Copyright 2005 Lippincott Williams & Wilkins Chapter 4 Prevention and the Promotion of Health, Wellness, and Fitness The function of protecting and developing health must rank even above that of restoring it when it is impaired — Hippocrates

Copyright 2005 Lippincott Williams & Wilkins The Context for Primary Prevention Physical therapists are expected to participate actively in health and wellness practices.

Copyright 2005 Lippincott Williams & Wilkins Prevention, Health Promotion, and Health Education Primary Prevention:  Includes health promotion, protection and preventative health services.  Takes place in the “prepathogenesis” period— before onset of disease.

Copyright 2005 Lippincott Williams & Wilkins Secondary Prevention Includes screening for the purpose of early diagnosis and treatment of disease, as well as disability limitation.  Secondary prevention services take place after the onset of illness or injury, in the presence of pathology.  e.g., breast and prostate screening, osteoporosis screening, medical pre-placement evaluations.

Copyright 2005 Lippincott Williams & Wilkins Tertiary Care Encompasses traditional physical therapy services.  Health status of patient will determine if information falls under primary, secondary, or tertiary care.  e.g., A diabetic patient receiving rehabilitation for an amputation would be receiving tertiary care. Overall health status will determine which category the patient requires.

Copyright 2005 Lippincott Williams & Wilkins Differentiation of Primary, Secondary, and Tertiary Prevention Prepathogenesis PeriodPeriod of Pathogenesis Health Promotion Health Protection Preventative Health Services Early Diagnosis and Prompt Treatment Disability Limitation Rehabilitation Primary PreventionSecondary Prevention Tertiary Prevention

Copyright 2005 Lippincott Williams & Wilkins Health Promotion A combination of educational and environmental programs or actions that are conducive to health.  Factors/interventions are considered beyond the exercise program (e.g., nutrition).

Copyright 2005 Lippincott Williams & Wilkins Combination Component  Variety of learning experiences (interventions) are necessary to influence change.  Interventions from other healthcare providers may be enlisted.  e.g., Nutrition, hormone therapy, and therapeutic exercise are combined as part of the osteoporosis intervention program.

Copyright 2005 Lippincott Williams & Wilkins Education Component: Health Education Any combination of learning experiences designed to facilitate voluntary actions conducive to help.  Health education activities are planned out and are voluntary. Examples:  Counseling patients on the risks of smoking.  An osteoporosis program.  Teaching children how to carry and load their backpacks safely.

Copyright 2005 Lippincott Williams & Wilkins Environmental Component Encompasses social forces that influence health: social, political, economic, organizational, policy, and regulatory issues.  Individual and social/regulatory activities are included.  Individual’s vocational policies must be considered to assist with positive responses (e.g., nonsmoking policy at work).

Copyright 2005 Lippincott Williams & Wilkins Health Promotion = Health Education?  Not significantly different. Health Promotion & Health Education: Broad and varied set of strategies to:  Influence individuals and their environment  Improve health behavior  Enhance health and quality of life

Copyright 2005 Lippincott Williams & Wilkins Health Protection/Preventative Health Services Health Protection Strategies dealing with engineering the physical environment. Preventative Health Services Traditional medical system efforts to prevent injury and illness.

Copyright 2005 Lippincott Williams & Wilkins Wellness and Lifestyle Concepts that embrace positive health behaviors and promote a state of physical and mental balance and fitness.

Copyright 2005 Lippincott Williams & Wilkins Wellness 1.Multidimensional concept. 2.Has salutogenic focus (what causes health). 3.Uses a systems perspective. 4.Size of each dimension within systems theory represents the amount of wellness an individual possesses.

Copyright 2005 Lippincott Williams & Wilkins Dimensions of Wellness  Physical  Psychological  Social  Emotional  Spiritual  Intellectual

Copyright 2005 Lippincott Williams & Wilkins The Wellness Model

Copyright 2005 Lippincott Williams & Wilkins Measurement of Wellness  Reflects the multidimensionality and systems orientation of the concept and has a health- causing (salutogenic) focus.  Includes perceptual tools when measuring wellness for all levels of prevention (primary, secondary, tertiary).

Copyright 2005 Lippincott Williams & Wilkins Perceptions that may be Assessed  General health  Status  Social support systems  Role and social functioning  Functional status in self-care and home- management activities  Work  Community  Leisure activities

Copyright 2005 Lippincott Williams & Wilkins Perceptual Measurement Tools Instrument  SF-36  Satisfaction w/life scale  Perceived wellness survey  NCHS general well-being schedule  Philadelphia Geriatric Center morale scale  Memorial University of Newfoundland scale of happiness Perceptual Construct  General health perceptions  Life satisfaction  Perceived wellness  General well-being  Morale  Happiness

Copyright 2005 Lippincott Williams & Wilkins Health Promotion and Wellness-Based Practices  Offering services beyond traditional patient– provider practices. Change the focus: Illness Wellness

Copyright 2005 Lippincott Williams & Wilkins From Illness to Wellness  Requires altering the approach to consider patients as “clients” who can be MORE well.  Patients convert to “members” after discharge and continue to use facility to continue their exercise program.

Copyright 2005 Lippincott Williams & Wilkins Establishing a Wellness-Based Practice  Facility is open and staffed at convenient hours.  Staff has expertise in exercise prescription and wellness.  Educational classes (nutrition, exercise, etc.) tap the intellectual aspect.  Provider often assumes the role of a facilitator.

Copyright 2005 Lippincott Williams & Wilkins Use of Screening as an Examination Tool within a Wellness-Based Practice  Used to identify whether client has risks that require investigation before intervention program. Examples:  Satisfaction with life scale  Perceived wellness survey  NHCS general well-being schedule

Copyright 2005 Lippincott Williams & Wilkins Starting a Wellness-Based Practice 1.Verify that “wellness” or “health promotion” is included in the definition and description of PT in the state practice act. 2.Check liability policy to ensure coverage. 3.Become educated on identifying/understanding the potential risks of a wellness-based practice. 4.Incorporate marketing and advertising programs and success evaluations.

Copyright 2005 Lippincott Williams & Wilkins Summary Classification of prevention – primary, secondary, tertiary. Health promotion and wellness – primary prevention. Most rehabilitation – secondary or tertiary. The terms health promotion and health education are often used interchangeably. Wellness is multidimensional salutogenic and requires a systems perspective. Perceptual measures (screening) – good predictors of general well-being. Wellness – Looking beyond physical domains and biomedical model.