scholarly journals Comparison of the Therapeutic Alliance Indicators according to the Results of the Survey of Cardiosurgical Patients and their Physical Therapists

2020 ◽  
Vol 5 (6) ◽  
pp. 275-281
Author(s):  
V. V. Vitomskyi ◽  
◽  
K. M. Al-Hawamdeh ◽  
M. V. Vitomska ◽  
S. V. Gavreliuk
Keyword(s):  
Cardiac Surgery ◽  
Physical Therapy ◽  
Therapeutic Alliance ◽  
Questionnaire Survey ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Early Mobilization ◽  
Therapeutic Exercises ◽  
Postoperative Physical Therapy ◽  
High Level

The purpose of the study was to determine and compare the indicators of the therapeutic alliance based on the results of a survey of cardiac surgery patients and their physical therapists. Material and methods. The survey involved 100 patients (over 18 years old, without cognitive impairment) who underwent cardiac surgery. The Working Alliance Inventory questionnaire was used to assess the level of therapeutic alliance formation. The SF Hatcher Client form (which consists of 12 questions) was used for the patient. These questions were divided into three groups / domains: "goal items", "task items" and "bond items". The questionnaire was filled in on the seventh postoperative day. The SF Hatcher Client form, which consisted of 12 questions, was used for the patient. Intervention: before surgery, patients received a short consultation with a physical therapist regarding the goals and content of physical therapy, the algorithm for activation after surgery; the postoperative physical therapy protocol included early mobilization, therapeutic gymnastics, the use of respiratory physical therapy techniques, and therapeutic walking under the supervision of a physical therapist. Patients were provided with information and tasks on therapeutic walking, a small set of therapeutic exercises and breathing physical therapy for independent implementation. Results and discussion. The indicators of the therapeutic alliance between physical therapists and cardiac surgery patients confirmed its high level, both according to the results of the questionnaire survey of patients and the results of the survey of specialists. The "goal items" domain had the highest score in the patient's assessment of therapeutic alliance. Since the patient and specialist questionnaires had a different number of questions and a different maximum score, it was decided to make comparisons of the overall estimates of the level of therapeutic alliance after converting them to a percentage of the maximum. A significantly better overall score for the therapeutic alliance was established according to the results of the questionnaire survey of physical therapists: 87.5 (82.5; 95) % of the maximum versus 81.25 (66.67; 89.58) % of the maximum (p = 0.000). Conclusion. Physical therapists rated the therapeutic alliance for a higher score

scholarly journals Analysis of the Influence of Demographic Indicators on Satisfaction with Stationary Physical Therapy among Cardiosurgical Patients

2020 ◽  
Vol 5 (5) ◽  
pp. 258-264
Author(s):  
V. V. Vitomskyi ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Physical Therapy ◽  
Normal Distribution ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Correct Diagnosis ◽  
Mean Value ◽  
Level Of Satisfaction ◽  
The Law ◽  
High Level

