What is
physiotherapy

We follow the definitions according the World Confederation for physical therapy being:

  • Physical therapy is the healthcare profession with expertise in prescribing movement and exercise throughout life and across the health spectrum.
  • Physical therapy includes specific interventions for individuals and populations where movement and function are or may be threatened by disease, ageing, injury, pain, disability, illness or environmental factors. Such interventions are designed and prescribed to develop, restore and maintain optimal health.
  • Physical therapy is an integral part of all areas of health and well-being, such as promotion, prevention, habilitation and rehabilitation, and includes physical, psychological, emotional and social factors.
  • Finally, physical therapy includes the interaction of the physical therapist with the client, including his/her family, carers and relevant other health professionals and communities.

Source: erwcpt.eu

What is a physiotherapist
or physical therapist?

  • Physiotherapists are autonomous health professionals responsible for developing, maintaining or restoring motor functions and movements throughout the lifespan using evidence-based practices.
  • Physiotherapists relieve pain and treat or prevent physical conditions related to injury, illness or other limitations.
  • Physiotherapists enable patients and their carers to manage their condition outside the clinical environment.
  • Physiotherapists work within their scope of practice and their own professional code of conduct.
  • Physiotherapists are regulated in 27 EU Member States and EFTA countries

Specialised physiotherapists have specific competences. They make complex decisions and manage risk in unpredictable contexts and within a defined area. They may focus on a specific area of clinical practice, teaching, research or professional management.

Source: erwcpt.eu

The role of physiotherapy
in healthcare

Physiotherapy
in primary healthcare

Primary care is an integrated, interdisciplinary, patient- and community-centred approach to health care. Primary care providers are a patient's first point of contact to explain his or her healthcare needs and to make an appeal to the healthcare system (1).

Physiotherapists are important primary care providers. As a medical profession, they are qualified to diagnose and, if necessary, refer for disorders of the musculoskeletal system, the nervous system, the respiratory system, paediatrics and other conditions (2,3).

Furthermore, physical therapy is an effective and high quality non-invasive care within the healthcare landscape (4,5,6). Also, the evidence regarding the safety and effectiveness of physical therapy in treating conditions is increasing (7,8). Furthermore, physical therapy reduces the overuse of other medical services (9). This allows other health care providers to free up more time for their specialisations.

 What does a physioterapist do
How much does physiotherapy cost?

Health and economical advantages
of physiotherapy in primary healthcare

The organisation of physical therapy differs between the different countries in Europe. In Belgium, a doctor's prescription is still necessary but this is no longer the case in most Western European countries (Sweden, the Netherlands, Norway and the United Kingdom). It is even recommended by the National Institute for Health and Care Excellence (NICE), the most renowned institute for healthcare advice. Direct access to physiotherapy is one of the next steps in the evolution of the profession in Belgium. 

Moreover, it has been shown that physical therapy (10,11,12,13):

  • Reduces waiting times in the healthcare landscape
  • Gives patients more autonomy to manage their condition and live more independently
  • Reduce the risk of developing chronic problems as a result of an acute complaint
  • Reduce pain and disability caused by a condition
  • Shortens disability
  • Reduce healthcare costs
  • Reduce the use of medication

Essential care and the need for direct access
to physiotherapy

The fact that physiotherapists work in primary care, hospitals, residential care centres and emergency departments shows how essential the profession is in the healthcare landscape of the 21st century.

As many as 30% to 50% of all complaints encountered by the general practitioner are of a musculoskeletal nature (14). It is striking that, for 85% of these conditions, a visit to the GP is unnecessary. Direct access would therefore greatly reduce the burden on the GP and greatly increase the capacity of primary care (15).

 

The clinical knowledge of the physiotherapist is also excellent. Diagnosis and triage advice for patients with hip and knee disorders is comparable to that of orthopaedic surgeons (17). Moreover, the quality of care provided by the physiotherapist is perceived as very high by the patient and results in a greater intention to follow advice and instruction through self-management (18).

It is also noteworthy that physiotherapists can reduce the pressure on acute emergency departments. Well-integrated primary care with physiotherapists can reduce emergency hospital admissions by as much as 55% and lower the associated healthcare costs (19).

