Full document - International Hospital Federation

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