As with most professions, physical therapy has developed and adapted with time….and will continue this way. Through use in war, hospital, private clinics, community care centres, sports teams and so much more, the profession of physical therapy has changed and grown. Today, each modern day approach may vary and each therapist uses his or her own techniques and tools to best achieve their goal, but one thing is pretty consistent. There is almost always a hands-on component. And now, with the development of the COVID-19 virus and the (hopefully temporary) move to a more virtual world, parts of the practice have changed once again. What does that mean for the future of physical therapy? As our lives develop virtually, it is possible that the practice will go back to exactly how it was before this pandemic. I don’t believe it will be the end of virtual physical therapy and the almost forced use of technology will prove to change the profession once more.
In The Past
Physical therapy hasn’t always been a regular component in health care. While the development of it really started before World War I (WWI), this is where we’ll start for the purpose of the article.
- WWI (1914–18) was when machine and basic movement was used to aid rehabilitation of injured soldiers.
- WWII (1939–45) saw specialized clinics established and the importance of physical therapy was truly recognized with predominant use of exercise, massage and traction.
- During the polio epidemic (significant in 1940–50s), physical therapists (PTs) became recognized as performing more than just reconstructive work. They worked to improve patients’ flexibility, used manual muscle testing, and determined the use of synergistic muscles for functional tasks.
- Later in the 1950s, PTs started work outside of hospitals for the first time. Over the next few decades orthopaedic specializations and the use of devices such as electrical stimulators commenced.
- In the late 1960s to 70s the use of PTs increased for management of cardiopulmonary disorders and as a part of pre- and post-operative care.
- The 21st century has seen even greater specializations like neurological, cardiopulmonary concerns, geriatric and paediatric care, and sports therapy develop. Patients are now able to see PTs as first-contact practitioners, without a referral required from a doctor.
- As modern day PTs emerge, the practice now often focuses on the importance of movement as an essential element of health and well-being, integrating many body systems for improved overall function.
How the profession has developed over time helps explain how PTs work and how they will continue to work, in the future.
Today
In present day, the various specializations and types of physical therapists are almost endless. As mentioned above, PTs work in hospitals in the ICU, post-operative, oncology and rehabilitation wards. They work in long-term care facilities and in specific paediatric centres for development. Neurological physiotherapy focuses on any disease or dysfunction that has affected ones brain or nervous system. Cardiorespiratory physical therapy aims to help one breath more clearly and improve lung function. There are physical therapists that specialize in arthritis, pelvic floor function, work with specific sports teams, and so much more. Some predominantly practice with manual work in sessions while others provide a lot of exercise therapy, and many use a combo of a few techniques. But the goal of physical therapy is always the same: prevent further injury and improve function and quality of life to achieve one’s goal.
Hands-on work may include manual muscle release or activation, joint mobilization, acupuncture, or providing exercises cueing. Whatever it is, people have come to expect that their PT will be physically touching (see the commonality there) them at some point. But with the recent development of COVID-19 and social isolation, like many other professions physical therapy has had to adapt and change once more. Virtual (telehealth) appointments were previously very rare in the physical therapy world, often used only in very remote settings where a PT was inaccessible. And still, legal and ethical considerations had to be made before such appointments took place. Now, as government guidelines have changed, so physical therapy colleges and insurance companies had to adapt. Virtual appointments have become a new option for many PTs that aren’t considered urgent care workers to allow work with patients to continue. While this has come with its limitations of course, it has forced the profession to grow in a new way. Required skill improvement on subjective assessment, observational skills and reliance on patient feedback are just a few of the areas of change. Patients may be even more engaged in sessions, relying less on the passive component of treatment and instead really tuning in with their bodies and how movements feel. Providing online exercise programs that both patients and clients can monitor regularly is a tool that many didn’t access previously. The PT-patient interactions often involve adjusting home office set-ups and figuring out ways to adapt to moving less and still feeling good. The patient must be a more active participant in virtual appointments, and so both patient and PT are learning with such a change. As a profession, physical therapy continues to help others however possible virtually — although some PTs are still working patient-facing for urgent care — and the profession and patient interaction will continue to develop as things progress.
The Future of Physical Therapy
So what does the future look like for physical therapy for both the therapists and their patients? Honestly, I can’t say for certain. A large part of that depends on the duration of our social isolation and clinic shut-downs, and the security that everyone feels in staying safe as we slowly emerge out of it. There are a few things I believe though.
For PTs, the in-person clinic practice will initially involve significantly heightened sanitation strategies, at least until a vaccine or similar is commonplace. And we won’t see the end of virtual appointments — as long as college regulations continue to allow them. They provide an accessible means of communication for patients who may require exercise modifications and/or progressions but who may not need hands-on work at this stage. It therefore would requires PTs to continue development of their subjective and observational assessment skills, as well as programming for injury, progressions, etc. Of course, the value and success of this from a therapist’s point of view very much depends on a patient’s injury and/or concern, as well as the communication level available between PT and patient.
For patients, virtual physical therapy may be just another option available in conjunction with in-person appointments. As people have come to recognize the value and benefit of such communications, telehealth may be used in place of in-person care for some, again pending legal allowance. It saves time for travelling, and provides someone the ease of seeing a PT from the comfort of their own home. However, it does require the patient to be more engaged and active in their sessions than previous. Understanding more of the ‘why and how’ of movements, and being able to interpret and explain sensations one experiences is more important and beneficial in such a virtual setting. Passive treatment is not available via telehealth, and so the patient must be an active participant throughout. Again, this option would not be appropriate for all.
What I hope that people get out of this pandemic and social isolation with respect to physical therapy is the value of preventative treatment. As a patient, now more than ever it would have been beneficial to make sure your body was moving optimally for what you want to be able to do. And as a therapist, having your patients move and understand their bodies before isolation even began would provide a much more solid starting point for virtual care benefits. Using an expert to teach the importance and methods for how to stay mobile, active, strong and prevent an injury from actually happening is a thing! Physical therapy is not just for rehabbing once already injured. Of course social isolation and working from home wasn’t expected, but understanding how your body moves and what you can do to help it could better assist preventing some of the aches and pains from this currently isolated lifestyle.
I don’t know when or how this pandemic state will improve, but I do know that the profession of physical therapy has always grown with the needs of society and the world. And it will continue to.
If you liked what you read and are interested in learning more, please visit my website at stephanioolup.com or follow me on instagram.
