PRELIMINARY SCIENTIFIC PROGRAMME

The scientific programme includes keynote speech, a focused symposium, workshops, oral and poster presentation.

Remarks:
* SMART: Sports Medicine And Rehabilitation Therapy
Surgeon and physiotherapists' view and approach in managing common musculo-skeletal disorders I : ACL ; II: The Shoulder

 

Focused Symposium

Health promotion in the Asia-pacific region - are we heading the right direction?

Focused Symposium Health promotion in the Asia-pacific region - are we heading the right direction? The focus in health care has shifted globally from acute service provision to disease prevention and community care, with health promotion becoming a task for all health care professions. This symposium provides an opportunity for participants to hear health promotion strategies in rehabilitation from experienced health care practitioners and educators in the Asia-Pacific region. Speakers in this Symposium include:

- Ms Cathy Bray,

Health Promotion in Australia has undergone a remarkable evolution over the last forty years. In the 1970's simple, limited budget, printed material was placed in waiting rooms and 'public announcement' radio and television promotions focused our attention on one major health issue over a long period of time. Today, on any single day, most Australians are exposed to multiple promotions, delivered via a number of media; some are 'true' health promotions, developed in response to public health service utilisation statistics, others are 'infomercials', supposedly promoting healthy lifestyle strategies but actually pushing 'wonder' products. Meanwhile, away from the advertising agencies and the research facilities (who are increasingly under pressure to advance their public profile to attract private funds to supplement limited government funding), there are numerous small scale programs, created and implemented by clinicians for their particular patient groups. Increasing competition for funding within all health organisations is resulting in the trialling of many new health promotion options in dedicated centres, particularly in the areas of patient self monitoring and activity strategies for age related conditions. Excitingly, the responsibility for developing, implementing and reviewing the effectiveness of particular promotions is falling on those health professionals who are directly involved in patient care. Are we heading in the right direction? Historically, not always: more recently, the increasing involvement of 'real' clinicians and the acknowledgement of the importance of social and cultural context and 'how' adults learn is improving outcomes. But look out ... there are big challenges ahead ... locally, for Australia and more widely, for the Asia / Pacific region.

- Professor Sumio Yamada

As population aging proceeds, knowledge and experience about issues in musculo-skeletal problems has become highlights and we physical therapists are expected to be one of leading professionals in community health care. However, to meet this expectation, we need to know new goal settings and strategies to attain those goals that are different from our daily practice in patients with motor disturbance in acute or convalescent care. To show those examples briefly, I will present two examples in health promotion by physical therapist in Japan. One is a care prevention program conducted by Dr. Obuchi who is in charge of care prevention program at Tokyo Metropolitan Institute of Gerontology and a member of advisory committee at division of health for the elderly, ministry of welfare. Their program is now widely accepted and becomes a model in community care in Japan. The other is our recently started secondary prevention program for light stroke patients at Nagoya University, School of Health Sciences. The former provides hints for the strategy of population approach, and the latter for the disease prevention program through the linkage with an acute hospital or mediacl clinics.

- Professor Jocelyn Agcaoili

Health Promotion Strategies of Filipino Physical Therapists – What directions are they taking?

Physical therapists because of their training and scope of practice are uniquely qualified health care professionals to take on activities for health promotion. However, as individual professionals most PTs in the Philippines are employed in hospitals and in outpatient clinics or are engaged in home health practice whose primary aim is to provide treatment and care to particular patients. As defined by the Ottawa charter health promotion is "the process of enabling people to increase control over, and to improve, their health and health promotion action aims at making conditions favorable through advocacy for health.” At present, it is a general consensus among Filipino PTs that there is little support coming from the government and other non-governmental and voluntary organizations to promote such advocacy for health, thus each must rely on individual efforts and willingness to take on responsibility of promoting health and wellness among their patients and in the community. The paper also undertakes to describe selected noteworthy programs initiated by PTs working individually or within an institution which may serve as exemplars to set in motion more encompassing projects that will involve more physical therapists.

