A multidisciplinary team is essential for the successful treatment of patients with rheumatic conditions and physical therapists are an integral component of the team. This article aims to give you an understanding of the role of a physical therapist, which patients benefit from physical therapy (PT), and which physical therapist may be most appropriate for your patient.
The Role of a Physical Therapist
The American Physical Therapy Association has a vision that, by 2020, all PT services will be provided by doctors of physical therapy (DPTs). DPTs should be considered the practitioners of choice for patients who have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.1 On January 1, 2016, the DPT will be the required degree for all entry-level physical therapist–education programs.2 Physical therapists are healthcare professionals who use evidence to provide effective care in order to maintain, restore, and improve movement and activity for individuals of all ages. In addition, physical therapists are involved in preventive health by promoting wellness and fitness through identifying risks, delaying functional decline and disability, and enhancing participation in daily activities.2
The profession has outlined the following elements of patient management: examination, evaluation, diagnosis, prognosis, intervention, and outcome assessment. This includes their physical and functional status—mobility, strength, ambulation, self-care skill, posture, and body mechanics—as well as musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary systems. A physical therapist may also prescribe special equipment or devices such as modified footwear, splints, or assistive devices. If appropriate, DPTs may apply modalities or perform manual therapy such as soft-tissue mobilization, joint mobilization/manipulation, myofascial release, and muscle energy techniques. Additionally, a therapist will prescribe therapeutic exercise and individualized home exercise programs aimed to improve the patient’s specific impairments.
Along with advances in PT education and research, evidence-based practice provides the foundation for patient care. Evidence-based practice helps ensure that patients will receive appropriately administered and scientifically supported interventions. To obtain more specific descriptions of physical therapist practice, refer to The Guide to Physical Therapist Practice on the American Physical Therapy Association website at guidetoptpractice.apta.org.
PT is one healthcare profession that is granted the gift of time with patients. This allows a patient to express questions or concerns about their disease process. A very common complaint of patients is feeling undervalued and unheard. Although there are many determinates of patient satisfaction, studies have shown a direct correlation between one-on-one time spent and satisfaction.3,4
When to Refer a Patient
Consider a physical therapist for your patients if they display any of the following: difficulty adapting to a new disability; significant impairments in range of motion or strength; significant balance or gait disturbance; decreased safety awareness; a history of falls; or a need for assistive device training, wheelchair adaptation or positioning, or training in mobility or transfers such as bed mobility, sit to stand, prolonged standing, ambulating, and ascending/descending stairs. Let us not underestimate the importance of prevention of the above impairments.
Physical therapists can help prevent a health condition in susceptible populations or individuals through risk identification. If you suspect a patient’s disease process may lead him or her down the path of limited activity or restricted participation in daily activities, the preventive aspect of PT is critical. Also, if you suspect or it is revealed through selected outcome measures that a patient presents with high fear and avoidance of activity, feelings of disablement, or a decrease in quality of life and functional mobility, they will likely benefit from a PT evaluation.
Presently, only Indiana, Michigan, and Oklahoma do not allow patients direct access to PT.1 However, direct access is still complicated because very few third-party payers will reimburse without a physician’s referral. Therefore, the majority of physical therapists are reliant on physician referrals.
PT Specialties
The PT profession and curriculum has grown immensely and, because of the breadth of knowledge and skills involved in treating diverse populations in multiple settings, most PTs choose an area of practice that allows them to focus their expertise. Physical therapists will commonly have additional credentials after their name. Currently, physical therapists may be a certified specialist in cardiovascular and pulmonary, clinical electrophysiology, geriatrics, neurology, orthopaedics, pediatrics, sports PT, and women’s health. Continuing education is also a large part of a physical therapist’s practice, but, again, this is dependent on the therapist’s clinical expertise and interest.
If you are looking for a therapist with specific continuing education on arthritis and rheumatologic management, you can browse the ACR’s membership directory at www.rheumatology.org/directory to look up physical therapists in your area. This will identify therapists with a special interest in rheumatology. I would also recommend visiting clinic websites or calling clinics directly. A clinic website will likely promote therapists who are specialized in rheumatology or other specific areas. A quick phone discussion will also provide insight as to the patient population treated and the clinic operations. Ask questions such as: What is the one-on-one PT-to-patient treatment time? How many patients with rheumatic conditions are typically treated at your clinic? Do patient outcomes seem to vary when a rheumatology patient is treated by a PT specialist versus a general physical therapist?
A study by Hurkmans et al had 233 therapists complete a questionnaire with current assessment and interventions.5 In the study, therapists were considered specialists if they had completed advanced arthritis training courses. Overall, the study revealed no statistically significant difference between the characteristics of a generalist and specialist. It did, however, find a statistically significant difference between a specialist and generalist regarding reported frequencies of performing diagnostic assessments and interventions, implying that a specialist may be more likely to provide evidence-based interventions. Minimal research has been conducted in this area, and, ultimately, all physical therapists possess the skill and knowledge to treat a referred patient. In general, communication between healthcare providers is optimal for the patient and is commonly the missing ingredient in patient management, secondary to time constraints, abundant paperwork, and demanding work schedules. Clinician and therapist communication is fundamental and critical if a patient’s medical diagnosis is complicated by multiple comorbidities or significant disability, or for a rare diagnosis that may be unfamiliar to a physical therapist—all of which can be concerns for rheumatology patients.
PT is often an essential part of care in the treatment of rheumatic diseases, along with other specialty areas like occupational therapy, nutrition, and psychology. The scope of PT practice is expansive, with a wide variety of settings and populations. Patients with a complex or rare diagnosis may benefit from a therapist with experience in rheumatic diseases or advanced training in the field.
Alicia Lovato, PT, DPT, is a physical therapist at Manual Therapy Associates, Inc. and Azura of Lakewood Rehabilitation Suites in Arvada, Colo. She studied PT at Regis University and is a member of the ARHP Practice Committee.
References
- American Physical Therapy Association. Vision 2020. Updated September 18, 2012. Available at www.apta.org/vision2020. Accessed December 7, 2012.
- American Physical Therapy Association. Today’s physical therapist: A comprehensive review of a 21st-century health care profession. January 2011. Available at www.apta.org/uploaded Files/APTAorg/Practice_and_Patient_Care/PR_and_Market ing/Market_to_Professionals/TodaysPhysicalTherapist.pdf. Accessed December 7, 2012.
- Dugdale D, Epstein R, Pantilat S. Time and the patient-physician relationship. J Gen Intern Med. 1999;14:34-40.
- Gross D, Zyzanski S, Borawski E, Cebul R, Stange K. Patient satisfaction with time spent with their physician. J Fam Pract. 1998;47:133-137.
- Hurkmans E, Li L, Verhoef T, Viliet T. Physical therapists’ management of rheumatoid arthritis: Results of a Dutch survey. Musculoskeletal Care. 2012;10:142-148.
