Decreasing Fall Risk in Older Adults: Understanding Health Care Providers Balance Assessment Practices in Urban and Rural Settings in Saskatchewan
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There has been limited research on how physical therapists assess balance in older adults however; it is unknown how other health practitioners, such as nurses and other rehabilitation specialists, administer balance assessment in their clinical practice. Additionally, it is unclear if there are differences in choices, facilitators and barriers to balance assessment in rural verses urban communities. The purpose of this study was to determine the factors influencing health care providers’ clinical choices, decisions and enablers, and challenges to conducting balance assessment in Saskatchewan. A secondary purpose was to compare practices between different professions and location of practice. Findings could contribute to inform future practice and opportunities for education and support to health care providers who are engaged in the assessment and management of fall risk in urban and rural locations in Saskatchewan. This study used an explanatory sequential mixed methods design. An electronic survey to determine balance assessment practices was merged into a larger study focussed on fall risk screening and assessment practices of health care providers in Saskatchewan. Data was collected from rehabilitation therapists (n=30), nurses (n=156) and other health professionals (n=10); with a comparison of assessment practices limited to rehabilitation therapists and nurses. Balance assessment practices from work locations (n=112), urban and (n=67) rural participants data were also compared. Follow-up interviews included physical therapists (n=6) and nurses (n=3) purposefully sampled from the survey who completed a 60-90-minute audio-recorded, semi-structured interview over the phone. From the survey, rehabilitation therapists were two times more likely to assess limits of stability (OR = 2.4; 95% CI 1.1-5.5) and three times more likely to assess dynamic stability (OR=3.0; 95% CI 1.0- 9.1) than nurses. Rehabilitation therapists are less likely (OR= .384; 95% CI .165-.894) to assess confidence than nurses. There was no significant association in the assessment of balance components amongst practice location in Saskatchewan. Interview results showed physical therapists tended to use balance specific tools whereas nurses would utilize general assessments of functional activity. In both professions, challenges identified included team staff shortages, patient status, and time needed to complete a thorough assessment. Tools and methods used for assessment of balance factors varied across professions but enablers and barriers were similar.
DegreeMaster of Science (M.Sc.)
CommitteeOates, Alison; Gyurcsik, Nancy; Goodridge , Donna
Copyright DateJanuary 2021
Balance, Older Adult, Rural, Urban, Health Care Providers