Rehab & Wellness:Creating an Innovative, Evidence-Based, Person-Centered
Wellness Model of Care Beyond TherapyCasey Shotts, PT, DPT, Senior Rehab Solutions, Dallas, TX
Julie Kirkwood, PT, Midland PACE, Topeka, KS Heidi Pickerell, Midland PACE, Topeka, KS
Overview
SRS & Midland PACE - how it all started
Rehab-Driven Wellness Model ApproachSenior Fitness Testing – 0-6 risk factors identifiedDetermine appropriate movement through rehab continuum/tracksTargeted wellness initiatives based on SFT outcomesOvercoming challenges, obstacles; enhancing participant engagement and satisfaction; scheduling
Zoom Login Instructions
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First round of Zoom Polling Introductions – Let’s Go!
Senior Fitness Test
Adults 60-90+ with broad range of abilitiesFocus on function – tests physical capacity to perform normal everyday activities safelySimple and economical; minimal equipmentComprehensive with normative valuesGood test-retest reliabilityCriterion-referenced test – predetermined standard of performance tied to physical independence
Senior Fitness Test Items
Test Purpose Functional Risk Areas30 Second Sit to Stand LE strength Transfers, Toileting, GaitArm Curl Test UE strength UB dressing, grooming,
hygiene; lifting/carrying6 minute walk test or 2 minute step test
Aerobic endurance Gait, endurance for prolonged tasks
8 Foot Up & Go Gait speed, agility, balance
Gait, standing balance, transfers
Chair sit and reach LE Flexibility LB dressing, functional reaching
Back Scratch test UE Flexibility UB dressing, toileting hygiene, home skills
SFT Normal Ranges - Women
SFT Normal Ranges - Men
Zoom Polling Senior Fitness Test
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30 Second Sit to Stand – Ready, Set, GO!
Rehab-Driven Wellness Model
• SFT data collection launched December 2017 on volunteer basis; ppt retested every 3 months
• New enrollment baseline assessments added June 2018 – new ppts tested during 1st month on PACE
• Use SFT data & PT/OT clinical judgment to determine appropriate rehab continuum track
• Use SFT data, outcome trending, PT/OT clinical judgment to modify programs and select targeted exercises for specificity
Rehab Continuum Tracks
• Continuous, multi-directional movement b/w tracks as needed & clinically appropriate
• Clinical judgement, IDT, and SFT assist with appropriate tier level
Skilled Rehab
WellnessIndependent
Skilled Rehab Track
Based on individual needs & change in condition –primary goal to improve functionAutomatic inclusion criteria > 4 SFT risk items identifiedNew or worsening SFT risk items triggeredSkilled level of care focused on addressing underlying impairments impacting functional abilities – PT, OT, ST 1:1 services
Skilled Rehab
WellnessIndependent
Wellness Track
Primary goal to maintain level of function; prevent decline when ableInclusion criteria </= 4 SFT risk items identifiedFocus on health promotion & education; engagement Group and individual exercise programmingOversight & training provided by PT/OT; carried out by trained team member –Wellness Technician
Skilled Rehab
WellnessIndependent
Independent Track
Future initiative – goal of ppt ownership & adoption of Wellness for quality of lifeHigh focus on ppt/caregiver training and educationUse satisfaction surveys and ppt report to create programs of interestEngagement & compliance are challenges
Skilled Rehab
WellnessIndependent
Zoom Polling SFT Trends
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SFT Initial Findings & Plan
Initial score findings (Volunteer round 1 and new ppt)• Scores in normal range for Arm Curl Test and Chair
Sit & Reach• Low physical functioning scores for: 30SST, 6MWT,
Back Scratch, 8 Foot Up & GooWellness exercise specificity for 30SST while also
addressing individual risk areas with each pptoSkilled OT focus on Back Scratch test when this item
was triggered and OT interventions deemed appropriate
Exercise Specificity
• Principle of specificity predicts that the closer the training routine is to the requirements of the desired outcome (i.e. a specific exercise task or performance criteria), the better will be the outcome
• Wellness exercises specific to 30 SST with anticipation of strength adaptations impacting other components of SFT
• Weekly meeting with Wellness Technician to review weekly trends, barriers, ppt response to targeted exercises
30-Second Chair Stand - Women
30-Second Chair Stand - Men
Exercises for 30 Second Sit to Stand
TARGETED EXERCISES GENERAL EXERCISES
Eccentric Chair SquatsUE Assisted Chair StandsChair Stand Speed DrillsChair Squats with Forward ReachEyes Open/Eyes ClosedCompliant SurfacesUnilateral Chair Squats with/without UEChair Squats with Free Weights
Seated/Standing MarchingResistance Ball SqueezesResistance bands for ABD/ADD Resistance bands ham curlsLungesWall SitsAnkle weight resisted LAQHeel Raises/Toe Taps
SFT Retest Findings & Plan
• Improvements noted round 2 (3 months after initial) of testing but then plateau with round 3 &4
• Improved initial vs. round 2 30SST scores & 6MWT scores – correlation?
