Welcome back to the Healing Pain Podcast with Dr. Elizabeth Dean
Surgery and drugs are always the go-to for doctors, but with the changing times there is now a need for the conventional ways to be reconsidered. Dr. Elizabeth Dean of the University of British Columbia in Canada believes that it is time to reconfigure a physical therapist’s role on healing a patient and help them live longer and healthier lives. It is also important to learn how lifestyle medicine can help in the assessment of nutrition and exercise. Dr. Elizabeth explains why the clinical community needs to be on the same page on nutrition and illness care.
I’m so excited you’re here where we can talk about natural ways to heal from chronic pain as well as chronic disease. Before we get started with the episode, just a couple of show notes. I want to thank the Hudson Valley District of the New York Physical Therapy Association for hosting me at the Burke Rehabilitation Hospital on September 28th. I gave everyone a wonderful lecture. There are about 30 people who attended for our lecture on how nutrition can influence musculoskeletal pain as well as inflammation.
If you follow me, my work and my podcast, you know that I am passionate about nutrition and how nutrition can impact the lives of yourself, your family, your friends and your patients. I’m super excited this week to have with me Dr. Elizabeth Dean, who is a professor at the University of British Columbia in Canada. She is a physiotherapist. Her scale of work focuses on bridging the ultimate knowledge translation gap between what is known about the cause and factors contributing to lifestyle-related non-communicable disease and physical therapy practice. She has a particular interest in epidemiology and information to maximize outcomes using health education and interventions such as physical activity. She conducts research in the Middle East and Asia as well as multicultural Canada and works with international teams with respect to health-focused physical therapy practice.
Currently, she is focusing on effective knowledge translation of existing and new knowledge by physical therapist to meet the priority healthcare needs of people globally in the 21st century specifically toward non-communicable diseases. She is a leader in health-based physical therapy. She has been invited to speak at over 30 countries where she has presented keynote addresses, guest lectures, workshops, symposia, consultation. Together with her colleagues, she has presented over three physical therapy global health summits and World Confederation for Physical Therapy conferences.
What I love about Dr. Dean is I actually love her research. When I first got into nutrition, I did a great paper for my doctoral dissertation and I used a lot of her research to really support the stance that I had in my personal scope of why nutrition was important for physical therapists.
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A Physical Therapist’s Role in Lifestyle Medicine with Dr. Elizabeth Dean
Dr. Dean, welcome to the Healing Pain Podcast.
Joe, it’s a real pleasure. Thank you very much indeed for inviting me.
You’re a Canadian physiotherapist, you’ve done doctor work, you’ve spoken all over the globe as far as nutrition, non-communicable diseases and how important it is to physical therapist, physiotherapist. Take me on a little bit of your journey as a professional, how you went from clinician to researcher and how this came under your spotlight?
I started off in intensive care. I loved it. I became quite well-known for oxygen transport, the pathway rather than just airways and lungs and that we really needed to look at the bigger picture, Joe. From that work, I started to get invitations around the world including to Singapore. Singapore General Hospital must be one of the biggest hospitals in the world. It has twelve ICUs. As I went around the hospital, I thought, “Most people here shouldn’t be here.” We would clear out so many of those ICU beds with addressing the lifestyle-related non-communicable diseases. In addition, we started to do research looking at mobilization. We found a group in the community, those people who had polio years ago who had very low functional capacity before we started to look at people who are hemodynamically unstable.
From that work, we started to look at these individuals. In fact, these people coming in from the community with that comorbidity, those are the things that everybody else in the aging population succumbs to, we realized that they are more scary than the ICU patient. We do not have them all hooked up to those monitors. We don’t have that team immediately in place. I think that was my journey to recognize we had so much to do. It doesn’t seem sexy to a lot of people but that’s where I felt ethically I had that professional responsibility to start doing the knowledge translation piece to the general public.
What I love about your work is that you really took a passion and you said, “Here’s my passion. Now, I’m going to show you the research and the science to prove that, one, we need this through the epidemiology and two, that obviously, this works.” The word non-communicable disease is a big, hefty word. Can you explain to people what that means in layman’s terms.
