Running Head: VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL...

Running Head: VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY

SELF-REPORTED USE OF VITAL SIGNS IN THE ADULT OUTPATIENT

PHYSICAL THERAPY SETTING

______________________________________________________________________________

An Independent Research Project

Presented to

The Faculty of the College of Health Professions and Social Work

Florida Gulf Coast University

In Partial Fulfillment

of the Requirement for the Degree of

Doctorate of Physical Therapy

______________________________________________________________________________

By

Joshua J. Peters

2014

VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY

APPROVAL SHEET

This Independent Research Project is submitted in partial fulfillment of

the requirements for the degree of

Doctorate of Physical Therapy

____________________________

Joshua J. Peters

Approved: May 2014

____________________________

Ellen Donald, MS, PT

Committee Chair

____________________________

Kathleen Swanick, DPT, MS, OCS

Committee Member

The final copy of this independent research project has been examined by the signatories, and we find that both the

content and the form meet acceptable presentation standards of scholarly work in the above mentioned discipline.


Acknowledgements

First and foremost, I would like to thank my wife Kim and our two sons Jordan and Jaden

for always supporting me in everything I do. This project would not have been possible without

your love, patience, and the sacrifices you’ve made along the way. You are the light of my life

and I love you all so dearly.

I would like to thank my father, David Peters, for inspiring me to learn more about

cardiovascular disease. You’ve approached your own “battle with the beast” with unwavering

determination and “grit.” You’re example has inspired many to join the fight and stand up to

cardiovascular disease.

I would like to thank my committee chair, Ellen Donald, MS, PT, and committee

member, Kathleen Swanick, DPT, MS, OCS. This study would not have been possible if it

wasn't for your affirmation during the early stages and your patience, expertise, and guidance

throughout the process. You are the epitome of excellence as professionals and I feel blessed to

have worked with you on this project. I would also like to thank professor Arie van Duijn, EdD,

PT, OCS for sharing his knowledge regarding statistics and data analysis. Thank you for your

time and guidance during that part of the process.

I would like to thank the Florida Physical Therapy Association (FPTA) for their support.

Without the FPTA’s co-operation, this project would not have been possible. Finally, I am

especially grateful for the time and thoughtful responses given by the individuals who responded

to the survey.


Abstract

Physical Therapists (PTs) are responsible for ensuring the safety of each patient being treated.

Measuring vital signs allows clinicians to screen for undiagnosed conditions, monitor existing

conditions, and facilitate patient safety through prevention. The purpose of this study was to

survey PTs regarding their use of vital signs in the clinical setting. Participants (N=45) included

licensed PTs currently practicing in adult outpatient clinics in the state of Florida. Participants

were recruited via the Florida Physical Therapy Association’s (FPTA) website. The survey

assessed the frequency of heart rate (HR), blood pressure (BP), and pulse oximetry (SpO2)

measurement in the six months prior to taking the survey; beliefs about the importance of

measuring vitals, reasons for not measuring vitals, and information pertaining to the

demographics of the respondents. Only 28.9% (n=13) of respondents (N=45) reported that their

clinic had a policy regarding the measurement of vital signs and few believed it was important to

measure vitals on each patient at every visit (“Extremely Important”; HR n=4, BP n=4, SpO2

n=3). When asked the reasons for not measuring vitals, the most frequently chosen responses

were “not important for my patient population” (40.0%; n=18) and “lack of time” (22.2%; n=10).

This study provides useful information about the gaps between the American Physical Therapy

Association’s (APTA) recommendations for measuring vitals and current clinical practices.

VITAL SIGNS IN ADULT OUTPATIENT PHYSICAL THERAPY 5

Table of Contents

Introduction ................................................................................................................................7

Purpose............................................................................................................................7

Research Questions and Hypotheses ................................................................................7

Review of the Literature ..............................................................................................................8

The Global Burden of CVD .............................................................................................8

Current PT Practices ........................................................................................................8

The Silent Killer ..............................................................................................................9

PT Interventions and the Cardiovascular System ........................................................... 10

Underutilization of Secondary Prevention Services ........................................................ 11

Use of Vitals .................................................................................................................. 13

Justification/Need for this Study .................................................................................... 16

Method ..................................................................................................................................... 16

Study Design ................................................................................................................. 16

Participants and Sampling.............................................................................................. 17

Survey Instrument ......................................................................................................... 17

Data Collection .............................................................................................................. 18

Data Analysis ................................................................................................................ 18

Results ...................................................................................................................................... 19

Characteristics of Respondents ...................................................................................... 19

Self-Reported Behaviors and Beliefs ............................................................................. 20

Analysis of Relationships: Beliefs, Behaviors, and Demographic Factors ...................... 22


Differences Based on ABPTS Certification and APTA Membership.............................. 23

Discussion ................................................................................................................................. 25

Summary of Findings .................................................................................................... 25

Future Research ............................................................................................................. 27

Conclusions ................................................................................................................... 28

References ................................................................................................................................ 29

Appendix A: Explanation of Study and Link to Survey on FPTA’s Website ............................. 32

Appendix B: Online Survey Consent Form ............................................................................... 33

Appendix C: Survey Instrument ............................................................................................... 36

Appendix D: Q3 Reasons for Not Measuring Vitals ................................................................. 39

Appendix E: Q4 Estimated Time it Takes to Measure Vitals .................................................... 42

Appendix F: Q5 Area of Practice.............................................................................................. 44

Appendix G: Q6 Primary Problems of Patients Treated During Last 6 Months ......................... 46

Appendix H: Q7 Current Practice Setting ................................................................................. 47

Appendix I: Q8 & Q9 Clinic Policies ....................................................................................... 48

Appendix J: Q10 Entry Level Degree & Q11 Highest Degree Earned ....................................... 50

Appendix K: Q12 & Q13 ABPTS Certification ........................................................................ 52

Appendix L: Q14 Years of Practice .......................................................................................... 54

Appendix M: Q15 & Q16 APTA Membership ......................................................................... 55


Introduction

The prevalence of cardiovascular disease (CVD) and the emergence of physical therapists

(PTs) as autonomous practitioners demand that therapists regularly measure vital signs. Vital

signs (vitals) have been operationally defined to include heart rate (HR), blood pressure (BP),

and pulse oximetry (SpO2). Measuring vitals allows therapists to screen for medical red flags,

incorporate relevant information into the plan of care, and monitor a patient’s cardiovascular

response to PT interventions. Currently, very few studies have examined PT’s engagement in

regularly measuring vital signs (Frese, Richter, & Burlis, 2002; Jette & Jewell, 2012). Likewise,

it is not known if factors such as entry level degree, American Board of Physical Therapy

Specialties (ABPTS) certification, American Physical Therapy Association (APTA)

membership, years of experience, clinic policies, or beliefs of the therapist influence clinical

practice.

Purpose

The purpose of this study is to examine information regarding the measurement of HR,

BP, and SpO2 performed by PTs in adult outpatient physical therapy clinics.

Research Questions and Hypotheses

This study seeks to answer the questions, (1) do PTs, practicing in adult outpatient

settings, routinely measure the HR, BP, and SpO2 of new and existing patients (routinely

measure = 80-100% of the time for their current caseload, in the 6 months prior to participating

in the study)? (2) Is there a relationship between factors such as highest degree earned, ABPTS

specialty, APTA membership, years of experience, clinic policies, beliefs about the importance

of measuring vitals, and the frequency of measuring HR, BP, and SpO2?


