Volume 8:1
Provision of Nutritional Counseling by Physical Therapists in the State of Tennessee
David A. Lehman, PhD, PT; George Abell, SPT; Elizha Burdette, SPT; Matthew Lindeman, SPT;Ryan Stromberg, SPT
Tennessee State University – Nashville, TN
Abstract
Objectives: To determine whether physical therapists (PTs) in Tennessee are legally permitted to provide nutritional advice to patients and if providing nutritional advice should be a part of the preferred physical therapy practice patterns.
Background: Proper nutrition is critical to the maintenance of health and the prevention of many diseases. The American Physical Therapy Association (APTA) states that physical therapists promote healthy lifestyles, wellness, and injury prevention. If proper nutrition is critical to health, and physical therapists (PTs) promote health and wellness, then it logically follows that PTs should advise their patients on proper nutrition.
Methods and Measures: The APTA, Commission on Accreditation in Physical Therapy Education (CAPTE), and Guide toPhysical Therapy Practice websites were searched using key terms such as nutrition, wellness, and diet. The Tennessee practice acts and accompanying policies and the Occupational Outlook Handbook (published by the US Bureau of Labor Statistics) for various professions were reviewed. Lastly, the website for the Center of Nutrition Advocacy (CNA) was reviewed.
Results: No official position on the provision of nutritional counseling by PTs in Tennessee could be found from the APTA, CAPTE, Guide to PT Practice, or the Tennessee Board of Physical Therapy. APTA has a policy that entry-level PTs are expected to recognize that nutrition is a “barrier that may impact the achievement of optimal functioning within a predicted time frame”. CAPTE lists nutrition as a primary content area in the “Foundational Sciences Matrix” of its normative model, which provides guidelines on what schools should teach PT students. The Guide to PT Practice lists nutrition as a “clinical finding” that may be reviewed during the patient history and lists nutritional status under “Factors That May Require New Episode of Care or That May Modify Frequency of Visits/Duration of Episode.” Search of the CNA website resulted in their official position regarding the provision of nutritional counseling by healthcare professionals. The CNA states that, “nutrition is not the sole purview of any single profession, but is a toolset skillfully used by a wide variety of trained professionals to improve the health of those they serve.”
Conclusion: The lack of specific inclusion of “nutrition” in the Tennessee PT scope of practice does not absolutely signify that PTs cannot provide nutritional counseling. “Diet” and “nutrition” are also not specifically mentioned in the physician, dentist, nurse, or chiropractor practice acts, even though they may all counsel patients on nutrition as part of their practices. PTs can legally provide services and information related to nutrition. Considering nutrition affects the patient and the physical therapy intervention, nutritional counseling should be included in the preferred physical therapy practice patterns.
Whole Body Vibration and Resistive Exercises May Reduce Risk Factors for Fractures in Type I Osteogenesis Imperfecta – Systematic Review
Taylor Barnes, SPT; Hillary Dow, SPT; Robert Felts, SPT; Elizabeth Robbins, SPT; Edilberto A. Raynes, MD, PhD
College of Health Sciences, Department of Physical Therapy, Tennessee State University – Nashville, TN
Abstract
There is a scarcity of research on whole body vibration exercise and resistance exercise as a combined program for children and adolescents with type I Osteogenesis Imperfecta (OI). Type I OI is the mildest and most common form, characterized by mild to moderate fragility without bone deformity. The goal of treatment when working with people with Type I OI is to reduce the risk of fractures primarily by increasing bone mineral density. Research has indicated that whole body vibration, by means of mechanical oscillation, and resistive exercise, that creates a tensile force on the bone and musculature, are effective means for increasing muscular strengthening and bone formation and for preventing the loss of bone mineral density. Using the Oxford Level of Evidence, a systematic review of literature was done to determine if whole body vibration and resistive exercise training can reduce risk factors for fractures in children and adolescents with type I OI. Based on the gathered evidence, we surmised that combining whole body vibration and resistive exercises yields greater effects on bone mineral density in reducing risk factors for fractures in children and adolescents with type I OI.
Adherence to Physical Therapy: A Qualitative Study
Kellie R. Stickler,SPT
University of Kansas Medical Center – Kansas City, KS
Abstract
Objectives: To determine the strategies practicing PTs use to increase adherence to prescribed home exercise programs and to compare these theories to the current research.
Background: Physical therapy is a popular treatment for physical disorders and musculoskeletal pain. For physical therapy to be effective, patients need to complete their prescribed treatment. Engström and Öberg (2005) found that only 24% of participants actually completed their exercise programs with full adherence.
Methods and Measures: In-person, semi-structured interviews were performed. By interviewing PTs, this study evaluates how practicing PTs are dealing with nonadherence in their clinics and how they try to increase adherence. PTs used their clinical opinion, based on subjective reports from patients and clinical judgment, to determine adherence rates.
Results: Five PTs were interviewed, and all reported the belief that patient education is the most important strategy for ensuring adherence; however, the literature supports patient self-efficacy and the therapist-patient alliance as important factors in predicting adherence. Although those interviewed engaged in many positive behaviors, PTs and the literature disagree on how to increase adherence. Of those interviewed, patients’ actual adherence is unknown, but it is estimated at higher than reported in the literature.
Conclusion: The information given by PTs suggests that the field of physical therapy needs to reevaluate how to increase adherence and examine training programs to include training PTs to prevent or manage non-adherence.
