Professional Therapists Research Articles

The Cultural Imperatives of Professionalism: Who's Protecting Whom?

What does it mean to be a professional therapist? This paper explores some of the personal and cultural pressures that influence how we see ourselves as professional therapists. It then explores how these pressures impact upon our capacity to protect children and ourselves.

316 THE DETERMINANTS OF SEEKING HELP FROM HEALTH CARE PROFESSIONALS BY PEOPLE WITH LOWER LIMB PAIN

Purpose: To explore the determinants of help seeking by people in the community, who have lower limb pain. Methods: Health care utilisation, defined as having seen a family doctor (GP) or hospital doctor during the past 12 months; or an allied health professional (AHP) or alternative therapist during the past 3 months, was assessed in 1079 persons reporting lower limb (hip/knee) pain from a community based sample aged 35 or over (The Somerset and Avon Survey of Health, SASH). Age and gender adjusted odds ratios were determined for: ethnicity, social deprivation, rurality, pain intensity (1−10, best-worst), the EQ5D mobility and anxiety/depression questions, the number of other self-reported health problems, and standard WHO categories of body mass index (BMI). A two-step cluster analysis was also performed to test associations between the variables. Results: Of the 1079 persons reporting pain in the hip or knee 18% had seen a doctor only, 2% an AHP only, and 4% an alternative therapist only. 22% had seen more than one category of health care professionals (categorised ‘COMB’). 54% had not seen any health care professional. People with mobility problems were 5 times more likely to visit an AHP (OR (95% CI) 5.54 (1.60−19.23)), and 3−4 times more likely to visit a GP (3.34 (2.19−5.08)), hospital doctor (2.83 (1.39−5.75)), or COMB (4.43 (3.06−6.43). Having two or more comorbidities doubled the likelihood of seeing a GP (2.43 (1.27−4.64)) and ‘COMB’ (1.89 (1.13−3.16)), and caused a 3-fold increased likelihood of seeing a hospital doctor (3.36 (1.06−10.57)) or alternative therapist (3.48 (1.22−9.91)). Pain severity was weakly associated with a visit to a GP (1.35 (1.22−1.50) or ‘COMB’ (1.57 (1.43−1.72)). A visit to a GP was also associated with living in urban areas (2.46 (1.24−4.88)) and obesity (2.34 (1.42−3.88)). Seeking ‘COMB’ was associated with anxiety/depression (1.78 (1.30−2.43)), overweight (2.05 (1.34−3.13)) and obesity (2.50 (1.59−3.92)). The cluster analysis showed that more severe pain, mobility problems, more health problems, obesity, female gender and higher age were all associated with each other, and that people from this cluster were more likely to see a GP, hospital doctor, AHP and COMB, although 46% of those not currently using health care also belonged to this cluster. Conclusions: A majority of people living with hip and knee pain in the community do not seek help from health care professionals. Pain severity and perceived anxiety/depression seem to be of less importance to help seeking than reduced mobility, obesity, and comorbidities. People may cope well with hip and knee pain alone, but if they have other health problems or significant disability as well, they are more likely to seek professional help.

Neurological Interventions for Physical Therapy, ed 2

Martin S, Kessler M. St Louis, MO 63146, Saunders Elsevier, 2007, paperback, 512 pp, illus, ISBN: 978-0-7216-0427-5, $59.95. An excellent text for the professional (entry-level) physical therapist student, this book also is suitable as a reference for practicing physical therapists interested in both pediatric and adult neurologic patient management. This book is organized into 3 sections. The first section consists of 4 chapters that provide a comprehensive review of anatomy and the foundations of neurologic patient management. Chapter 1 describes the Nagi disablement model and its relationship to the physical therapist's role as described in APTA's Guide to Physical Therapist Practice . Furthermore, this chapter relates the role of the physical therapist to that of the physical therapist …

Clients' Perceptions of How Reorientation Therapy and Self-Help Can Promote Changes in Sexual Orientation

Presented is a summary of 882 homosexual people's responses to 5 open-ended questions about sexual reorientation therapy. Of the 882 participants, 726 reported that they had received reorientation therapy from a professional therapist or a pastoral counselor. As a group, 779 (89.7%) of the participants viewed themselves as "more homosexual than heterosexual," "almost exclusively homosexual," or "exclusively homosexual" in their orientation before receiving reorientation therapy or making self-help efforts to change. The majority reported they believed sexual reorientation therapy and various forms of self-help were helpful to them, psychologically, spiritually, and sexually.

