Assessing cardiovascular parameters and risk factors in physical therapy practice: findings from a cross-sectional national survey and implication for clinical practice

Abstract

Background Cardiovascular diseases are the leading cause of death and comorbidity worldwide. High blood pressure and resting heart rate are risk factors (or vital signs) critical to cardiovascular health, patient safety, and medical management. Physiotherapists play a fundamental role in risk factor identification, early diagnosis, and subsequent management of cardiovascular disease. To date there is limited research in Europe investigating the level of knowledge and skills possessed by physiotherapists regarding cardiovascular disease screening. Three studies previously observed inadequate vital signs screening behaviors of physiotherapists practicing in the United States and Saudi Arabia. The primary aim of this study was to investigate cardiovascular knowledge and screening practices among Italian physiotherapists, according to the current practice recommendations. Methods A Cross-Sectional Survey was developed adapting two previous surveys. The survey was administered to members of the Italian Physiotherapy Association. Chi squared test, Mann-Whitney test or Kruskal-Wallis test were used to study differences among subgroups and question responses. Results The required sample size was met with total of 387 Italian physiotherapists completing the survey. 80% consider relevant cardiovascular assessment. However, 72.2% were not familiar to guidelines recommendations and only 50% screen vital signs routinely. Their knowledge of normative blood pressure (high-normal, 16%; hypertension, 12%) and heart rate values (bradycardia, 24%; tachycardia, 26%) were low. Although participants reported being skilled for blood pressure measurement (quite sure, 52%; sure, 27%), their adherence to guidelines is low (baseline measurement on both arm, 25%; 3 repeated measures, 46%). Only 27.8% reported to measure exercise related BP and 21.3% of them understood the concept of exaggerated BP. No significant differences between subgroups were found. Conclusions Our study revealed that a concerning proportion of Italian physiotherapists are not versed in fundamentals of properly performing cardiovascular screenings. This lack of knowledge is present across the profession and may impact on appropriate triage and management. The poorly executed screening has the potential to negatively impact the patient and the practitioner. Given the absence of Italian guidelines, we produced and implemented three infographics for public use, which have the dual objective of raising awareness about this subject and providing practical resources for everyday practice.

Screening for Referral of Serious Pathology by Physical Examination Tests in Patients with Back or Chest Pain: A Systematic Review

“…The continuous aging of the global population in the future may further increase the prevalence of serious pathologies. Therefore, primary healthcare professionals, especially if involved in direct access settings, need to be trained and capable of triaging the typical clinical presentations of such pathologies, which potentially mimic symptoms of most common musculoskeletal disorders [ 9 , 42 , 43 , 44 , 45 , 46 ]. Certain categories of primary healthcare professionals should further improve their knowledge and clinical reasoning skills to match the necessary knowledge and skills for a proper screening for referral process as currently performed by specific healthcare professionals [ 42 , 43 , 44 , 45 , 46 ].…”

“…Therefore, primary healthcare professionals, especially if involved in direct access settings, need to be trained and capable of triaging the typical clinical presentations of such pathologies, which potentially mimic symptoms of most common musculoskeletal disorders [ 9 , 42 , 43 , 44 , 45 , 46 ]. Certain categories of primary healthcare professionals should further improve their knowledge and clinical reasoning skills to match the necessary knowledge and skills for a proper screening for referral process as currently performed by specific healthcare professionals [ 42 , 43 , 44 , 45 , 46 ]. For these reasons, it would be appropriate for these skills to become a milestone of the core competence of all healthcare professionals, both for bachelor and post-graduate academic paths, and to make these skills mandatory topics in academic programs.…”

“…For these reasons, it would be appropriate for these skills to become a milestone of the core competence of all healthcare professionals, both for bachelor and post-graduate academic paths, and to make these skills mandatory topics in academic programs. Improvements in theoretical and practical knowledge will improve the quality of the pathway of care and daily clinical practice, and specifically, in the case of serious pathologies, it will increase screening for referral skills in order to ensure the most favorable prognosis for patients [ 9 , 42 , 43 , 44 , 45 , 46 ].…”

Physiotherapy Screening for Referral of a Patient with Patent Foramen Ovale Presenting with Neck Pain as Primary Complaint: A Case Report

“…Temperature was normal, and a regular pulse oxygen saturation level of 99% and 68 bpm resting heart rate (RHR) were assessed by a pulse oximeter [ 52 ]. Resting blood pressure (RBP) was measured on both arms and the higher one was used for follow-up measurements [ 19 , 47 ]. The mean of the last 2 measurements of the left arm—1 measurement every 2 minutes: (1) 125/85 mmHg; (2) 135/75 mmHg—was found to be 130/80 mmHg, suggesting a high-normal BP [ 47 ].…”

“…However, the screening for the referral process for serious pathologies of the neck is a real challenge [ 2 , 4 , 10 , 11 ]. That is, physiotherapists should be trained to triage vascular and neurological disorders [ 12 , 13 , 14 , 15 , 16 ], including the examination of cranial nerves [ 16 , 17 ] and cardiovascular parameters [ 12 , 14 , 18 , 19 ], in order to recognize those patients’ presentations which require referral for further medical opinion [ 15 , 20 , 21 , 22 ].…”