Understanding the Muslim Community From a PT-Specific Lens
By the year 2040, Muslims are projected to become the second largest religious group in the U.S. (Pew Research Center, 2018). Currently, the Muslim population faces health inequities, part of which stem from discrimination and a lack of religious accommodation in clinics.
Given the growth rate of the Muslim population, it is inevitable that the proportion of Muslim patients requiring physical therapy will similarly grow. Physical therapists and physical therapist assistants must therefore equip themselves with information that will help them to best address the needs of this population.
If health care practitioners fail to understand the sociocultural influences of a patient's condition, they may fail to successfully treat that patient. According to three published studies, Ethnicity & Disease: "Provider Factors Affecting Adherence: Cultural Competency and Sensitivity" (2009); Health Affairs: "Cultural Competence and Health Care Disparities: Key Perspectives and Trends" (2005); and Medical Care: "Physician Communication and Patient Adherence to Treatment: A Meta-Analysis" (2009), when patients perceive poor communication and a lack of congruency between their goals, values, and experiences, and those of their health care providers, patients may be more likely to delay care, be nonadherent, and distrust the health care system.
Today, Muslims in the U.S. may feel unwelcome in clinics that are not culturally competent in addressing their needs in the context of religion, as reported in a 2012 study published in the Journal of General Internal Medicine: "Religious Values and Healthcare Accommodations: Voices From the American Muslim Community." Patients should not have to educate health care providers who may not be aware of their faith requirements, but clinicians should ask the patient for guidance when needed. This way it creates an opportunity to ensure that their needs are met. It's important for PTs and PTAs to educate themselves about the needs of their patients who identify as Muslim to ensure that patient-centered care remains our profession's priority.
I chose to address this topic because I am a bridge between two worlds. I am both a devout Muslim woman and a second-year physical therapy student at Wayne State University.
I pursued physical therapy as a career in part due to the health needs of my community. Too many stories have come up about how fellow Muslims did not feel comfortable, accommodated, or accepted in clinical settings. In order to better care for Muslim patients, a basic awareness of their values and experiences is necessary.
Although we cannot say that every Muslim practices Islam the same way, there are certain behavioral trends in religious practice that PTs and PTAs should be aware of in order to provide the best care. Based on my experiences, I have compiled a few key considerations for therapists who directly influence patient care: modesty customs and the concept of spiritual activities of daily living.
At this point, I think that it is appropriate to mention that accommodation of different customs and traditions, be they of religious origin or otherwise, is not tantamount to endorsement of those customs and traditions.
As professionals, our role is to meet patients with our expertise in order to fulfill their needs and improve their health. This expertise should not conform to a single value system; rather, it should be adaptable to meet the needs of any patient who seeks our aid.
With this in mind, and considering the diversity of our patient populations, it is important for PTs and PTAs to create opportunities for patients to share their cultural needs instead of leaving it up to patients to find an appropriate moment to interject.
Since it may not be obvious that someone is Muslim, a few ways to ensure that any patient's religious values are met are to ask before an evaluation, "Is there anything my team and I can do to make you more comfortable?" or "Are there any religious, ethnic, or cultural values that you would like me to know about prior to beginning treatment?" These statements can serve as general additions to all patient interviews and are inclusive enough to apply to all patients.
Modesty is a general ruling for both men and women in Islam. This includes both being alone with a person of the opposite sex as well as concealing one's body parts. However, in a health care setting, health needs supersede those of modesty. Therefore, it is permissible for men and women to expose body parts in such settings.
In general, a Muslim patient will prefer to be treated in a private area by a therapist of the same sex. Most clinics are already equipped to fulfill these needs, as most have private spaces or curtains to draw around treatment tables. If these are not readily available, portable privacy screens may be purchased to serve the same purpose.
Although Islam has rulings of modesty, it is flexible toward the health needs of Muslims. In the rare instance in which no accommodations can be made, the health needs of Muslim patients supersede modesty, and it is permissible to proceed with care if the patient consents. However, PTs and PTAs should try as best as possible to make their patients comfortable during treatment; this is true for all religious affiliations. After all, an act as simple as keeping a door closed or a curtain drawn is truly appreciated by any patient in maintaining privacy and dignity.
Spiritual activities of daily living (ADLs).
