Intro to PT chapter 8 Flashcards
Noncommunicable disease
preventable causes of death and disability. Cardiovascular disease, diabetes, and many cancers
Health behaviors
physical activity, healthy eating, getting adequate sleep, not smoking and stress management.
Behavioral causes of death McGinnis & Foege
50% of deaths.
leading causes of death in 2016,2017
diseases of the heart.
physical activity and diet
make strong contributions to cardiovascular health.
diabetes mellites
diet and exercise can help.
Boissonnault 1999 comorbidities in PT patients.
hypertension, osteoarthritis, depression, asthma, heart disease, diabetes, heart attack, stroke and peripheral arterial disease.
Primary prevention
activities that prevent injury or illness/disease
Secondary prevention
activities and interventions that are provided after the onset of pathology and are intended to minimize the progression and severity of disease. acute
Tertiary prevention
activities and interventions designed to slow the progression of a disease and improve quality of life. chronic
Health promotion
The process of enabling people to increase control over and improve their health.
Health
a state of complete physical, social and mental well-being; not merely the absence of disease or infirmity. A resource used to lead a productive life.
Wellness
An individual’s sense of growth and balance across the physical, spiritual, emotional, intellectual, social, and phycological domains.
Health-related quality of life
individual’s or a group’s perceived physical and mental health over time.
Lifestyle
a way of living based on identifiable patterns of behavior, which are determined by the interplay between an individual’s personal characteristics, social interactions, and socioeconomic and environmental living conditions.
Health behavior
Any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting, or maintaining health, whether or not such behavior is objectively effective toward that end.
dietary choices
nutrient dense foods, fruits and vegetables. Low saturated fats. low added sugars and sodium.
Physical activity
any bodily movement that results in energy expenditure
exercise
subset of physical activity. planned, structured and repetitive movement intended to improve or maintain physical fitness.
Physical fitness
includes cardiorespiratory endurance, muscular strength and endurance, body composition and flexibility, which together enable a person to carry out daily tasks with vigor, enjoy leisurely pursuits and respond to unexpected emergencies.c
components of Physical fitness
Cardiorespiratory endurance
Muscular strength
Muscular endurance
Body composition
Flexibility
Physical activity guidelines
150-300 min moderate. or 75-150 min vigorous aerobic activity. Muscle strengthening activities two or more days a week. 30% of the population meet this.
healthy eating
following national nutritional guidelines and referring to dietitian.
obese
> 30kg/m^2
sleep shortage
associated with type 2 diabetes, heart disease, obesity, and depression
Enough sleep
necessary for functional motor learning and chronic pain.
enough sleep for 18-60 year old adults
7 or more hours a night.
enough sleep for 61-64 year old
7-9 hours
enough sleep 6-12 year old children
9-12 hours
teenagers enough sleep
8-10 hours
35.2% of adults reported (sleep)
getting less than 7 hours sleep.
sleep hygiene strategies
ways of maximizing the quality and quantity of sleep.
Leading cause of preventable death in US
tobacco use
adults who currently smoke as a percent
14%
smoking can
impair healing. (causes complications for some surgeries like back surgery.)-
Percent of PT patients who smoke
1 in 5 (20%) - Boissonnault
smoking cessation
Five
A’s of Smoking cessation
Ask about tobacco use
Advise to quit smoking
Assess willingness to quit
Assist patient to quit
Arrange for follow up
positive stress
short term and motivating
Hans Selye stress
“the nonspecific response of the body to any demand”
American Psychological Association survey of US adults regarding stress
64% by financial concerns.
64% by health concerns
48% by the economy
Sleep hygiene strategies
- Same bed time and wake time every day
- Planning at least 7 hours
(I plan 8 to get 7 and I plan 9 to get 8) - Relaxing bedtime routine.
- Only use bed for sleep and sex.
- quiet, dark cool temp. (I do 68 or 67 degrees)
- Limit exposure to bright light in evenings.
