[aptaoncology] Re: physical activity

From: "Kozempel, Jean A" <Jeannie.Kozempel@xxxxxxxx>
To: "aptaoncology@xxxxxxxxxxxxx" <aptaoncology@xxxxxxxxxxxxx>
Date: Tue, 18 Aug 2020 19:37:02 +0000

Sorry about the delay in responding back to everyone.  I took a week away from
all things techy including email.  Thank you to everyone for your thoughts and
ideas on this topic.  I have to agree with Nicole that my docs are truly
looking for an easy screen and not some additional test that they would need to
do.  They want something easy like the nutriscore that we currently use for
nutrition.  It is built into the emr.

[cid:image001.png@01D67575.6AC0EC20]
I am excited to have some key young docs very interested in including physical
activity screening in their practice.  I (un)fortunately can recall the days
when CRF was not considered anything that we could do something about.  “Tell
the patient to rest.”  We have made steady gains in cancer rehab and I am
excited for what we will accomplish moving forward.

I will keep this group informed of our progress and keep the conversation going.

Thanks again everyone!

Jeannie

From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> On
Behalf Of Nicole Stout
Sent: Saturday, August 8, 2020 12:54 PM
To: aptaoncology@xxxxxxxxxxxxx
Cc: aswisher@xxxxxxxxxxx
Subject: [aptaoncology] Re: physical activity

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Thanks for these comments Shana,
I agree and will just add a bit more food for thought.

Jeannie’s email was asking about a PA screen that the docs could do. I don’t
think that we should expect that they would consider ‘doing’ any type of
test/measure. I dont think we can expect them to do more than ask a few
questions and then ( hopefully) based on answers falling below a threshold,
send them for US to do the more detailed assessment.

When our SME group came together around the exercise screening and triage model
(the paper I lead in Cancer) we had several oncologists and onc nurses on that
paper. The minute someone would say...’ it’s just a grip strength test, or just
a 30 sec sit/stand’ those docs were adamant that it wont get done. They don’t
have the time/etc and to Anne’s point, they don’t know how (and frankly don’t
want to have to worry about) interpreting.
The spirit of the screening algorithm is to serve as that a ‘screen’. Not an
assessment. To Kiri’s point, I don’t believe we can ask our docs to do more
than ask questions and then trigger the referral to an appropriate setting for
exercise advice or prescription.

Now, AM-PAC is a series of questions for the patient, and could be leveraged to
quantify activity level and triage patients to an appropriate exercise program.
But, there are implications for cost and license to use that product.

Just some additional thoughts to differentiate the screen vs assessment. FYI,
there are also some nice prescription pads that are available from ACSM’d
Moving Through Cancer initiative that could help you create the easy button for
your docs: ask, advise, refer.

Best,
Nicole
Nicole L. Stout DPT, CLT-LANA, FAPTA

Sent from my iPhone

On Aug 8, 2020, at 11:51 AM, Shana Harrington (Redacted sender heel1998 for
DMARC) <dmarc-noreply@xxxxxxxxxxxxx<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:

This has been a great thread and I wanted to discuss some challenges I'm seeing
in this post that we face a lot as PT's and among health care providers. Our
language and definitions doesn't always seem to match. (I apologize if this is
long, but I'm very passionate about this topic. I'm also happy to discuss
further off the listserv).

I believe OP asked about physical activity, although I'd suggest some of the
recommendations provided in this post are more related to physical function. To
me, physical activity and physical function are not necessarily the same. I was
fortunate to be part of a recently published scoping review supported by the
research committee in the academy and we found a lot of variability in how the
term physical function was being used not only among physios but also health
care providers who treat individuals with cancer. Based on the scoping review,
I would suggest assessments like the 10 meter walk test, TUG, 5xSTS, AMPAC are
physical function tools and do not adequately measure physical activity.

               Harrington, S. E., Stout, N. L., Hile, E., Fisher, M. I., Eden,
M., Marchese, V., & Pfalzer, L. A. (2020). Cancer rehabilitation publications
(2008–2018) with a focus on physical function: a scoping review. Physical
Therapy, 100(3), 363-415.