The following hypotheses have been formulated: (1) PTs, practicing in adult outpatient

settings, do not routinely measure the HR, BP, or SpO2 of new and existing patients (routinely

measure = 80-100% of the time for their current caseload, in the 6 months prior to participating

in the study). (2) Factors such as highest degree earned, ABPTS specialty, APTA membership,

years of experience, clinic policies, and beliefs about the importance of measuring vitals will

correlate with reported frequencies of measuring HR, BP, and SpO2.

Review of the Literature

The Global Burden of CVD

Cardiovascular disease is an umbrella term referring to a group of disorders primarily

affecting the heart and blood vessels (World Health Organization [WHO], 2011). In 2006, over

600,000 people died from CVD in the United States, accounting for more than one in every four

deaths (Center for Disease Control [CDC], 2010). CVD is the leading cause of death in both

men and women in the United States (CDC, 2010) and globally, more people die each year from

CVD than from any other cause. In 2008, roughly 17.3 million people died from CVD. The

WHO (2011) predicts the number of annual deaths will increase to 23.6 million by 2030 (WHO,

2011).

Current PT Practices

The Guide to Physical Therapist Practice (Guide) lists HR, BP, and SpO2 as tools for

assessing aerobic capacity/ endurance levels and performing cardiovascular and pulmonary

screening. The Guide specifically recommends HR and BP measurements be included in the

examination of each new patient (American Physical Therapy Association [APTA], 2003). It is

unknown whether current practices are in alignment with the APTA’s recommendations. Recent


evidence suggests discrepancies may exist between the APTA’s recommendations and clinical

practice.

Frese et al. (2002) surveyed 387 clinical instructors regarding the importance of

measuring baseline heart rate and blood pressure in the outpatient setting. Only 45% of

respondents agreed (strongly agreed or agreed) that obtaining baseline vitals was essential.

Similarly 43% of respondents reported never measuring baseline vitals in the week prior to

taking the survey. When given a list of why HR and BP were not measured, the most frequently

chosen response was that it was not important for the patient population being treated (Frese et

al., 2002). Jette and Jewell (2012) found that physical therapists may not view themselves as

providers of primary or secondary prevention services. Even more concerning, were the findings

that patient management strategies associated with prevention services may be perceived as

unimportant or burdensome (Jette & Jewell, 2012). Such findings are alarming, especially

considering PT’s roles as autonomous practitioners.

It is increasingly common for PT’s to serve as the first point-of-entry for many people

into the health care system. This responsibility requires screening for undiagnosed CVD.

Although PT’s are not able to diagnose CVD they are equipped to recognize and respond to

patients requiring physician referral or emergency medical attention.

The Silent Killer

The American Heart Association ([AHA], 2012) identifies high blood pressure (HBP) as

a precursor for many other serious cardiovascular conditions including heart failure and stroke.

One in three adults in the United States has HBP (systolic BP ≥ 140 mm Hg/diastolic BP ≥ 90

mm Hg; or taking antihypertensive medication; or being told twice by a physician or other health

care provider that one has HBP) and roughly one in five are totally unaware that they have the


condition (AHA, 2011). Meissner et al. (1999) randomly measured the blood pressures of 636

men and women (age ≥45 years). Roughly 337 participants (53%) were found to be

hypertensive. One hundred thirty-one (39%) were reported to have been totally unaware they

had the condition. The remaining 206 (61%) reported already knowing about their HTN

(Meissner et al., 1999). The decreased awareness and sub-optimal management of HBP reported

among participants in this study, illustrate the need for routine vitals assessment. A strong

relationship exists between BP and increased risk for other cardiovascular related events

(American College of Sports Medicine [ACSM], 2010). This becomes especially relevant to

PT’s due to the volume of evidence found in the literature that suggests many PT interventions

illicit physiological responses by the cardiovascular system.

PT Interventions and the Cardiovascular System

Commonly prescribed therapeutic exercises have been shown to induce a cardiovascular

response. One example is the response to McKenzie exercises for low back pain. The results of

one study suggest that HR and BP increase with increasing repetitions. Participants included 59

men and 41 women with no history of CVD and mean ages of 31 years and 30.6 years

respectively (Al-Obaidi, Joseph, Dean, & Al-Shuwai, 2001). Peel and Alland (1990) examined

cardiovascular responses to isokinetic trunk exercises. Participants performed 30s of trunk

flexion and extension exercises at a moderate speed, followed by 60s of rest. After completing

five intervals, average peak HR increased to 148 bpm (SD ± 21 bpm) or 77% of average HRmax

(Peel & Alland, 1990). Even the most basic interventions, such as simple gait training with an

assistive device, have been shown to increase the demands being placed on the cardiovascular/

pulmonary system. Holder et al. (1993) reported finding assisted ambulation (using, axillary

crutches, standard walker, or rolling walker) caused greater increases in HR and O2 consumption


than unassisted ambulation in healthy participants. Another study found that a sustained passive

stretch, applied to the gastrocnemius and soleus muscles for 60s, prompted a HR increase of

approximately 5 bpm (Gladwell & Coote, 2002). This small increase can be attributed to a

physiological chain of events known as the muscle mechanoreflex. Type III (Aδ), sensory

afferent neurons depolarize in response to mechanical stimuli (i.e. isometric contraction or

passive stretching) and synapse in the cardiovascular control centers of the medulla. The

brainstem nuclei respond by simultaneously increasing sympathetic output and decreasing

parasympathetic output. These changes in autonomic activity result in increased HR and BP. At

first, the clinical significance of the changes in HR reported by Gladwell and Coote (2002) may

seem minimal. However, other studies have reported that the muscle mechanoreflex is

exaggerated in the presence of HBP (Middlekauff et al., 2001; Pickering, 1987). This adds to the

relevance of the findings reported by Gladwell and Coote (2002) and further illustrates the

importance of regularly measuring vitals.

Collectively, these studies demonstrate the wide range of cardiovascular responses to PT

interventions. In patients with CVD, these interventions may elicit an unexpected response that

could potentially be life-threatening. Additional evidence demonstrates the need to continuously

improve prevention services due to a growing number of patients with poorly managed CVD.

Underutilization of Secondary Prevention Services

Following a serious incident, individuals with CVD may participate in a cardiac

rehabilitation (CR) program. A current definition for CR comes from the U.S. Public Health

Service stating:

Cardiac rehabilitation services are comprehensive, long-term programs involving medical

evaluation, prescribed exercise, cardiac risk factor modification, education, and counseling.


These programs are designed to limit the physiologic and psychological effects of cardiac illness,

reduce the risk for sudden death or re-infarction, control symptoms, stabilize or reverse the

atherosclerotic process, and enhance the psychosocial and vocational status of selected patients

(as cited in Thomas et al., 2007, p. 1404)

There is a large body of evidence supporting the efficacy of exercised-based cardiac

rehabilitation programs.

After analyzing the results of 47 studies where a total of 10,794 patients were randomized

to either an exercise based CR program or usual care, Heran et al. (2011) reported that the

exercise based group reported “significantly improved health related quality of life.” This

analysis also established the effectiveness of exercise based CR in reducing the rate of

cardiovascular mortality (Heran et al. 2011). Koovor et al. (2006) conducted a randomized trial

of 142 patients and reported that exercise based CR significantly decreased several risk factors

associated with CVD. In the same study, patients who returned to work with no CR did not

experience the same decrease (Koovor et al., 2006). Studies have also shown that exercise based

CR improves the quality of life in patients with CVD by reducing risk factors such as anxiety

and depression (Yohannes, Doherty, Bundy, & Yalfanni, 2010; Zwisler et al., 2008). After

conducting a multivariate analysis of 441 patients, Barth et al. (2009) reported men and women

benefit equally from physical and psychological responses to exercise based CR. Although there

is strong evidence supporting the efficacy of exercise based CR programs, many are widely

underutilized.

The AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for

Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services found that

referral to CR programs occurs in less than 30% of patients who are eligible (Thomas et al.,


2007). Suaya et al. (2007) reported that only 50,000 of 267,427 or 18.7% of Medicare-eligible

patients over the age of 65 were referred to a CR program following a cardiac related event.

These findings suggest an increase in the number of people with diagnosed, yet poorly managed

CVD. This presents an opportunity for adult outpatient PT clinics to play an important role in

secondary prevention.

Consider the example of a patient with poorly managed CVD being treated for LBP at an

outpatient clinic. As suggested earlier, many PT interventions illicit a response from the

cardiovascular system. Regularly measuring vitals during therapy sessions may help prevent

another major cardivascular incident. Alternately, failure to properly measure vitals

compromises the health and safety of the patient. The increased incidence of CVD, physiological

demands of PT interventions, and underutilization of CR programs all demonstrate the

importance of patient management strategies for the prevention of CVD. Obtaining a thorough

past medical history, regularly measuring vital signs, and assessing the risk stratification for each

patient are effective practices for ensuring patient safety.

Use of Vitals

Risk stratification is the process of categorizing individuals as low, moderate, or high risk

for CVD. Assessment of risk stratification can enable PTs to make appropriate

recommendations for physical activity, select safe parameters for exercise, and determine when

further medical examination is warranted. HR and BP measurements should be included when

determining risk stratification. The ACSM (2010) suggests a risk stratification based on the

criteria outlined in Table 1. Asymptomatic men and women who have ≤ 1 risk factor are

considered low risk while asymptomatic men and women who have ≥ 2 risk factors are

considered moderate risk. Individuals are considered high risk if they have major signs and


symptoms suggestive of cardiovascular, pulmonary, or metabolic disease; or if they have been

previously diagnosed with any of those conditions.

Table 1

Risk Factors for CVD

Positive Risk Factors Defining Criteria

Age M ≥ 45 years, F ≥ 55 years

Family History Myocardial infarction

Coronary revascularization

Sudden death before 55 years of age in male first-degree relative

or 65 years of age in female first-degree relative

Cigarette Smoking Current smoker or quit within previous 6 months or

exposure to environmental tobacco smoke

Sedentary Lifestyle < 30 minutes of moderate intensity exercise (40-60% VO2R) on at

least 3 days of the week for at least 3 months

Obesity BMI ≥ 30 kg∙m2 or

Waist girth M > 102 cm; F > 88 cm

Hypertension *Systolic blood pressure (SBP) ≥ 140 mm Hg and/or diastolic

blood pressure (DBP) ≥ 90 mm Hg or

Currently prescribed antihypertensive medications

Dyslipidemia LDL-C ≥ 130 mg∙dL-1 or HDL-C < 40 mg∙dL-1 or

Currently prescribed lipid-lowering medication

Pre-diabetes *Fasting plasma glucose ≥ 100 mg∙dL-1 but < 126 mg∙dL-1 or

*2-hour oral glucose tolerance test ≥ 140 mg∙dL-1 but < 200

mg∙dL-1

* Confirmed on at least two separate occasions.


The AHA recommends that M ≥ 45 yrs. of age and F ≥ 55 yrs. of age, having 2 or more

risk factors, undergo medical examination and a medically supervised exercise test before

engaging in vigorous exercise. The AHA also proposes that men and women with moderate to

high risk for cardiac complications during exercise undergo constant ECG and BP monitoring

during training (as cited in ACSM, 2010). Both the AHA (2012) and ACSM (2010) recommend

measuring HR and BP before, during, and after exercise to monitor for abnormal responses.

The normal BP response to exercise includes a progressive increase in SBP, little change

in DBP, or possibly a slight decrease in DBP. For low-risk adults, exercise should be terminated

if SBP > 250 mmHg, DBP >115 mmHg, or SBP drops > 10 mmHg. Post-exercise HR and BP

should return to near resting levels before discontinuing monitoring. The ACSM and AHA

recommendations were developed to “reduce the incidence and severity of complications during

exercise” (as cited in Scherer, Noteboom, & Flynn, 2005, p. 731). It can be seen then, that there

is a consensus among the APTA, ACSM, and AHA of the importance of measuring vitals before,

during, and after exercise.

It is the therapist’s responsibility to ensure that each patient qualifies as an appropriate

candidate for physical therapy. A proper evaluation should include a thorough medical history

questionnaire, risk stratification, and measurement of vital signs. Additional measurements

should be made to monitor HR and BP during PT interventions. A decision not to measure vitals

is a decision to ignore critical information that should be incorporated into each plan of care.

Patient centered care involves active participation by the patient/patient’s family members in the

decision making process. Measurement of vitals is essential for providing patients with sound

information regarding their health status and empowering them to make informed health care

decisions.


Justification/Need for this Study

A large body of evidence suggests that many physical therapy interventions impact the

cardiovascular system to some extent. It is imperative that PTs ensure proper services are being

provided to each patient. The profession as a whole could benefit from this study by raising

awareness of the possible discrepancies between the APTA’s recommendations and current

practice behaviors. Understanding these behaviors is the first step towards improving the

standard of care and ensuring patient safety.

Method

Study Design

This a non-experimental quantitative survey study, designed to evaluate practice

behaviors, beliefs of the therapist, and demographic data related to the use of vitals in the adult

outpatient physical therapy setting. Participant recruitment coincided with the start of data

collection. Convenience sampling was utilized. Once IRB Approval was obtained, a brief

description of the study and a link to the informed consent form were placed on FPTA's

Research Support Page. A link to the survey was embedded in the online consent form. Survey

information and all links remained available on the FPTA’s Research Support Page for 21 days

(see Appendix A). The FPTA's Research Support Page was regularly promoted through FPTA

weekly updates, an e-newsletter sent to 3,500 members, the FPTA Facebook page and Twitter

account as per the FPTA's Policies and Procedures for the Research Support Page. A link

allowed potential respondents to access an on-line survey service, Survey Monkey. Information

provided on Survey Monkey included a detailed description of the nature and purposes of the

study, an on-line consent form (see Appendix B), a link for eligible participants to access the

survey, and instructions for individuals who did not want to participate in the study. No other


solicitation materials were used during this study. The link was deleted after three weeks of data

collection and individual responses were downloaded onto a flash drive and placed in a secure

location on campus.

Participants and Sampling

Participants (N=45) included PTs from the state of Florida practicing in the adult

outpatient setting for at least 6 months. Three questions to verify inclusion criteria were included

in the online survey consent form (1. Are you currently employed at an adult outpatient clinic?

2. Do you currently practice in the state of Florida? 3. Have you been practicing at an adult

outpatient clinic for at least 6 months?). These questions were designed to help ensure quality

and accuracy during data collection by verifying eligibility to participate in the study.

Candidates who answered "no" to any of the above questions did not meet the inclusion criteria

and were instructed to disregard the link to the survey. Candidates who answered "yes" to each

of these questions were asked to consider participating in the study and instructed to continue

reading the consent form.

Survey Instrument

The survey instrument (see Appendix C) was designed to evaluate clinical practice,

beliefs of the therapist, and demographic data. The 16 item survey questionnaire was developed

after a thorough review of current literature, with the help and expertise of the committee chair.

