Self-Reported Use of Vital Signs in the Adult Outpatient Physical Therapy Setting Independent Research Project

Joshua J. Peters, SPT; Ellen Donald, MS, PT; Kathleen Swanick, DPT, MS, OCS

Department of Physical Therapy & Human Performance

The purpose of this study was to survey PTs, practicing in adult outpatient

clinics, regarding their use of vital signs in the clinical setting.

Participants were recruited via the Florida Physical Therapy Association’s

website. The survey assessed the frequency of HR, BP, and 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.

Outcomes: Only 28.9% (n=13) of respondents (n=45) reported that their

clinic had a policy regarding the measurement of vital signs. Of the 45

participants, 66.7% (n=30) reported that 81-100% of their case load over the

last 6 months involved patients whose primary problems were musculoskeletal

in nature. A significant number of respondents believed it was important to

measure vitals (“Extremely Important”; HR n=20; BP n=21; SpO2 n=18) on

patients with a cardiovascular condition but 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 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).

Results: This study provides useful information about the gaps between the

APTA's recommendations for measuring vitals and current clinical practices.

PTs are 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.

• Only 28.9% (n=13) of respondents reported having a clinic policy regarding

the measurement/recording of vital signs.

• Practice setting most frequently covered at respondents clinics was

outpatient orthopedics (93.2%)

• 66.7% reported that 81-100% of their case load over the last 6 months

involved patients whose primary problems were musculoskeletal in nature.

• A significant number of respondents believed it was important to measure

vitals ( HR n=20; BP n=21; SpO2 n=18) on patients with a cardiovascular

condition but few believed it was important to measure vitals on each patient

at every visit HR n=4, BP n=4, SpO2 n=3).

• Reasons for not measuring vital signs: most frequently chosen responses

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

time” (22.2%; n=10).

• 45 respondents selected “lack of skill in taking these measurements” as their

reason for not measuring vital signs.

This study provides useful information about the gaps between the APTA's

recommendations for measuring vitals and current clinical practices.

Additional data analysis will be conducted to determine if any correlations exist

between demographic data, beliefs about measuring vitals, and behaviors for

measuring vitals. PTs are 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.

ABSTRACT RESULTS RISK STRATIFICATION

REFERENCES American Heart Association. (2012). What is Heart Disease. Retrieved July 4, 2012 from http://www.heart.org/HEARTORG/Conditions/Conditions_UCM_001087_SubHomePag e.jsp

Bohmert, J., Moffat, M., & Zadai, C. (Eds.). (2010). Guide to Physical Therapy Practice. Alexandria, VA: American Physical Therapy Association.

Center for Disease Control, Division for Heart Disease and Stroke. (2010). Heart Disease Facts. Retrieved October 8, 2011 from http://www.cdc.gov/heartdisease/facts.htm

Thompson, W.R. (Ed.). (2010). ACSM’s Guidelines for Exercise Testing and Prescription. Philadelphia, PA: Lippincott Williams & Wilkins.

World Health Organization. (2011). Cardiovascular Diseases (CVDs). Retrieved October 8, 2011 from http://www.who.int/mediacentre/factsheets/fs317/en/index.html 155, 1106-1113. doi:10.1016/j.ahj.2007.12.033

Table 1. Positive Risk Factors

Defining Criteria

Age: M ≥ 45 yrs.; F ≥ 55 yrs.

Family history: myocardial infarction, coronary revascularization, sudden death before 55 yrs. of age in male first-degree

relative or 65 yrs. 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 min of moderate intensity exercise (40-60% VO2R), 3+ days of the week for at least 3 months

Obesity: BMI ≥ 30 kg∙m2 or waist girth M > 102 cm; F > 88cm

Hypertension: *SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg and/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

, 2-hour oral glucose tolerance test ≥ 140 mg∙dL-1

but < 200 mg∙dL-1

* Confirmed on at least two separate occasions

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). Very few studies have

examined PT's engagement in regularly measuring vital signs and little is known about current

clinical practice, especially in the outpatient setting.

Cardiovascular disease (CVD) is an umbrella term referring to a group

of disorders primarily affecting the heart and blood vessels (World Health

Organization [WHO], 2011).

• CVD is the leading cause of death in both men and women in the United

States (Center for Disease Control [CDC], 2010) and globally, more people

die each year from CVD than from any other cause.

• The prevalence of CVD and the emergence of physical therapists (PTs) as

autonomous practitioners demand that therapists regularly measure vital

signs.

• 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.

• By regularly assessing vitals, PT’s have the opportunity to help identify

undiagnosed CVD and reduce the likelihood of a serious cardiovascular

incident during a therapy session.

Risk stratification is the process of categorizing individuals as low,

moderate, or high risk for CVD.

• The ACSM (2010) suggests a risk stratification based on the defining

criteria provided in Table 1.

• Both the AHA (2012) and ACSM (2010) recommend measuring HR and BP

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

• Participants included PTs currently practicing at an adult outpatient clinic, in the State of

Florida, for at least six months. A to the survey was made available for a 3 week period on the

FPTA’s website.

• The survey instrument was designed to evaluate clinical practice, beliefs of the therapist, and

demographic data.

• The 13 item survey questionnaire was developed after a thorough review of current literature

and with the help and expertise of the committee chair.

• The 13 item survey questionnaire assessed the frequency of HR, BP, and SpO2 measurement in

the six months prior to taking the survey; beliefs about the importance of measuring, 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

status.

• The majority of respondents (n=22, 48.9%) reported having a Bachelor’s Degree as their entry

level degree and 11 of the 22 had gone on to earn either a Master’s Degree or Doctorate. Out

of the 45 respondents, 13.6% (n=6) reported having an American Board of Physical Therapy

Specialties (ABPTS) Certification (Orthopedics n=5; Pediatrics n=1). The 3 most commonly

selected ranges for years of experience as a PT were 6-10 years (n=7), 16-20 years (n=7), and

26-30 years (n=7). 62.2% (n=28) were current members of the APTA. 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%).

PARTICIPANTS & METHODS

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 CVD

BP on patients with known CVD

SpO2 on patients with known CVD

HR on ALL patients EACH visit

BP on ALL patients EACH visit

SpO2 on ALL patients EACH visit