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The Harvard School of Public Health is another credible source for risk factor assessment tools. It has constructed online questionnaires on ‘‘Your Disease Risk’’ based on the extensive epidemiological data and regression analyses (Harvard School of Public Health, 2008). An individual’s risk of IHD, cancer ( classifications), stroke, and osteoporosis can be assessed with condition-specific risk assessment tools based on a relatively few specific questions and risk rated over several grades of severity from low to high risk. These risk classifications can serve as indexes or outcome measures to assess the effects of health behavior change. An individual may score above average risk for lung cancer, as an example, but if this score was the highest possible risk 6 months ago, this constitutes change in a positive direction.
Risk factor assessment needs to be based on credible tools. The two scales above predict the risk of developing specific conditions which is of considerable clinical relevance, whereas others are designed to predict mortality (e.g., the SCORE project developed in Europe) (Conroy et al, 2003).
Anthropometric measures are also important risk indicators. These constitute the new ‘‘vital signs’’ of the 21st century that warrant being assessment priorities if the tide of obesity is to be turned (Campbell, 2003). Body mass index below 18.5 and over 24.9 is associated with health risk—the latter with ischemic heart dis-ease and other systemic conditions. Waist girth is comparable to BMI as an indicator of risk, and waist-to-hip ratio is superior to either of these (Yusuf et al, 2005). Body weight, height, and waist and hip measures are fundamental to the physical therapy assessment in the 21st century and warrant being recorded based on standardized valid procedures.
Health-focused practice: Interventions
The physical therapist can use the results of the risk factor assessments for each lifestyle condition as the basis for intervention. Lifestyle conditions, however, often share common health behavior risk factors, hence, the current interest in multiple health behavior change (Noar, Chabot, and Zimmerman, 2008; Prochaska, 2008; Prochaska, Spring, and Nigg, 2008). For most people, at least those seen by the physical therapist for the first time, a comprehensive risk factor assessment of lifestyle conditions is warranted. The aim of risk factor reduction interventions is to shift the individual to the lowest risk severity category as possible. These categories are based on population statistics, so in relation to other cultures, these could still be considered high. The risk categories reflect the culture in which the original data underlining the ranges of risk were collected.
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