Home Health Physical Therapy Research Articles

Using Interpersonal Continuity of Care in Home Health Physical Therapy to Reduce Hospital Readmissions

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient’s admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤ .001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions.

Impact of the Comprehensive Care for Joint Replacement Bundled Payment Model on Postoperative Utilization of Home Health and Outpatient Physical Therapy Services

ObjectiveTo study the effect of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on postoperative home health and outpatient physical therapy (PT) for total hip or knee arthroplasty (THA/TKA). DesignRetrospective cohort with national Medicare data (5% claims) using a difference-in-differences analysis comparing January 2013-September 2015 (before) versus October 2016-September 2019 (after). SettingAdministrative claims from hospitals in 34 metropolitan statistical areas with mandatory CJR participation as of 2018 and 42 control metropolitan statistical areas. ParticipantsEpisodes in fee-for-service Medicare beneficiaries (5% claims) undergoing elective THA (n=6327) or TKA (n=10,764) with community discharge. InterventionsImplementation of CJR bundled payment program. Main Outcome MeasuresHome health and outpatient PT, including any use and number of visits. ResultsProgram implementation was associated with an increased percentage of THA episodes using home health PT (+8.0 percentage-point change; 95% CI, +3.5 to +12.6; P=.001) but a decreased per-episode number of home health PT visits for THA (−1.1; 95% CI, −1.6 to −0.6; P<.001) and TKA (−1.1; 95% CI, −1.4 to −0.7; P<.001). The program was also associated with an increased per-episode number of outpatient PT visits for TKA in the primary but not sensitivity analyses (+0.8; 95% CI, +0.1 to +1.4; P=.02). ConclusionsFindings of increased home health PT may reflect an intentional shift in care from the inpatient postacute setting to the community to decrease costs. Alternatively, the limited effect of CJR, particularly on outpatient PT, could reflect challenges with care coordination in a retrospective bundle spanning multiple care settings.

Impact of Frailty on Gait Speed Improvements in Home Health after Hospital Discharge: Secondary Analysis of Two Randomized Controlled Trials.

More than half of older adults are frail or prefrail in the United States, and hospital-associated deconditioning likely increases this risk. However, the impact of frailty on potential functional improvements after hospital discharge is poorly understood. We sought to identify the influence of baseline frailty on gait speed change in older adults receiving home health physical therapy (PT) after hospital discharge. The severity of frailty was assessed using Cardiovascular Health Study frailty criteria (weakness, slowness, weight loss, physical inactivity, and exhaustion). Gait speed was measured at baseline and 60-days post-hospital discharge. Upon admission to home health rehabilitation services, half of older adults (total N=250) were considered frail, with slowness (90%) and weakness (75%) being the most common characteristics. Older adults, whether pre-frail or frail, demonstrated similar and clinically meaningful improvements in gait speed after receiving home health rehabilitation for 60 days following hospital discharge. These results suggest that clinicians caring for older adults in the hospital can counsel both pre-frail and frail patients that, with home health rehabilitation, clinically significant improvements in function can be expected over the 2 months following discharge. Furthermore, we observed encouraging gait speed improvement with physical therapy following hospitalization in older adults. Results can inform anticipatory guidance on hospital discharge.

Prevalence of cognitive impairment in home health physical therapy.