I've seen individuals who are physically active but their physical function is
poor and vice versa. One example I use is I grew up swimming in St. Pete FL.
The master's team swam next to us and it was not unusual for a few 80 year olds
to be lap swimming. Several swam at least 5 days a week and swam a few
kilometers at a decent pace. So they were definitely physical active and met
the ACSM activity guidelines but some had questionable physical function. ie:
I'd see them get out of the pool (which that could be a struggle) and they had
a lot of gait difficulty with or without an assistive device.

Kiri brought up a great suggestion to use the ACSM recently updated cancer
guidelines of 150 minutes/week. If you have not reviewed the following
articles, I highly encourage everyone to do so. One of which was published in
our academy's journal - Rehabilitation Oncology and our former President, Steve
Morris serves as an author. If you have issues accessing any, please send me an
email.

                  Campbell, K. L., Winters-Stone, K. M., Wiskemann, J., May, A.
M., Schwartz, A. L., Courneya, K. S., ... & Morris, G. S. (2019). Exercise
guidelines for cancer survivors: consensus statement from international
multidisciplinary roundtable. Medicine & Science in Sports & Exercise, 51(11),
2375-2390.

                  Campbell, K. L., Winters-Stone, K. M., Patel, A. V., Gerber,
L. H., Matthews, C. E., May, A. M., ... & Morris, G. S. (2019). An executive
summary of reports from an international multidisciplinary roundtable on
exercise and cancer: evidence, guidelines, and implementation. Rehabilitation
Oncology, 37(4), 144-152.

We know a large percentage (ranges from 50-70% depending on the source) of
Americans do not meet the ACSM guidelines for weekly physical activity. Because
the majority of our patients aren't likely to meet these guidelines I think
this is a great talking point with the healthcare provider team and physicians
to get PT involved early and implement prospective surveillance.  We have so
much to offer and as Anne commented let's use our skills!

Another tool recommended was the BMAT. I'll admit, I'm not familiar with the
tool but one responder brought up a great point that it's a low level tool.
Therein lies one of the biggest challenge in trying to recommend screening
tools. There are going to be floor or ceiling effects for a lot of tools used
and you have to consider your patient population, type of cancer & setting
among other things to determine which is the best tool for the patients you're
seeing.

I'd also recommend the article Nicole Stout provided us regarding exercise
referral clinical pathways as it covers an entire range of individuals with
cancer from those with high complexities to those who are independent in the
community. I love tables & figures and figure 2 depicts the what, who and where
for this nicely.

I hope this helps and please continue these great, constructive discussions!

Shana Harrington PT, PhD
Board-Certified Clinical Specialist in Sports Physical Therapy (SCS)
Manual Therapy Certified (MTC)
heel1998@xxxxxxx<mailto:heel1998@xxxxxxx>

-----Original Message-----
From: Swisher, Anne <aswisher@xxxxxxxxxxx<mailto:aswisher@xxxxxxxxxxx>>
To: aptaoncology@xxxxxxxxxxxxx<mailto:aptaoncology@xxxxxxxxxxxxx>
<aptaoncology@xxxxxxxxxxxxx<mailto:aptaoncology@xxxxxxxxxxxxx>>
Sent: Sat, Aug 8, 2020 8:40 am
Subject: [aptaoncology] Re: physical activity
Just a reminder that administering these tests is easy to do, but interpreting
the results should not be delegated to someone else.  Taking the results
(numbers/percent of norms) is only part of the picture--what about the quality
of the patient's movement?  What about determining the cause of the poor
performance?

Please don't give away our expertise when another discipline asks for a 'quick
functional test'.  Offer to help them create it and show them how our
interpretation of the test results leads to movement diagnosis and a
personalized plan to improve/correct the movement.