The survey was peer reviewed by two Florida Gulf Coast University (FGCU) DPT faculty

members, three student physical therapists, and three unbiased lay persons. Feedback from the

peer reviewers was incorporated. Multiple edits were made to improve the overall content,

readability, and efficiency of the final instrument. All questions were carefully reviewed to

minimize bias and ensure ease of use. Question 1 (Q1) assessed the frequency of HR, BP, and


SpO2 measurement in the six months prior to taking the survey. Question 2 (Q2) assessed beliefs

about the importance of measuring vitals. The remaining questions asked about reasons for not

measuring, and an estimate of how long it takes to measure HR, BP, and SpO2; primary area of

practice within the adult outpatient setting, ownership of the clinic, clinic policies, characteristics

of patients treated in the six months prior to taking the survey, entry level degree, highest degree

earned, ABPTS certification, years in practice, and APTA membership (see Appendix A).

Data Collection

Ordinal and nominal data were collected via Survey Monkey and stored on a flash drive.

The data was then coded and transferred in an Excel spreadsheet.

Data Analysis

Data analysis was performed using SPSS, Release 21.0. Frequencies, means, medians,

and modes were used to describe the data. Responses to demographic questions were used to

describe the characteristics of the participants (see Appendices D-M for data summaries).

Data related to behaviors (Q1) were coded so that,”0-20% of visits” = 1,”21-40% of visits” =

2,”41-60% of visits” = 3,”61-80% of visits” = 4, and ”81-100% of visits” = 5 (see Table 2). Data

related to beliefs (Q2) were coded so that “Not at all important” = 1;”Somewhat unimportant” =

2; ”Neutral” = 3; ”Somewhat important” = 4, and ”Extremely important” = 5, (see Table 3). The

coded categorical data from Q1 and Q2 were analyzed for correlations. Categorical data related

to demographic questions about entry level degree, highest degree earned, years of practice, and

years of APTA membership were also coded. Non-parametric Spearman rho (rs) tests were used

to analyze for relationships between beliefs, behaviors, and demographic characteristics.

Questions about ABPTS certification (see Appendix K) and APTA membership (see

Appendix M) only provided “yes” or “no” answer options. Responses were coded so that “no” =


1 and “yes” = 2. ABPTS certification and APTA membership were used as independent

grouping variables to subdivide respondents. For example, all responses were divided into 2

groups. Group 1 (n=39) included all respondents who answered “no” to the question, “Do you

have an American Board of Physical Therapy Specialties (ABPTS) certification?” Group 2

(n=6) included all respondents who answered “yes”. A Mann-Whitney test (U) was used to

analyze differences between the 2 groups in their reported behaviors (Q1) and beliefs (Q2)

regarding measuring vitals. The same process was repeated using APTA membership as the

grouping variable.

Results

Characteristics of Respondents

While the majority of respondents (n=22, 48.9%) reported entering the profession with a

Bachelor’s Degree, 11 of the 22 had gone on to earn either a Master’s Degree or Doctorate. The

majority of respondents (n=28, 62.2%) were current members of the APTA and 6 (13.6%)

reported having an American Board of Physical Therapy Specialties (ABPTS) Certification

(“Orthopedics” n=5; “Pediatrics” n=1). The average range chosen for “years of clinical practice”

was 16-20 years (SD± 10 years) but a wide variety of experience levels were reported by

respondents. Most respondents (n=25; 55.6%) worked in outpatient clinics that were part of a

hospital system and the remaining 20 worked either in a PT owned clinic (n=14; 31.1%) or for a

corporation (n=6; 13.3%). Surprisingly only 28.9% (n=13) of respondents said their clinic had a

policy regarding the measurement/recording of vital signs. The most commonly reported area of

clinical practice was “outpatient orthopedics” (see Appendix H) and 66.7% reported that 81-

100% of their case load over the last 6 months involved patients whose primary problems were

musculoskeletal in nature. When asked reasons for not measuring vital signs, the most


frequently chosen responses were “not important for my patient population” (40.0%; n=18) and

“lack of time” (22.2%; n=10). None of the respondents selected “lack of skill in taking these

measurements” as a reason for not measuring vital signs.

Self-Reported Behaviors and Beliefs

Most participants reported measuring vitals 0-20% of the time during initial evaluations

and regularly scheduled visits, as shown in Table 2 and Figure 1. A summary of responses

indicating routine measurement of vitals (routine measurement = 0-80% of the time during

initial evaluations and regular visits) is presented in Table 3.

Table 2

Reported Vitals Measurement During Initial Evaluation and Regularly Scheduled Visits

Initial Evaluation Regular Visits

HR BP SpO2 HR BP SpO2

Mean a

2.47

2.47 2.13 2.13 2.04 1.84

Median b

1.00 1.00 1.00 1.00 1.00 1.00

Mode c

1.00 1.00 1.00 1.00 1.00 1.00

SD (±) 1.78 1.74 1.54 1.46 1.40 1.24

Note. 1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-60% of visits”; 4=”61-80% of visits”; 5=”81-100% of

visits.”

a,b,c All participants (N=45) provided answers for each of the 6 items (HR, BP, and SpO2 during initial evaluation

and HR,BP, and SpO2 during regularly scheduled visits).


Figure 1. Distribution of Responses for Q1.

Table 3

Summary of Responses Indicating Routine Measurement (80-100% of the time) of Vitals

Initial Evaluation Regular Visits

HR BP SpO2 HR BP SpO2

Responses Indicating Routine Measurement (n) 11

11 6 6 3 3

Percentage (% ) of Total Responses a

24.4 24.4 13.4 13.4 6.7 6.7

Note. 1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-60% of visits”; 4=”61-80% of visits”; 5=”81-100% of

visits.”

a All participants (N=45) provided answers for each of the 6 items (HR, BP, and SpO2 during initial evaluation and

HR,BP, and SpO2 during regularly scheduled visits).

The majority of respondents believed it was important to measure vitals (“Extremely

important”; HR n=20; BP n=21; SpO2 n=18) for patients with a cardiovascular condition but few

believed it was important to measure vitals for each patient at every visit (“Extremely

important”; HR n=4, BP n=4, SpO2 n=3). As seen in Table 4, mean responses related to beliefs

about measuring vitals for certain patients some of the time and patients with medical history of

05

101520253035404550

Heart rate

(HR) during an

initial

evaluation?

Blood pressure

(BP)during an

initial

evaluation?

Oxygen

saturation

(SpO2) during

an initial

evaluation?

HR during

regularly

scheduled

visits (not

including the

initial

evaluation)?

BP during

regularly

scheduled

visits (not

including the

initial

evaluation)?

SpO2 during

regularly

scheduled

visits (not

including the

initial

evaluation)?

In the LAST 6 MONTHS, what PERCENTAGE of the VISITS did you

measure...

0-20%

21-40%

41-60%

61-80%

81-100%


a cardiovascular condition each visit, were greater than mean responses for measuring vitals on

all patients, each visit.

