RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / Name of the candidate & address / JUSTY BABU THAIKKATTILB/303, Om Shivam apt., Gokul Township,
Bolinj, Virar [w] Dist: Thane , Maharashtra
401303
2. / Name of the Institution / K.T.G COLLEGE OF PHYSIOTHERAPY
Hegganahalli Cross, Vishwaneedam Post,
Sunkadakatte Via Magadi Road,
Bangalore – 560091
3. / Course of study and subject / MASTER OF PHYSIOTHERAPY
(PHYSIOTHERAPY IN CARDIO RESPIRATORY DISORDERS )
4. / Date Of Admission To Course / 1/04/2013
5. / Title of The Topic:
“PHYSIOTHERAPISTS’ PERCEPTIONS OF KNOWLEDGE AND CLINICAL BEHAVIOUR REGARDING CARDIOVASCULAR DISEASE PREVENTION: A SURVEY IN KARNATAKA STATE”
6.
7
8 / Brief resume of the intended work:
6.1 Need for the study:
According to WHO Cardiovascular disease (CVD) is caused by disorders of the heart and blood vessels, and includes coronary heart disease, cerebrovascular disease, hypertension, peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, an unhealthy diet and harmful use of alcohol.1
The pathophysiological conditions that underlie cardiovascular diseases are atherosclerosis, altered myocardial muscle mechanics, valvular dysfunction, arrhythmias, and hypertension. Atherosclerosis causes reduction in luminal diameter and is also a primary contributor to cerebrovascular disease (CVA) and peripheral vascular disease (PVA). Alteration in myocardial muscle mechanics will result in left ventricular dysfunction which results in heart failure also known as congestive heart failure (CHF). Arrhythmias are caused by disturbance in the electrical activity of the heart, resulting in impaired electrical impulse formation or conduction.2
Perception of risk was the primary factor associated with CVD preventive recommendations. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.20 Preventive efforts should target each major risk factor. Any major risk factor, if left untreated for many years, has the potential to produce CVD. Nonetheless, an assessment of total (global) risk based on the summation of all major risk factors can be clinically useful for 3 purposes which are as follows identification of high-risk patients who deserve immediate attention and intervention, motivation of patients to adhere to risk-reduction therapies, and modification of intensity of risk-reduction efforts based on the total risk estimate.12 Studies indicate that greater energy expenditure is associated with increased longevity. Walking and climbing stairs each independently predicted longevity. Participation in light activities, regardless of energy expenditure, appeared unassociated with mortality rates. In contrast, greater participation in moderate activities showed a trend toward lower mortality rates, while greater energy expended in vigorous activities clearly predicted lower mortality rates. Additionally, physical inactivity and overweight adversely affected longevity to a similar extent. Physiotherapists are best positioned to assess CVD patients and tailor exercise programs for this complex patient population to help them make essential lifestyle changes.2
Physiotherapist are the only clinicians who possess the core education and training to provide assessments and exercise interventions for this patient population in acute care, rehabilitation, outpatient, complex continuing care and homecare settings, all of which have been identified by the Canadian Association of Cardiac Rehabilitation (CACR) as key locations for CR programming. Evidence shows that interventions by a physiotherapist, including strengthening, aerobic endurance and lifestyle changes related to exercise, are both clinically- and cost-effective methods of addressing the needs of the CVD/CHF patient population. These interventions have been shown to increase physical capacity, improve functional activities, delay progression of the illness and increase health related quality of life. Access to physiotherapy services for CVD/CHF should occur both after acute episodes, in acute care and in-patient cardiac rehabilitation programs, but also in the community through clinic and home-based programs. Study has proved that physiotherapists are involved in primary and secondary prevention of CVD.21
Research clearly demonstrates the efficacy of CVD prevention. Increased levels of physical activity have been shown to decrease all-cause mortality and coronary heart disease. Based on extensive evidence, recommendations of optimal levels of physical activity have been established to promote and maintain health for the apparently healthy adult.6 Similarly, strong research evidence has established the efficacy and promoted guidelines for physical activity and lifestyle behavior modification in individuals with CVD. Primary CVD prevention focuses on CVD risk identification and modification in the apparently healthy person, while secondary CVD prevention seeks to minimize and reverse the effects of established CVD. The American Physical Therapy Association (APTA) has identified the value of CVD prevention.6 The Guide to Physical Therapist Practice recognizes the benefits of cardiovascular disease prevention, and encourages the promotion of health, wellness, and fitness to the public, in order to enhance individuals’ overall quality of life. It further designates a preferred practice pattern of “primary prevention/risk reduction for cardiovascular/pulmonary disorders,” and indicates that, as part of the evaluative process of any patient, a physical therapist should perform a cardiopulmonary system review that may include assessment of heart rate, blood pressure, respiratory rate, and presence of edema.6
This survey will be undertaken to establish the physiotherapist perception of knowledge and clinical behavior regarding CVD prevention in Karnataka state. An electronic mail questionnaire survey would be sent to all physiotherapists in Karnataka. Hence the purpose of this study is to establish whether physiotherapist support prevention of cardiovascular disease.
