Article

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. 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.
DESIGN: 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.

Langue : ANGLAIS