The prevalence of cognitive impairment in home health physical therapy (HHPT) is unknown. We sought to identify the prevalence of cognitive impairment, including cognitive impairment no dementia (CIND) and dementia, among older adults who used HHPT, and if cognitive impairment prevalence was higher among those with HHPT-relevant characteristics. For our cross-sectional analysis, we identified 963 fee-for-service Medicare beneficiaries with HHPT claims (>85 years old: 28.8%, women: 63.7%, non-Hispanic White: 82.1%) in the 2014 and 2016 waves of the Health and Retirement Study (HRS) and used a validated algorithm to categorize cognitive status as normal, CIND, or dementia. We estimated the population prevalence and calculated age, gender, race/ethnicity adjusted odds ratio (aOR) of CIND and dementia for characteristics relevant to HHPT service delivery including depression, walking difficulty, fall history, incontinence, moderate-vigorous physical activity (MVPA) ≤1x/week, and community-initiated HHPT using multinomial logistic regression. The population prevalence of cognitive impairment was 46.4% (CIND: 27.3%, dementia: 19.1%). The prevalence of cognitive impairment was greater among those with depression (46.7% vs. 39.5%), difficulty walking across the room (58.9% vs. 41.8%), fall history (49.1% vs. 42.9%), MVPA ≤1x/week (50.0% vs. 38.0%), and community-initiated HHPT (55.2% vs. 40.2%). Compared to normal cognitive status, the odds of cognitive impairment were greater for those with MVPA≤1x/week (CIND: aOR = 1.57 [95% CI: 1.05-2.33], dementia: aOR = 2.55 [95% CI: 1.54-4.22]), depression (dementia: aOR = 1.99 [95% CI: 1.19-3.30]), difficulty walking across the room (dementia: aOR = 2.54 [95% CI: 1.40-4.60]), fall history (dementia: aOR = 1.85 [95% CI: 1.20-2.83]), and community-initiated HHPT (dementia: aOR = 1.72 (95% CI: 1.13-2.61]). There is a high prevalence of CIND and dementia in HHPT, and no characteristics had a low prevalence of cognitive impairment. Physical therapists should be ready to identify cognitive impairment and adapt home health service delivery for this vulnerable population of older adults.

Exploring Family-Centered Care from the Perspectives of Home-Health Physical Therapists

Background and Purpose: Older adults often need caregivers to help them age in place successfully while maximizing their quality of life. These caregivers have the highest rates of burnout, injury, and turnover. Family-centered care (FCC) involves collaboration between the healthcare practitioner and the patient, family members, and caregivers. There is a paucity of evidence on how FCC is applied to older adults and their caregivers. The purpose of this general qualitative study was to explore how a group of home health physical therapists (HHPTS) deliver FCC to care-dependent older adults. Methods: This general qualitative study used individual, semi-structured interviews with a purposeful sample of 14 HHPTs working for a variety of home health agencies in San Diego County. The interview responses were hand transcribed, hand coded, thematically analyzed, and conceptualized in the International Classification of Functioning, Disability, and Health model (ICF model). The coding table and interview guide were modified based on reviews by experts in home health physical therapy. A proprietary coding software program called NVivo was used to triangulate the results. Results and Discussion: The 3 main themes that emerged were: (a) "FCC is Complex"; (b) "FCC Impacts Older Adults' Health Factors"; and (c) FCC is Impacted by Contextual Factors". Eleven subthemes also emerged. The themese and subthemes were conceptualized within the ICF Model. The first theme demonstrated that the HHPTs had a variety of understandings of, training on, and applications with FCC. The HHTP was conceptualized as an environmental factor that could impact the patient's health based on their knowledge and skills with FCC. The second theme demonstrated that FCC was utilized to address every ICF health factor by the HHPTs. This theme was conceptualized around the entire ICF Model. Neurological conditions and motivated families were seen as large factors in performing FCC. The third theme demonstrated that a wide variety of contextual factors impacted the HHPTs ability, time, and resources to perform FCC. This was conceptualized in ICF Model as personal and environmental factors that could facilitate or inhibit ("+/-") FCC approaches by the HHPTs. Conclusions: This study closed some of the gaps in the literature on how FCC is delivered to older adult clients, their caregivers, and their family members. This knowledge may help to foster changes in FCC approaches and research. Changes like these could lead to improved health outcomes for older adults through reduced hospital readmissions and improved caregiver satisfaction with care as seen in pediatrics. Key Words: Family-centered care, home health physical therapist, caregiver satisfaction, burnout, and International Classification of Functioning, Disability, and Health model.

Rare Case of Hip Pain Due to Iliopsoas Tendon Rupture; A Case Report and Review of the Literature

