Physical therapy
From Wikipedia, the free encyclopedia
This article concerns the health profession. For the band by the same name, see Physical Therapy (band)
Physical therapy (or physiotherapy*) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. It includes the provision of services in circumstances where movement and function are threatened by the process of ageing or that of injury or disease. The method of physical therapy sees full and functional movement as at the heart of what it means to be healthy.
Physical therapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. It involves the interaction between physical clients, families and care givers, in a process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physical therapists.
The physical therapists’ distinctive view of the body and its movement needs and potential is central to determining a diagnosis and an intervention strategy and is consistent whatever the setting in which practice is undertaken. These settings will vary in relation to whether physical therapy is concerned with health promotion, prevention, treatment or rehabilitation.<ref name="description">Description of Physical Therapy - What is Physical Therapy? WCPT website</ref>
Physical therapy interventions may include:
"Manual handling; movement enhancement; physical, electrotherapeutic and mechanical agents; functional training; provision of aids and appliances; patient related instruction and counselling; documentation and coordination, and communication. Intervention may also be aimed at prevention of impairments, functional limitations, disability and injury including the promotion and maintenance of health, quality of life, and fitness in all ages and populations."
Some of the conditions that physical therapists manage include:
- back and neck pain
- spinal and joint conditions, such as arthritis
- biomechanical problems and muscular control
- problems affecting children, such as cerebral palsy and spina bifida
- heart and lung conditions, such as chronic obstructive pulmonary disease and pneumonia
- sport-related injuries
- stress incontinence
- neurological conditions, such as stroke and multiple sclerosis
(* The terms physical therapy and physiotherapy are synonymous and can be used interchangeably. The term physical therapy appears to be favored in the United States, while physiotherapy - or physio - appears to be favored in Canada, Australia, and many other countries.)
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[edit] History of physical therapy
Physical therapy has its origins in ancient history with the advent of joint manipulation and massage in China circa 3000 BC. Hippocrates described massage and hydrotherapy in 460 BC.
[edit] Physical therapists
According to the American Physical Therapy Association (2006), physical therapists (PTs) are health care professionals who diagnose and treat people of all ages who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs also help prevent conditions associated with loss of mobility through fitness and wellness programs that achieve healthy and active lifestyles. PTs examine individuals and develop plans using treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. They provide care in hospitals, clinics, schools, sports facilities, and more. PTs must have a graduate degree from an accredited physical therapy program before taking the national licensure examination. The minimum educational requirement is a master's degree, yet most educational programs now offer the doctor of physical therapy (DPT) degree. Licensure is required in each state in which a physical therapist practices. <ref name="APTA description">APTA description. Retrieved Sept. 2, 2006</ref>
[edit] Scope of practice
The scope of practice of physical therapy varies from region to region, depending on the structure of the local health-care system.
Physiotherapists in some jurisdictions, such as Canada, Australia, New Zealand and most of the United States, enjoy professional autonomy, and have the ability to act as primary care providers, meaning that they do not require a referral from a physician to treat.
Physical therapists can practice in a wide variety of practice settings, including hospitals, outpatient clinics, schools, sports facilities, and home care. Some practice settings demand a broad knowledge of a wide variety of conditions, while others permit a special interest approach.
An advancement of technology has allowed physical therapists to give treatment advice via "telehealth", examples of which include cardiac rehab and online treatment of musculoskeletal injuries.
[edit] Physical therapy assessment
A physical therapist will initially conduct a subjective examination (interview) of a patient's medical history, and then go on to the objective assessment (physical examination). The subjective examination is guided by the presenting system and complaint, and the objective assessment is in turn guided by the history.
This semistructured process is used to rule out serious pathology (so called red flags), establish functional limitations, establish the diagnosis, guide therapy, and establish a baseline for monitoring progress. As such, the objective exam will then use certain quantifiable measurements to both guide diagnosis and for progress monitoring. These depend upon the system (and area) being managed, e.g. a musculoskeletal exam may involve, inter alia, assessment of joint range of motion, muscle power, neurological assessment, motor control, and posture, whilst a cardiopulmonary assessment may involve lung auscultation and exercise physiology testing.