One concept that is notably absent from physical therapy dialogue is the impact of health problems on spiritual or religious practices, such as kneeling in prayer. I have come to think of these as spiritual ADLs. Before getting into the specifics for the Muslim population, spiritual ADLs may be introduced into conversations with a simple question that may apply to people of all backgrounds. For example, while inquiring about difficulties with ADLs during an evaluation, a therapist may ask, "Are there any spiritual or religious activities in your daily life that have been affected by your symptoms?" This would open the door to patients sharing their customs, ranging from religious prayers to meditation.
For Muslims specifically, prayer and ablution (wudu) are spiritual ADLs of utmost importance. Muslims have five prayers that are interspersed throughout the day. The first is prayed before sunrise and the last is prayed in the night. From a PT perspective, the aspects that are most important for rehabilitation are the physical movements required for a successful prayer. The image below highlights the common positions of prayer and should serve as a baseline awareness of the movements required. It is also important for PTs and PTAs to recognize that some of these movements may be unattainable to patients, and they can be modified.
For example, patients who cannot pray standing may pray seated. There are countless modifications that can be made based on an individual's movement capacity. If faced with this, PTs and PTAs may discuss these issues with their patients and work together to modify the motions of prayer to suit patients' current abilities and future goals. In case of doubts, patients can be encouraged to speak about the permissibility of specific modifications with local religious leaders.
Another key consideration is wudu, or ablution. Wudu is the practice of cleaning and purifying the body with water in preparation for prayer. It entails cleaning the hands, mouth, nose, face, forearms, hair, ears, and feet. Once again, the important part for PTs to recognize are the movements required to complete wudu. As long as the body parts are washed, body position does not matter. Therefore, if patients identify wudu as an area of struggle, PTs may work with them to understand what difficulties are experienced and to brainstorm ways to make the task easier.
Although I can do a great deal to help my community, I cannot address everyone. The physical therapy community must contribute to this process. Islam is a religion that respects health and encourages health-seeking behaviors. Having health care providers who have awareness of Islamic values allows Muslim patients to better improve their health.
This article provides a basic awareness of religious and cultural considerations for the Muslim population in health care settings from a PT-specific lens. Its implementation serves as a step forward in inclusivity and cultural competency and brings us closer to achieving the APTA vision of transforming society by optimizing movement to improve the human experience.
APTA is committed to fostering a culture of diversity, equity, and inclusion within our community. This is a journey and that journey needs your perspective and support. If you have ideas to increase diversity and promote equity and inclusion, email us at firstname.lastname@example.org.
Bana Odeh, SPT, is a student at Wayne State University and a member of the Michigan Physical Therapy Association's Diversity, Equity, and Inclusion Committee. You can connect with Bana at email@example.com.
Four Things Good Physical Therapists Understand About People With Chronic Conditions
4 minute read
In the decade since being diagnosed with multiple sclerosis, I've seen a number of physical therapists.
And in that time I've realized that the best PTs have understood that working with patients with chronic conditions involve a different mindset from the traditional physical therapy patient.
Given that the typical course of physical therapy treatment is limited in sessions, one of the most beneficial things that PTs can do is give patients with chronic problems information, support, and guidance beyond the exercises themselves that patients can continue to use on their own. In other words at some point, because of the frequent mismatch between the amount of treatment needed and the amount covered, patients with chronic conditions are likely to have to become their own PT. To the extent that they can understand the thinking behind a course of physical therapy, it can help them be more successful on their own.
I realize that patients vary in how active they want to be in managing their condition. But for me, living with an unpredictable chronic problem is both tedious and frustrating, and I am eager to do anything that I possibly can that may help me to live a full, quality life.
I know others with MS who feel similarly. As such, rehabilitation goals may be different for people with chronic conditions, and success may have a different definition. Especially for people with degenerative diseases, even if we can't get back to normal, we still value maintaining function and any improvement, even if small. Many of us are not looking to run marathons or climb mountains; we are looking for better balance and mobility as we navigate our homes, stores, and other ordinary spaces.
The following is my insight for today's students and future clinicians for working with patients whose problems will likely outlast the course of treatment. While my points may apply to any patient, those with chronic conditions may particularly benefit from feeling like a true partner in the rehabilitation process.
It helps to know why I'm doing a particular exercise, and what it is supposed to accomplish.
When my shoulder froze a few years back, I didn't want to know the details of shoulder rehabilitation. I believed my shoulder would eventually get better and just wanted to get it working again. But I've had MS long enough to realize that maintaining functionality over time requires active involvement and thought on my part.
If I know how and why a particular exercise strengthens a given muscle or supports balance, it helps me stay focused. As I've discovered, it's easy to do an exercise wrong. Knowing why I'm doing it reminds me do it correctly.
It helps to see exactly how I need to change what I'm currently doing.
Partly because MS can affect proprioception and partly because I never paid attention to the mechanics of movement before my diagnosis, sometimes I'm not clear on how correct movements are supposed to feel or look. I don't realize what I'm doing incorrectly.
For example, I found that I can get by without using core muscles. It took me a long time to sense what an engaged core feels like and to understand how it assists me in moving more efficiently.
What may seem obvious to a PT is not always obvious to me. So for key movements, showing me what I am doing wrong, and perhaps filming me for a few seconds with my phone, will make things much clearer to me. Along those lines, the more you can show me how movements should look using skeleton or muscles models, the more I'll grasp what you are saying.
It helps if you can point out what look like bad habits.
In my case, bad habits of movement and posture predated my MS diagnosis. Although these habits feel difficult to change, mentally it is easier to think that I am working on a habit rather than only addressing neurological damage.
People with MS often get into a pattern of thinking that everything is an MS-related problem; sometimes we need reminding that it's not.
Pointing out any improvement, no matter how small, is a morale booster.
With a chronic condition, improvement is often incremental and undramatic. During a short course of physical therapy, change may be limited. However, I appreciate recognition of any progress, and it helps me build a sense of confidence and control. With the subtypes of progressive MS, little improvement is expected, so any change for the better, no matter how small it seems, is a big deal.
One frustrating aspect of conditions like progressive MS is the lack of a direct relationship between the amount of effort that goes into rehabilitation and the results. However, working with patients like me to develop a sense of understanding of what they are doing and to see the control they can have, can help keep them motivated long after the formal course of therapy ends.
Joan F. Peters, JD, MPH. Connect with Joan via email at firstname.lastname@example.org.
Podcast: Payment, Policy, and You: Ethics and Best Practices
Listening Time — 40:05
Value. Data. Ethics. Professionalism. Patient-centered.
These are all things today’s clinicians must account for in all settings, but what does it mean for you as current students and future clinicians?
In this episode, we talked with APTA payment and regulatory staff expert Kara Gainer, and physical therapists Bud Langham and Hannah Johnson on what students should know about the health care landscape, payment, and ethical practice, and included advice on things like documentation, ethical decision-making resources, and how to navigate tough conversations all while providing quality care to your patients.
Here’s our conversation with Kara, Bud, and Hannah.
To learn more and view APTA’s latest resources and information on payment and regulatory issues visit APTA.org/Payment.
APTA Podcasts like this one are available on Apple Podcasts, Google Play, and Spotify, or by visiting APTA.org/Podcasts.
Call for volunteers for 2020 House of Delegates
We are seeking student volunteers to serve as ushers at the 2020 APTA House of Delegates in Phoenix, Arizona, June 1-3, 2020.
As an usher, you will have the opportunity to see how the physical therapy profession governs itself and sets professional policies. You’ll get a first-hand look at APTA’s House of Delegates, a policymaking body of the association, and have the opportunity to learn from dedicated and experienced physical therapists as they set the professional standards for the coming year. This is a rewarding experience that many students have taken advantage of and this year, you can too!
If you are a student enrolled in a physical therapy or physical therapist assistant program and are interested in serving as an usher, please review the responsibilities and eligibility requirements before submitting an application online. The deadline to apply is Monday, March 30, 2020. If you have any questions please email email@example.com.
Putting Advocacy To Work at Federal Advocacy Forum
4 minute read
I have to be honest, I did not really know what APTA’s Federal Advocacy Forum was when I registered to attend in 2019. All I knew was that it was the place to be if you wanted to be involved in professional advocacy, which was really great because my passion for advocacy was growing stronger every day.
Admittedly, I was both very interested and very nervous.
I didn’t know if I was prepared enough to talk to senators and representatives about the legislative issues currently happening regarding our profession.
I tried my best to stay up to date with those efforts and to think of ways that I could make them stand out when talking to politicians. That brought another problematic thought to my head though.
