Physical Therapy in the Emergency Department: Development of a Novel Practice Venue

Background and Purpose The American Physical Therapy Association's Vision 2020 advocates that physical therapists be integral members of health care teams responsible for diagnosing and managing movement and functional disorders. This report details the design and early implementation of a physical therapist service in the emergency department (ED) of a large, urban hospital and presents recommendations for assessing the effectiveness of physical therapists in this setting. Case Description Emergency departments serve multiple purposes in the American health care system, including care of patients with non–life-threatening illnesses. Physical therapists have expertise in screening for problems that are not amenable to physical therapy and in addressing a wide range of acute and chronic musculoskeletal pain problems. This expertise invites inclusion into the culture of ED practice. This administrative case report describes planning and early implementation of a physical therapist practice in an ED, shares preliminary outcomes, and provides suggestions for expansion and effectiveness testing of practice in this novel venue. Outcomes Referrals have increased and length of stay has decreased for patients receiving physical therapy. Preliminary surveys suggest high patient and practitioner satisfaction with physical therapy services. Outpatient physical therapy follow-up options were developed. Educating ED personnel to triage patients who show deficits in pain and functional mobility to physical therapy has challenged the usual culture of ED processes. Discussion Practice in the hospital ED enables physical therapists to fully use their knowledge, diagnostic skills, and ability to manage acute pain and musculoskeletal injury. Recommendations for future action are made to encourage more institutions across the country to incorporate physical therapy in EDs to enhance the process and outcome of nonemergent care.

Download Full-text

Value-Based Care for Musculoskeletal Pain: Are Physical Therapists Ready to Deliver?

Physical Therapy ◽

10.1093/ptj/pzz171 ◽

2019 ◽

Vol 100 (4) ◽

pp. 621-632 ◽

Cited By ~ 1

Author(s):

Trevor A Lentz ◽

Adam P Goode ◽

Charles A Thigpen ◽

Steven Z George

Keyword(s):

Health Care ◽

Physical Therapy ◽

Musculoskeletal Pain ◽

Clinical Decision Making ◽

Physical Therapists ◽

Physical Therapist ◽

Great Promise ◽

Health Care Environment ◽

Early Physical Therapy ◽

Analytical Approaches

Abstract Early physical therapy models hold great promise for delivering high-value care for individuals with musculoskeletal pain. However, existing physical therapist practice and research standards are misaligned with value-based principles, which limits the potential for growth and sustainability of these models. This Perspective describes how the value proposition of early physical therapy can be improved by redefining harm, embracing a prognostic approach to clinical decision making, and advocating for system-wide guideline-adherent pain care. It also outlines the need to adopt a common language to describe these models and embrace new, rigorous study designs and analytical approaches to better understand where and how early physical therapy delivers value. The goal is to define a clear path forward to ensure physical therapists are aligned within health care systems to deliver on the American Physical Therapy Association’s vision of high-value care in a rapidly changing health care environment.

Download Full-text

The Continuum of Care for Individuals With Lifelong Disabilities: Role of the Physical Therapist

Physical Therapy ◽

10.2522/ptj.20130168 ◽

2014 ◽

Vol 94 (7) ◽

pp. 1043-1053 ◽

Cited By ~ 13

Author(s):

Margo N. Orlin ◽

Nancy A. Cicirello ◽

Anne E. O'Donnell ◽

Antonette K. Doty

Keyword(s):

Health Care ◽

Physical Therapy ◽

Health Care Services ◽

Physical Therapists ◽

Physical Therapist ◽

Functional Limitations ◽

Insurance Coverage ◽

Comprehensive Health ◽

Earning Power ◽

Smooth Transitions

Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.

Download Full-text

Reaching the Masses: Physical Therapist Students Learn to Use YouTube to Share Clinical Information with Patients and the Public

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2010.1323 ◽

2010 ◽

Author(s):

Wayne Moore

Keyword(s):

Health Care ◽

Physical Therapy ◽

Health Care Providers ◽

Physical Therapists ◽

Physical Therapist ◽

Clinical Skill ◽

Care Providers ◽

Physical Therapist Students ◽

Educational Videos ◽

Students Attitudes

Purposes: This pilot study (1) assessed physical therapist students’ attitudes toward using YouTube to share health-related videos on the Internet, and (2) determined whether a cohort of physical therapist students would use YouTube, or similar technologies, to share educational information with other health care providers and health care consumers once they enter practice. Methods: A cohort of 28-second-year Doctor of Physical Therapy students completed a project to produce and share educational videos on YouTube. Students, working in small groups, selected a clinical skill introduced and practiced during the Cardiopulmonary Physical Therapy course as the focus of their videos. A survey completed at the conclusion of the project collected data about students’ attitudes and experiences regarding the use of YouTube. Results: Tabulation of students’ responses revealed that 85% of the students enjoyed making videos and 96% of the students felt that physical therapists should share physical therapy-related information with the largest possible audience. Nineteen percent of the students reported that they are likely to share additional videos online. Conclusion:YouTube and other online video sites allow physical therapists to reach a large audience of people interested in the services and education they provide. However, some students may be reluctant to take advantage of this relatively new technology. Future research may focus on the relationship between the obligation students feel to produce educational videos and their reported reluctance to produce educational videos once they enter clinical practice.

