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Blood Pressure Attitudes, Practice Behaviors, and Knowledge of Outpatient Physical Therapists

Arena, Sara, K., PT, MS, DScPT1; Reyes, Alicia, SPT1; Rolf, Matthew, SPT1; Schlagel, Nicole, SPT1; Peterson, Edward, PhD2

Cardiopulmonary Physical Therapy Journal: January 2018 - Volume 29 - Issue 1 - p 3–12
doi: 10.1097/CPT.0000000000000068
Research Report
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Purpose: The purpose of this study is to describe and determine correlations among blood pressure (BP) attitudes, practice behaviors, and knowledge among physical therapists (PTs) practicing in the outpatient (OP) settings.

Methods: A survey was mailed to 1440 OP PTs matching inclusion criteria and through random selection from the American Physical Therapy Association Listserv. Self-reported demographics, attitudes, practice behaviors, and knowledge regarding BP measures of survey respondents were recorded. Descriptive statistics analyzed demographics and question responses; whereas a nonparametric Spearman version of the correlation coefficient analyzed correlations between variables.

Results: Three hundred thirteen surveys from males (41.3%), females (58.7%), and PTs with greater than 10 years' of experience (57.8%). Although 51.8% of respondents did not feel importance in measuring BP during evaluation, 94.2% felt confident in their ability to do so. In addition, 85.0% of respondents did not routinely measure BP during evaluations. One-third and two-third of respondents correctly identified criteria matching a prehypertensive or hypertensive BP, respectively. Furthermore, a positive correlation (r = 0.84, P < .001) was identified between attitude and practice behaviors; however, not between attitude or practice behavior and knowledge.

Conclusion: Initiatives to address misinformed BP attitudes and behaviors as well as gaps in knowledge of PTs providing care in OP settings is warranted.

1Physical Therapy Program, School of Health Science, Oakland University, Rochester, MI

2Department of Public Health Sciences, Henry Ford Health System, Detroit, MI

Correspondence: Sara K. Arena, PT, MS, DScPT, Physical Therapy Department, School of Health Sciences, Oakland University, Human Health Building- Room 3152, 433 Meadowbrook Road, Rochester, MI 48309-4401 (arena@oakland.edu).

Oakland University Physical Therapy Program Research Grant $5000. Grant #10738.

Human Subject Institutional Review Board Approval: Oakland University #530659.

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INTRODUCTION AND PURPOSE

National Prevalence rates of either a prehypertensive (P-HTN) or hypertensive (HTN) blood pressure (BP) measure have been reported at 28% and 33%, respectively.1 This is of specific concern as negative health sequelae from chronically elevated BP measures are well established and associated with elevated risk of heart attack, kidney disease, valvular diseases, stroke, and congestive heart failure.2 Despite 1 in 3 adults having HTN, nearly half of these individuals do not have their BP measures in control.3 Furthermore, as examination and clinical measurement of BP are commonly performed using an aneroid or autonomic sphygmomanometer, manometers that have undergone regular calibration checks, a cuff sized for each individual patient and a BP measurement attained using evidence-based methodology is essential to obtaining both an accurate BP measure and to guide clinical decisions that optimize care.4,5

Vital signs, including BP, obtained before and during both physical therapy examination and intervention provide physical therapists (PTs) insight into the physiological status of a patient's cardiovascular and pulmonary system and are instrumental in exercise prescription and monitoring.6 Frese et al7 reported infrequent vital sign measurement by PTs and perceived barriers to obtaining a measurement as a concern, as recognition of normal and abnormal physiologic changes during examination and intervention impacts safe exercise prescription and progression. Furthermore, Milar et al6 have reported low frequency of outpatient (OP) PTs measuring a heart rate or a BP of patients under their care. Although the Guide to Physical Therapist Practice supports the use of vital sign measures, inclusive of BP, in individuals with and without cardiopulmonary disease,8 previous studies have reported that only 4.4% of PTs always measure the BP of a new patient/client.7 Although it is conceivable that PTs may be choosing to use clinical judgment inclusive of visual inspection and previous medical history to determine whether BP measurement is necessary, a study by Feldman et al concluded that clinicians made poor clinical decisions regarding when to obtain a BP measure as they were unable to predict HTN status using the aforementioned strategies.9 Furthermore, evidence suggests that prevalence rates of P-HTN or HTN of patients under the care of a PT are in congruence and possibly in excess of rates reported in the general population.10-12

