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The Future of Physical Therapy

Wednesday, May 13, 2020   (0 Comments)
Posted by: Matthew Nicholas
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The Future of Physical Therapy

In the past, the IPTA has advocated to advance the PT profession, focusing on scope of practice, fair payment, and unrestricted access to care.  In the past several months, the health care landscape has dramatically changed, with safety becoming the driving factor.

What have we learned so far?

PPE is Essential for Physical Therapy

Last week, a blog from a Dartmouth professor was widely shared and included an example of how COVID-19 spread through a restaurant in just a 1-1.5 hours, beginning with a single asymptomatic carrier. Just by speaking and breathing, the carrier released low levels of the virus into the air and 50% of the people at the carrier’s table became sick over the next 7 days.  People at surrounding tables were also infected.

If we take that single asymptomatic carrier out of the restaurant and make him a patient receiving treatment in a physical therapy clinic on an average day, how many other people could potentially become sick? 

According to the information shared by the blogger, Erin S. Bromage, Ph.D, if you are a symptomatic or asymptomatic carrier, “Anyone you spend greater than 10 minutes with in a face-to-face situation is potentially infected.”  In a single treatment session, this puts the clinician “at the table” with the carrier and, depending on the direction of the clinic’s airflow, patients, clinicians and staff members are also potentially exposed from their “surrounding tables”.

This does not even take into consideration risk factors from surface contamination of treatment tables, equipment, bathrooms, and waiting areas. 

Personal protection equipment needs to be appropriately used by everyone, at all times.  This includes clinicians, patients, and support staff.  Determining what is appropriate is still evolving and access to legitimate PPE products remains a challenge.  Currently, the IPTA is pursuing two avenues for helping clinics and providers purchase PPE and cleaning products.

  • Advocating for physical therapists to be given access to Amazon COVID-19 Supplies.
  • Working with local distributors to leverage group purchasing power to obtain supplies and bulk pricing for physical therapy clinics.

Clinical Space May Need Redesign

If we compare the outpatient clinic’s physical environment to that of a fitness center, there is similar substantial risk when equipment is shared by patients and clients.  The Governor’s five phase plan for reopening Illinois only provides for gyms to open with limited capacity in phase 4 yet, as an essential business, physical therapy clinics are open.

We can look to ideas coming from both offices and fitness centers to re-imagine our clinical space.  Businesses looking to bring back office staff are repurposing areas to provide social distancing and that includes the elimination of shared spaces such as the break room, conference room and waiting areas.  For physical therapy, these kinds of communal spaces may need to be repurposed to provide private treatment areas for delivering both individual and telehealth services for certain patients.

Right now, fitness centers such as Lakeshore Sports and Fitness in Chicago are spending thousands of dollars to reduce exposure risks, including adding 10-foot-by-10-foot individual workout “pods” with a piece of cardio equipment, exercise mat and a choice of bands and weights that will all be sanitized between uses. 

When it comes to shared equipment in open space, both PPE and strict cleaning protocols must be implemented, and screening processes for both employees and patients should be, although the new reality is that everyone should be considered a risk, whether they are symptomatic or not.  While clinics may not have the budget for physical remodels like Lakeshore Sports, taking time to consider how to creatively reconfigure and use existing space is a sound investment.  Creating a virtual check in process that provides for patients to wait in their vehicles until their appointment, limiting entrance to the facility to patients only, and developing schedules that alternate between clinical and telehealth visits to allow for cleaning between patients are all ways to reduce the risk of exposure.

Skilled Nursing and Long Term Care Facilities and Home Health Care are at Higher Risk 

Reports have clearly demonstrated that there is a higher risks for spread in skilled nursing and long term care facilities that are home to our more fragile, elderly patients and then there are the unique risk factors associated with home health where the PT or PTA has very little control of the physical environment or of others residing in the home with the patient.  

Taking a lesson from what we learned in the 1980's and the HIV/AIDS epidemic, health care workers learned to assume everyone is HIV positive and take universal precautions to prevent exposure to blood and body fluids.  Those precautions include masks, gloves, and protective eye wear along with frequent hand washing.  The difference is now we are not just worried about blood and body, but also air and surface contamination, making it appropriate to apply the same precautions to interactions with every patient, all the time.  

The APTA continues to compile resources to help clinics determine how to best serve their patients, create safe environments, and implement policies to protect clinicians, staff, patients, and families.

