Saturday, March 25, 2017 10:30 am 11:50 am Auditorium Dr. Janet Bezner, PT, DPT, PhD Beyond Physical Therapy: Incorporating Health Promotion into Your Practice to Help Your Patients Move Better, Feel Better, Live Better Epidemiological data clearly reflect the association between chronic diseases (cardiovascular disease, cancer, stroke, diabetes, etc.) and modifiable lifestyle risk factors (lack of adequate physical activity, smoking, inadequate sleep, unhealthy eating, etc.). PTs and PTAs are uniquely qualified and positioned within the health care system to assess, address and monitor these and other lifestyle behaviors in their patients/clients. PTs provide a dynamic link between health care and health because of their skill in creating a physical therapy plan of care that addresses the patient/client s functional limitations and is supplemented by their ability to provide a holistic and personalized plan focused on the modification of lifestyle behaviors. While PTs and PTAs have the knowledge and skills to support patients/clients to adopt healthy lifestyle behaviors, they are not consistently capitalizing on the opportunities afforded to them in their daily clinical practices. Some of the barriers cited as to why there is a discrepancy between what physical therapists are capable of doing and what they are actually doing include low self-efficacy in how to advise/coach patients on behavior modification and having low outcome expectations that the behavior changes made by their patients/clients will persist. The improvement and practice of counseling skills by physical therapists and assistants in health behavior change and lifestyle coaching is paramount to successful adoption and maintenance of healthy behaviors in their patients/clients and to integrating health promotion into physical therapist practice. Session Learning Objectives: 1. Recognize and be able to assess various personal and environmental factors that impact behavior change (selfefficacy, values, barriers, knowledge, etc.) in the context of a health coaching encounter. 2. Describe the principles and key constructs of motivational interviewing. 3. Initiate and engage the patient/client in discussions about health behavior change. Speaker Bio: Dr. Janet Bezner, PT, DPT, PhD is an Associate Professor at Texas State University. Bezner conducts research on physical activity, is a leader in the employee wellness program, and is a Certified Health and Wellness Coach. She received a BS degree in PT at the University of Texas Medical Branch, her master s degree from Texas Woman s University, a PhD in health education from the University of Texas, and a DPT degree from Rocky Mountain University of Health Professions.
Beyond Physical Therapy: Incorporating Health Promotion into Your Practice to Help Your Patients Move Better, Feel Better, Live Better Janet Bezner PT, DPT, PhD Objectives 1. Recognize and be able to assess various personal and environmental factors that impact behavior change (self efficacy, values, barriers, knowledge, etc.) in the context of a health coaching encounter. 2. Describe the principles and key constructs of motivational interviewing. 3. Initiate and engage the patient/client in discussions about health behavior change. Role of the Physical Therapist and Physical Therapist Assistant in Prevention and Health Promotion The profession must adopt a visible leadership role in prevention, health, and wellness in addition to its existing role in rehabilitation The Physical Therapy and Society Summit (PASS) Meeting 2009 1
Physical Therapy Summits on Global Health Dean et al 2014 Recommendations from the Physical Therapy Summits on Global Health PT health promotion practice should include: Smoking cessation counseling or referral Basic nutrition advice or referral Physical activity and exercise prescription Basic sleep assessment and recommendations or referral Basic stress assessment and management strategies or referral Research Shows that Physical Therapists can be Effective Health Counselors Systematic review by Frerichs W et al. (2012) 2
Summary of theories that support health behavior change Environmental supports (social and physical) more important than motivation and personal behavior Stage of Change enables tailoring of intervention Benefits must be greater than barriers barriers are real, problem solve through them Self efficacy (Competence) THE most important characteristic that predicts success Internal Motivation leads to sustained behavioral change Build autonomy the client should be making choices, not the coach Processes are more important than outcomes redirect outcome goals to process or short term goals Connect to values what s most important is what s sustainable Health Coaching A process for helping a person to achieve a higher level of well being Particularly helpful when change is hard A growth promoting relationship that elicits Autonomous motivation Greater capacity to change Can include Visioning Goal setting Accountability 8 The PT/PTA as Health Coach WHY PTs/PTAs spend a lot of time with patients/clients Health behaviors impact healing/pt diagnosis The healthcare system is failing and we can be part of the solution Creates a competitive advantage HOW Ask about health behaviors on intake questionnaires or during examination Discuss current and former health habits while you are treating the patient/client Offer to assist if the patient/client is interested 3