ObjectiveHip pain is common in patients of advanced age and has a very broad differential. Of the potential aetiologies, iliopsoas tendon ruptures are rare. Consequently, there is a paucity of literature on iliopsoas rupture in the older adult population, and its rarity can lead to a delay in its diagnosis. When iliopsoas ruptures do occur, they are typically secondary to trauma; however, they can occur spontaneously. Iliopsoas injuries can be disabling, but they respond well to conservative management. We report here a case of a 70-year-old woman who presented to an unaffiliated emergency department with left anterior hip pain 2 weeks after a fall from standing height.ResultsInitial X-ray and computed tomography were negative for fracture, and the patient was discharged with home health physical therapy. Her symptoms persisted. At a subsequent emergency department visit several weeks later, magnetic resonance imaging revealed a complete left iliopsoas tendon rupture with retraction. She was treated conservatively and made a complete recovery after physical therapy.DiscussionThis paper reviews the literature related to iliopsoas injuries, highlights the importance of iliopsoas tendon injuries among the differential for acute hip pain, and provides management recommendations for this rare, but probably underdiagnosed, injury. This treatable condition warrants further attention, as delay in diagnosis can prolong morbidity.LAY ABSTRACTHip pain is common in the elderly population and has many causes. Of the potential sources of hip pain, a complete tear of the iliopsoas, or hip flexor, tendon is rare. When iliopsoas tears do occur, it is typically after trauma, such as a fall. However, tears can happen spontaneously. Diagnosis is best made using magnetic resonance imaging (MRI), but can be made with ultrasound. These injuries can be disabling, but respond well to conservative management consisting of rest and pain management principles, followed by physical therapy active rehabilitation. This paper reviews the literature on iliopsoas tears, provides management recommendations for this rare, but probably underdiagnosed, injury, and reports a case of a 70-year-old woman who experienced a complete iliopsoas tear after a fall from standing height. The diagnosis was missed on initial evaluation, and was subsequently made using MRI. The patient made a full recovery after conservative management.

Physical Therapy and Discharge Disposition Following Acute Hospitalization for UTI in Community-Dwelling Older Adults

Background: Bed rest during acute hospitalization is associated with new-onset mobility impairments in community-dwelling older adults, resulting in discharge to skilled nursing facilities rather than home. Purpose: The purpose of this retrospective study is to determine whether the number of physical therapy (PT) visits is related to discharge disposition following an acute hospitalization for urinary tract infection (UTI) in the older adult population. Methods: Medical records over a 3-year period of 523 community-dwelling older adults (65 years and older) admitted from home functionally independent were reviewed. Demographic and patient characteristics, including age, gender, living status, length of stay (LOS), discharge disposition, and the number of PT visits, were collected. Multinomial regression was conducted to determine predictors of disposition. Results: The multinomial logistic regression model was statistically significant, χ2(2) = 6.90, P = .032. Older age, longer LOS with fewer PT visits during acute hospitalization, and a higher comorbidity score were significant predictors of hospital discharge to subacute rehabilitation facilities than those who were able to return home with home health PT. These variables were not predictors of the disposition for younger patients with fewer comorbidities. Limitations: Due to the retrospective nature of this study, assessment of potential preexisting levels of frailty, standardized delivery of PT, and level of activity outside of PT could not be performed. Conclusions: Reduced frequency of physical therapist intervention for older adults hospitalized with UTI was associated with discharge to rehabilitation in a skilled nursing facility compared with those of similar age with increased PT intervention frequency.

The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia

Dementia is a leading cause of disability for adults older than 65 years. Exercise intervention slows functional decline and improves balance; however, the efficacy of physical therapy (PT) services for persons with dementia is unknown. The purpose of this study is to assess the effect of home health PT services on physical function for Medicare beneficiaries with a primary diagnosis of dementia. Observational cohort study using a combined Medicare data set of home health beneficiaries; we performed augmented inverse probability weighted regression with demographic, comorbidity, and symptom-level characteristics analyzed as covariates. Home healthcare, United States, 2012. Medicare beneficiaries who had a primary diagnosis of dementia and home health function evaluations at discharge (n = 1477). PT treatment, examined by (1) any PT and (2) PT visit number. Improvement in composite activity of daily living (ADL) scores from home health admit to discharge. Any PT increased the probability of improvement in ADLs by 15.2% (P < .001). Compared to 1 to 5 PT visits, 6 to 13 visits increased the probability of ADL improvement by 11.6% (P < .001). PT intervention is beneficial for ADL function improvement in Medicare home health beneficiaries with a primary diagnosis of dementia. J Am Geriatr Soc 68:867-871, 2020.

Rehabilitation After Total Knee Arthroplasty: Do Racial Disparities Exist?

