Has there ever been a push in PT for preventative "musculoskeletal check-ups"?

[BiffTheFlashRogers]

I'm a first year (almost second year! One week left!) SPT and was doing some reading the other day when something caught my attention.

In the article, a PT was talking about how it might be a good idea for the profession to get into providing some sort of yearly "musculoskeletal check-up", sort of how people go to their dentist for a check up and teeth cleaning every 6 months. This sort of check-up could obviously do a lot to catch potential musculoskeletal issues before they become actual problems and lead to patients needing longer term PT, surgery...etc down the road.

Obviously insurance companies would probably be the biggest barrier to this, but has there ever been a push for this? Anyone hear of PTs running cash based practices doing this?

---

Members don't see this ad.

 

[abynormal]

I am very interested in this as well! If we can show the,cost effectiveness towards preventative care than insurance has more reason to cover initial costs.

 

[PTX2]

I'm a first year (almost second year! One week left!) SPT and was doing some reading the other day when something caught my attention.

In the article, a PT was talking about how it might be a good idea for the profession to get into providing some sort of yearly "musculoskeletal check-up", sort of how people go to their dentist for a check up and teeth cleaning every 6 months. This sort of check-up could obviously do a lot to catch potential musculoskeletal issues before they become actual problems and lead to patients needing longer term PT, surgery...etc down the road.

Obviously insurance companies would probably be the biggest barrier to this, but has there ever been a push for this? Anyone hear of PTs running cash based practices doing this?

Maybe something like the FMS/SFMA?

 

[jblil]

I can hear chiros & orthopods howling...

 

[starrsgirl]

I haven't heard of this but I do wish we could at least take over the sports physicals.....

 

[atstudent]

I haven't heard of this but I do wish we could at least take over the sports physicals.....

Because PTs have the cardiac background to handle a sports physical?!?!

 

[BiffTheFlashRogers]

The plot thickens

http://www.apta.org/AnnualCheckup/

 

[Azimuthal]

Because PTs have the cardiac background to handle a sports physical?!?!

But here you go anyways.

Page 33.
http://www.capteonline.org/uploaded...reditation_Handbook/EvaluativeCriteria_PT.pdf

http://www.abpts.org/Certification/CardiovascularPulmonary/

http://www.abpts.org/Certification/Sports/

 

[NewTestament]

I imagine this will start first in cash-based clinics where reimbursement from insurance companies is not an issue. It's not a bad idea. One of my professors performed screens for female athletes. It's not exactly a "tune-up" or "check-up" but it's similar.

 

[DesertPT]

I've seen this mentioned on various social media several times recently. If insurance companies were smart they'd pay for it in a heart beat. You could pay for someone to go see their PT several times a year for life for the cost of one major orthopaedic surgery. Not to mention that PTs spend more time with patients and do more thorough evaluations than any other healthcare professionals. We all know that PTs catch things that physicians and other providers have missed all the time. If everyone got a 45 min eval by a PT once a year can you imagine the number of non-neuromusculoskeletal health conditions that would be caught early and could be referred out while they are more easily treatable, on top of all the neuromusculoskeletal conditions that could be prevented or slowed.

Not to mention the fact that the evidence is now overwhelming that regular exercise and physical activity prevents more disease than any other method. PTs are likely the most passionate healthcare providers when it comes to promoting physical activity, and are by far the most qualified providers to examine and assess an individual's capabilities for physical activity and to intervene to address the reasons why people are moving as much and as often as they should.

The US spends around $10,000 per person per year on healthcare. So I'd guess if every single man, woman and child had an annual head to toe eval by a PT each year it would raise US healthcare spending by less than 1/10th of a percent. But you'd be hard pressed to convince me that it wouldn't result in significantly more than 1/10th of a percent reduction in healthcare costs.