Motivational Interviewing Rollnick and Miller (2008) MOTIVATIONAL INTERVIEWING The What A GUIDING style of assisting a person in behavioral change vs. a DIRECTIVE style Purpose is to activate one s own motivation for and commitment to change A model for discovering motivation and building self efficacy MOTIVATIONAL INTERVIEWING People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the mind of others Blaise Pascal 4
MOTIVATIONAL INTERVIEWING The What A change from the expert approach More LISTENING vs. TALKING Want the individual to express THEIR reasons for change vs. us telling them why they SHOULD change Listens for and supports Change vs Resistance talk MOTIVATIONAL INTERVIEWING The HOW Open ended questions Affirmations Reflective Listening Summary statements Open Ended Questions Evokes motivation MI principles suggest that at least 50% or more of questions in an MI session should be open ended : Use Who, What, How, When; Avoid Why Examples: Tell me more about that.. How would you like things to be different? What if you continued doing this, how would your life look in 5 yrs.? If you were in my shoes what advice would you give yourself? How has this behavior held you back from accomplishing what you desire? 5
PRACTICE Asking Open Ended Questions 16 Affirm A statement that recognizes and acknowledges the good It helps to build and maintain rapport/trust Examples you clearly have determination ; your intentions were good even if you had some set backs My belief is stronger than your doubt Reflective Listening It is your best guess about what the person means It allows you to state your guess and get confirmation, thus avoiding assumptions Use statements vs. questions Examples You don t think this is a problem? vs You don t think this is a problem Are you listening or waiting to talk???? 6
PRACTICE Ask an open question Provide 2 reflections before asking another question 19 Summarize Pulling together what you heard Do it often throughout the conversation not just at the end Examples You can see the importance of doing the home exercises with your child yet you are having a hard time seeing the long term value of the exercises MOTIVATIONAL INTERVIEWING The How On a scale of 0 10; with 0 as not at all important and 10 as extremely important, how important would you say it is for you to? Why are you at a and not a 0? On a scale of 0 10; where 0 is not at all confident and 10 is certain, how confident are you that you could if you decided? Why are you at a and not a 0? 7
Instead of doing this Try this Explaining WHY pt. should change Listen with goal of understanding the dilemma. GIVE NO ADVICE until asked Describing specific benefits of changing Ask :What might be the benefits to you of changing? Telling them HOW to change Emphasizing how important it is to change Telling or inspiring pt. to change Ask: How might you do this so it fits into your life? Ask: How would your life be different if you changed? Ask: How can this change help you realize your values? Instead of asking Do you like to exercise? Try this What do you enjoy most about exercise? When did you exercise last? Do you think your health is at risk if you don t lose weight? Are you getting enough sleep? Do you want to quit smoking? What is the best experience that you have had with exercise in the past week? What will your life look like in 5 years if you don t lose weight? How would your life be different if you were to get 8 hours of sleep every night? What are the good things about smoking? What are the not so good things about smoking? Demonstration 8
Questions/Discussion Thank you Janet Bezner jb25@txstate.edu @jbezner Twitter References Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys Ther. 2015;95:1433 1444 Miller WR, Rollnick S. Motivational Interviewing: Helping People Change 3 rd Ed. New York, NY: The Guilford Press; 2013. Moore M, Jackson E, Tschannen Moran B. Coaching Psychology Manual 2 nd Ed. Philadelphia, PA: Wolters Kluwer; 2016. Pignataro RM, Huddleston J. The use of motivational interviewing in physical therapy education and practice: empowering patients through effective self management. J Phys Ther Educ. 2015:29 (2):62 71 Rollnick S, Miller WR, Butler. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: The Guilford Press; 2008 9