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PTA Blog Talk

Modalities and Treatments

Published July 9, 2014 8:32 PM by Jason Marketti

Since I follow the PT's direction in regard to patient care and treatment, I sometimes make suggestions in regard to modalities to facilitate the patient's recovery. Not every PT likes modalities and I respect that; however, if I see the OT providing treatment on a patient we are also seeing, and the OT is using modalities the PT doesn't agree with, what should I do?

I know OTs have different ideas and clinical reasoning behind what they do and why, just like us. But if we take an example of a heat pack and the OT is applying one every day and PT is not, eventually the patient is going to ask why he only gets heat with the OT. The same could be said of cold packs after a vigorous TKA workout. If the PT hasn't indicated an ice modality is okay to use, then I'm not allowed to place ice on a patient's swollen painful knee even though I know it would be beneficial post-treatment.

I understand we shouldn't overlap modalities with patients, but there are times when a patient would benefit from its use. A moist heat pack on the low back prior to activity can do wonders for some of the patients. And if OT provides it in the morning and PT in the afternoon, the patient would probably perform better. When patients ask whether they can have a hot or cold pack, I defer all questions to the PT and allow him to give a clinical reason why PT doesn't provide any modalities but OT does.

Maybe I should just weasel my way into the OT's treatment session for a co-treat because I know the patient will perform better after moist heat. Granted, most PTs will see the benefit and weigh the risks involved and decide ice and heat will allow better patient care and function than none at all. But what about the use of TENS for pain control or ultrasound for tissue adhesions?

If OT decides to treat two days a week and PT is treating for six or seven days a week, there are opportunities to complement what OT is doing in regard to any modality usage. Unless you work in one of those places that clearly divides the patient into different body sections, where only the OTs can work on the upper half and PTs on the lower half. And whenever I come across those places I ask, "Where exactly on the patient is the line?"

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2 comments

Has a experience license P.T. for 35 years.  I, am aware that Modalties should not  be co-treated with another displicine. Due to Medicare and other Insurance remibursement  

Angelita Williams, Physical Therapy - Consulant P.T., Contract Physical Therapy Services July 18, 2014 10:37 PM
New Orleans LA

Any conflict between the two therapies would necessitate the need for detailed communication, precision teamwork and frequent conferences between all rehab team members. While there is bound to be an occasional disagreement regarding some part of a patient's therapy, any conflict concerning modalities should be addressed and resolved without stressing out the patient. In extreme cases where a conflict cannot be resolved between therapists, a higher authority (DPt or orthopedist) may have to step in and make the call.

Mary, Freelance writer July 10, 2014 3:55 PM
Milton FL

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About this Blog


    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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