Practices of Nigerian physiotherapists with respect to lifestyle risk factor assessment and intervention: A national cross-sectional survey

Physiotherapists' Perceptions of the Influence of Their Health Behaviours on Their Advice to Patients

Background Healthcare professionals (HCPs) lifestyle behaviours can impact their health promotion counselling to patients. However, there is a lack of qualitative studies to understand the physiotherapists' perceptions of the influence of their lifestyle behaviours on their patient's advice. Aim This research aims to explore the physiotherapists' perceptions of the influence of their health behaviours on their counselling of patients. Method  This research was a qualitative study based on the interpretivism paradigm. 15 virtual semi-structured interviews were performed with physiotherapists working for a private company in the United Kingdom (UK). Thematic analysis was used to create four themes and ten sub-themes. Results 13 out of 15 participants stated that their lifestyle impacts their counselling, while for the other two, their counselling was based on their knowledge. Some drivers for health promotion included role modelling, having some knowledge concerning certain lifestyle behaviours and understanding their importance in health. Barriers to health promotion included lack of time and knowledge, some confusion if discussing some of these behaviours included in their scope of practice and perception of patients' reactions to certain questions and their relevance to the musculoskeletal (MSK) condition their patients were experiencing. Some strategies proposed to improve their health promotion skills included improvements in communication skills, discussions and sharing of evidence between peers and informative leaflets to distribute to patients. Conclusion In this study, 13 out of 15 participants believed their lifestyle impacts their counselling to patients. Despite this, multiple barriers to health promotion were identified. This study highlights the need for training physiotherapists about certain lifestyle behaviours, including smoking cessation, alcohol misuse and basic nutrition counselling which may improve their health promotion messages, potentially leading to patient behaviour change which ultimately may have a positive public health impact.

Perceptions of practising physiotherapists in Saudi Arabia about their role in the health promotion of patients with musculoskeletal conditions: a qualitative study

OBJECTIVE

This study aimed to explore physiotherapists' perceptions in Saudi Arabia about their understanding and role in health promotion through lifestyle behaviours and risk factors assessment and management of patients with musculoskeletal pain and disabilities.

STUDY DESIGN

Qualitative study.

METHOD

One-to-one interviews with 12 physiotherapists (six females; mean age 34.5 ± 8) within a constructivist framework. Interviews were recorded, transcribed verbatim, and analysed using a thematic analysis approach.

RESULT

Three themes were identified: (1) the physiotherapists' awareness and knowledge of health promotion; (2) current practice of physiotherapists to implementing health promotion practice; and (3) the physiotherapists' perceived barriers to implementing health promotion practice. Participants generally perceived health promotion to be within their scope of practice. However, their understanding and approaches to deliver this practice were varied and non-standardised. Some barriers to routine engagement in health promotion were identified, including time constraints, the beliefs of healthcare practitioners, and limited education and training.

CONCLUSION

This study highlighted that physiotherapists acknowledged the role of health promotion in their practice. However, there were different explanations of the concept and it was informally practised.

Physical Therapists’ Role in Health and Wellness Promotion for People with Musculoskeletal Disorders: A Cross-Sectional Description Study Conducted in Saudi Arabia

Background

Chronic non-communicable diseases and musculoskeletal disorders are primarily associated with poor lifestyle behaviors and underestimated public health issues. Physical therapists have an essential role in promoting health. Still, few studies have described the current role of physical therapy in health promotion to lessen the impact of public health issues and chronic musculoskeletal conditions. Therefore, this study aimed to explore physical therapists’ health promotion in the musculoskeletal practice setting and investigate potential barriers and needed education.

Design and Methods

A cross-sectional descriptive study was conducted, using an electronic survey distributed among physical therapists practicing in Saudi Arabia who managed patients with musculoskeletal disorders.

Results

A total of 150 physical therapists participated in this survey. The physical therapists dealing with musculoskeletal disorders were, to a fair degree, aware of the importance of lifestyle risk factors related to health and wellness, particularly those relating to physical aspects. However, participants’ knowledge and experience (according to their report) were relatively limited in other lifestyle behaviors such as smoking, nutrition, sleep, and stress management. Participants believed further education/training would be needed to address these behaviors.

Conclusion

The participants appreciated the importance of addressing lifestyle factors. Nonetheless, knowledge and experience in health promotion were limited. To optimize the outcome of musculoskeletal patients through health promotion, more training will be needed.

