Christopher Ball

The actual activity and food-intake logs as well as patient-subjective assessments measuring HRQoL (SF- 36) should also be tailored to ensure consistent and informed completion by the older-adult.32 Forms completed by the patient should integrate a format that is legible, straightforward, organized, where completion is most intuitive. Adapted versions (self-completed & interview administered) of the SF-36 were released in 1995 which addressed concerns regarding a small concentrated number of assessment questions frequently missed by older-adults who completed the assessment.38 These questions of concern all emphasized vocational tasks or vigorous activities and thus not tailored to or perceived as applicable by the older-adult.32 The Anglicized version of the SF-36 is suitable for those over 75 years old, quick to complete and is shown to hold its same or higher levels of sensitivity and validity.32 Program objectives are also centered upon the improvement and/or maintenance of independent functional mobility for the older-adult. To best acquire accurate measurements of functional mobility in the elderly, functional outcome measures were selected which measured multi-sensory components of balance (BERG), in-home functional ambulation (TUG) and functional strength and endurance of the lower-extremity. All functional outcomes selected allow for the use of assistive devices, are time efficient and require minimal space or equipment to complete. Furthermore the outcome measures chosen are valid and reliable when used in elderly cohorts, are simple to conduct, interpret and easily understood and completed by the older-adult.36 Evaluation tools function to identify if the program was effective or not. Allied health professionals such as DPTs are most qualified to correctly interpret result findings of the evidence based outcome measures chosen and thus indentify barriers to optimal effect. A score on the BERG of less than 45 indicates on is “at risk” for falling.40 Depending on the participants initial score on the BERG from highest to lowest balance capability, the minimal amount of change to be considered clinically significant (MCID) ranges between 3.3-6.3 points, respectively.40 Regarding the TUG, MCID is a reduction in time between 0.8-1.4 seconds.41 Participants who complete the instrument in less than 20 seconds typically indicates independence in most ADL’s and outdoor mobility while 20-29 seconds indicates probable need for a gait aid and supervision for outdoor mobility.41 Finally the MCID for the 30 second sit-to-stand test is an increase >/= 2.5 repetitions and correlated with “major improvement” on the Global Rating of Change Scale.42 Those principally involved in this health promotion program will also collaborate with larger public officials on the community, county or even state level to best advocate and most effectively publicize the potential benefit of allocating funds for interdisciplinary health promotion programs for the rural and underserved communities of North Carolina.35 One of the largest limitations but also strengths of the study is the large impact of volunteer participation. Presented in this proposal is the significant need across the country and state for interdisciplinary programs such as these within the rural and underserved community as a whole. These types of program interventions provide a valuable opportunity and incentive for current health professionals or student clinicians to practice or request clinical rotations in the rural and underserved environment. Practicing in the rural and underserved population requires embracing creativity rather than shying away from challenge when establishing evidenced based interventions that are of higher value and enable a larger impact regarding life-long positive health behavior change for all who reside rural and underserved communities