Would Physiotherapists be Public Health Promoters?: Concern or Opportunity for Indian Public Health System

Yasobant S¹* and Mohanty S²

¹Indian Institute of Public Health Gandhinagar, India

²Medcare Hospital & Research Centre, India

*Corresponding author: Sandul Yasobant, Indian Institute of Public Health, Gandhi nagar, India

Received: January 23, 2017; Accepted: March 24, 2017; Published: April 04, 2017

Abstract

Health promotion is a prevention strategy that allows people to manage and improve their overall health status. In the last few decades, there has been a call for reorientation of health services towards health promotion and prevention. As one of the many stakeholders, the physiotherapy profession needs to clearly define its role in the preventive health care system and establish the scope and boundaries of its role in multidisciplinary teamwork. Further linking of health promotion with physiotherapy could be one step in attaining this goal. Physiotherapists should become role models in looking at the big picture and should have confidence in addressing broader health issues in developing nations like India.

Keywords: Health promotion; Public health, Physiotherapists

Introduction

Health & Promoting health

Never before has health promotion been more important than it is today. The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. In the International Classification of Functioning, Disability and Health (ICF) model, the WHO further quantifies and measures health based on the ability of a person to participate in life. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions [2]. Numerous definitions of health promotion have been acknowledged [3,4]. One of the most cited definitions is presented in the Ottawa Charter for Health Promotion; which states that health promotion is “the process of enabling people to increase control over, and to improve, their health”. Also WHO defines Health promotion as the process of enabling people to increase control over, and to improve, their health [2].

Physiotherapists: healthcare professionals for health promotion

Health promotion is a prevention strategy that allows people to manage and improve their overall health status. Physiotherapy has been defined as “a healthcare profession concerned with human function and movement and maximizing potential”. Today, it is usually understood that physiotherapy is a science-based field of practice that uses mainly physical approaches that intend to promote, maintain and restore physical, psychological and social well-being [5]. Physiotherapists and related associate professionals assess, plan, organize, and participate in rehabilitative programs that improve mobility, relieve pain, increase strength, and decrease or prevent deformity of patients suffering from disease or injury (International Standard Classification of Occupations-ISCO 08 Code-2264) [5,6]. Currently, very few professionals engage in developing and implementing screening and preventative health promotion programs. Physiotherapy practitioners are trained to view a person holistically in the context of their daily lives, across the lifespan. For example, they can create health-promoting play activities for children to enhance physical well-being, develop injury prevention programs for adult workers, or educate seniors on home and activity modifications to prevent falls or identify and provide adaptations to cars so that seniors can drive more safely. Directly or indirectly Physiotherapists are involved in health promotion activities in their practices.

A person who enjoyed agriculture (the most common occupation in India) but gave up this meaningful activity due to back pain may experience improved well-being if they can continue through adapting minor ergonomic modifications to minimize strain on the back. Physiotherapy practitioners can identify and address barriers between the client’s abilities and the demands of their daily lives at home and at work, thereby promoting a healthier lifestyle. A physiotherapy practitioner working with a client with any chronic diseases/ disorders may teach healthier lifestyle and could assist the client in locating an accessible community exercise program.

Global Focus: A Discussion

Health promotion by physiotherapists: what India should learn from other countries: A global focus

Globally physiotherapists have been involved themselves in both clinical practices as well as in preventive healthcare services. It has been recently realized that Physiotherapists can make an important contribution to primary health care through their health promotion, prevention, screening, as well as triage, assessment and treatment activities [7,8]. In 2010, the Ontario Physiotherapy Leadership Consortium (OPLC) led an initiative to examine evolving areas of practice for physiotherapy in health promotion. The purpose was to describe insights from the Ontario-based process with a view to contributing to national momentum in exploring physiotherapists’ roles in health promotion and concluded that “Physiotherapists should become role models in looking at the big picture and should have confidence in addressing broader health issues” [9].

Similarly, Ministry of Health, State of Israel aimed at increasing movement ability, improving function and promoting physical fitness, thus improving health and the quality of life through physiotherapy works force. Adaptation of a physical activity program is carried out in various frameworks in the health system, in educational institutions, at work places, and in leisure activity frameworks, in individual appointments, group workshops, lectures and health days [10,11]. A study by Rea et al. in 2004 conclude health promotion behaviour most commonly thought to be practiced by physical therapists was assisting patients to increase physical activity (54%), followed by psychological well-being (41%), nutrition and overweight issues (19%), smoking cessation (17%) and in lower than desirable percentages based on Healthy People 2010 goals. This study demonstrated that a physical therapist’s confidence in being able to perform behaviour (selfefficacy) was the best predictor of perceptions of practice patterns and is an area to target in future interventions [12].

