Clinical decision making in exercise prescription for fall prevention.
BACKGROUND
Physical therapists often prescribe exercises for fall prevention. Understanding the factors influencing the clinical decision-making processes used by expert physical therapists working in specialist fall and balance clinics may assist other therapists in prescribing exercises for fall prevention with greater efficacy.


OBJECTIVE
The objective of this study was to describe the factors influencing the clinical decision-making processes used by expert physical therapists to prescribe exercises for fall prevention.


METHODS
This investigation was a qualitative study from a phenomenological perspective.


METHODS
Semistructured telephone interviews were conducted with 24 expert physical therapists recruited primarily from the Victorian Falls Clinic Coalition. Interviews focused on 3 exercise prescription contexts: face-to-face individual therapy, group exercise programs, and home exercise programs. Interviews elicited information about therapist practices and the therapist, patient, and environmental factors influencing the clinical decision-making processes for the selection of exercise setting, type, dosage (intensity, quantity, rest periods, duration, and frequency), and progression. Strategies for promoting adherence and safety were also discussed. Data were analyzed with a framework approach by 3 investigators.


RESULTS
Participants described highly individualized exercise prescription approaches tailored to address key findings from physical assessments. Dissonance between prescribing a program that was theoretically correct on the basis of physiological considerations and prescribing one that a client would adhere to was evident. Safety considerations also were highly influential on the exercise type and setting prescribed. Terminology for describing the intensity of balance exercises was vague relative to terminology for describing the intensity of strength exercises.


CONCLUSIONS
Physical therapists with expertise in fall prevention adopted an individualized approach to exercise prescription that was based on physical assessment findings rather than "off-the-shelf" exercise programs commonly used in fall prevention research. Training programs for people who prescribe exercises for older adults at risk of falling should encompass these findings.
Allied Health Clinical Research Unit, Southern Health, Kingston Centre, Cheltenham, Victoria, Australia.
Romi
R
Haas
Stephen
S
Maloney
Eva
E
Pausenberger
Jennifer L
JL
Keating
Jane
J
Sims
Elizabeth
E
Molloy
Brian
B
Jolly
Prue
P
Morgan
Terry
T
Haines
D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D003657:Decision Making; D015444:Exercise; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D061214:Patient Safety; D059825:Physical Therapists; D018570:Risk Assessment