Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Physical Therapists

Physical therapists are in a special position to promote the health of their clients, especially post-surgery or injury, and thus significantly reduce smoking among their clients.

The facts about smoking

  • Smoking impacts the speed and quality of recovery from injuries, illnesses, and other chronic conditions.1
  • Studies have demonstrated that current smokers have 44% fewer years of healthy life than individuals who have never used any substances.2
  • Individuals with disabilities typically have higher smoking rates than those without disabilities.2
  • Studies have shown that when smoking cessation interventions are administered from two or more health care providers, patients are three more times likely to make a quit attempt.2

The effects of tobacco on the body2

  • The effects of smoking on the lungs are well documented.  However, the physiologic effects of smoking on other parts of the body are of particular importance to physical therapists.
  • Smoking interferes with oxygen transport by reducing the proliferation of red blood cells.
  • Smoking decreases concentrations of antioxidant vitamins and nutrients, including folate and riboflavin, vitamins E and C, and melatonin.
  • Smoking leads to tissue damage through rapid vascular aging.
  • Tobacco use hinders tissue healing.
  • Tobacco use also suppresses immune response.
  • As people age, tobacco use may negatively affect balance and lead to reduced strength.
  • Nicotine can cross the blood-brain barrier and have a negative effect on brain circulation.
  • Research has shown links between smoking and increased instances of chronic pain.

The role of physical therapists in smoking cessation2

How can physical therapists help patients quit smoking?

  • There are several aspects to the therapy environment that make it an ideal setting for a smoking intervention: 
  • Physical therapists normally have frequent follow-up visits with their patients over an extended period of time to carry out their routine therapy exercises.
  • Visits with patients are personalized, which allow physical therapists an opportunity to build rapport with their patients.
  • Physical therapists center their sessions on patient education of their particular illness, injury or chronic condition.
  • Smoking questionnaires can help physical therapists identify smokers, their level of addiction, and their intention to quit.
  • Once smoking has been identified, the physical therapist may encounter “teachable moments” for patients in need of smoking cessation counseling in outpatient and inpatient settings.
  • Through coordinated planning, the physical therapist and physical therapist assistant can work together to set and meet goals for tobacco cessation in their patients.

The 5 A’s, outlined here, provide a guideline for physical therapists to address smoking with their patients.

Physical Therapists can assist with patient smoking cessation by1:

  • Incorporating tobacco assessments within the regular physical therapy appointments.
  • Providing ongoing support during the cessation process.  Building rapport with the patient after several routine visits can allow the physical therapist to monitor and assist the patient throughout their attempt to quit smoking.
  • Creating specific interventions that suit the individual needs of each patient.  After multiple follow up appointments, the physical therapist is able to develop a cessation plan and provide advice based on the learning style of each patient.
  • Including patient education about the health effects and consequences of smoking.  The physical therapy practice is centered on the patient and education, which will allow the physical therapist to include smoking cessation advice within the physical therapy education.
  • Keeping the patients’ other providers and specialists updated throughout the process.

Physical therapists can help their patients with smoking cessation even if they are not comfortable with counseling their patients. Physical therapists can screen their patients and provide them with smoking cessation resources, include the Maryland Quitline.1

Smoking cessation and athletes

Addressing smoking cessation in athletes

The Agency for Healthcare Research and Quality recommends that all any patients who smoke should be offered nicotine replacement therapy, social support, nutritional counseling, and physical activity training from health care providers, including physical therapists.2

There are several benefits of exercise to current smokers, including athletes receiving physical therapy2:

  • Studies show that smokers involved in physical activity typically live longer than smokers with a sedentary lifestyle.
  • Exercise reduces the risk of cerebrovascular disease and lung cancer in smokers.
  • Smokers who engage in regular physical activity are shown to have enhanced peripheral blood flow.
  • Physical activity can decrease vascular resistance in current smokers.

