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January 9, 2010

Is Physical Therapy Effective?

The New York Times printed a somewhat damning article about physical therapy. Many of the points of the article, I have to agree with. The push in my education is to emphasize evidence-based practice -- this is a point the industry agrees upon -- an issue faced by doctors and other health care professionals.

A second point they make concerns egregious use of modalities: heat, ice, e-stim, and ultrasound.

My doctor at the Hospital for Special Surgery in New York, Joseph Feinberg, seems to share my opinion. “Very often, I think the hot packs, cold packs, ultrasound and electrostimulation are unnecessary,” he said, adding, “For sure, in many cases these modalities are a waste of time.”

These techniques, unfortunately, are a way for unscrupulous therapists to make easy money. Use of multiple modalities in one treatment session and without progression away from these unskilled services, constitutes abuse if not malpractice. It's an easy way to bill extra to the insurance companies, and as a result, insurance is covering less of these palliative services. However, their use is not completely unjustified.

Working as an Aide this past summer, I applied ice and e-stim to many patients under the direction of the physical therapist. It was applied in combination at the end of therapy to help with post-therapeutic pain and swelling, not as a means of treating a condition exclusively. I also noticed that the application of ice, used also for swelling and pain in my skilled nursing internship, was not covered by insurance, but it was used anyway, free of charge.

The take home message from this article, I believe, is to ask around in order to find a reputable therapists, the way you would find a good doctor or a reputable mechanic for your car. Be aware, also, that the industry is in transition, which is why educational standards are being raised. A skilled therapists should be able to explain why they are doing what they do and how it will help you.

Don't forget to read the comments to this article -- people related both positive and negative experiences with PT, and professional weigh in with their reactions also.

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Posted by linda at January 9, 2010 8:03 AM

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