The purpose of the study was to assess satisfaction with physical therapy received during a stay in a cardiac surgery hospital, and to investigate the influence of gender and age of patients on its level. Material and methods. The study involved 87 patients (men n = 56; women n = 31; age 61.59±11.41 years) who underwent cardiac surgery. An adapted version of the Physical Therapy Satisfaction Questionnaire was used to assess satisfaction, which consisted of 17 statements. The obtained results were processed by methods of mathematical statistics. As the results of the vast majority of indicators did not comply with the law of normal distribution, the median (Me) and upper and lower quartiles (25%; 75%) were calculated. For the results of indicators that corresponded to the law of normal distribution, the mean value and the standard deviation (±S) were additionally calculated. To assess the significance of the difference, in the presence of a normal distribution of research results, Student's t-test (for independent groups) was used, and for indicators with a different distribution than normal, Mann-Whitney U-test (for independent groups) and χ2 test were used. Spearman's correlation rank criterion was used to study the effect of age on satisfaction with physical therapy. Results and discussion. Comparison of the results of men and women did not reveal significant differences in the results of the survey. Only two items (explaining the reasons for physical therapy; waiting after the appointment) out of seventeen had a significant inverse relationship with age, but its strength was weak. The results of all points of satisfaction with physical therapy were high. Most patients agreed or completely agreed with the statement of the questionnaire. The answer "uncertain" was observed much less often. In the analysis of the obtained indicators of satisfaction in the general sample of patients, the best results were obtained in the seventh item of the questionnaire (friendliness and politeness), the thirteenth (respect for the physical therapist) and the first (explanation of the reasons for physical therapy). The lowest scores were obtained in the third (the feeling the correct diagnosis of physical therapists), fifth (access to the necessary physical therapists for feedback on physical therapy procedures), sixteenth (matching the patient's ability to physical therapy). The reasons which could influence decrease in estimates in indicators with the lowest results are considered. The total score of all items was 81 (77; 85) points. Taking into account that the theoretical maximum is 85 points and a minimum of 17 points (with the answers "strongly disagree" in all points), the median was 94% of the maximum result, which further confirms the high level of patient satisfaction. Conclusion. The age and sex of cardiac surgery patients did not affect the level of satisfaction with physical therapy. The survey of patients confirmed a high level of satisfaction

scholarly journals The Influence of Approaches to Early Mobilization of Cardiosurgical Patients on the Duration of Hospitalization

2021 ◽  
Vol 6 (6) ◽  
pp. 194-199
Author(s):  
V. V. Vitomskyi ◽  
◽  
M. V. Vitomska ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Physical Therapy ◽  
Medical Staff ◽  
Physical Therapist ◽  
Early Mobilization ◽  
Old Patients ◽  
Therapeutic Exercises ◽  
Duration Of Hospitalization ◽  
The Impact

The purpose of the study was to compare the impact of approaches to early mobilization of cardiac surgery patients on the duration of hospitalization. Materials and methods. Early mobilization of patients after cardiac surgery and study of its effectiveness is an important issue of physical therapy. The beginning of the development of cardiac surgery was characterized by the fact that patients after surgery were in the intensive care unit on a bed rest for several days to improve recovery and prevent complications. The benefits of early mobilization were later recognized, and patient verticalization began earlier. The study involved 90 patients (over 18 years old). Patients were divided into two groups. The first group of mobilization (GM1, n = 49) included patients who underwent surgery on Monday or Tuesday, performed standing and if possible walking on the spot on the first postoperative day with a physical therapist. The second group of mobilization (GM2, n = 41) included patients who underwent surgery on Friday, were mobilized to sit in bed on the first postoperative day; performed standing and walking on the spot on the second or third postoperative day with the participation of medical staff. In addition, other early mobilization points (chamber walking and corridor walking) were performed statistically later in GM2. Patients did not differ in other features of physical therapy. All patients were told during the preoperative consultation with a physical therapist that if they were operated on Friday, they would perform mobilization and therapeutic exercises with medical staff on weekends. Patient case data (age, sex, study protocols and operations) were studied. Results and discussion. Among GM1 patients, the part of men was 69.39%, and in the GM2 group – 78.05% (χ² = 0.856; p = 0.355). Groups of patients did not have significant differences in age, anatropometric parameters, key results of preoperative studies, characteristics of surgical interventions. The study did not establish the effect of more progressive early mobilization performed in GM1 on the length of stay in the postoperative ward (7 (6; 8) nights versus 7 (5; 8) nights; p=0.428) and the total duration of postoperative hospitalization (9 (8; 10) nights against 10 (7; 11) nights; p=0.733). Statistically better indicators of the GM1 group were obtained in the number of nights spent in intensive care (all patients – two nights, except 3 patients in GM1 and 11 in GM2 – three nights; p=0.007), but this advantage should be considered taking into account the impact of patient logistics, namely longer stay in intensive care on weekends. Conclusion. The data confirmed the same effectiveness of approaches to early mobilization of cardiac surgery patients in terms of duration of postoperative hospitalization

scholarly journals Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management

