StudentPT: Health Promotion & Wellness

Goodness this week stinks... but it's all good... here is my review for the class that appears in the title of this post :-D

This would be easier if I could make a table, but the following info is adapted from Janet Bezner (who is a great presenter and I hope I do this section of your chapter justice). In Health and Wellness: The Beginning of the Paradigm (2007) she compares and contrasts illness (traditional or medical), prevention, and wellness paradigms. She goes on to break each down into how they stand on 6 parameters: view of human systems, program orientation, dependent variables, client status, intervention focus, and intervention method.

A wellness paradigm approaches the systems as integrative where they all work together and rely on each other. Illness looks at each system by itself, hence all the specialties of neurology, ortho, gyno, etc.). In prevention there is acknowledgment that systems interact but not in the reciprocal fashion as in wellness.

Program orientation in the illness paradigm looks to fix a pathology; in prevention it is normogenic, meaning there is a focus on maintenance; whereas wellness is the most proactive and tries to improve/cause health (salutogenic).

Dependent variables in illness are clinical (e.g. blood tests, tests & measures, etc.). Changes in these variables result in the pt. being more or less ill. Prevention deals with behaviors of people such as smoking, exercise, or safety precautions taken. Wellness focuses on what the individual feels and thinks about him/herself. Studies have shown that how well you THINK you are may be more important than how well you are measured clinically (the power of positive thinking...).

Client status in illness refers to a "patient". In prevention the "person-at-risk" is the one trying to maintain their level of health. Lastly, in wellness the client is a "whole person," thus emphasizing how the multiple systems work together. Most importantly emphasizing that a high-functioning or intact physical dimension, although important, is not necessary to achieve a state of well-being or a high quality of life.

Intervention focus is consistent with client status in illness (focus on symptoms) and in prevention (focus on risk factors). Wellness focuses on dispositions, or the tendency to act in a certain manner under given circumstances, thus having an impact on the psychosocial assessment of the whole person.

Lastly, the intervention method is prescriptive (focused on system affected by symptoms reported or pathology) in an illness paradigm. In prevention the intervention is lifestyle modification to minimize the identified risk. Wellness brings us to the "values clarification" which is aimed at self-understanding to really understand the whole person rather than the disease or condition. A change has to be made from within the person, because they want to make it in order for health to improve.

Another article we read was by Rimmer (1999) from the PT Journal. The major themes covered are that individuals with disabilities need prevention of secondary conditions. This will be cost-effective in the long term and create greater quality of life and greater function for those affected.

What role do PT's play in all of this? We are one of the primary advocates for our patients/clients. Not only can we educate the individual who has the disability about what they can do to help prevent these secondary conditions that include osteoporosis, OA, decreased balance, strength, endurance, fitness, and flexibility; increased spasticity; weight problems; depression; and other conditions. In the case of depression it may be necessary for us as PT's to refer to a specialist in this area, but PT's are one of the few health care workers who spend upwards of an hour with each patient/client and thus need to discuss these vital issues.

Another important point this article brings up is the definition of health. It used to just be "the absence of disease" but recently was redefined by WHO to read: "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Lastly, on the topic at hand anyway, we discussed sports injury prevention and ergonomics. There is way too much to go into with sports injury prevention, but know that prevention in the off season can keep you going for all of the regular season and much further. Some highlights:

ACL injuries Females>Males (for biomechanical reasons), 3 main theories behind this (ligament dominance, quad dominance or straight knee landing theory), 66% of ACL inj's are non-contact, cost America about $850 million/yr. Peak age is 16 in F, 19 in M.
Proper technique and plyometrics seem to be two of the bigger prevention strategies that work.

In ergonomics there are a lot of technical details. A good one to remember is when you sit "90-90-90" - as in your hips-knees-ankles in terms of degrees. It is good to constantly remind yourself to not slouch, and tell your kids or friends... it is just saving them back pain and other musculoskeletal problems later on... We are one of the few professions that would actually try to cure patients before they ever come see us to pay us...