"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Wednesday, March 19, 2008

Do Physical Therapists make a Diagnosis?

Do most physical therapists make a diagnosis before they start treating a patient?

Do physical therapist assistants require a diagnosis from their physical therapist before they begin to treat a patient.

I've asked that question in the form of a poll here at this blog, Physical Therapy Diagnosis.com and we are tracking reader response to get an idea of how many therapists make diagnoses.

The question assumes that, in fact, that most physical therapists don't make a diagnosis.

Unfortunately, I don't have the necessary evidence that most physical therapists don't diagnose - I am merely speaking authoritatively.

Authoritative speech is frowned on these days in physical therapy.

Therefore, you can help me collect evidence about physical therapy diagnosis.

Please fill out the poll at the bottom of the index page of this blog as to whether you do or do not consistently diagnose every patient you see.

Also, do you make a discharge diagnosis?

Do you make a diagnosis at each re-evaluation?

If not, post your comments as to why not.

Thank you.


Wednesday, March 12, 2008

What is Skilled Physical Therapy?

What do you do?

What do you do better than anyone else?

What can you do better than an athletic trainer, a massage therapist or a kinesiotherapist?

Can you progress your patient to a new level of exercise intensity, frequency or duration? Can you back down the intensity, frequency or duration?

Can you assess some new finding or physical sign not in the initial plan of care?

Will the patient leave your care better off than when they arrived?

Was their outcome more certain?

Physical therapists are paid more than athletic trainers, massage therapists or kinesiotherapists precisely because we do bring a greater level of certainty to each patient encounter.

Physical therapists produce better outcomes because risky patients don’t get worse with exercise interventions.

Physical therapists are paid more than athletic trainers, massage therapists or kinesiotherapists because the physician can expect that patients would otherwise not be safe.

An example of a post-surgical total knee replacement will help to illustrate this point.

Even an athletic trainer is qualified to show the patient how to do leg lifts for a weak quadriceps muscle.

But what if the patient came to therapy with a swollen calf, red, tender skin and radiating pain into the groin? Would the athletic trainer recognize a blood clot? Would the massage therapist use a standardized scale like the Well’s score to quantify the risk, document the findings and call the doctor?

Quantify the risk using standardized scales so that terms like better, risky and more are not just superlative adverbs but can be used as measurements for goal setting.

An impairment goal of therapy would be to reduce a Well’s score from 2/9 to 0/9.

A Well’s score of ‘3’ is a high risk for a blood clot.

See also the Medicare Benefit Policy Manual Section 220.2.C (page 20) for a definition and examples of skilled therapy.

References: Journal of Family Practice Online, December 2007. Web Accessed 3/12/08


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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.