Anne K. Swisher PT, PhD, CCS, FAPTA
Professor
Director, Scholarship Development
Division of Physical Therapy
Member, Mary Babb Randolph Cancer Center
West Virginia University
PO Box 9226
Room 8314
Morgantown, WV 26506-9226
phone 304.293.1319
fax 304.293.7105
email aswisher@xxxxxxxxxxx<mailto:aswisher@xxxxxxxxxxx>

________________________________
From:
aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>
<aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>>
on behalf of Guarnac@gmail <guarnac@xxxxxxxxx<mailto:guarnac@xxxxxxxxx>>
Sent: Saturday, August 8, 2020 8:34 AM
To: aptaoncology@xxxxxxxxxxxxx<mailto:aptaoncology@xxxxxxxxxxxxx>
<aptaoncology@xxxxxxxxxxxxx<mailto:aptaoncology@xxxxxxxxxxxxx>>
Subject: [aptaoncology] Re: physical activity

Agree with the recent comments - we use 30 sec STS while assessing  HR and O2
response for a snapshot of activity tolerance (and to assess safety of activity
for patient).  We also always do a hand dynamometer screen to assess upper body
strength - and usually TUG.  Gives a good quick picture of performance status,
strength and fall risk.  Quick and easy to
Do.

Sent from my iPhone

On Aug 8, 2020, at 6:30 AM, Andrew Chongaway
<achongaway@xxxxxxxxx<mailto:achongaway@xxxxxxxxx>> wrote:

Heidi: I agree with you about the 6 clicks, it's limited and looks at
functional mobility which to me is different than physical/performance status.

Shai: I like your input about the 5x or 30 sec. It's quick and relatively
little instruction needed. Pair it with the TUG which is quick and easy as long
as there is space and opens the objectiveness of the screen.

Andrew

On Fri, Aug 7, 2020, 10:39 PM heidi engel
<dmarc-noreply@xxxxxxxxxxxxx<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:
Definitely there is a wide spread love affair for the AMPAC score.
Sad to me. It’s such a limited subjective snap shot, but it is easy!
I’m going to back up Shai here- sit to stand is a better tool.
-Heidi
Sent from my iPhone

On Aug 7, 2020, at 4:38 PM, Kristen (Redacted sender kristen_0802 for DMARC)
<dmarc-noreply@xxxxxxxxxxxxx<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:

The hospital I work at also uses the AM-PAC or "6-clicks" outcome measure. The
rehab staff and nurses are all trained to use it; the therapists score the
AM-PAC every session with the patient. It's very quick and is being used at
several large university hospitals and helps with d/c planning. Case managers
are also trained and understand what the scores mean.

Kristen Knox, PT

On Friday, August 7, 2020, 01:22:19 PM EDT, Kristen E Krueger
<dmarc-noreply@xxxxxxxxxxxxx<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:

You should look at the AM-PAC for a self-reported functional assessment. Paul
LaStayo at University of Utah is using it and has some great data to back it up.

Kristen Krueger, PT
Physical Therapist III
Board-Certified Clinical Specialist in Oncologic and
Geriatric Physical Therapy
UC Davis Medical Center
Department of Physical Medicine
and Rehabilitation
kekrueger@xxxxxxxxxxx<mailto:kekrueger@xxxxxxxxxxx>
________________________________
From:
aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>
<aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>>
on behalf of Kozempel, Jean A
<Jeannie.Kozempel@xxxxxxxx<mailto:Jeannie.Kozempel@xxxxxxxx>>
Sent: Friday, August 7, 2020 5:55 AM
To: aptaoncology@xxxxxxxxxxxxx<mailto:aptaoncology@xxxxxxxxxxxxx>
<aptaoncology@xxxxxxxxxxxxx<mailto:aptaoncology@xxxxxxxxxxxxx>>
Subject: [aptaoncology] physical activity

Hello,

I have been asked to develop a “quick screening” method for docs to use to
assess a patient’s physical activity level.  Does anyone have a survey or
functional test that they are using to assess this?

Thanks,

Jeannie

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References:
- [aptaoncology] Re: physical activity
  - From: Shana Harrington
- [aptaoncology] Re: physical activity
  - From: Nicole Stout

[aptaoncology] Re: physical activity

Other related posts: