Direct Access to Physical Therapy: Should Italy Move Forward?

Direct access to physical therapy (DAPT) is the patient’s ability to self-refer to a physical therapist, without previous consultation from any other professional. This model of care has been implemented in many healthcare systems since it has demonstrated better outcomes than traditional models of care. The model of DAPT mainly focuses on the management of musculoskeletal disorders, with a huge epidemiological burden and worldwide healthcare systems workload. Among the healthcare professionals, physical therapists are one of the most accessed for managing pain and disability related to musculoskeletal disorders. Additionally, the most updated guidelines recommend DAPT as a first-line treatment because of its cost-effectiveness, safety, and patients’ satisfaction compared to other interventions. DAPT was also adopted to efficiently face the diffuse crisis of the declining number of general practitioners, reducing their caseload by directly managing patients’ musculoskeletal disorders traditionally seen by general practitioners. World Physiotherapy organization also advocates DAPT as a new approach, with physical therapy in a primary care pathway to better control healthcare expenses. Thus, it is unclear why the Italian institutions have decided to recognize new professions instead of focusing on the growth of physical therapy, a long-established and autonomous health profession. Furthermore, it is unclear why DAPT is still not fully recognized, considering the historical context and its evidence. The future is now: although still preliminary, the evidence supporting DAPT is promising. Hard skills, academic paths, scientific evidence, and the legislature argue that this paradigm shift should occur in Italy.

Reflections of Health Coaching Narratives

This narrative focuses on a health coach collaborating with a physical therapist and working with the emotional needs of physical therapy patients, but anyone looking to improve health can use the strategies presented. Integrative health coaching incorporates vision and values into a person's goal-setting process. Health coaches provide resources such as journal writing to assist the healing journeys of patients as well as strategies for healthy people who want to make wellness behavior changes.

Reflections of Healing Narratives

This narrative discusses research illustrating how writing assists patients in healing from both emotional and physical pain. An English professor and physical therapist collaborated to design a survey that uses writing prompts to assess goal setting for physical therapy patients. Advice for patients, such as keeping a pain journal of symptoms to share with a medical professional, demonstrates how writing helps the healing process while leading to collaboration between a patient and the medical team.

WOMEN’S HEALTH ISSUES: THE CONTINUING APPEAL FOR WOMEN HEALTH PHYSICAL THERAPY PRACTICE IN PAKISTAN

Women’s health in its widest definition includes study of whole body particularly examining biological characteristics unique to women, with a focus on reproductive organs, body structure, hormones, childhood development and genetics.1 In 2017, maternal mortality ratio was determined to be 211 deaths per 100,000 live birth globally and in Pakistan, the ratio was 186 deaths per 100,000 live births in 2021.2,3 Besides obstetrical health issues, Pakistani female are also facing gynecological maladies on a large scale as compared to other countries such as grade I and II pelvic organ prolapse that is likely to be managed through pelvic physical therapy as per National Institute for Health and Care Excellence (NICE) guidelines.4 Regrettably, the burden of disease is increased manifolds due to unavailability of expert women’s health physical therapist.5 Like many countries, Pakistan is signatory to several international commitments till now to empower the women. To overcome the lacking, women’s health issues should be fostered by a woman’s health physical therapist. A women health physical therapist evaluates, treats, and educates a woman throughout the stages of life starting form active child-bearing years, pregnancy, postpartum, perimenopause and post menopause.6 The area of practice has now spread to encompass all health concerns of a woman namely infertility, osteoporosis, fibromyalgia, rehabilitation following gynecological surgery, breast cancer rehabilitation, incontinence, dyspareunia, vulvodynia, pregnancy related musculoskeletal pain, lymphedema, wellness and exercise. A woman throughout the life span whether a childbearing woman, a menopausal and a young athlete or an elderly woman can obtain benefit from women’s health physical therapy (WHPT). The American College of Obstetricians and Gynecologists (ACOG) claims that conjoint care provided by physician and physical therapist can enormously improve treatment prognosis.7 An optimal quality of life for a woman can be ensured through clinical evaluation and assessment to plan physical therapy interventions incorporated with various modalities that are cautiously prescribed according to an individual’s scenario.8 It is about time to emphasize WHPT practice throughout the country. There is a prolonged schedule to fulfil all fundamental components of women’s health issues which demands the joint collaboration of health-care providers, governments, policy makers, and the overall population. This article shout-out to novice physical therapy professionals to get themselves enrolled in WHPT specialty degree for the betterment of women. It is the need of hour to incorporate the services of qualified and expert WHPT professional in large tertiary care hospitals whether public or private, so that the premium quality of medical services pertaining to women health is available to the masses of all walks of life.

Pelvic floor muscle exercise and training for coping with urinary incontinence

The pelvic floor consists of levator ani muscles including puborectalis, pubococcygeus and iliococcygeus muscles, and coccygeus muscles. Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters. PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency. This exercise has been recommended for urinary incontinence since first described by Kegel. When treating urinary incontinence, particularly stress urinary incontinence, PFME has been recommended as first-line treatment. This article provides clinical application of PFME as a behavioral therapy for urinary incontinence. Clinicians and physical therapist should understand pelvic floor muscle anatomy, evaluation, regimen, and instruct patients how to train the muscles properly.

The Influence of Approaches to Early Mobilization of Cardiosurgical Patients on the Duration of Hospitalization

The purpose of the study was to compare the impact of approaches to early mobilization of cardiac surgery patients on the duration of hospitalization. Materials and methods. Early mobilization of patients after cardiac surgery and study of its effectiveness is an important issue of physical therapy. The beginning of the development of cardiac surgery was characterized by the fact that patients after surgery were in the intensive care unit on a bed rest for several days to improve recovery and prevent complications. The benefits of early mobilization were later recognized, and patient verticalization began earlier. The study involved 90 patients (over 18 years old). Patients were divided into two groups. The first group of mobilization (GM1, n = 49) included patients who underwent surgery on Monday or Tuesday, performed standing and if possible walking on the spot on the first postoperative day with a physical therapist. The second group of mobilization (GM2, n = 41) included patients who underwent surgery on Friday, were mobilized to sit in bed on the first postoperative day; performed standing and walking on the spot on the second or third postoperative day with the participation of medical staff. In addition, other early mobilization points (chamber walking and corridor walking) were performed statistically later in GM2. Patients did not differ in other features of physical therapy. All patients were told during the preoperative consultation with a physical therapist that if they were operated on Friday, they would perform mobilization and therapeutic exercises with medical staff on weekends. Patient case data (age, sex, study protocols and operations) were studied. Results and discussion. Among GM1 patients, the part of men was 69.39%, and in the GM2 group – 78.05% (χ² = 0.856; p = 0.355). Groups of patients did not have significant differences in age, anatropometric parameters, key results of preoperative studies, characteristics of surgical interventions. The study did not establish the effect of more progressive early mobilization performed in GM1 on the length of stay in the postoperative ward (7 (6; 8) nights versus 7 (5; 8) nights; p=0.428) and the total duration of postoperative hospitalization (9 (8; 10) nights against 10 (7; 11) nights; p=0.733). Statistically better indicators of the GM1 group were obtained in the number of nights spent in intensive care (all patients – two nights, except 3 patients in GM1 and 11 in GM2 – three nights; p=0.007), but this advantage should be considered taking into account the impact of patient logistics, namely longer stay in intensive care on weekends. Conclusion. The data confirmed the same effectiveness of approaches to early mobilization of cardiac surgery patients in terms of duration of postoperative hospitalization

An Interdisciplinary Approach to Improve Head Tilt in Pediatric Torticollis Patients with the Use of Prism Glasses

Background: Infants with head tilts are most often diagnosed with torticollis and are referred to a pediatric physical therapist for evaluation and treatment. Determining if the head position is muscular or non-muscular when assessing these infants is key in making the appropriate referrals to other specialists and determining the best treatment approach. Most pediatric physical therapists treat patients with head tilts with manual therapy (i.e. massage, myofascial release, and passive/active range of motion). Many physical therapists only consider a visual etiology as a possibility after other treatment options have been exhausted and the head tilt persists. Although the incidence of torticollis has increased, based on the author’s experience, the number of cases of non-muscular etiology has also increased. There is a lack of current research on the use of prism glasses for treating head tilts in young children and infants carrying a diagnosis of torticollis, especially those presenting without any active/passive motion limitations. Traditionally, these patients undergo years of treatment without resolution of the head tilt. Case Report: A two-year-old patient initially presented with a diagnosis of torticollis with an intermittent and alternating head tilt for physical therapy. After several months of manual therapy, with little improvement in her head posture, the patient’s physical therapist referred her to a behavioral optometrist for a comprehensive vision examination and to pursue alternative treatment options. The optometric evaluation revealed ocular misalignment causing poor depth perception skills and prism glasses were prescribed full-time with the recommendation of continuing physical therapy for gross motor development. Conclusion: Prism glasses are an appropriate treatment consideration for some pediatric patients with persistent head tilts because they can provide immediate improvement in head position and depth perception. It is important to include optometrists in the multi-disciplinary team when working with patients with head tilts. Pediatric physical therapists would benefit from training on how to properly screen visual skills when evaluating children with head tilts. With such training, an appropriate optometric referral could be initiated early on in treatment.

Awareness and Use of Current Sports Injury Prevention Programs among Physiotherapists Worldwide

Purpose. Physiotherapists are trained to prevent, assess, and rehabilitate all kinds of injuries including sports injury. The goal of the physical therapist should be making sure that the athlete is in optimal shape to perform, with a minimal risk for developing an injury. This study aims to assess the physiotherapists’ awareness, implementation, and views of sports injury prevention programs (IPPs) from an international perspective. Materials and methods. A self-administered questionnaire was developed and distributed to physiotherapists worldwide through World Physiotherapy member organizations. The study targeted physiotherapists at an international level. The study included 484 participants, of whom 44.4% were male and 55.6% were female physiotherapists. Results. A total of 287 (59.3%) of the participants were aware of the current sports IPPs, 177 (36.6%) were implementing sports IPPs in their current practice. Participants who implemented the sports IPPs reported a positive opinion about the program efficacy, with a score of 7.3 ± 2.11 out of 10. Conclusions. Globally, physiotherapists have average awareness and low implementation levels of IPPs. Physiotherapists showed a positive score regarding the effectiveness of IPPS, especially the KIPP and the iSPRINT.