In this issue, we begin a series of “white papers” as an extension of the Editor's Message, that focus on strategies for “best practice” in geriatric physical therapy. This one contends that Walking Speed is a powerful and essential component of the physical therapy examination and evaluation process. Upcoming white papers will highlight the need to incorporate indicators of specificity, sensitivity, and minimally important clinical differences into our clinical decision making. Why a white paper? A white paper is a short report that defines a position about an issue or a problem, usually quite heavily referenced, and often promotes a change in policy or procedure. While historically white papers were government documents, currently agencies, nonprofits, professional associations, and other “special interest groups” use white papers to raise awareness, stimulate discussion, and effect change.
During a presentation on motor control of locomotion in persons with stroke at APTA's Annual Meeting in 2008, Section on Geriatric's member, Pamela Duncan, PT, PhD, FAPTA, FAHA, challenged her audience to consider walking speed as a “Sixth Vital Sign,” as an indicator of overall functional status and key element in both baseline and outcome assessment of physical therapy care. Dr. Duncan invited clinicians, educators, and researchers to join her in a “grass roots” effort to better incorporate walking speed into our examination and evaluation process. She gathered a “task force” of physical therapists (Kay Wing, DPT, NCS, GCS; Stacy Fritz, PT, PhD; Clayton Gable, PT, PhD; Doug Bidelspach; Michelle Lusardi, PT, PhD) who have been in lively discussion and debate, and have generated this white paper for your thoughtful consideration.
Why publish this white paper in the Journal of Geriatric Physical Therapy? Walking speed is a particularly important indicator of function for the older adults that we care for; as an indicator of present function; of risk for functional decline, falls, or hospitalization; of readiness to return to community living or need for change in living arrangements; and as a way to document efficacy of our interventions. I am using my “bully pulpit” as Editor to get the message about walking speed out, in the belief that members of the Section on Geriatrics are ready and able to take a leadership role in changing the profession's thinking about this functional vital sign. I look forward to hearing your thoughts! (firstname.lastname@example.org)