In some countries a physical therapist may order diagnostic imaging tests such as x-rays and MRIs to obtain more information about a patient's presenting condition and determine the treatment plan including referral to other practitioners. Physical therapists may also perform electromyography and nerve conduction testing to aid in the diagnosis of muscle and nerve disorders.
[edit] Physical therapy treatment
Guided by the assessment findings, the physical therapist will then develop and facilitate a treatment plan. Aside from the various physiotherapeutic techniques involved in therapy, the treatment regime may include prescribing and advice regarding assistive walking devices; should consider functional progress; and include ongoing review and refinement. Patient education is a key aspect of all treatment plans.
It is difficult to explore the many aspects of physiotherapeutic treatment options, especially considering their ongoing development in the face of an increasing research base. Nonetheless, some examples of treatment options are listed below.
[edit] Musculoskeletal physical therapy
Various therapeutic physical therapy modalities are available, including exercise prescription (strength, motor control, stretching and endurance), manual techniques (joint mobilization/manipulation), soft tissue massage, and various forms of so-called "electrophysical agents" (such as cryotherapy, heat therapy, iontophoresis and electrotherapy).
Despite ongoing research giving a clearer picture regarding the use of various modalities in specific conditions, the benefits of electrotherapy are widely debated.
The practice of physical therapy should not be defined by the use of modalities but rather the integration of examination, history, and analysis of movement dysfunction.
[edit] Cardiopulmonary physical therapy
Cardiopulmonary physical therapists work with patients in a variety of settings. They treat acute problems like asthma, acute chest infections and trauma; they are involved in the preparation and recovery of patients from major surgery; they also treat a wide range of chronic cardiac and respiratory conditions like Chronic Obstructive Pulmonary Disease (COPD), cystic fibrosis (CF) and post-myocardial infarction (MI). They work with all ages from premature babies to older adults at the end of their life. Physical therapists are pioneering new management techniques for non-organic respiratory problems like hyperventilation and other stress-related disorders as well as leading the development of cardio-pulmonary rehabilitation and non-invasive ventilation.
Cardiopulmonary physical therapists use physical modalities to treat people. This may involve using manual techniques to clear infected mucus from a person's chest, or using non-invasive ventilation to help a person breathe, or prescribing exercises to improve a patient's functional exercise capacity.
[edit] Neurological physical therapy
Treatment in neurological conditions is typically based upon exercises to restore motor function through attempting to overcome motor deficits and improve motor patterns. To achieve this aim various theoretical frameworks have been promoted, each based upon inferences drawn from basic and clinical science research. Whilst some of these have remained static, others are designed to take into account new developments, perhaps the most notable example being the "movement science" framework. The various philosophies often generate considerable debate.
[edit] Integumentary physical therapy
Treatment of conditions involving the skin and related organs. Common conditions include wounds and burns. Treatment interventions include debridement of wounds and burns, dressings, scar prevention and reduction.
[edit] Physical therapy education
[edit] Programs around the world
As with many aspects of the profession, physical therapy training varies considerably across the world. As a rule, physical therapy studies involve a minimum of four years of tertiary education. Some examples are described here.
In Australia, where physical therapy is called physiotherapy, an undergraduate physiotherapy degree (B.Phty) is typically undertaken over a four-year period, with the early components being predominantly theoretical including basic anatomy, biology, physics, psychology, kinesiology, goniometry and physiology. In the latter half of the degree students partake in practical components focusing on musculoskeletal physiotherapy, neuromuscular physiotherapy (notably Souvlis pain mechanisms), paediatric physiotherapy, geriatric physiotherapy, cardiothoracic physiotherapy, Vicenzino manipulations, Cupit massage and womens health. The program generally progresses with an increasingly clinical focus and usually the final year involves practical placements at clinics, and research. Postgraduate entry into physiotherapy is possible in some institutions, typically involving two years of study following the completion of a related (e.g. exercise physiology or science) Bachelor degree. Students in these courses are often supported by specific Physiotherapy societies, however the introduction of VSU by the Australian Government has reduced the functioning and support of these groups.