Research Question
Does physiotherapist have perception of knowledge and clinical behavior regarding cardiovascular disease prevention?
Hypothesis:
No hypothesis stated
6.2 Review of Literature:
R Scott Van Zant et.al (2013) studied the perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention and found out that they support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors.
J. Reynaldo A. Santos (1999) studied to assess and improve upon the reliability of variables derived from summated scales. This paper has demonstrated the procedure for determining the reliability of summated scales. It emphasized that reliability tests are especially important when derivative variables are intended to be used for subsequent predictive analyses. If the scale shows poor reliability, then individual items within the scale must be re-examined and modified or completely changed as needed. One good method of screening for efficient items is to run an exploratory factor analysis on all the items contained in the survey to weed out those variables that failed to show high correlation.
Lori Mosca et.al (2005) studied to evaluate physician adherence to cardiovascular disease (CVD) prevention guidelines and found out that perception of risk was the primary factor associated with CVD preventive recommendations and they stated that educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD.22
Scott M Grundy et.al (1999) Assessed of cardiovascular risk by use of multiple-risk-factor assessment equations a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. They stated that Preventive efforts should target each major risk factor. Any major risk factor, if left untreated for many years, has the potential to produce cardiovascular disease (CVD). Nonetheless, an assessment of total (global) risk based on the summation of all major risk factors can be clinically useful.14
Rajeev Gupta et.al (2012) studied regional variations in cardiovascular risk factors in India: India heart watch and found out that there are wide regional variations in cardiovascular disease mortality and burden in India. Apart from the well-known gender based differences, there are variations in mortality in different states and in urban and rural regions and among different socioeconomic groups within states.24
William E. DeTurk et.al (2008) studied Physical Therapists as providers of care: exercise prescriptions and resultant outcomes in cardiac and pulmonary rehabilitation programs in New York State and found that physical therapists are minimally involved in directing programs and writing exercise prescriptions. Exercise prescriptions are individualized to the patient. Outcome measures most frequently used by participating CR and PR program directors are consistent with nationally-recognized best practice.9
Ethel M Frese et.al (2002) did study on self-reported measurement of heart rate and blood pressure in patients by physical therapy clinical instructors and concluded that measurement of HR and BP should be included in physical therapy screening.10
Diane U. Jette et.al (2012 ) in their observational study on Use of Quality Indicators in Physical Therapist Practice and concluded that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.25
Jim Stone, 3rd Ed. (2009) states that interventions by a physiotherapist, including strengthening, aerobic endurance and lifestyle changes related to exercise, are both clinically- and cost-effective methods of addressing the needs of the CVD/CHF patient population. These interventions have been shown to increase physical capacity, improve functional activities, delay progression of the illness and increase health related quality of life. Access to physiotherapy services for CVD/CHF should occur both after acute episodes, in acute care and in-patient cardiac rehabilitation programs, but also in the community through clinic and home-based programs. This can be done in the primary care setting, and/or in the home setting.
6.3 Objectives of the study:
To determine the physiotherapist perception and clinical behavior regarding the role of physical therapy in cardiovascular disease prevention in Karnataka.
Materials and Method
7.1 Study Design:
A prospective cross sectional survey design.
7.2 Methodology
Study Population:
Physiotherapist with one year of clinical experience in any settings.
Sample size:
Non probability sample size-Estimated sample size is 250.
Study Setting and Source of data
Physiotherapist of Karnataka.
Sampling Method
Convenient sampling method.
Study Duration
Single time study.
Sample Selection
Inclusion Criteria:
Physiotherapists involved hospital care setups, academics, rehabilitation centers and in clinical settings.
Exclusion Criteria:
Physiotherapists involved in fitness centers
Materials used:
Questionnaires (appendix 1)
Outcome Measurements:
Questionnaires consisting of following four elements:
· EDCVD: Education of CVD/CVD Risk Factors
· PRECVD: Development/Administration of Primary CVD Prevention Protocols
· IDCVD: Identification of Underlying (Undiagnosed) CVD/CVD Risk
· MONCVD: Monitoring CV Status of Patients with Known CVD
This questionnaire contains questions which determines patient education of CVD/CVD risk factors (EDCVD), development/administration of primary CVD prevention protocols (PRECVD), identification of underlying (undiagnosed) CVD/CVD risk (IDCVD), monitoring of cardiovascular status of patients with known CVD (MONCVD). This questionnaire was developed specifically for this study and validated by eight expert physiotherapists who had at least one of the following criteria certified as a Cardiovascular and Pulmonary Clinical Specialist by the American Physical Therapist Association (APTA) or practiced primarily treating patients with cardiopulmonary impairments or taught cardiopulmonary physical therapy in accredited physical therapy education programs. PRECVD, IDCVD, 7 items covering the element MONCVD) was constructed, with each item containing a 5 item Likert scale response 5 = strongly agree, 4 = agree, 3 = neutral, 2 = disagree,1 = strongly disagree. Permission was obtained from authors to use the questionnaires to carry a survey in India. The filled questionnaires will be used for analysis.
