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Innovation and clinical specialities: physical therapy Responding to challenges in physical therapy ARTICLE BY CATHERINE SYKES PT, MSC professional policy consultant, World Confederation for Physical Therapy BRENDA MYERS BScPT, MHSA Secretary General, World Confederation for Physical Therapy MARILYN MOFFAT PT, DPT, PhD, FAPTA, CSCS President, World Confederation for Physical Therapy TRACY BURY MSc Grad Dip Phys MCSP professional policy consultant, World Confederation for Physical Therapy This paper describes a range of contemporary challenges affecting the physical therapy profession and its practice around the world, and the way the profession is responding to them. Physical therapists (called physiotherapists in some countries) provide services to individuals and populations to develop, maintain and restore maximum movement, functional ability and quality of life throughout the lifespan. Their practice encompasses the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. Their work includes incorporating the aspects of physical, psychological, emotional, and social wellbeing into their practice. The practice of physical therapy includes treatments/interventions for patients/clients with a multiplicity of diseases, disorders and conditions of the musculoskeletal, neuromuscular, cardiovascular/ pulmonary, integumentary, genito-urinary, endocrine, and immunological systems. Working with patients/clients, other health professionals, families, caregivers, and communities, physical therapists examine movement potential and establish mutually agreed upon goals, using knowledge and skills unique to them. Physical therapists practise in a wide variety of settings: not only in hospitals and other acute care settings but also in the community, out-patient clinics, private practices, rehabilitation centres, schools, work places, recreational facilities and public places. As governments seek to reduce healthcare budgets, services are moved from the expensive hospital environment to more community-based service delivery settings. Physical therapists have responded to the increasingly diverse service delivery system in flexible, responsive and unique ways that are reflective of local needs and resources. As the international voice of the profession, the World Confederation for Physical Therapy (WCPT) is instrumental in leading the profession, providing strong communication on behalf of its member organisations. WCPT is the international body founded in 1951 to represent the global interests of physical therapists and their patients/clients. It represents 101 member organisations and more than 300 000 physical therapists worldwide, providing the sole international voice for the profession. Evolution of the profession of physical therapy Physical therapy firmly established itself in the 20th century. Its growth was triggered by the large numbers of people injured particularly in World War I and and by the raging polio epidemics leaving untold numbers of children and adults with paralysis. Educated at the highest levels, physical therapists now deliver services as autonomous practitioners. Professional challenges Physical therapy now faces a number of new challenges around the world, which are being addressed by the World Confederation for Physical Therapy (WCPT). These include the growth of lifestyle-related diseases, such as arthritis, cardiovascular disease, diabetes and asthma; new technologies such as robotics; increasingly complex service delivery systems; the supply of physical therapists to meet service Figure 1: A physiotherapist working on a young child Hospital and Healthcare Innovation Book 2009/2010 109
Innovation and clinical specialities: physical therapy delivery requirements; and public access to physical therapy services. The World Confederation for Physical Therapy is addressing this range of challenges through its policies, programmes and advocacy. Lifestyle related diseases Chronic and lifestyle related diseases are the primary causes of death and disability in many countries, including those with low and middle incomes. Physical therapists are increasingly undertaking a primary care role, specifically in relation to the prevention and management of those lifestyle diseases that are associated with low levels of physical activity. As experts in movement and exercise and with a thorough knowledge of anatomy, physiology and the effects of pathology on all systems, physical therapists are the ideal professionals to promote, guide, prescribe and manage exercise activities. Exercise promotes wellbeing and fitness. It is a powerful intervention for strength, power, endurance, flexibility, balance, relaxation, recreation and the remediation of functional limitations. There is evidence of the cost benefits that this intervention can bring: ✚ One study showed statistically significant decreases in body mass index (BMI) over time in an intervention group of people with intellectual disabilities compared with a non-intervention group (Chapman et al 2009). ✚ A home-based programme of strength and balance retraining exercises, individually prescribed by a physical therapist, was effective in reducing falls and injuries in women aged 80 years and older. The benefit, for those who keep exercising, continued over a 2-year period (Campbell et al 1999). The reduction in healthcare costs per individual for treating fallrelated injuries was 1.85 times higher than the cost of implementing a fall prevention programme (Hektoen et al 2009). A range of policies and resources has been developed by WCPT for use by member organisations to support of the role of physical therapists in this area. New technologies Technology has been developing apace in recent years and, physical therapists with their educational background in the physical, biological, biomechanical, and kinesiological sciences can engage readily with these new technologies. Technology for delivering services Physical therapists have been using electronic channels, such as the telephone and the internet, to augment their service provision to patients and clients and to help to reduce the costs of service delivery. For example, a 12-week home-based tele-rehabilitation programme delivered to people with multiple sclerosis resulted in improved functional outcomes. The individualised exercise programmes devised during a face-to-face consultation with a physical therapist were monitored by online video conferencing. Advantages of this form of delivery included the ability to monitor performance, make progressions and address questions and complications promptly. Tele-rehabilitation was well accepted by the programme recipients and cost effective for providers (Finkelstein et al 2008). Web-based physical therapy advice is another means of providing prompt, cost-efficient access to physical therapy services, especially for those in remote areas. Simultaneous management of many people and access 24 hours a day are advantages of this form of self-management. The majority of users of this sort of low cost service were satisfied with the advice they received, did not require further health services and completely self-managed their condition (see: www.physioadvice.scot.nhs.uk). Technology as treatments/interventions As well as affecting how physical therapy is delivered, many new technologies have influenced treatments and interventions. Physical therapists are involved in the rapidly expanding field of exoskeletons and their varied uses, including gait training during post-stroke recovery and helping patients with neurological disorders. Robotic systems that augment physical therapy have shown improvements in the level and speed of recovery of functional performance of individuals with hemiplegic upperextremity impairments. New biofeedback mechanisms such as myoelectric signals enable the user to control prosthetic limbs (Moffat 2004). The Guidelines for Physical Therapist Professional Entry Level Education (WCPT 2007) ensure that physical therapists education constantly evolves to keep pace with new developments. Technology for evidence and communication Electronic health records (EHR) are the future for recording and monitoring health care provision, not only at the individual level, but also by aggregation of anonymised data for administrative reporting and statistics. The challenge is to ensure that functional status information is included in EHR in a way that is consistent and reliable across service settings such that the value of physical therapy can be demonstrated and communicated. For example, current administrative records use the International Classification of Diseases to describe the health condition (e.g. M06.0 Seronegative rheumatoid arthritis); however this does not describe whether the upper limbs or lower limbs are affected, whether the person can care for herself/himself and get around, or the sorts of equipment that they need to remain independent. Functional status information complements information about the disease and can be used to describe how the person lives with rheumatoid arthritis. To this end the WCPT has endorsed the International Classification of Functioning, Disability and Health (WHO 2001) with the aim that it be used as the framework for describing the functional status of individuals as part of physical therapy practice. WCPT also promotes the use of the classification for evidencing the efficacy of physical therapy practice. High quality, reliable data collected in daily practice can be used to make comparisons between services, identify service training needs, highlight where research is needed, support evidence-based policies, and help identify the best balance of human resources for the health system. Many of these new developments are showcased at the WCPT Congress; an event conducted every four years, which brings together more than 3000 physical therapists from across the world. Education WCPT recognises that there is diversity in the social, economic, 110 Hospital and Healthcare Innovation Book 2009/2010
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Contents Healthcare transformation
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