Physiotherapists in Health Promotion: Findings of a Forum

In 2010, the Ontario Physiotherapy Leadership Consortium (OPLC) led an initiative to examine evolving areas of practice for physiotherapy in health promotion. The purpose of this report is to describe insights from this Ontario-based process with a view to contributing to national momentum in exploring physiotherapists' roles in health promotion. As part of the process, OPLC developed a model of health promotion within physiotherapy practice (see Figure 1).

Figure 1.

Health promotion integrated within the scope of physiotherapy practice.

© 2010 Ontario Physiotherapy Leadership Consortium. Published with permission.

© 2010 Ontario Physiotherapy Leadership Consortium. All rights reserved. Exact copies may be made only for non-commercial personal and educational uses.

Concepts related to health promotion appear to varying extents in the seminal documents about physiotherapy in Canada. Health promotion appears explicitly in the Essential Competency Profile for Physiotherapists in Canada,¹ the Entry-to-Practice Physiotherapy Curriculum: Content Guidelines for Canadian University Programs,² and the Accreditation Standards for Physiotherapist Education Programs in Canada,³ but is less prominent in documents that currently inform entry-to-practice examination,^4,5 where it is considered an emerging trend rather than an entry-level skill.

When surveyed, Ontario physiotherapists reported familiarity with determinants of health and inclusion of health counselling in patient interventions. There was inconsistency, however, as to whether disease prevention and health promotion are distinct or overlapping concepts. Opinions diverged about advancing cautiously or boldly in health promotion. Advocates of caution cited barriers such as funding and access issues, while advocates of a bold approach emphasized the importance of promotion and prevention to the health of people served by physiotherapists.

At a policy forum sponsored by OPLC, Elizabeth Dean^6,7 supported the alignment of the profession with global and regional public health priorities. In her view, the profession needs to consider the models underlying practice and be cognizant of the Canadian health system's political drivers, as elaborated in the Lalonde,⁸ Romanow,⁹ and Kirby¹⁰ reports. Physiotherapists need to ask, “Is physiotherapy being done in a health-promoting way?” In the past, physiotherapists transformed their practice in response to wars and polio epidemics; the current public health challenge is of comparable magnitude.

Forum participants advocated finding ways to integrate the profession within the system at different levels. Physiotherapists should become role models in looking at the big picture and should have confidence in addressing broader health issues. Participants noted the need to build synergy and partnerships with other professions to provide communities with tailored services based on patients' needs. They also mentioned a need to educate the profession about the scope of physiotherapy in terms of health promotion.

Three physiotherapists presented their innovations to participants. Denise Taylor described initiatives to promote health among First Nations people at high risk of stroke in a remote community in northwestern Ontario. Dr. Julie Richardson described projects and findings related to physiotherapists' involvement in primary care in urban settings. Eric Wood-Salomon described starting a business providing strength- and conditioning-based treatment to clients. These exemplar innovators represent paradigm shifts in physiotherapists' roles. Although anchored in physiotherapists' foundational education, these examples expand considerably beyond it. Innovation was praised by forum participants, but they noted that funding models are uncertain, and a “slippery slope” concern was raised as to the shifting definition of physiotherapy. Arguably, it is not a shift but merely a stretch of what physiotherapists do—motivating and fostering people's ability to continue improving their health on their own.

The forum's ensuing discussion included a range of ideas. Some focused on acknowledging the current reality: physiotherapists have historically been somewhat resistant to change; the health-promotion challenges are more amorphous than those created by war or polio; physiotherapists don't explicitly see themselves in the promotion arena; a mental shift with respect to scope of practice and clarity of language is needed to align with health-promotion concepts. Others focused on strategizing for physiotherapists' role in health promotion: we don't have to do it all and can create alliances where needed; the regulatory college should adapt the standards for practice to reflect where physiotherapists are going; we need to highlight what some physiotherapists are doing to push boundaries and show the world what we can do. Underlying all these ideas were inspirational questions: Are we as a profession embracing our pre-eminence in non-invasive diagnosis and intervention? What if every physiotherapist measured health status? Will a “patient” always be our only type of “client”?

About the OPLC

The Ontario Physiotherapy Leadership Consortium is a tripartite organization of senior representatives from Ontario's five academic physiotherapy programmes, the College of Physiotherapists of Ontario, and the Ontario Physiotherapy Association. Current members are K. Norman (Queen's University), E.L. Geddes (McMaster University), K. Berg (University of Toronto), T. Overend (University of Western Ontario), and N. Paquet (Université d'Ottawa); L. Neill, President, and J. Robinson, Registrar and Chief Executive Officer, College of Physiotherapists of Ontario; and C. Winn, President, and D. Sauvé, Chief Executive Officer, Ontario Physiotherapy Association.