Preferred Vocal Range of Young and Older Adults: Implications for Music Therapy Majors' Clinical Training Experience

ABSTRACT: The purpose of Study 1 was to determine differences in female music therapy (MT) and non-music majors' vocal range. Twenty-seven female MT and 28 female non-music majors participated. Results indicated no significant difference for lowest mean comfortable singing note between groups; however, significant differences occurred regarding highest mean comfortable note, p Singing is an important therapeutic experience utilized by music therapists to meet various client needs. Over 25 years ago, professional music therapists reported that they implemented singing experiences during almost one-fourth of their working hours (Braswell, Maranto, & Decuir, 1979). Lathom (1982) found that 67.6% of music therapists used vocal skills in leading music therapy sessions. Recently the American Music Therapy Association's Professional Competencies and Standards for Clinical Practice delineated the therapeutic importance of singing in clinical training and for therapeutic outcomes, and research efforts continue to further validate the importance of singing (American Music Therapy Association, 2004). Researchers reported the benefits of singing to meet therapeutic objectives for children with and without special needs. Music therapists have used singing to increase prewriting, prereading, and reading skills for children in early intervention and school programs (Colwell, 1994; Hoskins, 1988; Standley & Hughes, 1997). Colwell and Murlless (2002) used singing and chanting to increase reading accuracy of elementary students with learning disabilities. Singing paired with signing has also increased receptive communication skills of ESOL children (Schunk, 1999). Singing and engaging in vocal exercises resulted in a significant increase in frequency range and a significant reduction of fundamental frequency for 22 children with severe and profound hearing impairments (Darrow & Starmer, 1986), and singing increased lung functioning of children with asthma (Wade, 2002). Researchers have also reported that singing improved speech and memory of adults with cognitive impairments. Singing instruction resulted in improvements in speech and verbal intelligibility for adults with communication disorders due to neurological impairments as well as individuals with Farkinson's dis ease (Cohen, 1992; Cohen & Masse, 1993; Haneishi, 2001). Furthermore, research regarding the effects of singing on memory of patients with Alzheimer's disease and other memory impairments revealed that individuals recalled words to songs more than spoken words, learned a new song even though many did not recall newly presented spoken material, and learned the names of some nursing home residents through singing (Carruth, 1997; Prickett & Moore, 1991). Other researchers found that therapeutic group singing resulted in greater vocal and verbal participation for patients with Alzheimer's disease compared to a discussion group (Olderog-Millard & Smith, 1989). Other research efforts revealed further benefits of singing in music therapy. Clinicians also used singing to enhance active coping in some individuals experiencing chronic pain, promote trust and cooperation, increase communication among participants, facilitate group cohesion, and create positive changes in mood (Anshel & Kipper, 1988; Kenny & Faunce, 2004; Unwin, Kenny, & Davis, 2002). Singing has been identified as an important aspect of music therapy treatment as evidenced by music therapists' reports of using singing during music therapy sessions, and researchers that have indicated positive therapeutic outcomes of singing for all age groups. …

Are Music Therapists at Risk for Voice Problems? Raising Awareness of Vocal Health Issues in Music Therapy

