A while back, we received an e-mail from Bahram Jam about 5 physiotherapy frustrations. For those of you who don’t know Bahram, he is the founder and director of APTEI (Advanced Physical Therapy Education Institute), an organization that offers physiotherapists evidence based clinical courses. He is a strong believer in growing the profession of physiotherapy by applying treatment options that have actually been shown to be effective through research, therefore treatment that is evidence based.
There are things that physiotherapists do that can put a negative spin on our profession. Far too often we hear people tell us that physiotherapy doesn’t work or they don’t feel comfortable going. If you ever had a bad experience with a physiotherapist, would you ever go and consult another? Is it worth the time and money?
Here are some of our frustrations with the physiotherapy industry:
1- Physiotherapists who see more than 4 patients per hour.
Can we actually call this Physiotherapy or is it just “fast food therapy” or as Mr Jam refers to it as “assembly line therapy”? Just think about how much treatment time the patient actually receives. If a physiotherapist sees 4 people per hour, that means each one of them gets about 15 minutes. Let’s break that down even more. The physiotherapist greets you and checks in on the progress since the last session, which can take 5 minutes. That potentially leaves about 5-10 minutes of active therapy. That doesn’t provide much time for more than a couple of techniques before the therapist has to go work with their next patient. Do you get good value for your therapy dollars? This is a very volume based type of practice. Excellent business model to generate revenue, but poor value for the consumer.
2- Physiotherapists who only use modalities (machines) on every patient
Have you sought out physiotherapy treatments in the past? What did it entail? We often hear the same story, the only treatment provided was ultrasound, IFC (interferential current – pain relief) and heat or ice. Many Medical Doctors and even potential clients think that physiotherapy is a waste of time because of the over reliance of the above mentioned “passive modalities”. They think that physiotherapy is passive therapy. We actually wrote a blog about this, have a quick look here.
Physiotherapy is actually a hands-on therapeutic approach. Some sort of joint or soft tissue mobilization should be used to actually create a mechanical change. We’re not saying that there is no place for modalities, but it should be judged case by case and not automatically included in everyone’s treatment plan. Modalities can assist in someone’s recovery, but with minimal change occurring, it’s no surprise that therapists ask their clients to come in 3 times per week for 4-6 weeks. This leads to our next point.
3- Physiotherapists who ask each client to come in 3 times per week for a number of weeks
After the initial visit it is very common for therapists to ask the patient to come in 3 times per week for the first 3-4 weeks. And this is regardless of the condition being treated, it has become automatic to suggest this frequency. This seems excessive and the costs quickly add up for clients. But again, if you are only receiving 15 minutes of treatment and spending time on machines, of course it will take a lot of repetition to create change and get better. How about spending more one-on-one time with the patient and providing solid education and home treatment options? This could reduce the number of visits needed to 1-2 times per week. Doesn’t that sound better? This is empowering the patient to have more control to manage their symptoms and recovery.
4- Clinics that schedule one client with multiple Physiotherapists
Don’t we see the same Dentist, Doctor, and Registered Massage Therapist? Why would physiotherapy be any different? Seeing multiple Physiotherapists over a course of a few sessions is often done to optimize therapist scheduling. This provides the less busy therapist to head home early or do other tasks around the clinic. It is very poor for client care as not all therapists will have the same level of continuing education and may not have the same treatment approach or skills. At the same time, the exact treatment plan may not be followed, affecting the continuity of care. As well, we can’t deny the rapport that develops between the client and therapist, especially after the initial consultation. Studies have shown that just the mire fact that someone has developed a good relationship with a treating therapist, they will feel like they are cared for and actually start feeling better.
5- Physiotherapists who do not use functional outcome measures to monitor their clients progress or lack thereof
How do physiotherapists know you are making progress? Is there anything being measured to track improvement? Are you still seeing a physiotherapist 3 times for a number of weeks with little to no change? Remember that just because things haven’t improved with one therapist doesn’t mean that physiotherapy doesn’t work. Maybe they aren’t using the latest techniques or treatment approach. If a physiotherapist is continuously measuring progress and modifying the treatment accordingly, you are in good hands. If this is not the case, you may want to see someone else or try another clinic.
Although all physiotherapists have the same basic training, some have taken continuing education courses to sharpen their treatment and diagnosis skills, while others will stick to the same old stuff. The treatment environment also makes a big difference, so make sure to do your research and get therapy from a practice that focuses on more of a one-on-one approach. As always, if you are unsure of the progress or approach to treatment, make sure to ask questions! You should be confident in the care you are receiving.