Physical Therapists' Knowledge, Skills, Beliefs, and Organizations Impact Physical Activity Promotion: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this study was to characterize factors that influence physical therapists' physical activity (PA) promotion practices and map these factors to the Theoretical Domains Framework (TDF) to inform future implementation efforts.

METHODS

Six databases (MEDLINE, EMBASE, Scopus, CINAHL, PsychInfo, and Web of Science) were searched from inception to March 11, 2021. Studies were included if they reported physical therapists' PA promotion practices and factors influencing these practices. Study quality was assessed with a modified Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. Studies were excluded if they did not separate physical therapist PA promotion practices and influencing factors from other health professionals.

RESULTS

The search yielded 12,835 references and 27 included studies. Twenty studies were included in a meta-analysis of proportions, whereas 15 studies were included in a meta-analysis of correlations. Very-low to moderate-quality evidence suggests that factors at the individual and organizational levels have very small to moderate associations with PA promotion practices.

CONCLUSION

Efforts to improve PA promotion by physical therapists should consider incorporating combinations of individual and organizational factors. Limitations to the body of evidence highlight the need for future research.

IMPACT

With PA projected to decrease in the general population by an additional 20% by 2050, PA promotion is urgently needed to maximize physical therapists' impact on the health of society. This study identifies factors that may prove useful for guiding the development of strategies to encourage greater engagement in PA promotion by physical therapists.

Ergebnisse einer deutschlandweiten Umfrage über Beratung zu lebensstilbezogener Verhaltensänderung (BzlV) in der physiotherapeutischen Versorgung – eine Querschnittstudie

Hintergrund Es ist unklar, in welchem Umfang Beratung zu lebensstilbezogener Verhaltensänderung (BzlV) in Deutschland bereits in die physiotherapeutische Arbeit integriert ist und ob Physiotherapeut*innen die erforderlichen Kompetenzen aufweisen.

Ziel Erfassung der Einstellung von Physiotherapeut*innen zur Gesundheitsförderung sowie zu Praxis, Kompetenzen und möglichen Barrieren für die Umsetzung von BzlV.

Methode Mittels Online-Umfrage wurden in Deutschland tätige Physiotherapeut*innen zu ihren allgemeinen Einstellungen zur Gesundheitsförderung sowie zu Praxis, Kompetenzen und möglichen Barrieren für die Umsetzung von BzlV befragt. Neben einer deskriptiven Analyse der Angaben wurden Unterschiede zwischen akademisch und nicht akademisch ausgebildeten Physiotherapeut*innen mithilfe des Mann-Whitney-U-Tests ermittelt.

Ergebnisse 511 Physiotherapeut*innen nahmen an der Umfrage teil, davon konnten 413 Fragebögen in die deskriptive Analyse eingeschlossen werden (Alter: 36,4 (± 10,88 SD) Jahre; w/m: 281/132). 92,7 % der Befragten hielten Gesundheitsförderung für einen fundamentalen Bestandteil der physiotherapeutischen Arbeit und 93,4 % stimmten zu, dass die Förderung eines gesunden Lebensstils zur Arbeit von Physiotherapeut*innen gehöre. Die Befragten erhoben (a) und berieten (b) am häufigsten zum Risikofaktor körperliche Inaktivität (a: 89,8 %; b: 91,3 %) und gaben an, über geringe bis mittlere Kompetenzen für die Beratung zur Verhaltensänderung zu verfügen. Akademisch ausgebildete Physiotherapeut*innen schätzten ihre Kompetenzen besser als nicht akademisch ausgebildete Physiotherapeut*innen (W = 8253,5, p = 0,001, r = 0,182) ein. Als häufigste Barrieren bei der Umsetzung von BzlV wurden strukturelle Ursachen, wie Zeitmangel (64,9 %) und fehlende Vergütung (70,5 %), genannt.

Schlussfolgerung Physiotherapeut*innen haben überwiegend eine positive Einstellung zur Gesundheitsförderung und erachten BzlV als sehr wichtig. Derzeit bestehen aber noch viele Barrieren, die Physiotherapeut*innen an der Umsetzung hindern. Damit diese in Deutschland dennoch einen Beitrag zur Gesundheitsförderung leisten können, sollten Rahmenbedingen und Ausbildungsinhalte angepasst werden.

