ABSTRACT SUBMISSION EXAMPLES APTA'S Combined Sections

Research Report

TITLE: Physical Therapy for People Living with HIV/AIDS: A Needs Assessment

Purpose/Hypothesis : The past three decades have shown significant medical advancements in the

treatment of the Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immunodeficiency

Syndrome (AIDS), with normal life expectancies seen for people living with HIV/AIDS (PLWHA) who have

access to proper medical management. This increased chronicity has increased the symptom burden of

musculoskeletal, neurologic and chronic pain conditions for PLWHA during their lifespan - many of which can

be treated with physical therapy (PT). The purpose of this study is to determine the knowledge and beliefs of

PTs regarding occupational exposure, pathophysiology and physical therapy treatment for PLWHA.

Number of Subjects : 129

Materials/Methods : One hundred twenty-nine licensed physical therapists were surveyed in the Atlanta area

to identify overall knowledge of HIV/AIDS, the perception of PT needs in PLHWA, views on the effectiveness

of PT interventions for HIV-related impairments and training needs of PTs to best care for PLHWA. One

hundred and twenty nine original surveys were administered to licensed physical therapists working at the five

major hospital systems in metropolitan Atlanta, Georgia, USA.

Results : The results of this study showed that the majority of respondents do encounter PLWHA in their

physical therapy practices. Most PTs viewed physical therapy as an effective adjunct therapy for HIV/AIDS

related impairments and felt comfortable treating common HIV-related impairments of muscle

wasting/deconditioning, peripheral neuropathy, and chronic pain. While most PTs self-identified their basic

knowledge of HIV/AIDS related impairments as “competent,” less than half of the respondents were able to

correctly identify the four transmission routes for HIV. Finally, most PTs indicated that they would like to have

additional training in some form to make them more comfortable providing physical therapy treatment for HIV-

related impairments in PLWHA.

Conclusions : This study further confirms the need for PTs to better understand occupational HIV exposure

risk and pathophysiology of HIV/AIDS. It also confirms the need for training of PTs in PT interventions for

PLWHA. The sample was limited to PTs in Atlanta, Georgia USA and therefore can only be generalized to this

demographic.

Clinical Relevance : As HIV becomes a chronic instead of immediately terminal condition, HIV-related

musculoskeletal, neurological and chronic pain issues contribute to the symptom burden experienced by

PLWHA. As PT becomes more necessary in the overall medical management of this population, it is essential

that PTs hold accurate information about HIV pathophysiology and proper interventions to manage these

impairments.

ABSTRACT SUBMISSION

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APTA’S Combined Sections

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abstract submissions for either a poster or a

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American Physical Therapy Association / 2

References (At Least 5 Within The Last 10 Years)

1. Centers for Disease Control and Prevention. HIV Among African Americans. Centers for Disease Control

and Prevention: Department of Health and Human Services.

http://www.cdc.gov/hiv/risk/racialethnic/aa/facts/index.html. Published February 2013. Accessed October 6,

2013.

2. Centers for Disease Control and Prevention. HIV among Latinos. Centers for Disease Control and

Prevention: Department of Health and Human Services. http://www.cdc.gov/hiv/pdf/risk_latino.pdf. Published

November 2011. Accessed October 6, 2013.

3. Centers for Disease Control and Prevention. HIV among Youth. Centers for Disease Control and

Prevention: Department of Health and Human Services.

http://www.cdc.gov/hiv/pdf/library_factsheet_HIV_amongYouth.pdf. Published December 2011. Accessed

October 3, 2013.

4. Centers for Disease Control and Prevention. HIV in the United States: at a glance. Centers for Disease

Control and Prevention: Department of Health and Human Services.

http://www.cdc.gov/hiv/resources/factsheets/us.htm. Published February 27, 2013. Accessed September 6,

2013.

5. Centers for Disease Control and Prevention. HIV and AIDS in the United States by Geographic Distribution.

Centers for Disease Control and Prevention: Department of Health and Human Services.

http://www.cdc.gov/hiv/pdf/statistics_geographic_distribution.pdf. Published June 2012. Accessed October 3,

2013.

Special Interest Report

TITLE: Weekly Mobility Rounds--a Patient-Focused Approach to Identifying and Decreasing Mobility Barriers

in the Cardiovascular ICU

Purpose: Early mobility in the intensive care unit (ICU) is currently recognized as optimal practice. However, it

can be challenging to implement. This abstract describes the process of implementing weekly rounds to

discuss facilitators and barriers to progressive mobilization by focusing on selected, specific patients each

week.

Description: A team of professionals interested in early mobilization was formed, including intensive care

physicians, nurses, staff and senior physical therapists, a specialist physical therapy consultant and

rehabilitation service managers in the cardiovascular ICU. Following brief education about early mobility and

the roles of various team members, a walking rounds was established. Once weekly, the team gathers to

discuss 2-3 patients selected by team members as representing challenges to mobilization. The team

discusses each patient’s current status and goals for mobility. During this discussion, many opportunities for

interprofessional education have arisen, been discussed and resolved. Examples include line placement vs.

movement of joints of body parts, skilled vs. unskilled transfers, optimizing scheduling of mobility, optimizing

nutritional status of critically ill patients, decreasing use of corticosteroids and paralytic medications, prioritizing

mobility in patients’ daily care plans, and developing behavioral approaches to patients limiting participation

due to fear or pain.

