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Back in Action

by Daniel Sean Kaye
New trends in physical therapy show an in-depth, scientific approach is leading the way

According to the American Physical Therapy Association (APTA), there are many important trends happening in the field of PT. These include autonomous practice, where the PT is independent and relies on his own professional judgment; direct access, where the PT can provide all services they choose without legal, regulatory or payer restrictions; and the ability for PTs to collaborate with—and refer patients to—other health care providers for medical needs beyond the scope of the PT practice.

But these may be just the beginning when it comes to meaningful advances in physical therapy.

Moving forward
“In the last decade, the field has been moving toward really focusing on returning patients’ function and performance needs,” says Kim Wallace, director of organizational development ancillary services for Rothman Institute. This means, if you’re an athlete, the focus is on what can be done to help you return to being an athlete. If you can no longer do your job, PTs emphasize what you need to do your job again. “It’s about tailoring your rehabilitation to aid in your recovery,” says Wallace. By using functional outcomes measures, she says, PTs can measure the patient’s limitations now as a way to better identify what they need. “We monitor your success. It’s quantitative measuring of how much improvement you’re making, collecting data, and then improving treatment.

Another important trend to Wallace is the rise of technology. “Technology allows us to look at bigger groups of patients and their treatments and compare outcomes so that we can provide more effective treatment. With this, we are making things more efficient,” she says. “It’s really just part of the evolution of health care. More technology helps us to see what works so we can implement best practices in health care.”

For Eric Cohen, a doctor of physical therapy at Advantage Therapy and Sleep Centers’ Washington Township location, Graston Technique is another trend to embrace. Graston Technique is a method with its own form of instruments developed in the 1990s to enhance detection of soft tissue dysfunction beyond that of the human hand. “The way the instruments are designed amplifies the feeling of soft tissue adhesions and restriction almost in the way a stethoscope is able to enhance the sound of a heartbeat or pulse,” explains Cohen. After a few sessions, initial feelings felt with the instruments will reduce or be eliminated, allowing for a faster recovery time.

Another big change is evidence-based practice, says Cohen. “One of the biggest reasons patients are being treated more efficiently is because most techniques being taught these days have research to back up that they actually do work,” he says. “Of course, therapists do use techniques from the past which help as well, but all of the techniques being researched that show results quicker are taking a front seat to [past techniques] which weren't as effective or weren't effective at all.”

Increasing efficiency, decreasing costs
Adopting functional outcomes and evidence-based practices helps reduce hospital re-admittance numbers and health care costs for older citizens, says Elizabeth Olkowski, coordinator of PT clinical services at Fox Rehabilitation and a board-certified specialist in geriatric PT. By using clinical decision-making algorithms and differential diagnosis to accurately evaluate and treat patients, PTs are standardizing exercise prescriptions to maximize proper dosage and strength gains. Functional outcomes are being used with standardized data to evaluate patients from the beginning of their care to discharge, to show gains and optimize function. “It’s important to use evidence-based screens to identify patients’ risk factors before they experience a fall or significant decline in function,” she says.

“Sustained and widely adopted trends provide better treatments,” says Rocco Gervasi, a doctor of PT with Advantage Therapy and Sleep Centers’ Cherry Hill location. “This is accomplished by medical education and preventive medicine delivery. As a practitioner detects propensities toward specific pathologies, [she] may be able to intervene and attenuate those progressions. As functional mobility increases and quality of life improves, people become less sedentary, more active participants in society,” he says.

“By being proactive and performing evidenced-based fall screens or diabetic foot screens in community settings or in assisted living facilities, we can identify those at risk for falls or decreased sensation,” adds Olkowski. “This way we can intervene before an individual has a fall or develops a wound and cut down hospital costs by billions of dollars.”

Future trends
Two important growing trends are therapists having a doctorate degree, and direct access, which allows patients to seek PT treatment without a physician’s prescription, says Wallace. “As the population ages and people need quicker access to health care, there will be a higher demand on physicians, and direct access allows a patient to access PT care without necessarily seeing their doctor first.”

Gervasi strongly agrees. “I would like to see all our PTs graduating with a doctoral degree being addressed as doctors, just as a chiropractor, dentist or physician. We earned our status, committed seven years of our lives to earn our degree. One would be surprised with the level and depth of education we attain,” he says. “As patients are becoming more aware of our scope, relevance and efficacy, I believe more patients will begin to understand our roles in the medical field. Disciplines are becoming less compartmentalized and viewed more as a team approach.”

As rehab funding decreases, PTs have to educate other health care professionals about the importance of seeing a PT at the first sign of decline rather than waiting until more serious issues develop, says Olkowski. “For example, as a house-calls therapist, we may be the first person to perform a diabetic foot screen and have the patient take off their shoes and socks. This screen can reveal neuropathy and increased risk of developing a wound,” she says. “In addition, with technology, we can take an interactive approach with our patients, providing home exercise programs on iPads, performing treatments using a Wii, or using smartphone applications to perform interactive postural screens.”

Although trends are important, they need to be based on sound clinical research and must provide safe, dependable and consistent clinical relevance, says Gervasi. “Trends create the foundation of how we dictate care. They are important and enlightening tools that we utilize as a component to our practice that guides our care. Successful treatment trends promote our value in society and assure our relevance as contemporary caregivers.”

Resources

Advantage Therapy and Sleep Centers
Cherry Hill: (856) 424-2000
Mt. Laurel: (856) 840-0700
Washington Township: (856) 256-0007
ADTherapy.com

Fox Rehabilitation
Serving South Jersey
(877) 407-3422
FoxRehab.org

Rothman Institute
Serving South Jersey
(800) 321-9999
RothmanInstitute.com

Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 3, Issue 9 (November, 2012).
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