ISSL 2015 Bates

Community Health & Wellness Screening by Physical Therapy Students at a Local YMCA 6th International Symposium on Service Learning – May 29, 2015 Frank Bates, PT, DPT, MBA – Assistant Professor, University of Indianapolis

Outline ¡  Background Information / History

¡ Description of the Experience

¡  Results / Discussion

What is Physical Therapy? ¡  “Physical therapy provides services to individuals and populations to

develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by ageing, injury, pain, diseases, disorders, conditions or environmental factors. Functional movement is central to what it means to be healthy.”

¡  “Physical therapy is concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social wellbeing. Physical therapy involves the interaction between the physical therapist, patients/clients, other health professionals, families, care givers and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.”

Annual Physical Therapy Checkup

¡ APTA Vision Statement: “Transforming society by optimizing movement to improve the human experience.”

¡  “An annual [checkup] allows physical therapists to determine health status and identify health risks of individuals in their community.”

¡ Why provide an annual checkup? “Physical therapists have the education, experience, and expertise necessary to provide a broad health screening to allow tracking the patient's health status over time. It may also lead to a referral for a physical therapist evaluation and treatment plan or to another health care professional for potential problems identified during the checkup.”

Physical Therapist Education ¡  In the US: typically 3 years, culminating in Doctor of Physical

Therapy (DPT) degree

¡  Physical Therapy Clinical Education: “These experiences comprise all of the formal and practical real-life learning experiences provided for students to apply classroom knowledge and skills in the clinical environment. Experiences would include those of short and long duration (e.g., part-time, full-time, internships) and those that provide a variety of learning experiences (e.g., rotations on different units within the same practice setting, rotations between different practice settings within the same health care system) to include comprehensive care of patients across the life span and related activities.”

UIndy DPT Program ¡  8 semesters, 115 credits (20 credits of full-time clinical education)

¡ Clinical Education: ¡  Year 1 – Integrated experiences as part of the academic coursework

¡  Twelve 3- or 4-hour experiences, evenly spaced over 2 semesters

¡  Year 2 – Two 8-week full-time experiences

¡  Year 3 – One 8-week and one 15-week full-time experiences

¡  Integrated experiences allow for early exposure with… ¡  Integrated didactic content

¡  Supervision by licensed physical therapists (some are full-time faculty)

¡  Small groups of 3-4 students

¡  Exposure to traditional and community experiences

DPT Program – Integrated Experiences

¡  7 “traditional” experiences: acute care, pediatric acute care, home health, subacute care, acute rehab, outpatient neuro rehab, and a developmental preschool

¡  5 service-learning experiences at 3 sites: ¡  Fountain Square Clinic (2x)

¡  Outpatient pro bono clinic

¡  Adult Day Center

¡  Exercise class

¡  Baxter YMCA (2x)

¡  Health & wellness screenings for older adults ¡  Fitness following disability exercise class

DPT Program – Fall, Year 1 ¡  Fall Semester (21 credits) – Keywords from course descriptions ¡  PT 610 – Gross Anatomy (6) ¡  Human regional anatomy, surface anatomy, cadaver dissection

¡  PT 611 – Movement Science (2) ¡  Basic principles, motor control, motor learning, gait, posture,

balance, transitional movements ¡  PT 612 – Clinical Medicine I (5) ¡  Cell injury, inflammation, repair; physiology; pathology; differential

diagnosis (“red flags”) ¡  PT 617 – Clinical Seminar I (2) ¡  Role of physical therapy, professional behaviors, communication

¡  PT 619 – Clinical Skills I (6) ¡  Basics of examination, evaluation, intervention; bed mobility;

transfers; assistive devices; medical terminology; documentation; basic tests and measures

Co

urs

e S

ch

ed

ule

for

PT 6

17 –

Clin

ica

l Se

min

ar I

Clinic Visit Schedule for PT 617 – Clinical Seminar I

YMCA of Greater Indianapolis ¡ Vision: “Become one of the country’s ten healthiest communities

by 2025.”

¡ Mission: “To put Christian principles into practice through programs that build healthy spirit, mind, and body for all.”

¡  “Being healthy is about more than just exercising your body. It’s about balancing physical fitness with an equally strong mind and spirit. At the Y, we offer the people, programs and facilities that let everyone pursue this balance. Whether you’re reconnecting with family members during Y Family Night, learning how to combat Type II Diabetes in the YMCA Diabetes Prevention Program, discovering new skills in a class or sports league, or simply burning off a few pesky calories in pilates, the Y is a place where you can make yourself healthier every day—and in every respect.”




