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  • New in the Literature: High-intensity PRST in Older Adults (Arch Phys Med Rehabil. 2013 Mar 6. [Epub ahead of print])

    High-intensity progressive resistance strength training (HIPRST) improves lower limb strength more than lesser training intensities in older adults, although it may not be required to improve functional performance, say authors of a systematic review published this month in Archives of Physical Medicine and Rehabilitation. They note that training volume also is an important variable, and HIPRST appears to be a safe mode of exercise in this population.  

    For this systematic review, the authors searched online databases from their inception to July 2012. Randomized controlled trials of HIPRST of the lower limb compared with other intensities of PRST in older people (mean age ≥ 65 years) were identified. Two reviewers independently completed quality assessment using the PEDro Scale and data extraction using a prepared checklist.

    The authors included 21 trials. Study quality was fair to moderate (PEDro Scale range 3 to 7). Studies had small sample sizes (18 to 84) and participants were generally healthy. Meta-analyses revealed HIPRST improved lower limb strength greater than moderate- and low-intensity PRST, SMD 0.79 and 0.83, respectively. Studies where groups performed equivalent training volumes resulted in similar improvements in leg strength, regardless of training intensity. Similar improvements were found across intensities for functional performance and disability. The effect of intensity of PRST on mood was inconsistent across studies. Adverse events were poorly reported; however, no correlation was found between training intensity and severity of adverse event.

    The authors call for further research into HIPRST's effects in older people with chronic health conditions across the care continuum.

    PTs Needed for Research Project on Patients With Arthritis

    If you currently primarily see patients with arthritis in your practice and would like to be included in a formative research project, contact Anita Bemis-Dougherty, PT, DPT, MAS, APTA department of clinical practice, by Monday, April 1. You will be asked to complete a 20-minute phone interview with Westat, a research company, to understand physical therapists' (PTs) current knowledge, attitudes, and recommendation practices related to arthritis community-based physical activity/self-management education (PA/SME)  programs, and to explore communication preferences for learning about these programs.

    APTA is working with the National Association of Chronic Disease Directors (NACDD) and the Centers for Disease Control and Prevention (CDC) to inform a strategy to increase PT recommendations to PA/SME interventions for patients with arthritis. To do this, NACDD is working with Westat to develop a marketing strategy and arthritis educational materials to assist PTs in recommending evidence-based community arthritis PA/SME interventions to their patients with arthritis when indicated. 

    Westat will conduct the primary research with the following objectives: (1) assess PTs' awareness of and attitudes toward community-based interventions, (2) identify messages that motivate PTs to recommend interventions to their patients, (3) identify preferences about the form of the communications and additional resources needed, (4) identify how to disseminate messages to PTs, and (5) develop recommendations for marketing strategy and materials.

    If you have any questions, contact anitabemis-dougherty@apta.org.

    Many Practices Cannot Accommodate Patients With Mobility Impairment

    Authors of an article published this month in Annals of Internal Medicine report that many subspecialists are unable to accommodate patients who use wheelchairs. 

    Researchers enrolled 256 subspecialty medical practices in 5 large US cities (Atlanta; Dallas; Houston; Portland, Oregon; and Boston) in the study. The practices were assigned to 1 of 2 groups: those where transfer from a wheelchair to an examination table is required for adequate care (endocrinology, gynecology, orthopedic surgery, rheumatology, and urology) and those where transfer might not be necessary (otolaryngology, ophthalmology, and psychiatry).

    The researchers called practices and tried to make an appointment for a fictional patient who was obese (99 kg) and was partially paralyzed on 1 side of the body. The patient used a wheelchair and was unable to self-transfer from the chair to an examination table. The patient could not bring a family member to assist with transfer.

    More of the practices that would have to transfer the patient to provide adequate care were accessible than those that might not have to transfer the patient to provide adequate care (95% vs 74%). In all, 56 practices (22%) could not accommodate the patient. Nine of these practices said that their buildings were inaccessible, and 47 said that they could not transfer the patient to an examination table. The practices gave different reasons for inability to transfer the patient, including a lack of staff who could perform the transfer (37 practices), a concern about liability (5 practices), and that the "patient was too heavy" (5 practices).

    Of the 160 practices in the group that required transfer for adequate care, 22 (9%) reported using special equipment for transfer, such as height-adjustable examination tables and mechanical lifts. Another 88 (55%) planned to transfer the patient from the wheelchair to a high table that was not height-adjustable without using a lift. Gynecology had the highest rate of inaccessible practices (44%).

    The authors call for improved awareness about the Americans with Disabilities Act requirements and the standards of care for patients with mobility impairment.

    Remember to Vote For Your Favorite 'Fit After 50' Member

    Voting for APTA's "Fit After 50 Member Challenge" winner is in full swing! The top 10 featured finalists were nominated for their commitment to being fit, active, and mobile at age 50+. Read their stories and vote for the member who you feel is most active and fit and who inspires others to be the same. The winner should also have served the 50+ community and promoted the role of the physical therapist. Encourage your friends, family, community, and colleagues also to vote. Voting is open until April 5. The top 3 winners will receive prizes from APTA and recognition at the APTA Conference and Exposition in June.