BackgroundRacial disparities in functional outcomes after total knee arthroplasty (TKA) exist. Whether differences in rehabilitation utilization contribute to these disparities remains to be investigated. MethodsAmong 8349 women enrolled in the prospective Women's Health Initiative cohort who underwent primary TKA between 2006 and 2013, rehabilitation utilization was determined through linked Medicare claims data. Postacute discharge destination (home, skilled nursing facility, and inpatient rehabilitation facility), facility length of stay, and number of home health physical therapy (HHPT) and outpatient physical therapy (OPPT) sessions were compared between racial groups. ResultsNon-Hispanic black women had worse physical function (median score, 65 vs 70) and higher likelihood of disability (13.2% vs 6.9%) than non-Hispanic white women before surgery. After TKA, black women were more likely to be discharged postacutely to an institutional facility (64.3% vs 54.5%) than white women, were more likely to receive HHPT services (52.6% vs 47.8%), and received more HHPT and OPPT sessions. After stratification by postacute discharge setting, the likelihood of receipt of HHPT or OPPT services was similar between racial groups. No significant difference in receipt of HHPT or OPPT services was found after use of propensity score weighting to balance health and medical characteristics indicating severity of need for physical therapy services. ConclusionRehabilitation utilization was generally comparable between black and white women who received TKA when accounting for need. There was no evidence of underutilization of post-TKA rehabilitation services, and thus disparities in post-TKA functional outcomes do not appear to be a result of inequitable receipt of rehabilitation care.

Examining the Effects of an Otago-Based Home Exercise Program on Falls and Fall Risks in an Assisted Living Facility.

The Otago exercise program is a strengthening, balance, and walking program designed to decrease falls among community-dwelling older adults. Few studies have examined the effects of the Otago program in an assisted living environment. The purpose of the current study was to assess the effects of an Otago-based home exercise program in decreasing falls and the risk of falls among older adults living in an assisted living facility. A retrospective chart review of 30 individuals residing at either of 2 assisted living facilities in central Florida was undertaken. Participants had a mean age of 87 years, were at risk for falls as determined by the Tinetti Performance-Oriented Mobility Assessment (POMA), and were provided with an Otago-based intervention by home health physical therapy. The outcome measures were the number of falls in the previous year, the number of falls in the year following the intervention, and Tinetti POMA scores pre- and post-intervention. The mean (SD) number of falls significantly decreased from 1.4 (0.9) to 0.5 (0.7) fall per person per year after home health physical therapy with the tailored Otago based-exercise intervention. The intervention resulted in a statistically significant improvement in Tinetti POMA scores from 11.8 (2.5) to 17.6 (3.8). An Otago-based strengthening, balance, and walking home exercise program can potentially be used to decrease the number of falls and the risk of falling among older adults residing in an assisted living facility.

The Value of Home Health Physical Therapy.

The purpose of the Triple Aim is to improve population health, reduce healthcare costs, and improve the patient experience. These goals-to reduce cost while improving health outcomes and patient experiences have shifted utilization of services from other postacute care settings to the home. The purpose of this perspective article is to discuss how home healthcare services, and home physical therapy (PT) specifically, provide value to patients, caregivers, and payers to meet the goals of the Triple Aim. This article will substantiate the value of home PT and provide healthcare professionals with evidence-based information on the value of home PT.

Benefits of direct patient discharge to outpatient physical therapy after total knee arthroplasty

Purpose: To investigate the effectiveness of home health physical therapy followed by outpatient physical therapy as compared to patients discharged directly to outpatient physical therapy in improving functional performance, strength/activation and residual knee pain outcomes among patients who received a total knee arthroplasty.Materials and methods: A secondary analysis of longitudinal data in which patients with total knee arthroplasty underwent home health physical therapy or were discharged directly to outpatient physical therapy. Main outcome measures included the stair climb test, timed up and go, 6-min walk test, quadriceps and hamstring strength, quadriceps activation and residual knee pain.Results: Patients referred to home health physical therapy prior to outpatient physical therapy demonstrated significantly greater declines in stair climb test (10.3; 95% CI [6.5, 14.1]; t = 5.41; p < 0.0001), timed up and go (2.0; 95% CI [1.0, 3.0]; t = 4.10; p < 0.0001), 6-min walk (53.8; 95% CI [29.4, 78.2]; t = 4.35; p < 0.0001), quadriceps strength (21.7%; 95% CI [19.3%, 24.9%]; t = 2.53; p = 0.01), hamstring strength (44.7%; 95% CI [43.4%, 45.7%], t = 3.17; p = 0.002) and higher residual knee pain (0.53; 95% CI [0.04, 1.03]; t = 2.17; p = 0.03) 1 month after total knee arthroplasty compared to those referred directly to outpatient physical therapy.Conclusions: These findings suggest that patients discharged directly to outpatient physical therapy had a more rapid recovery 1 month after total knee arthroplasty. Additional research is needed to investigate the potential causal relation between care pathways and clinical outcomes following total knee arthroplasty.Implications for rehabilitationTotal knee arthroplasty, typically performed to alleviate end-stage knee osteoarthritis, is the most commonly performed elective surgery in the United States.Despite improvement in pain, objective measurements of functional performance and strength often remain at preoperative levels one year after total knee arthroplasty.Patients discharged directly to higher intensity outpatient physical therapy have a more rapid recovery after total knee arthroplasty compared with those patients who received two weeks of home health prior to undergoing outpatient physical therapy.

