Facilitating Health Promotion in Physical Therapy using Yoga

Facilitating Health Promotion in Physical Therapy using Yoga
by Ginger Garner PT, MPT, ATC

This capstone addresses health promotion in physical therapy through yoga with a focus on optimizing health through a biopsychosocial model of care. The project will be educational in nature, targeting its use in the Health and Wellness Promotion course in the School of Medicine, Department of Physical Therapy at The University of North Carolina at Chapel Hill, with a future goal of interdisciplinary instruction at other schools of medicine.

Project Development & Additional Education

The project was supported by work penned in support of this capstone, my first text on the yoga in rehabilitation and wellness care, titled Medical Therapeutic Yoga: Biopsychosocial Rehabilitation and Wellness Care. This project was facilitated by my work and experience in the field of medical yoga, as well as instructional design. Coursework taken during my fall 2015 semester in the Department of Mathematical Sciences & Instructional Technology at East Carolina University has greatly aided my front-end instructional design analysis, which was required in order to optimize outcomes in instructional design planning and execution.

Needs Analysis

Instruction in health and promotion topics that embrace mind-body medicine are necessary because there is  a universal need for expanded education in mind-body medicine and wellness and prevention, especially in light of great need for healthcare reform and the increased involvement and utility of physical therapy and its expertise in life coaching across the lifespan. This instruction would fill a perceived gap in PT education that calls for a shift from the acute-driven physical therapy care of the 20^th century to care of epidemic rates of chronic disease and disability (Dean et al., 2009, 2011), driven by lifestyle choice and behavior management. Health promotion in physical therapy is not yet a common theme found in all physical therapy education, and development of coursework that would focus on lifestyle management via what Roger Nelson, in the 44^th McMillan lecture, envisioned as “PT as life coach” has enormous implications for widening physical therapy horizons, chiefly opportunities for collaborate, interdependent, and interprofessional practice. Attention to change readiness, identification of obstacles to practice, and partnership-based communication building for fostering creativity are all critical components of yogic biopsychosocial practice and evolving physical therapy and general medical practice, all of which will be addressed in this capstone project.

Additionally, instruction is imperative because the profession of physical therapy, and medicine in general, needs to use bold language to take an active role in healthcare reform. The Centers for Disease Control’s (CDC) statement, “Real health care reform starts with prevention,”(Anderko et al., 2012) contains the bold language necessary to propel wellness services through community action and education to the forefront of healthcare reform. Also not to forget is the epidemic rates of chronic disease that are, in large part, driven by lifestyle choices (Pomeroy 2012) which can be impacted by physical therapy intervention via health promotion. After all, the health of a nation is determined by the health of its citizens (Garner 2016).

The current language concerning wellness promotion in the Affordable Care Act (ACA) is myopic and singular in its discourse. It only addresses workplace wellness as the method for addressing wellness care. Current ACA language on wellness promotion does not currently include or cite the value of physical therapy to offer preventive screenings or wellness services (Anderko et al., 2012, Wellness Programs 2016, ACA and Wellness Programs Fact Sheet 2013, US Dept. HHS 2016).

While the ACA is laudable in many ways, it is only a preliminary first step toward healthcare reform. Many Americans will and do fall through the cracks this binary approach provides (or fails to) – including but not limited to those who are self-employed, employed by a small business with few employees, and those whose employer offered no wellness programs. Those without knowledge of the importance of prevention (and the “how’s and why’s”) would also fall through the proverbial crack. If they do not know these services are valuable, they will not partake in them. Specifically, the middle-class socioeconomic climate shared by the majority of most Americans dictates that most may miss out on receiving wellness services due to the limitations of the “workplace wellness program” crevasse.

However, action to secure physical therapists’ place in the prevention and wellness sector as a practitioner of choice can begin on a local level. For example, universities can include education in physical therapy programs to prepare their students to take on the important role of “life coach” in order to address epidemic rates of chronic disease in this country.

Workforce wellness programs are important but they are, by far, not the only methodology to affect public health promotion. PT’s need to be situated on the frontlines of medicine, in ER’s, in free-standing clinics, in workplace health programs – including education like the one offered in this capstone – so that we can be practitioners of choice within an interdisciplinary team, to offer Americans their best chance at an optimal quality of life and longevity. The instruction provided in this capstone would be a first step toward preparing PT’s to take an active role in health promotion across the lifespan, including wellness/prevention screening, via offering an optional yogic-based biopsychosocial model of assessment.