Physical Therapists can play a significant role with monitoring the physical activity of patients attempting to quit smoking.2

  • Physical therapy exercises stimulate endorphin release.  This process can help reduce nicotine withdrawal symptoms, cravings, and negative changes in mood.2
  • Exercise contributes to increased blood flow to the skin and other parts of the body to enhance the healing process.3

Smoking cessation and inpatients

Addressing smoking cessation in inpatients2

  • According to the Joint Commission for Accreditation of Healthcare Organizations’ operating guidelines, smoking cessation counseling must be provided for inpatients who are hospitalized for community-acquired pneumonia, acute myocardial infarction, and congestive heart failure.
  • A recent study revealed a smoking prevalence rate of 10.3% in an inpatient rehabilitation population.
  • Approximately 54.5% of patients who smoked prior to admission to the hospital resumed smoking after discharge, even when they had not smoked for an average of 40 days prior.
  • It is recommended that physical therapists emphasize smoking cessation with their patients after discharge from the inpatient setting.

Smoking cessation and trauma patients

Addressing smoking cessation in trauma patients4

  • A neurologic physical therapist is a physical therapist that specializes in the evaluation and treatment of individuals with movement problems due to disease or injury of the nervous system.4
  • Physical therapists who specialize in neurology work with a range of conditions that includes spinal cord injury, multiple sclerosis, Parkinson’s disease, and brain injury resulting from trauma.4
  • Results of a recent study with trauma patients showed that a smoking history was only taken from 66% of patients.  Of those patients, only 54% had been advised to stop smoking.  Motivation to stop smoking was only assessed in 4% of patients.5
  • Physical therapists should incorporate the 5 A’s in order to better serve the needs of their patients.5

Resources

The American Physical Therapy Association's Advocacy webpage includes Women's Initiatives related to lung cancer and smoking.

The American Physical Therapy Association of Maryland, Inc. provides more information for physical therapist and their role to assist patients with smoking cessation.

The Fax to Assist and the Fax Referral Program can be helpful resources for HIPPA-covered facilities to further assist patients with smoking cessation.

 

Did you know that the Medicaid population is significantly more likely to use tobacco than the general population? Do you want to enhance your skills at reaching and intervening with Medicaid patients who use tobacco? MDQuit has an online training to teach you the strategies that can be utilized with all patients—regardless of their health insurance status. You can sign-up for this FREE self-paced online training by going to https://HABITSLabTraining.litmos.com/self-signup/ and entering the training code, "medicaid". 

 
References: 
  1. Bodner, M. E., & Dean, E. (2009). Advice as a smoking cessation strategy: A systematic review and implications for physical therapists. Physiotherapy Theory & Practice, 25(5/6), 369-407. Retrieved October 2, 2012 from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=2fa1c03a-ca6f-492...
  2. Pignataro, R. M., Ohtake, P. J., Swisher, A., & Dino, G. (2012). The role of physical therapists in smoking cessation: Opportunities for improving treatment outcomes. Physical Therapy: Journal of Physical Therapy Association, 92(5), 757-766. Retrieved October 2, 2012 from http://ptjournal.apta.org/content/92/5/757.full.pdf+html?sid=57bf0c1c-21db-4cd6-8c8d-150b3aeb142a
  3. Emery, C. F., Kiecolt-Glaser, J., Glaser, R., Malarkey, W.B., & Frid, D. J. (2005). Exercise accelerates wound healing among healthy older adults: A preliminary investigation. Journal of Gerontology: Medical Sciences, 60.A (11), 1432-1436. Retrieved October 2, 2012 from http://biomedgerontology.oxfordjournals.org/content/60/11/1432.full.pdf
  4. American Physical Therapist Association. What is a neurologic physical therapist. Retrieved October 18, 2012 from http://www.neuropt.org/index.cfm?objectid=ce822d72-a91d-4774-fc6db4ffdeb...
  5. Battersby, C., Jermin, P., Haigh, G., & Towers, T. (2011). Clinical experience of smoking cessation advice in hospital trauma units. European Journal of Orthopaedic Surgery & Traumatology, 21(6), 453-456. doi:10.1007/s00590-010-0733-2