Despite incomplete evidence of causative factors for the omission of a BP measurement despite evidence of the prevalence of P-HTN and HTN BP measure among patients under the care of PTs in the OP practice setting, reports of other health care professions suggest deficiency in knowledge regarding correct equipment sizing and body positioning to obtain an accurate BP measure as a potential contributing factor.13-16 In addition, a study conducted within the discipline of nursing found that the intention to take an accurate BP measurement increased the accuracy of the measures obtained suggesting that the Theory of Planned Behavior could foretell an individual's intention to measure a BP accurately and ensuing behavior that followed.13 Further contributors to inconsistencies may include predisposing negative or neutral BP-related attitudes, gaps in knowledge, or perceived or actual practice constraints in the OP practice setting. Therefore, the purpose of this study is to describe and determine correlations among the attitudes, practice behaviors, and knowledge of BP assessment among PTs practicing in the OP settings.

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METHODS

Research Design

After securing Oakland University Institutional Review Board approval to assure the rights of the participants were protected, a prospective descriptive survey research study was initiated.

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Sampling Criteria

One thousand four hundred forty (1440) OP PTs residing in 6 Midwestern states (Michigan, Illinois, Ohio, Indiana, Wisconsin, or Minnesota) were randomly selected from the American Physical Therapy Association (APTA) “A-List” member mailing list rental (http://www.apta.org/Advertise/ListRentalPoliciesRates/) if: (1) A licensed PT, (2) a member of the orthopedic special interest section, and (3) practicing in a health system, hospital based or private practice OP setting. Physical therapist assistants and physical therapy students were excluded in addition to non–APTA members as only a pool of APTA members were included in the Listserv used for sampling. Assuming a 20% response rate, a sample size of 288 would result in 95% confidence interval with a half-width of 5%.

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Study Protocol

Individuals were mailed a 28-question survey tool in August 2014, in addition to an information sheet describing the purpose, amenity, instruction for completion, and option for withdraw from the study. Respondents' return of the survey tool served as consent of participation and identifying information was blinded to investigators. Respondents' self-reported attitudes (5 questions), practice behaviors (7 questions), knowledge (6 questions), and miscellaneous items (5 questions) regarding BP measures in addition to 5 demographics questions were encompassed within the survey (Appendix 1). The survey tool was previously tested for expert and face validity and reliability using a 3-step protocol inclusive of: (1) validity of survey questions as determined by 7 content experts, (2) face validity testing for readability and completion time by 13 doctors of physical therapy students who had completed the cardiopulmonary course curricular content and (3) test–retest reliability analysis of the survey used a Cohen kappa coefficient for ordinal data and an intraclass correlation coefficient for nominal data of data obtained from 27 OP PTs.17 All questions were found to have good (0.40–0.75) or excellent (>0.75) reliability with the exception of question #1 (0.33), #4 (0.34), and #14 (0.29); however, content experts recommended retention of these questions within the survey.

Questions #1 to 5 capture respondents' attitudes using a 5-level Likert-type scale. Questions #7 to 11 and #15 to 16 capture respondents' practice behaviors using ordinal data. Responses for all these questions were converted to nominal responses for statistical analysis with a “1” assigned for the most negative response througha “5” reflecting the most positive response. An ordinal variable for attitude was formed as the sum of recoded responses for questions #1 to 5. A similar variable for behavior was compiled as the sum of the recorded responses for questions #7 to 11 and #15 to 16. Questions #18 to 19 captured respondents' knowledge regarding values defined as P-HTN and HTN, respectively. For the purposes of this study, correct responses were defined using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).5 A P-HTN BP reading was defined as a systolic BP (SBP) of 120-139 mm Hg and/or a diastolic BP (DBP) of 80 to 89 mm Hg, whereas a HTN BP was defined as a SBP greater than or equal to 140 mm Hg and/or a DBP greater than or equal to 90 mm Hg. Responses matching these criteria were recorded as correct (scored a 1) and those overlapping with this operational definition were recorded as partially correct (scored a 2) including a response for P-HTN SBP of “120” or DBP of “80” or a response for HTN SBP of “140” or “90” as these values do not specifically match the JNC7 definition. If the response did not match any part of the definition, it was recorded as incorrect (scored a 3). The 2 BP scores for #18 and for #19 were summed to form the knowledge score. Questions #20 to 23 were included for the purpose of capturing a respondent's knowledge of BP measures indicative of contraindication for exercise initiation, exercise termination, or physician notification. However, as variability and contradiction within the literature as to one discreet response to this line of queries lends itself to a breadth of responses, the use of respondents answers to these questions were limited to descriptive reporting and were not used in the correlation analysis.

