The Critical Role of Nutrition Care to Improve Pain Management: A Global Call to Action for Physical Therapist Practice

An exploration of self-perceived competence in providing nutrition care among physiotherapists in Ireland: a cross-sectional study

BACKGROUND

Integrating nutrition care into physiotherapy can address modifiable risk factors contributing to chronic diseases, providing comprehensive and effective patient care, and supporting a wellness-oriented approach to healthcare.

OBJECTIVE

To investigate physiotherapists' self-perceived confidence in their competence in nutrition care in Ireland.

METHODS

Cross-sectional study using data from a validated online survey tool. Four constructs of competence in nutrition care were assessed: knowledge, skill, communication and counseling, and attitude. Open-ended responses were collected to gather opinions on nutrition knowledge requirements. Participants were chartered physiotherapists representing public and private workplaces across geographical settings in Ireland.

RESULTS

447 physiotherapists completed the survey. Most were female (n = 364, 81%), in private practice (n = 136, 31%), and located in a city (n = 215, 48%) with a mean 17 years post-qualification experience. Participants' self-perceived confidence in nutrition care competence was positive (mean score of 107.2/175). However, knowledge (mean score of 18.5/35) and skills (mean score of 27.2/55) related to nutrition care received lower ratings. Age and years of practice were positively associated with higher confidence in providing nutrition care. Most participants (n = 314, 71%) agreed that additional nutrition education is needed. Three overarching themes were identified regarding nutrition knowledge requirements: importance of providing nutrition advice, stated knowledge needs for nutrition education and training, and feasibility of nutrition care within physiotherapy practice.

CONCLUSIONS

Physiotherapists in Ireland have confidence in provision of nutrition care but rated their knowledge and skills in nutrition as relatively low. Nutrition knowledge and skill are essential for physiotherapist practice as they can significantly impact patients' outcomes.

Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis

OBJECTIVE

To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population.

DESIGN

A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions.

METHODS

Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated.

RESULTS

Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given.

CONCLUSION

This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.

Guiding Principles for the Practice of Integrative Physical Therapy

Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition.

IMPACT

This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.

Implementation of Nutritional Assessment and Counseling in Physical Therapy Treatment: An Anonymous Cross-Sectional Survey

In the context of the evolving role of Physical Therapists (PTs) in health promotion, this study explored the incorporation of nutritional assessment and counseling into PTs' professional practice in Israel. Using an anonymous cross-sectional survey design, the research gauged PTs' professional background, nutritional knowledge, lifestyle habits, and the extent of nutritional care integration. Our survey gathered data from 409 certified PTs in Israel, revealing inadequate nutritional knowledge, commendable nutritional lifestyles, and limited nutritional care integration. Participants with over 13 years of clinical experience demonstrated significantly higher levels of nutritional assessment and counseling integration within their physical therapy practices. Workplace setting, nutritional lifestyle, and nutritional knowledge emerged as significant predictors for nutritional care integration. Specifically, working in outpatient clinics and possessing better nutritional lifestyles and knowledge were associated with the increased integration of nutritional assessment and counseling within physical therapy practice. These findings underscore the need for targeted interventions and formal nutrition education to bridge the knowledge gaps and optimize patient care. These results advocate for comprehensive nutrition education in physical therapy curricula and the fostering of PTs as role models. Integrating nutrition care could empower PTs to enhance patient outcomes and fulfill their role in preventive healthcare.

Academy of Plant-based Physical Therapy: overdue to address a nutrition crisis with a transformative population approach

This timely evidence synthesis supports the need for an Academy of Plant-based Physical Therapy. Given epidemiological and empirical evidence and the profession's values and practice scope, the time has come for a specialty of plant-based physical therapy based on population health principles. This review connects these factors. Non-communicable diseases (NCDs) are largely nutrition-related resulting from unnatural elements of our diet (i.e., heart disease, several cancers, hypertension, stroke, diabetes, obesity, gastrointestinal diseases, autoimmune diseases, renal disease, and Alzheimer's disease). Most adults, even children, have NCD risk factors or manifestations. Alternatively, plant-based nutrition can prevent, manage, as well as potentially reverse these diseases, as well as augment conventional physical therapy outcomes by reducing inflammation and pain. Proposed competencies for plant-based physical therapists include high-level competency in health and NCD risk assessments/evaluations, to establish population health-informed nutrition needs for maximal health, healing and repair, in turn, function and wellbeing; and assessment of patients' nutrition-related knowledge, beliefs/attitudes, self-efficacy, and readiness-to-change. Population-informed nutritional counseling is initiated as indicated. An Academy of Plant-based Physical Therapy could advance the profession globally at this point in history and also serve as a role model to other health professions through practicing evidence-based, plant-based nutrition built upon population health principles.

The Key Role of Lifestyle Factors in Perpetuating Chronic Pain: Towards Precision Pain Medicine

Chronic pain has a massive personal and socioeconomic impact and remains a challenge for many clinicians around the world [...].