Physiotherapy

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Physiotherapy
Classification and external resources
This physiotherapist is assisting two polio-stricken children holding on to a rail whilst they exercise their lower limbs.
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Physiotherapy (or physical therapy as it is known in the U.S.) is a healthcare profession concerned with prevention, treatment and management of movement disorders arising from conditions and diseases. Physiotherapy is performed by either a physiotherapist (PT) or an assistant (PTA) acting under their direction.[1] However, various other health professionals (e.g., chiropractors, Doctors of Osteopathy) use some physical therapeutic methods.[2] A program of physical therapy will typically involve caregivers.[3]

PTs utilize an individual's history and physical examination in diagnosis and treatment, and if necessary, will incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g. electromyograms and nerve conduction velocity testing) may also be of assistance.[4] PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, extended care facilities, homes, education or research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.[5]

Contents

[edit] History

A woodcut of the reduction of a dislocated shoulder with a Hippocratic device.
A woodcut of the reduction of a dislocated shoulder with a Hippocratic device.

Physicians like Hippocrates and Hector are believed to have been the first practitioners of a primitive physiotherapy, advocating massage and hydrotherapy to treat people in 460 B.C.[6][verification needed] The earliest documented origins of actual physiotherapy as a professional group, however, date back to 1894 when four nurses in England formed the Chartered Society of Physiotherapy.[7] Other countries soon followed and started formal training programs, such as the School of Physiotherapy at the University of Otago in New Zealand in 1913,[8] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."[9]

Research catalyzed the physiotherapy movement. The first physiotherapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA)). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physiotherapy as a treatment for Polio.[10]

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.[11][12] Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed,[13] which has played an important role in advancing manual therapy worldwide ever since. In the 1980s, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which finally gained FDA approval in the U.S. in 2002.[14]

[edit] Specialty areas

Because the body of knowledge of physiotherapy is quite large, some PTs specialize in a specific practice. While there are many specialty areas in physiotherapy,[15] the following are the five most common specialty areas in physical therapy:[16]

[edit] Cardiopulmonary

Cardiovascular and pulmonary rehabilitation physiotherapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is utilized in this field to assist in clearing lung secretions experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit from cardiovascular and pulmonary specialized physiotherapists.[16]

[edit] Geriatric

Geriatric physiotherapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physiotherapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.[16]

[edit] Neurological

Neurological physiotherapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common symptoms of neurological disorders include paralysis, vision impairment, poor balance, inability to ambulate, and loss of functional independence. Therapists work to improve these areas of dysfunction.[16]

[edit] Orthopedic

Orthopedic physiotherapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system as well as rehabilitation after orthopedic surgery. This specialty of physiotherapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post operative joints, acute sports injuries, arthritis, and amputations. Joint mobilizations, strength training, hot/cold packs, and electrical stimulation (e.g., cryotherapy, iontophoresis, electrotherapy[17]) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging treatment in this field is the use of sonography to guide treatments like muscle retraining.[18][19][20] Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit from assessment by a physiotherapist specialized in orthopedics.

[edit] Pediatric

Pediatric physiotherapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis, may be treated by pediatric physiotherapists.[16]

  • Another PT specialty area is Integumentary (treatment of conditions involving the skin and related organs).

[edit] Education

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Further information might be found on the talk page or at requests for expansion. (May 2008)
  • In the United States, physical therapists must have a degree (BSPT, MSPT, or DPT) from an accredited physical therapy program before taking the national licensing examination. Federal law also requires physical therapists to pass the National Physical Therapy Examination[21] after graduating from an accredited physical therapist educational program before they can practice. Also physical therapists must apply for a state license to practice. Each state regulates licenses for physical therapists independently.

According to the American Physical Therapy Association, there were 210 accredited physical therapist programs in 2008–of those 23 offered the Master of Physical Therapy, and 187 offered the Doctor of Physical Therapy (DPT) degree. Most programs are in transition to a DPT program.[22]

