Journal of Novel Physiotherapies
Open Access

Health promotion; Outpatient care; Health education; Clinical physiotherapy practice

Introduction

Health promotion is an umbrella term resting its essence on enabling people to gain control over their health. Health is now seen as a sole entity and it is being practiced at a large scale in schools, colleges, offices & other institutes . There has to be an equal interaction between the person & the community for health to be promoted in an individual. By that we mean there has to be an individual equally motivated in an opportunistic environment where he finds enough opportunities to promote a healthy lifestyle. Stretching has been recommended as one of the treatment techniques for patients with NP. Strengthening and fitness exercises have shown to be effective at preventing NP and reducing its severity [1]. Neck movement is dictated by the sternocleidomastoid, and longus capitis for flexion, a concerted effort of the splenius capitis, semispinalis, sub occipital, and trapezius for extension, and the scalene, sternocleidomastoid, and fibres from the trapezius to control lateral bending.

There have been numerous approaches proposed for effective health promotion. The super setting approach is one of the most significant ecological approaches, which enables placing individual in a social, environmental & cultural context & with the help of an holistic approach enables to change potentials & developmental processes with a starting point in the circumstances of the people.

Physiotherapy has been a part of the broader perspectives of rehabilitation that aims at decreasing disability using biomedical, social & psychological measures. Physiotherapy has been defined as a healthcare profession concerned with human function & movement & maximizing potential [2]. Today it is usually understood that physiotherapy is a science based field of practice that uses mainly physical approaches that intend to promote, maintain & restore physical, psychological & social well-being.

As for health promotion, it is part of the broader field of public or community health which is defined by the world health organization as “all organised measures to prevent disease, promote health & prolong life among the population as a whole. O’neill & cardinal argue that use of the expression “health promotion” should be restricted to the wide range of practices it encompasses, including strategies such as health education, social marketing, mass communication, political action, community organisation & organisational development. The first three strategies aim mainly at modifying individual behaviours, & last three focus mostly on enabling planned changes in the environment & in collective aspects of behaviours.

The second concept is the linking of physiotherapy with empowerment. This method enables people to take charge of their own health. Empowered individuals may better take care of them even after cessation of the physiotherapy treatment. Practicing clinical Physiotherapists, interns or final year students have been often encouraged to adopt person centred & person empowered approaches to health care. Such approach facilitates patient empowerment, of which the means of attainment are collaboration between therapist, & patient, clinical reasoning, patient education, & establishment of a good patient-therapist relationship.

Health promotion as a physiotherapist

In the last few decades, managing health has shifted its paradigm from surgical to conservative treatment options. Physiotherapy stands as flag bearer for providing conservative treatments to multiple diseases. As physiotherapists can be consulted directly without medical referral are absolutely apt to serve as link between disease control & health promotion. Patient education in whatever form, it may be verbal as an advice, written as an ergonomic care or as a treatment intervention has always been included in the intervention programs for patients [3-6]. The importance of patient education as a type of intervention program in low back pain patients cannot be denied as they have to be educated about their condition as much as before any implementation of exercises advised.

There have been numerous studies for low back pain & health promotion. In this study postural neck pain has been undertaken to study the effects of health education. Weather health education can in any form reduce the impact of the work culture & certain habitual postures if advised & corrected could curb the harmful effects such as neck pain & muscle spasms or not.

Methodology

To know whether physiotherapists were actually actively involved in the health promotion strategies in the physiotherapy OPD and to assess the post outpatient care in such patients, a longitudinal study was carried out at the Dasmesh College of physiotherapy, DIRDS after taking the institutional ethical committee clearance. A total of 100 patients coming to the physiotherapy OPD from the age of 25-35 years were included. Patients included in the study were mainly computer operators who had a 9am-5pm job. So they would be spending a minimum of 6 hours on the desktops. They were included in the study on convenience sampling.