Very simply, at the beginning of the 20th century, there were still acute infectious disease antibiotics came along and then we had the war years. We moved on to a period of considerable affluence and that affluence, all sorts of generation of companies and making money became important and people wanted a good life and we started to overindulge. We started to exercise less, eat food that was available but not necessarily the right mix. Smoking in the first half of the last century was quite prevalent and then in the latter half we realized that with smoking restriction, it helped to bring down the rate of chronic obstructive lung disease. What happened was this transition from acute infectious disease and the non-communicable diseases that are life-style related include heart disease, cancer, which most of us are dying from, COPD, hypertension and stroke, Type 2 diabetes and obesity.
In our global summits, we’ve gone around the five WCPT regions, the regions of the World Confederation for Physical Therapy. All the member countries of WCPT, we’ve synthesized those regionally. Even in the low and middle income countries, we are now seeing the rise of these non-communicable diseases, which the World Health Organization has said for 30 years are largely preventable and this huge leg time in really making a dent in these conditions. We’re seeing the rise as I stay in low-income countries where I also spent quite a bit of time. That’s what we need to do, that’s our agenda.
You just said a whole bunch which I want to get back to a couple of points in there because there are some really eloquent points. My first question is just so people can wrap their brain around this, is chronic pain an NCD or a non-communicable disease?
When this first started, this non-communicable disease stuff, that’s a cardiovascular, cardiopulmonary thing and then I started to speak to more generalist audiences including going to IFOMPT, the leading Orthopedic Conference in the world. I’m invited to speak there, which I didn’t think would happen in my lifetime. The reason was is that our work, and we’ve published this not unlike the talks you’ve been recently giving, showing that the relation, that those risk factors for these lifestyle-related non-communicable diseases are those for chronic pain and a lot of musculoskeletal issues that bring patients to physical therapists, which I think is just astounding when you look at that body of work. That is not just a cardiovascular, pulmonary, endocrine issue. It affects us all.
Not only does it help us address the chronic pain considerations or pain in general but also it helps us to fix that person’s life so they have good quality life and a short end of life morbidity. Biomedicine will keep you going with your chronic conditions for almost a full life expectancy. Is that what you really wanted just to provide that service so people can walk well with their canes after they’ve had a stroke and have the right devices? I’m not so sure. Let’s prevent that stuff, minimize it so people can at a 115, break their ankle skiing and that’s the demographic we’re treating. That’s a very interesting question. Chronic pain certainly could be lumped into that lifestyle-related non-communicable condition.
You started talking about these topics, let’s say the World Confederation of Physical Therapy, the WHO has been talking about this probably for a couple of decades. If you are a cardiologist, you probably have attended a lecture on nutrition or lifestyle or how sleep affects your physical function, your disease, your oxidation, things like that. When you first started talking to our peers in the physiotherapy and the physical therapy world and maybe this started just with your colleagues, let’s say at your University. What was their initial reaction to this type of talk? We still have in physical therapy a very biomedical model and really a biomechanical model in a lot of cases. Some these topics are new for people.
I think this was off the air conversation that we had and you brought it up and we speak to this is practitioner self-efficacy. We’ve done a huge study of smoking cessation in Canadian physiotherapists that was published on several articles, one in physical therapy. The practitioners understand the importance and don’t have the competencies. I think when it comes to nutrition, that feels one step removed and it feels that’s somebody else’s responsibility. I don’t think so. I relate that.
Your organization, your national organization and mine and I’m also a member of APTA, that we’ve adopted the International Classification of Functioning, Disability and Health. That classification system is predicated on the World Health definition of health, which is health is a complete state of physical, mental, and emotional well-being. That came out in 1948. Have we really in our so-called healthcare system, which are really sickness, illness care system and we need those. I don’t just miss it for a minute. We need illness care.
I broke my foot a couple of years ago, I wanted my good quality illness care, injury care but we don’t do the health piece right. We have not. We shouldn’t get confused with healthcare and illness care. We do. We get our terminology confused. That’s I think one of the things as physical therapists, we couldn’t do the health piece right and a fabulous study from the big nursing study in the big database that came out a few years ago where those nurses that over the years had had better nutrition had less physical impairment. It may not all be causal but when you connect the dots, we see this. If we’re going to improve functional capacity, it’s not just energy. There are many other components: healing and repair, immunity and so on that all lead to nutrition. We are our nutrition.