2011 ◽  
Vol 91 (10) ◽  
pp. 1490-1502 ◽  
Author(s):  
Susie Thomas ◽  
Shylie Mackintosh ◽  
Julie Halbert
Keyword(s):  
Hip Fracture ◽  
Physical Therapy ◽  
Acute Care ◽  
Best Practice ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Acute Care Hospital ◽  
Early Mobilization ◽  
Care Hospital ◽  
Retrospective Case

Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.

scholarly journals Comparison of three respiratory physical therapy techniques and their impact on pulmonary function restoration among cardiac surgery patients in hospital settings

2021 ◽  
Vol 23 (4) ◽  
pp. 531-535
Author(s):  
V. V. Vitomskyi
Keyword(s):  
Cardiac Surgery ◽  
Physical Therapy ◽  
Pulmonary Function ◽  
Vital Capacity ◽  
Physical Therapist ◽  
Forced Expiratory Volume ◽  
Control Group ◽  
Therapeutic Exercises ◽  
Significant Difference ◽  
Respiratory Exercises

The aim. To compare three respiratory physical therapy techniques and their impact on pulmonary function restoration among cardiac surgery patients in hospital settings. Materials and methods. The study involved 126 patients of both sexes who were admitted for cardiac surgery. All the procedures were performed by sternotomy with cardiopulmonary bypass and cardioplegic arrest. The patients were randomly divided (with a ratio of 1:1:1 by envelope method) into the control group (CG, n = 42), incentive spirometry group (ISG, n = 42) and іnspiratory muscle training group (IMTG, n = 42). The examined patients underwent standardized physical therapy (early mobilization; therapeutic exercises; coughing). The groups varied in respiratory therapy. Patients of the ISG group performed additional respiratory exercises using a Tri-Ball respiratory exerciser (three repetitions of 10 forced, full and rapid inspirations through the respiratory exerciser under the supervision of a physical therapist; besides, they were recommended to perform 3 repetitions with 10 inspirations each hour). Patients of the IMTG group performed additional respiratory exercises using Respironics Threshold IMT breathing exerciser, received explanations and recommendations like patients of the ISG group. The pulmonary function test (PFT) was performed for the patients of all groups before the surgery and on the 7 postoperative day. Results. PFT scores did not differ statistically between the groups of patients before the surgery. The three groups of patients had a negative dynamic of all test indicators, except Tiffeneau index. The analysis of PFT final scores did not confirm a significant difference in the studied indicators among the groups: vital capacity (P = 0.599), forced vital capacity (P = 0.393), forced expiratory volume in one second (P = 0.589), peak expiratory flow (P = 0.326), forced inspiratory vital capacity (P = 0.258), peak inspiratory flow (P = 0.569). Conclusions. Statistical analysis of PFT indicators did not reveal any significant differences among the groups of cardiac surgery patients at the preoperative examination and on the 7 postoperative day, despite the differences in postoperative respiratory physical therapy.

scholarly journals From Persuasion to Coercion: Responding to the Reluctant Patient in Rehabilitation

2016 ◽  
Vol 96 (8) ◽  
pp. 1234-1240 ◽  
Author(s):  
Lynley Anderson ◽  
Clare Delany
Keyword(s):  
Physical Therapy ◽  
Patient Autonomy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Early Mobilization ◽  
Best Interests ◽  
Ethical Responsibility ◽  
Successful Rehabilitation ◽  
Treatment Pressure ◽  
Ethical Quandary

