Physical therapy

Physical therapy (or physiotherapy^[1]) is a healthcare profession concerned with prevention and management of movement disorders occurring throughout the lifespan. Physical therapy can only be performed by either a qualified physical therapist (physiotherapist) or physical therapist assistant (PTA). ^[2] Despite this, various alternative health professions continue to employ the use of some physical therapeutic modalities in practice.^[3] Individualized management may involve the interaction between patient/client, families, caregivers, and healthcare team in a process of assessing movement potential and in establishing 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.^[2]

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Interventions

Physical therapy interventions may include:

"Spinal and extremity manipulation; therapeutic exercise; electrotherapeutic and mechanical agents; functional training; provision of aids and appliances; patient education and counseling; 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."

History

Physical therapy has its origins in ancient history, It is reported as a form of manual therapy in China circa 2500 BC. Hippocrates described massage and hydrotherapy in 460 BC.

However, even before that the need for physical (manual) handling of patients body was well understood and advocated in "Ayurveda" - the oldest medical system known. A tradition of Ayurvedic Therapists still exists in India and is an integral part of Health care.

Modern physical therapy

The modern practice of physical therapy was developed in London in 1896, believing hospital patients needed to be mobilized on a regular basis in order to maintain adequate muscle function and mobility. This special interest group grew rapidly and in 1920 the Chartered Society of Physiotherapy was formed in the Country of United Kingdom. Similar organizations were developed in other countries, including the USA.

The care and rehabilitation of the large numbers of amputees resulting from the World Wars of the early 20th century, as well as care of patients suffering from diseases such as polio galvanized the development of physical therapy worldwide. One of its principal advocates was Sister Elizabeth Kenny, an Australian nurse who made a significant impact on the treatment of polio during the 1930s and 1940s.

Physical therapy and science

For decades, Physical therapy practice has been the subject of criticism for its lack of a research base.^[4] In a late 1990s survey of English and Australian physical therapists, fewer than five percent (5%) of survey respondents indicated that they regularly reviewed scientific literature to guide practice decisions.^[5][6] Despite an overall positive attitude towards evidence based practice,^[7] most physical therapists utilized treatment techniques with little scientific support.^{[5][8][9][10][11][12]} Although numerous calls have been made for a shift toward the use of research and scientific evidence to guide practice decisions, most physical therapists continued to base practice decisions largely on anecdotal evidence.^[12]

To overcome these limitations, the World Confederation for Physical Therapy (WCPT),^[13] the American Physical Therapy Association (APTA),^[14] and a number of authors^[15] have called on the profession to adopt and adhere to evidence based practices formally based on the best available scientific sources. The move towards the Doctor of Physical Therapy (DPT) professional postbaccalaureate degree indicates increased awareness of and training in the sciences, research, and interventions.^{[citation needed]}

Physical therapists

Physical therapists (PTs) are health care professionals who evaluate and manage health conditions for people of all ages. They may use the title "Dr." as some complete doctorate programs. Typically, individuals consult a PT for the management of medical problems or other health-related conditions that cause pain, limit ability to move, or limit the performance of functional activities. PTs also help prevent health conditions through prevention, restoration of function and through fitness and wellness programs that achieve healthy and active lifestyles. PTs evaluate individuals, diagnose conditions, and develop management 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.

Physical therapy assessment

A physical therapist will initially conduct a subjective examination (interview) of a patient's medical history, and then provide objective assessment in the form of a physical examination. The subjective examination is guided by the presenting symptoms 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. The objective exam will then use certain quantifiable measurements to both guide diagnosis and monitor progress. The particular focus of a regimen will depend on the system and area being managed. Whereas a musculoskeletal exam might assess joint range of motion, muscle power, and posture among other metrics, a cardiopulmonary assessment might 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 a treatment plan, including referral to other practitioners. Physical therapists may also perform sonography, electromyography and nerve conduction testing to aid in the diagnostic process.

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 technology including mobility aids, standing frames, and walking devices. The physical therapist 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.

