APPLICATION OF
WELLNESS IN
PHYSICAL THERAPY
Wellness and Physical Therapy Chapter 2 by SE Fair WRCruzPTRP
CHAPTER OBJECTIVES:
Upon the completion of this chapter, the students should be able to:
Define the disciplines that contribute to and impact wellness.
Differentiate between the credentials of wellness practitioners and
medical professionals.
Differentiate between medical providers with and without an expertise
in wellness.
Differentiate between the terms restorative physical therapy,
maintenance physical therapy, prevention physical therapy, and wellness
physical therapy.
CHAPTER OBJECTIVES:
Upon the completion of this chapter, the students should be able to:
Discuss the issues of standards of care and malpractice as they relate to the practice
of wellness by physical therapists.
Identify why physical therapists need to possess an operational knowledge of
wellness.
Discuss the entry-level physical therapy accreditation requirements related to
wellness.
Describe how a patient’s wellness can affect her or his health and ability to engage in
and benefit from physical therapy.
Explore how physical therapists answer patients’ questions about wellness.
Discuss physical therapists as wellness role models.
WELLNESS PRACTITIONERS:
Disciplines That Contribute To and Impact Wellness
Many disciplines contribute to public wellness and health promotion
including, but are not limited to:
athletic trainers Nurses
Chiropractors occupational therapists
Dentists physical therapists
Dieticians Podiatrists
exercise physiologists Psychologists
healthcare administrators recreation therapists
medical physicians social workers
mental health counselors speech and language pathologists
WELLNESS PRACTITIONERS:
Disciplines That Contribute To and Impact Wellness
Other disciplines that contribute to wellness Scientists who contribute to
include, but are not limited to: wellness include, but are
• Accountants not limited to:
• Architects • Biologists
• Economists • Chemists
• Educators • Epidemiologists
• Entrepreneurs • Statisticians
• financial planners
• insurance personnel
• Managers
• marketing personnel
• Politicians
WELLNESS PRACTITIONERS: Credentials
• Generally speaking, the hierarchy of credentials
from most to least prestigious is:
• Licensure
• Registration
• Certification
• Credentials and accreditation of medical and
healthcare practitioners varies from discipline to
discipline and from state to state
• Credentials of medical and healthcare practitioners
are often linked to their educational requirements.
• Physical therapy programs, occupational therapy
programs, and medical programs each must be
accredited by a specific entity
WELLNESS PRACTITIONERS: Credentials
In the case of wellness:
• Unlike all other medical and healthcare practitioners,
with the notable exception of exercise physiologists,
there is no regulation of wellness practitioners.
• There are no minimal educational requirements and no
state license or registration is needed by anyone
providing wellness services.
• While several organizations offer a certification in the
fitness aspect of wellness (e.g., APTA and the American
College of Sport Medicine [ACSM]), proof of education
or certification in wellness is not required for someone
to offer wellness programs.
WELLNESS PRACTITIONERS: Provider
Expertise
PHYSICAL THERAPY CLINIC WELLNESS CLINIC
employs physical therapists and support personnel (e.g., does not provide medically indicated physical therapy
physical therapist assistants, aides, office employees) services
provide restorative (i.e., medically indicated) physical provides wellness therapy only
therapy to patients
may provide prevention and/or maintenance services
Only those providers with the appropriate expertise
should provide skilled services Typically, do not employ physical therapists but instead
employ healthcare providers whose salary requirements
most insurance companies do not recognize or are less than that of a physical therapist
differentiate between the expertise of an athletic trainer,
exercise physiologist, and many other healthcare providers include an athletic trainer, exercise physiologist,
providers or a so-called “fitness trainer.”
“fitness trainers” may or may not have completed a
series of courses or specific education in fitness and
wellness, and may not even be certified
PHYSICAL THERAPY SERVICES:
RESTORATIVE, MAINTENANCE,
PREVENTION, AND WELLNESS
While in many (if not most) cases
physical therapists provide restorative
physical therapy, they also provide
maintenance physical therapy.
Independent of the type of physical
therapy a physical therapist provides,
she or he must maintain high
standards of care and not commit
malpractice.
PHYSICAL THERAPY SERVICES:
RESTORATIVE, MAINTENANCE, PREVENTION,
AND WELLNESS
Although the APTA (2001b) states that individuals
receiving physical therapy may be referred to as a
“patient” or as a “client,” the author thinks that:
◦ patient if she or he is receiving restorative physical therapy
◦ client if she or he is receiving wellness services
◦ “customer” under any circumstances, even if the individual is
purchasing a physical therapy or wellness product from a
physical therapist or a physical therapy clinic
PHYSICAL THERAPY SERVICES:
RESTORATIVE
Restorative physical therapy is also referred to as medically
indicated, skilled, or traditional therapy.
