Physical therapy

Physical therapy Classification and external resources
This physical therapist is assisting two children with polio holding on to a rail whilst they exercise their lower limbs.

Physical therapy, the Physiotherapy in most English speaking countries, is a health care profession which provides services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services 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 concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. Physical therapy involves the interaction between physical therapist (PT), patients/clients, other health professionals, families, care givers, and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.^[1] Physical therapy is performed by either a physical therapist (PT) or an assistant (PTA) acting under their direction.^[2]

PTs utilize 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. Electrodiagnostic testing (e.g. electromyograms and nerve conduction velocity testing) may also be of assistance.^[3]

Physical therapy has many specialties including cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics to name some of the more common areas. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.^[4]

Educational qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others requiring masters and doctoral degrees.

The integration of research evidence into practice has been, and continues to be, a challenge across the scope of medicine and physical therapy is no exception to this.^[5]

History

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 physical therapy, advocating massage and hydrotherapy to treat people in 460 B.C.^[6] The earliest documented origins of actual physical therapy as a professional group, however, date back to 1894 when four nurses in Great Britain 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 physical therapy movement. The first physical therapy 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 physical therapy 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 Orthopaedics. 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.

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy,^[14], the American Board of Physical Therapy Specialties list seven specialist certifications, including Sports Injuries and Clinical Electrophysiology.^[15] Worldwide the six most common specialty areas in physical therapy are:^[16]

Cardiopulmonary

Cardiovascular and pulmonary rehabilitation physical therapists 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 physical therapists.^[16]

Geriatric

Geriatric physical therapy 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 physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.^[16]

Neurological

Neurological physical therapy 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 and treat the patients.^[16]

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations. Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting.^[17] Additionally, an emerging treatment in this field is the use of sonography for diagnosis and to guide treatments such as 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 physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy 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 physical therapists.^[16]

Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

Education

• In the United States, training in physical therapy culminates in either a masters degree, a doctor of physical therapy degree or a PhD. (MSPT, DPT or PhD.) from an accredited physical therapy program. All US programs used to grant the BSPT degree before transitioning to the MSPT degree. All US programs are now transitioning to grant the DPT degree nationwide. There are still many physical therapists currently practicing in the US who were trained with a BSPT degree. Physical therapist education includes clinical internships. All states also require physical therapists to pass the National Physical Therapy Examination before they can practice.^[21] 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 the Philippines, physical therapy programs are generally 5 years in length and awards the Bachelor of Science in Physical Therapy (BSPT) degree upon graduation. The program consists of basic sciences, 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. During the internship year, students are required to fulfill clinical affiliations with hospitals, outpatient physical therapy clinics, and other healthcare facilities. Due to the healthcare structure in the Philippines, clinics and therapy departments are often headed by a Physiatrist who performs evaluation and 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. To be able to secure a license to practice PT in the Philippines, one must be able to pass a grueling licensure examination (board examination) given by Board of Physical Therapist under the supervision of the Professional Regulation Commission (PRC). Under R.A. 5680, successful examinees will be allowed to include P.T.R.P. in their name which stands for Physical Therapist Registered Philippines. Licensure examination for physical therapists in the Philippines is governed by Republic Act 5680, also known as The Philippine Physical Therapy and Occupational Therapy Law.

• 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 5 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 don't 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 and one college Riphah Institute of Physical Therapy is offering now DPT (five years duration) and tDPT(two years).In this way Pakistan has become the third country offering DPT in the world.

• In Australia, a few different programs are available at both undergraduate and post graduate level. The physiotherapy degree can be undertaken over a 4 years period as an undergraduate or 2-3 years post graduate 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. Australian programs offer either the (B.Physio, BSc (Physio), or DPT) degrees.

• In Canada, entry-level physiotherapy education is offered at 13 universities. Some of these university programs are at the Master's level, meaning that applicants must have already completed an undergraduate degree prior to applying; all of them are slated to be at the Master's 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 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 [2] 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 colleges offering undergraduate program in physiotherapy (BPT) and more than 50 colleges 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.

Evidence-based practice

The integration of research evidence into practice has been, and continues to be, a challenge across the scope of medicine.^{[23][24][25][26]} Physical Therapy is no exception to these challenges.^[5] Despite an overall positive attitude towards evidence-based practice,^[27] most physiotherapists utilized treatment techniques with little scientific support.^[28][29] 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."^[29]

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

See also

References

External links

• Physical therapy at the Open Directory Project
• Federation of State Boards of Physical Therapy
• List of DPT Programs
• World Confederation for Physical Therapy
• U.S. Physical Therapist Salary Data
• Rehab License Network- PT License Information
• Physical Therapist Centralized Application Service

Journals and publications

Physical therapists utilize 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.