7.3 Methods of data collection
Ethical Clearance
As this study involve human about subjects, the ethical clearance has been obtained from research and ethical committee of K.T.G college of physiotherapy, Bangalore as per the ethical guidelines for Bio-Medical research on human subjects, 2000 ICMR, New Delhi.
The study will be conducted by sending a questionnaire. An electronic mail would be sent to all the physiotherapists in India. It will be sent to all the physiotherapist working in hospital setup, academics, and clinical setup as well.
Outcome measures:
Electronic mail questionnaire and online survey
7.4 Statistical Tests
Mean differences of numeric survey responses would be analyzed via Analysis of Variance test using SPSS (version 17) statistical program.
List of References:
1. World Health Organization for cardiovascular diseases [online] updated on march 2013. Available at http://www.who.int/
2. Susan .B. O’ Sullivan , Thomas .J. Schmitz Physical Rehabilitation 5th ed. Philadelphia
3. Rajeev Gupta, Soneil Guptha, Krishna Kumar Sharma, Arvind Gupta, Prakash Deedwania Regional variations in cardiovascular risk factors in India: India heart watch World Journal of W J C Cardiology 2012 April 26; 4(4) : 112-120.
4. Dean E. Physical therapy in the 21st century (Part II): Evidence-based practice with the context of evidence-informed practice. Physiother Theory Pract. 2009; 25(5-6): 354-368..
5. American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. 4th ed. Champaign, IL; Human Kinetics; 2004.
6. R Scott Van Zant et.al. Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention. Cardiopulmonary Physical Therapy Journal. 2013 June vol. 24
7. Merz C, Buse J, Tuncer D, Twillman G. Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes. J Am Coll Cardiol. 2002; 40:1877–1881.
8. DeTurk WE, Scott L. Physical therapists as providers of care: exercise prescription and resultant outcomes in cardiac and pulmonary rehabilitation programs in New York state. Cardiopulm Phys Ther J. 2008;19(2):35-43.
9. Frese EM, Richter RR, Burlis TV. Self-reported measurement of heart rate and blood pressure in patients by physical therapy clinical instructors. Phys Ther. 2002; 82:1192-1200.
10. Scherer SA, Noteboom JT, Flynn TW. Cardiovascular assessment in the orthopaedic practice setting. J Orthop Sports Phys Ther. 2005; 35:730-737.
11. Jette DU, Jewell DV. Use of quality indicators in physical therapist practice: An observational study. Phys Ther. 2012; 92:507-524.
12. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010; 303(3):1235-1241.
13. Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple risk-factor measurement equations: A statement for health care professionals from the American Heart Association and the American Academy of Cardiologists. Circulation. 1999; 100:1481-1492.
14. Cohen MR. Medication Errors: Causes, Prevention, Risk Management. Sudburry: Jones and Barlett; 1999.
15. American Physical Therapy Association. Guide to Physical Therapist Practice. 2nd ed. Alexandria, VA: APTA; 2003
16. Centers for Medicare and Medicaid Services. 2009 Reporting Experience Including Trends 2007-2010. Physician Quality Reporting System and Electron Prescribing [eRx] Incentive Program Reporting Experience. Appendix A. 2011. Available at: http://www.cms.gov/PQRS/. Accessed September 27, 2012.
17. Dean E. Physical therapy in the 21st century (Part I):Toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract. 2009; 25(5-6): 330-353.
18. American Physical Therapy Association. Health Care Reform: Issues in Focus Series. Quality Reporting for Physical Therapists in Private Practice (PTPPs). 2010. Available at: http://www.apta.org/issuesinfocus/ quality improvement. Assessed June 30, 2012.
19. / Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics – 2012 update. Circulation.2012; 125:e2-e220
20. Berlin JA, Colditz GA. A meta-analysis of physical activity in the presence of coronary heart disease. AmJ Epidemiol. 1990; 132:612-628
21. Lori Mosca et.al. National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines. Circulation 2005 February : 499
22. Canadian Association of Cardiac Rehabilitation (CACR). Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention, 3rd Ed. 2009. (Accessed at:http://media.cacr.ca/guidelines/index.html
23. Haskell WL, Lee I-M, Pate RR, et al. Physical activity and health: Updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc.2007; 38(8):1423-1434.
24. Diane U. Jette, Dianne V. Jewell Use of Quality Indicators in Physical Therapist Practice: An Observational Study Physical Therapy 2012 January 6 92:507-524
25. J. Reynaldo A. Santos Cronbach's Alpha: A Tool for Assessing the Reliability of Scales. Journal of Extension 1999 April; 37
9. / Signature of Candidate
10. / Remarks of the Guide
11. / Name and Designation of
11.1 Guide :
11.2 Signature
11.3 Co-Guide :
11.4 Signature
11.5 Head of Department :
11.6 Signature
12. / 12.1 Remarks of the Chairman & Principal
12.2 Signature
ANNEXURE –I