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Health behavior change : does the physical therapy literature reflect the pandemic of lifestyle-related… Burniston, Jamie; Eftekhari, Faezeh; Hrabi, Sarah; Worsley, Rachel Aug 31, 2011

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Health Behavior Change Does the physical therapy literature reflect the pandemic of lifestyle-related conditions? Jamie Burniston, Faezeh Eftekhari, Sarah Hrabi, Rachel Worsley RATIONALE ? ?Lifestyle-related conditions? are leading causes of death worldwide ? Key lifestyle behaviors contribute to preventable lifestyle-related conditions  ? Lifestyle-related conditions decrease quality of life of individuals and strain health care system resources  RATIONALE ? Physical therapy is a health care discipline that is well poised to tackle lifestyle conditions through non-invasive practices such as healthy lifestyle education  ? This research examined if the physical therapy literature has adequately responded to the increasing prevalence of co-morbidities and lifestyle-related conditions  ? To determine whether the pandemic of lifestyle-related conditions has lead to a change in the volume of literature on physical therapy involvement in lifestyle behaviours over the last 20 years, specifically:  ? Physical activity and exercise ? Smoking cessation ? Nutrition optimization ? Weight control ? Stress management ? Sleep hygiene  PURPOSE AIMS 1. To determine if the proportion of peer reviewed articles published on each of the six lifestyle behaviors in physical therapy journals has changed from 1986-1989 to 2006-2009.  2. To determine if the overall proportion of peer reviewed articles on lifestyle behaviors published in physical therapy journals has changed from 1986-1989 to 2006-2009.  OPERATIONAL DEFINITIONS Lifestyle Behaviors Modes of living that impact an individual?s health status (e.g. physical activity and exercise, smoking cessation, nutrition optimization, weight control, stress management, and sleep hygiene)  Physical Activity  A general term used for any activities that involve voluntary movement of the skeletal muscles resulting in increased energy expenditure. (CINAHL) Exercise Physical activity which is usually regular and done with the intention of improving or maintaining physical fitness or health. (CINAHL) Smoking Cessation Discontinuing the smoking habit. (CINAHL) Nutrition Optimization Obtaining the nutrition essential for healing and repair, immunity, maintaining an optimal body weight as well as providing energy for metabolism (Dean,2009b) Weight Control The process by which individuals attempt to achieve and/or maintain a healthy body weight. (CINAHL) Stress Management Strategies to minimize physical, psychological or emotional stressors of the body. Sleep Hygiene  The environmental factors, nightly habits or other practices that can influence sleep length and quality (ICSD 2001) Responsiveness of Literature Change over time in the proportion of peer reviewed articles on lifestyle related conditions and lifestyle behaviours to reflect the changing prevalence in society of those issues.  Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO) Lifestyle-Related Conditions Multi-factorial health problems that can result from negative lifestyle behaviors (e.g.: ischemic heart disease, chronic bronchitis and emphysema, hypertension, stroke, diabetes mellitus, and some cancers)  METHODS ? Journals: ? Australian Journal of Physiotherapy   ? Physical Therapy ? Physiotherapy ? Physiotherapy Canada ? Physiotherapy Theory and Practice ? Electronic Databases: ? CINAHL  Dates:  1986 ? 1989 2006 - 2009 Australian Journal of Physiotherapy Search journal title pages online CINAHL Physical Therapy CINAHL CINAHL Physiotherapy Search print journals by hand CINAHL Physiotherapy Canada Search print journals by hand CINAHL Physiotherapy Theory and Practice Search journal title pages online CINAHL SEARCH STRATEGY JOURNALS Australian Journal of Physiotherapy Physical Therapy Physiotherapy Canada Physiotherapy Physiotherapy Theory and Practice BEHAVIOURS Physical Activity and Exercise Smoking Cessation Nutrition Optimization Weight Control Stress Management Sleep Hygiene  TIME PERIODS 1986-1989 2006-2009 SEARCH STRATEGY SEARCH STRATEGY Article Selection: ? Titles and abstracts were retrieved and reviewed for inclusion by two reviewers independently.  ? Each article was assigned to the appropriate lifestyle behaviors.  ? If agreement was not obtained, a third reviewer was consulted to make the final decision on inclusion.  METHODS Articles which are: i. Peer reviewed ii. Written in English iii. Published in Australian Journal of Physiotherapy, Physical Therapy, Physiotherapy, Physiotherapy Canada or Physiotherapy Theory and Practice iv. Published in one of two time periods: 1986 to 1989 and 2006 to 2009 v. Focused on key lifestyle behaviors: physical activity and exercise, smoking cessation, nutrition optimization, weight control, stress management and sleep hygiene vi. Promoting health according to the WHO definition: ?a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.?  INCLUSION CRITERIA Articles which discuss: i. Long term lifestyle modifications for any one condition, with the exception of: cardiovascular disease, smoking-related respiratory conditions, hypertension, stroke and cerebrovascular disease, cancer, diabetes mellitus, obesity.  ii. Short term treatments as opposed to ongoing interventions that address health behavior changes. EXCLUSION CRITERIA Total Counts: ? Proportions were calculated to account for any change in the total number of articles published during each time period and avoid skewing our results.  ? Title page counts were conducted by two independent reviewers. METHODS Articles which are: i. Peer reviewed ii. Written in English iii. Published in Australian Journal of Physiotherapy, Physical Therapy, Physiotherapy, Physiotherapy Canada or Physiotherapy Theory and Practice iv. Published in one of two time periods: 1986 to 1989 and 2006 to 2009.  INCLUSION CRITERIA Specific inclusion criteria for total count: ? Case Reports ? Clinical Reports ? Reprints from other journals ? Technical Reports ? Anatomy Reviews ? ?Discussions? (Physiotherapy) ? ?Perspectives? (Physical Therapy) ? ?Reading Tips? (Physical Therapy) ? ?General Communications? (Physiotherapy Canada) ? ?Brief Communications? (Physiotherapy Canada) ? ?Education? (Physical Therapy) ? ?Administration? (Physical Therapy) ? ?Clinical Notes? (Physiotherapy Canada) ? ?Special Communications? (Physical Therapy)  INCLUSION CRITERIA Specific exclusion criteria for total counts: ? Editorials ? Commentaries ? Letters and Responses ? Conference Proceedings ? Congress Reports, Symposiums ? Rejoinders (Physical Therapy) ? ?Mary McMillan Lectures? (Physical Therapy) ? ?The Bottom Line? (Physical Therapy) ? ?Suggestions From the Field? (Physical Therapy) ? ?Enid Graham Memorial Lecture? (Physiotherapy Canada)      ? ?Founder?s Lecture? (Physiotherapy) ? Corrections ? Book/Manuscript/Multimedia Reviews ? Equipment/Product Reviews ? Scholarships ? Fellowships, and Grants ? News/Notices ? Association Business ? Supplements ? Progress Reports  ? Presidential Addresses ? ?Equipment Notes? (Physiotherapy) ? ?Treatment Notes? (Physiotherapy  EXCLUSION CRITERIA FLOW CHART FLOW CHART STATISTICAL ANALYSIS  ? Fisher?s Exact Test ? Data analyzed using the computer program SPSS ? p-value ? each lifestyle behavior ? overall number of articles on all lifestyle behaviors combined ? < .05 = significant   RESULTS: SUMMARY TABLE ? Physical Activity and Exercise ? 12 ? 34 articles ? 1.2% ? 3.67%  ? P <0.001 ? Smoking Cessation ? 2 ? 4 articles ? 0.20% ? 0.43%  ? P = 0.363 ? Nutrition Optimization ? 4 ? 5 articles ? 0.40% ? 0.54% ? P = 0.655  RESULTS: SUMMARY TABLE ? Weight Control ? 2 ? 5 articles ? 0.20% ? 0.54%  ? P = .216 ? Stress Management ? 15 ? 5 articles ? 1.50% ? 0.54%  ? P = 0.018 ? Sleep Hygiene ? 0 ? 3 articles ? 0.00% ? 0.32% ? P = 0.038  RESULTS: SUMMARY TABLE  ? Total Articles on Lifestyle Behaviors ? 23 ? 42 ? 2.30% ? 