PM&R Opinion on Physical Therapy Effectiveness

[blob2121]

I am a student who has recently been accepted to physical therapy school. I have spent a lot of time observing and researching physical therapy. Through this research and observation, I have come to have some reservations about the profession. I was hoping, given your vast experience in the field of rehabilitative medicine, you could give me your opinion on some questions I have about physical therapy. It is my understanding that PMR doctors often work closely with physical therapists. I am hoping I can get an outside opinion as I often find physical therapists to exist in an echo chamber.


My main questions are:

1. Do you believe the majority of physical therapy treatments that you prescribe for you patients are more effective than a placebo treatment?

2. Given the lack of evidence surrounding many physical therapy practices, how do you justify prescribing it for many patients?



As you can probably tell my main concerns focus on the evidence supporting physical therapy. I am having trouble finding a substantial amount of convincing evidence supporting the practices used in the profession. I have even seen practices used which have substantial evidence against them. I have asked physical therapists and most have politely danced around the kernel of my questions. I realize you are not physical therapists, but I would appreciate your insight into the matter.



If there is anything else you would like to know about me or questions you have for me, please feel free to ask.

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[DubVille]

Depends on what the physical therapy is for. If its for inpatient rehab following a stroke, TBI, or spinal cord injury I am a huge fan and believer.

For outpatient chronic pain, meh. Some are better than others but there isnt fantastic evidence. Then again, there isn't any slam dunk evidence for many of the injections I'm doing either. I prescribe it because it requires patients to (hopefully) take responsibility and learn good habits/techniques/exercises going forward. Plus i have to in order to get an MRl.

 

[sloh]

I'd highly recommend you read this. Eric Meira is one of the most respected PT's in your field, at least among the evidence based bunch.

The Ethics of Healthcare Advertising – The Science PT

"Many physical therapists are frustrated right now. They feel that at one end, the medical establishment is referring less, criticizing the profession for lacking efficacy and having only “low-value” effectiveness. From the other side, we are “getting our assess kicked” by the targeted and effective advertising strategies of alternative medicine providers. People are either going home without our services or going elsewhere for the services that we believe should be provided by a physical therapist.

First, as a profession we need to ask ourselves who we are. Let’s think of this as asking, “What ID card do you carry?” Falling under the very large health services umbrella, there are two cards that your profession can carry: Medical Professional or Consumer Service. You can’t play both cards…we’ll get to that.

The first thing we need to establish here is whether or not we are “medically necessary”. This matters because this is what defines us as being worthy of coverage by 3rd party payers. The quickest way to lose that is to embrace the position of being medically unnecessary.

Many people who have a potential medical concern can become anxious about the uncertainty of their situation. This makes them very susceptible to fear mongering – using fear to motivate action. This is very effective from a marketing perspective. Not so good from a public health perspective. For example, telling someone that their “creaky knee” could be the sign of something that needs to be treated is a very bad way to keep unnecessary patients out of the healthcare system.

“But I’m not TRYING to scare anyone.”

Look buddy, it doesn’t matter what you are TRYING to do. It matters what you are ACTUALLY doing. And you are actually fear mongering. When you are using it to expand the markets for your treatment, it’s called disease mongering.

There is a table where healthcare policy decision makers sit. Everyone sitting at that table has pledged an oath to serve society as a whole; Everyone sitting at that table plays by the rules of science and speaks in the language of epidemiology and population wide cost-benefit analyses. They all understand that sometimes what is best for their profession may not be what is best for society as a whole. And vice versa.

Currently, physical therapists have a seat at the table. Remember, in order to sit at that table, we have certain understood ethical constraints whether self-imposed or not. When we start violating those constraints in the name of self-promotion instead of promoting public health as a whole, we say to everyone else at that table, “I don’t have to play by your rules! I want the freedom that they have down there under the table!” And guess what they’ll say?

“Give us your card…and your seat.”

Instead of promoting your profession, you may be killing it."

PT's aren't the only ones being scrutinized. See below

Level Of "evidence" for Pain vs Other Medical Specialities