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As a relatively regular reader of this site, and a somewhat infrequent poster, I wanted to take a few minutes to list some things that potential PTs should be on the lookout for when they are observing/shadowing. After reading some of the more recent posts, it is clear that not only does the general populace have a poor idea of what physical therapy is and what a physical therapist does, but so do our potential future therapists. This can certainly stem from their pre-PT exposure to the profession through observation hours, so I would urge all who are considering the profession to make sure that you are observing a quality PT.
Here are some "Red Flags" that would make me question the quality of the care provided at a PT clinic (This is primarily from the perspective of an outpatient orthopaedic physical therapist):
1. Use of a lot of modalities (ultrasound, electrical stimulation) - there is virtually no evidence supporting the efficacy of these interventions, yet their use continues to be perpetuated by PTs with limited knowledge, patient's expectations that PT is more about machines than about other interventions, and uneducated referral sources who continue to order this garbage. If the PT you are shadowing is plugging more people in than he/she are putting their hands on, run, dont walk, to find another PT to shadow.
2. No mention of evidence for the interventions they choose, either when educating the patient, or when discussing patient cases with their colleagues.
3. Similar treatments and exercises for large groups of patients, i.e. low back pain. If all of your PTs patients with low back pain (LBP) get hamstring stretching, posterior pelvic tilts, etc., they are not practicing physical therapy, because they are not using their examination findings to determine the best treatment for a patient. Rather, they are providing a generalized treatment for a generalized condition that will yield generally poor results.
4. Use of manual therapy interventions with no support in the relevant PT literature. By this I am talking about things such a Myofascial Release and/or Cranio-Sacral Therapy. Both interventions are based on flawed scientific theory and if the therapist you are shadowing is using these techniques at all, they have either bought into a pseudo-scientific explanation for a treatment closer to voodoo than medicine/physical therapy, or they have chosen to ignore the preponderance of evidence that shows these therapies to be ineffective. Neither reason is acceptable.
5. No concern by the PT about the efficacy of the patients home exercise program. If the therapists patients are primarily coming to them to reduce their pain, then the home exercise program should reduce the patients symptoms when it is performed. Many PTs blame poor outcomes on poor patient compliance, If a patient comes to me in pain, and I show them exercises that reduce or resolve those symptoms, there generally isnt a compliance problem. Maybe our patients who exhibit poor compliance have been given home exercise programs that either dont change their symptoms are make them worse.
As prospective future PTs, take the time to seek out high-quality observation opportunities. They will improve your knowledge of what good physical therapy is, and likely get you more engaged in the profession as a result. Letting poor quality physical therapy frame your knowledge and opinion of the profession perpetuates many of the problems with the profession that have been discussed in numerous posts here, as well as at other message boards.
Here are some "Red Flags" that would make me question the quality of the care provided at a PT clinic (This is primarily from the perspective of an outpatient orthopaedic physical therapist):
1. Use of a lot of modalities (ultrasound, electrical stimulation) - there is virtually no evidence supporting the efficacy of these interventions, yet their use continues to be perpetuated by PTs with limited knowledge, patient's expectations that PT is more about machines than about other interventions, and uneducated referral sources who continue to order this garbage. If the PT you are shadowing is plugging more people in than he/she are putting their hands on, run, dont walk, to find another PT to shadow.
2. No mention of evidence for the interventions they choose, either when educating the patient, or when discussing patient cases with their colleagues.
3. Similar treatments and exercises for large groups of patients, i.e. low back pain. If all of your PTs patients with low back pain (LBP) get hamstring stretching, posterior pelvic tilts, etc., they are not practicing physical therapy, because they are not using their examination findings to determine the best treatment for a patient. Rather, they are providing a generalized treatment for a generalized condition that will yield generally poor results.
4. Use of manual therapy interventions with no support in the relevant PT literature. By this I am talking about things such a Myofascial Release and/or Cranio-Sacral Therapy. Both interventions are based on flawed scientific theory and if the therapist you are shadowing is using these techniques at all, they have either bought into a pseudo-scientific explanation for a treatment closer to voodoo than medicine/physical therapy, or they have chosen to ignore the preponderance of evidence that shows these therapies to be ineffective. Neither reason is acceptable.
5. No concern by the PT about the efficacy of the patients home exercise program. If the therapists patients are primarily coming to them to reduce their pain, then the home exercise program should reduce the patients symptoms when it is performed. Many PTs blame poor outcomes on poor patient compliance, If a patient comes to me in pain, and I show them exercises that reduce or resolve those symptoms, there generally isnt a compliance problem. Maybe our patients who exhibit poor compliance have been given home exercise programs that either dont change their symptoms are make them worse.
As prospective future PTs, take the time to seek out high-quality observation opportunities. They will improve your knowledge of what good physical therapy is, and likely get you more engaged in the profession as a result. Letting poor quality physical therapy frame your knowledge and opinion of the profession perpetuates many of the problems with the profession that have been discussed in numerous posts here, as well as at other message boards.