AbstractEarly mobilization of patients while in hospital has been demonstrated to provide better outcomes for patients and use fewer resources. Physical therapy–based rehabilitation is central to achieving those goals. Successful rehabilitation requires that patient's and therapist's goals align, and this is commonly the case. However, occasionally, physical therapists will come across patients who are competent but reluctant to mobilize. This situation leaves the physical therapist in an ethical quandary: either accept the patient's right to refuse proposed treatment or utilize other strategies to encourage the patient to adhere to treatment. Practically, physical therapists will use a range of treatment pressures, including persuasion, offering incentives, inducements, possibly threatening or coercing, and even explicitly overriding the patient's wishes (compulsion). Deciding which treatment pressure is ethically acceptable involves the physical therapist balancing his or her therapeutic view of what is in a patient's best interests against the therapist's ethical responsibility to respect patient autonomy. This article evaluates some common strategies used by physical therapists to influence, persuade, or perhaps pressure patients to adhere to rehabilitation. The work of Szmukler and Appelbaum is utilized in analyzing treatment pressures. The authors conclude that there is a spectrum of treatment pressures, with some (persuasion and incentives) being more acceptable than others (threats and compulsion). As physical therapists balance health system pressures for rapid turnover of beds with obligations to benefit patients within limited reimbursement models, while respecting the patients' autonomy, they must be mindful of the effects of treatment pressure on patient care.

scholarly journals The results of the analysis of the criteria of therapeutic alliance of patients orthopedic profile of outpatient physical therapy program

2019 ◽  
Vol 5 (3) ◽  
pp. 15
Author(s):  
S.M. Fedorenko ◽  
V.V. Vitomskyi ◽  
О.B. Lazarіeva ◽  
M.V. Vitomskа
Keyword(s):  
Statistical Analysis ◽  
Physical Therapy ◽  
Therapeutic Alliance ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Medical Center ◽  
Scientific Information ◽  
International Classification Of Functioning ◽  
Therapy Program ◽  
Literary Sources

<p><strong>Objective:</strong> to determine the peculiarities of forming a therapeutic alliance in outpatients with disorders of orthopedic profile after completing a course of physical therapy and their physical therapists depending on the psychotype of patients.</p><p><strong>Methods of research:</strong> theoretical analysis and generalization of literary sources, method of systematization of scientific information; Working Alliance Inventory questionnaire Form SF Hatcher (WAI). Patients were grouped using the International Classification of Functioning and Disease Types. The obtained results were processed by adequate methods of mathematical statistics. The study involved 113 patients who underwent a course of physical therapy at FESCO Medical Center during 2013-2015.</p><p><strong>Results.</strong> According to the results of the statistical analysis, patients with irrational attitude to the disease (irrational psychotypes) had significantly lower scores on the eight items of the WAI questionnaire out of twelve, as well as on all three totals. In particular, the «goal» score was significantly better in patients with rational psychotypes: Me (25; 75) scores were 14 (12.75; 15) points, versus 12 (11; 14) scores among patients with irrational psychotypes (p&lt;0,01). Similarly, the score of the "task" was 15 (13; 15) points against 12 (11; 15) points (p &lt;0.01), and the total score of the "bond" points 16 (16; 17) points against 14 (13; 15) points (p &lt;0.01). Thus, it can be stated that the evaluation of the “goal” items showed the lowest results, which were the farthest from the maximum values.</p><p><strong>Conclusion.</strong> The results obtained and the statistical analysis made it possible to evaluate the different sides of the level of formation of the therapeutic alliance, to identify the strengths and weaknesses and, thus, necessitated the development of ways to improve the union of the patient and the physical therapist.</p>

scholarly journals Issues Affecting the Delivery of Physical Therapy Services for Individuals With Critical Illness

2013 ◽  
Vol 93 (2) ◽  
pp. 256-265 ◽  
Author(s):  
Amy J. Pawlik ◽  
John P. Kress
Keyword(s):  
Critical Illness ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Interprofessional Collaboration ◽  
Functional Limitations ◽  
Early Mobilization ◽  
The Body ◽  
Routine Practice ◽  
Therapist Competence