Some of the research you’ve done, which I think is groundbreaking, I’m not sure if anyone has read Dr. Dean’s work. Go into PubMed or go on Google and start to Google Dr. Elizabeth Dean, PT, PhD and start to read some of her research. I want to talk to you about one of your pieces of literature where you talked about the types of clinical competencies that a physiotherapist or a physical therapist may need to make them competent. What are those types of lifestyle interventions that a physical therapist does have the skills to grow on, to start to train people and educate people and inform people regarding lifestyle and medicine really?
Two years ago, in physical therapy, we published a prospectus; ten of the faculty members and myself. It was called Prioritizing the Non-communicable Diseases in Physical Therapy Curricula. We felt we’ve done enough talking now, we had two summits and then the last one was in Cape Town this past July and we said, “Now, we’ve got to create the toolbox.” We’ve done enough talking around this topic. What is in the toolbox? What are the competencies that can be readily integrated into an episode of care by a physical therapist? Those really distilled out pretty clearly. It doesn’t have to be complicated or hugely time-consuming. In my own clinic, we give the questionnaires out before people come, email these days and basically a simple smoking questionnaire, nutrition. That’s a bit harder to get a good nutritional assessment but we’re doing our best. We are now assessed-sitting, which is distinct from physical activity which is distinct from exercise. You can be doing all the right things in terms of exercising at 70% to 85% of your age predicted maximum, 20 to 40 minutes, three to five times a week and still have risk factors for metabolic disease. It’s independently related.
Then we go to sleep because we know that in North America, we’re particularly sleep-deprived and stressed; the degree of how manageable our stress is. We have assessment tools for those. They are going to be on a website, we call it the toolbox website. We initially designed it for physical therapists, now, we feel that all health professionals, we should be speaking the same language from all of us. The three biggest established health professions in the world are nursing, followed by medicine, followed physical therapy. We are the leading non-pharmacologic. There are some countries now where there’s a scope of pharmacologic prescription. By and large, we are characterized by being non-pharmacologic. Let’s embrace that. All these conditions, now, we have interventions and we need to be very good at brief advice and motivational interviewing. There’s one or two question you can ask and get a lot of information based on motivational interviewing. Then of course, following up.
In our publications, there are references to these tools. The interventions that are needed in that respective piece that I mentioned was published in 2015 about what a physical therapy curricula should now include and we are going to make based on our summit last July. We have a paper under review now that will be recommendations to the WCPT for accreditation standards. We expect in your country and mine that if you’re going to treat a chronic back pain, that there are certain assessments that you do, interventions and reassessment. This has to be true for health.
I was part of the volunteer committee that worked with the APTA in getting the new language passed around the scope of practice for nutrition for physical therapists. Once it passed, I was super excited because the APTA did a really awesome job at putting together this committee and really creating language that I think is really solid for a profession to now grow from.
With that, I then emailed my former director of my DPT program. I said, “Let’s wave the victory flag.” He said, “This is great, Joe. I know you worked on this a long time. It was part of your dissertation and it’s in your book that you wrote and on your blog and your podcast.” He said to me, “I’m struggling as a director of a program, how do I now integrate this information into education?” I think the paper that you are creating will inform professors like him who are creating curricula for physical therapy programs. How do you squeeze this into an already packed DPT program? It is a valid point but it doesn’t have to be an entire five courses let’s say dedicated to nutrition.
It has to be integrated across the board. Just having a course that students will never understand or appreciate, that’s just in that little box. Now, we’ll get back to the manual therapy. It has to be in every case study and it has to be addressed in every patient. I’ve heard all the arguments, very, very predictable. The standard response to this one is, let’s look at physical therapy history. We go back hundreds of years but in recent years, go back a hundred years. The world wars came along. Go to the journals that came out. They weren’t randomized controlled clinical trials but they were all about wound healing. They were all about amputations. They were all about crutch walking. They were all about wheelchairs. We rose to the occasion. Where could non-pharmacologic care fit? When the great war, as so-called, came along.