Summary of Use: After 15 months of 1-hour, weekly rounds, there is now an expectation of all ICU staff that

mobility is a goal for all patients. Staff feel free to raise issues and questions freely in the discussions without a

feeling of hierarchy or fear of having suggestions rejected. Patients are frequently observed walking in the

hallways or even being taken outdoors despite requiring life-saving equipment such as extracorporeal

membrane oxygenation (ECMO), mechanical ventilation or continuous renal replacement therapy (CRRT).

The focus on specific patients and their issues helps all staff persons feel their input is valued and translate

American Physical Therapy Association / 3

theoretical knowledge to specific interventions. Patients and families are more optimistic about recovery due to

greater levels of mobility. We aim to implement similar rounds in other ICU units in the near future, sharing our

model and outcomes.

Importance to Members: Early mobility in the critical care setting requires more than just knowledge of

physiology and medical treatments. A culture of seamless interprofessional communication and teamwork

must be developed for any plan to be successful. We have found that a minimal time commitment (1 hour per

week) can be extremely valuable to instituting and maintaining an early mobility program that is truly embraced

by all disciplines. Physical therapists are the logical champions of mobility in the critical care environment, but

must be effective interprofessional team members in leading the necessary culture change

References (At Least 5 Within The Last 10 Years)

1. Adler J, Malone D. Early mobilization in the intensive care unit: A systematic review. Cardiopulm Phys Ther

J 2012;23(1):5-13.

2. Hodgson CL, Capell E, Tipping CJ. Early mobilization of patients in intensive care: Organization,

communication and safety factors that influence translation into clinical practice. Crit Care 2018;22:77.

3. Costa DK, Whilte MR, Ginier E, et al. Identifying barriers to delivering the awakening and breathing

coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically

ventilated patients: a systematic review. Chest 2017;152:304-11.

4. Parry SM, Knight LD, Connolly B, et al. Factors influencing physical activity and rehabilitation in survivors of

critical illness: A systematic review of quantitative and qualitative studies. Intensive Care Med 2017;43:531-42.

5. Holdsworth C, Haines KJ, Francis JJ, et al. Mobilization of ventilated patients in the intensive care unit: An

elicitation study using the theory of planned behavior. J Crit Care 2015;30(6):143-1250.

Case Study Report

Title: Successful Non-Operative Management of a Collegiate Wrestler with an Acute ACL Injury

Background and Purpose: Following an ACL injury, conventional treatment for athletes is often

reconstruction; yet, current outcomes demonstrate that rates of return to prior level of play are lower than

believed.

1,2,3,4

In a study comparing immediate surgical treatment, delayed surgical treatment, or non-operative

treatment of ACL tears; no significant difference in patient reported outcomes were found.

Non-operative

management has been shown to be a viable option following a treatment algorithm. In a 10-year prospective

study of this algorithm

, athletes who met non-operative screening criteria (potential copers or PC)

demonstrated a 72% successful return to pre-injury level of sports participation.

7,8

The algorithm provides

criteria for a temporary return to sport (RTS) protocol, initially focusing on impairment resolution including full

range of motion (ROM) of the knee, >70% quad strength index (QI), trace or less effusion, pain-free hopping,

and no repairable meniscus tear. Screening includes: ≤1 episode of giving way, >80% on timed hop test,

>80% Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), and >60% Global Rating Scale

(GRS). If met, progressive physical therapy is initiated, including 10 visits of perturbation training and sports

specific skills. The purpose of this case report is to describe the successful non-operative treatment of a

collegiate wrestler using an ACL injury treatment algorithm for temporary RTS.

Case Description: A 21 y/o male collegiate wrestler sustained a complete ACL tear in pre-season. The

patient was seen for evaluation 2 weeks after his injury displaying full knee ROM, trace effusion, and QI of

92.3% (without stimulation) and 85.6% (with stimulation) via Burst Superimposition testing. Using the ACL

American Physical Therapy Association / 4

injury treatment algorithm, the patient was screened for potential temporary RTS. Results included: ≤1 episode

of giving away, hop testing LSI all >90%, KOS-ADLs 87% and GRS 95% indicating patient was a PC. The

patient began a plan of care consisting of 10 treatments of progressive perturbation training, strength training,

and sport-specific activities.

Outcomes: Throughout treatment, the patient’s knee effusion remained at trace or less without any episodes

of instability. Discharge findings included Burst testing QI of 95.5% (without stimulation) and 107.6% (with

stimulation), all hop testing LSI of > 90%, KOS-ADL 100% and GRS 90%. The patient returned to wrestling

practice 2 months after his injury, competing a few weeks later, and finishing fourth in the division III NCAA

tournament.

