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  • Survey of PTs Reveals 'Significantly Inadequate' Rates of BP and HR Measurement

    Despite the frequency with which physical therapists (PTs) in outpatient settings encounter patients who have or are at risk for cardiovascular disease (CVD), rates of blood pressure (BP) and heart rate (HR) screening remain "significantly inadequate," say authors of a new study based on a nationwide survey of PTs. The survey reveals that only 14.8% of respondents reported measuring BP and HR on initial examination of new patients, and sheds some light on factors that influence the tendency to perform the screens—or forgo them.

    The analysis, published in the July issue of PTJ (Physical Therapy), is based on survey responses from 1,812 PTs who worked in outpatient settings and were members of the APTA Academy of Orthopaedic Physical Therapy at the time of the survey. The survey was administered online and consisted of 30 multiple-choice questions that delved into CVD-risk screening behaviors and related rationales as well as demographics and education background of the respondents, and patient characteristics.

    The results showed that although 51% of PTs reported that at least half of their current caseload included patients with or at moderate-to-severe risk of developing CVD—and 28% reported that more than 50% of their patients were in this category—only 14.8% said that BP and HR screenings were a regular part of their initial examination of a new patient. When researchers dug deeper into the results, they uncovered other interesting details, including:

    • Nearly 7 in 10 PTs (68.9%) said they encountered a new patient with or at risk for CVD at least twice a week, and 29% said they encountered this kind of new patient daily.
    • In terms of how frequently BP and HR were measured at the initial visit, 63.74% of the respondents reported doing the measurements less than 50% of the time; 39.8% said they conducted the screenings less than 25% of the time; and 13% responded by saying that they never measured BP or HR.
    • The most commonly reported barriers to BP and HR screening were lack of time (37.44%) and "lack of perceived importance" (35.62%). Most respondents reported that they were adequately equipped to perform routine screening and felt confident in their ability to do so.
    • When it came to factors that were linked to more frequent BP and HR measurements, respondents with higher percentages of patients with or at risk for CVD tended to perform the screenings more often, as did PTs who had completed a residency or fellowship training program, and clinicians with more than 20 years of practice experience. Possessing a board-certified specialization credential of any kind was not linked with increased likelihood of conducting the screenings.

    Authors of the PTJ article describe the results as "surprising," particularly given the typical respondent caseload and the PTs' apparent confidence in their ability to perform BP and HR screenings. They write that current rates, while better than in the past, are still "significantly inadequate in relation to the high rates of CVD risk factors present in the patient population."

    As for what might be done to improve the rates, the researchers point to the link between postprofessional education (specifically, residencies and fellowships) and increased screening as one promising possibility, but they also stress other avenues for increasing clinician knowledge, such as wider use of social media to "improve clinician knowledge and practice patterns." Clinics could make a difference as well, they add, by changing policy to emphasize the importance of initial BP and HR measurements.

    APTA members Richard Severin, PT, DPT, PhD(c); Adam Wielechowski, PT, DPT; and Shane Phillips, PT, PhD, were among the authors of the study. Severin is a board-certified cardiopulmonary clinical specialist; Wielechowski is a board-certified specialist in orthopaedic physical therapy.

    [Editor's note: for an exploration of the importance of blood pressure screening and the role of PTs, check out this #PTTransforms blog post that discusses the impact of changes made to blood pressure guidelines in 2018.]

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • Good Article, I think it would be beneficial to add a link on how to assess blood pressure and heart rate. This would work as a good refresher for us. thanks,

      Posted by Mark Wilson -> @FYa?M on 7/10/2019 4:26 PM

    • Did the survey find a distinction between practice patterns of PTs who are receiving patients through direct access vs those receiving patients as a result of primary care referral? Presumably, patients who are referred from their primary care providers would have had their vital signs measured prior to the PT referral, and in many cases, the PTs have access to those recordings through the electronic medical records. I suspect that PTs receiving patients through direct access would have a higher likelihood of measuring vital signs at the initial PT evaluation. Therefore, I am interested to know if the survey found this distinction.

      Posted by David Bell on 7/11/2019 3:28 PM

    • Hey Mark to all other readers. Here are some free resources created by the APTA CVP Section #VitalsAreVITAL campaign on blood pressure measurement technique and interpretation. Thank you! http://cardiopt.org/vitalsarevital/

      Posted by Richard Severin on 7/12/2019 8:06 AM

    • We recently submitted an abstract proposal for Denver-CSM where we collected BP data on 98 patients (who had rested-10-min) coming to an outpatient PT facility here in TX. Only 21% were normotensive and 38.2% had an elevated BP. Only 56% of the sample reported taking medications and few could name their medications. PT can help these patients. Jill Jumper, PT, DPT, GCS Dennis G. O'Connell, PT, DPT, Ph.D, FACSM

      Posted by Dennis O'Connell -> >GT\?O on 7/12/2019 3:43 PM

    • Measuring and interpreting vital sign responses to changes in positions and physical exertion/activity/exercise demonstrates: 1) clinical skill, 2) knowledge of good fall risk and pain assessment practice, and 3) need for medically necessary treatment to improve self-care health literacy. What is the reasoning for not measuring and assessing vital signs with every new patient?

      Posted by Lise McCarthy on 7/14/2019 10:56 PM

    • I am not sure the format will remain the same but here is the template I have been using. If there are newer BP recommendations and other self-care strategies than what I have listed please share with the group! The billing code I use for self-care healthcare literacy training is 97535. 97535 = SELF-CARE HEALTH LITERACY: BLOOD PRESSURE Skilled training: [1, 2, 3, 4, 5, 6] 1) Discussed signs and symptoms of orthostatic hypotension = blood pressure dropping to abnormally low levels upon rising, feelings of light-headedness and/or dizziness may simultaneously occur but that sometimes blood pressure drops are not felt until it is too late (e.g. fall upon standing up). 2) Discussed low BP screen and classification of high BP. 3) Discussed preventive and corrective strategies for low blood pressure: a) good hydration throughout the day, b) using paced exercise (e.g. ankle pumps, leg kicks for 1 minute before standing up) to stimulate or relax BP system, and c) wearing pressure hose. 4) Discussed trends in BP measures. 5) Discussed diet, sleep and stress reduction interventions for self-managing especially high blood pressure. 6) Identified and discussed blood pressure medications. HYPERTENSION CLASSIFICATION: Patient's resting blood pressure stage = [??]. Stage 0 = < 150/90 mmHg Stage 1 = 150-159/90-99 mmHg Stage 2 = 160-179/100-109 mmHg Stage 3 = 180+/110+ mmHg ORTHOSTATIC HYPOTENSION SCREEN Resting sitting: BP [??], PR [??]. Immediate standing: BP [??], PR [??]. Post 3-minute standing: BP [??], PR [??]. Is patient clinically orthostatic? [??]. Orthostatic BP Type (i.e. immediate, delayed) = [??]. NOTE: If SBP responds with > 20 mmHG drop AND any SBP is below 90 mmHG, referral may be indicated even in the absence of symptoms.

      Posted by Lise McCarthy on 7/15/2019 8:14 AM

    • I am a student, new direct patients should be tested atleast on the first visit. And i doubt it is a problem of clinical logistics or policies since usually the first visit should be of an hour.

      Posted by francisco lemus on 7/15/2019 1:44 PM

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