Cardiovascular Assessment in the Orthopaedic Practice Setting

Abstract

As consumer access to physical therapy practice expands, it is important that physical therapists are familiar with and implementing accepted methods of identifying the cardiovascular status of their clients. Established guidelines for assessing cardiovascular risk prior to initiating aerobic exercise programs are available and can be readily adopted by physical therapists in diverse clinical settings. We have provided a process for integrating existing guidelines into clinical practice. Because little evidence exists regarding the clinical behaviors and knowledge of orthopedic physical therapists in the area of cardiovascular risk, we conducted a survey to assess current practice patterns. The results suggest that orthopedic physical therapists are performing cardiovascular screening at frequencies similar to other components of the history and systems review, but that monitoring baseline or exercising vital signs does not occur with every exercise session. J Orthop Sports Phys Ther 2005;35:730-737.

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

“…Surprisingly, 60.2% reported that cardiovascular measurements are outside their scope of practice. This finding is similar across the profession as indicated by previous studies conducted in other countries [ 1 , 10 , 34 , 48 ]. For example, although the American Physical Therapist Association Guide to Physical Therapist Practice encourages early screening for medical conditions, including a review of the cardio-vascular/pulmonary system by measuring HR and BP [ 8 ], it was observed that only 10-15% of U.S. outpatient physiotherapists did perform a routine cardiovascular assessment because it is believed to be beyond their competence [ 1 ].…”

“…Physical inactivity alongside increasing time of sedentary behavior can have, in isolation or combination, a repercussion on the cardiovascular system with an increased disease incidence and deaths [ 48 ]. This tendency of sedentary behavior has been recently amplified by the recent Covid-19 pandemic [ 61 , 62 ].…”

Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

“…Eligibility criteria for patients with axSpA were ≥ 18 years old, a member of a SVMB exercise group, and provision of written informed consent. All patients were screened for cardiovascular risk [ 29 ]. Patients identified as at increased risk required confirmation from a PT or medical doctor that a higher level of exercise was not contraindicated.…”

Physical Therapy Student Reports of Blood Pressure Guidelines Learned in the Classroom, and Observed and Practiced in Clinical Experiences

“…Brooks et al analyzed 182 survey responses from active American Physical Therapy Association (APTA) members finding nonoutpatient practitioners were 2 to 3 times more likely to assess BP daily than their outpatient counterparts. 23 Scherer et al 24 concluded that BP is not regularly taken as a baseline measurement in outpatient settings and that physical therapists use subjective responses from patients as their monitoring tool. Millar et al observed 15 physical therapists during 74 patient sessions at an outpatient orthopedic clinic and found that preactivity BP was recorded in only 2 instances and postactivity BP was recorded once.…”