Prevention and Health Promotion in Entry-Level Physical Therapy Education: Meeting Societal Needs
Todd Davenport: 0000-0001-5772-7727
THEORY: Several theories and models exist to support prevention and health promotion at the individual and community levels. These include (but are not limited to) social cognitive theory1, socio-ecological theory2, and health belief models3. Life course health development is one framework, rooted in these prevention and health promotion theories, that can be used to explain health outcomes, understand the key factors or determinants underlying health disparities, and inform the choice of strategies to prevent disease and promote health4,5. Understanding prevention and health promotion theories, and applying relevant frameworks in physical therapy practice are crucial skills for entry-level clinicians to possess if we hope to meet societal needs in the 21st century6.
PHENOMENON: In the last century, chronic, non-communicable diseases (NCDs) such as cardiovascular disease, diabetes and cancer have taken the place of many acute, infectious diseases as the leading causes of mortality and morbidity in the United States (US) and globally7. Despite important advances in medicine and rehabilitation, rates of NCDs continue to rise, and the cost associated with management of these conditions further burdens an already strained health care system. As a result, traditional health care paradigms rooted in individual-level biomedical and biopsychosocial models are shifting toward population-level prevention and health promotion models, and adopting a life course health development framework5.
PURPOSE: The purpose of this proposal is to provide a rationale for the integration of prevention and health promotion theory into entry-level physical therapy education through the use of a life course health development framework so that graduates are better-equipped to provide care that is holistic and salutogenic (i.e., health-promoting).
EVIDENCE: In 2016, the US alone devoted more than $3 trillion to its health care system for things like hospital care, professional and long-term services (including physical therapy), and medical products8. Despite outspending its peers on health care, key health outcomes (e.g., infant mortality, chronic conditions, and obesity) tend to be much worse in the US9. Our current financial model reflects a belief that receipt of health care is the most important determinant of health, yet evidence suggests that individual health behaviors and environments contribute far more toward our nation's health10. We know that the conditions in which we live, learn, work and play influence our health long before we see a medical provider. For many, chronic stress resulting from economic hardship, unsafe neighborhoods, or poor working conditions leads to physiological changes in nearly every body system that further contribute to NCD and chronic pain epidemics11. Despite this mounting evidence, we devote a small fraction of our nation's wealth to the creation of healthy environments and the promotion of healthy behaviors, relative to health care12. This imbalance is also reflected in entry-level physical therapy education where we spend a fraction of our time developing prevention and health promotion strategies relative to traditional rehabilitation skills that, while incredibly important to an individual client, only help once that individual becomes sick or injured13. In light of these realities, the American Physical Therapy Association House of Delegates adopted various policy statements that address the role of physical therapy in prevention and health promotion14. In addition, the Commission on Accreditation in Physical Therapy Education outlines specific criteria related to prevention and health promotion15.
TESTABLE HYPOTHESIS: By integrating prevention and health promotion theory, concepts and strategies into entry-level physical therapy education, new graduates will be better prepared to apply prevention and health promotion strategies at the individual and community level. As a result, individual clients and communities will experience lower rates of NCDs and report better overall health compared to their current levels.
IMPORTANCE: The approach described in this proposal represents a fundamental and necessary shift in entry-level physical therapy education so that we may become a health-facing profession that promotes health within our clients and our communities, and progresses toward our vision of transforming society by optimizing movement to improve the human experience.
Annual Meeting of the American Physical Therapy Association (APTA NEXT)
June 27-30, 2018
Davenport, Todd E.; Magnusson, Dawn M.; Patel, Rupal; Eisenhart, Mike; Rethorn, Zachary D.; and Milligan, Mark, "Prevention and Health Promotion in Entry-Level Physical Therapy Education: Meeting Societal Needs" (2018). All Faculty Scholarship. 556.