To be medically indicated, physical therapy must be
◦ 1) necessary; that is, there must have been a change in condition that
warrants a new episode of care;
◦ 2) reasonable in terms of frequency, duration, and type;
◦ 3) anticipated to provide significant benefit, especially in terms of
functional gains
◦ 4) provided by an individual with the appropriate credentials, such as a
physical therapist or in some cases a physical therapist assistant
PHYSICAL THERAPY SERVICES:
RESTORATIVE
typically provided to clients in a rehabilitative setting:
◦ medical center
◦ skilled nursing home
◦ outpatient center
◦ patient’s home (also termed home health)
Restorative physical therapy often is provided one-on-one;
however, group therapy is an option for patients who present with
a similar diagnosis.
largely, if not totally, reimbursed by a third-party payer, which most
likely is the patient’s health insurance company
PHYSICAL THERAPY SERVICES:
MAINTENANCE
primary goal: maintain the current level of function and/or other medical status
(e.g., safe blood pressure levels)
not medically indicated.
there is no change in condition that warrants restorative physical therapy and/or
it is not anticipated that the patient/client will obtain a significant benefit from
this therapy
the patient’s function and/or other medical status may decline secondary to
disease progression and/or advancing age over the course of the maintenance
therapy
The instructor of a maintenance session may require an expertise but not
necessarily the knowledge of a physical therapist
PHYSICAL THERAPY SERVICES:
MAINTENANCE
typically is provided to patients/clients by a sponsoring
organization, such as a skilled nursing facility or an
assisted living facility
may be provided free of charge or charge a fee to
participants
can be provided to a group of clients or to an individual
PHYSICAL THERAPY SERVICES:
MAINTENANCE
Example:
◦ physical therapist who provided maintenance therapy to a
gentleman who had chronic functional deficits secondary to a
cerebral vascular accident (stroke) sustained years earlier.
Both the physical therapist and the patient recognized that
the therapist’s interventions would not enhance the patient’s
function, but they were successful in delaying his decline in
function. This physical therapist had been providing
maintenance to the patient twice per week for well over 5
years and the client was happy to self-pay for the therapy.
PHYSICAL THERAPY SERVICES:
PREVENTION
Goals:
◦ to avoid or delay onset of a disease (primary
prevention)
◦ to provide an early diagnosis and prompt intervention
to at-risk clients (secondary prevention)
◦ to provide interventions to prevent a regression of a
chronic or irreversible condition
PHYSICAL THERAPY SERVICES:
PREVENTION
It is not anticipated that clients will obtain significant
functional benefit from prevention therapy. However, it can
enhance a client’s function and quality of life.
often sponsored by an organization, such as a health club, a
company, or a skilled nursing facility
not typically reimbursed by insurance companies but may be
provided free of charge to participants.
PHYSICAL THERAPY SERVICES:
WELLNESS PHYSICAL THERAPY
primary goal of wellness physical therapy is to maintain or enhance the
wellness practices of an individual or group.
Wellness practices can be related to the physical, mental, and/or social
domains
not medically indicated
will enhance one or more aspects of a client’s overall wellness (e.g.,
aerobic capacity wellness or mental wellness)
While the client may derive much benefit from the wellness therapy (e.g., a
woman reducing her body fat from 35% to 28%), the benefit is not
considered significant in the medical community
PHYSICAL THERAPY SERVICES:
WELLNESS PHYSICAL THERAPY
instructor of a wellness session may require expertise but not
necessarily the depth of knowledge of a physical therapist.
example of wellness therapy:
an exercise and nutrition program to reduce body fat. (Note: If the
client is obese, this type of therapy might be considered restorative.
However, if the client is simply over-fat, and there is no medical/rehab
diagnosis; it can be defined as wellness therapy, if not also prevention
therapy.)