Musculoskeletal (Orthopaedic) physical therapy

Musculoskeletal (Orthopaedic) physiotherapists are able to diagnose, treat and using the range of techniques outlined below help with prevention of pain/pathology.

Various therapeutic physical therapy modalities are available, including exercise prescription (strength, motor control, stretching and endurance), manual therapy techniques like joint mobilization/manipulation, soft tissue massage, and various forms of so-called "electrophysical agents" (such as cryotherapy, heat therapy, iontophoresis and electrotherapy).

Nowadays, in various countries physiotherapists are specializing in orthopaedic medicine. Those people can use diagnostic and therapeutic infiltration/injections to various soft tissue and joints. They are trained to diagnose and treat various orthopaedic conditions.

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, analysis and restoration of movement dysfunction.

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.

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.

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.

Paediatric physical therapy

Treatment and management of paediatric neurological, cardiothoracic, and musculoskeletal conditions. Common conditions include asthma, cerebral palsy, developmental delay and torticollis.

Physical therapy education

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 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 PHD 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, Vancover. 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.physical therapist have a good scope in government and private hospitals and they are awarded 17 grade pay scale.

• 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, 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. 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. The University of Melbourne is introducing a new postgraduate physiotherapy degree as part of the Melbourne Model. The Melbourne Model will enable students to enrol in a 3 year undergraduate degree in Biomedicine or Science (commencing in 2008) followed by a 3 year postgraduate Physiotherapy 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 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 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 university degrees constist of a 3 years program and several post-graduated courses are available for practitioners. There are 38 universities training physiotherapists in Spain.

• In the United States a student completes an undergraduate degree with a strong science component prior to gaining entry into a Doctor of Physical Therapy program. Students complete clinical internships as part of their education.

• 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, Physiotherapy is offered as bachelor degree after a student successfully completes four year course of physiotherapy in a college affiliated to a university. Mangalore city has highest number of physiotherapy colleges in India.

• I n Sri Lanka, Physiotherpay is available as a Diploma course for 2years in School of Physiotherapy & Occupational Therapy which is affilited to the National Hospital of Colombo from 1957. After the 6 months of training students were sending to the Hospitals for clinical practise. From the year 2005 Medical Faculties of University of Peradeniya & University of Colombo have started the undergarduate course for 4years.

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.

Qualifications in the United States

Physical Therapists must have a graduate degree from an accredited physical therapy program before taking the national licensing examination. Most educational programs now offer the Doctor of Physical Therapy (DPT) degree. All states (in the United States) require physical therapists to pass the [National Physical Therapy Examination] 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 2007. Of the accredited programs, 31 offered the Master of Physical Therapy, and 179 offered the Doctor of Physical Therapy degree. Virtually all programs are in transistion to the DPT degree.

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.

Journals and publications

Physical therapists have access to a wide range of publications and journals. ^[16] Some are strictly limited to physical therapy, while others (eg. various orthopedic and surgical journals) are not as specific, yet physical therapists contribute to them and read them. Here are a few:

• Advance for Physical Therapists & PT Assistants
• 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
• [2] Australian Journal of Physiotherapy
• American Journal of Sports Medicine
• BMC Musculoskeletal Disorders Open Access Journal

References

See also

• Bobath concept
• Brunnstrom Approach
• Doctor of Physical Therapy
• Exercise
• Joint manipulation
• Master of Physical Therapy
• Occupational Therapy
• Physiatry
• Orthopaedic Manual Physical Therapy
• Orthopedic pillow
• Iontophoresis
• Phonophoresis

National associations

• International Association of Healthcare Practitioners
• 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
• The Japanese Physical Therapy Association
• Korean Physical Therapy Association
• New Zealand Society of Physiotherapists
• Norwegian Physiotherapy Association
• Singapore Physiotherapy Association
• South African Society of Physiotherapy
• Spanish Physiotherapy Association
• Swedish Association of registered Physiotherapists
• (UK) Chartered Society of Physiotherapy
• (Taiwan) The Physical Therapy Association of The R.O.C.