Saale B1, Fell D1, Burns S1, Colson K1, Howard E1, Lucas C1
1University of South Alabama, Physical Therapy, Mobile, United States
Background: Gait speed has been identified as an important indicator of fall risk, functional limitation, and risk of hospitalization. It has also been shown to be a key factor in determining rehabilitation needs. Gait speed measurement tests, such as the four meter walk test (4MWT), are quick and easy to administer, yet these measurements are frequently under-utilized in the clinic.
Purpose: The purpose of this study was to identify the barriers to measuring gait speed and to determine if gait speed utilization could be influenced by removing certain barriers within an inpatient rehabilitation facility. These barriers included lack of education, lack of dedicated space to measure, and lack of support for measurement and interpretation.
Methods: Researchers provided clinicians with a 45 minute education session focused on utility of gait speed measurement, process for calculation and interpretation, and hands-on practice regarding clinic resources. Clinical resources included two pathways marked for the 4 MWT, a paper handout demonstrating calculation procedure and interpretation with examples, and access to an ipod touch with the 4MWT iOS app to help with measurement and interpretation of the 4MWT results. Frequency of gait speed measurements was collected two weeks before and two weeks after the presentation. Data was collected for the 17 PTs that attended the presentation and was analyzed using a z-test. 14 PTs returned a pre-survey and 6 returned a post-survey, which assessed clinician's perceptions of measuring gait speed. Survey results were evaluated using thematic analysis.
Results: Common barriers reported on pre-research surveys include time and facility constraints, gait speed measurement not applicable for patient, patient too weak for 10MWT, status of patient, and patient required devices/assistance. 75% of post-survey data revealed that most barriers were eliminated with the education session and provision of clinic resources. Gait speed was measured in 2% of the patients in the pretest period by clinicians and 11% in the post test period. A z-test indicated there was a significant increase (p=.01) in the frequency of gait speed measurements for ambulatory patients after the presentation and provision of resources.
Conclusion(s): Providing resources and education for gait speed measurement had a small but statistically significant impact on utilization in the clinic. These findings indicate that frequency of gait speed measurements may be affected by the identification and elimination of certain barriers within the clinic. Future studies should examine factors leading to long term success rates and to evaluate the impact of addressing other barriers to gait speed measurement. Some of these barriers may require more than a single education session as they involve a significant cultural shift in many clinics. For example, 80% of survey respondents said that gait speed measurement was not appropriate for a majority of their patients, but 85% of ambulatory patients in the post-test period walked sufficient distances at evaluation to qualify for the 4MWT measurement.
Implications: Addressing barriers and identifying ways to make gait speed easier for clinicians to measure may lead to greater utilization in the clinic.
Keywords: Gait velocity, Outcome measures, Utilization
Funding acknowledgements: None
Purpose: The purpose of this study was to identify the barriers to measuring gait speed and to determine if gait speed utilization could be influenced by removing certain barriers within an inpatient rehabilitation facility. These barriers included lack of education, lack of dedicated space to measure, and lack of support for measurement and interpretation.
Methods: Researchers provided clinicians with a 45 minute education session focused on utility of gait speed measurement, process for calculation and interpretation, and hands-on practice regarding clinic resources. Clinical resources included two pathways marked for the 4 MWT, a paper handout demonstrating calculation procedure and interpretation with examples, and access to an ipod touch with the 4MWT iOS app to help with measurement and interpretation of the 4MWT results. Frequency of gait speed measurements was collected two weeks before and two weeks after the presentation. Data was collected for the 17 PTs that attended the presentation and was analyzed using a z-test. 14 PTs returned a pre-survey and 6 returned a post-survey, which assessed clinician's perceptions of measuring gait speed. Survey results were evaluated using thematic analysis.
Results: Common barriers reported on pre-research surveys include time and facility constraints, gait speed measurement not applicable for patient, patient too weak for 10MWT, status of patient, and patient required devices/assistance. 75% of post-survey data revealed that most barriers were eliminated with the education session and provision of clinic resources. Gait speed was measured in 2% of the patients in the pretest period by clinicians and 11% in the post test period. A z-test indicated there was a significant increase (p=.01) in the frequency of gait speed measurements for ambulatory patients after the presentation and provision of resources.
Conclusion(s): Providing resources and education for gait speed measurement had a small but statistically significant impact on utilization in the clinic. These findings indicate that frequency of gait speed measurements may be affected by the identification and elimination of certain barriers within the clinic. Future studies should examine factors leading to long term success rates and to evaluate the impact of addressing other barriers to gait speed measurement. Some of these barriers may require more than a single education session as they involve a significant cultural shift in many clinics. For example, 80% of survey respondents said that gait speed measurement was not appropriate for a majority of their patients, but 85% of ambulatory patients in the post-test period walked sufficient distances at evaluation to qualify for the 4MWT measurement.
Implications: Addressing barriers and identifying ways to make gait speed easier for clinicians to measure may lead to greater utilization in the clinic.
Keywords: Gait velocity, Outcome measures, Utilization
Funding acknowledgements: None
Topic: Outcome measurement; Professional issues
Ethics approval required: Yes
Institution: University of South Alabama
Ethics committee: Institutional Review Board
Ethics number: IRB approval number: 1133845-1
All authors, affiliations and abstracts have been published as submitted.
