Taking a “Whole Person Approach” in Physical Therapy Practice

An Interview with Dr. Rose Pignataro

Recently we sat down with Dr. Rose Pignataro to chat about the “whole person” approach to physical therapy care. Read about Dr. Pignataro here

What is a “whole person approach” to physical therapy? People often seek physical therapy care for a specific problem that can involve anything ranging from back pain to a non healing wound. Ultimately, these people see the biggest improvements in their quality of life and specific complaints when treated using a whole person approach to their rehabilitation. But what is it?

Essentially – Integrative and Lifestyle Medicine (ILM) sums up the “whole person approach” in physical therapy. The whole person approach to physical therapy care requires skills, knowledge, and techniques – all of which you can learn via ILM.

Physical therapists are in a unique position to deliver a whole person approach to care as healthcare providers (HCP). Why?

We typically have more time than any other HCP with our patients which allows us to create a deeper connection to the person seeking help. This is a role that requires a deep sense of responsibility.  It’s imperative that we realize this capacity…and through this understanding, we can create meaningful changes in their lives.

Rose Pignataro

Taking a “Whole Person Approach” in Physical Therapy Practice
Dr. Rose Pignataro PT, PhD, DPT

This responsibility is not lost on Dr. Rose Pignataro PT, PhD, DPT, CWS, CHES, who is a professor at Emory & Henry College.  Her research focuses on prevention, wellness, and health behavior change.  She has special interests in reducing health disparities, especially among people with disabilities.  Additionally, she teaches her students on the topics of health promotion, wound management, cardiopulmonary health, and professional issues.  

We had the opportunity to ask Rose a few questions, regarding her recent contributions to the book, Integrative and Lifestyle Medicine in Physical Therapy, and how using a whole person approach can transform physical therapy care.

Q: What made you choose physical therapy?

A: I have been in the PT field for more than 30 years. Knowing I am a bit of a dinosaur (specifically, a PTerodactyl – haha), I work hard to make sure to avoid extinction by continually learning new things. Thankfully, being a core faculty member in the PT Program at Emory & Henry College makes this easier. Our students are incredibly inquisitive and innovative. They teach me new things as much as I teach them! I became a physical therapist because of my strong belief in people’s resilience and ability to recover when given the proper supportive resources.

Q: What is your favorite thing about being a physical therapist?

A: There are so many things I love about being a PT that this is very difficult to answer. I like that there is always something new to learn. I also greatly enjoy the ability to interact with healthcare professionals from other areas of practice, but the aspect I enjoy the most is the opportunity to form meaningful relationships with patients and clients. PTs generally enjoy longer treatment encounters and episodes of care than many of our colleagues, enabling us to create a strong therapeutic alliance that can ultimately be leveraged to empower our patients with better self-management skills. 

Q: How did you become interested in using Integrative and Lifestyle Medicine in your research or practice of physical therapy?

A: As a wound management specialist, I have a deep appreciation for all the factors that influence risk of wounds and delayed healing. Many of these factors are modifiable, for example, suboptimal nutrition and weight management, sedentary lifestyle, inadequate sleep, ineffective stress modulation, and of course, substance use. I have found that when I focus on the whole person, and not just the wound, treatment outcomes are improved. More than that, people benefit in terms of increased quality of life and decreased chances of recurrence or future health issues.

Q:  What do you think the biggest challenge facing physical therapists is today?

A:  Many of our patients present with very complex issues. Often, the primary reason they are seeking physical therapy is compounded by other conditions and chronic diseases, such as hypertension, heart disease, diabetes, and mental health concerns. At the same time, PTs and other healthcare professionals face tremendous administrative burdens. Unreasonable documentation and billing standards, as well as lack of fair payment for services, places us under a lot of stress. There’s a limit to how much we can bear before experiencing our own health challenges. This makes self-care and professional advocacy essential.

Q: How do you think we can overcome or navigate this challenge?

A: There are several ways we can overcome the challenges faced in contemporary practice. First, educate consumers about the value of our services. This empowers our patients and clients to recognize and insist on proper physical therapy services when indicated. Second, although I usually avoid political topics, within the United States, politics and healthcare are undeniably linked. That means that PTs need to be well informed about laws and policy changes that affect provision of care. Collectively, we can band together to tell legislators how their decisions affect ourselves and our patients. Among developed nations, the US ranks first in healthcare expenditures and last in key health outcomes. PT professionals are optimally positioned to have a significant impact on common health risk factors for chronic non-communicable diseases that drive up costs of care. It’s past time that we were recognized for our ability to prevent and mitigate prevalent causes of morbidity and premature mortality.

Q: If there was one thing from your chapter of the book that you thought everyone needed to know, what would it be?

A: Nicotine is a highly addictive substance. However, most people who smoke or use tobacco products would like to quit. Lack of self-efficacy is often the biggest barrier. To the extent that nicotine affects tissue healing across all systems, PT professionals need to be prepared to address tobacco cessation as a component of a holistic and effective plan of care. Brief tobacco cessation counseling interventions can be delivered in as few as 5-7 minutes. This does not even have to occur all during the same session. In fact, dividing the intervention over several visits may allow for better follow-up and increase patient motivation to successfully quit.

Q: What do you think people should really know about ILM – if you could only give them ONE tip? 

A: ILM is not really a foreign concept. When physical therapy committed itself to using a biopsychosocial approach, it inherently committed to integrative lifestyle medicine. ILM enables us to address essential contextual components of patient management that contribute to optimal prevention and recovery.

Q: What song do you think represents physical therapy from your point of view?

A: This is a great question! I would have to choose Stand by Me by Ben E. King. Physical therapy professionals are privileged by patients’ trust in us to stand by them during very challenging circumstances in life. Our presence and professional expertise helps reduce fear and helps them find their way on the road to recovery.

Q:  Is there anything you want to add about the whole person approach? 

A:  The opportunity to contribute to Integrative and Lifestyle Medicine in Physical Therapy was incredibly rewarding. It combined some of my greatest passions in terms of prevention, wellness, and rehabilitation and addresses key topics in contemporary practice. I strongly recommend it to both students and practicing clinicians.

Thank you Rose for all your support to our profession and giving your students the tools to treat their patients using the whole person approach with Integrative and Lifestyle Medicine.

Want to learn more? Read this short interview with Dr. Nola Peacock on Why Patient Collaboration is Key in Physical Therapy