Table 4

Summary of Self-Reported Beliefs-Importance of Vitals Measurement

Certain Patients/Some of the Time Patients with Medical History of CVD All Patients/Each Visit

HR BP SpO2 HR BP SpO2 HR BP SpO2

Mean a 4.44 4.49 4.27 4.15 4.18 3.96 2.42 2.42 2.27

Median b 4.00 5.00 4.00 4.00 4.00 4.00 2.00 2.00 2.00

Mode c 5.00 5.00 5.00 5.00 5.00 5.00 2.00 2.00 2.00 SD ( ±) 0.59 0.59 0.84 0.93 0.94 1.06 1.20 1.20 1.08 Note. 1=Not at all important; 2=”Somewhat unimportant”; 3=”Neutral”; 4=”Somewhat important”; 5=”Extremely

important.”

a,b,c All participants (n=45) provided answers for each of the 9 items (HR, BP, and SpO2 for certain patients some of

the time, patients with medical history of CVD, and all patients each visit).

Analysis of Relationships: Beliefs, Behaviors, and Demographic Factors

A strong correlation was observed between behaviors of measuring vitals during initial

evaluations and measuring vitals during regularly scheduled visits (rs = 0.798, p < .01).

Moderate correlations between behaviors and beliefs for patients with a history of cardiovascular

disease are described in Table 5. Weak to moderate correlations, also shown in Table 5, were

found between frequency of measuring vitals (during the initial evaluation and during regular

visit) and beliefs about measuring vitals for all patients each visit and for certain patients some of

the time (Cohen, 1988).


Table 5

Relationships Among Beliefs and Behaviors for Measuring Vitals

Measured During Importance of Measuring

All Patients, Each Visit b Certain Patients, Some Visits b Patients With CVD b

Initial Evaluations a

Moderate Relationship

(rs = .39, p < .01)

Weak Relationship

(rs = .25, p < .01)


(rs = .45, p < .01)

Regular Visits a


(rs = .47, p < .01)

Weak Relationship

(rs = .28, p < .01)


(rs = .50, p < .01)

Note. The abbreviation rs denotes Spearman rho test for correlation between variables using non-parametric data. a Q1 responses are related to behaviors, b Q2 responses are related to beliefs.

No statistically significant correlations existed between the demographic variables being

examined and either the frequency of measuring vitals or beliefs about the importance of

measuring vitals.

Differences Based on ABPTS Certification and APTA Membership

Responses about ABPTS specialty certification (“Yes” = 2, n = 6 “No” = 1, n = 39 ) and

APTA membership (“Yes” = 2, n = 28 ; “No” = 1, n = 17 ) were used as independent grouping

variables. A Mann-Whitney (U) test for differences between groups was used to analyze each

grouping variable for differences regarding behaviors and beliefs. No significant between group

differences were present regarding behaviors (Table 6 and Table 7) or beliefs (Table 8 and Table

9).


Table 6

Behaviors and ABPTS Certification


Regular Visits a

Mann-Whitney U 97.500 104.500

Probability (p) 0.549 0.730

Note. Q12 responses, regarding ABPTS certification, were used as the grouping variable. Group 1 included

respondents who did not have ABPTS certification (n = 39, responded “no” to Q12). Group 2 included

respondents who had ABPTS certification (n = 6, responded “yes” to Q12). a Q1 coded responses were pooled on an individual basis (1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-

60% of visits”; 4=”61-80% of visits”; 5=”81-100% of visits”). The sum of the coded responses for the

frequency of HR, BP, and SpO2 measurements performed during initial evaluations was calculated as a single

score for each respondent. This score was used to represent the reported frequency of all vitals measured during

initial evaluations for each respondent. This process was repeated for Q1 coded responses regarding regularly

scheduled visits.

Table 7

Behaviors and APTA Membership


Regular Visits a

Mann-Whitney U 210.000 188.500

Probability (p) 0.485 0.217

Note. Q14 responses, regarding APTA membership, were used as the grouping variable. Group 1 included non-members (n = 17, responded “no” to Q14). Group 2 included APTA members (n = 28, responded “yes” to

Q14).

a Q1 coded responses were pooled on an individual basis (1=”0-20% of visits”; 2=”21-40% of visits”; 3=”41-

60% of visits”; 4=”61-80% of visits”; 5=”81-100% of visits”). The sum of the coded responses for the

frequency of HR, BP, and SpO2 measurements performed during initial evaluations was calculated as a single

score for each respondent. This score was used to represent the reported frequency of all vitals measured during

initial evaluations for each respondent. This process was repeated for Q1 coded responses regarding regularly

scheduled visits.


Table 8

Beliefs and ABPTS Certification

Certain Patients Some Time a Patients with CVD a All Patients Each Visit a

Mann-Whitney U 85.000 106.500 107.000

Probability (p) 0.287 0.790 0.802

Note. Q12 responses, regarding ABPTS certification, were used as the grouping variable. Group 1 included

respondents who did not have ABPTS certification (n = 39, responded “no” to Q12). Group 2 included

respondents who had ABPTS certification (n = 6, responded “yes” to Q12). a Q2 coded responses were pooled on an individual basis (1=”Not at all important”; 2=”Somewhat

unimportant”; 3=”Neutral”; 4=”Somewhat important”; 5=”Extremely important.”). The sum of the coded

responses regarding beliefs about the importance of measuring HR, BP, and SpO2 for “certain patients, some of

the time” was calculated as a single score for each respondent. This score was used to represent beliefs about

the level of importance for measuring all vitals with “certain patients, some of the time.” This process was

repeated for Q2 coded responses for “patients with a known history of CVD” and “all patients, each visit.”

Table 9

Beliefs and APTA Membership

Certain Patients Some Time a Patients with CVD a All Patients Each Visit a

Mann-Whitney U 237.000 199.500 230.500

Probability (p) 0.980 0.351 0.853

Note. Q14 responses, regarding APTA membership, were used as the grouping variable. Group 1 included non-members (n = 17, responded “no” to Q14). Group 2 included APTA members (n = 28, responded “yes” to

Q14).

a Q2 coded responses were pooled on an individual basis (1=”Not at all important”; 2=”Somewhat

unimportant”; 3=”Neutral”; 4=”Somewhat important”; 5=”Extremely important.”). The sum of the coded

responses regarding beliefs about the importance of measuring HR, BP, and SpO2 for “certain patients, some of

the time” was calculated as a single score for each respondent. This score was used to represent beliefs about

the level of importance for measuring all vitals with “certain patients, some of the time.” This process was

repeated for Q2 coded responses for “patients with a known history of CVD” and “all patients, each visit.”

Discussion

Summary of Findings

This survey study seems to be one of the first research efforts to report information on the

use of vitals in adult outpatient PT clinics. The study attempted to answer the questions, (1) do

PTs, practicing in adult outpatient settings, routinely measure the HR, BP, and SpO2 of new and


existing patients (routinely measure = 80-100% of the time for their current caseload, in the 6

months prior to participating in the study)? (2) Is there a relationship between factors such as

highest degree earned, ABPTS specialty, APTA membership, years of experience, clinic

policies, beliefs about the importance of measuring vitals, and the frequency of measuring HR,

BP, and SpO2?

The evidence suggests that the majority of respondents did not routinely measure the HR,

BP, and SpO2 of the patients on their current caseload, as discussed in Table 3. The results of

this study also highlight the discrepancies between beliefs about what is considered important in

clinical practice and what is actually taking place in the clinic. For example, the majority of

respondents believed it was “extremely important” to measure vitals for patients with CVD, each

visit (HR n = 20, BP n = 21, SpO2 n = 18). However very few respondents reported routinely

measuring vitals during initial evaluations (“80-100% of the time”; HR n = 11, BP n = 11, SpO2

n = 6) and even fewer reported routinely measuring vitals (“80-100% of the time) during regular

visits (HR n = 6, BP n = 3, SpO2 n = 3). Although many clinicians believe it’s extremely

important to measure vitals each time they treat someone with known CVD, a small portion are

actually routinely measuring vitals.