Then the polio epidemics came along. The biggest one was in the middle part of the last century. Go to the journals. What was there? What could physical therapy do as the leading established non-pharmacologic health profession? We responded; manual muscle testing, gait reeducation. When there was ventilatory involvement, we have the RN lung suctioning airway clearance and management. It was a huge growth spurt, the polio epidemics. I feel we got stuck in the polio years. Then the lifestyle conditions came along. The literature is full. I actually go into a catatonic state if I read one more article that good health is good for you. I can’t just go there. I want to move on. I bypass them. I don’t need to know that lifestyle helps. I’ve got a wonderful article that I’m taking on my next talk. It says that with intensive lifestyle, diet and exercise, Type 2 diabetes can go into remission. Remission? It’s cured. Scrap remission. It’s as if it’s there. Even our terminology around the power of lifestyle is shocking actually.
We’ve ceased being as responsive. When it comes to thinking about our curriculum, what should be there? Let’s look at the problems. Let’s connect the dots. What are the epidemiological problems? Nine out of ten of your leading causes of premature death and disability are related to these conditions. Let’s go to the literature and see what can non-pharmacologic interventions do? No drug or surgery. They are important. I wouldn’t require to anybody showing up at the ER and needing a stent put in or in a hypertensive crisis, of course, drugs and surgery are the go-to tools. Beyond that, Joe, we are not doing the right thing. Maybe we should scrap our conventional physical therapy content and let’s reconfigure it to today’s needs.
When you connect the dots, it’s very clear where we should be. I actually applaud you and your work and your commitment because it’s easier to go with the flow, the path of least resistance. Here I am a physical therapist and a clinical exercise physiologist as you are and yet, we got to get committed to the nutrition piece to make the function go well, both brain and body. I have to tell you, I’m reading a lot more now on nutrition and psychiatry.
I have a very good friend who was also on the podcast. Her name is Dr. Nicole Beurkens. She is a PhD Trained Clinical Psychologist. She focuses on pediatrics and she uses nutrition as a big part of her practice. When kids come in and they are jacked up on sugar and they are missing Omega 3 fatty acids from their diet and they have nutrient deficiencies that oftentimes happen because they have been eating processed foods for too long, she says, “I can do all the Cognitive Behavioral Therapy in the world but if they’re not getting the nutrition they need, then we’re not going to support their brain function.” I actually echoed that notion and I echoed that approach when we talked about chronic pain, which you know, chronic pain is a function of the brain. Pain is an output of the brain. If your brain really is on a state toward Type 3 diabetes, which we know is insulin resistance of the brain, your patient’s cognitive function relies a lot on their nutrition.
You can have the best informed approach that you want in the world with the pain science, the best approach you want with manual therapy but if they don’t have good nutrition and their blood sugar is not normalized, it’s going to be very difficult for that patient’s decreased inflammation in their body and their nervous system and become 100% healthy again.
Let me play the devil’s advocate with you for a moment. I’ve read your research. People who are listening to us right now, we are both passionate about this. They’re probably saying, “These two PTs are waving their carrots around and their kale.” You have this toolbox and in your toolbox, there are assessments for things like smoking, nutrition, sleep, stress, exercise which everyone should be saying, “Yes, I’m a physical therapist. I can assess for exercise.” You’re saying we can assess for them. My question for you is, does a physical therapist have, when they come out of school, do they have the baseline knowledge as a springboard to now start to provide treatment for those types of interventions?
This need I think to be better integrated into our curriculum. This is why because there are students in your country and mine, they do need some psychology but that basic 101 Psychology is you’ll learn some theories but you don’t learn how it’s integrated into practice. There are many psychological theories. I don’t know if you’re familiar with the Grieve’s Modern Manual Therapy and now it’s Musculoskeletal Physiotherapy and then the fourth edition which came out a few years ago, we were invited to do a couple of chapters, not just one, two. That’s what we talked about was again the tools. We had to make it compelling that it would improve their outcomes and what would these tools look like and how much time will it take? Everybody is concerned about the time. Then they do need to acquire and know some of the fundamental Cognitive Behavior Theory, operant conditioning, respondent conditioning, acceptance and commitment therapy. We can take those tools. They’ve been translated many times to make them more user-friendly for the average clinician. In fact, we wrote a chapter for cardiologists and cardiac surgeons on improving their outcomes by doing this piece better. We enumerated the kinds of competencies and the theoretical basis for these things to make it more compelling.