Additional questions were not used in correlative statistics but were analyzed for descriptive qualities. Specifically, questions #6, #12 to 14, and #17 garnered insight on equipment available to the respondent, retraining practices, barriers to obtaining measures, and whether PTs use other care providers within their clinic to perform a BP screening. Furthermore, questions #24 to 28 capture respondent's demographics including sex, highest PT degree obtained, primary practice setting, and description of PT provider's patient population. Specifically, question #27 served to assure respondents did indeed practice in an OP setting and delineate if hospital based, private practice, or another OP setting. In addition, years of experience working as a PT was reported and categorized for analysis as follows: 0 to 3 years, 3 to 5 years, 6 to 10 years, 11 to 15 years, 16 to 20 years, and >20 years.

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Data Analysis

Descriptive statistics provided data on respondent's demographics and responses to each survey question. Combined ordinal responses for attitude, behavior, and knowledge-directed questions were calculated for each survey by summation of responses corresponding to each variable. A higher score was considered more positive and a lower score more negative. When 2 categorical variables are examined, a nonparametric Spearman correlation coefficient was computed to judge the linear relationship between the ranks of the 2 variables. A nonparametric Wilcoxon test and 2-sample tests of proportions were used to analyze the relationships between the respondent's demographics and responses to each question regarding attitudes, behavior, and knowledge of BP. Statistical analysis was performed using the Statistical Analysis Software version 9.4 (SAS Inc., Cary, NC).

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RESULTS

Respondent Demographics

Three hundred thirteen (313) surveys were returned by respondents between August and November 2014 with 11 of the original 1440 mailings returned undeliverable, therefore resulting in an ultimate response rate of 21.9%. Respondents were 58.5% female (n = 183) and 41.2% males (n = 129), with one of unknown sex .3% (n = 1). Primary settings in which the respondent practices physical therapy were as follows; 42.5% (n = 136) from hospital-based OP clinic, 52.8% (n = 169) from private practice OP clinic, and 4.7% (n = 15) reported practice in “other” OP settings. Years of experience as a licensed PT, highest physical therapy degree obtained, and primary patient/client populations served are reported in Table 1.

TABLE 1

TABLE 1

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Blood Pressure Attitudes

Disagreement or strong disagreement was reported among 51.8% (n = 162) of the respondents in regard to their “feeling that it is important to take a BP reading on every patient during an evaluation or re-evaluation.” Similarly, 62.6% (n = 196) and 67.4% (n = 211) reported disagreeing or strongly disagreeing, respectively, that it is important to take a BP reading on every patient before treatment or after treatment, respectively. Conversely, 94.2% (n = 295) and 83.7% (n = 262) reported agreeing or strongly agreeing “feeling able to take an accurate BP reading” or “feeling confident in their ability to educate patients/clients about BP related findings,” respectively. Responses to all attitude-related questions are detailed in Table 2.

TABLE 2-a

TABLE 2-a

TABLE 2-b

TABLE 2-b

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Blood Pressure Practice Behaviors

Respondents reported performing BP measurements during a patient/client evaluation or reevaluation less than half the time, seldom, or never at rates of 85% (n = 266). In addition, respondents reported performing a BP measurement less than half the time, seldom, or never before or after a physical therapy treatment at rates of 96.1% (n = 301) and 97.8% (n = 306), respectively. Responses to all practice behavior–related questions are detailed in Table 2.