In Canada, entry-level physiotherapy education is offered at 13 universities. Many of these university programs are at the Master's level, meaning that applicants must have already completed an undergraduate degree prior to applying. (All entry-level programs in Canada are slated to be at the Masters level by 2010.) Many universities also offer graduate programs in physiotherapy, rehabilitation, or related disciplines at the masters or doctoral level. Many physiotherapists may advance their education at these levels in such Clinical Practice Areas as cardiorespirology, geriatrics, neurosciences, orthopaedics, paediatrics, rheumatology, sports physiotherapy, and women's health.
In India, an undergraduate physiotherapy degree (Bachelor of Physiotherapy - BPT) typically consist of four years of course study and six months of internship, irrespective of universities the first year of an undergraduate course focus on theorotical and laboratory based studies. The later stages increasingly have a clinical focus. There are more than fifty universities that offer under graduate and post graduate physical therapy courses in India. Postgraduate entry into physiotherapy in many institutions is based upon entrance examinations. Post graduate courses (Master of Physiotherapy - MPT) involve two years of subject specific dissertational study.
In New Zealand, there are currently two schools of physiotherapy offering four-year undergraduate programs. Many New Zealand physiotherapists work in the private health care system as musculoskeletal physiotherapists and the curriculum reflects the need to prepare graduates for autonomous practice. Students follow an educational program similar to Australia with an emphasis on biomechanics, kinesiology and exercise. Postgraduate study typically involves two years of subject specific learning.
In the Philippines, physical therapy programs are generally 5 years in length and award the B.S. Physical Therapy degree upon graduation. The program consists of 2 years of general education, 2 years of physical therapy subjects, and a final year of internship & research/thesis. Some schools require students to complete a full 12 months of internship while other schools only require 10. During the internship year, students are required to fulfill clinical affiliations with hospitals, outpatient clinics, and other healthcare facilities. Due to the healthcare structure in the Philippines, clinics and therapy departments are often headed by a Physiatrist who writes out specific treatment orders for the PT to follow, and majority of the treatments are cash-based since not a lot of people have health insurance. Recently, the M.S. Physical Therapy postgraduate program has been made available by the University of Santo Tomas (Manila, Philippines). Once a student graduates from the BSPT program, he/she is then required to pass a national licensure exam adminstered by the Professional Regulation Commission. The said paper-based exam is a grueling 2 day ordeal which consists of approximately 730 questions. It is only administered twice a year and the names of those who pass the exam are published in several national newspapers. Those who pass the exam become licensed PTs and are then entitled to add the initials PTRP (Physical Therapist Registered in the Philippines) after their name.
In South Africa the degree (B.PhysT, B.Sc Physio or B.Physio) consists of four years of general practice training, involving all aspects of Physiotherapy. Typically, the first year is made up of theoretical introduction. Gradually, time spent in supervised practice increases until the fourth year, in which the student generally spends about 80% in practice. In the fourth year, students are also expected to complete Physiotherapy research projects, which fulfills the requirements of an Honours degree. Professional practice and specialization can only be entered into after a state governed, compulsory year of community service is completed by the student after graduation.
In the United Arab Emirates[1] the Bachelor Of Physiotherapy (BPT) consists of a 4 year undergraduate degree program. In the first year of the program they are introduced to pre-clinical subjects such as Anatomy, Physiology, Biochemistry, Human Behaviour & Socialisation & Basic Medical Electronics & Computers. The students also get hands on experiences in cadaveric dissections while learning Human Anatomy during the first year of the program. The students progressively are introduced to supervised clinical practice and the integrated curriculum offers the best learning experiences in addition to extensive inhouse elearning programs. The course offers Case Based Learning experiences and focusses on Evidence Based Practices. The program culminates with a six month internship ending with a research project work.
In the United Kingdom university degrees tend to be three rather than four years in length, as British students historically specialise earlier in their education than in most developed countries. Thirty-five universities and tertiary level institutions train physiotherapists in UK. The vast majority of physiotherapists work within the National Health Service, the state healthcare system.
