A Systems View of Physical Therapy Care: Shifting to a New Paradigm for the Profession

Abstract

Physical therapist management of patients who are acutely ill is receiving increased attention. This year, 2 observational and descriptive studies were published that report on the utilization of physical therapy in the acute care setting.1,2 This attention is timely as health care reform is debated and changes are proposed to current care delivery. As Jette et al2 state, the advent of bundled payments, or reimbursement based on the entire episode of care, will test not only the profession of physical therapy, but every profession providing care in the acute care setting and on through all care settings, including the home. All health care professions will have to adequately describe and quantify current practice, establish more robust outcome measures, and perform research to understand optimal or preferred practice as it relates to patient outcome. Physical therapists have a long history of treating people in acute care settings, and there is evidence that physical therapy intervention can make a positive difference. For example, a landmark study in 1954 defined the abnormality (postoperative pulmonary complications), divided a relatively large patient cohort (172 patients who had undergone upper-abdominal surgery) into 3 intervention groups, and measured significant decreases in the complication rate with one preferred physical therapy approach.3 Those patients who received both preoperative and postoperative pulmonary physical therapy had a 12% incidence of pulmonary complications, compared with those who received only postoperative pulmonary physical therapy (27% incidence of pulmonary complications) and those who received usual care (42% incidence of pulmonary complications). Postoperative complications for patients who had undergone upper-abdominal surgery were a major cause of morbidity and mortality in the 1950s. The reasons for …