I ask my PT colleagues all the time, do you talk about diet and nutrition with your patients? Most of the time I hear, “no it’s not within our scope of practice”. I will give my personal bias (but not really since it is backed by the physical therapy governing bodies), that yes I believe it is very important to discuss the topic of nutrition with patients. However, my opinion doesn't matter, the evidence does.
This post is dedicated to answering the question- is diet and nutrition apart of the physical therapy scope of practice?
Well folks, the quick answer is yes, discussing nutrition is within our scope of practice. In 2015, the American Physical Therapy Association (APTA) provided a document with a statement discussing the role of the physical therapist in diet and nutrition:
HOD P06-15-22-17: Diet and nutrition are key components of primary, secondary, and tertiary prevention of many conditions managed by physical therapists. It is the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice. This includes appropriate referrals to nutrition and dietary medical professionals when the required advice and education lie outside the education level of the physical therapist. (Link to document here)
The APTA has now taken a stance that nutrition is within our scope of practice since it is a key component to many conditions that we manage. Nutrition can directly affect a patient’s function and recovery from injury. It is considered reimbursable under patient education and self-care. (However, always check your third party-payers). The APTA also states that PTs should refer onto a dietitian when information is outside of information found in public domain. APTA suggests using the dietary guidelines from the US Department of Health and Human Services’ Office of Disease Prevention and Health Promotion. (Summary of guidelines here… this is a really good reference guys)
The Academy of Nutrition and Dietetics provides a resource that can be used to find local Registered Dietitian Nutritionists. (Link here). I suggest finding your local dietitians and building relationships with them.
In addition to the APTA’s scope of practice, we also need to make sure that we are following our own states practice act.
Here is California’s stance on nutrition:
The Physical Therapy Practice Act does not mention diet and/or nutrition. A document titled Statutes Outside Physical Therapy Practice Act (Link to document here) states:
Division 2- Chapter 5, Article 3, 2068:
This chapter shall not be construed to prohibit any person from providing nutritional advice or giving advice concerning proper nutrition… For purposes of this section the terms ‘providing nutritional advice or giving advice concerning proper nutrition’ means the giving of information as to the use and role of food ingredients, including dietary supplements.
Any person in commercial practice providing nutritional advice or giving advice concerning proper nutrition shall post in an easily visible and prominent place the following statement in his or her place of business:
(See link for exact wording of “NOTICE” that must be visibly placed on no smaller than an 8 1/2 in by 11 in paper with lettering no smaller than 1/2 in length (except “NOTICE” is not to be smaller than 1 in length)
If you aren’t sure of your states practice act, APTA has a resource that will connect you to your state (click here)
Lastly, remember that we each have our own personal scope of practice. Just because your state practice act says that it is within your scope of practice, if you do not know enough about that topic then don’t practice it. Meaning, don’t practice what you don’t know.
Here is a link to APTA’s resource on Personal Scope of Physical Therapy Practice.
We are lucky, we get 30 minutes to an hour with our patients. Most health care providers do not get that time. We have the time. Let’s not side step the topic of nutrition with our patients/clients. It is our job to discuss lifestyle, health and wellness with our patients who are trying to recover from an injury and/or illness. Diet and nutrition have affects on inflammation, obesity, arthritis, autoimmune diseases, diabetes, and chronic/persistent pain. If you still aren’t convinced that you should be discussing nutrition with your patients, check out Dr. Joe Patta's blog post on the APTA website here for additional reasons why pain and nutrition go hand in hand.
Many of the top physical therapy continuing education institutes are starting to add nutrition based courses to their programs. Here are a few examples:
- Herman & Wallace: Nutrition Perspectives for the Pelvic Rehab Therapist.
- Medbridge: Nutrition in Sports
- Progressive Therapy Education: The Changing Paradigm of Wellness- The Role of Nutrition and Fitness in the Prevention of Chronic Disease
Hopefully you now at least somewhat agree that nutrition isn’t outside of our scope of practice as physical therapists. But you may now be thinking that you don’t want to step on another professions toes, anger your local dietitians that may be sending you patients. I fully believe that PTs discussing general nutrition topics will not in any way take away from the importance or referrals to dietitians or nutritionists. If anything, it may help to open the door between patients and dietitians. In California and most states, we now have direct assess to patients, meaning this may be the first time nutrition has been brought up to a patient in regards to it’s affects on healing the body. We can help assist patients and physicians to find the right dietitian for them. We can be a link between other healthcare providers and patients. I hope that you start asking your patients about their dietary habits, just as I would hope a dietitian would ask their patients/clients about their exercise habits. That way, we can work together as a team to best help our patients.
Additional resources:
Dr. Joe Patta, DPT, CNS is an excellent resource. His focus is treating persistent pain, and you bet nutrition is a part of that. He has a blog and a podcast, and is currently working on a functional nutrition and pain science training for healthcare practitioners. Check out his website here.
Find a local Registered Dietitian here.
Physical Therapy Board of California laws here.
US Department of Health and Human Services- Dietary Guidelines 8th edition 2015-2020 here.
No comments:
Post a Comment