What is physical therapy and why you should consider it

What is physical therapy (PT) and why you should consider it.

What is the profession of Doctors of Physical Therapy? 

Ever since the beginning of my career as a physical therapist (PT), there is one question my patients ask that has been most memorable – “What is physical therapy and how can you help me”? A valid question indeed, and one that should always be asked to any healthcare professional. Incidentally, this has been my most favorite question to answer over the duration of anyone’s treatment, and now I would like to attempt answering in a short sit down read. 

First and foremost, the profession of a licensed physical therapist begins with about three years of graduate schooling, which includes both didactic and clinical courses, similar to the all familiar medical school of four years. Upon graduating from an accredited school, students will receive their “Doctorate of Physical Therapy (DPT).” This means that graduates have been trained to assess, diagnose, and treat movement problems which cause functional disability due to a number of impairment factors ^1,2. To practice in any U.S. state, graduates will then be assessed on a national licensing exam,  in order to practice in their state of choice (additional testing requirements may vary by states) ³. Furthermore, PT’s are also qualified to complete referrals to other healthcare professionals if an issue is outside their scope of practice. In summary, PT’s are highly trained healthcare professionals requiring completion of a doctorate program, and passing a national licensing exam in order to practice in the U.S. 

What to expect from your first physical therapy session? 

Upon your first visit to any physical therapy session, questions about your injury and health history will be posed, followed by physical testing to arrive at a diagnosis. This part is most crucial in the beginning to formulate the correct anatomical injury, using both subjective and objective data related to your movement problem. This method follows a scientific method for diagnosing that has been researched and is evidence-based.  These steps will then lead to the best treatment options that will create a plan of care to follow for some frequency and duration of weeks. Further, it is best to have pertinent documents at hand that relate to the current injury (e.g. referrals or X-rays), and to wear comfortable athletic clothing at the initial evaluation.

A physical therapist’s scope of practice

Moving on to the “how” part of  our initial question: Currently PT’s are considered a type of “general practitioner,” in assessing movement dysfunction, and have the ability to practice in multiple settings. Depending on the setting, a PT will specialize in how to assess, diagnose and treat the type of injuries and conditions that setting has to offer. See below for bullet point summaries and click the following website for further access on which PT specialty may best fit you: Choosing Your PT – ChoosePT.com 

• Orthopedics – includes any type of neuro-musculoskeletal injuries, ranging from the sprained ankle, low back pain, vertigo, women’s health, to post-surgical rehabilitation. This may also include injuries to the nervous system with conditions such as drop foot, MS, and Parkinson’s, where some outpatient clinics may specialize in seeing only neurological impairments. 
• Acute Inpatient – this setting includes seeing patients at a hospital for short stay where the goal is to discharge them home safely, or to another facility for continued rehab. PT’s may encounter a range of patients for post-operative surgeries, transplants, cardiovascular injury, neurological injury, cardiopulmonary injury, and much more. PTs work in a multidisciplinary team to help consult on the best plan of care for every patient. 
• Inpatient Rehab – this involves patients who will require much rehabilitation on a daily basis (usually 3-5 hours), where it will also involve a multidisciplinary team of occupational therapists, speech therapists, social workers and medical doctors. The range of diagnoses may include: stroke, spinal cord injury, amputation, burn injuries, and much more. 
• Skilled Nursing – this setting involves PTs providing rehabilitation services to nursing facility residents on long-term stay, or residents who require further rehabilitation status post hospital discharge before returning home safely and more independently. 
• Home Health – this setting is for patients who require rehabilitation services from their home due to difficulty in getting to/from an outpatient facility on their own. The scope of injury could include difficulty in walking, transfers, neuro-musculoskeletal injuries, cardio-pulmonary issues, and more. 
• Telehealth for Physical Therapy – a relatively new setting utilizing virtual technology, and one that has gained more attention since the onset of the COVID-19 pandemic. This involves PT’s using real-time video technology, and/or asynchronous technology (email, video, text) in order to assess, diagnose and treat patients from their preferred location, but without physical contact. Currently, more musculoskeletal injuries may be consulted and treated through telehealth. However, more evidence-based research on the efficacy of assessing and treating through telehealth is still being done for PT providers ⁵. Nonetheless, patient satisfaction and return to PT telehealth still remain significantly high (92%) out of 3885 telehealth sessions ⁶_.

How do physical therapists work with other healthcare providers? 

Physical therapists are part of a large system of highly skilled healthcare providers who specialize in their respected profession. This multidisciplinary approach helps patients receive the best plan of care that is patient-centered, evidence-based, and allows for a holistic approach on each patient’s unique situation. Many, if not all PT settings, will be integrated with at least one other healthcare provider that may include, but not limited to: medical doctors and surgeons, nurses, nurse practitioners, occupational therapists, speech therapists, respiratory therapists, massage therapists, social workers, podiatrists, and psychologists. 