References

  1. American Academy of Family Physicians (http://www.aafp.org/about/policies/all/primary-care.html)
  2. Boissonnault WG, Ross MD (2012).Physical therapists referring patients to physicians: a review of case reports and series. J Orthop Sports Phys Ther. 2012 May;42(5):446-54. doi: 10.2519/jospt.2012.3890. Epub 2012 Jan 25 (https://www.ncbi.nlm.nih.gov/pubmed/22282166)
  3. Ludvigsson M, Enthoven P (2012).Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy 2012 June Volume 98, Issue 2, Pages 131–137. (http://www.physiotherapyjournal.com/article/S0031-9406(11)00425-1/abstract)
  4. Marks et al (2016).Increasing capacity for the treatment of common musculoskeletal problems: a non-inferiority RCT and economic analysis of corticiosteroid injection for shoulder pain comparing a physiotherapist and orthopaedic surgeon. (https://research.bond.edu.au/en/publications/increasing-capacity-for-the-treatment-of-common-musculoskeletal-p)
  5. Mitchell JM, de Lissovov G (1997).A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997 Jan;77(1):10-8. (https://www.ncbi.nlm.nih.gov/pubmed/8996459)
  6. Ojha HA, Snyder RS, Davenport TE (2013).Direct access compared with referred physical therapy episodes of care: a systemic review. Phys Ther. 2014 Jan;94(1):14-30. doi: 10.2522/ptj.20130096. Epub 2013 Sep 12. (https://www.ncbi.nlm.nih.gov/pubmed/24029295)
  7. Mintken PE et al (2015). Direct access to physical therapy services is safe in a University student health centre setting. J Allied Health. 2015 Fall;44(3):164-8. (https://www.ncbi.nlm.nih.gov/pubmed/26342614)
  8. Swinkels et al (2014).An overview of 5 years of patient self-referral for physical therapy in the Netherlands. See comment in PubMed Commons below Phys Ther. 2014 Dec;94 (12):1785-95. doi: 10.2522/ptj.20130309. Epub 2014 Jul 31. (https://www.ncbi.nlm.nih.gov/pubmed/25082921)
  9. Bornhoft L, Larsson ME, thorn J (2015).Physiotherapy in primary care triage – the effects on utilization of medical services at primary health care clinis by patients and sub-groups of patients with musculoskeletal disorders: a case-control study. Physiother Theory Pract. 2015 Jan;31(1):45-52. doi: 10.3109/09593985.2014.932035. Epub 2014 Jul 2 (https://www.ncbi.nlm.nih.gov/pubmed/24988315)
  10. The Chartered Society of Physiotherapy (2012).Musculoskeletal physiotherapy: patient self-referral. London: National Institute for Health and Care Excellence. (https://www.csp.org.uk/documents/musculoskeletal-physiotherapy-patient-self-referral-qipp-endorsed-pathway)
  11. Government S (2015). Allied Health Professionals Musculoskeletal Pathway Minimum Standards: a framework for action 2015-2016. Edinburgh: Scottish Government; 2015 (http://www.gov.scot/Publications/2015/05/4529)
  12. Department of Health. Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. London: Department of Health; 2008 (http://data.parliament.uk/DepositedPapers/Files/DEP2008-2505/DEP2008-2505.pdf)
  13. Holdsworth LK, Webster VS, McFadyen AK. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy. 2007;93 (1):3-11 (https://www.physiotherapyjournal.com/article/S0031-9406(06)00081-2/fulltext)
  14. BriggsTimothy WR. Getting it right first time: improving the quality of orthopaedic care within the National Health Service in England. London: British Orthopaedic Association: 2015: (https://www.boa.ac.uk/standards-guidance/getting-it-right-first-time.html)
  15. Ludvigsson ML, Enthoven P. Evaluation of physiotherapy as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy. 2012;98 (2):131-7 (https://pubmed.ncbi.nlm.nih.gov/22507363/)
  16. Holdsworth LK , Webster V (2004). Direct access to physiotherapy in primary care: now? -and into the future?Physiotherapy June 2004 Volume 90, Issue 2.Pages 64-72 (https://www.csp.org.uk/journal/article/physiotherapy-june-2004/direct-access-physiotherapy-primary-care-now-future)
  17. Desmeules Fetal (2013). Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic.BMC Musculoskeletal Disorders 2013 14:162 (https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-14-162)
  18. Samsson KS, Bernhardsson S, Larsson M (2016). Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial.BMC Musculoskeletal Disorders 2016 17: 257 (https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1112-x)
  19. Kent Community Health NHS Trust. The Human Touch, transforming Community Services in Kent.Service in the spot light: Pro-Active Care: Long Term Conditions. Maidstone: Kent Community Health NHS trust; 2013 (https://www.erwcpt.eu/file/227)