Overview on the Guide to Physical Therapist Practice and its implications for neurologic physical therapy

Neurology Report, Aug 1999 by Harro, Cathy C

A second important conceptual framework evident in the Guide is the Integration of Prevention and Wellness Strategies into physical therapist intervention. Physical therapists play an important role in prevention of impairment, functional limitation, or disability by identifying disablement risk factors and buffering the disablement process. Three types of prevention are defined in the Guide: 1) primary prevention-"preventing disease in a susceptible or potentially susceptible population through specific measures such as general health promotion;" 2) secondary prevention- "decreasing duration of illness, severity of disease and sequelae through early diagnosis and prompt intervention;" and 3) tertiary prevention- "limiting the degree of disability and promoting rehabilitation and restoration of function in patients with chronic and irreversible diseases."1(xii) Primary prevention patterns are developed and described for the Musculoskeletal, Cardiopulmonary, and Integumentary Patterns (patterns 4A, 6A, and 7A respectively) and focus on identification of individuals at risk and risk factors for disability, education of prevention strategies, and intervention for risk factor reduction. For example, Pattern 7A for the Integumentary Patterns is Primary Prevention/Risk Factor Reduction for Integumentary Disorders. This pattern identifies individuals at risk for potential disruption of integument, such as patients with amputation, spinal cord involvement, central nervous system disorder, and vascular disease. A range of interventions are recommended that would promote risk factor reduction, education of prevention strategies, and safe, efficient performance of self-care, home management activities, and instrumental activities of daily living. Through this framework of primary prevention, the patient is empowered with health promotion strategies and the potential sequelae of impairment, functional limitations, and disability is reduced or prevented. The Neuromuscular Patterns is the only major Practice Pattern group that does not have a Primary Prevention pattern. Certainly, neurologic physical therapists are playing a critical role in the development of screening tools and primary prevention programs for reduction of falls in the elderly. Neurologic physical therapists should carefully consider their potential role in primary prevention and provide feedback to the Advisory Panel on possible prevention patterns that might be included in future revisions of the Guide.

Secondary prevention is addressed as a critical component in the expected outcomes section in all practice patterns, including the Neuromuscular Patterns. For example, Pattern 5F- Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord would be the practice pattern identified for a patient with spinal cord injury secondary to trauma.Aerobic conditioning may be effective for not only improving aerobic capacity to enhance endurance for functional activities, but may also address secondary prevention by providing the patient health promotion strategies to maximize his/her fitness. This intervention then may prevent the deconditioning cycle common in patients with chronic disabilities that can lead to further disability and decreased quality of life. Physical therapists also play a critical role in tertiary prevention in neurologic physical therapy because of their understanding of chronic progressive neurologic disease processes, such as Parkinson's Disease, combined with their expertise in analyzing the contribution of primary and secondary impairments on functional limitations and disabilities in these patients. Interventions can be developed and directed to minimize secondary impairments and maximize function given an understanding of the stage of the disease process. The Guide provides strong support and an important position statement to the public and health care payers about physical therapists' critical role in prevention and health promotion. We can use this document to advocate for preventive services for our clients.