Therapy Isn’t a Cure All
Recently one of our student bloggers wrote about PT being more than a massage. While massage has a place in the healing, physical therapy is so much more. I want to add to this discussion of what physical therapy is not. It is not the intervention of last resort. It is not something to be ordered when nothing else has been effective. Everyone I know has at least one story about MDs ordering therapy because they didn't know what else to do. Therapy is also not the answer for patients who refuse to get out of bed. Those patients aren't going to get up for us, either. When I worked OP I saw patients who were referred to therapy to keep them from constantly bothering their physicians.
For PT to be effective, a treatment diagnosis is necessary. A POC is created based on a practice pattern which is developed on the results of diagnostic tests. The PT Guide was developed as a tool to help with this. There is no practice pattern for someone who doesn't want to get up. Nor is there a practice pattern for patients with multiple complaints but no functional limits.
Another necessity for effective intervention is realistic expectations. Ordering gait training for an obtunded patient isn't realistic. I have received those very orders. Such orders may give the appearance the patient is receiving aggressive care, but aren't appropriate. A POC working on cognitive stimulation, OOB and exercise is more likely to be beneficial. I've run into a similar problem in treating patients with progressive diseases such as MS or Alzheimer's. These patients lose the ability to move as the disease process progresses. I have little to offer someone whose brain is unable to communicate with muscles.
I think this happens for two reasons: physicians want to do something for their patient and patients want something to be done. Referring someone to therapy is definitely doing something. The problem is that's not always the right something. It might even be the wrong something. Too much activity can delay the healing process if the body is asked to do too much. Every PT wants to help his patients by providing the best care possible. Referral sources need to remember effective care requires appropriate patients.