As mentioned above, PTs have the ability to refer their patients to the most relevant healthcare provider when a patient’s symptoms may implicate further testing outside the scope of a PT. Also, within the continuum of referring patients, PTs also have autonomy in being the initial provider for a patient’s first injury encounter. This is a legal qualification, called “Direct Access,” where its terms of use may vary from state to state. Direct Access may be very beneficial for patients, as this allows for quick initiation in rehabilitation for a faster recovery, and reduced medical care costs by seeing less providers for one problem. Additionally, Direct Access in physical therapy demonstrated significantly better patient outcomes and higher satisfaction vs. referred physical therapy (by a physician) ⁷. Of course, only as long as the injury encounter is determined by a PT to be in their scope of practice, can a patient be treated. 

Why have physical therapy first? 

Direct Access in the U.S. has grown dramatically in the last five years, and now all 50 states allow patients to see a PT without a doctor’s referral. However, this may be contingent upon your type of insurance ^5,7! I believe that this more novel autonomy will pose great benefits to our healthcare system in the long term. 

One of the best benefits of receiving Direct Access care is faster initiation of treatment, which not only benefits the patient to getting rehab at the appropriate time, but saving money throughout their continuum of care. This may allow for a more cost-effective system in America’s healthcare economy vs. initially spending hundreds or thousands of dollars on unnecessary testing and office visits. 

Secondly, physical therapists are highly trained professionals to treat pain originating from the neuro-musculoskeletal system. For many decades, Americans have relied heavily on opioids and its derivatives for pain management, which may have negative consequences from long-term use. PT’s offer alternative pain management methods to pain medication, or mixed pain medication use. There has been a steady increase in evidence that this alternative pain management method has high patient satisfaction and positive outcomes ⁸.

Further, the interventions provided by a physical therapist are very low risk with high reward, compared to more invasive interventions ⁸. While more invasive procedures definitely have a role in providing good patient outcomes, every patient should still have the option to seek conservative or more invasive treatment interventions, and assistance in deciding whether invasive procedures are applicable or not ⁹.

In summary, there are multiple benefits from receiving therapy first in the U.S. healthcare economy and as an initial treatment option in the continuum of care. There is much evidence to demonstrate that physical therapy is a highly skilled profession to provide initial interventions for an injury, and that it is more cost-effective. There is low risk of secondary injury, and is a viable option for pain management. Everybody’s path to rehabilitation is unique, and the physical therapy profession allows for an evidence-based, and patient centered approach to satisfactory outcomes. 

– Your friendly PT,

Dr. Becca

References:

1. Andrew A Guccione, Physical Therapy Diagnosis and the Relationship Between Impairments and Function, Physical Therapy, Volume 71, Issue 7, 1 July 1991, Pages 499–503.
2. Jensen, G., Gwyer, J., Hack, L., & Shepard, K. (2007). Expertise in Physical Therapy Practice. Elsevier Inc. https://doi.org/10.1016/B978-1-4160-0214-7.X5001-0.
3. NPTE website: Licensees – Explore FSBPT resources designed for you | FSBPT
4. Choose PT website: Choosing Your PT – ChoosePT.com
5. Adam S. Tenforde, Jaye E. Hefner, Jodi E. Kodish-Wachs, Mary A. Iaccarino, Sabrina Paganoni, Telehealth in Physical Medicine and Rehabilitation: A Narrative Review,PM&R, Volume 9, Issue 5, Supplement, 2017, Pages S51-S58, ISSN 1934-1482, https://doi.org/10.1016/j.pmrj.2017.02.013.
6. Matthew J Miller, DPT, PhD, Sang S Pak, DPT, Daniel R Keller, DPT, Deborah E Barnes, PhD, MPH, Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic, Physical Therapy, Volume 101, Issue 1, January 2021, pzaa193, https://doi.org/10.1093/ptj/pzaa193.
7. Heidi A. Ojha, Rachel S. Snyder, Todd E. Davenport, Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review, Physical Therapy, Volume 94, Issue 1, 1 January 2014, Pages 14–30, https://doi.org/10.2522/ptj.20130096.
8. Piscitelli D, Furmanek MP, Meroni R, De Caro W, Pellicciari L. Direct access in physical therapy: a systematic review. Clin Ter. 2018 Sep-Oct;169(5):e249-e260. doi: 10.7417/CT.2018.2087. PMID: 30393813.
9. Deyle, D. Direct Access Physical therapy and Diagnostic Responsibility: The Risk-to-Benefit Ratio. Journal of Orthopaedic & Sports Physical Therapy. 2006; 36 (9): 632-634.