MEDICAL CLEARANCE OF OLDER ADULT PRIOR TO PREVENTATIVE DIRECT ACCESS PHYSICAL THERAPY: a RETROSPECTIVE ANALYSIS

PURPOSE/HYPOTHESIS: Evidence for the effectiveness of prevention‐focused programming among older adults utilizing direct access referrals from community centers to physical therapists (PTs) has been reported. However, the outcomes of cognitive and cardiovascular screenings administered to older adults prior to enrollment in PT‐led prevention programming is limited. Therefore, the purpose of this study is to describe rationale for participation exclusion or need for medical clearance among older adults prior to participating in a PT direct consumer access prevention‐focused exercise program. NUMBER OF SUBJECTS: Research records from 214 community dwelling older adults. MATERIALS AND METHODS: After securing ethics board approval, a retrospective descriptive analysis of data obtained during a prior randomized controlled trial (RCT) was analyzed. Two unique data sets emerged from the RCT: Group‐S was screened for study inclusion criteria but ultimately not enrolled and Group‐E was enrolled and participated in the preventative exercise programming. Participant demographics including a confirmed Alzheimer's diagnosis or recent hospitalization, outcomes of cognitive screenings (Mini‐Cog, Trail Making Test Part B), outcomes of a cardiovascular screening (American College of Sports Medicine Exercise (ACSM) Preparticipation Health Screening), and the ethics board record of adverse or medical events was extracted from the RCT records. Descriptive statistics were generated for demographic and outcome variables and inferential statistics were analyzed using the Chi‐squared tests with significance determined at P<05. RESULTS: Records from 70 individuals in Group‐S and 144 individuals in Group‐E were available for analysis. 18.6% (n = 13) in Group‐S were not enrolled due to medical instability or potential safety considerations. Specific rationale for non‐inclusion was as follows: 11.4% (n = 8) did not pass a cognitive screening and/or had a confirmed Alzheimer's diagnosis, 4.3% (n = 3) had a recent hospitalization, and 2.9% (n = 2) were told it was unsafe to exercise by their medical provider. A significant relationship was identified between not passing the Mini‐Cog and advancing age (P = .02). The ACSM Preparticipation Health Screening identified 40%(n=58) ofGroup‐E participants as needing medical clearance prior to initiating the exercise programming. No adverse or medical events related to program participation were reported. CONCLUSIONS: A PT‐led prevention‐focused program utilizing direct access referrals from community senior centers offers a safe option for older adults to participate in individualized exercise that may reduce falls and health related risks. CLINICAL RELEVANCE: Cognition and cardiovascular screenings are effective in identifying medical clearance needs of older adults prior to engagement in PT‐led prevention focused health care services. Furthermore, a PT direct access referral mechanism is an opportunity to bridge a gap between public health and medical care delivery options for older adults.