"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, December 14, 2009

Sugar, Fat and Physical Therapy

Can diet affect physical therapy outcomes?

Does the typical 'American diet' - high fat, high sugar - lead to the expression of anxiety-related behaviors?

University of South Florida researcher David Diamond, PhD recently found that a high carbohydrate/high fat diet caused 'avoidance behaviors' and anxiety among rats.

Dr. Diamond presented his findings at the Society of Neuroscience meeting in Chicago in November 2009.

Dr. Diamond concluded:
"This work indicates that the combination of high fat and sugar diets, as is found in typical American foods such as donuts, cheeseburgers and french fries, not only contributes to obesity, but may also contribute to the development of anxiety disorders."
He has also published studies on the link among high fat diets, chronic stress and the development of anxiety.

Now, I know you don't treat rats (not even the animal physical therapists!) but the effect of diet on mood and affect may have implications for physical therapy treatments - on humans.

I wonder if diet affects physical therapy outcomes?

Fear Avoidance Behaviors (FAB) may be the largest single, measurable factors leading to disability in people with musculoskeletal disorders seen in physical therapy clinics.

Fear-Avoidance Behaviors may explain why some people recover from their acute episode but never regain their full function and eventually go on to suffer recurrences of pain and disability - consuming greater and greater amounts of health services during their lives.

The 1987 Volvo Award in Clinical Medicine went went to Dr. Gordon Waddell of Scotland for his work in quantifying a test (Waddell's Signs) that proposed to assess 'illness behaviour' in orthopedic patients.

Dr. Waddell's 'illness behavior' was described in his award-winning study: A New Clinical Model for the Treatment of Low Back Pain.

'Illness behavior' morphed into the Fear-Avoidance Model that may explain from 15-30% of the variance in rehabilitative outcomes - the largest single factor physical therapists can modify in our patients.

Waddell's signs have since proved to be more 'common sense' than statistically predictive (Waddell's Signs have a positive Likelihood Ratio of 1.7).

Dr. Waddell, however, explained that:
...pathoanatomy does not correlate with pain and this is why we must take a functional approach.
The treatment goal is not pain relief but disability prevention.
The Fear-Avoidance Model improves physical therapists' diagnoses by shifting the emphasis during examination away from patho-anatomy and towards psychosocial stressors consistent with the Biopsychosocial Model.

Dr. Diamond's rats fed the 'American diet' exhibited 'stronger evidence of fear memories' and more fear on tests of memory and anxiety.

Physical therapists can modify or reduce Fear-Avoidance Behaviors by the use of:
"...effective brief psycho-educational strategies that can address the cognitive and affective processes that motivate pain-related activity avoidance."
Should we try to improve our patients' functional outcomes by providing advice on their diet?

Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.