The other thing I’d like to mention, Joe, is our role as health role models. I do work in the Middle East. I’ve been working in Kuwait for about twenty years. I have to say, the oil-rich countries have a disproportionately high rate of obesity and Type 2 diabetes and all those other nasty things. We at the Health Sciences Center at Kuwait University are developing a culture of health and raising the provocative question that for admission to a health profession at the university level, we can compromise a little on grade point average and put more attention to the health of that individual, their commitment to health because your power as a role model is totally deemphasized in the literature. Also, a patient will view you that you will be more likely to talk about health promotion. Hopefully, we will make it a competency so you’ll be required to, a requisite, a creditable competency. At the moment, if you are healthy yourself, you’re more likely to engage health promotion to tap in your conversation. Your patient views you and your advice much more credibly if you are healthy yourself and exudes good health yourself.
Really, what you’re saying is that when you embody these principles as a clinician, a practitioner yourself, that in many ways that could enhance a therapeutic alliance between you and your patient and probably get you a better outcome.
I’ve heard the opposite as well. Recently, somebody is saying, “If I’m overweight, I’d preferred to go to a chunky healthcare provider.” That may happen in some instances. I think if we’re united, we have to have a united front in these so-called health professions and come from a place of health and reinforce health, which is not just the absence of disease or dysfunction.
Can you bring us up to speed with what’s going on in Canada as far as let’s say scope of practice issues around things like nutrition or counseling on stress reduction or integrating aspects of Cognitive Behavioral Therapy, which is typically been under the practice of a psychotherapist. How is that being viewed? In the United States it’s actually worse because we have our national association and each state has their own practice acts. What are we seeing in Canada how this is developing?
In Canada, we have thirteen programs. There’s huge variability because accreditation standards in the US and Canada, they’re generally worded. I read these things pretty carefully. The word health does come up but you need to operationalize that. These are fairly global concepts. When you read, it’s really still quiet musculoskeletally dominated. More so in your country than mine because I understand there are still programs in the US actually that have no cardiovascular and cardiopulmonary, metabolic content really but there are manual therapy programs. I’m not sure how that gets passed accreditation standards. We, I think are more generalist. We do cover off many of the major specialty areas.
There’s much talk. I’m feeling the ground swell. In fact, recently in my own program now, we’re addressing the nutritional piece better or trying to. I think we made it at a higher level. We’ve got to get this standardized across. The other thing is we have a very close working relationship with our clinical community, our clinical instructors. We have to bring them up to speed because we don’t want to hear that recurrent theme of, “You learn that in school but that doesn’t happen in practice.” We’ve got to get them practicing it so the students can see it in action. As I say, it’s not perfect and we believe now that we have to make a very compelling case for the minimal accreditable standards so we’re all doing the same thing not at our own national level but also at the world level. That’s the plan.
This is a podcast in and of itself but let’s just talk for a moment around the insurance-base reimbursement issues that might surround or the challenges that come up with now how do I code for something like Cognitive Behavioral Therapy for sleep? Or how do I code for three sessions of nutrition? To be honest, a lot of times people just need three or four and you see them for three or four visits of nutrition over the course of a month or two months. How do we start to look at these topics as a profession? I can tell you in US or the CPT codes as they are called are way, way outdated. We’ve known that for decades. How does a clinician in practice start to look at this and say, “How do I go into the clinic on Monday and start to bill for this?”
My answer to that would be in terms of the low-hanging fruit. What are the things that we can really do instantly? That will be things that will be medium range and longer range goals. The things that we can do immediately, it’s not other. It’s not something that we add into. This has to be an integrated part of our practice. It’s not like you’re going to have to bill for Behavior Cognitive Therapy because that’s part of what you do when you’re speaking to your patient. Those are the principles. In my clinic, after, “How was the bus ride?” and “What’s the weather like?” then I go into my motivational interviewing mode and so on. Every moment is a teachable moment. It’s very, very much integrated. I think that that’s one. Rather than think of it as other and additional, it’s just truly a part of what we do.
