Physical therapists plan, organize, and administer treatment in order to restore functional mobility, relieve pain, and prevent or limit permanent disability for those suffering from a disabling injury or disease. Their patients may include accident or stroke victims and handicapped individuals. Among the conditions likely to require treatment by a physical therapist are multiple sclerosis, cerebral palsy, nerve injuries, amputations, fractures, arthritis, and heart disease, with patients varying in age from the new born to the elderly.
Therapists may treat patients with a wide variety of problems, or they may specialize. Specialty areas include pediatrics, geriatrics, orthopedics, sports medicine, neurology, and cardiopulmonary physical therapy.
Since treatments may be prolonged, the full cooperation of the patient is very important. As a first step, therefore, a physical therapists must become familiar with a patient's personal background as well as medical history, and make an effort to gain the patient's trust and confidence. The quality of the therapist-patient relationship can make a big difference in the effectiveness of the treatment.
Next, the physical therapist conducts an evaluation. Tests are performed and measurements taken in order to determine a patient's strengths, weaknesses, and ability to function. The exact nature of an evaluation, and the time required to conduct one, depend upon the type and severity of the injury or impairment. For instance, football players with knee injuries usually require less evaluation time than automobile accident victims suffering from a variety of injuries such as broken bones and head injuries.
After reviewing the patient's medical records and completing the evaluation, the therapist interprets the findings and develops a treatment plan, a process that requires a high level of clinical problem-solving skills. The goal is to help patients attain maximum functional independence, muscle strength, and physical skills, while helping them adapt to what may be a drastic change in their physical abilities.
In some settings, the treatment plan is developed on a team basis, with physicians, nurses, occupational therapists, or speech pathologists contributing ideas from the perspective of their own discipline. Like other rehabilitation personnel, physical therapists are educated and trained to work as a member of a multidisciplinary team, and to participate effectively in team meetings where patient care plans are reviewed and services coordinated.
Initial treatment may be nothing more than helping a bedridden patient become used to being in an upright position. Such patients often lose strength and flexibility in their limbs and trunk. A physical therapist may use a special tilt-table to help rebuild leg strength by slowly raising a patient from a horizontal to a vertical position. Passive exercise is another technique that therapists use. Patients who have been immobile for long periods of time often become stiff in the joints, losing flexibility in muscle, connective tissues, and tendons. To regain flexibility, the patient relaxes while the therapists stretches and manipulates the patient's extremities, according to the patient's tolerance. Another portion of the treatment may include the application of heat, electricity, or ultrasound to relieve pain or improve the condition of muscles or related tissues. Cold, light, and water may be used in other treatments, including the reduction of swelling and the treatment of burn patients.
The therapist may introduce additional therapeutic techniques designed to improve flexibility, strength, endurance, and coordination. These may include resistance exercises with weights to strengthen particular body parts, or gymnastic exercises designed to improve balance and coordination. For patients who may have suffered some permanent disability, the therapist may give instruction in the use of assistive devices, and training on how to perform daily activities. To perform these duties, therapists must have detailed knowledge of human anatomy and physiology and know what steps to take in treating the effects of disease and injury. Therapists need to be sensitive and supportive, as well as technically proficient since their patients, particularly those who are newly disabled, are likely to experience emotional as well as physical stress.
Physical therapy can be more effective and progress faster if there is a coordinated effort between the therapists, the patient, and the family to establish and implement specific goals and a clearly understood treatment plan. This may require instruction on how to conduct prescribed therapies at home. Patients and families may need specific training such as in the techniques of muscle contraction and relaxation or in the care and use of braces or prosthetic appliances. As treatment progresses, physical therapists monitor and assess their patients in order to identify problems and evaluate progress. Periodic evaluations help the therapist to decide whether to continue, modify, or end a course of treatment. Physical therapists may provide the treatment personally or supervise the work of another therapists or a physical therapist assistant.
All physical therapists keep a variety of notes and records, including initial evaluations, daily progress notes, physician reports, internal staff notes, interdisciplinary conference notes, and discharge notes. Documentation must be maintained to track the patient's progress and to identify areas requiring more or less attention in subsequent visits. Records are also kept for legal purposes; physical therapists are legally responsible for their actions whenever they evaluate a patient, plan a physical therapy program, and carry it out. Finally, accurate records are needed for reimbursement purposes to justify the cost of each treatment billed.
