How PT can change lives, save health care dollars & improve outcomes
“Physical therapy” are two words that are frequently combined, but what do they really mean? What factors should you consider when you choose your physical therapist and how can they help? The Journal of the American Medical Association research found that early physical therapy results in less overall cost when compared to pain medications and diagnostic imaging. In fact, clients who receive an MRI instead of physical therapy first spend nearly $5000 more in the care of low back pain. When it comes to healthcare quality and value, PT is a key player in getting clients back to where they need to be.
History of Physical Therapy
Physical therapy as a profession started in the 19th century and it grew in response to the polio epidemic as well as the care of soldiers after World War I. Since the 1900’s, PT has evolved into a doctorate level profession requiring 3 years of graduate school and state licensure to be able to practice. Indeed, the only profession that can legally state they perform physical therapy are physical therapists. Doctors of physical therapy (DPT) are not medical doctors, however PT’s, primary care providers and other professionals work closely together in the care of their client who benefit from the expertise of a health care team.
The physical therapist’s first job is to ensure that each client is appropriate for physical therapy. Six out of ten individuals will have back pain in their life, and 1% of those will have serious pathology, the symptoms of which are called ‘red flags’. Physical therapists are trained and legally required to screen for red flags regardless of how straightforward the condition appears to be. A thorough evaluation is absolutely essential, for every client. When we find something of concern we send the client to their primary care provider for further assessment and diagnosis. In our clinic, we have called the physician after the evaluation revealed medical issues including deep vein thrombosis (DVT), pneumonia, fracture, dangerously high blood pressure or other non-mechanical reasons for the client’s condition.
Physical therapist expertise in anatomy, biomechanics, neuroscience, physiology and manual therapies are essential in the prevention, diagnosis, and rehabilitation of clients with physical challenges of any kind. Additional Board Certifications demonstrate a deep set of knowledge and skills related to a specialty clinical practice, including orthopedics, women’s health, sports, geriatrics, cardiopulmonary and clinical electrophysiology.
Treat the client, not the diagnostic image
A client once asked me, “How do you KNOW what is going on unless you see it on MRI?” Physical therapists combine detailed history, observation of posture and biomechanics with hands-on tests that have high diagnostic accuracy for finding the reasons for the client’s challenge. This method, called evidence-based practice, integrates the science of the best research with the PT’s clinical knowledge, and, most importantly, the client’s experience. All are needed in the design of each client’s customized rehab program.
Diagnostic imaging plays a critical role in evaluation and treatment and for many years it was the first line of assessment for musculoskeletal discomfort. More recently, however, analysis on the treatment of low back pain and other conditions indicates that receiving imaging before PT increases the overall cost of care substantially without changing outcomes. Researchers have found that imaging may ‘label’ a client’s low back pain. Findings that might otherwise be viewed as nonspecific and uncomplicated instead amplify fear in the client and increase the likelihood of high-risk interventions being sought. Normal MRI findings in asymptomatic individuals include disk degeneration, bulges, and herniations. In fact, truly abnormal findings for anyone over 45 would be structural perfection! According to a 2014 study in Spine, Brinjikji found that painless disc degeneration occurs within 37% of 20-year-olds and 96% of 80-year-olds. Research supports that early physical therapy reduces downstream costs in the treatment of low back pain and other conditions, playing a critical and cost-saving role for consumers.
Be picky until you find YOUR PT
Direct access in Washington means that anyone can work with the PT clinic of their choosing. Consumers should research PT clinics in their area to ensure that they get the most out of their rehab, and go to the right PT the first time. Proximity to work and home may seem convenient, but not unless you have a positive experience with a knowledgeable clinician who delivers great care for a good value. You should expect to be impressed with the knowledge base, professionalism and experience you have with every member of the clinical team. Find the PT that is a good match for your needs, your personality and your expectations. Your PT will assess contributing factors and structural deficits to design what you need, and work with the rest of your medical team to get you where you need to be.
Elizabeth Hampton PT, DPT, WCS, BCB-PMD is the owner and Clinic Director of CorePhysio, located in Fairhaven for 12 years. She along with a team of 9 clinicians and 4 business experts work everyday to create positive clinical experiences for their clients. (Scholarly references are available upon request.)