Physical Agents: In or Out?
Since becoming the editor of ADVANCE
in 2000, the thought has often occurred to me that PTs and PTAs are a surprisingly well-informed and opinionated bunch.
But they are also a lot of fun as well.
This was proved to me on June 13 at the annual APTA conference in San Antonio, as APTA premiered its first Oxford Debate. PT experts on both sides considered whether physical modalities that might not be based on evidence should be used and billed by PTs. Despite the seriousness of the topic, the therapists on hand made being confined to a conference room on a gorgeous sunny day in Texas more entertaining than can be expected!
The debate addressed the question: Should physical therapists remove the use and billing of selected (infrared, laser, diathermy, thermal agents) physical agents from their practice?
The idea behind the debate was to question the appropriateness of the removal or maintenance of use of these interventions, the impact of them on current practice, and how removal of them would affect PT's image and independence as a professional body.
An Oxford debate is similar to British Parliamentary debate, pitting two teams of three making the arguments both for and against the question. Each team selects an opening speaker, a second "rebuttal" speaker and a third "summator" speaker for their respective arguments, and the audience comprises the "floor," allowed to ask questions of each panel before the summator speakers wrap up. Competitors are encouraged to maintain civility but also to debate with "animation, passion and creativity," according to traditional Oxford rules. And the PT panelists certainly rose to the challenge.
The debate was lively, fun and inciteful (thanks to the participants!). In a unique twist, whenever one side gave an argument, the audience could move from one side of the room to the other to show their support for the stated argument. There was a lot of up and down as many therapists switched sides.
This struck me as particularly interesting, because it showed how complex the issue really was. More than one debate attendee mentioned that professional credibility for PT could be at stake if PTs turn too often to unproven agents for treatment.
Should PTs use modalities in the clinic-and bill for them-when patients can find hot packs and other agents in drug stores and use them at home? How much should therapists rely on physical agents when there is little to no solid evidence that they work in the long-term? Are therapists just billing, in effect, for placebos? Or are therapists wrong to reject agents that might work well for their patients' rehab?
What do you think about using physical agents? Do you use them, and how? Do you feel other therapists might rely on them too often?