Rupal Patel is a physical therapist and professor at Texas Woman’s University. Lisa VanHoose is the physical therapy program director at the University of Louisiana Monroe and owner of the Ujima Institute. Zachary Rethorn is a Faculty Development Resident at Duke University, owns his own telehealth practice called Rethorn Physical Therapy and Practice and current PhD Student in health promotion and wellness.

Rupal, Lisa, and Zachary spoke together at CSM in Denver on their presentation “Better Together in Diversity, Equity, and Inclusion: Engaging Diverse Populations to Improve Rehabilitation Outcomes.”

To breakdown DEI, diversity are all the components that create a person. Equity is those opportunities or objects that become fit for an individual. Inclusion is welcoming the diversity of others.

Discussing public health issues, these begin to include people with disabilities, lower literacy, language barriers, and communities with minimal opportunities. The communities that integrate DEI into their culture demonstrate less gap between high-income and low-income individuals.

There are different factors that affect health – 40-50% of health is related to our social context and environment. Healthcare and access to healthcare is at most 20% of health. Our health behaviors make up the rest of the 30-40%.

The panel believes clinical practice will begin to shift by diving deeper into a patient’s social environment as health begins in those social contexts. The biggest barrier is starting the conversation. Someone’s own self efficacy and self-confidence can get in the way of addressing the sensitive issues of our patients.

The Health Leads Social Needs Screening Toolkit helps clinicians to take those steps to understand a patient’s social needs. The AAFP has a Neighborhood Navigator Tool and the website are great ways to connect patients with supportive resources in their community.

To improve physical therapy outcomes, looking “upstream” means to consider other factors that could be contributing to a patient’s health rather than solely looking at the condition or chief complaint. Check this TED Talk about upstream medicine and how upstreaming can improve your patient’s outcomes.


11:43 “Voting rights are a public health issue.” – RUPAL

16:22 “So everyone brings diversity into a room with them. It’s just whether or not we recognize it.” – LISA

19:23 “An inclusive group by definition can be diverse, but a diverse group is not always inclusive.” – RUPAL

23:02 “Why do we treat people and then send them back to the very condition that made them sick.” – ZACHARY

27:45 “The folks that have had enough, they don’t need to listen. I think there are plenty of folks who want to listen and learn.” – RUPAL

45:30 “You are the average of the 5 people that you spend the most time with.” – LISA


1:05:15 “Sometimes people are taking the action because they need to be seen and heard.” – LISA

1:05:43 “Our environments cultivate our communities, and our communities nurture our health.” – RUPAL

1:06:16 “I got three ‘what if’s’- ZACH

1.       What if we continue to embrace the patient client relationship and start seeing our communities as our patients as well?

2.       What if we framed our framed not just as one to one, but one to many?

3.       Finally, what if we recognized that your zip code may be more important than your genetic code and your social environment is going to trump any treatment that we are going to offer in the clinic.”