Download Full-text

The Physical Therapy and Society Summit (PASS) Meeting: Observations and Opportunities

Physical Therapy ◽

10.2522/ptj.20100138 ◽

2010 ◽

Vol 90 (11) ◽

pp. 1555-1567 ◽

Cited By ~ 25

Author(s):

Colleen M. Kigin ◽

Mary M. Rodgers ◽

Steven L. Wolf

Keyword(s):

Health Care ◽

Physical Therapy ◽

Physical Therapists ◽

Physical Therapist ◽

Care Delivery ◽

Cost Effective ◽

Steering Committee ◽

Health Care Team ◽

Health Care Environment ◽

Care Needs

The construct of delivering high-quality and cost-effective health care is in flux, and the profession must strategically plan how to meet the needs of society. In 2006, the House of Delegates of the American Physical Therapy Association passed a motion to convene a summit on “how physical therapists can meet current, evolving, and future societal health care needs.” The Physical Therapy and Society Summit (PASS) meeting on February 27–28, 2009, in Leesburg, Virginia, sent a clear message that for physical therapists to be effective and thrive in the health care environment of the future, a paradigm shift is required. During the PASS meeting, participants reframed our traditional focus on the physical therapist and the patient/client (consumer) to one in which physical therapists are an integral part of a collaborative, multidisciplinary health care team with the health care consumer as its focus. The PASS Steering Committee recognized that some of the opportunities that surfaced during the PASS meeting may be disruptive or may not be within the profession's present strategic or tactical plans. Thus, adopting a framework that helps to establish the need for change that is provocative and potentially disruptive to our present care delivery, yet prioritizes opportunities, is a critical and essential step. Each of us in the physical therapy profession must take on post–PASS roles and responsibilities to accomplish the systemic change that is so intimately intertwined with our destiny. This article offers a perspective of the dynamic dialogue and suggestions that emerged from the PASS event, providing further opportunities for discussion and action within our profession.

Download Full-text

Use of Quality Indicators in Physical Therapist Practice: An Observational Study

Physical Therapy ◽

10.2522/ptj.20110101 ◽

2012 ◽

Vol 92 (4) ◽

pp. 507-524 ◽

Cited By ~ 11

Author(s):

Diane U. Jette ◽

Dianne V. Jewell

Keyword(s):

Health Care ◽

Physical Therapy ◽

Observational Study ◽

Secondary Prevention ◽

Quality Indicators ◽

Health Care Quality ◽

Physical Therapists ◽

Physical Therapist ◽

Care Quality ◽

Published Evidence

AbstractBackgroundThe Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited.ObjectiveThe primary purpose of this study was to determine the use of quality indicators in physical therapist practice.DesignThis was an observational study.MethodsAll members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use.ResultsParticipants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%–51.3%) and use of standardized measures (5.5%–35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques.LimitationsThe survey was not assessed for test-retest reliability. A low response rate was a source of potential bias.ConclusionThe study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

Download Full-text

Closing the Gap Between Ethics Knowledge and Practice Through Active Engagement: An Applied Model of Physical Therapy Ethics

Physical Therapy ◽

10.2522/ptj.20090379 ◽

2010 ◽

Vol 90 (7) ◽

pp. 1068-1078 ◽

Cited By ~ 34

Author(s):

Clare M. Delany ◽

Ian Edwards ◽

Gail M. Jensen ◽

Elizabeth Skinner

Keyword(s):

Health Care ◽

Physical Therapy ◽

Moral Agency ◽

Ethical Issues ◽

Physical Therapists ◽

Physical Therapist ◽

Health Care Systems ◽

Applied Ethics ◽

Active Engagement ◽

Ethical Decisions

Physical therapist practice has a distinct focus that is holistic (ie, patient centered) and at the same time connected to a range of other providers within health care systems. Although there is a growing body of literature in physical therapy ethics knowledge, including clinical obligations and underlying philosophical principles, less is known about the unique ethical issues that physical therapists encounter, and how and why they make ethical decisions. As moral agents, physical therapists are required to make autonomous clinical and ethical decisions based on connections and relationships with their patients, other health care team members, and health institutions and policies. This article identifies specific ethical dimensions of physical therapist practice and highlights the development and focus of ethics knowledge in physical therapy over the last several decades. An applied ethics model, called the “active engagement model,” is proposed to integrate clinical and ethical dimensions of practice with the theoretical knowledge and literature about ethics. The active engagement model has 3 practical steps: to listen actively, to think reflexively, and to reason critically. The model focuses on the underlying skills, attitudes, and actions that are required to build a sense of moral agency and purpose within physical therapist practice and to decrease gaps between the ethical dimensions of physical therapist practice and physical therapy ethics knowledge and scholarship. A clinical case study is provided to illustrate how the ethics engagement model might be used to analyze and provide insight into the ethical dimensions of physical therapist practice.