- Turning off electronic devices 30 min before bed. (I’m bad at this.)
- Not eating a large meal before bedtime and avoiding caffeine in the late afternoon or evening.
- Exercising regularly and maintaining a healthy diet.
Stress Management framework
- Identify stressor
- Relieve the stress by incorporating a relaxation or coping strategy
- Seek solutions to avoid, control or manage the stress
- take steps to improve overall physical fitness and health
- Think differently to respond differently to the stressor
Mindfullness/relaxation/biofeedback
help with stress management
Transtheoretical model (TTM)
five stages of chage
Precontemplation - unaware of the need to change.
Contemplation - weighing the pros and cons of changing
Preparation - starting to make plans to change
Action - engaging in the behavior
Maintenance performing the behavior regularly for at least 6 months.
Termination (6th stage) More than 6 months and no longer susceptable to temptation.
self-effecacy and decisional balance drive from stage to stage.
Social cognitive theory
Albert Bandura - self efficacy is the single most important prerequisite for behavior change. (behavior results from the continual interaction between environment, personal factors and the behavior itself.)
PT should address both physical and social environment
PT should assess self-efficacy.
Self-Determination Thory (SDT)
Three basic needs
q
Competence - degree to which people feel able to achieve their goals and desired outcomes.
Autonomy - refers to the degree to which people feel responsible for the initiation and maintenance of their behavior.
Relatedness - The extent to which people feel connected to oters in a warm, positive, interpersonal manner.
SDT extrinsic and intrinsic motivations
When motivations are intrinsic the change is likelyt o succeed. When motivations are extrinsic they are less likel to succeed.
PT should first identify what type of motivation the patient has.
PT strategizes to develop intrinsic motivations.
PT create and maintain an evironment in which the patient feels respected, understood, and cared for at all times.
Health Behavior Questions
- Are you physically active
- Do you get at least 150 minutes of moderate physcial activity or 75 min of vigorous a week
- eat 5 or more servings of fruits and vegtables a day
- 6-8 8ounce glasses of water a day
- smoke - how much
- 7-9 hours of sleep
- do you feel tired when you wake up
- do you fall asleep quickly
- Do you feel sleepy during the day
- Do you wake up at night?
- Do you feel stressed?
Health Risk Assessment
Health related behaviors mixed with clinical variables such as blood pressure, weight, and cholesterol levels.
Stage of change questionaire for performing strengthening exercieses
- I currently do not perform strengthening exercises and have no intention to start performing stregthening exercises (precontemplation)
- I currently do not perform stregthening exercises at least two times per week, but plan on starting to perform exercises in the next 6 months.(contemplation)
- I currently do not perform stregthening exercises twice a week, but I plan to start performing stregthening exercises at least twice a week within the next month. (preparation)
- I perform stregthening exercises at least twice a week, and have been doing so for less than 6 months (action)
- I perform stregthening exercises at least twice a week , and have been doing so for 6 months or more (maintenance.)
knee and hip osteoarthritis quality of life questionaire (OAKHQOL)
designed to asses a patient’s perception of how their disease impacts their daily life.
Assessment of cognitive factors
patient examination. general and desease specific. Include The Medical Outcomes Short-Form Health Survey (SF-36) and Percieved Wellness Survey (PWS)
Physical Activity Self-efficacy Questionair
scale: 1 not confident 2=slightly confident 3=moderatly confident 4=very confident 5= extrememly confident
how confident you are that you could be physically active in each of the following situations:
- When I am tired
- When I am in a bad mood
- when I am on vacation
- when it is raining or snowing
Awareness as one of the factors to successfully adopt healthy behavior
bringing into a person’s conciousness both the harmful and the positive health effects of behaviors. - education
Skill as one of the factors to successfully adopt healthy behavior
ensuring the patient knows how to perform the healthy behavior and how to integrate it into their life. including environment changes.