Pre-Work To-Do List ¡ One month prior to start of course ¡  Get clinic site visit dates from course coordinator

¡  Contact YMCA wellness programs coordinator to develop participant sign-up sheet

¡  First day of course ¡  3-minute discussion during class with expectations about the site

¡  Orient students to the site information sheet with expectations

¡  Directions, contact information

¡  Objectives for the clinic site visit

¡  Remind them to bring in an article on exercise and older adults for discussion

¡  Remind them to read instructions about the health and wellness screening prior to the visit date

General Schedule ¡  8:00-8:10 AM: Brief orientation to the YMCA and services offered

¡  8:10-8:30 AM: Instructor sets up the screening stations ¡  Students read instructions for the screenings, for each station.

¡  8:30-9:15 AM: Mock screening on a student ¡  If finished early, begin discussing articles.

¡  9:15-10:15 AM: Screening of first 2 clients, with feedback

¡  10:15-11:15 AM: Screening of second 2 clients, with feedback

¡  11:15-11:55 AM: Reflection and discussion ¡  Complete discussing articles during this time. ¡  Incorporate concepts from didactic courses.

¡  11:55 AM-Noon: Clean-up

¡  After: Students complete self-reflection sheets and turn in to instructor ¡  Instructor provides individual feedback and return sheets to students

Brief Orientation to YMCA ¡  Mission of the YMCA

¡  Programs for older adults ¡  Nutrition and wellness course

¡  Group exercise: ¡  Silver Sneakers Classic ¡  Silver Sneakers Circuit ¡  Silver Sneakers Yoga ¡  Active Older Adult Low Impact

Aerobics ¡  Zumba Gold ¡  Pilates for Beginners

¡  Aquatics group exercise: ¡  Active Older Adult ¡  Aqua Zumba ¡  Shallow Water Fitness ¡  Deep Water Arthritis ¡  Arthritis

¡  Individual exercise: ¡  Lap pool open swim ¡  Weight gym ¡  Stretching areas ¡  Cardio equipment ¡  2 free personal training sessions

Health & Wellness Screening ¡ Combination of 2 screening tools ¡  Adult Fitness Examination

¡  APTA created exam with step-by-step instructions

¡  Population: adults 18-60

¡  Backed by research data with norms

¡  Use the balance portion of the exam

¡  Senior Fitness Test (SFT, Fullerton Functional Fitness Test)

¡  Created by professors at California State University, Fullerton

¡  Population: 60+ years old

¡  Backed by extensive research data with norms

¡  Use the entire test (flexibility, strength, aerobics, agility, body mass)

Screening Process ¡ Client completes, then reviewed by instructor ¡  Informed consent and liability release ¡  Physical Activity Readiness Questionnaire (PAR-Q)

¡  1-2 students are paired-up with 1 client

¡  Students review signs of overexertion with the client ¡  Verbal and written ¡  Explain that the client, instructor, or students may terminate or pause

testing

¡ Adult Fitness Examination – Balance Tests ¡  Single Limb Stance – static single-limb balance ¡  Upper Extremity Functional Reach – dynamic double-limb balance ¡  Lower Extremity Functional Reach – dynamic single-limb balance

Adult Fitness Exam – Balance ¡  Single Limb Stance ¡  Upper Extremity Functional Reach ¡  Lower Extremity Functional Reach

Senior Fitness Test ¡  Station 1: 30-Second Chair Stand Test

¡  Station 2: 30-Second Arm Curl Test

¡  Station 3A: Height & Weight

Senior Fitness Test ¡  Station 3B: 2-Minute Step Test ¡  Station 4: Chair Sit-and-Reach Test ¡  Station 5: Back Scratch Test ¡  Station 6: 8-Foot Up-and-Go Test

Screening Process ¡  Senior Fitness Test ¡  Station 1: 30-Second Chair Stand Test – leg strength ¡  Station 2: 30-Second Arm Curl Test – arm strength ¡  Station 3A: Height & Weight – calculate body mass index (BMI) ¡  Station 3B: 2-Minute Step Test – aerobic capacity ¡  Station 4: Chair Sit-and-Reach Test – leg flexibility ¡  Station 5: Back Scratch Test – arm flexibility ¡  Station 6: 8-Foot Up-and-Go Test – agility

¡  Students calculate client data and compare to norms ¡  Prepare profile sheets that the client can take home or to trainer

¡  Students explain results and suggest possible activities at the YMCA to improve scores on the profile sheets ¡  Instructor assists as needed

Equipment List ¡  Equipment to bring: ¡  Station signs

¡  10-foot tape measures

¡  18-inch rulers

¡  Masking tape

¡  Stopwatches

¡  Cone

¡  Normative data sheets

¡  Score sheets from past tests

¡  Equipment at the YMCA: ¡  5# & 8# dumbbells

¡  Armless chairs

¡  Scale

¡  Clipboards

¡  Pens

¡  Testing papers

How DPT Students Benefit ¡  Interactions with real clients ¡  Clients are generally healthy, not in rehab process (low acuity) ¡  Practice communication and patient-practitioner interaction skills

¡ Classroom integration ¡  Practice communication and patient-practitioner interaction skills ¡  Practice examination skills ¡  Problem-solve to arrive at basic suggestions for interventions ¡  Clients have real diagnoses (sometimes need to modify testing) ¡  Referral to other health providers (trainers, physicians, dieticians, etc.)