Most respondents (40%, n = 18) selected “not important for my patient population” as

their primary reason for not measuring vitals. Roughly 2 out of every 3 respondents reported 81-

100% of their case load over the last 6 months involved patients whose primary problems were

musculoskeletal in nature. Solid research suggests that a percentage of those patients whose

primary problems are “musculoskeletal in nature” are also likely to have some form of CVD

(AHA, 2011 & Meissner et al., 1999).


No significant correlations were found between many of the variables being examined.

Weak to moderate relationships exist between beliefs about the importance of measuring vitals

and the frequency of measuring HR, BP, and SpO2. Although we didn’t observe any strong

correlations between these variables, our findings provide enough information to warrant further

study in this area. Other useful information related to reasons for not measuring vitals, estimated

time to measure vitals, area of clinical practice, current practice setting, and clinic policies we

reported (see Appendices B, C, D, F, and G). Such information may be useful to future studies.

Limitations

The important limitations of this study were lack of a random sample and the small

sample size. Our design included the use of convenience sampling and participant recruitment

using the FPTA’s website. Because the survey was distributed through the FPTA’s website, the

responses gathered may be skewed. Unfortunately we were unable to calculate a response rate

for this study. It should be noted that the findings of this study are limited to describing our

sample (n = 45) and the results should not be generalized to a larger population.

Future Research

Future studies are needed to continue examining the use of vitals in the outpatient setting.

The survey instrument used in this study could be modified and used to gather data in a sample

that is more representative of all PTs. Improvements could be made to the survey itself to

facilitate a more efficient data analysis and strengthen the data analysis. Future research should

examine the disconnect between beliefs and behaviors to determine the reasons why PTs with

strong beliefs may not practice according to those beliefs. Another area for future study has to

do with lack of clinical resources that are specific to PT profession. Current information about

evidence based practice and resources, such as criteria for risk stratification (Table 1) and


exercise guidelines, were developed by the ACSM and the AHA. Future research should address

this issue in some way. For example it would be feasible for the APTA to create a risk

stratification for CVD and set guidelines for measuring vitals based on the number of

characteristics a patient presents with. This could help guide clinical decision making and would

be a wonderful resource to clinicians.

Conclusions

Although our findings are based on non-parametric data, they do provide useful

information regarding an area of clinical practice that has not been well studied. It seems fitting

that the strongest correlation determined by this research was related to the behaviors reported by

respondents. PTs who measured vitals during the initial evaluation were significantly more

likely to also measure vitals during regular visits (rs = .798, p < .01). Therapists are ultimately

responsible for ensuring the safety of each patient being treated. Measuring vitals allows

clinicians to screen for undiagnosed conditions, monitor existing conditions, and facilitate safety

through prevention.


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Appendix A: Explanation of Study and Link to Survey on FPTA’s Website


Appendix B: Online Survey Consent Form

Online Survey Consent Form

Study Title: Self-Reported Use of Vital Signs in the Adult Outpatient Setting

Principal Researcher: Joshua J. Peters, SPT

Faculty Sponsor: Ellen Donald MS, PT

You are being asked to participate in an online survey for a research project conducted

through Florida Gulf Coast University. This research is being conducted as a program

requirement for successful completion of the Doctor of Physical Therapy degree. The University

requires that you give your approval to participate in this project. You must be at least 18 years

old to take this survey.

Your participation in the study is completely voluntary. If you decide to participate now

you may change your mind and stop at any time, for any reason, without penalty or loss of any

future services you may be eligible to receive from the University or the Florida Physical

Therapy Association. You can choose to not answer an individual question or you may skip any

section of the survey by clicking “Next” at the bottom of the survey page to move to the next

question.

The purpose of the study is to examine information regarding the measurement of vital

signs performed by PTs in the adult outpatient setting. This research is important because little

is known about PTs behaviors, beliefs, or the demographic factors related to this topic. I am

asking you to take part in the study because you are currently employed as a licensed PT

practicing at an adult outpatient clinic in the state of Florida. As a quality measure, please

answer yes or no to each of the following questions:

1. Are you currently a licensed physical therapist practicing at an adult outpatient clinic?

2. Do you currently practice in the state of Florida?

3. Have you practiced at an adult outpatient clinic for at least 6 months prior to this date?

If you answered “no” to any of the above questions, you do not meet the eligibility requirements

for participation in this study. Please delete this email and thank you for your consideration.

If you answered “yes” to each of the questions, you are eligible to participate in this study.


If you agree to be part of the research study, you will be asked to complete an online

survey about your practice behaviors and beliefs regarding measuring heart rate (HR), blood

pressure (BP), and pulse oximetry (SpO2). The survey also includes questions about your

demographic data. We expect the survey will take a maximum of 10-15 minutes to complete.

The survey will remain available for 21 days and can be completed in more than one session.

Your participation will be kept anonymous. However, working with email or the internet

has the risk of compromising privacy, confidentiality, and/or anonymity. Despite this possibility,

the risks to your physical, emotional, social, professional, or financial well-being are considered

to be 'less than minimal’ by completing the survey.

Although your participation in this research may not benefit you personally, it will help

us understand current practices, beliefs, and demographic factors related to measuring vital signs.

We believe this study will provide valuable information about what is actually occurring in

clinical practice. This knowledge will serve as a foundation for understanding the factors

influencing clinical decision making. It is our sincere hope that the data collected from this

study will be used to help guide clinical practice and ensure patient safety.

If you join the study, we will make every effort keep your information confidential and

secure by taking the following steps. Your name and email address will remain confidential and

will be stored on an account through SurveyMonkey.com. We will not have access to your name

or email address at any time and all completed surveys will be assigned a number. All data,

including the data analysis, will be transmitted via a secure browser. Once the data analysis is

complete, the SurveyMonkey.com account will be deleted. However, despite these safeguards,

there is the possibility of hacking or other security breaches that could compromise the

confidentiality of the information you provide. Thus, it is important to remember that you are

free to decline to answer any question that makes you uncomfortable for any reason. Click here

http://www.surveymonkey.com/mp/policy/privacy-policy/ for SurveyMonkey’s privacy policy

or here http://www.surveymonkey.com/mp/policy/security/ for SurveyMonkey’s security

statement.

We will not release information about you unless you authorize us to do so or unless we

are required to do so by law. If results of this study are published or presented at a professional

meeting, no information will be included that would make it possible to identify you as a study

participant.

You will not be paid to take part in this study. If you have any questions about this study,

you may contact Professor Ellen Donald MS, PT at 239-590-7531. If you have any questions

about your rights as a participant in this research, or if you feel you have been placed at risk, you

can contact the Chair of the Human Subjects' Institutional Review Board through Sandra

Terranova, Office of Research and Sponsored Programs, at 239-590-7522.

Statement: I have read the preceding information describing this study. I am 18 years of age or

older and freely consent to participate in the study. My decision to participate or to decline

participating in this study is completely voluntary. I understand that I am free to withdraw from


the study at any time. I am aware of my option to not answer to any questions I choose. I am

currently a licensed physical therapist practicing at an adult outpatient clinic located in the state

of Florida, and have been practicing in this setting for at least 6 months prior to participating in

this study. I understand that it is not possible to identify all potential risks. I believe that

reasonable steps have been taken to minimize both the known and potential but unknown risks.

The submission of the completed survey is my informed consent to participate in the study.