Motivation as one of the factors to succcessfully adopt healthy behavior
intrinsic motivation, is an important prerequisite for behavior change. Assistance from PT to find the type of motivation that will sustain a halth behavior.
Environmental supports as one of the factors to successfully adobt healthy behavior
access to safe places to be physically active. healthy food, smoke free environments and suppportive family and friends.
Health Coaching
a patient centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of interpersonal relationship with a coach. The coach is a health care professional trained in behavior change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being.
rating on behavioral counseling
US Preventive Servicers task Force
rates a B to improve diet and increase physical activity in adults who are overweight and at risk of cardiovascular disease. (more benifits than portential harms)
Rethorn and Pettitt
Need more randomized trials to show benifits of coaching, but it’s probably effective.
Motivational Interviewing
identification of intrinsic motivations for change by identifying conflict between current behaviors and personal values and resolving ambivalences about behavior.
non confrontational guiding approach rather than an expert approach.
- ideal for persons in the contemplation stage of the Transtheoretical model.
Guiding principles of Motivational Interviewing (8.10) 1st principle
Principle: resist the righting reflex
Description: don’t tell patient what to do. ask questions so patient verbalizes it themselves.
PT Behaviors: Ask Pro Con of current behavior. Listen. Reflect. Emphasize autonomy. Avoid giving advice without permission
Guiding principles of Motivational Interviewing (8.10) 2nd principle
Principle: undertand the patient’s motivations.
Description: PT focuses on reasions patient wants to change rather than providing advice.
PT Behaviors: Ask about the patient’s values. Link the behavior to patient values. Point out discrepancies between values and behavior.
Guiding principles of Motivational Interviewing (8.10) 3nd principle
Principle: Listen with empathy
Description: Respectful understanding of another person’s experience, including feelings, needs and desires.
PT behaviors: Listen more than talk. Open ended questions. Permit the patient to articulate the reasons they want to change and the barriers to changing.
Guiding principles of Motivational Interviewing (8.10) 4th principle
Principle: Empower the patient
Description: An actively engaged patient will achieve better outcomes.
PT behaviors: Support the patient to find the best way to adopt the behavior. Provide hope and optimism that the client can be successful. Build self-efficacy in the patient. Assist the patient to solve problems to overcome barriers.
Goal setting
commonly used in PT in plan of care. also used to help the patient identify the specific actions they want to take now that will lead to the adoption of a new behavior.
SMART framework goal writing
specific, measurable, action-based, realistic, and time-referenced.
When a patient only partially meets a goal
Instead of focusing on the negative, focus on what they did do and how to enhance that.
Sleep hygiene strategies.
- same bed time every day
- Planning to get 7 hours sleep
- setting bedtime and wakeup scheduale
- relaxing bedtime routine
- using bed for only sleep and sex.
- dark quiet cool bedroom
- limit bright lite
- turn off electronic devices 30 min
- no large meals
- exercise regularly healthy diet.
Negative stress
chronic and impacts health
Self efficacy can be determined
on a 1 to 10 scale and can be activity based.
Education as a principle of intervention
- Awareness of healthy habits
- Guidlelines for performing them
- Correcting misinformation
-
education is not sufficient to produce change most of the time.
*
Motivational
support
PT inquires about the patient’s experience with the goal (the
best thing about the goal and what the patient learned from
the goal)
APTA’s Health Promotion and Wellness Network
a community for physical therapists, physical therapist assistants, and students who are interested in incorporating prevention, health promotion, and wellness as an integral aspect of physical therapist practice
State practice act and laws about professionally giving nutrition advice
may prevent PTs from giving nutrition advice. It may not be reimbursable and may be illegal. PT should refer out when the required education is beyond general information that can be found in the public domain.
female athlete triad and relative energy deficiency
neg affect metabolism, menstrual function, bone health, immunity, cardiovascular health and psychologicial health. need to reduce emphasis on thin body ideal.
