Definitions
Physical
Therapy
Physiotherapy (also known as physical therapy)
is a health profession concerned with the assessment,
diagnosis, and treatment of disease and disability
through physical means. It is based upon principles
of medical science, and is generally held to be
within the sphere of conventional (rather than
alternative) medicine. Physiotherapy is practiced
by physiotherapists (also known as physical therapists,
e.g. in the United States), though aspects may
also be practiced under supervised delegation
by physiotherapy assistants or other health professionals.
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Scope of practice
Physiotherapists' scope of practice varies considerably
across the world, both in terms of the degree
of professional autonomy enjoyed and the range
of conditions managed.
Physiotherapists in some juristications, such
as the Australian states, enjoy professional autonomy,
with the ability to act as primary care providers
and to determine — and be responsible for
— a patient's management plan. Conversely,
physiotherapists in some other juristictions work
upon referral from, and largely under the direction
of, other professionals (typically medical practioners).
The major conditions managed by physiotherapists
can be broadly grouped into three categories:
musculoskeletal, cardiopulmonary and neurological.
Many areas of physiotherapy, e.g. rehabilitation
or paediatrics, cross all three areas. Depending
on the local healthcare system, physiotherapists
may be involved in all areas, or may only manage
certain aspects (e.g. in some United States juristictions,
respiratory therapists manage many aspects of
cardiopulmonary therapy).
Depending on the structure of the local healthcare
system, physiotherapists may function either privately
(e.g. in a private clinic) or publicly (e.g. in
a hospital or community setting). Furthermore,
physiotherapists may work as generalists managing
a wide range of conditions, or may specialise
in certain fields. The process of determining
career structure and specialisation varies geographically.
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Assessment
A physiotherapist will initially conduct a subjective
examination (interview) of a patient's medical
history, and then go on to the objective assessment
(physical examination). The subjective examination
is guided by the presenting system and complaint,
and the objective assessment is in turn guided
by the history.
This semistructured process is used to rule out
serious pathology (so called red flags), establish
functional limitations, refine the diagnosis,
guide therapy, and establish a baseline for monitoring
progress. As such, the objective exam will then
use certain quantifiable measurements to both
guide diagnosis and for progress monitoring. These
depend upon the system (and area) being managed,
e.g. a musculoskeletal exam may involve, inter
alia, assessment of joint range of motion, muscle
power, motor control and posture, whilst a cardiopulmonary
assessment may involve lung auscultation and exercise
physiology testing.
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Treatment
Guided by the assessment findings, the physiotherapist
will then develop and facilitate a treatment plan.
Aside from the various physiotherapeutic teachniques
involved in therapy, the treatment regimen may
include prescribing and advice regarding assistive
walking devices; should consider functional progress;
and include ongoing review and refinement. Patient
education is a key aspect of all treatment plans.
It is difficult to explore the many aspects of
physiotherapeutic treatment options, especially
considering their ongoing development in the face
of an increasing research base. Nonetheless, some
examples of treatment options are listed below.
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Musculoskeletal
physiotherapy
Various therapeutic physiotherapy modalities
are available, including exercise prescription
(strength, motor control, stretching and endurance),
manual techniques, soft tissue massage, and various
forms of so-called "electrophysical agents"
(such as cryotherapy, heat therapy and electrotherapy).
Despite ongoing research giving a clearer picture
regarding the use of various modalities in specific
conditions, the benefits of electrotherapy are
widely debated.
The practice of physical therapy should not be
defined by the use of modalities but rather the
integration of examination, history, and analysis
of movement dysfunction.
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Cardiopulmonary
physiotherapy
Techniques used in cardiopulmonary conditions
include manual techniques and breathing exercises
to improve lung ventilation, mobilise secretions
and decrease work-of-breathing; and endurance
rehabilitation training.
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Neurological
physiotherapy
Treatment in neurological conditions is typically
based upon exercises to restore motor function
through attempting to overcome motor deficits
and improve motor patterns. To achieve this aim
various theoretical frameworks have been promoted,
each based upon inferences drawn from basic and
clinical science research. Whilst some of these
have remained static, others are designed to take
into account new developments, perhaps the most
notable example being the "movement science"
framework. The various philosophies often generate
considerable debate.
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Physiotherapy
education
As with many aspects of the profession, essential
physiotherapy training varies considerably across
the world. As a general rule, physiotherapy studies
involve a minimum of four years tertiary education.
Some examples are described here.
In Australia, an undergraduate physiotherapy
degree is typically undertaken over a four-year
period, with the early components being predominantly
theoretical and with an increasingly clinical
focus throughout the latter stages. Postgraduate
entry into physiotherapy in possible in some institutions,
typically involving two years of study following
the completion of a related (e.g. exercise physiology
or science) undergraduate degree.
In the United States an undergraduate student
typically undertakes a science-related course
(such as biology or physics) prior to gaining
entry into a graduate program specialising in
physical therapy in which they undertake their
physical therapy training.
Following basic physiotherapy training, experienced
practitioners may undertake further study towards
certification as a specialist practitioner. For
example, in the United States, experienced physical
therapists may apply to take a specialty exam
to earn board certification in any of seven sub-specialty
areas: Cardiovascular and Pulmonary, Clinical
Electrophysiologic, Geriatric, Neurologic, Orthopaedic,
Pediatric, and Sports physical therapy.
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