Are physical intervention techniques likely to cause pain or injury when applied to manage the severely aggressive older adult? A survey of physiotherapist’s expert views in the UK

Abstract

To establish whether a professional consensus can be established amongst musculoskeletal physiotherapists or whether they believe certain physical intervention techniques would cause pain or injury if applied to an older adult. Physiotherapist involvement in the context of a multidisciplinary team framework to develop adaptive techniques as required for complex physical presentations has resulted in lower injury rates than in working-age adults. Physiotherapists are experts in anatomy and human movement and are ideally placed to contribute to the safe application of physical intervention in older adults. A survey design was used. A questionnaire was developed and tested to ascertain the physiotherapist's opinions of the likelihood of each technique causing the patient pain and/or injury. The lead author distributed 41 questionnaires to physiotherapists in two busy hospitals in the UK. Thirty-four (83%) of physiotherapists returned the completed questionnaires. The physiotherapists had particular concerns about the use of wrist flexion and kneeling on the older adult in prone causing pain and/or injury. Some other techniques that we have advocated in our earlier research were approved by many of the respondents, e.g. supporting the forearm with both hands proximal to the wrist joint. None of the physiotherapists had attended a physical intervention course or applied it in the clinical setting, thus enabling them to analyse the techniques purely from a biomechanical movement perspective. Implications for nursing practice are discussed. It is anticipated that this research will stimulate nurses and course providers to develop patient group-specific physical intervention techniques and thus reduce the risk of causing them pain and/or injury. This study reaffirms the heightened risks associated with applying restraint techniques to older adults. An issue that needs to be addressed is whether the duty of care which is explicit and implicit within the relationship between nurse and patient is to be fully discharged. It also reinforces prior research that has called for patient-specific physical intervention techniques and highlights some commonly used techniques that may have a deleterious effect on aggressive older adults. It also identifies the professional support that physiotherapists can offer to teams implementing physical intervention techniques within the context of clinical practice.