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Blood Pressure Knowledge

Knowledge of BP measurement criteria indicative of P-HTN or HTN matched established SBP values at rates of 17.9% (n = 49) and 23.6% (n = 67), respectively; whereas matching of established DBP classifications were reported correctly at rates of 19.2% (n = 52) and 25.5% (n = 72), respectively (Table 2). Table 3 details responses for questions #20 to 23.

TABLE 3-a

TABLE 3-a

TABLE 3-b

TABLE 3-b

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Responses to Miscellaneous Questions

Although 70.5% (n = 220) of the respondents reported no barriers to measuring BP, 29.5% (n = 92) reported barriers to obtaining this measure in their practice setting. Time was most commonly cited as a barrier (20.1%), followed by inadequate equipment (10.2%). Manual BP cuffs were available to 93% (n = 290) of respondents; whereas 50% (n = 156), 8.9% (n = 12), and 2.9% (n = 9) reported availability of automated or electronic BP cuff, mercury BP cuff, or of ultrasound or Doppler equipment, respectively. Varied size BP cuffs were available to respondents as follows: standard adult 95.2% (n = 298), large adult 61.3% (n = 192), small adult 25.9% (n = 81), child 18.5% (n = 58), thigh cuff 4.8% (n = 15), and infant 3.8% (n = 12). Responses to question #6 and #14 are detailed in Table 2.

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Correlation of Attitudes, Behavior, and Knowledge

A significant positive Spearman correlation r = 0.44 (P < .001) was identified between attitude and practice behaviors; however, no statistically significant Spearman correlations were identified between attitude or practice behavior and knowledge (r = −0.11, P < .069 and r = −0.11, P < .089), respectively.

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Comparison of Attitudes, Practice Behaviors, and Knowledge to Respondent Demographics

No significant associations were identified between sex and any of the 3 variables, attitude, behavior, and knowledge based on the 2-sample Wilcoxon test. However, an inverse relationship between attitude and years worked was detected based on a negative Spearman correlation of r = −0.12 (P = .04). In other words, as the number of years worked increases, a positive attitude regarding BP decreased. No significant Spearman correlations were identified between behavior or knowledge and years worked (r = 0.10, P = .09 and r = 0.04, P = .53), respectively.

Furthermore, PTs working in a hospital-based OP clinic had significantly more positive behaviors (based on the Wilcoxon test) toward recommended BP practices (P = .030) when compared with the aggregate of respondents from all other OP settings, primarily comprised PTs in private practice clinics. The most identified primary population served by the respondents was musculoskeletal with sample sets for comparison in the other disciplines too small for meaningful analysis.

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DISCUSSION

The purpose of this study is to describe and determine correlations between the attitudes, practice behaviors, and knowledge of BP assessment among PTs practicing in the OP settings. Although assessment of a BP among PTs interacting with the orthopedic population in an OP setting is instrumental in exercise prescription and cardiovascular risk identification, they are an important aspect of care regardless of whether a preexisting cardiovascular diagnosis is present,18 more than half of the survey respondents strongly disagree or disagree that BP measures should be performed on every patient and less than 15% performed the measures during evaluation. These findings have remained relatively stable in the 15 years since Frese et al first reported the practice habits of PTs in regard to vital sign measurement and raise specific concern given the growing national HTN epidemic and increase HTN prevalence.7,19 In addition, direct consumer access to physical therapy services, whereby PTs may be the point of entry for an individual into the health care system, adds more urgency to the finding of this study. Furthermore, it is notable that although 94% of respondents were confident in their ability to obtain an accurate BP, low frequencies in compliance with recommended measurement techniques including sizing a cuff to a patient or a determination of maximal cuff inflation level suggest a potential for overestimations by respondents in regard to their ability to perform a BP assessment consistent with current evidence-based techniques, Despite well-established BP classification criterion,5 the frequency of incorrect responses to questions of knowledge of these measures raises concern. If indeed PTs are providing examination and intervention without a clear recall of the established diagnostic markers, individuals under the care of PTs may be at risk of missed prevention opportunities. As the profession of physical therapy continues to integrate with the growing knowledge base of BP-related topics in the health care industry, knowledge gaps may suggest the omission of or changes in the baseline academic education of these clinical guidelines.20 This is further supported by the finding of this study that suggests that as years of work as PTs increased, the attitude toward measuring a BP decreased. Furthermore, the results of this study are not unique to the practice of physical therapy as findings are in congruence with reports of other health care providers including nurses, physicians, and chiropractors.13-16 Therefore, a continuation of national health care initiatives such as Measure Up Pressure Down aimed toward all health care providers is warranted.21

