Background/Statement of Need:
Every five years or so, a significantly larger amount of individuals both around the world and within our country are becoming part of the elderly population.1,2 It’s hard to believe Americans aged 65 and older will comprise about one fifth of the population in 2030.1 Aging is not only associated with an increased risk of falls within the United States, but it’s also linked to a higher risk of comorbidity conditions.1 In fact, two out of three elderly Americans have several chronic health conditions.2 Although there’s been an increase in elderly Americans with declining health, as physical therapists we can help prevent falls, reduce medical costs associated with falls, and improve quality of life through appropriate footwear education.1-4 Expenditures related to falls and the elderly are very costly for seniors, their families or caretakers, our government, and taxpayers.3 More than thirty-one billion was spent in 2016 for Medicare falls related expenditures, and the yearly Medicare expenditure is likely to increase in the coming years.3 Keeping senior citizens as independent as possible, as well as mobile, is imperative to enhance their quality of life.1
Overview:
Even before PT school I’ve had a strong interest in the geriatric population. After working with several older adult individuals throughout all of my clinical affiliations, I wanted to focus on the elderly for my capstone. When I developed a PICO question for my Evidence-Based Practice (EBP) II PHYT 752 course, I wanted to learn more about what footwear conditions or characteristics contributed to falls. My PICO question was “In a 65 year old male with history of falls ((≥1 fall within past year) and unsteady balance (Berg score ≤45) is non-supportive shoewear or decreased proprioception a greater predictor of increased falls risk.” In order to answer this PICO question, I completed a review of existing literature and composed a Critically Appraised Topic which is available to view within the capstone related materials below.
As a future physical therapist, I wanted to create an audio recorded presentation about appropriate footwear for older adults which would be useful for practicing physical therapists and physical therapy assistants. My initial plan was to incorporate recent clinical evidence related to footwear and falls, provide clinical example applications, and to review basic footwear terminology, aging characteristics, common foot related pathologies, and key considerations for a shoe fitting. As I began working on my capstone the material covered grew substantially. I decided to expand the list of basic shoe vocabulary terms, detail a few types of partial foot amputations, and provide more of an in depth explanation of certain footwear terms like outer sole and last.
Capstone and capstone related materials:
My main capstone product is an audio recorded PowerPoint presentation which takes approximately one hour to watch.
*PDF version of my PowerPoint presentation
Capstone related materials include:
My CAT from the EBP II PHYT 752 course, a recent evidence table (reviews footwear and the geriatric population, footwear and falls, footwear and its impact on overall balance, aging changes, footwear terminology), a set of 9 questions for a post presentation evaluation survey, and a list of ten questions which could be used for a pre/post presentation quiz or examination with physical therapists and physical therapy assistants.
In the future my capstone may become a component of a continuing education course for a falls prevention program known as the Community Health and Mobility Partnership (CHAMP).5 You can learn about the CHAMP program here.5 Vicki Mercer helped create CHAMP and continues to oversee the CHAMP program.5
Self-Assessment:
My capstone project has greatly changed from its mid-term draft status to the final draft. I’ve made several changes which together helped make the presentation more concise and progress appropriately. Some examples of changes made include the: combination or omission of certain slides, addition of reference materials, dispersion of evidence throughout the presentation as opposed to placement at the end, and the completion of client scenarios, footwear characteristic recommendations, and a review of Brannock device® use. One limitation of doing an audio recorded presentation instead of a live presentation is the reduced amount of interaction between the presenter and learners. In a live presentation I could have learners work in groups to answer the client scenarios, and I could clarify or answer any questions that arose during the presentation.
Throughout the capstone drafting process, I’ve learned a lot about footwear terminology and its relevance to the geriatric population. I appreciate the learning process I’ve gone through to get to the final product, it took patience, frequent editing, and an open attitude towards feedback to reach this final stage. There were different challenges I experienced as well, such as limited search results for information or images, and misguided explanations of certain footwear terms. Although this presentation was not intended to be 71 slides in length, I’m excited to have created my final product! I truly hope this presentation is able to assist current PTs and PTAs learn more about appropriate footwear and the older population. My work on this capstone project has increased my desire to continue learning about common foot related pathologies and their relationship to footwear with older adults.
Evaluation:
The set of ten pre/post examination questions I created could be used for a future continuing education course module. The post examination results can indicate if a viewer retained information presented. I also created a sample post presentation evaluation form future viewers can fill out to provide feedback in order to improve the presentation.
Acknowledgements:
My final capstone draft wouldn’t have been completed without the help of various professionals including Dr. Vicki Mercer, Dr. Mike Gross, Nick Cameron DPT, Pat Pande PT, Martha Zimmerman PT, clients used for capstone client examples, and my colleague Lindsey Valtrakis DPT.
I couldn’t have made progress with my capstone without the help of Vicki Mercer PT, PhD, Mike Gross PT, PhD, FAPTA, Nick Cameron DPT, Pat Pande PT, Martha Zimmerman PT, and my colleague Lindsey Valtrakis DPT. Throughout the entire capstone drafting process Dr. Mercer has been an invaluable resource. She provided feedback on multiple occasions, which helped guide and enhance the quality of my capstone draft materials. Dr. Gross helped with my review of footwear terminology and provided examples of shoe modifications needed for individuals who excessively pronate or supinate during ambulation. Nick Cameron and Dr.Gross agreed to be on my capstone committee. Pat Pande provided information and resources related to a sample footwear evaluation document. Martha Zimmerman gave suggestions towards my midterm and final capstone draft materials. She also shared three helpful relevant footwear articles. Lindsey Valtrakis provided advice regarding capstone planning. Client capstone examples couldn’t have been completed without the assistance of G.S. and B.W.
References:
- Cdc.gov. The State of Aging & Health in America 2013. 2013:II,III,1,3,4,5. National Center for Chronic Disease Prevention and Health Promotion, Division of Public Health. https://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf.
- Wan H, Goodkind D, Kowal P. An Aging World:2015. Report Number: P95-16-1.cdc.gov. http://www.census.gov/library/publications/2016/demo/P95-16-1.html. Published March 28,16. Updated March 31, 2016.
- Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥ 65 Years- United States, 2014. MMWR Morb Mortal Wkly Rep September 23, 2016; 65(37);993-998.cdc.gov. Updated September 22, 2016. doi: http://dx.doi.org/10.15585/mmwr.mm6537a2.
- Menant JC, Steele JR, Menz HB et al. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev. 2008; 45(8):1167.doi:10.1682/JRRD.2007.10.0168.
- Mercer, V. Community Health and Mobility Partnership (CHAMP). Uncch.pure.elsevier.com. https://uncch.pure.elsevier.com/en/projects/community-health-and-mobility-partnership-champ. Accessed December 28, 2016.
Images:
I. Public Domain Pictures. http://www.publicdomainpictures.net/pictures/120000/velka/human-footprints-in-the-sand.jpg
For a complete list of my audio recorded PowerPoint presentation references please view References.