Products

The following materials were created to support the project:

• Front End Analysis (includes Needs Analysis, Learner Analysis, Task Analysis, Instructional Goals/Performance Objectives, “ABCD Backstory”, Instructional Strategy/Plan, Instructional Techniques, a complete list of Instructional Materials, including Evaluation Components)
• Book chapter: The Biopsychosocial Model for Yoga in Healthcare from Medical Therapeutic Yoga – This is a prospectus for publication and cannot be shared or distributed in any form. The final chapter will be published in the full text in June 2016. 
• Case Study
• Student Assignment
• Evaluation Component
• The Role of Partnership in Creativity – A second book chapter I wrote, which was published in 2014, is also used as an adjunct to learning materials (for a full list of instructional materials please see the Front End Analysis and Evaluation link above). This chapter is shared via the stated copyright law mandated by the publisher in the link. 

Feedback, Evaluation, and Reflection

Mid-term and final feedback and evaluations were received from Carla Hill, DPT, MPT, OCS, Matthew Taylor, PhD, PT, Patricia J. Slagter van Tryon, EdD, and Karen McCulloch PhD, PT. From that feedback, I drafted a formative evaluation, summative evaluation, and reflection. Assessment and Evaluation

Self-Evaluation & Reflection – This will be completed in full once evaluations of, and questions concerning, the capstone are received via the capstone website. However, I woud like to suggest improvements I know that can be made in the project as it currently stands prior to its defense:
After making changes to the introduction and instructional materials, the instructional materials list shrunk significantly, which is probably a good idea for students so they are not overloaded. However, I would like to see the materials offered expand and grow, but first that would probably require having more teaching time. I am completely open to that possiblity and, in the future, would be happy to expand on the material taught so that a more comprehensive experience in health promotion (through a biopsycosocial, interdisciplinary, integrative medicine lens) could be offered to the students. I would also like to see an expanded offering of experiential practices available for students, which I indicated would be made available for the fall term after I film an extensive collection of them in May 2016. Finally, as use of an integrated biopsychosocial model becomes more widely used in physical therapy, I hope to expand on the material offered in this course section beyond my own book chapters, podcasts, and experiential instruction (yoga practices).

Conclusion

Use of a biopsychosocial model In healthcare, specficially in physical therapy, is often discussed in research and is, for the most part, universally taught in physical therapy education; however a biopsychosocial form of assessment taugth through the lens of yoga philosophy or other integrative method, is far less common. The purpose of this capstone is to introduce phyiscal therapy (and in the future all medical, nursing, and rehabilitation) students to the ancient system of yoga philosophy through the modern lens of biopsychosocial practice. Endorsed by the WHO and IOM (2002, 2011), biopsychosocial-driven assessment and intervention is well supported (WHO 2002, IOM 2011, Pergolizzi et al., 2013) to be a permanent fixture for present and future healthcare practice. Further, the systems-based outcomes that yoga can achieve, chiefly reduction in allostatic load to imrpove all-health outcomes through the mind-body approach, promises to offer a solid evidence-base on which to build a foundation for mainstream inclusion of yoga as a form of health promotion across the lifespan in physical therapy practice.

References

Refer to the following documents for references:

• Front-End Analysis References
• Book Chapter References

Acknowledgements

To Karen McCulloch, for believing in the power of integrative medicine and contemplative sciences when used in the practice of physical therapy, and for her unending supply of creative ideas, such as at the one that fueled the creation of this capstone. Her support has been continuous, beginning with completion of my MPT in 1998 here at UNC through the completion of my tDPT now, almost 20 years later. I look forward to our continued partnership through research and community advocacy to forward interdisciplinary medical yoga intervention. Also a big thanks to Karen and the department for helping me navigate two unexpected medical diagnoses which extended my time in the program by a year. To my committee members, Patricia J. Slagter van Tryon, Matthew Taylor, and also to Carla Hill, your feedback and support has been tremendous and formative in my completion of this project, and others like it. Finally, thanks to my husband and three young sons, whose perpetuating patience (“Mom, are you done with school yet?”) and extra hard work during tough times saw me through. My gratitude and thanks are immeasurable.