Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice

Abstract

Background and Purpose: Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. Summary of Key Points: Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. Recommendations for Clinical Practice: Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).

Descriptive analysis of post-stroke patients in a neurological physical therapy unit

“…At the regional level, it is recommended to evaluate the pwS as soon as possible, preferably in the first 24-48 h (except in cases of severe complications), and prescribe the start of a PT treatment (29). In the hospital scope, the scientific literature (18,(30)(31)(32)(33)(34)(35) highlights the physical and psychological benefits of early mobilization after suffering a CVA. Bernhardt et al (35) analyzed 30 clinical practice guides, of which 22 recommended early PT (to be started in the first 48 h after the CVA), whereas the other eight advised very early PT (in the first 24 h after the CVA).…”

“…This diagnosis is based on the International Classification of Functioning, Disability, and Health (ICF), which considers deficiencies in bodily functions and structures, activity limitation, participation restriction, and existing contextual factors, both environmental and personal (12,16). This allows for establishing the prognosis and the treatment objectives and developing a PT intervention plan (17,18). The pwS's degree of recovery depends on different factors, such as the amount of brain tissue affected, age, localization of the damaged area, early rehabilitation, and environmental and psychosocial factors (19).…”

Addressing Opportunities and Barriers in Telehealth Neurologic Physical Therapy: Strategies to Advance Practice

“…We strongly encourage clinicians to document the telehealth assessment and treatment practices, use of outcome measures, and thus, share experiences through participation in local or national conferences and advocate for the use of telehealth at this time. Rafferty et al suggested that documenting clinical practices, measuring outcomes, and sharing knowledge are essential components of evidence-based practice 42. It is important to note, however, that telehealth can widen the disparity gap among vulnerable populations or in individuals with poor technological access or literacy 43.…”

“…Rafferty et al suggested that documenting clinical practices, measuring outcomes, and sharing knowledge are essential components of evidence-based practice. 42 It is important to note, however, that telehealth can widen the disparity gap among vulnerable populations or in individuals with poor technological access or literacy. 43 Therefore, initial screening for telehealth appropriateness and ongoing advocacy efforts may be required to increase equitable PT utilization in patients with neurologic conditions.…”

Physical Activity Coaching via Telehealth for People With Parkinson Disease: A Cohort Study

“…[23][24][25] Coaching to promote PA is an integral part of the consultative therapy model of care, and it is also well-suited for telehealth delivery. 26,27 Physical therapists are training in motivational interviewing-style techniques and have expertise in exercise and PD management. Therefore, they are wellpositioned to deliver PA coaching and consultation starting in early disease stages.…”