• Decline 6MWT round 3, 4 or refusal to completeo Plan - Replace 6MWT with 2MSTo Better ppt response to 2MST; scores = low functioning
• Arm Curl Test decline initial vs. round 2 – possibly related to LE strength focus and UE ROM focus?o Plan - Increase UE resistance training; no change noted yet
30-Second Arm Curl - Women
30-Second Arm Curl - Men
Exercises for Arm Curl Test
TARGETED EXERCISES GENERAL EXERCISESSingle/Double Arm CurlsSingle/Double Hammer CurlsAlternating CurlsIsometric HoldsEccentric Curls
Boxing with or without dumbbellsWall push upsResistance band rows, lat pull downsTriceps kickbacksUpright rowOverhead pressFunctional tasks – carrying large items, bags, etc.
Lessons & Challenges
• SRS learning PACE• Volunteer vs. Enrollment standard• Day Center challenges• Ppt satisfaction/engagement
o 6MWT vs. 2MSTo Pedometerso Competition, games, prizes, FOOD
• Data collectiono Flexibility testing o Behavioral?o Non-ambulatory options
Future Wellness Opportunities
• Possible assessment additions/modificationso Non-ambulatory testingo Quality of Life and depression scaleso Cognition, memoryo Fall risk assessment o New test entirely?
• Routine survey and polling for satisfaction & engagement – working well with CCRC campuses
• Increase service offerings for health promotion and education – monthly topics/challenges (mirror current programming in CCRC campuses?)
Zoom Polling Conclusion
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Thank You!
• Questions? Please contact:
Casey Shotts, PT, DPT Clinical Support SpecialistSenior Rehab [email protected]
References
• Reliability of the Senior Fitness Test in Community‐dwelling Older People with Cognitive Impairment Karin Hesseberg Hege Bentzen Astrid Bergland13 June 2014; https://doi.org/10.1002/pri.1594
• The Intensity and Effects of Strength Training in the Elderly Frank Mayer, Friederike Scharhag-Rosenberger, Anja Carlsohn, Michael Cassel, Steffen Müller, Jürgen Scharhag; Deutsches Ärzteblatt International | Dtsch Arztebl Int 2011; 108(21): 359–64
• Steib S, Schoene D, Pfeifer K: Dose-response relationship of resistance training in older adults: a meta-analysis. Med SciSports Exercise 2010; 42: 902–14.
• Orr R, Raymond J, Fiatarone Singh M: Efficacy of progressive resistance training on balance performance in older adults. A systematic review of randomized controlled trials. Sports Med 2008; 38: 317–43.
• Jordan M. Glenn, Michelle Gray and Ashley Binns, Relationship of Sit-to-Stand Lower-Body Power With Functional Fitness Measures Among Older Adults With and Without Sarcopenia, Journal of Geriatric Physical Therapy, 40, 1, (42), (2017).
• Megan D Salvatore, Alexandra M Colacino, Meghan E Hess, Samuel W Todd and Nathan W Saunders, Concurrent validity and minimum detectable change of Senior Fitness Test components: instrumented vs. manual assessment, Physical Therapy and Rehabilitation, 4, 1, (13), (2017).
