A Survey of Assessment Anxiety, Depression, and Visual Dependence in Neurologic and Geriatric Physical Therapy Practices

Background: Anxiety, depression, and visual dependence (ADVD) affect functional outcomes in people with neurologic diagnoses and older adults. The purpose of this project was to determine if physical therapists evaluate ADVD consistently in neurologic/geriatric physical therapy and if treatment strategies are standardized across providers. The hypothesis was that ADVD are not consistently assessed and that treatment strategies are not standardized.

Methods and Findings: Ninety-five physical therapists identified as primarily treating people with neurologic diagnoses were invited to complete an electronic survey about the assessment of ADVD. Clinical practice setting, typical caseload, experience, and degrees/certifications were recorded for each participant. Survey completion rate was 40% (n=38). Approximately 18% of the therapists “always” assess for anxiety (32% “most of time”; 8% “half the time”; 32% “sometimes”; and 10% “never”). Depression assessment was similar, and visual dependence was reported to be assessed slightly more than anxiety and depression. Qualitative evaluation revealed that physical therapists use varying assessment methods and intervention strategies for ADVD. There were significant positive associations between clinical practice setting and the assessment of visual dependence (χ² (2, N=45) = 15.67, p < 0.001, with more physical therapists assessing visual dependence in the outpatient setting. Positive associations were also found between visual dependence assessment and the physical therapist being a board certified neurologic clinical specialist (χ² (1, N=45) = 7.16, p= 0.007) or having a Doctorate of Physical Therapy (χ² (1, N=45) = 7.19, p= 0.007). A major limitation of this study was that the surveyed physical therapists were all within the same geographical location.

Conclusion: Our results indicate that physical therapists are not consistently assessing for ADVD and the treatment strategies are not standardized, even when ADVD is evaluated. Additional education is warranted to improve care.

Author(s): Brooke NK, Patrick JS, Carrie WH, Kathleen B and Susan LW

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