- Dr. Celia Tan

Physical inactivity, a sedentary lifestyle and poor nutrition are highly correlated to diseases that plague modern society. These diseases include diabetes mellitus, hypertension and heart diseases. In a 2007 survey by the Ministry of Health, Singapore, the top 3 killers are still cancer, Ischaemic heart disease and pneumonia, with diabetes coming top 7 conditions for mortality. These lifestyle-related diseases share a common set of risk factors, physical inactivity, obesity, smoking, diabetes, hypertension and high blood cholesterol.

In the current climate of primary prevention, increasing physical activity and improving fitness are therefore important goals in primary prevention efforts to avoid developing national epidemics obesity which is being faced by developed countries elsewhere. Key components of such measures include accurate assessments of the fitness level, health status and level of physical activity, counselling, proper nutrition counseling, appropriate workplace and personal management of stress and the ability to maintain and sustain a healthy lifestyle.

Rehabilitation Professionals, which also includes Dietitians, Medical Social Workers, Occupational Therapists and Physiotherapists. Do we all have a role to play in health promotion ? and if yes, what is that role ?

Self-management education has been recognised as the cornerstone of care for all individuals with chronic lifestyle diseases who want to achieve successful health-related outcomes. To facilitate this activity, a multidisciplinary approach has to be taken to develop holistic programmes to help these individuals integrate themselves into the society. In view of this need, an integrated multidisciplinary hospital-based centre that provides programmes for the management of chronic lifestyle diseases, lifestyle behavioural issues, health prevention and wellness programmes, as well as research and training for such diseases would be the ideal solution for health promotion. Such a hospital-based centre, called the LIFE or Lifestyle Improvement and Fitness Enhancement Centre, was established at the Singapore General Hospital in 2007.

- Dr. Tsauo Jau-Yih

There is a paradigm shift in health care from treatment and care in hospital to health promotion in community globally. However, Most PTs in Taiwan are employed in acute and chronic care hospitals or outpatient clinics. Physical therapy involvement in health promotion is emerging slowly. The first government endorsed big-scale physical therapy service in community commenced after the 921 earthquake in 1999. A health promotion and long term care project was implemented in the earthquake area for 3 years in central Taiwan. In 2004, Taipei City government initiated a community health experimental project with cooperation of Taipei Society of Physical Therapy which led to a routine service nowadays. Researchers have experimented on the effects of physical therapists-lead community health promotion programs for fall prevention or intervention for frailty and osteoporosis. Yet these results failed to promote a nation-wide movement of physical therapy services into the community. We, PTs in Taiwan, are on the way to community.

- Dr. Chulee Jones

Traditionally, physiotherapy has generally been concerned with treatment and rehabilitation, with an emphasis on orthopaedic problems. Increasingly, however, it has become evident that the role of physiotherapy has to expand, to include the health risks associated with lifestyle choices, smoking, alcohol, overeating and inactivity which are as much a threat in developing countries as they are in more affluent societies. In Thailand, the top three non-communicable diseases which are causes of mortality and morbidity are heart disease, cancer and diabetes mellitus, the incidence of which has increased 6 fold in the last 10 years, with hypertension-obesity-diabetes being the major problem. The Thai government has been active in promoting a healthier lifestyle with an emphasis on smoking and alcohol cessation and increased physical activity and Physiotherapy, as a health profession in Thailand, has to play its part. The precise role that physiotherapy can play is still being discussed but there are three main areas. The first is in medical out-patient departments where advice and encouragement can be given to the patient and their family for home treatment to prevent the progression or recurrence of disease. Smoking cessation should be included in physiotherapy programmes for smokers and as part of the physiotherapy teaching curriculum. The second area is in out-reach programmes where, again, help and advice can be given about lifestyle (physical exercise, respiratory care, smoking cessation, relaxation, diet, traditional Thai massage) to the community in general and to specific groups at risk. There are also home-based therapeutic treatments that can be taught for more specific problems in the community such as the back problems of rice farmers. The final way in which physiotherapy can play an important role in promoting health is through research. Based on the scientific method, we can develop widely accessible treatments. This is particularly important in regions where there are financial and logistical limitations to the clinical treatments that can be offered. As an example, I have recently developed a simple and cheap respiratory loading device for home use that provides an inspiratory load and is very effective in reducing blood pressure. It offers a non-pharmacological adjunct for the treatment of essential hypertension, one of the rapidly increasing disorders seen throughout the world.