The significant correlation between attitudes and practice behaviors identified in this study are consistent with the constructs of the Theory of Planned Behavior which suggests that behavior is predicted by an intention to perform a given activity.22 This intention is informed by a combination of an individual's attitude, perceived control, and the subjective or social norms. The findings of this study suggests that future educational programming with attention toward reducing clinic-specific barriers (eg, not enough time and inadequate equipment), workplace policies toward BP measurement compliance, and education on evidence-based BP assessment techniques (eg, cuff sizing and determination of maximal cuff inflation level) and JNC7 BP classifications may be fruitful in increasing intention, thereby increasing the likelihood of an OP PT measuring a BP. Furthermore, administrative policies supporting a culture of performing BP measurement in addition to education on P-HTN and HTN prevalence in OP physical therapy practice may aid in positive strides toward inclusion of BP measure as a standard of practice in this practice setting.

Responses to knowledge questions #20 to 23 reported in Table 3 demonstrate the breadth and variation of answers to questions of BP measures which contraindicated starting exercise, terminating exercise, and instances for which a physician should be notified. Variations including a patients diagnosis or risk factors underlie these clinical decisions confounding definitive guidelines for a therapist's action to a given BP measures. For example, one reference may suggest discontinuation of exercise if the SBP is greater than >200 mm Hg at rest or with exercise among individuals with stroke23 whereas another suggests >260 mm Hg24 as an endpoint to terminate an exercise test. Similar findings in regard to DBP measures to guide discontinuation have been reported in the literature.23,24 Furthermore, BP measures at which an OP PT should contact a physician may be confounded by a patient's comorbidities, medication prescription, and physician preference. Future BP-specific clinical decision-making guidelines may be useful in providing a framework of best practice recommendation for OP PTs.

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Study Limitations

Limitations of this study include regional biasing as survey responses were only obtained from 6 Midwestern states. In adddition, utilization of the APTA Listserv for randomized sampling excluded non–APTA members and therefore may not reflect responses of all licensed PTs. Furthermore, the use of combined nominal and ordinal data responses may confound correlation findings reported in this study. Finally, utilization of a survey tool presents disadvantages including but not limited to a respondents comfort level in providing accurate answers or those that present themselves in an unfavorable manner. In addition, answer options may be interpreted differently by respondents and/or a survey format does not preclude a respondent from searching out answers to knowledge-related questions.

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Future Research

Recommendations for future research include implementation of this survey in other geographic regions or in other subsets of physical therapy clinical practice. In addition, studies assessing change when control variables such as educational initiatives or departmental policy change initiatives aimed toward implementation of routine BP screening and assessments are warranted. Finally, future research may consider regression techniques to predict why a clinician performs a BP measurement, thereby informing future education intention toward increasing the frequency of BP measurement among OP PTs.

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CONCLUSION

The findings of this study suggest that the current clinical practice culture among OP PTs in regard to attitudes, practice behaviors, and knowledge of BP-related examination and intervention are not in line with the Guide to Physical Therapist Practice suggestion of vital sign assessment as an important component of a PT examination for individuals with and without cardiopulmonary disease. Initiative to address misinformed attitudes and behaviors as well as gaps in knowledge may lead to optimization of the health and wellness of individuals under the care of OP PTs.

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Acknowledgments

The authors acknowledge The Oakland University Physical Therapy Faculty Grant and Rich Severin PT, DPT, CCS for his efforts in prereviewing the manuscript for submission.