 

[BiffTheFlashRogers]

I've seen this mentioned on various social media several times recently. If insurance companies were smart they'd pay for it in a heart beat. You could pay for someone to go see their PT several times a year for life for the cost of one major orthopaedic surgery. Not to mention that PTs spend more time with patients and do more thorough evaluations than any other healthcare professionals. We all know that PTs catch things that doctors and other providers have missed all the time. If everyone got a 45 min eval by a PT once a year can you imagine the number of non-neuromusculoskeletal health conditions that would be caught early and could be referred out while they are more easily treatable, on top of all the neuromusculoskeletal conditions that could be prevented or slowed.

The US spends around $10,000 per person per year on healthcare. So I'd guess if every single man, woman and child had an annual head to toe eval by a PT each year it would raise US healthcare spending by less than 1/10th of a percent. But you'd be hard pressed to convince me that it wouldn't result in significantly more than 1/10th of a percent reduction in healthcare costs.

I completely agree with all of this. The question is, how does one convince the insurance companies to pay for this? It seems like common sense, but common sense only gets you so far. A research study to get evidence would have to be one hell of a longitudinal study.

 

[DesertPT]

It seems like common sense, but common sense only gets you so far. A research study to get evidence would have to be one hell of a longitudinal study.

Indeed. Let's hope somebody get's crackin' on one ASAP. Though a study would have to be a massive in scope and conducted over the course of decades to be conclusive, the question being asked would be elegantly simple: here's a million people who went to a PT for an annual check-up, and here's a million that didn't. What is the difference in their lifetime healthcare costs? I'm confident I know what the answer would be.

 

[atstudent]

View attachment 202531

But here you go anyways.

Page 33.
http://www.capteonline.org/uploaded...reditation_Handbook/EvaluativeCriteria_PT.pdf

http://www.abpts.org/Certification/CardiovascularPulmonary/

http://www.abpts.org/Certification/Sports/

I do think that PTs could play an active role in sports physicals. That doesn't mean I'd ever accept one that they are signing off on. Same thing with ATs and chiropractors. They have a role. But should never be the sole provider. IMO. In fact, if I get my way at my current school, our physicals process would include PT/chiropractors, ATs, nurses, orthopedic surgeons, and PCP all in one comprehensive physical exam process.

 

[BiffTheFlashRogers]

Indeed. Let's hope somebody get's crackin' on one ASAP. Though a study would have to be a massive in scope and conducted over the course of decades to be conclusive, the question being asked would be elegantly simple: here's a million people who went to a PT for an annual check-up, and here's a million that didn't. What is the difference in their lifetime healthcare costs? I'm confident I know what the answer would be.

Given the vast amount of time that such a study would take to complete, I guess that the other logical path forward would be to market the idea to the public...and/or physicians? If we could get PCPs to suggest PT check-ups to patients that could help get the message out. PCPs wouldn't be shelling out money like insurance companies would, so it might be easier to play the common sense angle with them since they wouldn't have anything to lose, in theory.

 

[redrose424]

I've seen this mentioned on various social media several times recently. If insurance companies were smart they'd pay for it in a heart beat. You could pay for someone to go see their PT several times a year for life for the cost of one major orthopaedic surgery. Not to mention that PTs spend more time with patients and do more thorough evaluations than any other healthcare professionals. We all know that PTs catch things that physicians and other providers have missed all the time. If everyone got a 45 min eval by a PT once a year can you imagine the number of non-neuromusculoskeletal health conditions that would be caught early and could be referred out while they are more easily treatable, on top of all the neuromusculoskeletal conditions that could be prevented or slowed.

Not to mention the fact that the evidence is now overwhelming that regular exercise and physical activity prevents more disease than any other method. PTs are likely the most passionate healthcare providers when it comes to promoting physical activity, and are by far the most qualified providers to examine and assess an individual's capabilities for physical activity and to intervene to address the reasons why people are moving as much and as often as they should.

The US spends around $10,000 per person per year on healthcare. So I'd guess if every single man, woman and child had an annual head to toe eval by a PT each year it would raise US healthcare spending by less than 1/10th of a percent. But you'd be hard pressed to convince me that it wouldn't result in significantly more than 1/10th of a percent reduction in healthcare costs.

I always love your posts and you make me really excited to be starting school this June!