ABSTRACT: Music therapy can be a vocally demanding profession. The purpose of this article is to raise awareness within our profession of the physiological, environmental, and personal factors that may lead to vocal strain or abuse. In an extensive literature review and database search, no articles were found on the prevalence of vocal health issues among music therapists. However, it is logical that with the daily vocal demands faced by music therapists, they may be at risk for vocal problems. This article identifies some of the environmental and habitual factors that influence vocal health. Parallels are drawn between the vocal demands and working environments of music therapists and other professional voice users such as teachers for whom prevalence, causal factors, and treatment modalities are known. It is hoped that by raising awareness, music therapists experiencing difficulty with their voices will be more likely to seek medical assistance and consider the habits and surroundings that may pose risks to their vocal health. There is a great deal of literature that addresses the use of percussion, guitar, and piano in the field of music therapy. Though instrumental and vocal improvisation have emerged as viable music therapy approaches and techniques, an area that has had little exposure is the role of vocal health for the music therapist. Many students receive only the minimum amount of voice training required by their collegiate program. As a result, these same students may receive little or no guidance in vocal health issues that can arise once they are working as a professional music therapist. Vocal problems develop for individuals in the teaching profession as well as other vocations that require a high level of voice use (Koufman, 1999; Voice Academy, 2003e). Music therapists are not exempt from these problems. Even those students with several years of applied vocal study can develop vocal problems once they enter the professional realm. As music therapy educators, we have observed vocal health issues arise for our students in music therapy fieldwork, during internship, and into the professional world. These issues have affected both those who claim the voice as a primary instrument of study as well as those who claim it as a secondary instrument. There appears to be little to no awareness about the vocal demands and needs of music therapy students among conventional voice instructors. In addition, many attendees at our state, regional, and national music therapy conference presentations, who have ranged from students through seasoned professionals, have discussed their own vocal struggles and clinical challenges and have expressed eagerness for more information on this topic. The current American Music Therapy Association (AMTA) (2004) professional competencies addressed the vocal ability/ skills required for entry-level practice are as follows: 1. Music Theory and History 1.3 Sight-sing melodies of both diatonic and chromatic makeup 6. Voice Skills 6.1.1 Lead group singing by voice 6.1.2 Communicate vocally with adequate volume (loudness) 6.1.3 Sing a basic repertoire of traditional, folk, and popular songs in tune with a pleasing quality 8. Improvisation Skills 8.2.1 Compose and develop original melodies, accompaniments, and short pieces extemporaneously in a variety of moods and styles, vocally, and instrumentally (p. 27) Clearly, the AMTA places a major emphasis on the use of voice by music therapists. While the AMTA professional competencies outlined the use of voice in various capacities, curriculum in schools can vary greatly thus impacting the level of awareness about vocal health issues for each music therapist. Undergraduate requirements for students not pursuing a concurrent degree in vocal performance do not necessarily address physiological understanding or care of the voice, yet the voice is a primary instrument in a music therapist's clinical work. …

Commentary on “Use of Demographic and Quantitative Admissions Data …”

Student recruitment and selection into professional physical therapist education programs is an issue of contemporary importance to the profession and especially to the physical therapy academic community. On an annual basis, academic programs are charged with evaluating the credentials of applicants to programs and to make predictive judgments about applicant appropriateness and likelihood for success as a physical therapist. The outcomes of these decisions have enormous effects on the applicant, on the program, on the institution where the program resides, and, ultimately, on the physical therapy profession and the community. It is to this process that Utzman and colleagues make timely and important contributions. The authors address 2 important questions facing admissions committees: (1) Will this student complete the program without academic difficulty? and (2) Once graduated, will this student pass the National Physical Therapist Examination (NPTE)? The answers to these questions are determined by the ability and motivation of the applicant and the strength and expectations of the faculty and curriculum. It is examining these questions using a national representative sample of physical therapist education programs and a systematic method to study demographic, program, and academic variables affecting student outcomes where the authors shine a light on these issues. The focus of these studies is to identify predictive characteristics of applicants that can assist with admissions decision making. In doing so, they affirm some basic tenets of admissions decision making related to applicant qualifications and also uncover some issues that need the attention of the profession. The authors affirm some basic dogma ascribed to by physical therapy admissions committees. Students need to be well prepared academically to learn in a physical therapist education program. This is the message that needs to be understood by people who are considering physical therapy as a career choice. In the first study,1 …

Quality of life diagnosis and therapy as complex intervention for improvement of health in breast cancer patients: delineating the conceptual, methodological, and logistic requirements (modeling)

A system for quality of life (QoL) diagnosis and therapy in breast cancer patients was developed according to the Medical Research Council (MRC) framework of complex interventions. Along MRC's five phases in the continuum of evidence, the present paper deals with phase I: modeling (i.e., delineating the conceptual, methodological, and logistic requirements). Theoretical background is a new conceptualization of QoL that provides a rational basis to diagnose "diseased" QoL. A care pathway as the central part of modeling is composed of the following interrelated structural elements: patients (n = 170), clinicians (n = 10), experts in a quality of life unit (n = 5), coordinating practitioners (n = 38), local opinion leaders (n = 12), and professional therapists for QoL enhancing therapies (n = 75). Networking of these structural elements was achieved by clinical algorithm. In the clinical center, the patient and doctor delivered a questionnaire (EORTC) and health status report. The QoL unit transformed it into a profile and experts' report. The coordinating practitioner transformed the latter into a decision on QoL therapy and the care pathway ended with the professional therapists. Implementation of this system used a multifaceted strategy including educational outreach visits, local opinion leaders, and quality circles. The suffering cancer patient is the main focus of this QoL diagnosis and therapy system. It will have to pass the rigorous test of a definitive randomized trial.