A. Attitudes, Knowledge, and Practice Behaviors Regarding Blood Pressure Readings. Circle the response that best describes you:

  1. I feel it is important to take a blood pressure reading on every patient/client during an evaluation or re-evaluation
  2. a) Strongly disagree
    b) Disagree
    c) Neutral
    d) Agree
    e) Strongly agree
  3. I feel it is important to take a blood pressure reading on every patient/client PRIOR to physical therapy treatment
  4. a) Strongly disagree
    b) Disagree
    c) Neutral
    d) Agree
    e) Strongly agree
  5. I feel it is important to take a blood pressure reading on every patient/client AFTER physical therapy treatment
  6. a) Strongly disagree
    b) Disagree
    c) Neutral
    d) Agree
    e) Strongly agree
  7. I feel I am able to take an accurate blood pressure reading
  8. a) Strongly disagree
    b) Disagree
    c) Neutral
    d) Agree
    e) Strongly agree
  9. I feel confident in my ability to educate patients/clients about blood pressure related findings
  10. a) Strongly disagree
    b) Disagree
    c) Neutral
    d) Agree
    e) Strongly agree
  11. A physical therapy assistant, technician, or other health care provider obtains the blood pressure measurement in my practice setting
  12. a) Never
    b) Seldom
    c) Less than half the time
    d) More than half the time
    e) Always
  13. I measure blood pressure during patient/client evaluation or re-evaluation
  14. a) Never
    b) Seldom
    c) Less than half the time
    d) More than half the time
    e) Always
  15. I measure blood pressure on a patient/client PRIOR to physical therapy treatment
  16. a) Never
    b) Seldom
    c) Less than half the time
    d) More than half the time
    e) Always
  17. I measure blood pressure on a patient/client AFTER physical therapy treatment
  18. a) Never
    b) Seldom
    c) Less than half the time
    d) More than half the time
    e) Always
  19. I inform a patient/client of their blood pressure reading after each measurement
  20. a) Never
    b) Seldom
    c) Less than half the time
    d) More than half the time
    e) Always
  21. I standardize the patient/client position each time I perform a blood pressure measurement
  22. a) Never
    b) Seldom
    c) Less than half the time
    d) More than half the time
    e) Always
  23. I have the following blood pressure measurement tools available to me at my place of employment (Circle all that apply)
  24. a) Manual blood pressure cuff
    b) Automated or electronic blood pressure cuff
    c) Mercury blood pressure cuff
    d) Ultrasound/Doppler
    e) Unknown
    f) None
    g) Other (Please specify):__________________
  25. I have the following blood pressure cuff sizes available to me in my clinic: (Circle all that apply)
  26. a) Infant
    b) Child
    c) Small Adult
    d) Adult
    e) Large Adult
    f) Thigh Cuff
    g) Other: (Please specify)__________________
  27. My clinical site performs yearly retraining of blood pressure measurement techniques
  28. a) Yes
    b) No
    c) Unknown
  29. I use a different size blood pressure cuff depending on the measurement site used for each patient/client
  30. a) Yes
    b) No
    c) Unknown
  31. I measure the maximal cuff inflation level prior to taking a blood pressure measurement
  32. a) Yes
    b) No
    c) Unknown
  33. There are barriers to measuring blood pressure in my patient/client practice setting
  34. a) Yes: (Please describe)__________________
    b) No
    Please legibly fill in the blank(s) or circle “unknown” if applicable for questions 18 to 23
  35. Blood pressure value(s) considered to indicate pre-hypertension:
  36. a) Systolic__________________
    b) Diastolic_________________
    c) Unknown
  37. Blood pressure value(s) considered to indicate hypertension:
  38. a) Systolic__________________
    b) Diastolic_________________
    c) Unknown
  39. It is contraindicated to start exercise with a blood pressure reading of:
  40. a) Systolic__________________
    b) Diastolic_________________
    c) Unknown
  41. It is recommended to terminate exercise with a blood pressure reading of:
  42. a) Systolic__________________
    b) Diastolic_________________
    c) Unknown
  43. It is recommended to inform a physician or similar health care provider of a blood pressure reading BELOW:
  44. a) Systolic__________________
    b) Diastolic_________________
    c) Unknown
  45. It is recommended to inform a physician or similar health care provider of a blood pressure reading ABOVE:
  46. a) Systolic__________________
    b) Diastolic_________________
    c) Unknown