 

[jesspt]

Because PTs have the cardiac background to handle a sports physical?!?!

Nope. Don't think we do. I certainly don't want to be the one who has do try to pick up a heart arrhythmia during an exam.

 

[jesspt]

Maybe something like the FMS/SFMA?

Is there data that suggests that the findings of FMS/SFMA are generalizable to the general populace?

 

[Azimuthal]

Nope. Don't think we do. I certainly don't want to be the one who has do try to pick up a heart arrhythmia during an exam.

Just curious. Do you feel uncomfortable with performing the screening because you were not formally educated on the subject or lack of experience performing said screenings, or both?

When I was going through my program, we got the basics and went through lab, where the screenings can be performed by a PT (specialist). An MD/PA/NP was always present for findings. The ECG/EKG (which ever, if ordered), were interpreted by an MD, and abnormalities highlighted by the tester. Note that these tests were far in-between and most of the time they were still cleared as I was informed that well conditioned athletes will have some irregularities. I personally would not be comfortable with it. However, there are many PT's out there that are and have been performing these examins, though not entirely in a sports setting.

That aside, any PT performing heart auscultations should be familiar with normal heart sounds through the cardiac cycle. Any red flags from questionnaires or abnormal heart sounds should be referred out immediately. One of the benefits of having a sports physician available during the screening, of course, is a plus. I like atstudent's multi-model approach.

 

[Azimuthal]

Is there data that suggests that the findings of FMS/SFMA are generalizable to the general populace?

I have not come across any.

 

[jesspt]

Just curious. Do you feel uncomfortable with performing the screening because you were not formally educated on the subject or lack of experience performing said screenings, or both?

When I was going through my program, we got the basics and went through lab, where the screenings can be performed by a PT (specialist). An MD/PA/NP was always present for findings. The ECG/EKG (which ever, if ordered), were interpreted by an MD, and abnormalities highlighted by the tester. Note that these tests were far in-between and most of the time they were still cleared as I was informed that well conditioned athletes will have some irregularities. I personally would not be comfortable with it. However, there are many PT's out there that are and have been performing these examins, though not entirely in a sports setting.

That aside, any PT performing heart auscultations should be familiar with normal heart sounds through the cardiac cycle. Any red flags from questionnaires or abnormal heart sounds should be referred out immediately. One of the benefits of having a sports physician available during the screening, of course, is a plus. I like atstudent's multi-model approach.

My cardiopulmonary PT class was quite a while ago, and it was heavily tilted toward pulmonary rehab. And since then, I have worked in an outpatient ortho setting almost exclusively. I don't think I would have been comfortable clearing any athlete for participation in sports from a cardiac standpoint even when I had used that skill set more recently.

 

[jesspt]

I have not come across any.

Was hoping for a response from @PTX2 .

 

[NJ DPT HOPEFUL]

I'm going to agree with Jesspt on PT's not "taking over sports physicals".

I'm very for a PT check-up and I think doing this as a preventative measure could help to identify issues (such as stenosis or a muscle weakness) and correct this before it becomes more serious and causes a workers comp situation.

However with a sports physical a lot more is looked at besides the movement system. I don't think that the doctors/PAs do a bad job with this and there is no reason for us to have that liability.

Now if you want to say that student athletes should also have to have their movement system checked out by a PT in addition to the medical aspects of a physical, you might have a better argument.

If these Annual PT checkups do catch on you could have student athletes required to get one in addition to their trip to the doctor.

 

[jesspt]

I'm going to agree with Jesspt on PT's not "taking over sports physicals".

I'm very for a PT check-up and I think doing this as a preventative measure could help to identify issues (such as stenosis or a muscle weakness) and correct this before it becomes more serious and causes a workers comp situation.

However with a sports physical a lot more is looked at besides the movement system. I don't think that the doctors/PAs do a bad job with this and there is no reason for us to have that liability.

Now if you want to say that student athletes should also have to have their movement system checked out by a PT in addition to the medical aspects of a physical, you might have a better argument.

