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Health-focused practice: Components
There are outlines of a proposed structure for health-focused practice that is consistent with contemporary definitions of physical therapy and can serve as a primary pillar of practice and competency standards for the 21st century. The foci of care include multiple health behavior change (i.e., smoking cessation, nutrition, weight control, physical activity, exercise, stress management, and optimization of sleep). A plethora of literature exists to support the inclusion of these topics and the benefits of their being addressed. Traditionally, health care professionals, including physical therapists, have focused on impairment, ill health, injury, and disability. As outlined in Table 1, inclusion of health and determinants of health and the requisite knowledge, skills, and attitudes into entry-level curricula that are needed to effect optimal health in our clients and patients is timely. In this way, health and well-being are legitimized as the first priority of the physical therapist in advancing world health, the health of the community in the context of the general public, the workplace, schools, as well as at the level of the individual client or patient. This would focus the physical therapist’s attention to health in the generally well population and on managing an individual’s presenting problem in the context of the individual’s overall health risks and chronic conditions.
The assessment of health and well-being is distinct in that it consists of assessing the com-ponents of the ICF model (2002) in relation to their adequacy and the individual’s abilities and health-related quality of life. Multisystem status may reflect the individual’s lifestyle choices over time and environmental exposure. The goal of health promotion is to reinforce positive health behaviors and reduce negative heath behaviors. Decision analysis can be a useful tool to effect health behavior change by having the individual compare the benefits and costs of changing and of not changing a given health behavior or multiple health behaviors.
Health-focused practice: Risk factor assessment and evaluation
Risk factor assessment refers to the systematic assessment of an individual’s non modifiable and modifiable risk factors for the lifestyle conditions. There are many risk factor assessment tools available for use; however, standardized tools constructed from credible sources are essential to maximize their clinical utility with respect to assessing an individual’s type and degree of risk. Risk factor assessment and classification are based on the results of valid and reliable tools. These are usually questionnaire format and based on longitudinal epidemiological and population health studies of large numbers of people. By tracking the non modifiable and modifiable risk factors for the lifestyle conditions, clinicians can predict the conditions for which a given individual may be at risk, and they also can be used as outcomes by tracking change over time and in response to intervention.
The global health assessment was published for use by health care professionals (Grundy et al, 1999). This risk factor assessment consists of six questions including lipid levels. Degree of risk is distinct for men and women and color coded for teaching purposes such that an individual can readily observe current level of risk and a shift in risk on reevaluation.
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