The OT Journal Club

-Journal Club (JC) host-  Abigail Brown - Specialist Mental Health Occupational Therapist (UK), providing inpatient rehabilitation.

-Research title-  The cost of inaction on physical inactivity to public health care systems: a population-attributable fraction analysis

-Research authors-  Costa Santos, A., Willumsen, J., Meheus, F., Ilbawi, A. and Bull, F.C.

-Journal of publication-  The Lancet Global Health

-Publication date- January 2023 (Volume 11, Issue 1)

>> A link to the full article can be found at the end of this JC

-Background-

Most countries are falling behind on their commitments to the 2030 UN Sustainable Development Goal (SDG) 3.4, to reduce by a third the premature mortality from non-communicable diseases (NCDs) - the leading cause of death and ill health globally. Physical inactivity is a major modifiable risk factor.

The study aimed to estimate the public healthcare costs associated with these diseases because of physical inactivity, to help policy makers prioritise investment in enabling people to become more active.

-Methods-

A population-attributable fraction formula was used to estimate the direct public healthcare costs. Physical inactivity was defined as not meeting the WHO physical activity recommendations: for adults, at least 150 minutes of moderate-intensity aerobic physical activity, or at least 75 minutes of vigorous-intensity aerobic physical activity per week.

-Implications-

This is the first global study to provide estimates of the number of new cases and associated public healthcare costs that would occur from 2020 to 2030, that could be prevented if levels of physical inactivity were reduced or eliminated.

This study provides new population-attributable fractions for seven health outcomes and mental health conditions - coronary heart disease, stroke, type 2 diabetes, cancers (breast, colon, bladder, endometrial, gastric, oesophageal, and renal), depression and dementia - with strong evidence for the association with physical inactivity.

This data will equip policy makers with evidence to inform and advocate for greater investment in policy interventions that increase physical activity levels. This study calls for urgent action by countries to prioritise investments in interventions that reduce this modifiable risk factor. WHO's Global Action Plan on Physical Activity provides clear guidance on evidence-based policy recommendations, which - if implemented by countries - will improve health, reduce the burden on health systems and save money.

-Limitations-

The methodology of using weighting factor to extrapolate costs is arguably the best available approach, as a proxy to calculate health-care costs in lower-income settings; however further methodological development is required.

Unfortunately, this study lacks a focus on exploring the interventions required to support policy makers to initiate changes in practice. Consequently, there is a need for further research to apply the findings to clinical practice.

-JC host's rationale for article selection-

I work in a mental health rehabilitation ward. We find that the focus of care is based on a medical model and with limited resources directed towards therapy (both psychological and occupational) and improving physical activity. There is a lack of therapy input given a focus on diagnoses and medication, rather than prevention and health promotion.

This article has provided me with further research, on a global scale, to support with my case for requesting further funding for occupational therapy supporting roles within my team. I plan to complete a quality improvement project, to demonstrate the value of health prevention through developing a consistent ward routine of physical exercise and other rehabilitation activities (e.g. health promotion education and skills sessions). I will use outcome measures (clinician and patient-rated assessments) to assess the impact of this project.

-Original journal article-