Reducing Hospital Readmissions in Patients With Heart Failure Receiving Home Heath Physical Therapy Services

To determine if home health physical therapy (PT) impacts hospital readmissions in patients with heart failure (HF).

Outpatient Rehabilitation Care Process Factors and Clinical Outcomes Among Patients Discharged Home Following Unilateral Total Knee Arthroplasty

Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home.

REHABILITATION OF A CENTENARIAN.

Background & Purpose: The population over the age of 100 is increasing. Individuals are living longer with chronic conditions. At present, there is little published on this group. This decreases our ability to design effective plans for these patients. Physical therapists must be aware of these patients'functional potential. This case description attempts to document this potential in a patient in this age group. Case Description: The subject is a 100 year old female residing in an assisted living facility (ALF) prior to admission to acute care with shortness of breath. PMH included degenerative joint disease, hypertension, congestive heart failure (CHF), spinal stenosis, dementia, and functional decline. Eleven days after admission, she transferred to an inpatient rehabilitation facility (IRF) and began physical therapy (PT) for debility due to decompensated CHF and an electrolyte imbalance. She received 19 PT treatments for a total of 810 minutes over a period of 15 days. She also received occupational therapy. Upon the IRF PT assessment, she demonstrated an increased risk for falls (Tinetti score 13/28), gross strength UEs 3+/5 and LEs 4−/5, and decreased functional status (total Functional Independence Measure [FIM] score =57). On admission the FIM score for transfers=2, walking=1, toilet transfers=3 and tub transfers=0. Her mental status was 27/30 as measured by the Mini Mental State Exam. She was able to walk 30 feet with a rolling walker and minimum assistance. She required maximum assistance to move in bed, and maximum assistance for transfers (supine to/from sit). Interventions included education and training for gait, transfers, balance, endurance, and strength. Outcomes: At discharge, the patient needed supervision for bed mobility. Transfers required minimal assistance (FIM =4). She was able to ambulate 60 feet (twice in a 45 minute session) with a rolling walker and supervision (FIM =2). She was able to transfer to/from a toilet and a tub with minimal assistance (FIM =4). At discharge, her total FIM score was 83, representing a gain of 26 points. The adjusted national average for admission FIM during the same quarter the patient was treated was 58.1, and the national average discharge FIM was 86.9, resulting in an average FIM gain of 28.8 (national data from Uniform Data Systems). The patient was discharged back to her ALF with home health PT, nursing, and an aide. Discussion: This patient presented with multiple comorbidities and significant functional decline. Despite these challenges, she made functional gains similar to those of the national average. It is important to note that these averages include a younger population. This case report demonstrates that patients among the oldest old (100 years old) can improve in functional areas measured by the FIM. Results in this case are only slightly lower than national averages for the same time period. These patients can benefit from the intensity of services provided in an inpatient rehabilitation facility. This level of service allowed this patient to return home environment and avoid institutionalization.

Adherence to Exercise Scale for Older Patients (AESOP)

To develop a measure of 3 social cognitive theory constructs (self-efficacy expectations, outcome expectations, and outcome expectancies) for predicting home exercise program (HEP) adherence in older adults after discharge from home health physical therapy. A questionnaire was developed, pilot-tested, and administered to 50 participants (mean age 79.9 years, range 65-91 years) who were being discharged from home health physical therapy on a HEP. Participants also completed the 12-item Short-form Health Survey (SF-12), Mini Mental State Examination, and short form of the Geriatric Depression Scale. Participants reported level of adherence to the HEP at 1 month. There was a strong positive response bias for all 42 items comprising the questionnaire. Two constructs (self-efficacy expectations and outcome expectations) demonstrated test-retest reliability, while the third (outcome expectancies) did not. There was no association between any of the 3 constructs and the 2 scales of the SF-12. Participants' scores on the questionnaire did not predict HEP adherence. While previous studies have shown that questionnaires based on social cognitive theory constructs predict exercise adherence in community-dwelling older adults, the current study did not establish this relationship in older adults after discharge from home health physical therapy. Future research should address scaling issues.