PHYSICAL THERAPY SERVICES:
WELLNESS PHYSICAL THERAPY
provided to clients by a sponsoring organization such as a company or health club
sponsoring organization may provide the wellness free of charge or charge a fee
can be provided to a group of clients (e.g., a healthy cooking class at a wellness
center) or to an individual (e.g., personal training)
not reimbursed by insurance companies
Examples of these wellness services include, but are not limited to:
◦ develop a wellness program for the employees
◦ present a private seminar about fitness and body composition wellness to small groups
◦ present an 8-hour wellness seminar to physical therapists
◦ assess and provide recommendations to single individuals or those in small groups
PHYSICAL THERAPY SERVICES:
STANDARDS OF CARE AND MALPRACTICE
Standards of care: ways and means by which services should be delivered to give
reasonable assurance that desired outcomes will be achieved in a safe manner
Organizations that influence the standards of care of medical and healthcare
practitioners include federal and state statutes (e.g., Medicare statutes and state
practice legislations), professional organizations (e.g., the APTA and the ACSM),
third-party payers (e.g., Medicare as well as the policies of other insurance
companies, such as Blue Cross and Blue Shield), and medical corporations and
agencies (e.g., the rehabilitation company for which you might be employed)
Important to ascertain and consider the standards of care of the prospective
employer to ensure that they are compatible with your personal convictions
PHYSICAL THERAPY SERVICES:
STANDARDS OF CARE AND MALPRACTICE
Negligence: failure to comply with a standard of care
◦ Tort: civil wrong by an individual committing negligence
◦ Malpractice: negligent acts by a medical provider
Because wellness practitioners are unregulated, acts of
negligence are not considered malpractice. However, if a
physical therapist or another medical practitioner provides
wellness services, she or he can be liable for malpractice
secondary to his or her credentials as a physical therapist. In
addition, the physical therapist’s licensure may be jeopardized.
PHYSICAL THERAPY
EDUCATION
Students in physical therapy programs should endeavor to possess an
operational knowledge of wellness because A Normative Model of Physical
Therapist Professional Education has required entry-level students to be
educated in wellness since 2001
◦ A Supplement to a Normative Model of Physical Therapist Professional Education: Version
2000 contained three sections related to wellness: exercise science, exercise physiology,
and nutrition
◦ 2004: 1) a practice management section dedicated to prevention, fitness, health
promotion, and wellness, and 2) a section related to wellness in the Foundational Sciences
Matrix.
Physical therapists who did not explore wellness in their entry-level
curriculum should gain a competence in wellness so they can enhance their
marketability and improve patient/client care.
WHY SHOULD PHYSICAL THERAPISTS POSSESS
AN OPERATIONAL KNOWLEDGE OF WELLNESS?
Wellness is important in the provision of physical therapy since it directly
affects the patient’s/client’s health, which in turn can decrease her or his
ability to engage in and benefit from physical therapy; and may negatively
impact those with chronic condition if impaired
Stuifbergen, Becker, Blozis, Timmerman, & Kullberg (2003) found that a
wellness intervention improved health-promoting behaviors, self-efficacy for
health behaviors, mental health scales, and pain scales in women with
multiple sclerosis. In addition, decreased body composition wellness
negatively impacts the exercise capacity of those with type 2 diabetes (Ribisl
et al., 2007) and also negatively impacts those with osteoporosis (Zhao et al.,
2007).
WHY SHOULD PHYSICAL THERAPISTS POSSESS
AN OPERATIONAL KNOWLEDGE OF WELLNESS?
Independent of a patient’s physical health and medical (including
physical therapy) diagnoses, a patient’s wellness affects her or his
ability to engage in and benefit from physical therapy
most if not all of your patients/clients will present with an impaired
level of wellness
we should examine, evaluate, diagnose, define prognoses, and treat
those dimensions of wellness that are medically indicated and within
our scope of expertise
WHY SHOULD PHYSICAL THERAPISTS POSSESS AN
OPERATIONAL KNOWLEDGE OF WELLNESS?: PHYSICAL
THERAPISTS ARE WELLNESS ROLE MODELS
Diverse nonphysical therapy medical professionals, including physicians, nurses,
psychologists and counselors, recognize and support their status as wellness role
models
positive role modeling can enhance patient compliance
role model is one who is “walking the talk”
◦ “Being a model means that you consciously decide to act in a way that others will want to emulate. . . . [It]
demonstrates a commitment to yourself and others as you “walk your talk” . . . . It means you care about
yourself and how you present yourself to the world. . . . It says that you take yourself . . . seriously. Modeling
for others doesn’t mean that you expect others to be like you; you can only model your personal best. But
when you model a way of being; others can learn to adopt those qualities they find most . . .
PTs should prioritize fitness self-wellness and role model fitness wellness
Despite our value as wellness role models, particularly fitness wellness role models,
there is no evidence that physical therapists actually are well in terms of their
fitness wellness.
