Theory-informed clinical practice: How physical therapists can use fundamental interventions to address social determinants of health

The APTA’s Vision Statement for the profession is guided by principles of innovation, access, equity, and advocacy, which calls on physical therapists to stretch their influence beyond the walls of the clinic and the individuals they treat. Access and equity are problems that span multiple health care professions and entities; yet, addressing social determinants of health (SDOH) is a paradigm shift that clinicians’ need continued support to achieve. This paper has two objectives: (1) to define the Fundamental Cause Theory (FCT) and the Socioecological Model (SEM) within the context of physical therapy in order to promote best clinical practice and (2) to apply the concept of “fundamental interventions” in clinical practice to mitigate the negative impact of downstream effects of social determinants of health across levels of the SEM–individual, interpersonal, institutional, community, and societal. This theoretical lens provides the conceptual framework necessary for physical therapists to think creatively about ways to change their practice in their own contexts to impact the life of individual patients and transform the movement health of society.

Impact
As health care providers, physical therapists have a responsibility to make every effort to meet the needs of their patients and optimize movement health in society; yet significant structural and systemic barriers often prevent patients from reaching their fullest potential. Clinicians can no longer subscribe to a narrow scope of practice focused on individual attainment of therapy goals. This Perspective discusses FCT and SEM theoretical frameworks that can help physical therapists develop, test, and implement functional interventions to address the needs of society as a whole.