Adding Consumer-Providers to Intensive Case Management: Does It Improve Outcome?

Adding Consumer-Providers to Intensive Case Management: Does It Improve Outcome?

Therapeutic Exercise: Treatment Planning for Progression

Huber FE, Wells CL. St Louis, MO 63146, Saunders, 2006, paperback (with DVD), 400 pp, illus, ISBN: 072164077X; $49.95. The authors developed this text to provide an evidence-based therapeutic exercise guide with an emphasis on treatment progression for physical therapist students. Therapeutic exercise is a challenging subject to teach professional physical therapist students, and this text attempts to address this challenge. Several therapeutic exercise texts are currently available, but this book is unique in its presentation of basic exercise concepts and its inclusion of a wide spectrum of populations and disease states. The book contains 7 chapters. Chapter 1 starts with an introduction to general concepts of therapeutic exercise. This chapter also discusses the disablement model, documentation and writing goals, and patient education. A nice feature of the second chapter, “Addressing Functional Limitations and Disability With Therapeutic Exercise,” is the analysis of basic functional movement patterns geared for the beginning student. The next 5 chapters address specific impairments commonly treated …

Características do processo de desmame da ventilação mecânica em hospitais do Distrito Federal

Concerning the mechanical ventilation, the weaning is a usual and significant intensive care process. Identifying, describing and demonstrating the techniques used by Respiratory Therapists in weaning and also obtaining its parameters in Intensive Care Units (ICU). A survey related to the weaning process was done with active ICU Respiratory Therapists from (FD) in the year 2005. The survey consisted of 31 subjective and objective questions, some of them allowing multiple answers. Eighty surveys were carried out at twenty hospitals. 90% of participants were specialized staff with a mean of three year working experience in ICU. In 98.7% of the answers, doctors and respiratory therapists were responsible for operating the ventilators. In 61.3%, doctors and respiratory therapists were responsible for their use and, in 36.3%, the responsibility was solely on the respiratory therapist professionals. It was found that only twenty-four respiratory therapists (30%) follow the weaning protocol. Among the most practiced parameters from the weaning process are: respiratory frequency (98%), tidal volume (97.5%) and periferic oxygen saturation (92.5%). The least utilized are the maximum inspiratory pressure (18.8%) and the vital capacity (13.8%). Great differences were observed in the weaning methods, choice of parameters and the way they were collected. These variations suggest that there is a lack of routine and the need to implement simple protocols.

Training Massage Therapists to Work in Oncology

Professional massage therapists (MTs) require specialized training to work safely and effectively with cancer patients and to prepare them for their role in multidisciplinary clinical settings. This article describes "Medical Massage for the Cancer Patient," a certificate course offered to achieve those goals by the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center. MTs are taught the clinical, logistic, and legal requirements; the basic details of cancer and cancer treatments; necessary massage adaptations; and what will be required of them as members of a health care team. The core competencies this training program aims to impart, and the program developed to reach them, are outlined here. Specific training by a credible oncology team is required prior to any hands-on work with cancer patients.

Physical therapy education and provision in Cambodia: A framework for choice of systems for development projects

Purpose. Rehabilitation agencies, policy makers and donors are faced with the choice of the level of rehabilitation provider to promote in developing countries. This is particularly the case after conflict when new systems are considered and the need for rehabilitation becomes a priority. The complete decimation of medical services in Cambodia highlights the effects of both social change and development agency impact on the establishment of rehabilitation services. This paper discusses the factors that led to the development of four types of physical therapy provider levels in Cambodia with the goal of providing a framework for these decisions.Methods. Case study analysis utilizing interviews, site analysis and literature review.Results. There are four levels of physical therapy provider systems that were initiated at different stages of the rebuilding of the country. Rehabilitation workers were trained during the war in refugee camps and afterwards in rehabilitation centers, professional physical therapists were trained in a university programme after the conflict ceased and community follow-up workers and community-based rehabilitation workers were trained to address some of the geographic accessibility issues. Factors that affected the different systems include the post-conflict development agency philosophy, instructor availability and training, financial support, high school education standards, geographic and rural/urban distribution and cost and time for training. The community-based rehabilitation and community follow-up models also address referral systems and social and vocational support.Conclusions. The comparison of the different types of provider and the initiating or driving forces that led to development of these systems are discussed in order to provide agencies which are planning to implement training of rehabilitation providers in developing countries with a decision-making framework. A combined system is the optimal approach; however, the choice of which type of provider level to promote will differ according to political stability, stage of development, presence of trained educators, rural vs. urban need, funding agency philosophy and educational standards in the country.

