The establishment of Physical Therapy dated back during World War I in response to treating wounded veterans returning from the battlefield during the early 1900’s. Originally known as “Reconstruction Aide”, these individuals underwent extensive classroom and didactic training to provide various rehabilitative and recovery assistance. During the 1920’s, a group of health care providers formed the first professional organization for Physical Therapy known as the “American Women’s Physical Therapeutic Association” and later retitled as the “American Physical Therapy Association” (“American Physical Therapy Association,” (n.d.)). This distinct group adapted to the increase demand for specialized clinicians to manage service members with various types of debilitating injuries. By the 1960’s, the successful progression of medicine and technology demonstrated how vital Physical Therapy are to ensure continuity of care.
With professional growth comes along the responsibility and necessity to establish a clearly defined scope of practice. A Doctor of Physical Therapy [DPT] is described as the subject matter expert in the “treatment or management of physical disabilities, malfunction, or pain by exercise without the use of medicine, surgery, or radiation” (Whitney, (n, d)). DPT are expected to understand the inner workings of the musculoskeletal and neuromuscular systems of the human body. They are required to deliver a thorough clinical assessment, accurate diagnosis, and effective treatment plan created specific for each individual patient. Lastly, A DPT must properly employ an effective curricula of exercises, strength, conditioning, and other specified therapies to restore regular body functions.
The profession of Physical Therapy is most often associated with DPT and Physical Therapist Assistant [PTA] as the standard type of healthcare provider in this particular field of medicine. Some private practices strategically integrate additional specialties such as Doctor in Chiropractor, Strength & Conditioning Coach, and Sports Physiologist to attract a selective consumer population. Comparably, public hospitals and community clinics may offer several sub specialties that focus exclusively on a particular disability to improve success rate of recovery. For example, a post-partum female patient with chief complaint of weak bladder control may directly benefit from a specialty consult to a Women’s Health Therapist (Sahrmann, 2014, p.1037). Similarly, other sub specialties of Physical Therapy exist to provide a comprehensive health network and better standard of care.
With nearly 200 highly competitive Physical Therapists programs available across the United States, DPT candidates are required to commit on average six to seven years towards a highly demanding and competitive career field. Following successful graduation, the candidate has to complete an additional year of clinical residency and fellowship if they decide to specialize in a particular area. Upon completion of the medical program, the candidate must successfully pass the National Physical Therapy Examination [NPTE] to become licensed in the state where they choose to practice. After successfully passing the NPTE examination, the Clinician may further expand their scope of practice by attaining certification in a medical specialty. As a result, this selective and highly demanding educational program produces quality health care providers (“American Physical Therapy Association,” (n.d.)).
The type of patient population that is best served by a Physical Therapist are generally individuals presenting with a chief compliant of musculoskeletal or neuromuscular disorders. Understandably, these type of disability can easily effect patients of all ages and under various health conditions. Often times, multiple providers are necessary to optimize a patient outcome. In-patient care usually involves a network of clinicians and utilize DPT primarily as an ancillary service. More recently, patients are selecting to bypass the traditional clinical referring procedure and employing DPT as their primary care manager.
The progression and recognition of DPT as a clinical practitioner was shaped by the new health care paradigm known as “Vision 2020”. This medical model effectively redefines the scope of care and privileges of a DPT. Most importantly it established DPT to have autonomous practice. Patients now have direct access without the need of a conventional consultation. Vision 2020 also established guidelines emphasizing the accountability and professional duty necessary to better serve the growing consumer. Vision 2020 also acknowledge the potential increase in legal liability. As the primary care physician, DPT will likely experience a greater risk to malpractice claims; a trend not seen historically (El-gohary, 2017, pp.1-2).
Coordination between Physical Therapy and other health care providers primarily follows a systems-based practice. This refers to the governmental organization and integration of each specialty to provide a higher quality and cost effective health system. Also, the incorporation of a standard appointment system and consultation process simplify communication to the requesting consumer. Patients are provided the autonomy and direct access to the type of clinician by their choosing. The referral process can be applied to any health care provider who needs expertise consultation or guidance. This inherently promotes an ideal working environment and creates a strong network of clinical providers with a common goal.
During my intern at a sports medical clinic, I was able to appreciate and value the interpersonal relationship between the patient and provider. One patient that I remember in particular was a mid 30’s active duty male who was referred from his primary care manager to a DPT to receive follow-up evaluation status post parachuting accident. The incident occurred three weeks ago with an initial injury to his mid-lower back caused by downward force spinal compression. His referring clinician conducted the initial assessment to include physical exam and imaging. X-ray and MRI results were unremarkable with no evidence of bony pathology or spinal disc involvement. Medications were provided for temporary pain relief however it was unsuccessful. The primary physician communicated the various differential diagnosis to the receiving DPT. The DPT implemented a clear rehabilitation regime for the patient to follow for three weeks. Upon completion of treatment plan the patient was instructed to follow up for reevaluation to ensure continuity of care.
This case scenario demonstrated the effective communication and collaboration between the health care team. The ancillary x-ray and MRI imaging provided a more accurate clinical picture. The coordination between clinicians demonstrated overlapping thought processes to ensure a precise diagnosis and effective treatment plan. The employment of PTA to assist the patient with daily therapeutic exercises to reduced pain and improved mobility. The documentation of care ensured insurance claim and liability was addressed. Follow-up plan established to monitor health progression and reevaluation in necessary.
The medical studies of Physical Therapy have developed throughout the years and demonstrated its value to the health care community. Physical Therapy is recognized as an intricate part to ensure every patient with a musculoskeletal or neuromuscular disorder receive a proper level of care. Collaboration with other clinicians and specialists provide a better networking opportunity and sharing of knowledge. Autonomy of practice will expand the career field and promote a new generation of health care providers.