The working environment of physical therapists varies from specially equipped physical therapy departments of hospitals or clinics to private homes where furniture may need to be moved to provide room for treatment. Thus, a physical therapist must be adaptable.
Evening and weekend hours may be required, especially for those in private practice who must be available at times convenient for their patients. The job can be physically demanding. Duties may require the therapist to stoop, kneel, crouch, and stand for long periods of time. In addition, therapists must move equipment and help patients turn, stand, or walk. Physical therapy can be emotionally demanding, and the frustration that can result from seeing little or no improvement over time can contribute to stress.
Physical therapists held about 70,000 jobs in 1990; about 1 in 5 worked part time.
Hospitals were the largest single employer of physical therapists, providing 2 out of 5 salaried jobs in 1990. Many other jobs in this field are in rehabilitation facilities, home health agencies, and nursing homes. These may be either salaried staff or contract positions. Therapists also work in residential facilities for handicapped children, school systems, clinics, health maintenance organizations, and physician's offices.
A substantial number of physical therapists are in private practice. Whether in solo practice, group practice, or associated with a consulting group, private practitioners normally treat patients referred to them by physicians. (In 12 States, physical therapists treat patients who come directly to them without a physician referral.) Private practitioners also provide physical services on a contract or consultant basis to institutions or organizations such as nursing homes, home health agencies, adult day care programs, public schools, and hospitals.
Some therapists teach, conduct research, or serve as consultants.
Training, Other Qualifications, and Advancement
All States, the District of Columbia, and the Commonwealth of Puerto Rico require a license to practice physical therapy. Applicants must have a degree or certificate from an accredited physical therapy educational program prior to taking the licensure examination.
Three different types of programs provide education preparation for entry level jobs in this field: Baccalaureate degree programs in physical therapy; certificate (or second baccalaureate degree) programs for those who already hold a baccalaureate degree in another field, such as biology; and entry level master's degree programs in physical therapy.
In 1990, entry level training was offered in 94 bachelor's degree programs, 6 certificate programs, and 13 master's degree programs. One of the master's degree programs is sponsored jointly by the U.S. Army and Baylor University; graduates are commissioned as officers in the Army.
Currently, the minimum educational requirement for entry into the profession is a bachelor's degree. For a number of reasons, however, pressure is increasing to lengthen the educational process. Chief among these is the rapidly expanding body of knowledge which has enabled physical therapists to provide a wider variety of therapy and rehabilitation services. In addition, the expansion of services into home and community- based settings calls for additional training on how to treat patients in other than the traditional settings. For these reasons, many schools are expected to upgrade their entry level educational requirements from the baccalaureate to the master's degree level.
The physical therapy curriculum includes science courses such as anatomy, physiology, neuroanatomy, and neurophysiology; it also includes specialized courses such as biomechanics, human growth and development, manifestations of disease and trauma, and specific therapeutic procedures. Besides classroom instruction, students receive supervised clinical experience in hospitals and other treatment centers.
Competition for entry to physical therapy programs is keen. Consequently, students interested in enrolling in a physical therapy program must attain superior grades in high school, especially in science course. High school courses that are useful include health, biology, chemistry, social science, mathematics, and physics. Individuals who want to determine whether they have the personal qualities needed for this occupation are advised to volunteer for summer or part-time work in the physical therapy department of a hospital or clinic. Indeed, such experience is required for admission to most education programs.
Personal traits that physical therapists need include patience, tact, persuasiveness, resourcefulness, and emotional stability to help patients and their families understand the treatments and adjusts to their handicaps. Physical therapists also should have manual dexterity and physical stamina.
Graduate education is available for individuals wishing to specialize in an area like the popular field of sports physical therapy. A graduate degree combined with clinical experience increases opportunities for advancement, especially to teaching, research, and administrative positions.
Practicing physical therapists should expect to participate in additional education from time to time throughout their careers. Continuing education courses, workshops, and symposia are offered by professional associations, private consultants, and colleges and universities. Occasional attendance at such sessions is customary in physical therapy, as in the health professions in general. Continuing education is required by law to maintain licensure in Delaware, Georgia, Iowa, Kansas, Nevada, New Mexico, and Puerto Rico. Requirements vary by State.
