In our ever-evolving healthcare landscape, it is clear that we must focus on prevention, and physiotherapists are uniquely positioned to lead this charge, jointly write CSP practice and development director Ashley James and practice and development assistant director Ruth ten Hove.
The concept that prevention is better than cure is not new. Promoting health and wellbeing, and preventing conditions from worsening are fundamental principles underpinning public health and improving the health of the population.
The Essential Need for Prevention
The rise of non-communicable diseases (NCDs) such as obesity, cardiovascular disease, and diabetes presents one of the most daunting public health challenges of our time. These lifestyle-related conditions are leading causes of death and disability worldwide, consuming vast healthcare resources and impacting countless lives (Parra et al. 2017; Dennis 2016). Physical inactivity is a major risk factor for these diseases, with approximately 31 per cent of the global population not getting enough exercise (Parra et al. 2017; WHO 2018).
We are witnessing a growing number of patients with multimorbidity, coupled with increasing health inequalities. There are stark inequalities in healthy life expectancy between the most and least deprived areas in the UK. Increasing rates of multiple health conditions, alongside rises in frailty and obesity, indicate the need for more targeted action in prevention. Covid-19 has also added to the challenge, causing an increase in complexity and long-term impact for people who already had long-term conditions, with reduced physical activity and increased sedentary behaviour playing their part.
The Challenge of Shifting Towards Prevention in the UK
Despite the clear benefits of preventive healthcare, shifting towards a prevention-focused model in the UK is fraught with challenges. One of the most significant barriers is funding. The UK’s healthcare system has long been geared towards treatment rather than prevention, with the bulk of NHS resources allocated to managing acute and chronic conditions once they have developed. This leaves limited funds available for preventive measures, despite their potential to reduce long-term healthcare costs and improve quality of life (Buck and Frosini 2012).
National policy has also struggled to make prevention a priority. While there have been numerous initiatives aimed at promoting public health, these efforts often lack the sustained investment and comprehensive approach needed to make a significant impact. Additionally, the pressure on the NHS to deliver immediate results can overshadow the long-term benefits of preventive care (CSP 2016).
Making the Case for Prevention
In this challenging environment, it is more important than ever to champion the role of physiotherapists in prevention. Preventive care can lead to significant cost savings for the NHS by reducing the incidence of costly chronic conditions and decreasing the demand on healthcare services. This is not just an investment in health; it is an investment in the sustainability of our healthcare system (Lee et al. 2012).
Physiotherapists are crucial in tackling the root causes of many NCDs. We are uniquely positioned to deliver effective interventions that can prevent these diseases from developing in the first place (Bezner 2015).
Why are Physiotherapists Effective in Prevention?
Physiotherapists deliver evidence-based interventions that support individuals and populations to improve their health and wellbeing. From improving the mobility and respiratory function of premature babies to encouraging people with extreme frailty to engage in strength and balance exercises, physiotherapy practice is rooted in the principles of prevention.
Physiotherapists take a coaching approach to understand what is important to individuals, setting personalised goals and building self-confidence to manage their conditions. Embedding ‘Making every contact count’ (MECC) provides an opportunity to understand an individual’s circumstances and help them adopt healthier behaviours.
Early intervention is a central tenet of effective physiotherapy practice, focusing on primary prevention. Physiotherapists in primary care or private practice, who are often the first point of contact for patients, can address problems early and effectively through personalised coaching.
Access to pulmonary, cardiac, and cancer rehab services offers comprehensive programmes of exercise, education, and peer support with a strong focus on secondary prevention. This secondary prevention is vital for maintaining function and independence, preventing patients from returning to more expensive parts of the health system (acute hospitals).
Enabling people to remain well and at home reduces pressure on secondary care. Interventions such as community rehabilitation, urgent community response, and virtual wards allow people to stay in their homes, recover more rapidly, and prevent the deleterious effects of hospital admission.
The skills of physiotherapists, as well as their presence in all parts of the health system make us ideally placed to contribute extensively to prevention for patients.
Conclusion
As we navigate the complexities of healthcare in the UK, a shift towards prevention is essential. Physiotherapists have the skills, knowledge, and passion to lead this shift, significantly impacting public health and the sustainability of our healthcare system.
To enhance the impact of physiotherapists in prevention, we must:
• Make access easy by promoting all referral options.
• Amplify the physiotherapist’s role as a coach to facilitate effective self-management.
• Involve patients and carers in service redesign.
• Provide rehab earlier in the disease trajectory and move it into community and fitness centres.
• Offer core rehabilitation services for all long-term conditions in the community.
• Lead programmes to increase MDT confidence to prevent deconditioning in hospitals.
• Scale up strength and balance programmes for local populations.
• Incorporate vocational rehabilitation to enable people to remain in or return to work.
Together, we can transform the health of our communities, reduce healthcare costs, and create a better quality of life for all. Let us embrace our role in prevention and lead the way towards a healthier future.
References
1. Bezner, J. R. (2015) 'Promoting health and wellness: implications for physical therapist practice', Physical Therapy, 95(10), pp. 1433-1444. Available at: https://academic.oup.com/ptj/article/95/10/1433/2686451
2. Buck, D. and Frosini, F. (2012) 'Clustering of unhealthy behaviours over time: Implications for policy and practice', The King’s Fund. Available at: https://www.kingsfund.org.uk/publications/clustering-unhealthy-behaviours-over-time
3. Chartered Society of Physiotherapy (CSP) (2016) 'Physiotherapy works: prevention and public health'. Available at: www.csp.org.uk/professional-clinical/professional-guidance/public-health-physical-activity
4. Dennis, S. (2016) 'Secondary prevention of chronic health conditions in patients with multimorbidity: what can physiotherapists do?', Journal of Comorbidity, 6(2), pp. 50-52. Available at: http://www.swissmedicalpress.com
5. Giuffre, S., Domholdt, E. and Keehan, J. (2018) 'Beyond the individual: population health and physical therapy', Physiotherapy Theory and Practice. Available at: https://doi.org/10.1080/09593985.2018.1490364
6. Lee, I-M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., and Lancet Physical Activity Series Working Group (2012) 'Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy', Lancet, 380(9838), pp. 219-229. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61031-9/fulltext
7. National Institute for Health and Care Excellence (NICE) (2014) 'Behaviour change: individual approaches', Public Health Guideline [PH49]. Available at: https://www.nice.org.uk/guidance/ph49
8. Parra, D.C., Held Bradford, E.C., Clark, B.R., Racette, S.B. and Deusinger, S.S. (2017) 'Population and community-based promotion of physical activity: A priority for physical therapy', Physical Therapy, 97(2), pp. 159-160. Available at: https://academic.oup.com/ptj/article/97/2/159/2996718
9. Public Health England (PHE) (2016) 'Health matters: getting every adult active every day', PHE. Available at: https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day
10. World Health Organization (2018) 'Global action plan on physical activity 2018–2030: More active people for a healthier world', WHO. Available at: https://www.who.int/publications/i/item/9789241514187
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