Research supports the provision of physical therapy intervention and early mobilization in the management of patients with critical illness. However, the translation of care from that of well-controlled research protocols to routine practice can be challenging and warrants further study. Discussions in the critical care and physical therapy communities, as well as in the published literature, are investigating factors related to early mobilization such as transforming culture in the intensive care unit (ICU), encouraging interprofessional collaboration, coordinating sedation interruption with mobility sessions, and determining the rehabilitation modalities that will most significantly improve patient outcomes. Some variables, however, need to be investigated and addressed specifically by the physical therapy profession. They include assessing and increasing physical therapist competence managing patients with critical illness in both professional (entry-level) education programs and clinical settings, determining and providing an adequate number of physical therapists for a given ICU, evaluating methods of prioritization of patients in the acute care setting, and adding to the body of research to support specific functional outcome measures to be used with patients in the ICU. Additionally, because persistent weakness and functional limitations can exist long after the critical illness itself has resolved, there is a need for increased awareness and involvement of physical therapists in all settings of practice, including outpatient clinics. The purpose of this article is to explore the issues that the physical therapy profession needs to address as the rehabilitation management of the patient with critical illness evolves.

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

scholarly journals Effect of Physical Therapy on Fall-Risk and Physical Status in Older Adults with Frailty and Metabolic Syndrome

2020 ◽  
Vol 5 (6) ◽  
pp. 282-291
Author(s):  
N. P. Koval ◽  
◽  
M. G. Aravitska
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Metabolic Syndrome ◽  
Physical Therapy ◽  
Therapeutic Alliance ◽  
Fall Risk ◽  
Physical Therapist ◽  
Main Group ◽  
Frailty Syndrome ◽  
Physical Status

The constant increase in the proportion of the disabled or partially disabled elderly population and, accordingly, patients of this age contingent, leads to the need for rehabilitation and physical therapy of persons with geriatric syndromes and various comorbid pathologies. The purpose of the study was to determine the effectiveness of a physical therapy program based on the dynamics of indicators of the fall-risk and physical status in older adults with frailty syndrome and metabolic syndrome. Material and methods. 96 older adults were examined. The control group consisted of persons without metabolic syndrome and without frailty syndrome. The main group 1 consisted of persons with metabolic syndrome and frailty syndrome who did not express a desire to cooperate with a physical therapist and / or actively improve their health on their own (low level of therapeutic alliance). They were provided with recommendations on the WHO CINDI program (diet modification, extension of household and training physical activity). Main group 2 included patients who showed consent to take active steps to improve their own health under the supervision of a physical therapist (high level of therapeutic alliance). We developed a physical therapy program for them using kinesitherapy, massage, nutritional correction, education of the patient and his family, elements of cognitive training and occupational therapy for one year. The dynamics of the state was assessed according to the results of the Short Physical Performance Battery, hand dynamometry, Senior Fitness Test, the Berg Balance Scale. Results and discussion. Older adults with metabolic syndrome and frailty syndrome demonstrated a high fall-risk (according to the results of a Short battery of physical activity tests and the Berg scale) and a statistically significant lag in physical status parameters (coordination, balance, strength, flexibility, endurance, agility) according to the parameters of the Senior Fitness Test, hand dynamometry, Short battery of physical activity tests) from their peers. These results increase the risk of adverse health effects, loss of autonomy and death. The use of physical therapy in main group 1 subjects led to a statistically significant (р<0.05) improvement in physical qualities, a decrease in the intensity of frailty signs; leveling the fall-risk in them. The low level of therapeutic alliance of persons in the main group 2 led to unsatisfactory fulfillment or non-fulfillment of the recommendations provided and is associated with a lack of improvement in their physical status and a high fall-risk. Conclusion. It is advisable to include physical therapy means in the rehabilitation programs for elderly patients with comorbid pathology of frailty and metabolic syndrome

scholarly journals Patient Participation in Physical Therapy Goal Setting

2001 ◽  
Vol 81 (5) ◽  
pp. 1118-1126 ◽  
Author(s):  
Susan M Baker ◽  
Helen H Marshak ◽  
Gail T Rice ◽  
Grenith J Zimmerman
Keyword(s):  
Patient Satisfaction ◽  
Physical Therapy ◽  
Elderly Patients ◽  
Goal Setting ◽  
Patient Participation ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Assessment Instrument ◽  
Initial Examination ◽  
Goals And Objectives

Abstract Background and Purpose. An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. Subjects and Methods. Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (X̄=76.4 years of age, SD=7.1, range=65–94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. Results. Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. Discussion and Conclusion. In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.

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