What are the essential services that acute care physical therapists provide to patients? I am questioning that after recent experiences with a family member's involvement with rehabilitation services.
My father has paraplegia from polio, along with progressing weakness from post–polio syndrome, that has resulted in him using a wheelchair for locomotion and that makes transfers in and out of the wheelchair very difficult. In the fall he developed gastrointestinal problems that resulted in an electrolyte imbalance that required hospitalization. Several days of hospitalization for medical tests and treatments was accompanied by a loss of functioning that required 2 weeks of inpatient rehabilitation, followed by several weeks of home care services. Across numerous encounters with health care providers, including physical therapists in the hospital and the skilled nursing facility, he was told that he would not benefit from services from a physical therapist “because he could not walk” before the onset of his recent medical problems.
I am surprised, and disappointed, that physical therapy services were determined unnecessary for a person because he uses a wheelchair for locomotion. However, occupational therapy was deemed appropriate and he received rehabilitation services from occupational therapists in the hospital, the skilled nursing facility, and through home care.
I was frustrated that another health care professional had contributions to improve the functioning of a person who requires a wheelchair for locomotion, while physical therapists denied having services to contribute to improving his outcome. This should be in our scope of practice—according to the Guide to Physical Therapist Practice (Guide). Physical therapy interventions include “Functional training in self-care and home management is the education and training of patients/clients in activities of daily living (ADL)... Self-care includes ADL such as bed mobility, transfers, dressing, grooming, bathing, eating, and toileting.”1 Refer to Table 1 for a full description of the role for functional training provided by physical therapists.
Why did physical therapists inform my family that the physical therapy profession did not have valuable services to provide? Has the profession moved away from these services and the Guide has not kept up? Or, is the Guide an accurate description of the profession and unique decisions by those physical therapists, or local traditions, prevented him from receiving those services? In either situation, I am concerned that variations in practice of this scale adversely affect patients, the profession, and our standing in the health care system.
I recommend that early in his course of illness, physical therapists should have promoted preventive services, and later in the course of his recovery interventions focused on community reintegration, to manage his health and physical problems for an optimal outcome. I propose that he would have benefitted from therapeutic exercise interventions customized to his weakness and post–polio syndrome, functional training and problem-solving to improve functioning, energy-conservation strategies specific to post–polio syndrome, assessment of the role for assistive and adaptive devices for functioning, assessment and interventions to increase safety, and decision making for managing transitions between settings. Early initiation of those services could have mediated the effects of inactivity and reduced the later use of health care services; services later in his course should have been directed at community reintegration and achievement of optimal functioning.1,2 If we accede that role, our patients lose the benefits of our services, our profession becomes marginalized, and patients experience suboptimal outcomes.
Another concern I hear from acute care physical therapists is that other members of the health care team do not respect us and do not value our contributions to the complex decision making involved in managing acute care patients. Have we contributed to that perception by promoting ourselves as the health care providers who treat patients with walking? Or, has this been an intentional strategy to reduce the workload on overburdened physical therapists and physical therapist assistants in departments that struggle with insufficient staffing due to constricting budgets? Either of these positions is troublesome, as the health care system will respond favorably to other providers willing to address the needs of patients with reduced functioning. While we are shrinking the services we provide to accommodate to a constrained health care environment, there are athletic trainers, exercise physiologists, kinesiotherapists, personal trainers, and others advocating for their role to address the problems of acute care patients. I encourage acute care physical therapists and physical therapist assistants to add advocacy to our duties within our communities so that we clarify our role to health care colleagues and we are valued for the services that we provide to patients.
Jim Smith, PT, DPT
President, Acute Care Section—APTA
1. American Physical Therapy Association. Interactive Guide to Physical Therapist Practice With Catalog of Tests and Measures [Electronic Resource]. Alexandria, VA: American Physical Therapy Association; 2003.
2. Wojciechowski M. Community reintegration of patients: The role of the PT. PT Motion. 2014;6(1):44–52.
Stephen Carp, Temple University
Diane Clark, University of Alabama at Birmingham
Kimberly Cleary, Eastern Washington University
Lee Ann Eagler, Lynchburg College
Gerry Fluet, Rutgers University
Meri Goehring, Grand Valley State University
Sharon Gorman, Samuel Merritt University
Kelly Hawkins, Wingate University
Karen Holtgrefe, Mount Saint Joseph University
Jeanine Kolman, Inova Fair Oaks Hospital
G. Stephen Morris, Wingate University
Shane Patman, University of Notre Dame Australia
Jennifer Ryan, Rush University Medical Center
Beth Smith, University of Southern California
Bonnie Swafford, Saint Luke's Hospital
Lori Tuttle, San Diego State University
Deborah Wendland, Mercer University