Tracking PT Student Wellness Behaviors Using the Sustainable Health Index Phone Application
Purpose/Hypothesis: The purpose of this project was to assess and monitor the health of 96 first and second year physical therapy students during one semester (fall, 2018) using a novel phone application known as the Sustainable Health Index (SHI)
Number of Subjects: 48 first year and 48 second year physical therapy students in a southwestern US entry level doctor of physical therapy program
Materials and Methods: The sustainable health index (SHI) is an evidence based phone application that assesses and monitors health in five dimensions; disease risk, nutrition, stress, physical fitness and movement quality (presence of pain). The SHI was developed by Jennifer Gamboa PT, DPT, OCS, for use in physical therapist clinical practice to assess client wellness, enhance client engagement and support health behavior change. Physical therapy students utilized the phone application in conjunction with their courses in health and wellness and clinical communication. Using an evidence-based algorithm for each of the five health dimensions, the SHI stratifies disease risk into three levels on a 20-point scale (1-7= low risk; 8-12= moderate risk; 9-20=high risk). The SHI also assesses client activation (readiness, confidence, ability) using a 1-10 score, and utilizes this to deliver appropriate messaging to support behavior change. Finally, the SHI enables users to select educational modules (stress management, nutritional support, or the enhancement of movement quality and fitness). These modules include daily 2-3 minute videos, and suggestions for further reading and educational activities (i.e. reading food labels). The PT students in each class were asked to complete the 5-dimension health assessment and to select one educational module to complete during the fall, 2018 semester.
Results: 98% of the students in both classes completed the wellness assessment and 44% completed one educational module as assigned. The average overall disease risk for both PT student classes (n-94) was 8 (moderate risk). With respect to the levels of risk 49% of the overall participants were considered low risk, 39% were considered moderate risk, and were considered 12% high risk. Moreover, 60% of all participants reported difficulties with movement quality, 43% reported poor nutrition, and 30-41% were either sedentary or moderately sedentary. With respect to activation, 77% of students in both classes reported a high level of readiness for change, 69% reported a high level of confidence in their ability to do so, and 44% remained engaged throughout the semester.
Conclusions: The use of the Sustainable Health Index Phone application provided physical therapy students with an early introduction to emerging wellness technologies that will be increasingly available in their future practice. The application provided students the opportunity to assess their wellness in five dimensions, to assess their activation towards health behavior change, and to engage in interventions in areas of interest. Despite their health challenges, the physical therapy students in this project demonstrated high levels of readiness and confidence for change. In contrast, ongoing engagement was less than 50% over the course of the semester long program, possibly due to the prioritization of academic pursuits at the expense of those related to personal health.
Clinical Relevance: Data from the application suggests that physical therapy students face health challenges related to insufficient exercise, chronic pain affecting movement quality and poor nutrition. These challenges may be related in part to the demands of a rigorous academic program which involves sitting for extended periods, and suggest the need for the integration of movement breaks, standing desks and the creation of opportunities for exercise within the context of PT educational programs. Chronic pain may be the result of previous involvement in collegiate athletics and is a finding worthy of further exploration. Furthermore, physical therapy students may face financial challenges that limit their options for the purchase of healthy foods, an issue that currently faces a significant proportion of college students nationwide.