If you would like a copy of the consent form, print a copy before continuing.

By clicking the survey link below you are consenting to participate in this research survey. If

you do not wish to participate please delete this email.

(Link to survey)

Thank you for your time.

Josh Peters, SPT


Appendix C: Survey Instrument

Part I – Practice Behaviors & Beliefs

Q1. In the last 6 MONTHS, what PERCENTAGE of the VISITS did you measure…

0-20% 21-40% 41-60% 61-80% 81-100%

HR during an initial evaluation?

BP during an initial evaluation?

SpO2 during an initial evaluation?

HR during regularly scheduled visits

(not including the initial evaluation)?

BP during regularly scheduled visits (not including the initial evaluation)?

SpO2 during regularly scheduled visits

(not including the initial evaluation)?

Q2. I believe it is important to measure…

Not at all

Important

Somewhat

Unimportant

Neutral Somewhat

Important

Extremely

Important

HR on certain patients some of the time

BP on certain patients some of the time

SpO2 on certain patients some of the time

HR on patients with known history of CVD each

visit

BP on patients with known history of CVD each

visit

SpO2 on patients with known history of CVD

each visit

HR on all patients each visit

BP on all patients each visit

Spo2 on all patients each visit


Q3. What are your reasons for not measuring vital signs - HR, BP, and/or SpO2? (CHECK ALL THAT APPLY)

____ Not important for my patient population

____ Vitals are measured by other staff members at my clinic

____ Lack of time

____ Equipment not available

____ Lack of skill in taking these measurements ____ Other (please explain):

Q4. If you have full access to the appropriate equipment, how long would you say - on average - it would take to

measure a patient’s HR, BP and SpO2? (Average length of time in MINUTES) ____________minutes

Part II – Demographic Information

Q5. Which of the following BEST describes the areas of practice covered at your clinic? (CHECK ALL THAT

APPLY)

____ Aquatic Physical Therapy

____ Cardiovascular & Pulmonary Physical Therapy ____Wound Care

____ Geriatric Physical Therapy

____ Hand Rehabilitation

____ Neurologic Rehabilitation

____ Orthopedic Physical Therapy

____Sports Physical Therapy

____ Women’s Health Physical Therapy

____ Other (please explain):

Q6. Which classification BEST describes the PRIMARY PROBLEMS (reasons for seeking PT services) of the

patients you’ve treated over the LAST 6 MONTHS? (PERCENTAGE of YOUR caseload over the LAST 6

MONTHS)

Percentage of caseload over the last 6 months

0% 1-25% 26-50% 51-75% 81-99% 100%

Musculoskeletal

Neurologic

Cardiovascular

Pulmonary

Integumentary

Lymphatic

Metabolic

Q7. Which of the following BEST describes your current practice setting? (CHECK ALL THAT APPLY)

____ PT Owned

____ Physician Owned

____ Hospital System

____ Corporation

____ Other (please explain):


Q8. Does your clinic have a policy regarding the measurement/recording of vital signs?

____ YES ____NO

Q9. If you answered YES to question 8, please describe the policy.

Q10. Which of the following BEST describes your ENTRY LEVEL degree?

____ Certificate

____ Bachelor’s Degree

____ Master’s Degree

____ DPT

Q11. Which of the following BEST describes the HIGHEST degree you’ve earned?

____ Bachelor’s Degree

____ Master’s Degree

____ Doctorate

Q12. Do you have an American Board of Physical Therapy Specialties (ABPTS) certification?

____YES ____ NO

Q13. If you answered YES to question 12, please indicate the area(s) of your specialist certification. (CHECK ALL

THAT APPLY):

____ Cardiovascular & Pulmonary

____ Clinical Electrophysiology

____ Geriatrics

____ Neurology

____ Orthopedics

____ Pediatrics

____ Sports

____ Women’s Health

Q14. How many YEARS have you been practicing as a licensed physical therapist?

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40+

Q15. Are you CURRENTLY a member of the American Physical Therapy Association (APTA)?

____ YES ____ NO

Q16. If you answered YES to question 15, how many YEARS have you been a member?

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40+


Appendix D: Q3 Reasons for Not Measuring Vitals

Q3. What are your reasons for not measuring vital signs - HR, BP, and/or SpO2?

(CHECK ALL THAT APPLY)

Table D1

Frequency of Responses Q3

Response

Percent

Response

Count

Not important for my patient population

62.1% 18

Vitals are measured by other staff members at my clinic

13.8% 4

Lack of time

34.5% 10

Equipment not available

10.3% 3

Lack of skill in taking these measurements

0.0% 0

Other (please specify)

23

Note. Responses for “Other (please specify)” included in Table B2.

Figure D1. Frequency of Responses for Q3.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Not important for

my patient

population

Vitals are

measured by other

staff members at

my clinic

Lack of time Equipment not

available

Lack of skill in

taking these

measurements


Responses (n = 23) to Q3, “Other (please specify)”

“If pt's don't have abnormal symptoms than usually don't take during tx visits.”

“patient is stable and having no observable signs or symptoms of having any issues”

“straight forward younger patients without history of cardiovascular disease may not need

monitoring as this takes time and if visit is only 30 minutes, it takes time away from their

treatment”

“Vitals do not always have a bearing based upon Dx and tretament being given.”

“My patient population is pediatrics”

“pt not appropriate for vitals due to condition”

“We only see pt for 30 mins. We have only 1 BP cuff. Not practical.”

“taking HR, BP every visit, take SpO2 for pts with cardiopulmonary insufficiency”

“unclear parameters / protocol for what is too high/ low for individual patients

clinical assessments done ongoing to assess response to exercise in all pts; vitals taken for

targeted pts with active cardiac concerns that have been acute”

“non-compliance”

“All visits”

“All patients regardless of age and diagnosis are tested at the initial evaluation. After that, those

with normal measurements and no history or medications for heart, BP or lung conditions are not

measured. Others are measured at each visit.”

“WE MEASURE THEM WHEN WE FEEL THE SITUATION WARRENTS”

“Patient has proven to be stable in previous treatments “

“Not clinically indicated”

“No indication”

“forget to do”

“none, I usually always check initially especially if HTN or cardiac hx”

“we are required to assess vital signs at each treatment session.“


“Make the clinical decision after the initial evaluation if these examination measures are

important to monitor”

“I only take vitals if I am concerned about stability of vitals or if I need to determine level of

exertion”

“Healthy, asymptomatic outpatients are less likely to be monitored after initial. Those with no

S&S's are also less likely. Usually always monitor/check inpatients or pts who are symptomatic

or with recent event (MI, cardiomyopathy, angina, etc)”


Appendix E: Q4 Estimated Time it Takes to Measure Vitals

Q4. If you had full access to the appropriate equipment, how long would you say - on average -

it would take to measure a patient's HR, BP, and SpO2? (Average length of time in MINUTES)

Responses (n = 45) to Q4

3

3-5 minutes

2 mins

5

2

the equipment is shared by 15 other therapists; if available and returned to the correct place to be

found by the next theraist, it takes approx 5 minutes--I have to adjust the cuff at times if it says

error which takes extra time as well as you must wait at least 2 minutes per studies between

consecutive measurements

<5

2

2 mins

1-2 minutes

10

8

4

5 mins

4 mins

3-5 minutes

10 mins with documentation, if normal- longer if abnormal and physicians needs notifying!