Physical Therapy Has a Role in COVID-19 Recovery

Physical therapy is an important part of COVID-19 treatment and recovery -- and not only for patients ill enough to require hospitalization.  Even patients with manageable symptoms can benefit from cardiorespiratory physical therapy that can reduce the potential need for hospitalization and mechanical ventilation.  

Hospitalized patients can also benefit from physical therapy.  The APTA, the APTA Cardiovascular and Pulmonary Section, the APTA Academy of Acute Care Physical Therapy, the World Confederation for Physical Therapy, and other international professional associations have endorsed the Physiotherapy Management for COVID-19 in the Acute Hospital Setting: Recommendations to Guide Clinical Practice

It is important to remember that a discharge from a hospital does not mean that the patient is no longer contagious, it just means the patient no longer needs 24 hour medical care.  Care providers need to continue to be diligent in following safety precautions.

Teletherapy Has a Place in Our Profession’s Future

The fear of an invisible enemy has caused the essential shutdown of society and, in the process, the delivery of physical therapy as we know it.  Clinicians – and insurers – have had to quickly adopt telehealth practices as the only “safe” alternative to traditional care.  Determining the appropriateness and effectiveness of teletherapy has been left to the individual therapist’s discretion and, in certain situations and environments, teletherapy is not appropriate – or even possible – due to a variety of reasons including access to technology, medical complexity, and, most importantly, the type of treatment needed for the patient to recover.  

Utilization of telehealth in physical therapy practice is being tested with very few boundaries right now: even HIPAA regulations have been relaxed.  Up until this point, we had to rely on limited studies and our imagination on how teletherapy – and payment for teletherapy – would look.  Now, we can test our theories and look at real outcomes for an unlimited number of conditions, a variety of environments, and using all sorts of technology.  

As we look to the future, this will be the information that will provide the most value as the IPTA looks to advance the future of physical therapy in Illinois.  For the remainder of this year, we anticipate that the Illinois General Assembly will continue to limit their business to budgetary and COVID-19 related legislative matters.  In 2021, we anticipate there will be opportunity to move legislation forward that will solidify telehealth’s place in Illinois health care and we need to be prepared to propose guidelines that will enhance access to physical therapy while providing appropriate public protections and justify fair payment for those services. 

Physical Therapy Education Needs to Evolve

This is only the beginning of the evolution of physical therapy practice, and does not consider the changes that will need to take place in order for us to continue to prepare students for careers in physical therapy.  Virtual classrooms may very well be the norm next fall, but how will educators create lab experiences that teach the hands on skills that are the basis of physical therapy, and how will clinical rotations have to be altered to ensure that students have the variety of experience needed to solidify their foundational knowledge and prepare them for practice?  This is a work in progress, as is addressing the delay for graduating students who are frustrated that the pandemic has caused the cancellation of April PT and PTA exams, continued testing site closures that limit May testing, and delays in processing paperwork for those trying to register for July exams.

COVID-19 Is Not Going Away Soon

Years ago and for decades, thousands of children would become ill with paralytic poliomyelitis, or polio, during the summer months.  The outbreaks would start around Memorial Day and grow increasingly worse until they finally would end around Labor Day.  Not everyone who contracted the virus would come down with a severe case of polio, but they would be carriers. No one knew how polio was contracted and it would hit certain areas harder than others one year and show up in different areas the next summer.  There was no cure and no vaccine  - and every child was vulnerable to polio. Beaches, swimming pools, bowling alleys and movie theaters closed. Families kept their children inside and the slightest illness in a child would cause a parent to panic. It wasn't until 1955 that a vaccine was developed and, quickly the number of annual cases went from over 50,000 in 1952 to less than 3,000 in 1960.  

Medicine, technology, and knowledge about how diseases are spread has come along way since the polio epidemic, as has our ways to disseminate information and educate the public on how to protect themselves and others from COVID-19.  What hasn't changed is the fear that parents felt when it came to the health of their children years ago or how society fears COVID-19 today.  Closing pools, beaches, and movie theaters, wearing masks and gloves, keeping hand sanitizer on hand, and staying close to home is the new normal until we can be sure that the public is protected from this pandemic in the form of a vaccine or an annual shot like the flu.  Regardless of how we win the battle against COVID-19, physical therapy will continue to evolve and be a part of the solution - and the future.

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