research Unit, Kingston Centre, Southern Health, Victoria, Australia.

Copyright

(Copyright © 2012, American Physical Therapy Association)

DOI

10.2522/ptj.20110130

PMID

22228609

Abstract

Background: Physical therapists often prescribe exercises for falls prevention. Understanding the factors influencing the clinical decision-making process behind this employed by expert physical therapists working in specialist falls and balance clinics may assist other therapists to prescribe exercises for falls prevention with greater efficacy. Objective: To describe the factors influencing the clinical decision-making process used by expert physical therapists to prescribe exercises for falls prevention.DesignQualitative study from a phenomenological perspective. METHODS: Semi-structured telephone interviews were conducted with n=24 expert physical therapists recruited primarily from the Victorian Falls Clinic Coalition. Interviews occurred across three exercise prescription contexts; face-to-face individual therapy, group exercise and home exercise programs. Interviews elicited therapist practices and therapist, patient and environmental factors influencing the clinical decision-making processes around selection of exercise setting, type, dosage (intensity, quantity, rest periods, duration, frequency) and progression. Strategies for promoting adherence and safety were also discussed. Data were analysed using a framework approach by three investigators. RESULTS: Participants described highly individualised exercise prescription approaches tailored to meet key findings from physical assessment. Dissonance was evident between prescribing a program that was theoretically correct according to physiological considerations and one that a client would adhere to. Safety considerations were also highly influential on prescription of exercise type and setting. Terminology for describing the intensity of balance exercises was vague relative to terminology for describing intensity of strength exercises. CONCLUSIONS: Expert falls prevention physical therapists adopt an individualised approach to exercise prescription, imbedded in physical assessment findings in preference to using "off the shelf" exercise programs commonly used in falls prevention research. Training programs for those who prescribe exercises for older adults at risk of falling should encompass these findings.

Language: en