The use of diet and nutrition is gaining popularity among physical therapists, and has been established to be well within the scope of physical therapy practice. Unfortunately, it can be extremely difficult to determine the most effective ways to incorporate these new ideas into existing treatment plans and the large amount of often contradictory information on the internet is often challenging to sort through. This creates a dilemma for physical therapists who want to begin implementing diet and nutrition into their practices, as consistent and accurate knowledge is necessary to provide safe and effective treatment. This article summarizes the ideas presented in a 2021 paper published in the Physical Therapy and Rehabilitation Journal which emphasizes the most effective plans of action for physical therapists interested in integrating nutrition and diet into their practices.
When are dietary and nutritional interventions best utilized?
One of the major challenges with implementing these interventions is identifying when they should be used and when other options are more effective. In some cases a patient’s specific circumstances may make an intervention of this kind ineffective, while in others a diet or nutrition intervention can make a huge difference in results. For this reason, one of the best ways to identify the right time to utilize dietary and nutritional interventions is to take a multifaceted approach to patient evaluations. The authors of this paper recommend physical therapists gather additional information on the following three areas during patient examinations:
General Health and Well-Being
A common part of most patient evaluations includes asking about the patient’s general lifestyle habits, diet, and general health status. These types of questions can help physical therapists get a better understanding both of the patient’s need for a dietary or nutritional intervention and of their willingness to make the changes that would be required. Patient readiness and self-confidence have both been linked to greater success in behavior change interventions, making this a critical part of the process.1 In some cases, BMI measurements can also be used to identify patients who may benefit from a dietary or nutritional intervention in addition to normal treatment.
Nutritional Information
Nutritional intake is another important piece of information to consider, and can be easily obtained by using standardized screening tools. For example, food frequency questionnaires can provide the physical therapist with valuable information about a patient’s eating habits and reveal effective starting points for treatment. Likewise, it can be useful to ask more general questions about the patient’s typical consumption of different food groups including fruits and vegetables.
Malnutrition Screening
Screening for malnutrition is especially important for physical therapists as inadequate nutritional intake has been linked to an increased risk of delayed healing, sarcopenia, and more.2-4 Many characteristics of malnutrition can be easily identified during a patient examination and include loss of muscle mass, fluid accumulation, and loss of subcutaneous fat. Other signs of malnutrition such as unintentional weight loss can be uncovered by reviewing the patient’s medical history. Only an estimated 40% of patients identified with malnutrition receive nutritional interventions, meaning physical therapists could have a significant positive impact on patient health by properly addressing this issue.5
How can physical therapists implement dietary and nutritional interventions while remaining within the scope of their practice?
After confirming the need for an intervention, it is just as important to choose the correct course of action to ensure the patient receives the best treatment they can. The authors of the paper describe two major ways that physical therapists can implement dietary or nutritional interventions, in addition to referring patients to other professionals in cases where it is appropriate:
Education
Physical therapists play a crucial role in educating their patients on the benefits of a healthy diet and nutritional intake. The surplus of information on the subject available on the internet is likely to confuse and discourage the patient, meaning the physical therapist should aim to be a source of clear, factual, and consistent information. For example, a patient reluctant to decrease their intake of fast food could be introduced to the benefits of cooking at home more than 3 times per week (which is a strong indicator for healthier eating patterns).6
Behavioral Change Strategies
Of course, it will rarely be sufficient to simply provide patients with information about a subject and expect them to make the necessary changes on their own. An educational program is often best paired with behavioral change strategies that help the patient form healthier habits and adhere to their own health-related goals. Information about the patient’s general feelings toward their own health and willingness to change is extremely helpful in this regard, as it will be important to develop intrinsic and extrinsic motivation and support systems to aid the patient in achieving their goals. Many of these strategies are very familiar to physical therapists because of their similarity to the processes used in physical rehabilitation and lifestyle interventions.
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Physical therapists can and should start taking action to implement these strategies!
While it is well-established that nutrition and diet fall within the scope of physical therapy, it can be a challenge to start implementing these aspects into existing treatment plans. This article provides several basic aspects of dietary and nutritional screening as well as starting points for integrating that information into a comprehensive and effective treatment option, but it by no means exhausts the list of possibilities. It is strongly recommended for physical therapists to begin strategizing how they will incorporate dietary and nutritional interventions into their practice in order to better help their patients improve their lifestyles and health-related habits, and these ideas are a great place to start.
REFERENCES:
- Bandura A. Self-Efficacy: The Exercise of Control. New York: WH Freeman; 1997.
- Severin R, Berner PM, Miller KL, Mey J. The Crossroads of Aging: An Intersection of Malnutrition, Frailty, and Sarcopenia. Top Geriatr Rehabil. 2019;35:79-87.
- Phillips MB, Foley AL, Barnard R, Isenring EA, Miller MD. Nutritional screening in community-dwelling older adults: a systematic literature review. Asia Pac. J. Clin. Nutr.2010;19:440-9.
- White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Parenter Enteral Nutr. 2012; 36:275-283. doi:10.1177/0148607112440285.
- Starr KN, McDonald SR, Bales CW. Nutritional vulnerability in older adults: a continuum of concerns. Curr. Nutr. Rep.2015;4:176-84.
- Mills S, Brown H, Wrieden W, White M, Adams J. Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study. Int. J. Behav. Nutr. Phys. Act. 2017;14:109.