Integration of Cultural Competence in Physical Therapist Education

Background and Purpose. The purpose of this study is to describe the integration of cultural competence in physical therapist education program. Case Description. The sample population was obtained using snowball sampling to identify physical therapist educational programs in which the faculty has significantly integrated cultural competence into their curricula. This paper outlines the process of integration of cultural competence of one program. The study involved an ethnographic, qualitative design. Data collection included document analysis, program site visit, class observations, and interviews. Data were analyzed using an inductive constant comparative analysis. Themes were generated as they emerged from the data. Outcomes. The physical therapist education program studied integrated cultural competence in its curriculum by (1) developing strategic plan where faculty were committed to diversity, (2) immersing faculty and students in diverse environments, (3) using artifacts, language, and teaching methods to raise diversity to conscious level, and (4) incorporating reflection and discussion that allowed individuals to discover their own cultural values and beliefs, as well as those of others. Discussion and Conclusion. Faculty members embraced diversity and applied theory to practice, resulting in an educational model for developing culturally competent practitioners. Key Words: Culture, Cultural competence, Physical therapist education. BACKGROUND AND PURPOSE Twenty-first century health care providers are challenged to meet the needs of population differing in age, gender, race, ethnicity, disability status, sexual orientation, and religious affiliation, as well as sociocultural and socieconomic status.1,5 Physical therapists are called to recognize and respond to these changes and the accompanying needs of their patients/clients and the population around them. The physical therapy profession, through its Core Values, advocates that physical therapist professionals be prepared to provide physical therapy to all populations who can benefit from our services. Physical therapist educators are encouraged to educate graduates for professional (entry-level) practice who can identify, respect, and act with consideration for patients'/clients' differences, values, preferences, and expressed needs in all professional activities. 6(p12) Yet, how does one educate culturally competent practitioners for 2 1st century diverse society? The purpose of this study was to describe the integration of cultural competence in physical therapist education program. Leavitt2 defines cultural competence as a set of behaviors, attitudes, and policies that come together in continuum to enable health care system, agency or individual practitioner to function effectively in transcultural interaction. (p26) Numerous authors suggest that an individual starts with an understanding of one's own culture, as well as consciously acknowledging and considering one's values and beliefs about those different from oneself.5,7-13 The culturally aware person is conscious of many of the cultural assumptions he or she has internalized unconsciously.14 In one approach, an inwardoutward approach, the individual starts by assessing values, beliefs, and biases about his or her own culture and then seeks to become informed about other cultures, taking on more global perspective, while understanding that each of us is product of the decades in which we were born and raised.5,15 Physical therapist educators choosing this approach can encourage their students to reflect on their pasts to understand how the values and beliefs they developed throughout their lives have shaped their thought processes about themselves and others. Rorie and Paine16 state that becoming culturally competent health care provider requires an accurate knowledge of one's own cultural roots, beliefs, and behaviors. …

The Essentials of Existential Psychoanalysis

The purpose of this inquiry was to provide a guide for discussing the essential requirements for existential therapy, in particular within the initial phase. From the responses of a sample of professional therapists, three essential themes have been identified: convenience (that is, having a script that will allow the therapist to reach a rapid understanding of the nature of the client’s existential being), mythic familiarity, and an emphasis upon imaginal techniques.

Songs Composed for Use in Music Therapy: A Survey of Original Songwriting Practices of Music Therapists

While researchers have documented the efficacy of clinical songwriting in music therapy, limited research has been conducted on songs composed by music therapists that address clinical goals. The purpose of this research was to examine the original songwriting practices of music therapists. Professional music therapists (N = 1,364) received a 14-question survey via email asking each to identify client populations and clinical goals addressed by original songs, their length of time in clinical practice, and specifics about their acquisition of songwriting skills. The data collected from 302 completed surveys revealed that respondents who used original songs were most likely to work with children and adolescents in schools or the developmental disability field and wrote songs in order to individualize treatment. Music therapists working with persons over 65 years of age in long term care or assisted living programs were the least likely to use original songs in clinical practice, opting for interventions utilizing the client's familiar music. Most music therapists found songwriting generally easy, but only 37% indicated that they acquired this skill during their undergraduate degree. Additional research on the clinical efficacy of original songs and therapist's compositional processes is needed to identify best practices models for strategic songwriting.

