Table 5:

Application Examples of Health Promotion and Wellness Delivery Models

Model	Model 1 = Acute to Outpatient Continuum HPW Integration Model	Model 2 = Consultative, Proactive, ‘Dental’ Model	Model 3 = Skilled Maintenance Model	Model 4 = Health Promotion and Wellness Center/Clinic
Client Examples (non-exhaustive)	Individual with new injury (e.g. stroke, TBI, SCI) or illness in acute inpatient rehabilitation	Individual newly diagnosed with neuro-degenerative condition (e.g. PD, MS) or individual with chronic condition (stroke)	Individual with significant impairment or chronic condition at high risk of functional decline (e.g. ALS, advanced PD, MS)	Individual with subacute injury or illness requiring significant community support (e.g. subacute SCI, stroke)
Physical Activity and Exercise Promotion within PT Delivery Model	Educate on the importance of lifestyle physical activity. Facilitate peer mentor visit describing active lifestyle. In OP PT, introduce to progressive walking programs and adaptive exercise equipment. Fade frequency of visits while investigating community-based physical activity resources. Transition to model 4.	Baseline evaluation of walking, balance, physical activity, and exercise participation. 3 additional visits every 2-4 weeks to increase duration and intensity of structured exercise program in community gym with trainer. Condition-specific exercise programs. Re-check in 6 months.	OP or HH PT 1-2/week. Transitioned to 1-2x/month during periods of stability, to provide skilled care to monitor for changes in functional status. Problem-solve, modify, and progress exercise, recommend equipment. Family/client education and training.	Refer to a specialized medical fitness center for post-rehabilitation exercise. Center is staffed by PT, OT, and exercise physiologists who provide a fitness evaluation, and design and assist as needed in an individualized exercise plan. Center is accessible and has condition-specific equipment (e.g. standing frame, body weight support, FES cycle, and wheelchair treadmill.
Cost of Physical Activity Plan of Care within PT Delivery Model	Insurance co-pays, followed by model 4 costs.	Insurance copays, community exercise expenses (gym, trainers, PD-specific exercise class).	Insurance co-pay	Monthly gym membership (Medicare Silver Sneakers coverage), cash-pay for additional services with scholarships available (personal training/exercise therapy).
Example of physical activity measures	• Prior activity level with PA measure	• Physical Activity Vital Sign110, 111 • Godin Leisure Time Exercise Questionnaire79 • Exercise Self-Efficacy114, 115 • Accelerometry-based measure108, 109	• International Physical Activity Questionnaire-Long form112, 113 • Accelerometry-based measures108, 109	• Physical Activity Vital Sign110, 111 • Godin Leisure Time Exercise Questionnaire79 • Exercise Self-Efficacy Scale114, 115 • Accelerometry-based measures108, 109
Example Additional HPW Measures and/or Screening Questions * Can be Used in Any Model**	Nutrition • How many fruits and vegetables do you eat per day? • Starting the Conversation Tool117 • Readiness to Change116 Sleep • How many hours of sleep do you regularly get? Do you feel well rested when you wake up? • Pittsburgh quality sleep index119 • Stop-Bang Questionnaire for Sleep Apnea120 Stress • How is your stress level? • Perceived stress scale-14121 • Brief-COPE122 Smoking • Do you smoke? (non-smoker, current smoker, stopped smoking in the past 6 months)? • Readiness to Change116
Additional HPW Education Component Examples Can be Used in Any Model** See table 3 for educational resource materials.	Nutrition • Recommend well-balanced diet and dietician consult. • Educate on how diet impacts energy and activity. Sleep • Educate on sleep hygiene. • Educate on reducing sedentarism and increasing lifestyle PA. • Recommend peer and caregiver support groups. Caregiver respite services if needed. Stress • Educate on stress management, possibly including meditation and mindfulness. • Recommend counseling or peer support groups Smoking • Use MI-informed communication strategies • Use the 5A’s and 5R’s model for smoking cessation education and support.8, 118 • Educate on importance of smoking cessation • Recommend peer support groups

^*See Bezner 2015 and APTA Annual PT Visit for additional tools & questions.^{6, 56}

^**The additional HPW measures, screening questions, and education should be applied across all the delivery models as needed for their clients. Education should begin with assessment or screening questions, dialogue to understand readiness to change, and should proceed using principles of shared decision-making.

Abbreviations: ALS, amyotrophic lateral sclerosis; CVA, cerebrovascular accident; FES, functional electrical Stimulation; HH, home health; OP, outpatient; OT, occupational therapy; PD, Parkinson’s disease; PT, physical therapy; SCI, spinal cord injury; y/o, years old