Tobacco Cessation Counseling Within Physical Therapist Practice: Implementation of the US Public Health Service Clinical Guidelines ("The 5 A's")

Smoking remains a leading public health threat. Among people with disabilities, smoking prevalence is 10% higher than non-disabled peers. Physical therapists have a unique opportunity to address smoking-related health outcomes within this population through implementation of evidence-based guidelines for tobacco cessation counseling (TCC). This study investigated current practice regarding TCC as a component of physical therapist (PT) practice, as well as potential barriers towards implementation of the United States Public Health Service Guidelines for TCC, commonly known as “The 5 A’s.” An anonymous state-wide survey was conducted in Fall 2014.  Of 220 licensed PTs throughout Florida, fewer than 20% reported prior TCC training. Less than 3% had received training in how to screen for nicotine addiction, and the vast majority (94%) were unfamiliar with “The 5 A’s.”  Only 31% reported that they regularly recommended cessation for patients who smoke. However, 74% agreed that all patients should be screened for tobacco use, and 69% believed PTs should provide TCC.  Individual barriers to provision of TCC included anticipated patient disinterest (41%) and time constraints within the clinical setting (28%).  Systems barriers included absence of dedicated personnel (71%), written patient education materials (68%), screening methods to identify patients who smoke (47%), lack of coordinated referral efforts for tobacco cessation support or interprofessional consultation (78%), and lack of administrative support for TCC (85%).  By elucidating need for improved practice, as well as potential barriers, this study forms the basis for professional education and systems modification to promote TCC as a component of PT services.