Physical therapy
Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention, and health promotion. Physical therapist is the term used for such professionals in the United States, and physiotherapist is the term used in many other countries.
For the jazz fusion band, see Physical Therapy (band). For the journal, see Physical Therapy (journal).
The career has many specialties including musculoskeletal, orthopedics, cardiopulmonary, neurology, endocrinology, sports medicine, geriatrics, pediatrics, women's health, wound care and electromyography. PTs practice in many settings, both public and private.[1]
In addition to clinical practice, other aspects of physical therapy practice include research, education, consultation, and health administration. Physical therapy is provided as a primary care treatment or alongside, or in conjunction with, other medical services. In some jurisdictions, such as the United Kingdom, physical therapists may have the authority to prescribe medication.[2]
Overview[edit]
Physical therapy addresses the illnesses or injuries that limit a person's abilities to move and perform functional activities in their daily lives.[3] PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies like X-rays, CT-scan, or MRI findings. Physical therapists can use sonography to diagnose and manage common musculoskeletal, nerve, and pulmonary conditions.[4][5][6] Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be used.[7]
PT management commonly includes prescription of or assistance with specific exercises, manual therapy, and manipulation, mechanical devices such as traction, education, electrophysical modalities which include heat, cold, electricity, sound waves, radiation, assistive devices, prostheses, orthoses, and other interventions. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain, and restore maximum movement and functional ability throughout the lifespan. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease, or environmental factors. Functional movement is central to what it means to be healthy.
Physical therapy is a professional career that has many specialties including musculoskeletal, orthopedics, cardiopulmonary, neurology, endocrinology, sports medicine, geriatrics, pediatrics, women's health, wound care and electromyography. Neurological rehabilitation is, in particular, a rapidly emerging field. PTs practice in many settings, such as privately-owned physical therapy clinics, outpatient clinics or offices, health and wellness clinics, rehabilitation hospital facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial and these workplaces or other occupational environments, fitness centers and sports training facilities.[1]
Physical therapists also practice in non-patient care roles such as health policy,[8][9] health insurance, health care administration and as health care executives. Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.[10]
Education varies greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post-doctoral residencies and fellowships.
Regarding its relationship to other healthcare professions, physiotherapy is one of the allied health professions.[11][12][13][14] World Physiotherapy has signed a "memorandum of understanding" with the four other members of the World Health Professions Alliance "to enhance their joint collaboration on protecting and investing in the health workforce to provide safe, quality and equitable care in all settings".[15]
Physical therapist–patient collaborative relationship[edit]
People with brain injury, musculoskeletal conditions, cardiac conditions, or multiple pathologies benefit from a positive alliance between patient and therapist. Outcomes include the ability to perform activities of daily living, manage pain, complete specific physical function tasks, depression, global assessment of physical health, treatment adherence, and treatment satisfaction.[84]
Studies have explored four themes that may influence patient-therapist interactions: interpersonal and communication skills, practical skills, individualized patient-centered care, and organizational and environmental factors.[85] Physical therapists need to be able to effectively communicate with their patients on a variety of levels. Patients have varying levels of health literacy so physical therapists need to take that into account when discussing the patient's ailments as well as planned treatment. Research has shown that using communication tools tailored to the patient's health literacy leads to improved engagement with their practitioner and their clinical care. In addition, patients reported that shared decision-making will yield a positive relationship.[86] Practical skills such as the ability to educate patients about their conditions, and professional expertise are perceived as valuable factors inpatient care. Patients value the ability of a clinician to provide clear and simple explanations about their problems. Furthermore, patients value when physical therapists possess excellent technical skills that improve the patient effectively.[85]
Environmental factors such as the location, equipment used, and parking are less important to the patient than the physical therapy clinical encounter itself.[87]
Based on the current understanding, the most important factors that contribute to the patient-therapist interactions include that the physical therapist: spends an adequate amount of time with the patient, possesses strong listening and communication skills, treats the patient with respect, provides clear explanations of the treatment, and allows the patient to be involved in the treatment decisions.[87]
Effectiveness[edit]
Physical therapy has been found to be effective for improving outcomes, both in terms of pain and function, in multiple musculoskeletal conditions. Spinal manipulation by physical therapists is a safe option to improve outcomes for lower back pain.[88] Several studies have suggested that physical therapy, particularly manual therapy techniques focused on the neck and the median nerve, combined with stretching exercises, may be equivalent or even preferable to surgery for carpal tunnel syndrome.[89][90] While spine manipulation and therapeutic massage are effective interventions for neck pain, electroacupuncture, strain-counterstrain, relaxation massage, heat therapy, and ultrasound therapy are not as effective, and thus not recommended.[91]
Studies also show physical therapy is effective for patients with other conditions. Physiotherapy treatment may improve quality of life, promote cardiopulmonary fitness and inspiratory pressure, as well as reduce symptoms and medication use by people with asthma.[92] Physical therapy is sometimes provided to patients in the ICU, as early mobilization can help reduce ICU and hospital length of stay and improve long-term functional ability.[93] Early progressive mobilization for adult, intubated ICU patients on mechanical ventilation is safe and effective.[94]
Psychologically informed physical therapy (PIPT), in which a physical therapist treats patients while other members of a multidisciplinary care team help in preoperative planning for patient management of pain and quality of life, helps improve patient outcomes, especially before and after spine, hip, or knee surgery.[95]
Telehealth[edit]
Telehealth (or telerehabilitation) is a developing form of physical therapy in response to the increasing demand for physical therapy treatment.[96] Telehealth is online communication between the clinician and patient, either live or in pre-recorded sessions with mixed reviews when compared to usual, in-person care.[97] The benefits of telehealth include improved accessibility in remote areas, cost efficiency, and improved convenience for people who are bedridden and home-restricted, or physically disabled.[97] Some considerations for telehealth include: limited evidence to prove effectiveness and compliance more than in-person therapy, licensing and payment policy issues, and compromised privacy.[98] Studies are controversial as to the effectiveness of telehealth in patients with more serious conditions, such as stroke, multiple sclerosis, and lower back pain.[99] The interstate compact, enacted in March 2018, allows patients to participate in Telehealth appointments with medical practices located in different states. [100]
During the COVID-19 pandemic, the need for telehealth came to the fore as patients were less able to safely attend in-person, particularly if they were elderly or had chronic diseases. Telehealth was considered to be a proactive step to prevent decline in individuals that could not attend classes. Physical decline in at risk groups is difficult to address or undo later. The platform licensing or development are found to be the most substantial cost in telehealth. Telehealth does not remove the need for the physical therapist as they still need to oversee the program.[101][102][103]