Patients were clinically diagnosed for chronic neck pain. Patients with tumour, cervical spondylosis, herniation, PIVD, acute pain, age beyond 35 & below 25 were excluded. Considering the disability status of the patient for pain only, they were rated on the neck disability Index (NDI) & quality of life scale. Two groups were formed. For the first group experimental group the intervention consisted of myofascial release of the bilateral trapezius for spasm & an exercise program which included neck isometrics (strengthening) for 3 weeks, (4 sessions per week) with a set of ergonomic advices for the maintenance of an ideal posture, stretching techniques were taught while sitting in their chairs & working on their desktops along with the MFR & exercise program. They were advised to perform the neck stretches, neck rotations & general stretching of the shoulder girdle, every two hourly. They were also advised to have a proper seating posture most suitable for them which would have minimal impact on their neck. Patient education was in the form of ergonomic advices, dos & don’ts & general advisory for non- harming techniques in day to day life to the patient. The second group , i.e the control group was given myofascial release of the bilateral trapezius for spasm & an exercise program which included neck isometrics (strengthening) for 3 weeks, (4 sessions per week). The study duration of the trail was 3 months. Therefore patients had a follow up of three months after the actual treatment procedure concluded. The post interview consisted of any signs of aggravated pain, discomfort & weather there was religious following of the ergonomic advices given by the physiotherapists [7].

Results

During the three month study trial, 86 patients had submitted the neck disability Index & quality of life scale report, 42 from the intervention group, and 44 from the control group. Loss of follow up was due to several other reasons. Results were calculated using SPSS software by un-paired t-test. There was a significant difference in the neck disability index rating (p=2.4) which in turn correlated with the improvement in overall quality of life of the patients .The value for quality of life scale was significant (p=2.15) & was rated on 7 criteria’s. It is a patient reported scale which is self-perceived. There was a significant change in the quality of life of patients which was evident by the reduction of pain.

Discussion

There have been many studies to correlate the effect of health promotion & low back pain. Low back pain is a much more complex problem. But health promotion plays an extremely important role in the recurrence of the any type of mechanical pains caused due to wrong postures or any other physical distress. It is one of the most expensive musculoskeletal ailments in our society.

In this study we tried to relate neck optimal postures, exercises for neck & shoulder with only the conventional treatment for neck pain. Patients who exercised were to show much better results than only who got the physiotherapy treatment [8]. Lifestyle modification & a behavioural modification are two very important aspects of health, which are a part of health education & health promotion.

Health education & health promotion are two terms which have been used often interchangeably. Health education is providing health information & knowledge to individuals & communities & providing skills to enable individuals to adopt healthy behaviours voluntarily.

Empowerment is frequently related to the practice of health promotion. Indeed empowerment is the core principle forming the basis of health promotion. We believe that people are far more capable of taking care of themselves once given a chance for managing their health. When individuals were given the responsibility of their own health, they were in a much better position to gain command over pain & disability. When patients were taught a series of stretching exercises in conjunct to the physiotherapy treatment, they sustained better effects of the treatment overall. Also empowered individuals may make better use of health care services & resources & recognize their roles in getting better.

Conclusion

In today’s world where health care costs are increasing day by day, it is essential for the therapist & the patient to realise the importance of investing time in promoting ergonomics & health beneficial advice on a regular basis. Physiotherapists need to put in extra efforts in not only giving treatment but also administering some extra time for prescribing certain health promotional advices which would bring long lasting effects to the patients. The results of this study suggest that there should enough time given to every patient in not only prescribing therapeutic exercises but certain preventive strategies to completely ascertain the long term benefits of therapeutic exercises in Physiotherapy. Small lifestyle changes in the patient’s routine activities can benefit him to reap long term benefits & cut the cost of recurrent medical expenses. The limitations of the study are that there was no standardized protocol for health promotional advisories or recommendations. Therefore in the future studies we shall try using a standardised protocol for health advisories for one type of disability that would avoid any type of bias towards patients.

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