Genetics Education for the Physical Therapy Profession

Journal of Physical Therapy Education, Spring 2005 by Goldberg, Allon

Background and Purpose. Advances in our understanding of human genetics holds out the promise of significant diagnostic and therapeutic benefits in many fields of medicine, A number of basic questions and issues with respect to genetics and physical therapy practice and education need to he addressed. The purpose of this position paper is to highlight and explore some of those questions and issues, with the objective of advocating for increased education in relevant genetics-related topics and issues for both practicing physical therapists and students enrolled in physical therapist professional (entry-level) education programs. Position and Rationale. The position adopted in this paper is that increased education in relevant genetics-related topics and issues should be a priority for practicing physical therapists and students enrolled in physical therapist professional education programs. The rationale for this position is that in order to practice in the genomics era, health care clinicians should possess certain genetics-related competencies to more effectively manage and care for their patients. Some of the patient-related benefits that will result from an increased level of genetics education and awareness from within the physical therapy profession are the positive shaping of patients' attitudes towards genetic testing and counseling, the provision of accurate genetics information to patients, the generation of appropriate and timely referrals to genetics professionals, and effective advocacy on behalf of patients being discriminated against due to their genetic profiles. Recommendations. The implications of advances in genetics on physical therapist practice and education needs to be considered in a substantive manner. Academicians, clinicians, the American Physical Therapy Association (APTA), and the National Coalition for Health Professional Education in Genetics (NCHPEG) should initiate dialogue to decide on appropriate genetics competencies for the profession. Genetics education should be considered a priority in order for physical therapists to function as effective direct access practitioners and members of the health care team in the genomics era.

Key Words: Human Genome Project, Genetics education and physical therapy, Genetics Core Competencies.

INTRODUCTION

Unprecedented growth in our understanding of human genetics and its role in disease, coupled with recent technological advances such as the advent of powerful gene sequencing and gene mapping techniques, are expected to yield significant diagnostic and therapeutic benefits in many fields of medicine.1-3 Because physical therapists are integral members of the health care team, physical therapist clinicians and educators alike need to consider the impact of genetics on contemporary clinical practice and education, both professional and beyond. In considering the implications of advances in human genetics on physical therapist practice and education, several basic questions need to be addressed. Should physical therapists in clinical practice concern themselves with a patient's genetic information? Are there minimum genetics competencies that clinicians should possess? Should physical therapists be educated in the ethical, legal, and social implications (ELSI) of genomics? In short, should issues relating to clinical genetics remain solely within the domain of the medical geneticist, genetic counselor, and nurse, or do they also need to be considered by physical therapists? The answers to these questions are important because they will ultimately determine the level of genetics education required by members of the physical therapy profession.

Leaders in the genetics community have questioned whether primary care physicians are prepared for the incorporation of genetics into mainstream medicine,4 a question that could also be asked of physical therapists. The purpose of this position paper is to highlight and explore some of the questions and issues relating to genetics and physical therapy practice and education, with the objective of advocating for increased education in relevant genetics-related topics and issues for both practicing physical therapists and students enrolled in physical therapist professional education programs. The rationale for this position is that in order to practice in the genomics era, health care clinicians should possess certain genetics-related competencies to more effectively manage and care for their patients. The need for genetics education for health care professionals is a viewpoint that has been articulated by leaders within the field of genetics.1'5'7 Not only physicians, but also nurses and other health care providers, will need to become familiar with the emerging field of genetic medicine.5'7 It is in this vein that this position paper articulates the need for the physical therapy profession to align itself with the medical community at large and seek relevant genetics education.

THE HUMAN GENOME PROJECT

The Human Genome Project (HGP) began in 1990 as a multicenter initiative with a number of important goals, such as the sequencing and mapping of the human genome by the year 2005. The first "working draft" sequences and analyses of the human genome were in fact published in 2001,8,9 and on April 14, 2003, the International Human Genome Sequencing Consortium, led in the USA by the National Human Genome Research Institute (NHGRI) and the Department of Energy, announced the completion of the HGP more than 2 years ahead of schedule. The HGP holds much promise for many patients suffering from conditions having genetic components. One area of medical practice that will surely benefit from the project is oncology. Sequencing and mapping of genes and identification of mutations that predispose to tumor formation will facilitate screening and earlier detection, diagnosis, and treatment of malignancies. One such example is the mapping of a gene (BRCAl) influencing susceptibility to breast and ovarian cancer, to chromosome 17.10,11 Conditions, diseases, and pathologies such as aortic aneurysm,12 osteoporosis,13 Huntington disease,14 obesity,15 and numerous others, all have genetic underpinnings.