If these Annual PT checkups do catch on you could have student athletes required to get one in addition to their trip to the doctor.

I don't understand why everyone is focused predominantly on a population (student athletes) for which we have few/no screening tools that have been validated. What movement screening tool would people propose we use on a student athlete?

Why not focus on an annual PT visit for our elderly patients and screen them for falls risk using things such as Berg Balance Scale? This seems like a better fit to me.

 

[NJ DPT HOPEFUL]

I don't understand why everyone is focused predominantly on a population (student athletes) for which we have few/no screening tools that have been validated. What movement screening tool would people propose we use on a student athlete?

Why not focus on an annual PT visit for our elderly patients and screen them for falls risk using things such as Berg Balance Scale? This seems like a better fit to me.

I was going with that population as a response to sports physicals being brought up. I don't think there is any dispute that checkups would be beneficial for elderly patients. I'd also add for working age patients. Because when they have these preventative injuries it costs the state, their employer and their insurance money. I think they would a good population to sell the idea with


Also a footnote. I'm starting my PT program in a month so I certainly have a ton to learn (which is the main reason I read these types of posts)

 

[PTX2]

Is there data that suggests that the findings of FMS/SFMA are generalizable to the general populace?

No, not as far as I can tell doing a quick search for articles. Research on the FMS/SFMA is relatively young and the majority of research is focused on athletes and/or highly active populations. I have to assume it is just easier to test the screen's efficacy on populations that are already extremely active.

As I think about this more I can see how the FMS/SFMA may be too population specific. I do think an annual check in with a PT could be beneficial. Perhaps, starting with a basic interview to gather the patients's history and how they feel in general would then determine what type of "check up" you would need to perform on them.

 

[BiffTheFlashRogers]

Perhaps, starting with a basic interview to gather the patients's history and how they feel in general would then determine what type of "check up" you would need to perform on them.

Which would make sense. Physicians look at different things during examinations across the lifespan.

 

[starrsgirl]

Serious question...how do we feel about chiropractors doing sports physicals? I know they perform them. Do they have more cardiac training than we do?.

As for cardiac screening, yes, I think PTs are as well qualified as a family doc, PA or NP. I'm sad to hear that many people don't feel like we can do that. I'm still in school and we spend an awful lot of time training with the stetescopes and talking about how we should check vitals on many different patients/situations. If we as a profession don't think we can ID red flags, then why are we even pretending to teach it in school? I was assuming to get even more hands on practice in my clinicals.

As a side note, sadly, cardiac auscultation is not very reliable in general. I've seen numbers from 26% to 40% on identifying abnormal heart sounds. So really, for a sports physical the best we are hoping to catch are BIG ISSUES or red flags from family history or symptoms. This is why there is a push to bring in other technology (like ultrasound or a listening type of device to better capture these.)

 

[jesspt]

Serious question...how do we feel about chiropractors doing sports physicals? I know they perform them. Do they have more cardiac training than we do?.

As for cardiac screening, yes, I think PTs are as well qualified as a family doc, PA or NP. I'm sad to hear that many people don't feel like we can do that. I'm still in school and we spend an awful lot of time training with the stetescopes and talking about how we should check vitals on many different patients/situations. If we as a profession don't think we can ID red flags, then why are we even pretending to teach it in school? I was assuming to get even more hands on practice in my clinicals.

As a side note, sadly, cardiac auscultation is not very reliable in general. I've seen numbers from 26% to 40% on identifying abnormal heart sounds. So really, for a sports physical the best we are hoping to catch are BIG ISSUES or red flags from family history or symptoms. This is why there is a push to bring in other technology (like ultrasound or a listening type of device to better capture these.)

That's frightening to me. A PCP has gone through 4 years of medical school, an intern year, and a residency, getting much more patient contact that we do in our education, and in general treating and examining more patients with cardiac conditions. The preparation between the two professions in this regard is not even close.

You want to sign off that a kid can run cross country and then dies of a cardiac event? Do you think a jury will view your preparation as adequate to have cleared them?

