Anticipatory Care for Long Term Conditions in Physiotherapy

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Jess Bell, Kim Jackson, Lucinda hampton, Tony Lowe, Tarina van der Stockt, Vidya Acharya and Olajumoke Ogunleye

Introduction

Long term conditions (LTCs), also known as chronic diseases or Non-communicable diseases (NCDs), are defined as physical and mental health condition that require management over a long period of time.

Examples:

• Heart disease
• Stroke
• Cancer
• Diabetes
• Chronic lung disease such as chronic obstructive pulmonary disease and asthma

Stats & Facts

• Long term conditions are responsible for 41 million deaths each year , accounting for 70% of all deaths around the globe The number is estimated to reach 52 million by 2030.

• Accodring to the World Health Oganization, Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million)
• 15% of young adults aged 11-15 have an LTC
• 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years
• In Scotland, LTCs account for 80% of all GP consultations and they twice as likely to be admitted to hospital
• In England, It's estimated that only 59% of people living with LTCs are in work, compared with 72% of the general population.
• NCDs disproportionately affect people in low- and middle-income countries

Causes and Risk Factors

Unhealthy Harmful behaviour such as sedentary lifestyle, unhealthy diets, exposure to tobacco smoke or the harmful use of alcohol are all contributing factors to LTCs.

The World Health Orgaization classified LTCs contributing factors into two categories:

Modifiable behavioural risk factors:

• Tobacco (including second-hand smoking)
• Excess salt/sodium intake
• Alcohol use
• Lack of or insufficient physical activity

Metabolic risk factors:

• Hypertension
• overweight/obesity
• hyperglycemia (high blood glucose levels)
• hyperlipidemia (high levels of fat in the blood)

Impacts on Individual and society

Long term conditions are associated with multimorbidites that impact the quality of life of the individual and burdens the healthcare system.

People with multimorbidity have poorer functional status, quality of life,working capacity and health outcomes than are those without multimorbidity.

LTCs can negatively affect the individual's mobility and result in social consequences such as home-bounding, self-care disability and bed-bounding, the ultimate consequences being social isolation, family conflicts and even stigma.

Coping with the long term conditions might be difficult and is maybe stressing or disabling . Lost of interest, feeling guilty or responsible and low self-esteem can worsen the development of the disease. The person might also lose the ability to engage in activities that bring a sense of meaning and purpose to life.

The economic burden of LTCs is significant. The United Nations has estimated that the cumulative loss to the global economy could reach $47 trillion by 2030 due to LTCs.

The estimated cost of Long Term Conditions care in the UK was at £320 million in 2017.     

Healthcare Policies

The role of behavoiural factors in developing LTCs is significant and altering these factors can help in the prevention and management.

The healthcare model is supporting the prevention and anticipatory care of LTCs by preventive measures, health promotion and encouraging patient's advocacy.

Making every contact count (MECC) is an approach to behaviour change that encourages healthcare professionals to utilise day to day interactions to promote changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations.

MECC focuses on the lifestyle changes that can influence the health of the individuals such as:

• Stopping smoking
• Limit alcohol drinking to the recommended limits
• Healthy eating
• Physical Activity
• Keeping healthy weight
• Mental health and wellbeing

Read more about MECC here

Physiotherapy and health Promotion

Physiotherapy can have a significant role in the prevention of LTCs throughtout different stages:

1. Medial Prevention by utilising different intervention in Cardio rehabilitation for cardiac diseases
2. Behavioural preveniton by supporting individuals and encourage healthy lifestyle mesures
3. Social/enviromental by education on enviromental measures and supporting occupational policies

Making every contact count model can be integrated in the physiotherapy practice on four stages:

1. Screening of health status and identifying areas of change
2. Agenda setting by discussing needed changes with the patient
3. Readiness to change by discussing and assessing obestacles to change
4. Goal setting using SMART goals

Mental readiness can be an obestacle to lifestyle changes. There are six stages of mental preparation that physiotherapists need to be aware of to help their patients improving their health and well being:

• Pre-consultation: patient is aware of the problem but not willing to take an action
• Contemplation: patient is aware of the road to change
• Preparation: physiotherapists can help by using SMART goals
• Action plan: based on identified goals
• Maintainance: where most people fail. Physiotherapists can help by encouraging and supporting patient's commitment
• Relapse: if happend, physiotherapists can help by re assessing and setting new goals

Self-management:

Self-management is a powerful tool that enables pateints to take control of their treatment where pateints actively cooperate to take actions toward their recovery.

The role of physiotherapy in self-management:

• support paitent to get proper diagnosis and understand the pathology clearly
• communicating with patients using open-ended questions. Encourages patients to engage and reflect on their lifestyle and behaviour
• setting goals to show patients their potentials
• Utilise Digital/telehealth: to sympathize and connect with patients easily especially in cases of difficult traveling/commuting. The avialabity of videos and pictures can make treatment simpler and easy t understand. Smart phone application offer easy and accessable interface, exercise templates, onine agenda, feedback in realtime, monitoring vitals
• Promoting the use of self-testing and vital signs kits for diabetes and BP
• Utilisation of pateints screening tests to help identify risks such as walking speed test and get up and go test
• Workng in integrated care team and using a valid referal scheme to connect pateints with other services and direct them to support when needed