5

5 min

5 minutes

5 minutes hr and Bo. Not sore spo2

8 mins

5 mins

less than 5 minutes

5


2 minutes

10

5

5 minutes

2

4

2

4

5-7 min

3 minutes

2 minutes

7 minutes

10

1

3 minutes

3

2

3

2

3 minutes


Appendix F: Q5 Area of Practice

Q5. Which of the following BEST describes the areas of practice covered at your clinic?


Table F1

Frequency of Responses Q5

Response Percent Response Count

Aquatic Physical Therapy 15.9% 7

Cardiovascular and Pulmonary Physical Therapy 9.1% 4

Wound Care 2.3% 1

Geriatric Physical Therapy 47.7% 21

Hand Rehabilitation 11.4% 5

Neurologic Rehabilitation 31.8% 14

Orthopedic Physical Therapy 93.2% 41

Sports Physical Therapy 50.0% 22

Women's Health Physical Therapy 20.5% 9

Other (please specify) 6

Note. Responses for “Other (please specify) included in Table D2.

Figure F1. Frequency of Responses to Q5.

0.0%10.0%

20.0%

30.0%

40.0%

50.0%60.0%

70.0%

80.0%

90.0%

100.0%

Aq

uat

ic P

hysi

cal

Ther

apy

Car

dio

vas

cula

r

and

Pulm

onar

y

Physi

cal…

Wound C

are

Ger

iatr

ic

Physi

cal

Ther

apy

Han

d

Reh

abil

itat

ion

Neu

rolo

gic

Reh

abil

itat

ion

Ort

hoped

ic

Physi

cal

Ther

apy

Sp

ort

s P

hysi

cal

Ther

apy

Wo

men

's H

ealt

h

Physi

cal

Ther

apy


Responses to Q5 (n = 6), “Other (please specify)”

“oncology, lymphedema”

“pediatrics”

“Pediatric”

“Pediatrics, Wheelchair assessment”

“home health”

“outpatient and inpatient”


Appendix G: Q6 Primary Problems of Patients Treated During Last 6 Months

Q6. Which classification BEST describes the PRIMARY PROBLEMS (reasons for seeking PT

services) of the patients you've treated over the LAST 6 MONTHS? (PERCENTAGE of

YOUR caseload over the LAST 6 MONTHS)

Table G1

Frequency of Responses to Q6

0% 1-25% 26-50% 51-75% 81-99% 100% Response Count

Musculoskeletal 0 0 5 9 21 9 44

Neurologic 3 21 8 3 3 0 38

Cardiovascular 12 16 1 2 1 0 32

Pulmonary 18 7 3 1 0 0 29

Integumentary 23 4 0 0 0 0 27

Lymphatic 21 4 0 2 0 0 27

Metabolic 21 8 0 0 1 0 30

Figure G1. Frequency of Responses to Q6.

05

101520253035404550

0%

1-25%

26-50%

51-75%

81-99%

100%


Appendix H: Q7 Current Practice Setting

Q7. Which of the following BEST describes your current practice setting?


Table H1

Frequency of Responses (n = 45) to Q7


PT Owned 31.1% 14

Physician Owned 0.0% 0

Hospital System 55.6% 25

Corporation 13.3% 6

Other (please specify) 0

Figure H1. Frequency of Responses to Q7.

PT Owned

Physician Owned

Hospital System

Corporation


Appendix I: Q8 & Q9 Clinic Policies

Q8. Does your clinic have a policy regarding the measurement/recording of vital signs?

Table I1

Frequency of Responses (n = 45) to Q8


Yes 28.9% 13

No 71.1% 32

Figure I1. Frequency of Responses to Q8.

Yes

No


Q9. If you answered YES to question 8, please describe the policy.

Responses (n = 13) to Q9

“Patients with CV conditions should have VS measurements”

“Take BP/HR/Sats when appropriate”

“BP, HR taken beginning of every visit”

“take vital signs when warranted.”

“All vital signs has be done every visit.”

“Policy is to monitor HR, BP on individuals with history of CVD and SPO2 on patients with pulmonary disease.”

“All patients have their VS- HR, BP and oxygen sat measured at the evaluation. Any patient with history of medical

conditions of the heart, lungs, kidney, and HTN are measured at follow up visits.”

“Measure vitals at every encounter”

“Vitals are taken prior to therapy start by MA”

“Measure at each visit as indicated”

“required to assess BP, HR, respirations, SpO2 (if cardiopulm patient), and temperature at eval and each treatment

session.”

“BP and HR at every patient encounter”

“competency and scope of practice in place”


Appendix J: Q10 Entry Level Degree & Q11 Highest Degree Earned

Q10. Which of the following BEST describes your ENTRY LEVEL degree?

Table J1



Certificate 2.2% 1

Bachelor's Degree 48.9% 22

Master's Degree 26.7% 12

DPT 22.2% 10

Note. (n=45).

Figure J1. Frequency of Responses to Q10.

Certificate

Bachelor's Degree

Master's Degree

DPT


Q11. Which of the following BEST describes the HIGHEST degree you've earned?

Figure J2. Frequency of Responses to Q11.

Bachelor's Degree

Master's Degree

Doctorate

Table J2



Bachelor's Degree 24.4% 11

Master's Degree 28.9% 13

Doctorate 46.7% 21

Note. (n=45).


Appendix K: Q12 & Q13 ABPTS Certification

Q12. Do you have an American Board of Physical Therapy Specialties (ABPTS) certification?

Figure K1. Frequency of Responses to Q12.

Yes No

Table K1

Frequency of Responses to Q12.


Yes 13.6 % 6

No 86.4 % 38 Note. (n=44).


Q13. If you answered YES to question 12, please indicate the area(s) of your specialist

certification. (CHECK ALL THAT APPLY)

Table K2



Cardiovascular & Pulmonary 0.0% 0

Clinical Electrophysiology 0.0% 0

Geriatrics 0.0% 0

Neurology 0.0% 0

Orthopedics 83.3% 5

Pediatrics 16.7% 1

Sports 0.0% 0

Women's Health 0.0% 0

Note. (n=6).

Figure K2. Frequency of Responses to Q13.

Cardiovascular & Pulmonary

Clinical Electrophysiology

Geriatrics

Neurology

Orthopedics

Pediatrics

Sports

Women's Health


Appendix L: Q14 Years of Practice

Q14. How many YEARS have you been practicing as a licensed physical therapist?

Table L1


Years Response Percent Response Count

0-5 13.3% 6

6-10 15.6% 7

11-15 13.3% 6

16-20 15.6% 7

21-25 11.1% 5

26-30 15.6% 7

31-35 8.9% 4

36-40 4.4% 2

40+ 2.2% 1

Note. (n=45)

Figure L1. Frequency of Responses to Q14.

0-5

6-10

11-15

16-20

21-25

26-30

31-35

36-40

40+


Appendix M: Q15 & Q16 APTA Membership

Q15. Are you CURRENTLY a member of the American Physical Therapy Association

(APTA)?

Table M1



Yes 62.2% 28

No 37.8% 17

Note. (n=45).

Figure M1. Frequency of Responses to Q15.

Yes No


Q16. If you answered YES to question 15, how many YEARS have you been a member?

Table M2


Years Response Percent Response Count

0-5 6.7% 2

6-10 33.3% 10

11-15 23.3% 7

16-20 3.3% 1

21-25 3.3% 1

26-30 13.3% 4

31-35 10.0% 3

36-40 3.3% 1

40+ 3.3% 1

Note. (n=30).

Figure M2. Frequency of Responses to Q16.

0-5

6-10

11-15

16-20

21-25

26-30

31-35

36-40

40+

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