  • 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 other developed countries. In order to qualify, students are required to complete 1000 hours of clinically based learning: this typically takes place in the final two years; however, some courses also have clinical placement in the first year. Thirty-five universities and tertiary level institutions train physiotherapists in the UK. The vast majority of physiotherapists work within the National Health Service, the state healthcare system.
  • In Turkey, the Physiotherapy (BPT) education is provided by physiotherapy schools in universities (Hacettepe University, Dokuz Eylül University, İstanbulUniversity, Baskent University, Pamukkale University, Dumlupınar University, Süleyman Demirel University) after high school education. Education takes 4 years or 5 years with preb classes. MSc and Ph.D. education is given by institutes of medical sciences.
  • In Bangladesh, the Bachelor of Physiotherapy (BPT) course is provided by the Medicine Faculty of University of Dhaka. There are two affiliated institute who provides 4 years of Professional education including one year mandatory internship. Those are Bangladesh Health Professions Institute (BHPI) situated at Savar and the another one is National Institute of Traumatology Orthopaedic and Rehabilition, situated at Dhaka. Bangladesh Physiotherapy Association and Bangladesh Physiotherapy Society are two professional body of Physiotherapy here. Recently Bangladesh Physiotherapy Association has got the Professional Recognistion from WCPT at 2007, Vancouver. Presently BPA Members are working for the Registered Interest Group of IFOMT to develop Orthopaedic Manipulative Therapy skills in here. But its a great Regrat that in Bangladesh Government still dont take any step for Posts of Physiotherapits.
  • In Pakistan there are 8 colleges offering Bsc. Physiotherapy and 2 colleges offering Msc in PT. Physiotherapists have a good scope in government and private hospitals and they are awarded 17 grade pay scale.
  • In Australia, a few different programs are available. The physiotherapy degree can be 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, and women's health. The program generally progresses with an increasingly clinical focus and usually the final year involves practical placements at clinics, and research. These programs are usually offered to those with no prior degree and graduate with the (B.Physio) degree.
  • 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, pediatrics, rheumatology, sports physiotherapy, and women's health.
  • 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 three years of subject specific learning.
  • In the Philippines, physiotherapy 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 physiotherapy 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 administered 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 Spain a physiotherapy student is required to complete 3 years of training after having passed a university entrance exam. After completing a physiotherapy program, another exam can be taken to work for the public health system of an autonomous community, or a graduate can work for private hospitals, clinics, etc. There are 43 universities with physiotherapy faculties in Spain.
  • In the Republic of Ireland, Physiotherapy is available as an undergraduate course in four universities,, Trinity College, University College Dublin, Royal College of Surgeons and University of Limerick. Courses are four years in length with clinical practice in the final two years. Students are required to complete 1000 hours of clinical practice before graduation.
  • In India, universities offer undergraduate program of physiotherapy with four years of academic and clinical program and 6 months of compulsory internship. There are over 250 collages offering undergraduate program in physiotherapy (BPT) and more than 50 collages offering masters in Physiotherapy (MPT) with 2 years duration. PhD in Physiotherapy is offered in some universities of the states Maharashtra, Karnataka and Tamil Nadu.
  • In Sri Lanka, Physiotherapy is available as a Diploma course for 2 years in School of Physiotherapy & Occupational Therapy, which is affiliated to the National Hospital of Colombo from 1957. After the 6 months of classroom training students are sent to hospitals for clinical practice. During the 80's foreign students from Australia, Belgium have studied at the Physiotherapy School. From the year 2005 Medical Faculties of University of Peradeniya & University of Colombo have started the undergraduate course for 4 years.
  • In Taiwan, Physical Therapy is available as a four-year undergraduate course in 14 universities. There are also three junior colleges to provide a five-year program. Clinical practice is required in the final year of the both programs mentioned above. Once a student graduates from the PT program, he/she is then required to pass a national licensure exam administered by the Ministry of Examination, Taiwan, R.O.C. Many universities also offer graduate programs in physical therapy, rehabilitation, or related disciplines at the masters or doctoral level.

[edit] Evidence-based practice

For decades, physiotherapy practice has been the subject of criticism for its lack of a research base.[23] In a late 1990s survey of English and Australian physiotherapists, fewer than five percent (5%) of survey respondents indicated that they regularly reviewed scientific literature to guide practice decisions.[24][25] Despite an overall positive attitude towards evidence-based practice,[26] most physiotherapists utilized treatment techniques with little scientific support.[27][28] Although numerous calls have been made for a shift toward the use of research and scientific evidence to guide practice decisions, at least throughout the 1990s, "most physiotherapists continued to base practice decisions largely on anecdotal evidence."[28]

To overcome these limitations, the World Confederation for Physical Therapy,[29] the American Physical Therapy Association (APTA),[30] and a number of authors[31] have called on the profession to adopt and adhere to evidence-based practices formally based on the best available scientific sources.[32]

