Health Promotion in Therapy

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Health promotion initiatives are an essential element of a therapy plan of care. The World Health Organization defines health promotion as “the process of enabling people to increase control over, and to improve, their health.” The home healthcare setting provides an ideal venue to introduce and reinforce health-promoting strategies in a practical way. Providing care within the context of an individual's home offers a unique opportunity to address determinants of health inclusive of personal, social, economic, and environmental factors that may not be recognized or evident in a clinic-based setting.
In many practice settings outside the home, physical therapists and occupational therapists receive a social history based on the patient's or caregiver's interpretative recall. This information has potential to be void of relevant detail or may be biased to portray a scenario the patient assumes the healthcare provider wants to hear. However, home healthcare therapists have the distinct advantage of being present in a patient's living space, thereby conducting real-time, observable, and reliable assessments of an individual's daily activities and current determinants of health. For example, when conducting an assessment of a home healthcare patient who verbally reports they are receiving adequate nutrition, a therapist may discover various barriers to adequate nutritional support. This may include cross-discipline findings of lack of in-home food availability, or presence of unhealthy food options in the home. A therapist may also discover environmental and/or functional limitations that could prevent shopping for food or preparing a complete meal. Morris et al. (2009) suggested poor nutrition can lead to pathology and negatively influence recovery from movement dysfunction; therefore, adequate nutrition is one example of a health-promoting variable that may influence the attainment of therapy outcomes.
Incorporation of health promotion strategies into a therapist's daily practice is supported by both the American Physical Therapy Association and the American Occupational Therapy Association. The American Physical Therapy Association's position statement advocates for the physical therapy professional to be an expert in rehabilitation and habilitation, and to help individuals and populations improve overall health and prevent the need for avoidable healthcare services (American Physical Therapy Association, HOD P06-16-06-05). The American Physical Therapy Association further asserts that physical therapists are uniquely educated and trained to adapt healthcare recommendations to the community environment where individuals live, work, learn, and play. A similar position is held by the American Occupational Therapy Association and encourages occupational therapists, to “Teach strategies to incorporate healthy habits and routines into daily activities for clients of all ages and abilities.”
Frerichs et al. (2012) provide evidence that PTs can be effective health counselors, specifically with respect to lifestyle behavior change. However, to fully understand the depth and impact therapists can have on health promotion, Bezner (2016) has provided a basis for understanding health promotion terminology, identifying the knowledge and skills therapists require to address health-promoting behaviors, and discussing barriers and opportunities associated with integrating the promotion of health and wellness into practice. Although there are numerous areas in which a therapist can promote health, Bezner suggested that physical therapists are well positioned to address the topics of physical activity, nutrition, smoking cessation, sleep, and stress management with the patients and clients they encounter. Furthermore, the American Occupational Therapy Association provides its members resources including fact sheets aimed at The Role of Occupational Therapy with Health Promotion (Gupta, et al., 2017) and Occupational Therapy's Role in Sleep (Picard, 2017).
Utilization of assessments inclusive of biometric measures, timed or graded exercise tests, psychosocial and behavioral risk and wellness assessments as well as motivational interviewing during a home healthcare episode of care may be beneficial in identifying health promotion needs and goals.
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