Employment of Physical therapists is expected to grow much faster than the average for all occupations through the year 2000 in response to the rapidly growing need for rehabilitation and long-term care services. Advances in rehabilitation medicine and therapeutic techniques are likely to create additional demand. Other openings will result from replacement needs.
Most new positions for physical therapists will result from the expansion of services for people with physical disabilities--a highly diverse group. It includes the elderly, whose number will rise sharply by the year 2000. Especially rapid growth is projected for the population age 85 and above, a group that suffers a high incidence of disabling conditions such as arthritis or stroke. Also, some surgical procedures are more common among elderly patients. Anticipated increases in hip replacements, knee replacements, and other surgical procedures used to treat diseased or arthritic joints, as well as other conditions, will heighten demand for postoperative physical therapy.
As the baby-boom generation moves into middle age, a period in increased risk of heart disease and stroke, demand for cardiac rehabilitation programs is expected to rise sharply. Younger persons, too, will need physical therapy. Advances in medical technology have saved lives that only a few years ago would have been lost: Children with severe birth defects, for example, and car accident victims, a disproportionate number of whom are teenagers and young adults. Future biomedical developments are certain to permit even more people to survive traumas that in the past would have been fatal, thereby creating a need for rehabilitative care.
Other factors likely to spur demand for physical therapy services include the growing importance of sports medicine and widespread interest in health promotion. As more people engage in regular exercise programs, the number of injuries that require physical therapy treatment will grow as well. Industrial health programs are also growing in popularity. Various industries are employing physical therapists to perform worksite evaluations, develop exercise programs, and teach safe work habits in hopes of reducing injuries in the workplace.
Demand for physical therapists will be affected in the years ahead by changes in the way health care is delivered and paid for. Perhaps the foremost consequence of the new financial environment is a redefinition of the role of the hospital. In an attempt to cut costs, hospitals are expanding outpatient services and reducing the length of inpatient hospital stays. As a result, services such as diagnostic work-ups that formerly were provided in the course of a hospital stay are now provided on an out-patient basis. Increasingly, patients will be hospitalized only for the most serious portion of an illness, a period when they will need intensive care.
Physical therapists will be less likely than in the past to see a hospital patient through the entire course of treatment. Instead, they will refer patients for further care by physical therapists in nursing homes, home health agencies, and outpatient rehabilitation facilities. As a means of capturing a share of the rapidly growing outpatient market, hospitals are expected to develop or expand their own outpatient rehabilitation programs.
The anticipated growth of hospital-based outpatient services is expected to cause hospitals to remain a major employer of physical therapists. Turnover will create many additional openings for hospital-based physical therapists as experienced therapists transfer to other practice settings or leave the profession altogether.
Restructuring of the health industry, together with a continuation of favorable third- party reimbursement policies, will contribute to very rapid growth in the number of physical therapists in private practice. Also expected to spur growth in the number of private practitioners is the practice of relying on contract personnel to provide therapeutic and rehabilitation services in nursing homes and home health agencies.
Home health is an increasingly important area of practice, not only because of changes in the way treatment is provided in hospitals, but because of the prevalence of functional disabilities among older persons, and consumer preference for health care in home or community-based settings. The home health field is expected to experience spectacular growth by the year 2000, and should provide very good opportunities for physical therapists.
Job prospects in physical therapy should continue to be excellent through the year 2000. New graduates are in great demand, and the number of people completing training programs is expected to fall short of that needed to fill job openings. Total enrollments in accredited physical therapy programs have remained relatively stable in recent years. If the number of graduates remains at current levels while demand for rehabilitation services continues to grow, prospects for jobseekers may become even more favorable than they are today.
Starting salaries in hospitals for new physical therapy graduates averaged about $26,000 a year in 1990; experienced individuals averaged about $34,700.
Physical therapists are concerned with the treatment and rehabilitation of persons with physical or mental disabilities or disorders. They may use general or specialized exercises, massage, heat, water, electricity, and various therapeutic devices to help their patients gain independence. Others who do similar work include occupational therapists, speech-language pathologists and audiologists, orthotists, prosthetists, respiratory therapists, chiropractors, and athletic trainers.
Sources of Additional Information
Additional information on a career as a physical therapist and a list of accredited educational programs in physical therapy are available from:
American Physical Therapy Association, 1111 North Fairfax St., Alexandria, VA 22314.