Client Aggression Towards Therapists: Is It More or Less Likely with Transgendered Clients?

ABSTRACT It is well known that clients occasionally threaten or assault their therapists. No studies to date have attempted to systematically measure client aggression by transgender patients towards clinicians. One of the major questions of this study was to determine if clients with gender dysphoria have greater levels of aggression towards therapists than non-gender dysphoric clients. One hundred and fourteen professional therapists who are members of the Harry Benjamin International Gender Dysphoria Association responded to a questionnaire that addressed aggression by both transgender and non-transgender clients. Transgender clients were shown to commit significantly less acts of aggression than did non-transgendered clients (p = 0.0094). Within the relatively small subgroup of transgender clients that did commit acts of aggression, male-to-female transgender clients were significantly more likely to do so than female-to-male clients (p = 0.002). While the transgendered client undergoes significant suffering in violating inviolable gender boundaries, this suffering, in general, does not translate into acting out behaviors directed towards their therapists.

Mental capacity and professional advice in a patient with dysphagia

This article considers the implications of a dispute between a speech therapist and other health professionals over whether a patient suffering from dysphagia should be allowed to take liquids by mouth. The right of the patient to act contrary to professional advice is discussed. The patient cannot insist that a health professional acts contrary to his or her professional judgment. The article also considers the law if the patient were to lack mental capacity.

Comparative Study of Hands-On Therapy With Active Exercises vs Education With Active Exercises for the Management of Upper Back Pain

Objective The aim of this study was to compare hands-on therapy, including heat, massage, and active exercises with postural education that emphasized increased self-efficacy and postural self-awareness along with education about the physiology of the disorder, and prescribed daily active exercises. Subjects Twenty-four randomly selected women, 12 custodians and 12 students, with neck and shoulder pain and stiffness. Methods All subjects received a medical examination and x-ray before the study to rule out any pre-existing neurologic deficits and an evaluation that included history taking and self-reporting of pain according to a numeric pain scale. Student participants received education and exercise instructions to be continued daily. The custodial workers received once-per-week hands-on treatment. Results Data were compared using a nonparametric analysis (Wilcoxon signed rank test) and showed evidence of statistically significant reductions in neck, shoulder, and back stiffness and shoulder muscle tension for most of the study subjects. Conclusion Treatment of repetitive stress injuries that combines maintenance of daily active exercises prescribed and modeled by a professional therapist, which emphasize postural awareness to correct poor posture and provide a basic physiological understanding of the disorder, is as crucial to reducing upper back and neck pain and stiffness as hands-on therapy with active exercise provided in a clinical setting.

A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery

Purpose. To evaluate and compare the effectiveness of supervised and non-supervised exercise programs for improving health and rehabilitation outcomes for elderly persons following hip surgery.Method. Prospective, descriptive and quantitative study involving two groups: The class-based program (group A, n = 34: 21 females, 13 males, mean age 79.2 years ± 5.23) was directed and administered in the outpatient clinic, and a home-based program (group B, n = 29, 17 females, 12 males, mean age 80.3 years ± 5.74) which administered in the patient's home. Sixty three elderly patients began at a period of 2 weeks post hip surgery for open reduction with internal fixation. The training period took place for 14 consecutive weeks. The main outcome measures include results from physical performance test, functional reach test and short form-36 health survey questionnaire.Results. Fifty five patients completed the exercise program. No significant difference according to gender or Body Mass Index was found between the groups. At the conclusion of 14 weeks of exercise training both groups demonstrated improvement in physical function. However, only 4 of 6 total tasks of a physical performance test were improved in the home-based group compared to improvement in all 6 tasks for the class-based group. The SF-36 scores and the functional reach test indicated that the class-based subjects also presented significant gains in contrast to no significant changes in the home exercise group.Conclusions. Both groups demonstrated improvement in a number of issues. However, there appears to be more positive health outcomes presented by the participants in the supervised/class-based group when compared to the non-supervised/home-based group. And therefore, patients may select to participate to either a home-based or class-based regime. The clinical relevance is the significant of the necessity for close supervision by a professional therapist. In addition, the results could have some political and economical implications on the healthcare system.