At the time, I was a second-year physical therapy student and I had not yet been on any full-time clinical affiliations. I wasn’t sure if I had enough experience to speak to any of the pressing issues we’d be discussing.
Even with all of that uncertainty I wanted to go and experience #PTAdvocacy in action and learn where I fit in to all of it.
Upon arrival at FAF, I immediately felt a different atmosphere than other professional conferences. Everyone was there for a reason and had a task to accomplish. That feeling was inspiring! I felt that I was part of a group with a true purpose.
I had been learning in my classes about the many fights that the physical therapy profession had won impacting our scope of practice, patient access, payment, and more. The most notable of those being the repeal of the Medicare therapy cap, which was a long-fought initiative that paid off in 2018. But what I was really learning was that there were still many initiatives that needed a lot of work and advocates behind, and I knew that I wanted to be one of them. I was ready to start advocating for my profession and showing everyone the breadth of what we can do.
The first thing that I learned was that it didn’t matter how much I knew about policy and legislation. As long as you came with a passion for your patients and the future of our profession, you would make a definite impact.
The speakers did a great job of preparing everyone for their meetings with legislators. They went over everything from the best way to communicate during our upcoming meeting with legislators to the best entrance to use to get into the building quickly.
One of the issues of focus at FAF 2019 was the ways to lessen the burden of student debt. We talked a lot about the newly proposed bill to add physical therapists to the National Health Services Corps. As a student, it was great to hear that our professional organization was taking this problem seriously. It almost felt that this was meant to be who better to talk about student debt than me, a student, who was being impacted by it in real time. I knew at that moment that I had something significant to add to this experience.
After a couple of days of learning as much information as we could about professional advocacy, policy priorities for APTA and the profession, and prepping for our meetings with legislators it was time to meet with our senators and representatives.
Since I am from a small state (shout out to Rhode Island!), I had the unique opportunity to be a part of a small group meeting with all of our state legislators. We made sure to talk about the NHSC bill and the many positive changes it could make for our country and our state. We also made sure to highlight the #ChoosePT campaign and the impact that physical therapy has had on the opioid crisis as well as the improvements this bill could have on student debt. Rhode Island sadly has a very serious problem with opioid overdose deaths, and listing PTs in NHSC would add our profession to our local community health centers and bring more resources to those who may not be able to access them otherwise. Our meetings were very successful, not only for communicating our information, but also for fostering relationships with our state legislators that will hopefully continue in the future. It was an unbelievable experience to be in those meetings, talking to our legislators, and putting #PTAdvocacy to work!
So, should you attend the upcoming Federal Advocacy Forum? Yes. Should you be worried that you do not have enough experience with legislation or advocacy? No. Do you need to have years of professional experience to be to make an impact? Definitely not. All you need is a willingness to learn about our current legislative efforts and a passion for improving the future of our profession.
Join us March 29-31, 2020, in Washington, DC, for APTA’s Federal Advocacy Forum. Registration is open now through March 16.
Erin Sayles, SPT, is a student at the University of Rhode Island and serves as the chair of the APTA Student Assembly Advocacy Project Committee. You can connect with Erin on Twitter at @ErinSaylesSPT.
A Conversation on Advancing Diversity, Equity, and Inclusion
2 minute read
These second-year students from Sacred Heart University in Connecticut discussed efforts to advance diversity, equity, and inclusion within the profession, while sharing their experiences and insights as students who identify as members of racial or ethnic minority populations.
Here are just some of the highlights from their conversation.
Do you think that being a minority will help you become a better physical therapist?
I feel as a minority, I am able to listen to those who feel like their voices are not being heard and am able to give them quality treatment that they might not be receiving from others. Being a minority student in the clinic, I feel like I helped others who were minorities by inspiring them to become physical therapists or to be more involved in physical therapy treatment sessions – now that they see somebody who looks something like them and can relate to their struggles.
– Tyler Lee
How do you think being a minority student has helped you in the clinic?
Personally, being a minority I know how it feels and how people sometimes look at you or talk down to you, so I take that into consideration while I treat patients and try to do the opposite of that and treat everyone fairly, equally, and with the same amount of respect.
– Lizzie Klein
A lot of our professors talk about treating patients equally, no matter what their ethnicity or background is, so I think I brought that into my clinical rotations. And also – being diverse myself – helps me become even more-open minded when treating patients.