¡  Feedback ¡  Instructor – to group and individual ¡  Peer ¡  Self-reflection

How YMCA and Clients Benefit ¡  YMCA benefits: ¡  No-cost programming to meet programming goals

¡  Programming ties in with the mission of YMCA

¡  Increases group exercise participation

¡  Promotes the value of the YMCA membership

¡ Client benefits: ¡  Opportunity for screening of the “movement system”

¡  Free health and wellness screening with gender/age norms

¡  Advice on targeted areas for improvement

¡  Individualized screening to help clients select appropriate exercise

¡  Increased awareness of benefits of YMCA membership

¡  For repeat clients, opportunity to assess changes since last screening

Sen

ior Fitn

ess Te

st

Ad

ult Fitn

ess

Exam

ina

tion

- Ba

lan

ce

Tests




Utilization Data ¡ Number of appointments available: ¡  2013 – 48

¡  2014 – 48

¡ Number of screenings performed: ¡  2013 – 36

¡  2014 – 46

¡  Utilization: ¡  2013 – 75%

¡  2014 – 96%

Student Site Survey Data ¡  “I was able to make connections between the classroom and

the clinic at this Clinical Seminar site.” (2013, 2014) ¡  Total affirmative: 96%, 96%

¡  Strongly agree: 32%, 43%

¡  Agree: 64%, 53%

¡  “I was able to apply the concepts and skills I had learned in class to the patients/clients at this Clinical Seminar site.” (2013, 2014) ¡  Total affirmative: 96%, 98%

¡  Strongly agree: 41%, 40%

¡  Agree: 55%, 58%

Student Comments ¡ Actual experience: ¡  “I really liked that we got to jump in and work with the patients instead

of standing back to watch….” ¡  “I really liked the hands on aspect of this clinic experience.”

¡ Clinical correlations: ¡  “We learned what a balance deficit actually looks like….” ¡  “It was great to see a variety of older people in different categories. It

really showed that if you do work out, it can benefit you in the long run.” ¡  “It was neat to be able to work with an older adult population in a

setting that was not inpatient or nursing home to get a new perspective on the exercise standards of the senior population.”

¡  “Seeing a healthy elderly population was nice compared to a typical population that physical therapists might see which would most likely be disabled.”

Student Comments ¡  Improving communication: ¡  “One of the most beneficial things I gained from this site is seeing how

important it is to be clear when giving instructions. I realized how important clear communication with a patient/client can be to get the results you want.”

¡  “Going to the Baxter YMCA played a really important part of helping me to develop my communication skills. I got to interact with individuals who genuinely wanted my help and weren’t just volunteers.”

¡  “The instructor helps us learn how to better deliver ‘hard news.’ For example, we had to figure out BMI and tell the clients when this BMI number was a concern. This was a pretty scary thing for me to have to tell a person that their BMI indicated that they were overweight, but the instructor showed us how to better have that conversation.”

Challenges & the Future ¡ Challenges are opportunities to role-model professional flexibility! ¡  When a client no-shows…

¡  When a client shows without scheduling…

¡  When a client shows at the wrong time or on the wrong day…

¡  When meeting space is double-booked…

¡  Looking to the Future ¡  Involving other programs on campus

¡  Expanding to other sites (YMCAs?) around Indianapolis

¡  Audience ideas/suggestions?

References ¡  American Physical Therapy Association. Available at:

http://www.apta.org. Accessed May 28, 2015.

¡  Millrood D, Chua C. Adult Fitness Examination: A Physical Therapy Approach. Alexandria, VA: APTA. 2012.

¡  Rikli RE, Jones CJ. Senior Fitness Test Manual, 2nd ed. Champaign, IL: Human Kinetics. 2013.

¡  University of Indianapolis. Available at: http://uindy.edu. Accessed May 28, 2015.

¡  World Confederation for Physical Therapy. Available at: http://www.wcpt.org. Accessed May 28, 2015.

¡  YMCA of Greater Indianapolis. Available at: http://www.indymca.org. Accessed May 28, 2015.