We also have a culture of health. You can walk in and there’s the Mediterranean Food Guide. Back in Okinawa, the food pyramid are the most evidence-based in the world. I don’t know if you know the blue zone countries but these are where people live well-over 100 years of age, their end of life morbidity. They are highly functioning throughout those later years and their end of life morbidity, which we all hope is going to be minimal is minimal in those countries and good brain health, good physical health and so on.
I think bearing those in mind, what we do and based on the literature, we have a culture of health. We talk health. We’ve got signs and symbols around. We change things up a bit. Our patients don’t frequently come one off or one or two because they’re all over our province. This culture of health permeates their whole visit to the clinic. We promoted and everything that we say and do and they’ve already got the tone of this. When we write our reports to physicians, we start off and say this is contemporary physical therapy. We’re starting off with a health assessment and then we go into the traditional strength and endurance and range of motion and pain and those things.
I think it doesn’t have to be so formidable as being, “It’s just one more thing.” It’s just changing up the way we’ve been doing a lot of good things and getting better outcomes. Not only that though, I have to tell you, a tremendous physical therapy outcome is your capacity to reduce drugs and the need for surgery. You may possibly eliminate the need for either if not reduce the potency, the drugs that they’re taking or the length of time. Maybe reduce the need for surgery from a higher level, more invasive to a keyhole type surgery.
I was in Iceland and we were talking about a program for patients going for elective surgery and putting them on a training program. Obviously, that has to be cautiously and carefully depending on the needs of a patient and whether they’re in pain and so on. It can’t be done because we know patients who are better and better are going to have fewer complications and less hospital stay, less ICU stay if that’s required. It’s so clear what needs to be done.
I agree and no other time in history is non-pharmacologic care more important than now with the opioid epidemic taking a hold in the United States and as well as globally. Of course that’s not the only drug that people take and it’s not the only drug that causes side effects. In fact, a lot of the drugs that patients take to prevent chronic disease even though it may regulate their blood sugar still has side effects that can be very serious.
In fact, out of the British Medical Journal a few years ago was a review that showed, and I think it was on many, many, many people, that the public overestimates the benefits of biomedicine and underestimates its harms or potential. It’s not to discourage anybody. You can have better living through chemistry at times but we’ve got to reduce and change some attitudes both by the medical profession and patients. I think we are seeing some resistance to this but we can’t resist all drugs and surgery because there’s a place for those. I think there is a ground swell and making the public a little bit more savvy about these issues.
One of the biggest roles you can play as a physical therapists is helping a patient with the informed consent that they were never provided when they were given an opioid or an antidepressant or any kind of medication. Every single medication has side effects. It’s a huge point. I’d like to hear what you have that you’re passionate about that’s coming down the pike in the next two years let’s say. You’re so active. You’re travelling all over the world, you’re doing research, you’re teaching at the University of British Columbia in Canada. Tell me what you’re up to?
We got our sights on Geneva 2019 where there’s going to be another World Confederation for Physical Therapy. We haven’t quiet decided what that might look like quite yet. We’ve had enough talk. We’ve had three summits. We established that does physical therapy have a role in addressing these lifestyle-related non-communicable conditions? Yeah. We went region by region around the world. I don’t know if you know World Café Methodology but it’s a dialogue format, and very clear. We heard much more about facilitators rather than barriers and what needs to be done. Then we did the toolkit and now, it’s under review, that’s the toolkit and seeing if we can make those. I think our short-term goal is certainly getting that toolkit out. I think just getting and educating and empowering clinicians now. I think understanding there’s some importance here but shifting to the competency. Self-efficacy as Bandura stated years ago is a combination of your degree of importance that you assign to something and then your degree of competence in delivering it. We put a lot of attention to that in our patients. They’ve got to appreciate the importance as well as having competence to self-care and self-management but it’s us. We’ve got to have that sense of capability of doing these things and making a difference.
