When it comes to outpatient Orthopedic Physical Therapy, what does Physical Therapy offer that is intrinsically unique from other “overlapping” professions? I posed this question via a horribly worded tweet that lead to an interesting and very involved conversation. Check it out here.
Many of our treatment modalities are not confined to the domain of Physical Therapy, but are utilized by a broad spectrum of professionals. In terms of competitive advantages, exercise might be the weakest of our modalities. It has one obvious glaring shortcoming: the landscape of exercise is becoming flatter everyday. You can learn proper efficient exercise from any smart & experienced individual. They don’t have to be a Physical Therapist. They could be an athletic trainer, personal trainer, chiropractor…even your local gym rat. Information on exercise is becoming so ubiquitous that you could simply pull up a Youtube video to coach you through “corrective exercises”.
What about Ultrasounds & Electric Stimulation? Let’s put aside any knee-jerk reactions related to their effectiveness and think along the lines of Competitive Advantages. There is nothing stopping a chiropractor or athletic trainer from using these modalities. Even worse, utilizing these modalities requires a very short learning curve. Everything that involves binary decision-making combined with the potential for technological adoption will further flatten the competitive landscape and be vulnerable to outsourcing. Ultrasound & Electric Stimulation are no exceptions to this concept.
What about various joint & soft tissue mobilization techniques? The advantage will last only as long as the material is taught specifically only to Physical Therapists. Since Continuing Education is a capitalistic enterprise, these courses are usually offered beyond the confines of Physical Therapy. Therefore, any advantage conferred by these “techniques” is arbitraged against time. I believe Dry Needling fits under this umbrella. Once these “techniques” are utilized by other professionals, the advantage will moderate.
Is there any Evidence to “prove” our unique effectiveness as Physical Therapists? This article from 2001 was the only one brought to my attention. Notice that none of the main points are encouraging from an Outpatient Orthopedic point of view. According to the article, the only advantages conferred by being a Physical Therapist lies in niches.
Speaking of evidence, more evidence doesn’t mean more effectiveness. It simply means “more evidence”. The data is democratic, and the evidence can be applied by anyone of any profession, regardless of who did the research and produced the evidence. Simply because we may claim to be the profession that produces a sizable amount of neuro-musculoskeletal research, that doesn’t mean it is applied exclusively within our domain. Evidence has a level of promiscuity that should be appreciated.
The twitter thread mentioned earlier turned into an octopus and grew in different directions. This one was interesting because it eventually hit on something I had in mind. It’s about the Framework of approach that might be unique to Physical Therapy.
According to Tim, our uniqueness lies in our integrative framework to address functional deficits of any individual. Based on this perspective, Physical Therapy isn’t about “what” we do as much as it is about “how” we do what we do. While this sounds powerful (which it is!), the tricky part of it is the variety of philosophies & approaches within the profession don’t seamlessly lend themselves to a unifying framework. Other professions also view themselves as systems that incorporate different perspectives into a Plan of Care. After all, “integrative” is quite the catch-phrase these days. A unique & integrative framework will only remain a unique advantage as long as the process to understanding and utilizing the framework requires substantial achievement and effort. Once these hurdles are either lowered or removed there will no longer be a unique value proposition.
Even worse, here’s what the research says about perception of Rehabilitation Professionals:
So, we don’t “own” any treatment modality, and we don’t have evidence to back up our unique effectiveness. Are we in a rat race against “sameness”? Back to the initial question:
What’s so special about Orthopedic Physical Therapy?
What are your thoughts?
P.S. – There was a #solvePT discussion that revolved around the central concept of the post you just read. Check it out here.
For Further Reading: