During the past few years, as I completed a manual therapy fellowship, I have been much more involved with the PT community online. I have seen many blogs and tweets in social media promoting physical therapy with the #GetPT1st hashtag and giving testimonials on patient outcomes. I think these efforts are valuable and should continue. I have also seen many online posts encouraging PTs to promote our profession’s worth to the general public, referral sources, and to insurance companies. It is to this effort which I wish to comment.
I’ve noticed that many of these calls for action are fairly vague, with some simply stating “we need to show people our value” without saying how to do so. Perhaps these Twitter PTs have ideas on how but simply do not have enough space within 180 characters. But perhaps they also have not thought of concrete steps.
I will not claim to have all the answers, and although there may be some merit to picketing outside of Cigna’s corporate office for better reimbursement or preaching door-to-door at every physician’s office, I think a good first step would be to improve the level of what we already provide. Since most of my life has revolved around sports I like the phrase “Raise Your Game” to describe this idea.
The idea of “raising your game” refers to providing the ideal exercise dosage, diagnostic testing, manual forces, visit frequency, etc., in the treatment of the patient. When you look around at the treatment being provided at your PT practice, is it in line with the plethora of research evidence that is already available? Each provider has to answer that question on their own, but here are a few tendencies I have noticed that are worth considering.
1) Poor Dosing – Most of what I have encountered in PT clinics comes nowhere near an exercise intensity sufficient to induce muscle hypertrophy. I have also seen many past colleagues fail to provide sufficient force to restore ROM in a stiff joint, or provide insufficient power to achieve joint cavitation with thrust manipulation.
2) Poor Testing – This can refer to many practices that should be undertaken as a doctorate-level healthcare provider. It may refer to not taking responsibility to screen for non-musculoskeletal pathology. I recall one of the clinics I worked in earlier in my career that didn’t even have a blood pressure cuff when I first started there. Poor testing may also mean not expressing concerns to referring medical doctors when symptoms do not represent a typical musculoskeletal pattern. In such cases the proper thing to do is consult with the provider about a warranted diagnostic study.
3) Poor Follow-up – It has become common in the PT world to think of ideal treatment as occurring during a set episode of 1-3 months in length. In my opinion, both insurance companies, as well as a perception of other healthcare professions, have contributed to this idea. Insurance companies have required that we fit our treatment into 1-3 month packages where the patient should then be “all better.” But the fact is that that this model is not ideal in many cases, as some recent evidence on booster or maintenance sessions indicates.1,2 Additionally, many in the PT community have heard stories by patients or professors regarding business practices that demand an inordinate number of treatment sessions. I believe disingenuous business practices should be discussed and remedied, but we must be careful not to overdo this zeal by neglecting the long-term welfare of our patients.
In summary, if our profession wants to truly “show our value” to patients and the healthcare community, we would be wise to rise from the status quo to a truly doctorate level of treatment. This may include expanding our current scope of practice in the future, but in the present should at least require expertise in what we already provide.
References:
1. Abbott JH et al. The incremental effects of manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther 2015;45:975-983.
2. Senna MK and Machaly SA. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine 2011;36(18):1427-1437.
