Exploring Balance Assessment Practices and Utilization of Academy of Geriatric Physical Therapy Clinical Guidance Statement in Fall Management by U.S.-Practicing Physical Therapists: A Mixed-Methods Approach

Background: Falls and balance impairments in older adults are major public health concerns. Physical therapists (PTs) play a major role in preventing and managing falls in the U.S. healthcare system. PTs are doctoral healthcare professionals who evaluate and treat balance impairments that impact prevalence of falls. As autonomous practitioners, PTs should incorporate evidence-based tools in balance assessment and management of falls. The American Physical Therapy Association (APTA) recommends PTs utilize evidence-based tools such as the (a) Academy of Geriatric Physical Therapy (AGPT) Clinical Guidance Statement (CGS) in Community-Dwelling Older Adults (CDOA and (b) the APTA balance tests and measures in balance assessment and falls management. Purpose: This mixed-methods study explored the balance assessment of U.S.-Practicing PTs. Specifically, the study addressed the utilization of (a) the APTA balance tests and measures, (b) the AGPT CGS for the CDOA in management of falls, and (c) the barriers associated with balance assessment practices. Methods: The study employed an embedded mixed-methods design in which a partial qualitative strand was embedded in a primarily quantitative design. Three hundred and four U.S.-Practicing PTs completed both Part A and Part B of the Assessment of Balance Practices and Associated Barriers (ABPAB) survey. Part A contained the Saskatchewan Physiotherapists’ Balance Assessment Practices Survey (SPBAPS), developed by Oates et al. (2017). Part B contained PI-developed open-ended questions associated with barriers in balance assessment practices. Results: Of the 304 study participants, 201 responses were obtained, meeting the 80% completion rate requirement, and were included for data analysis. Overall, study participants regularly assessed only three out of the nine components of balance with 84.5% assessing motor system, 80.3% assessing dynamic stability, and 82.1% assessing static stability. However, fewer than 50% assessed only five out of the nine components of balance. While the 32 balance tests and measures listed on the APTA website and the 23 Canadian balance tests and measures were included for analysis in this survey, movement observation was the primary reported measure to assess balance (70.5%), followed by the Timed Up & Go (64.3%), the Five Times Sit to Stand (63.4%), the Single Leg Stance (52.1%), the Functional Gait Assessment (44.1%), and the Tandem Standing/Walking (44.1%). The top three barriers that impacted PTs’ clinical decision-making in balance assessment practices were lack of time (reported by 78.4%), lack of knowledge (62%), and balance tests identified as not appropriate for populations (34.3%). Conclusions: Movement observation, which relies on visual observation skills, was the preferred measurement, followed by time-based measures of two functional tasks. U.S.-Practicing PTs in this study are not effectively utilizing a multisystem approach to guide their balance assessment practices. Our quantitative and qualitative findings both show that some barriers in balance assessment practices are non-modifiable, such as patient status and lack of time; however, there are modifiable barriers that we should address occurring at the PT level, the organizational level, and/or at the professional level. It is imperative to promote diverse knowledge translation opportunities for PTs’ multisystem approach to fall management and balance assessment.

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