4.53%  ? P = 0.007 RESULTS RESULTS ? Physical Activity and Exercise ? Largest increase over time ? Suggests increased focus on role of exercise in health promotion ? Core element of physical therapy ? Important role in other lifestyle behaviors  ? And yet, 47% of Canadians remain inactive  ? Let?s close the gap! DISCUSSION ? Smoking Cessation ? No change over time ? Suggests little attention placed on the role of physical therapists in promoting smoking cessation ? Physical therapists should play a role: ? Preventative health educators ? Adjunct to cardiorespiratory physical therapy ? Exercise to aid smoking cessation  ? How do we prepare physical therapists to fill this role? DISCUSSION ? Nutrition Optimization ? No change over time ? All in one journal in 1986-89, spread among three journals in 2006-09 ? Reflects wider spread of focus among physical therapy community? ? Important role in tissue healing, muscle building, performance sports, weight control and immune function  ? Potential for further research on the role of physical therapists in nutrition guidance DISCUSSION ? Weight Control ? No change over time ? Obesity rates continue to rise ? Global issue; impacts all areas of physical therapy ? Only considered independently in two of five articles ? Linked to exercise and nutrition  ? How to incorporate effective weight management interventions into physical therapy treatment plans? DISCUSSION ? Stress Management ? Only lifestyle behavior to decrease over time ? Greatest number of articles in 1986-89 ? May reflect how prominent an issue stress was at the time ? Stress plays a strong role in motivation, performance and perception of pain  and disability  ? Do physical therapists recognize the role they could play in stress management? DISCUSSION ? Sleep Hygiene ? Increase in volume over time ? However? 0 ? 3 articles ? Appears to be a new and under-examined topic in physical therapy  ? Risk factor for other health conditions  ? Further research on the role of physical therapists in sleep hygiene management? DISCUSSION ? All Lifestyle Behaviors ? Total proportion of articles increased over time ? Physical therapy academic community appears to be placing more attention on lifestyle behaviors and their role in patient health ? Increase driven by physical activity and exercise results ? However, the prevalence of lifestyle-related conditions continue to rise ? Where is the gap between knowledge and practice?  ? Where can we go from here?   DISCUSSION ? Purely quantitative ? Does not evaluate the content or quality ? Does not include editorials or opinion pieces ? Data was extracted from only the five major generalist physical therapy journals ? Does not include trends in specialist journals ? Current core generalist journals (Nov. 2010) ? Physical Therapy, Journal of Physiotherapy ? Lifestyle behavior categorization ? Academic ? ? Clinical LIMITATIONS CONCLUSION ? Statistically significant increase in proportion of articles focused on: ? Physical activity and exercise ? Greatest increase ? Sleep hygiene ? All lifestyle behaviors combined ? Suggests that the academic physiotherapy community has been responsive to the increasing prevalence of lifestyle-related conditions ? Recommendations for future research: ? Adapt and expand our methods to review all of the physical therapy-related literature and grey literature Applying for publication in Physiotherapy Canada DISEMMINATION   We would like to acknowledge Dr. Elizabeth Dean, Charlotte Beck, Dr. Teresa Liu-Ambrose, Dr. Darlene Reid and Jodie Woolner for their contributions to this work! ACKNOWLEDGEMENTS QUESTIONS REFERENCES 1. Obesity: World health organization health topics [Internet].: WHO; 2011; cited August 2011]. Available from:  2. Just breathe: Becoming and remaining smoke free [Internet]. Canada: Heart and Stroke Foundation of BC and Yukon; 2011; cited Aug 11, 2011]. Available from:  3. Report of the surgeon genera; reducing tobacco use [Internet]. Atlanta, USA: Centers for Disease Control and Prevention; 200b; cited April 2010]. Available from:  4. 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