In the United States a student completes an undergraduate degree prior to gaining entry into a graduate program (Masters or Doctorate level) specializing in physical therapy. Most educational institutions in the United States have transitioned or are transitioning to an entry-level Doctor of Physical Therapy degree for physical therapy practice.
Following basic physical therapy training, experienced practitioners may undertake further study towards certification as a specialist practitioner. For example, in the United States, experienced physical therapists may apply to take a specialty exam to earn board certification in any of seven sub-specialty areas: Cardiovascular and Pulmonary, Clinical Electrophysiologic, Geriatric, Neurologic, Orthopaedic, Paediatric, and Sports physical therapy.
[edit] Qualifications in the United States
Physical Therapists must have a graduate degree from an accredited physical therapy program before taking the national licensure examination. Most educational programs now offer the Doctor of Physical Therapy (DPT) degree. All states (in the United States) require physical therapists to pass a licensure exam after graduating from an accredited physical therapist educational program before they can practice.
According to the American Physical Therapy Association, there were 209 accredited physical therapist programs in 2006. Of the accredited programs, 46 offered master's degrees, and 163 offered doctoral degrees.
Physical therapist programs start with basic science courses such as biology, chemistry, and physics, and then introduce specialized courses such as kinesiology, biomechanics, neuroanatomy, human growth and development, pathology, diagnostics, physical examination techniques, and therapeutic procedures. Besides classroom and laboratory instruction, students receive supervised clinical education.
Physical therapist education is rigorous, so interested students should attain superior grades in high school and college, especially in science courses. Courses useful when applying to physical therapist educational programs include anatomy, biology, chemistry, social science, mathematics, and physics. Before granting admission, many professional education programs require experience as a volunteer in a physical therapy department of a hospital or clinic.
Physical therapists should have strong interpersonal skills to successfully educate patients about their physical therapy treatments. They should also be compassionate and possess a desire to help patients, and sometimes to interact positively with the patient's family.
Physical therapists are expected to continue professional development by participating in continuing education courses and workshops. A number of states require continuing education to maintain licensure.
Many physical therapists pursue board certification in one of seven specialty areas (orthopaedic, pediatric, neurologic, sports, electrophysiologic, geriatric, and cardio-pulmonary). Board certified specialists must have demonstrated special expertise in their clinical area.
[edit] Journals and publications
Physical therapists have access to a wide range of publications and journals. <ref>Mapping the literature of physical therapy. E M Wakiji. Bull Med Libr Assoc. 1997 July; 85(3): 284–288.</ref> Some are physical therapy specific, while others (eg. various Orthopedic and surgical journals) are not so specific yet are authored and read by many physical therapists. Here are a few:
- Acta Orthopaedica Scandinavica
- American Journal of Physical Medicine & Rehabilitation
- Archives of Physical Medicine and Rehabilitation
- Clinical Orthopedics and Related Research
- Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
- Journal of Rehabilitation Medicine
- Neurology
- Physical Therapy: Journal of the American Physical Therapy Association
- PT--Magazine of Physical Therapy
- Spine
[edit] See also
Links:
- International Orthopaedic Medicine (CYRIAX):
http://www.cyriax.com/default.html
- International MAITLAND Teachers Association:
- The MULLIGAN Concept Web Site:
- KALTENBORN-EVJENTH Concept:
- IFOMT:
- Kinésithérapie Analytique (basée sur le Concept SOHIER):
http://users.skynet.be/KineAnalytique
[edit] References
[edit] External links
National associations
- American Physical Therapy Association
- Australian Physiotherapy Association
- Austrian Physiotherapy Association
- Canadian Physiotherapy Association
- Danish Physiotherapy Association
- Finnish Association of Physical Therapists
- German Physiotherapy Association
- Icelandic Physiotherapy Association
- Indian Association of Physiotherapists
- The Irish Society of Chartered Physiotherapists
- Korean Physical Therapy Association
- New Zealand Society of Physiotherapists
- Norwegian Physiotherapy Association
- Singapore Physiotherapy Association
- South African Society of Physiotherapy
- Spanish Physiotherapy Association
- (UK) Chartered Society of Physiotherapy
- (Taiwan) The Physical Therapy Association of The R.O.C.
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