Balanced Physical Therapy

A Letter Sent to Physicians on May 5, 2008

Susan Hardy, MD and colleagues recruited 439 adults age 65 and older to assess multiple possible predictors of mortality that could be used in primary care.¹  Their results were published recently in the Journal of the American Geriatric Society.  They performed physical assessments on all participants at baseline.  Seniors who showed no improvement in habitual gait speed after one year experienced an eight year mortality rate of 49.3%  Participants who showed a gain in gait speed during a quarterly assessment but lost the gains by the one year assessment experienced a mortality rate of 41.2% over the next eight years.  Seniors who showed only a 0.1 meter per second improvement in gait speed after one year experienced a much improved mortality rate of 31.6% over the next eight years.  Hardy et al state that their findings support the recommendations that primary care practitioners should assess gait speed as part of annual geriatric exams.  The Timed-Up-and-Go-Test serves as a simple in-office test to quantify gait speed and compare results to established norms.  Hardy et al also suggest that their findings may underscore the importance of prescribing interventions that affect habitual gait speed. 

Therapeutic exercise can improve habitual gait speed in older adults.^2,3   Balanced Physical Therapy’s Balance C.A.M.P. offers your patients a course of proprioceptive rehabilitation, lower extremity strengthening, gait training, and other PT interventions as indicated by individual assessments.  For each patient, Balance C.A.M.P. begins with a thorough assessment that will identify very specific characteristics that can contribute to accidental falls (e.g. gaze instability, leg weakness, suboptimal proprioception, postural deficits, gait problems, limited range of motion, etc.).  The assessment will help Balanced PT therapists choose specific training and rehabilitation paths that address each patient’s specific deficits.  We find this individualized approach more efficient and more effective than putting every patient through essentially the same course of therapy.  Like most good fall prevention programs, Balance C.A.M.P. empowers patients with a home exercise plan, but Balance C.A.M.P. also provides your patients with the convenient option of joining a fun and supportive exercise group at Balanced Movement Studio. 

Hardy et al recruited patients from two primary care practices serving Medicare populations - making these results particularly relevant to primary care.  Patients using walking aides were included.  Improvement in gait speed proved to be a strong predictor of mortality regardless of whether a patient had been hospitalized during the year.  This study also highlights the importance of general practitioners making physical therapy referrals directly from their practices.

REFERENCES

1. Hardy S, Perera S, Foumani Y, et al. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007; 55 (11): 1727-1734.
2. Lopopolo R, Greco M, Sulliivan D, et al. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: A meta-analysis. Phys Ther 2006; 86:520-540.
3. Ettinger W, Burns R, Messier S, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997; 277: 25-31.