Download Full-text

Writing Patient-Centered Functional Goals

Physical Therapy ◽

10.1093/ptj/80.12.1197 ◽

2000 ◽

Vol 80 (12) ◽

pp. 1197-1203 ◽

Cited By ~ 61

Author(s):

Kenneth E Randall ◽

Irene R McEwen

Keyword(s):

Health Care ◽

Physical Therapy ◽

Motor Learning ◽

Physical Therapists ◽

Physical Therapist ◽

Patient Centered ◽

Step Process ◽

Care Policies ◽

Health Care Policies ◽

Learning Research

Abstract Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.

Download Full-text

Guide to Physical Therapist Practice

Physical Therapy ◽

10.1093/ptj/77.11.1163 ◽

1997 ◽

Vol 77 (11) ◽

pp. 1163-1650 ◽

Cited By ~ 41

Keyword(s):

Health Care ◽

Physical Therapy ◽

Professional Education ◽

Health Care Services ◽

Physical Therapists ◽

Physical Therapist ◽

Daily Practice ◽

Care Services ◽

Provision Of Services ◽

American Physical

Preface All health care professions are accountable to the various publics that they serve. The American Physical Therapy Association (APTA) has developed Guide to Physical Therapist Practice (“the Guide”) to help physical therapists analyze their patient/client management and describe the scope of their practice. The Guide is necessary not only to daily practice but to preparation of students. It was used as a primary resource by the Commission on Accreditation in Physical Therapy Education (CAPTE) during its revision of evaluative criteria for physical therapist professional education programs and is an essential companion document to The Normative Model of Physical Therapist Professional Education, Version 97. Specifically, the Guide is designed to help physical therapists (1) enhance quality of care, (2) improve patient/client satisfaction, (3) promote appropriate utilization of health care services, (4) increase efficiency and reduce unwarranted variation in the provision of services, and (5) promote cost reduction through prevention and wellness initiatives. The Guide also provides a framework for physical therapist clinicians and researchers as they refine outcomes data collection and analysis and develop questions for clinical research.

Download Full-text

Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations

Physical Therapy ◽

10.1093/ptj/pzaa034 ◽

2020 ◽

Vol 100 (6) ◽

pp. 1008-1019

Author(s):

Richard Severin ◽

Ahmad Sabbahi ◽

Ali Albarrati ◽

Shane A Phillips ◽

Sara Arena

Keyword(s):

Blood Pressure ◽

Health Care ◽

Physical Therapy ◽

Health Care Providers ◽

Physical Therapists ◽

Physical Therapist ◽

Standard Of Care ◽

Morbidity Rate ◽

Routine Practice ◽

Care Providers

Abstract Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.

Download Full-text

The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II): A Guide for Patient Management

Physical Therapy ◽

10.1093/ptj/83.5.455 ◽

2003 ◽

Vol 83 (5) ◽

pp. 455-470 ◽

Cited By ~ 73

Author(s):

Jules M Rothstein ◽

John L Echternach ◽

Daniel L Riddle

Keyword(s):

Health Care ◽

Decision Making ◽

Clinical Practice ◽

Physical Therapy ◽

Patient Management ◽

Physical Therapists ◽

Physical Therapist ◽

Functional Deficits ◽

Original Algorithm ◽

Contemporary Practice

Abstract In this era of health care accountability, a need exists for a new decision-making and documentation guide in physical therapy. The original Hypothesis-Oriented Algorithm for Clinicians (HOAC) provided clinicians and students with a framework for science-based clinical practice and focused on the remediation of functional deficits and how changes in impairments related to these deficits. The HOAC II was designed to address shortcomings in the original HOAC and be more compatible with contemporary practice, including the Guide to Physical Therapist Practice. Disablement terminology is used in the HOAC II to guide clinicians and students when documenting patient care and incorporating evidence into practice. The HOAC II, like the HOAC, can be applied to a patient regardless of age or disorder and allows for identification of problems by physical therapists when patients are not able to communicate their problems. A feature of the HOAC II that was lacking in the original algorithm is the concept of prevention and how to justify and document interventions directed at prevention.

Download Full-text