I think we can identify red flags and refer appropriately for MSK conditions. I don't think PTs should be involved in cardiac screening.

 

[jesspt]

No, not as far as I can tell doing a quick search for articles. Research on the FMS/SFMA is relatively young and the majority of research is focused on athletes and/or highly active populations. I have to assume it is just easier to test the screen's efficacy on populations that are already extremely active.

As I think about this more I can see how the FMS/SFMA may be too population specific. I do think an annual check in with a PT could be beneficial. Perhaps, starting with a basic interview to gather the patients's history and how they feel in general would then determine what type of "check up" you would need to perform on them.

It appears to be only applicable to NFL or Division I collegiate football players. I don't see many of those in my clinic. Certainly not enough to justify the 1,000,000 SFMA courses that I see.

 

[NJ DPT HOPEFUL]

@jesspt or someone else experienced, can you answer the part about Chiropractors doing sports physicals? I've never heard that before

 

[jesspt]

@jesspt or someone else experienced, can you answer the part about Chiropractors doing sports physicals? I've never heard that before

It doesn't happen in the greater Chicago area, at least that I'm aware of. I'm sure that some would like to - there are some DC's that want to be PCPs (*shudder*).

 

[ptisfun2]

Is there data that suggests that the findings of FMS/SFMA are generalizable to the general populace?

Not 100% what you are looking for, but something....http://www.ncbi.nlm.nih.gov/pubmed/26203739

 

[Fiveoboy11]

I could buy annual check ups with a PT for: fall prevention, exercise program opinions, help to reduce disability, f/u after prior D/C, etc. A sports physical is for another group IMO (i.e. MD/DO or at least PA/NP). To me a physical therapy annual check up should be geared to the disabled and elderly, not the young athlete.

 

[atstudent]

@jesspt or someone else experienced, can you answer the part about Chiropractors doing sports physicals? I've never heard that before

Unfortunately here in Texas they are allowed to do it. We had a chiropractor group approach our school nurse about setting up a partnership for them to do a lot of physicals for us I quickly shut down any chance of that! Like I said earlier, chiropractors, PTs, and ATs all have a role in the sports physicals process IMO, but they still need to be signed by an MD or DO IMO...

 

[jesspt]

This might be applicable - haven't had time to take a full read just yet.

 

[el_duderino]

Out of curiosity, what do you do if you determine an elderly person is at increased fall risk? And why can't that be performed at the regular physicals they're already getting from their doctors?

I think this is an interesting idea, but I'm wondering what kinds of things you hope to catch and treat.

 

[jesspt]

Out of curiosity, what do you do if you determine an elderly person is at increased fall risk? And why can't that be performed at the regular physicals they're already getting from their doctors?

I think this is an interesting idea, but I'm wondering what kinds of things you hope to catch and treat.

Well, their physicians would have to be aware of balance tests such as the Berg Balance Scale and be willing to take the time to administer them. I'm not holding my breath...

 

[jesspt]

Out of curiosity, what do you do if you determine an elderly person is at increased fall risk? And why can't that be performed at the regular physicals they're already getting from their doctors?

I think this is an interesting idea, but I'm wondering what kinds of things you hope to catch and treat.

Berg Balance Scale - a useful predictor of individuals who are likely to suffer multiple falls.

Mortality rate after hip fracture.

 

[BiffTheFlashRogers]

Fitting video someone on a different forum provided:

 

[DesertPT]

It doesn't happen in the greater Chicago area, at least that I'm aware of. I'm sure that some would like to - there are some DC's that want to be PCPs (*shudder*).

Most DC's refer to themselves as "physicians" (*double shudder*)

 

[Fiveoboy11]

Out of curiosity, what do you do if you determine an elderly person is at increased fall risk? And why can't that be performed at the regular physicals they're already getting from their doctors?

I think this is an interesting idea, but I'm wondering what kinds of things you hope to catch and treat.

It's complex and depends on the case. Doubtful most physicians know how or how to intervene. IMO it's outside the scope of their training and profession.

 

[el_duderino]

So.... what's the intervention?