I have to say the last thing, and probably this a goal of ours, is that we used to be very outcome-oriented in terms of, “Did the person stopped smoking? Did they improve their nutrition? Did they lose weight? Are they sitting less, exercising more, sleeping better?” We don’t even go there anymore. It’s the behavior is the outcome. If we can get the behavior in place, we know 95% of the time that’s going to work. We’ve just let go of the oars and thinking we’ll just get the behavior right because we’re not going to be able to follow these people necessarily for the months that it would take because their health condition did not arise overnight. It took years and years sometimes decades, so why do we expect that we’re going to see immediate change? Also weight loss, if we just get the diet right; I hate the word diet but it’s not about calorie restrictions, just eating better.
What I love about what you just said is if practitioners, no matter what kind of practitioner you are, if you’re really listening to what Dr. Dean just mentioned is that it takes the pressure off you to be a fixer. You’re no longer responsible for fixing the person a 100%. You’re just responsible for providing and educating the information and seeing that that person has taken that information and started down the road with behavioral change. Once they do that, eventually that behavioral change. Depending on how metabolically damaged they are, that behavior change may fix them, let’s say in four weeks, it may take them four months.
We know you can be first in some people diabetes and hypertension with diet primarily and then exercise on top of that within days. It doesn’t happen with everybody but drugs don’t work for everybody. I have to say you and I do speak the same language in that regard and I’m frequently with patients use the word, “I’m your life coach.” I’m your coach because I think sometimes a health provider was supposed to do something and the expectation is you’re going to do something. I’m empowering you. I’m giving you some tools here. I’m here for you. I’m a resource for you. I can give you other resources. We also got to get better and see as our role referral to others because you and I would have gone into nutrition if we wanted to be nutritionist. We need that information, knowledge translation. We’re not trying to be nutritionist. We’re doing some basic instruction.
Everybody has access to these food pyramids and whatnot and just putting that into action and to know where our scope of practice ends. Or you might need to see a qualified nutritionist or a qualified smoking cessation counselor. To even a brief advice, we did a massive systematic review that was published in our special issue on Physical Therapy in the 21st Century: A New Evidence-informed Practice Paradigm and Implications. For smoking, all the biggies, nutrition, even exercise, sleep and stress, we asked, don’t give us more of the literature about why this is a good idea. Journals are filled with that. We need the how-to now. This is all about assessment, intervention. When it came to the exercising piece, it was about motivating and sustaining physical activity and so on. Those I think are things that we’ve embraced.
I have been speaking with Dr. Elizabeth Dean. She is a Canadian physiotherapist and a professor at the University of British Columbia in Canada. She has amazing research on lifestyle-related factors and how you can influence either your patient’s health or your own health if you’re somebody struggling with some type of chronic disease or chronic pain. If you liked this interview, please make sure to share this out with your friends and family on whatever social media platform you use: Facebook, Twitter, LinkedIn, that’s all great information. Make sure to go on to iTunes and give us a 5-star review. Dr. Dean, can you tell us how everyone can learn more information and find you?
Going on the internet and just put in health and lifestyle and some keywords along with my name. That’s a good source. I think they would find it interesting and informative and we’ll always keen ourselves to know how we can package this message even better.
I want to thank her for being on the Healing Pain Podcast. Please stay tuned and join us next week. Thank you.
About Dr. Elizabeth Dean
Dr. Dean’s scholarly work focuses on bridging the ultimate knowledge translation gap between what is known about the causes of and factors contributing to lifestyle-related non-communicable diseases (heart disease, smoking-related conditions, cancer, hypertension and stroke, obesity, diabetes, and osteoporosis) and physical therapy practice. She has particular interest in their epidemiology and cross cultural means of maximizing outcomes of health education and interventions such as physical activity. She conducts research in the Middle East and Asia as well as multicultural Canada, and works with international teams to capacity build with respect to health-focused physical therapy practice. Dr. Dean has conducted extensive work on the management of chronic poliomyelitis based on a model of health and consideration of cultural factors. Currently, she is focusing on effective knowledge translation of existing and new knowledge by physical therapists to meet the priority health care needs of people globally in the 21st century, specifically non-communicable diseases.
The Healing Pain Podcast features expert interviews and serves as:
A community for both practitioners and seekers of health.
A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.
If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at [email protected]. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.
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