A qualitative study on perceptions of physiotherapists about their role in health promotion at an acute hospital indicates that physiotherapists perceived health promotion to be within their scope of practice, particularly in relation to the promotion of physical activity and smoking cessation. Whilst some facilitators to engaging in health promotion were discussed in that study, a large number of barriers to routine engagement in health promotion were also identified. These included time constraints, the focus of acute settings on discharge, and scepticism of effectiveness [13]. Another study from Sweden indicated that Physiotherapists’ understanding and approach to health promotion work in compulsory school: Perceiving and supporting coherence [14]. The understanding and approach were discussed in this paper with relation to challenges of a historically embedded constitution of physiotherapy when entering the area of health promotion in compulsory school; which shows a positive indication of involving these healthcare professionals.

In which dimensions of health promotion, physiotherapists could be engaged?

Physiotherapy practitioners work with individuals across the life span, with populations and with organizations. They work with individuals and groups who have disabilities as well as healthy individuals [15]. Physiotherapy services related to health promotion are broad ranging from general prevention strategies for a healthy population such as backpack awareness day and car safety recommendation programs for adult drivers to specific health enhancing activities for individuals with chronic medical conditions. Physiotherapy enables people of all ages live life to its fullest by helping them to promote health, make lifestyle or environmental changes, and prevent or live better with injury, illness or disability. By looking at the whole picture a client’s psychological, physical, emotional, and social make-up Physiotherapy assists people to achieve their goals, function at the highest possible level, maintain or rebuild their independence and participate in the everyday activities of life. In areas such as fall prevention, arthritis, chronic lung disease, incontinence, diabetes, physical inactivity and obesity, osteoporosis, workplace safety and mental health, the role of exercise “upstream” is well documented [16]. Physiotherapists are the ideal health professionals to act as both providers and consultants in the area of specialized exercise programming.

Examples of Physiotherapy-based Health Promotion programs:

Workplace injury prevention and wellness programs
Ergonomic principles applied to computer workstations in workplaces to decrease repetitive motion and musculoskeletal disorders
Community-based fall prevention programs for seniors
Physical Stress Prevention and Management programs
Backpack safety to prevent injury from heavily loaded backpacks in school-age children
Chronic Diseases and Prevention programs
Occupational Ergonomics Programs
Quality of Life & Physical Activity Promotion
Acquired Disability Prevention programs
Healthier life Promotion & Life style Management programs

Advocating physiotherapists’ role in health promotion

As one of the many stakeholders, the physiotherapy profession needs to clearly define its role in the health promotion and establish the scope and boundaries of its role in multidisciplinary teamwork [17]. It must advocate for its role by demonstrating to other health care providers, governments and policy makers how physiotherapy can contribute to the health promotion approach [7,8]. In the words of So ever (2006); “… physiotherapists need to demonstrate how they have the potential to contribute to the sum of the parts” (p.13) so that the skills and knowledge of physiotherapists are fully utilized in any reshaping of Australia’s primary health care system. It is also clear that current educational knowledge of Indian physiotherapists need to be improved by introducing a special module on “Health Promotion & Practices in Physiotherapy” in the course curriculum as done in Australia [18] or a special training program need to be developed by Ministry of Health & Family Welfare to train the Physiotherapy practitioners in the field of Health promotion. Specific rules & regulations need to be developed in collaboration with national governing bodies [19] to establish a clear cut guideline within their domains, for engaging physiotherapists in the field of health promotion. Same time issues like unmet need for a National Policy & Framework for Health promotion, and support for Research & Development in the field of health promotion need to be considered in relation to Indian healthcare system [20,21].

Conclusion

In the last few decades, there has been a call for reorientation of health services towards health promotion and prevention. Furthermore linking of health promotion with physiotherapy could be one step in attaining this goal. Physiotherapists should become role models in national perspective and should have confidence in addressing broader health issues. Physiotherapists in education, practice, and research settings can participate in the advancement of health promotion not only to the mainstream but to the forefront of public health practices. Historically, physiotherapists have taught patients how to manage illness; in the future, the focus must be on teaching people how to remain healthy. Physiotherapists must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large. As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and the health of their families, the overall health of the population will improve.