In delivering the 56th Mary McMillan Lecture at APTA’s Combined Sections Meeting in Houston, Terry Nordstrom, PT, EdD, FAPTA, posed a question he thinks the physical therapy profession must answer:
“What is our individual and collective responsibility to improve the environmental and social drivers that affect movement of people in our communities?” he asked.
Nordstrom’s call to action was at the heart of his Mary McMillan Lecture titled “The Heart of Movement: ‘What’s Love Got to Do With It?’”
Nordstrom is an emeritus professor in the Department of Physical Therapy at Samuel Merritt University in Oakland, California. During his 30-year tenure at the university, his roles included department chair, assistant academic vice president, and vice president of enrollment and student services. He served as president of the American Council of Academic Physical Therapy and is a former member of the APTA Ethics and Judicial Committee.
Nordstrom referenced research that about 50% of health outcomes are influenced by social and environmental factors and 30% by health behaviors, which leaves 20% of the outcome to be influenced by the profession's effectiveness in diagnosing and treating movement disorders.
That means PTs and PTAs need to know what is weighing patients down when they walk into a clinic and what is lifting them up. What stresses their movement, health, and well-being? What offers them strength and resilience?
“It isn’t like they over packed for their vacation,” he said. “They did not choose about half of what they carry. That half comes from their interactions with their environment and other people. While its source is external, it is internalized. While it is vitally important that we are excellent at the 20%, we must pay attention to the other 80% to optimize movement for every patient.”
Nordstrom named three reasons he believes the profession should work to lighten patients’ loads: it fulfills the professions’ responsibility to the communities it serves, it meets the profession’s evolving role in primary care, and it reduces the causes of environmental and social drivers of health in physical therapy.
Firstly, the profession’s responsibility extends beyond providing high-quality PT services for each patient, he said.
“We have been given one of the most valuable gifts anyone can receive: the gift of being entrusted with someone’s health when they can no longer move in the way they need to,” Nordstrom said.
Secondly, the profession’s role in health care has dramatically changed over the past 100 years, Nordstrom said, and it continues to evolve to meet society’s health needs.
“Primary care is one area where we have an increasing role because of how central movement is for healthy people and for our communities,” he said.
Finally, Nordstrom cited APTA’s “Code of Ethics for the Physical Therapist” and “Standards of Ethical Conduct for the Physical Therapist Assistant,” which say that PTs and PTAs shall “participate in efforts to meet the health needs of people locally, nationally, or globally.”
He specifically called for strengthening the profession’s commitment to pro bono services for people in need.
Health disparities can be based on a range of factors, such as gender, race, ethnicity, sexual orientation, or disability, Nordstrom said.
He cited “Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review,” in which authors found “widespread disparities in outcomes” after PT services were provided. The article was part of a featured collection on health disparities in rehabilitation published in APTA’s scientific journal, PTJ: Physical Therapy & Rehabilitation Journal. Nordstrom also noted the differing impact of COVID-19 pandemic on various communities.
Additionally, Nordstrom called on the profession to have “a stronger magnetic attraction to justice than it does now.” Justice needs to play a bigger role in considering the things people carry with them into the clinic, he said; in other words, what’s holding people down.
Nordstrom called for a national discussion about understanding health disparities and the profession’s role in decreasing them. Those town halls must include diverse voices, particularly people from underrepresented groups. People with disabilities, other health professionals, and community leaders should also be invited to these discussions.
“Our work, our profession’s purpose, is about movement. If we think about every breath as movement, every heartbeat as movement, then life, literally, does not exist without movement,” he said.
A video of the lecture will be available via APTA CSM On Demand. Full registration in-person attendees receive free access, and others can purchase On Demand for access to the lecture and two-thirds of the programming from this year’s APTA CSM.