 

[DesertPT]

Out of curiosity, what do you do if you determine an elderly person is at increased fall risk? And why can't that be performed at the regular physicals they're already getting from their doctors?

I think this is an interesting idea, but I'm wondering what kinds of things you hope to catch and treat.

I really appreciate you coming into our forum and asking this question in a way that sounds like you actually want the answer. Unfortunately their are still a lot of medical students/residents and physicians out their who are very skeptical of the abilities of physical therapists. I hope you interpret the rest of my post as an honest reply and not as a pompous attempt to show off PT knowledge.

There is lots of evidence showing that elderly people at increased risk for falls should be prescribed exercises for improved balance, strength and endurance. Working on these exercises with a PT and being given a good home exercise program has been shown repeatedly to reduce the incidence of falls. The Otego HEP program is a good example of a community-based initiative but a customized program based on the specific impairments identified in a PT exam would be ideal for older adults at higher risk.

In general I don't believe the regular physicals most people get from their doctors include a thorough and objective assessment of history of falls and current fall risk, which would include testing of functional balance using something like the Berg or BESTest/miniBESTest, assessment of proprioceptive/coordination deficits, measurement of balance confidence and fear of falling (which has also been shown to be a major predictor of fall risk) through something like the ABC, strength and ROM assessment, gait assessment, etc. This then has to be followed with prescriptive exercise that addresses the specific impairments that are putting that person at higher risk for falls, given at the right dose to challenge the person to a sufficient degree to result in real gains without compromising safety. Prescription of an appropriate HEP is then necessary, and follow up with the person on the HEP as well as continued re-assessment and modification of the program as needed is critical to ensure they continue to progress. Prescription and fitting of an appropriate assisstive device may also be necessary, and this isn't always just give granny a walker and tell her to use it. Balance deficits due to vestibular pathology are also common in the older adult, and correct assessment and treatment here is commonly performed by PTs and will be necessary for them to reduce fall risk.

I would be pretty unfair to expect a person's PCP to be knowledgeable about all of the above when we are already asking them to be knowledgeable about every area of medicine, and then actually implement it in the meager time they are usually given for a physical exam, on top of everything else that already needs to by done in a physical. Physicians are experts in human disease, physical therapists are experts in human movement. The two of course have some overlap and ultimately should function in a complimentary way that maximizes outcomes for the patient.

 

[DesertPT]

Basically I wouldn't want my physician attempting to assess and treat my balance and gait deficits any more then I would want my PT attempting to diagnose and treat my kidney disease.

 

[el_duderino]

I'm old enough to need a PT every now and then! I know you guys are very educated and very good at what you do. Thanks for the reply. I'm just a second year,but we had some lectures by a PM&R physician that talked about a lot of those things, such as the BESS test and others. It was mostly in the scope of measuring progress following traumatic brain injury and sports medicine as opposed to PT. I suppose a PM&R doc might have a lot of overlap with what you describe, but then again a PM&R doc probably has no business treating an elderly patient's chronic kidney disease and emphysema either.

 

[DesertPT]

I suppose a PM&R doc might have a lot of overlap with what you describe, but then again a PM&R doc probably has no business treating an elderly patient's chronic kidney disease and emphysema either.

Indeed. PM&R is also focused on the relevant neuro-MSK medical management of rehabilitation patients, not so much on the actual physical rehabilitation itself. Again, both are needed for the pt to really benefit from rehab, particularly in the inpatient setting.

 

[Bostonspine]

Indeed. PM&R is also focused on the relevant neuro-MSK medical management of rehabilitation patients, not so much on the actual physical rehabilitation itself. Again, both are needed for the pt to really benefit from rehab, particularly in the inpatient setting.

Balance deficits in the elderly are multi-factorial and require an interdisciplinary treatment approach include physical therapy and medical management. Most of the medical management involves discontinuing med(Beers criteria) or treatment for neurodegenerative conditions. PMR or Neurology are probable the best to work in concert with PT to optimize. Primary care docs can only do so much in 15min


Sent from my iPhone using SDN mobile