Called, but Reluctant, to Address Lifestyle Behaviors: A Model to Help
Purpose
Globally, physical therapy professional organizations are calling for physical therapists (PTs) to perform lifestyle-behavior management during customary care, or health-focused care (HFC). This call is due to the increasing mortality and morbidity related to noncommunicable diseases (NCDs) such as heart disease, stroke, and cancer. The World Health Organization reported that NCDs are largely preventable through interventions that address lifestyle behaviors such as tobacco use and physical inactivity. Unfortunately, many PTs do not practice HFC despite being well-positioned to do so. Barriers cited by PTs for not performing HFC include low self-efficacy, limited time, and lack of counseling skills. To address these perceived barriers, we developed and validated the Health-Focused PT Model (HFPTM) to guide and encourage PTs to adopt HFC. This validated model has informed entry-level and post-professional curricular content in our Doctor of Physical Therapy and Postprofessional Certificate Program in Health Focused Care for PTs programs respectively. Critical steps in the model include anticipating population needs, determining need for lifestyle change, collaborating with patients/clients, using lifestyle behavior change interventions (including referral) and assessing lifestyle behavior change outcomes. Presenters will explore health consequences associated with physical inactivity and smoking as well as benefits realized when adopting these healthy behaviors. Application of the HFPTM will enable PTs to integrate lifestyle behavior management into usual PT care and facilitate patients’/clients’ adoption of healthy choices related to physical activity and smoking.
Methods and/or Description of Project
The presenters used a mixed methods approach to validate the HFPTM.The preliminary model was informed by the literature and the investigators’ shared experience in health promotion and PT. The model was refined from varied health professionals’ shared input using a World Café method. The investigators then used a Delphi process to establish content validity with 8 PTs with health promotion and education expertise.
Results/Outcomes
World Café participants indicated that: 1) physical therapists are well positioned to engage in health promotion and wellness; and 2) the model facilitates interdisciplinary collaboration and consultation. Delphi process participants reached majority consensus in 1 round. The average model CVI was .915 for physical activity and .899 for smoking. Agreement concerning the model schematic was 88% for either behavior. Investigators made few editorial changes after the Delphi process.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
This study found that other health professionals believe PTs should practice HFC and that the HFCPT model may be a viable model to help students and PTs adopt HFC.This session is best aligned with the thematic topic of "Using Evidence and Benchmarks in Curricular Planning."
References
1. American Physical Therapy Association (APTA) House of Delegates (HOD). Health Priorities for Populations and Individuals HOD P06-15-20-11. http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/HealthPrioritiesPopulationsIndividuals.pdf. Accessed 6/15/2016.
2. APTA HOD. The Association’s Role in Advocacy for Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability HOD P06-15-22-14. http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/AssociationRoleAdvocacy.pdf. Accessed 6/15/2016.
3. APTA HOD. Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of disease and Disability HOD P06-15-23-15. http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/PTRoleAdvocacy.pdf. Accessed 6/15/2016
4. APTA. Introduction to the Guide to Physical Therapist Practice In: Guide to Physical Therapist Practice 3.0. Alexandria VA. 2014. http://guidetoptpractice.apta.org/content/1/SEC1.body Accessed April 19, 2016
5. Dean E, Al-Obaidi S, Dornelas de Andrade A, et al. The First Physical Therapy Summit on Global Health: Implications and recommendations for the 21st century. Physiother Theory Pract. 2011;27(8):532-547.
6. Dean E, Dornelas de Andrade A, O’Donoghue G, et al. The Second Physical therapy Summit on Global Health: Developing an action plan to promote health in daily practice and reduce the burden of non-communicable disease. Physiother Theory Pract. 2014;30(4):261-275.
7. World Health Organization (WHO). Major causes of death. In: The top 10 causes of death. http://www.who.int/mediacentre/factsheets/fs310/en/index2.html. Accessed April 14, 2016
8. WHO. 10 facts on Noncommunicable Diseases http://www.who.int/features/factfiles/noncommunicable_diseases/facts/en/index4.html . Accessed April 14, 2016
9. Shirley D, van der Ploeg H, Bauman AE. Physical Activity Promotion in the physical therapy setting: Perspectives from practitioners and students. Phys Ther 2010; 90:1131-1322.
10. Healey WE, Broers B, Nelson J, Huber G. Physical therapist’s health promotion activities for older adults. J Geriatr Phys Ther. 2012; 35: 35-48.
11. Bodner ME, Miller WC, Rhodes RE, Dean E. Smoking cessation and counseling: knowledge and views of Canadian physical therapists. Phys Ther 2011; 91: 1051-1062.
12. Pignatro, RM, Ohtake PJ, Swisher A, and Dino G. THe role of physical therapists in smoking cessation: opportunities for improving treatment outcomes. Phys Ther. 2014;92(5):757-766.
13. Lein Jr DH, Clark D, Graham C, Perez P, Morris D. A model to integrate health promotion and wellness in physical therapy practice: development and validation. Submitted to Phys Ther J 12/15/2016 for consideration.
Course Objectives
At the end of this educational session, participants will be able to:
1. Provide a rationale for PTs to promote healthy lifestyle change during customary PT care
2. Discuss how physical inactivity and smoking affect health
3. Discuss the framework for lifestyle behavior management provided by the Health Focused PT Care Model
4. Use the Health Focused PT Care Model for promoting physical activity and smoking cessation.
Instructional Methods
Lecture, case studies, small group discussions, question and answer
Tentative Outline/Schedule
5 minutes – Welcome, introductions, and session overview.
5 minutes - Rationale for PTs incorporating health promotion during customary PT care
10 minutes – Address the prevalence, incidence, morbidity and mortality of heart disease, cancer, stroke, and diabetes and its association to physical inactivity and smoking
15 minutes – Overview of the development and validation of the Health Focused PT Practice Model
10 minutes – The Health Focused PT Practice Model applied to physical inactivity (including a case study).
20 minutes – The Health Focused PT Practice Model applied to smoking (including a case study)
5 minutes – Additional resources on promoting physical activity and smoking
5 minutes – Conclusion; Q/A