A Multidisciplinary Approach to Total Joint Replacement

A multidisciplinary team was formed to look at consolidating and improving patient education for patients preparing to undergo total knee replacement or total hip replacement. The objective was to encompass disciplines from across the continuum of care, beginning with the surgeon's office through postdischarge rehabilitation. Project goals for the team were to develop the "ideal" pre and postoperative orders for total joint patients, review and revise current clinical and patient pathways for the total knee replacement patient and the total hip replacement patient, add rehabilitation services to clinical pathways, and develop a patient education class and patient education booklet. This article describes how working together with all disciplines involved resulted in a consolidated order set, clinical and patient pathways that reflected actual care and processes, a user-friendly patient education book, and a multidisciplinary patient education class. The end products led to consistency in the quality of care across the continuum from preadmission through postdischarge rehabilitation for total joint replacement patients.

“For the Sake of Our Patients, It Is the Right Thing to Do”

I love to hear patients tell me about their experiences with physical therapists and physical therapist assistants who have embraced our Vision 2020 and exemplify our core values. Many of these conversations are or could be about physical therapists and physical therapist assistants who are sitting here in this room. One such experience involves a frail 82-year-old woman with chronic obstructive pulmonary disease who was receiving home health physical therapy. The patient had not seen her physician in about 3 weeks. She was receiving home health nursing and physical therapy twice a week. The physical therapist who treated her was very familiar with her condition. Before her treatment, the physical therapist always did a general health screening, including checking her vital signs and listening to her lungs. During one visit, the physical therapist assessed that her condition had deteriorated and that she needed immediate medical attention. The physical therapist called the physician, the nurse, and the rescue squad. She stayed with the patient until she was transported to the hospital, where she was diagnosed with congestive heart failure. The patient's children are eternally grateful, because their mother probably would have died if it were not for the expertise and comprehensive care provided by her physical therapist. I know many of you are not surprised by this story, as I am sure it is not an uncommon occurrence. Thirty years ago, when I first started practicing physical therapy, however, this probably would not have happened. Physical therapists did not always do routine screenings of a patient's medical condition beyond the basics and mostly avoided anything not specifically written on the doctor's prescription. I recently talked to a man who was experiencing severe pain in his back. Although he had been seen by numerous physicians, he was still in excruciating pain. He …

Home health physical therapy: practice patterns in western New York.

Home health care is a rapidly growing form of practice for physical therapists. This study examined how physical therapists are providing these services in one metropolitan area of western New York. By completing a log sheet, 19 home health physical therapists provided data on 737 home visits, indicating the number of minutes spent in 50 home health activities over a 2-week period. Visits were recorded for 279 patients with an average age of 64.3 years (SD = 21.8, range = 0-101). Therapists reported that direct patient treatment was the most time-consuming portion of each home visit and that exercise was the most frequent and time-consuming type of treatment provided. Older patients received shorter treatments than younger patients received. Patients with neurological diagnoses received the longest treatments. Patient education was provided in 54% of all home visits. This study provides data regarding the practice patterns of home health physical therapy in one community. Further research is needed to determine how these patterns compare with those in other parts of the country. Studies of the effectiveness of home health physical therapy are also necessary.

Functional Mobility of Patients Receiving Home Health Physical Therapy

The purposes of this paper are to present an assessment system and form designed for efficient use in home health setting and to document the progress made by a sample of patients who were assessed using the form. To achieve the second purpose a retrospective analysis was performed of 25 randomly selected patient charts. Though possessing a number of diagnoses, the majority of patients had experienced cerebrovascular accidents or fractures. The assessment system included measures of bed mobility, sitting balance, transfers, ambulation, stair gait and wheelchair propulsion. Initial and discharge scores on the functional measures were compared using the Wilcoxon Signed Ranks Test. Discharge scores were significantly higher than the initial scores for all activities. Therefore the patients receiving home health physical therapy showed functional progress. The assessment and the form used to document this progress were simple and convenient.