Beyond Treatment: Patient Education for Health Promotion and Disease Prevention

ABSTRACT: As health care providers, physical therapists tire also health educators and health promoters. The Guide to Physical Therapist Practice supports a practice that includes health promotion, education, and wellness, yet this is not reflected in many physical therapy settings. The purpose ofthis paper is to increase the practice ofhealth promotion and disease prevention activities among physical therapy clinicians through patient education. Concepts of health promotion and disease prevention are presented including specific health objectives from Health), People 2010. A model of health behavior change. the Transtheoretical Model of Change, is used to assist clinicians in helping patients change risk behaviors. Methods of assessing and managing risk are explored. Emphasis is placed on specific guidelines.for improving nutrition and physical activity, smoking cessation, and preventing falls. In the past, the major focus in health care has been on managing the disease and sequelae of disease. It could be more financially beneficial, however, to concentrate efforts on preventing disease rather than treating disease. Many Americans have diseases that are associated with modifiable risk factors, which are often obvious long before disease onset. Physical therapy clinicians need to understand and act in their role as health educators and health promoters. The purpose of this paper is to increase the practice of health promotion and disease prevention activities among physical therapy clinicians through (1) discussion of Health People 2010 objectives regarding physical activity, injury prevention, nutrition, and smoking, (22) discussion of the Transtheoretical Model for behavior change, and (3) application of these health behavior change principles in physical therapy practice with a shift of focus from tertiary prevention to primary prevention. THE PHYSICAL THERAPIST AS HEALTH EDUCATOR AND HEALTH PROMOTER As health care providers, physical therapists are also health educators and health promoters. The American Physical Therapy Association's (APTA) Guide to Physical Therapist Practicel states that physical therapists are involved in wellness initiatives, including health promotion and education, that stimulate the public to engage in healthy behaviors, and provide preventive care that forestalls or prevents functional decline and the need for more intense care. The question that arises is: How can physical therapists and physical therapist assistants become health promoters? First, every patient's health risk status must be assessed and health behaviors associated with disease risk noted, Next, physical therapists must provide information and education for patients regarding risks and associated health behaviors. Third, behavior change, from risk-related behavior to healthier behavior, must be encouraged. In addition to encouraging behavior change, it is imperative that specific strategies and skills for making that behavior change be provided to the patient. Finally, appropriate referrals must be made when there is a problem beyond the scope of practice of physical therapy. Despite the position of APTA on health promotion and wellness in physical therapy practice, many physical therapists and physical therapist assistants do not practice health promotion activities in treatment settings and perhaps not in their own lives. A study conducted by Chase et al2 examined physical therapists' perceptions toward patient education, where patient education was defined as a planned learning experience using a combination of methods such as teaching, counseling, and behavior modification techniques that influence patients' knowledge and health behavior. Results showed that physical therapists felt some barriers to delivering patient education included patient attitudes about illness or disability, patient attitudes or expectations regarding physical therapy outcomes, patient attitudes toward therapy, and patients' cognitive status. …