Health Competency Standards in Physical Therapist Practice

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.

Knowledge, Attitudes, and the Practice of Health Promotion among Physiotherapists in Nigeria

Purpose: In spite of the growing epidemic of non-communicable diseases in Nigeria and the compelling need for the active participation of physiotherapists in health promotion activities around the world, there is no evidence that physiotherapists in Nigeria are engaged in health promotion activities. This study aimed to investigate the knowledge of, attitudes toward, and practice of health promotion among physiotherapists practising in Nigeria. Method: This was a cross-sectional study. We contacted members of the Nigeria Society of Physiotherapy (n = 368) by email; the message contained a link to an online questionnaire. Results: A total of 229 (62%) physiotherapists responded. Most demonstrated a good knowledge of health promotion (approximately 70%) and indicated that they often incorporated aspects of health promotion into their patients' treatment (63%). However, fewer than one-fifth strongly agreed that health promotion was taught in their entry-level programme and had equipped them with the necessary health promotion skills. Conclusions: The majority of the physiotherapists surveyed demonstrated good knowledge and often incorporated health promotion into their routine daily practice. Nevertheless, the respondents stated that their entry-level physiotherapy education had not sufficiently equipped them for health promotion practice. These findings provide a baseline reference that can be used to track capacity building for health promotion practices. The results also highlight important gaps in the physiotherapy entry-level curriculum and the health promotion training needs of physiotherapists in Nigeria.

A Model to Integrate Health Promotion and Wellness in Physical Therapist Practice: Development and Validation

BACKGROUND

Globally, physical therapy professional organizations have called for physical therapists to perform lifestyle behavior management during customary care, or health-focused care, due to increasing morbidity and mortality related to noncommunicable diseases. Given the potential for health-focused care to improve health outcomes, physical therapists should integrate health promotion into their daily clinical practice. A clinical model that illustrates necessary steps to deliver health-focused care would be helpful to educate present and future physical therapists.

OBJECTIVE

The purpose of the study was to develop and validate the Health-Focused Physical Therapy Model (HFPTM) for physical inactivity and smoking.

METHODS

The authors used a mixed method approach. The preliminary model was informed by previous research and the investigators' shared experience in health promotion and physical therapy. An interdisciplinary group of health professionals provided input into the preliminary model by way of a World Café format. Eight physical therapists with health promotion and education expertise then engaged in a Delphi process to establish content validity.

RESULTS

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 content validity index (CVI) was .915 for physical inactivity and .899 for smoking. Agreement concerning the model schematic was 88% for either behavior. Investigators made few editorial changes after the Delphi process.

LIMITATIONS

Limitations of this study include using only 2 unhealthy lifestyle behaviors for testing, and performing the testing in a nonclinical setting.

CONCLUSIONS

An interdisciplinary group of health professionals believes that physical therapists should practice health-focused care and that the HFPTM is a valid model. This model could help physical therapist educators when educating physical therapist students and clinicians to practice health-focused care.

Promotion of healthy nutrition in clinical practice: A cross-sectional survey of practices and barriers among physiotherapists in southeast Nigeria

Background:

Healthy diet counselling is an important concept in health promotion. Physiotherapists are well positioned to initiate or support healthy nutrition in addition to physical activity counselling, in routine patient consultation.

Objective:

To determine the practices about and barriers to diet counselling practices among physiotherapists in Southeast Nigeria.

Methods:

In this cross-sectional survey, a total of 140 questionnaires were distributed among physiotherapists.

Results:

Overall, 103 physiotherapists responded. Physiotherapists are confident and consider the incorporation of dietary counselling very important and of high priority in their daily clinical work. They, however, assessed and counselled on dietary status opportunistically in patients. Notwithstanding, physiotherapists believed that the diet counselling they give could be effective in helping patients change their unhealthy dieting practices. Patients were also amenable to physiotherapists advocating on diet issues as part of their consultation. Several barriers to incorporating diet counselling into physiotherapy practice were identified, including lack of access to a dietician/health promotion staff/counsellors, lack of proper patient education materials, lack of expertise in relation to dietary risk factors’ assessment and management, and uncertainty about what dietary services to provide.

Conclusion:

Although physiotherapists consider it important to incorporate diet counselling in their daily clinical practice, development and implementation of strategies to improve physiotherapists’ diet counselling knowledge, competence, skills, and practice are warranted.