Policy shifts needed to make physical therapy accessible to everyone who needs it
Adults with relatively low levels of education attainment and lower incomes appear to be less likely to receive physiotherapy – or physical therapy as it is known in the US and some other countries – than their better-off counterparts.
That is the conclusion of a paper titled 'Social determinants of health are associated with physical therapy use: a systematic review' that appears in the latest issue of the British Journal of Sports Medicine (BJSM).
The paper was written by a team led by Amanda Day Braaten, a doctor of physical therapy at Duke University’s division of orthopaedic surgery in Durham, North Carolina.
After conducting a systematic review of the relevant literature, the authors focused on 36 studies involving more than two million people that took place in eight different countries.
They found that being female and having a ‘non-Hispanic white race/ethnicity’ were associated with a greater likelihood that people would use physical therapy.
Having gained a relatively high level of education, living in an urban setting, having access to transport, being in employment, and having a high socioeconomic status and private insurance were other factors.
The authors note: ‘The results of this study have implications for policy and future research regarding populations that have been shown to be using physical therapy services less, such as those with lower levels of education, those in a rural area, or those in a low socioeconomic class.’
Further research needed
They suggest that physiotherapists’ hands are, to some extent, tied when it comes to making the changes required to make physical therapy accessible to everyone – whatever their socioeconomic status, for example.
‘Individuals associated with lower usage of physical therapy will require systemic changes outside the realm of healthcare to increase their likelihood of using physical therapy.’
However, the authors voice a hope that their review will help the physical therapy profession to address health inequalities by ‘promoting policy and further research to improve utilisation in disadvantaged populations’.
Global aspirations
In 2019, the World Health Organization (WHO) launched its Rehabilitation 30 initiative. This ‘draws attention to the profound unmet need for rehabilitation worldwide and highlights the importance of strengthening health systems to provide rehabilitation’. See: https://www.who.int/initiatives/rehabilitation-2030
Among other objectives, the WHO argues that rehabilitation should be available to all the population and through all stages of their life. ‘Efforts to strengthen rehabilitation should be directed towards supporting the health system as a whole and integrating rehabilitation into all levels of health care.’
The BJSM paper states: ‘The WHO suggests that effective action on combating health inequalities starts with monitoring inequalities through data sources and research.’
Health equity
Health equity means giving individuals equal opportunities for optimal health by removing obstacles stemming from social determinants of health (Amanda Day Braaten and colleagues]
The BJSM article states: ‘Whether or not a SDH is “modifiable”, or “non-modifiable”, it is important to recognise that health equality does not mean health equity, and future efforts should focus on increasing health equity,' the authors state.
'According to the Robert Wood Johnson Foundation, health equity means giving individuals equal opportunities for optimal health by removing obstacles stemming from SDH.
They add: ‘The results of our study have larger implications than individuals simply not using physical therapy services. These individuals will require systemic changes outside the realm of healthcare to increase their likelihood of using physical therapy.’
Link for 'Social determinants of health are associated with physical therapy use: a systematic review': http://dx.doi.org/10.1136/bjsports-2020-103475
Author: Ian A McMillan
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