– Abby Wolfin
How do you think that you can make the profession more accessible to the minority community?
In order to do that as minorities in the profession, I think that we need to make our voices heard outside of the community of physical therapy. So if we make our voices heard, then minorities will feel more comfortable coming in for physical therapist services and then everybody will benefit.
– Abby Wolfin
How can you as a minority student help make APTA more of an inclusive organization?
For me, being able to make APTA more inclusive is through informing younger people who are possibly looking at this as a profession, that it can be done. And there are people who are actually in the field making them more confident and comfortable that they will want to pursue this as a potential career option for them.
– Jair Davis
As a minority student, how has your university supported you?
At SHU, we have a board for each class and I am part of that. I think that Sacred Heart has helped me become more inclusive in everything because the board was elected by our fellow classmates, so everyone had an equal chance to get the positions.
– Lizzie Klein
Speaking about the APTA Vision and minority specific health issues:
There are certain health issues that plague minority communities. And so, as a responsibility of APTA and as physical therapists, we can use our knowledge and our assistance to better those communities.
– Patrick Seweje
APTA is committed to fostering a culture of diversity, equity, and inclusion within our community. This is a journey – and that journey needs your perspective and support. If you have ideas to increase diversity and promote equity and inclusion, email us at firstname.lastname@example.org.
(From left to right: Second-year SPTs Patrick Seweje, Jair Davis, Lizzie Klein, Abby Wolfin, and Tyler Lee)
A Balancing Act: Choose You
3 minute read
You’ve made it into physical therapy school. Between the schoolwork and your personal life it can be difficult finding balance. Perhaps you’ve figured it out or maybe you’re still fine-tuning it. I’m in my last year of school, and with each rotation I find new challenges as life, clinic, and I evolve.
By now you’ve likely heard of burnout and ways of preventing it. That starts even now, in school. Not only should you provide optimal care, but taking care of yourself is just as vital. It’s going to look different for each person. According to a May 2019 USA Today article by Dalvin Brown, the World Health Organization recognizes burnout as an official medical condition. WHO describes burnout as “feelings of energy depletion or exhaustion” (prolonged studying can easily do that); “increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job” (maybe you’re not here yet, but you may have had your doubts about school); and “reduced professional efficacy” (we’ve all had days where we just can’t anymore).
In one of my first rotations at a level 1 trauma hospital I ended up getting the flu. It started with a runny nose that could not have been more frustrating. After having to take regular tissue breaks and handing off the patient to my clinical instructor, I had to do something. My CI and I discussed how you make that decision between your health and the patient’s — how was up to me. I concluded that if I wasn’t able to take care of myself, how could I care for someone sicker than me? It was a grueling time off, despite it being the right decision in the end.
On another rotation in Europe, I fell ill (it’s a recurring thing with me, but at least it gives me pretty good immunity the rest of the year!). The exhaustion was bad enough. I was also concerned about infecting patients. It got to the point where I could not handle the psychosocial and physical stress after more than a week of chest wracking coughs and drainage. The amount of negativity going on in my head was overwhelming, especially at the thought of completing the final few weeks in my current state. Thankfully, my family understood and discussed my options. Despite my apprehensions, my program coordinator fully supported me and stayed in contact throughout the journey. The coordinator assured me that I could make up the time lost in the clinic and told me what paperwork would be needed to file with my school to facilitate the process. This was not an easy decision. However, my health had to come first, as I was only getting worse and my time in the clinic suffered.
I give these examples to highlight the importance of knowing your limits, which are especially evident in high-risk situations. However, I hope that you can make these assessments on a daily basis. Sometimes, you have to prioritize your own health and well-being in order to optimize your potential. So with the daily grind of school, I hope that you can give yourself grace through it all. All you can do is your best, which changes at any given time. There are many variables that factor into how much you can do physically and mentally at any given moment. If getting that muffin, attending that HIIT class, taking that nap, making that food, or spending some mind-numbing time doing your favorite chill activity is what you need to get through the day, I will be the first to cheer you on. I’ve been there. So many times.
School is tough, and so is the clinic. It’s all entirely doable. Remember to work on yourself now to start those positive habits. You’ve got this.
Sonali “Sonny” Aggarwal, SPT, is a third-year physical therapy student at the University of North Texas Health Science Center and a student worker in the Physical Therapy Department. Connect with Sonny via email at email@example.com.