The primary health care team typically consists of the physician, nurse, social worker, medical technologist, representatives of psychology, psychiatry, physical therapy, nutrition, pharmacology, dentistry, podiatry, health education, gerontology, and communication. In the course of this paper we will discuss the health care professional role of physical therapy.
Most of the literature focuses on the physical therapy as the care giver. These professionals play an important part in health care, where the active professional intervention is vital to positive outcome of the patient’s treatment.
Health Care Professional Role
Physical therapy (also known as physiotherapy) is a health profession concerned with the assessment, diagnosis, and treatment of disease and disability through physical means (Wikipedia). Physiotherapy is a paramedical profession which conforms to Schön’s (1990) concept of professional practice in which professionals cope daily with unexpected, unforeseen, previously unknown, uncertain and unique human situations.
Physical therapists work closely with occupational therapists in a variety of settings. Known together as the rehabilitation therapies (or related services in the schools), occupational therapists and physical therapists share similar or common goals for their clients and offer complementary approaches to intervention.
For example, both therapies address activities of daily living (ADLs), but would approach these outcomes using different techniques and theories. They would make complementary recommendations to the family. Physical therapists assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities (Shelden 1998).
The minimum educational requirement to become a physical therapist is a master’s degree after 2002. Physiotherapy is generally a four year university degree course involving theoretical and practical work, much of it hospital based.
Studies are undertaken in anatomy, medical biology, physics, physiology, applied anatomy and kinesiology, psychology, research methods, pathology and physiotherapy. In 1999, 173 colleges and universities nationwide offered professional educational programs in physical therapy, and 7 university programs offered an entry-level doctoral program (Sluijs, Kerssens, van der Zee ; Myers1999).
Other universities are developing clinical doctoral programs (APTA, 1999). Physical therapists and educators have proposed that the doctor of physical therapy is the appropriate professional level in the profession, but this opinion has generated discussion and controversy. At all entry levels of physical therapy education, the graduates must pass a state administered licensure examination, enabling the candidate to practice in that particular state.
In all states, physiotherapists must obtain registration from the relevant board. They are subject to disciplinary and impairment provisions similar to those applying to doctors. Physiotherapists are strongly advised to have professional indemnity insurance.
Physical therapy professional educational programs prepare students to be generalists, capable of entering general settings, such as hospitals or rehabilitation centers. The entry-level curriculum provides basic information about working with children and families; however, pediatric content is not a primary emphasis of the course work.
Physical therapists provide intervention to children with neuromuscular, musculoskeletal, or cardiopulmonary impairments. Competencies for physical therapy with young children have been developed. These competencies can be achieved through experience, continuing education, and graduate studies.
Physical therapist assistants work under the supervision of physical therapists (Shelden 1998). They assist the physical therapist in implementing treatment programs, training children in exercises and ADLs, and conducting treatment, and they report the child’s responses to the physical therapist.
A physical therapist assistant must complete a 2-year educational program, typically offered through a community or junior college. The program consists of 1 year of general education and 1 year of technical courses on physical therapy procedures and clinical experience.
Physiotherapists work predominantly in hospital or independent private practice, but may also be employed in rehabilitation centers, sports medicine centers, community health centers, schools, industry, research and education.
Most physiotherapy schools offer a range of postgraduate masters and doctoral courses in advanced physiotherapy practice. The College of Physiotherapy also provides formal specialization leading to fellowship. Physiotherapists may practice as generalists or concentrate on specialist areas.
These specialized domains are usually closely aligned to medical practice, covering such areas as orthopedic and reconstructive surgery, neurology, cardiothoracic medicine and surgery and others.
Physiotherapists have traditionally worked very closely with doctors and until the late 1970s had a policy of only accepting patients upon referral from a doctor. Physiotherapists expect doctors who refer patients for treatment to provide sufficient information regarding the patient history and diagnosis to enable relevant therapy to be applied.
However, physiotherapists reserve the right to, and have a professional responsibility to, make their own assessment of the problem and its appropriate management. Only a small proportion of doctors claim expertise in and provide treatment by manipulation or by such methods as diathermy or ultrasound. The vast majority will refer patients who may benefit from such methods to physiotherapists.