- Dr. Regina Ching

Strategies in Health Promotion : where quality matters

Effective health promotion operates best as a militant wing of public health, challenging the focus of individualism or victim-blaming as the root cause of ill health. Acceptance of the empowerment approach for health improvement gives rise to the recognition of broader social, cultural and environmental factors that impact on people's health. It follows that health promoters must stand ready to contribute to individual empowerment as well as take political action against adverse circumstances. Ideology aside, effective health promotion calls for systematic programme planning, whether it is bedside patient care, group work in a community context or a school-based enterprise. Important elements of systematic planning include health needs assessment, construction of community profiles, stakeholder engagement, institutionalisation, evaluation, learning, and so on.

- Trisha Leahy

Over the past few years there has been increasing international recognition that young people cannot successfully achieve in sport and reap the well-documented benefits of sports participation unless they are protected from harm. As well as the coach, sports medicine and sports science support personnel are in key positions to monitor the maintenance of a safe sporting environment for young athletes and to be an advocate for athletes well-being, so that they can optimise their athletic giftedness in safety and learn life-long positive exercise and health habits. ‘Safety’ refers to both psychologically and physically healthy environments. Lack of psychological safety can occur where the sporting environment is marked by abusive, threatening, or humiliating coaching styles. This not only significantly increases the immediate stress on athletes, but has also been found to be associated with long-term psychological harm. Lack of physical safety can occur where extreme physical activities are used as a punishment for errors or failure to perform. And the sexual abuse of young athletes is a documented reality in many of our countries. At the highest level of elite competitive sport the International Olympic Committee (IOC) has recently issued a Consensus Statement regarding sexual harassment and abuse in sport. The IOC has stated its aim is “to improve health and protection of athletes through the promotion of effective preventative policy as well as to increase awareness of these problems among the people in the entourage of the athletes (IOC, 2007). Sports medicine and scientific support staff with their close involvement in the sporting life of young athletes are often the first point of contact for athletes in distress and need to be aware of the potential for these forms of harm, and the relevant social policy and procedures for reporting and referring. In this presentation I will overview some of the research in this area and discuss the implications for professional education programmes with a view to empowering and enabling support personnel to be effective gate-keepers protecting young athletes from harm and to be effective advocates for appropriate child and youth protection policies within the organised sports system.

- Dr Sandra Howell

Exercise in Individuals with Healthy vs. Pathologic Hearts

Individuals with a normal, healthy cardiovascular system have significant potential to improve exercise capacity by routinely carrying out aerobic fitness training. Increased exercise endurance can be achieved because the cardiovascular and skeletal muscle systems in a healthy individual undergo adaptive changes in response to aerobic training. In the cardiovascular system, enhanced myocardial contractility, increased compliance of the left ventricle and an enlarged blood volume occur. These changes significantly augment cardiac output, and thus, physical performance. The second, corresponding adaptive changes that take place in skeletal muscle fibers include an increased capacity for oxygen consumption and energy production resulting in improved exercise endurance.
In contrast, an individual with a cardiovascular disorder, such as congestive heart failure (CHF), may have a limited tolerance for exercise as well as activities of daily living. It is notable that the nature of reduced physical stamina in CHF may not be simply cardiac in nature, but can result from negative adaptive changes that are occurring in skeletal muscle fiber structure and function. These changes are triggered by the neurohormonal responses engendered by congestive heart failure. In this regard, a reduction in cardiac output activates the release of chemical and hormonal agents that act to augment contractility of the failing heart. However, at the same time, the agents produce complex changes in skeletal muscle fibers, such as altered muscle fiber type, atrophy, disruption of cellular calcium metabolism, contractile dysfunction and muscle fiber death. These negative outcomes in skeletal muscle fibers impair skeletal muscle contractility, endurance and the quality of life.

 

The duration of the symposium will be one and a half hour.