Discussion: After meeting screening criteria and following a progressive rehabilitation program the patient

was able to meet all functional testing criteria for return to sport and had a successful collegiate season

without any instability. The outcomes of this case report support the use of an ACL injury treatment algorithm

to guide clinical decision making for athletes with an ACL tear who want to delay surgery and return to play in

the short term.

References (At Least 5 Within The Last 10 Years)

1. Ardern, Clare L., et al. "Return to sport following anterior cruciate ligament reconstruction surgery: a

systematic review and meta-analysis of the state of play." Br J Sports Med 45.7 2011; 596-606.

2. Lynch AD, Logerstedt DS, Grindem H, et al. Consensus criteria for defining 'successful outcome' after ACL

injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med. 2013;49(5):335–342.

3. Failla MJ, Logerstedt DS, Grindem H, et al. Does Extended Preoperative Rehabilitation Influence Outcomes

2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-

Oslo ACL Cohorts. Am J Sports Med. 2016;44(10):2608–2614

4. Ardern, C. L., Taylor, N. F., Feller, J. A., & Webster, K. E. Return-to-Sport Outcomes at 2 to 7 Years After

Anterior Cruciate Ligament Reconstruction Surgery. The American Journal of Sports Medicine. 2012; 40(1),

41–48

5. Frobell RB, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate

ligament tears. N Engl J Med. 2010; 363:331-342

Theory Report

Title: A Train-the-Trainer Approach to Increasing Physical Activity for Persons with Dementia across Care

Settings

Theory/Body:

Persons with dementia (PWD) are at high risk for mobility disability and poor health due to limited physical

activity (PA). Interventions that combine exercise and behavioral management techniques are effective in

improving PA and functional mobility in PWD. In addition to cognitive impairment, barriers to increasing and

sustaining PA in PWD include comorbidities, limited access to therapy services, and reduced social support.

To address these barriers, across care settings, care staff involvement is needed. Physical therapists (PTs)

can play a vital role in promoting PA for PWD by implementing strategies that support task shifting to other

care team members. Direct care staff can be effectively trained to provide exercise and behavioral

interventions that increase PA and improve function in PWD.

American Physical Therapy Association / 5

This project, funded by the NIH National Institute of Aging (5P30AG034592-07), developed and implemented a

train-the-trainer program to deliver EM-STAR (Exercise for Mobility & Staff Training in Assisted Living

Residences) within adult day health and residential programs. EM is a dementia-specific moderate intensity

program of familiar procedural movements designed to be led by non-rehab direct care staff. STAR is a

curriculum designed to help staff improve care of PWD via behavioral management strategies.

A two-tiered program was developed. Phase 1 prepares rehab professionals as EM-STAR trainers and site

coordinators. Phase 1 rehab professional objectives: (1) demonstrate knowledge about importance of exercise

to reduce mobility disability in PWD, (2) demonstrate self-efficacy around training care staff in exercise and

behavioral strategies, (3) demonstrate proficiency in the role of site coordinator, including staff training,

participant enrollment, monitoring safety, and ensuring program fidelity. Phase 2 prepares care staff to

become exercise leaders. Phase 2 care staff objectives: (1) demonstrate knowledge about importance of

exercise to reduce mobility disability in PWD, (2) demonstrate self-efficacy around leading exercise classes

and managing challenging behaviors, (3) demonstrate competency in day-to-day management of the program

and leading group exercises.

To facilitate program development, focus groups were conducted with rehab professionals and care staff.

Resulting program materials include an EM-STAR handbook for trainers and exercise leaders, protocol cards

for EM exercises, timed music to coincide with the exercises, and a video of the EM routine to ensure training

fidelity. Rehab professionals are certified as site coordinators after they demonstrate proficiency in training and

certifying care staff as exercise leaders. Observational performance audits with a program checklist are

implemented to certify the care staff as exercise leaders. The EM-STAR program demonstrates an evidence

informed program that aims to increase PA in PWD. PTs can play a vital role in the scaling up of PA, across

care settings, through programs that involve train-the-trainer strategies designed to prepare direct care staff to

lead and sustain moderate intensity exercise programs with a high degree of safety and fidelity.

References (At Least 5 Within The Last 10 Years)

• Gitlin LN, Arthur P, Piersol C, et al. Targeting Behavioral Symptoms and Functional Decline in Dementia:

A Randomized Clinical Trial. J Am Geriatr Soc. 2018;66(2):339-345.

• Hauer K, Schwenk M, Zieschang T, Essig M, Becker C, Oster P. Physical training improves motor

performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc. 2012;60(1):8-15.

• Nyman SR, Adamczewska N, Howlett N. Systematic review of behaviour change techniques to promote

participation in physical activity among people with dementia. Br J Health Psychol. 2018;23(1):148-170.

• Schwenk M, Dutzi I, Englert S, et al. An intensive exercise program improves motor performances in

patients with dementia: translational model of geriatric rehabilitation. J Alzheimers Dis. 2014;39(3):487-498

• Spector A, Revolta C, Orrell M. The impact of staff training on staff outcomes in dementia care: a

systematic review. Int J Geriatr Psychiatry. 2016;31(11):1172-1187.

Last Updated: 06/23/2020

Contact: eventprogram@apta.org