[edit] References

  1. ^ American Physical Therapy Association. Discovering Physical Therapy. What is physical therapy. American Physical Therapy Association. Retrieved on 2008-05-29.
  2. ^ Homola, S (2006). "Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor" (PDF). The Journal of Manual & Manipulative Therapy 14 (2): E14–E18. 
  3. ^ World Confederation for Physical Therapy (2007-06). Description of Physical Therapy - What is Physical Therapy?. World Confederation for Physical Therapy. Retrieved on 2008-05-29.
  4. ^ American Physical Therapy Association Section on Clinical Electrophysiology and Wound Management. Curriculum Content Guidelines for Electrophysiologic Evaluation (PDF). Educational Guidelines. American Physical Therapy Association. Retrieved on 2008-05-29.
  5. ^ American Physical Therapy Association (2008-01-17). APTA Background Sheet 2008. American Physical Therapy Association. Retrieved on 2008-05-29.
  6. ^ Wharton MA. Health Care Systems I; Slippery Rock University. 1991
  7. ^ Chartered Society of Physiotherapy (n.d.). History of the Chartered Society of Physiotherapy. Chartered Society of Physiotherapy. Retrieved on 2008-05-29.
  8. ^ Knox, Bruce (2007-01-29). History of the School of Physiotherapy. School of Physiotherapy Centre for Physiotherapy Research. University of Otago. Retrieved on 2008-05-29.
  9. ^ Reed College (n.d.). Mission and History. About Reed. Reed College. Retrieved on 2008-05-29.
  10. ^ Roosevelt Warm Springs Institute (n.d.). History. About Us. Roosevelt Warm Springs Institute. Retrieved on 2008-05-29.
  11. ^ McKenzie, R A (1998), The cervical and thoracic spine: mechanical diagnosis and therapy, New Zealand: Spinal Publications Ltd., pp. 16-20, ISBN 978-0959774672 
  12. ^ McKenzie, R (2002). "Patient Heal Thyself". Worldwide Spine & Rehabilitation 2 (1): 16–20. 
  13. ^ Lando, Agneta (2003). History of IFOMT. International Federation Orthopaedic Manipulative Therapists (IFOMT). Retrieved on 2008-05-29.
  14. ^ Eugene Physical Therapy (2004-04). History of Physical Therapy. Eugene Physical Therapy. Retrieved on 2008-05-29.
  15. ^ American Physical Therapy Association (n.d.). APTA Sections. American Physical Therapy Association. Retrieved on 2008-05-29.
  16. ^ a b c d e Inverarity, Laura; Grossman, K (2007-11-28). Types of Physical Therapy. About.com. The New York Times Company. Retrieved on 2008-05-29.
  17. ^ Cameron, M. (2003). Physical Agents in Rehabilitation - From Research to Practice, USA: W.B. Saunders Company. ISBN 0-7216-9378-4
  18. ^ Bunce SM, Moore AP, Hough AD (May 2002). "M-mode ultrasound: a reliable measure of transversus abdominis thickness?". Clin Biomech (Bristol, Avon) 17 (4): 315–7. PMID 12034127. 
  19. ^ Wallwork TL, Hides JA, Stanton WR (October 2007). "Intrarater and interrater reliability of assessment of lumbar multifidus muscle thickness using rehabilitative ultrasound imaging". J Orthop Sports Phys Ther 37 (10): 608–12. PMID 17970407. 
  20. ^ Henry SM, Westervelt KC (June 2005). "The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects". J Orthop Sports Phys Ther 35 (6): 338–45. PMID 16001905. 
  21. ^ The Federation of State Boards of Physical Therapy (2008-01). For Consumers - Physical Therapy. The Federation of State Boards of Physical Therapy. Retrieved on 2008-06-03.
  22. ^ American Physical Therapy Association (2008-04-18). Number of PT and PTA Programs as of April 18, 2008 (PDF). American Physical Therapy Association. Retrieved on 2008-05-29.
  23. ^ Turner, P.. "Evidence based practice and physiotherapy in the 1990's". Physiotherapy Theory and Practice 17. 
  24. ^ Turner, P.. "Physiotherapists' reasons for selection of treatment techniques: A cross-national survey". Physiotherapy Theory and Practice 15: 235–246. doi:10.1080/095939899307649. 
  25. ^ Turner, P.. "Physiotherapists' use of evidence based practice: A cross-national study". Physiotherapy Research International 2(1): 17–29. 
  26. ^ Jette, Diane U.; Kimberly Bacon, Cheryl Batty, Melissa Carlson, Amanda Ferland, Richard D Hemingway, Jessica C Hill, Laura Ogilvie and Danielle Volk (2003-09). "Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists". Physical Therapy 83 (9): 786–805. PMID 12940766. 
  27. ^ Newham, D. "PracticalResearch". Physiotherapy 80: 337–339. 
  28. ^ a b Schreiber, J (2005-10). "A review of the literature on evidence-based practice in physical therapy". The Internet Journal of Allied Health Sciences and Practice 3 (4). 
  29. ^ World Confederation for Physical Therapy (2008-01-25). Declarations of Principle - Evidence Based Practice. World Confederation for Physical Therapy. Retrieved on 2008-06-03.
  30. ^ American Physical Therapy Association. Evidence-Based Practice. American Physical Therapy Association. Retrieved on 2007-12-21.
  31. ^ Schreiber, J.; P. Stern (2005-10). "A Review of the Literature on Evidence-Based Practice in Physical Therapy". The Internet Journal of Allied Health Sciences and Practice 3 (4). 
  32. ^ Bridges PH, Bierema LL, Valentine T (2007). "The propensity to adopt evidence-based practice among physical therapists". BMC Health Serv Res 7 (103). doi:10.1186/1472-6963-7-103. PMID 17615076. 

[edit] See also

[edit] External links

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[edit] Journals and publications

Physical therapists have access to a wide range of publications and journals.[1] Some are dedicated solely to physiotherapy topics, while others (e.g., various orthopedic and surgical journals) cover a broader range of health-improvement topics, including physiotherapy.

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