B. Demographic Information Circle the response that best describes you:

  1. I am a
  2. a) Male
    b) Female
  3. How many years have you worked as a licensed physical therapist?
  4. a) Not Applicable
    b) Less than 3 years
    c) 3 to 5 years
    d) 6 to 10 years
    e) 11 to 15 years
    f) 16 to 20 years
    g) More than 20 years
  5. What is your highest physical therapy degree obtained?
  6. a) Baccalaureate degree
    b) Master's degree
    c) PhD (or equivalent, eg EdD or ScD)
    d) DPT
    e) tDPT
    f) Other (please specify):__________
  7. Which of the following best describes the practice setting in which you primarily work?
  8. a) Hospital based outpatient
    b) Private practice outpatient
    c) Inpatient rehabilitation
    d) Skilled nursing facility
    e) Acute care
    f) Home health care
    g) School system
    h) Other (please specify):______________
  9. Which of the following best describes the patient population for which you provide physical therapy services? (circle all that apply)
  10. a) Integumentary
    b) Musculoskeletal
    c) Cardiopulmonary
    d) Neurological
    e) Other (Please specify):________________
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REFERENCES

1. Albarwani S, Al-Siyabi S, Tanira MO. Prehypertension: Underlying pathology and therapeutic options. World J Cardiol. 2014;6(8):728–743.
2. American Heart Association. Statistical Fact Sheet 2013 Update. Hyattsville, MD: National Center for Health Statistics. Published 2013. Accessed May 28, 2013.
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4. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the subcommittee of professional and public education of the American heart association council on High blood pressure research. Hypertension. 2005;45(1):142–161.
5. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national Committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA. 2003;289:2560–2571.
6. Millar AL, Village D, King T, et al. Heart rate and blood pressure assessment by physical therapists in the outpatient setting—an observational study. Cardiopulm Phys Ther J. 2016;27:90–95.
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11. Kasinskas C, Wood RD, Koch M. Blood pressure monitoring in outpatient physical therapy clinics: Should it be performed routinely? Cardiopulm Phys Ther J. 2011;22(4):31.
12. Van Zant RS, Cape KJ, Roach K, et al. Physical therapists' perceptions of knowledge and clinical behavior regarding cardiovascular disease prevention. Cardiopulm Phys Ther J. 2013;24(2):18–26.
13. Nelson JM, Cook PF, Ingram JC. Utility of the theory of planned behavior to predict nursing staff blood pressure monitoring behaviors. J Clin Nurs. 2013;23:461–470.
14. Crosley AM, Rose JR. Knowledge of accurate blood pressure measurement procedures in chiropractic students. J Chiropr Educ. 2013;27(2):152–157.
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17. Hedden A, McCue C, Robinson A, Arena S. Development of a valid and reliable survey tool to assess outpatient physical therapists' attitudes, behaviors and knowledge of blood pressure measurement. Poster Presentation Michigan Physical Therapy Association Fall Conference. October 2015.
18. Scherer SA, Noteboom JT, et al. Cardiovascular assessment in the orthopaedic practice setting. J Orthop Sports Phys Ther. 2005;35(11):730–737.
19. Lackland DT. Systemic hypertension: an endemic, epidemic, and a pandemic. Semin Nephrol. 2005;25(4):194–197.
20. Plack MM, Wong CK. The evolution of the doctorate of physical therapy: Moving beyond the controversy. J Phys Ther Educ. 2002;16(1):48–59.
21. Measure Up Pressure Down. American Medical Group Foundation. N.P. http://http://www.measureuppressuredown.com/. Accessed July 18, 2016.
22. Godin G, Kok G. The theory of planned behavior: A review of its application to health related behaviors. Am J Health Promot. 1996. 11(2):87–95.
23. American Physical Therapy Association. Pocket Guide: Physical Fitness for Survivors of Stroke. Supplement to PT Magazine. 2006. http://http://www.apta.org/pfsp/. Accessed July 17, 2016.
24. ACSM's Guidelines for Exercise Testing and Prescription: American College of Sports Medicine. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2010:138.
Keywords:

blood pressure; physical therapy; outpatient

© 2018 Cardiovascular and Pulmonary Section, APTA