Geriatric Medicine Clinic and Primary Care Physical Therapy

Physical therapists are required to have an understanding of “psychologically informed practice” and use a “universal precautions” approach based on trauma-informed care principles to reduce the risk of re-traumatizing patients, given the built environment of Baltimore City. Training for physical therapists is provided via mock interviewing using an interview protocol, through which physical therapists learn how to ask patients about ACEs using positive questions and not solely focus on negative questions, so as not to re-traumatize or make patients feel like these events are their fault.

The concept of “re-traumatizing” is based on the conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial trauma event. It can be triggered by a situation, an attitude or expression, or by certain environments that replicate the dynamics (loss of power/control/safety) of the original trauma. The risk of re-traumatizing applies to our own interactions with our clients with a history of trauma, likely unknown to the therapist, in which we may inadvertently trigger a negative reaction.

Having been a PT for 28 years and as a recent public health graduate, I began to wonder about the Adverse Childhood Experience (ACE) study done by Anda and Felitti. Reading more on this topic made me begin to reflect on many of my patients who did not benefit from PT for their acute or chronic pain. As I developed relationship-centered care, some of my patients would provide me with more life experiences. Many of these stories related to home or community violence, both when they were young and as adults. From these stories, I began to assume many of my patients likely had these experiences and I should approach trauma as a “universal precaution.” These experiences in childhood might be the reason why some have their pain resolved and others not, and why pain perception may be altered just as their risk of chronic medical conditions is significantly increased.

The qualitative evidence used is the Health-Related Quality of Life measure in addition to the Fear of Falling questionnaire. Additional measures to be explored are Patient-Reported Outcome Measure, narrative-based approaches looking at symptom burden, and functional impact, being mindful that “providing care that is respectful of, and responsive to, individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” Other measures that would be interesting to track would be hospitalizations from chronic diseases.

This trust practice is in development and its inception occurred before the pandemic. During the initial months of the pandemic, ambulatory clinics were closed, and I was redeployed to a different non-direct patient care position. We are returning to this project currently. Adoption of this project into a scalable form of health promotion and intervention would need further investigation into effectiveness, reach and adoption; human, technical, and organizational resources; costs; intervention delivery; contextual factors and appropriate evaluation approaches. Addressing these issues would likely develop better acceptance to expand this promising project into larger practice within the Hopkins Health System, such as expanding into Internal Medicine, Orthopedics, and Mental Health.