Pediatric Physical Therapy:
Clinical Bottom Line
Littlefield Physical Therapy, Inc Temecula, California
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Physical Therapy, D'Youville College, Buffalo, New York
“How could I apply this information?”
Pediatric obesity remains a serious public health problem with nearly 32% of youth aged 2 to 19 years overweight or obese. The study results by Schlessman et al indicate that physical therapists (PTs) identify themselves as professionals of choice for educating others on health promotion (HP)/obesity prevention (OP)/physical activity (PA) but that PTs are not viewed by the selected community (of non-therapists) to be the professionals of choice for HP/OP/PA. This gap in awareness needs to be bridged in order for our profession to combat the obesity epidemic more actively. If therapists believe that they are well equipped to disseminate this information, what can be done to best inform the public on how PTs can help in this epidemic? Physical therapists need to examine first why this gap exists. One reason may be that PT management is perceived as an individual-based treatment approach designed to address acute problems, with less emphasis on community health interventions that target chronic problems like obesity. Physical therapists could begin changing perceptions of their role in obesity management by greater engagement in community activities that market their role in HP/OP/PA, such as wellness fairs, speaking events, and designing continuing education courses for teachers and school/recreational programs. Since children spend a majority of their time in school, this is an ideal setting where PTs can train teachers (and parents) to help youth incorporate PA approaches for obesity management. Most of these activities require us to move beyond the traditional role of health care practitioner, which many therapists may not be comfortable doing. Unfortunately, our health care reimbursement systems are focused on disease management rather than prevention. Clearly, funding for these types of venues is limited and may require grant support or strategic marketing programs to assist with funding. Funding alone is a major barrier requiring our creativity and, most likely, good will. The complexity of this epidemic necessitates that we work together with multidisciplinary professionals to address the many facets of this problem. The bottom line is that as a community we need to change societal and environmental supports that directly influence behavioral lifestyles, a huge undertaking that requires commitment from all avenues; consequently, it is troubling that PTs are not currently seen as a primary player.
“What should I be mindful about in applying this information?”
The sample for this study was from 1 limited geographic region and might not reflect perceptions in other geographic areas. Although the tool was found to be reliable, validity was limited to face validity, as judged by faculty. The HP/OP/PA are examined together as a single variable, and it cannot be determined if participants’ responses are in reference to only 1, 2, or all 3 components of this variable. Perhaps, responses would have been different if the authors asked participants to respond to each component separately. Since dieticians were identified by parents and teachers as the profession of choice, do these same parents and teachers believe low PA to be an important source of our country's obesity epidemic? If not, the role of PA and reduction in sedentary behavior in OP needs to be addressed better. Physical therapist practices have changed significantly over the last 2 decades in response to our growing body of evidence on the influence of preventative health measures on enhancing community health. We realize now more than ever that it is not only vital to our long-term health to prevent disease, but also our country cannot continue to finance health care without an attention to the critical benefits of preventative measures. Unfortunately, our funding model still reimburses for tertiary care over preventative measures. The role PTs play in the obesity epidemic will be crucial for our country's well-being. It is up to us as a professional to determine the effect we will create and how our role in obesity management will be perceived.