(Childs et al 2005 - "Physical therapist students and licensed physical therapists tended to have higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists.")
It is important that you to make a well-informed decision regarding your physical therapy. While you may be referred to a specific physical therapist, clinic, or company by another health care professional, the choice of where to attend is always yours.
Orthopedic manual physical therapy is not a commodity or standardized treatment like a medication or an injection; it is highly individualized. Levels of education and skill vary greatly between physical therapists. Therefore it is more important to choose a physical therapist than to choose a physical therapy clinic or company.
While other intangible variables certainly come into play, such as the chemistry between your personality and that of the physical therapist, the questions below should serve as a great starting point in your search for both the best physical therapist and optimal practice setting for you and should optimize both your experience and your outcome in physical therapy.
Here, in my opinion, are the 6 most important questions to ask every prospective physical therapist or physical therapy practice:
1.) Will I be treated by a licensed Doctor of Physical Therapy?
This may seem like a given. However, not all who advertise "physical therapy" have a licensed physical therapist on staff. Be sure to ask first to ensure that you are receiving treatment from a licensed Doctor of Physical Therapy.
2.) Will I see the same physical therapist at every appointment?
Seeing a different physical therapist or assistant each time you attend physical therapy is unlikely to optimize your progress, and it may make it challenging for the various physical therapists or assistants involved in your care to maintain an acceptable level of continuity. Insist on seeing the same physical therapist at each and every appointment.
3.) How much direct, one-to-one time will I have with my physical therapist?
Some companies have patient care handled by assistants who are not licensed physical therapists. A study in 2008 by Resnik et al observed that clinics that utilized these assistants to provide care proved to be less effective, demonstrated poorer patient outcomes, and required longer courses of physical therapy - increasing health care utilization and placing a higher financial burden on the patient without the results to justify it.
Other companies require their physical therapists to treat multiple patients at the same time to increase productivity. Insist on receiving direct one-to-one care by a licensed doctor of physical therapy at every appointment and for the duration of each appointment.
4.) Is my physical therapist in-network with my health insurance company?
While outcomes - feeling better and getting back to life - may rightly be your top priority in choosing a physical therapist, cost may also be an important factor to consider. To avoid any surprises, be sure to inquire ahead of whether or not your physical therapist is in-network with your health insurance company and what your financial responsibility will be. Take the time to understand terms like "deductible", "copay", "coinsurance", and "out-of-pocket" - and how they differ from one other. Inquire about a self-pay or private-pay option as going this route may actually be more cost-effective for you than going through insurance.
5.) Is my physical therapist a board certified specialist?
The American Board of Physical Therapy Specialties (ABPTS) maintains a database of board certified experts in specialized areas of practice. It states: "Specialization is the process by which a physical therapist builds on a broad base of professional education and practice to develop a greater depth of knowledge and skills related to a particular area of practice, exceeding that of the physical therapist at entry into the profession."
These specialized areas are currently Cardiovascular and Pulmonary, Clinical Electrophysiology, Geriatrics, Neurology, Oncology, Orthopaedics, Pediatrics, Sports, Women's Health, and Wound Management. Board certified specialists are recognized for ensuring clinical excellence, expert clinical reasoning, and a current knowledge of research.
A study by Childs et al in 2005 concluded that physical therapists who are board certified in orthopedic physical therapy or board certified in sports physical therapy have superior knowledge in managing musculoskeletal dysfunction compared to that of general physical therapists, general physicians, and physician specialists with the exception of orthopedists.
Next, a study by Jette et al in 2006 noted that physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.
Further, a study by Rundle et al in 2016 found that physical therapists’ knowledge in managing musculoskeletal conditions greatly increases with an ABPTS board certification in either sports and/or orthopedics compared to those who do not possess a board certification.
6.) Has my physical therapist received Fellowship training?
A Fellowship Program in Orthopedic Manual Physical Therapy is the highest level of education available to practicing orthopedic physical therapists and requires years of rigorous study of the best available research and the most advanced and evidence-based hands-on techniques.
As a reference, students in the entry-level Doctorate of Physical Therapy program receive on average one class over two semesters in Orthopedic Physical Therapy in addition to coursework in the other specialty areas of physical therapy, such as pediatrics, geriatrics, cardiopulmonary, etc. In comparison, the Fellowship program typically involves 2 to 3 years of study specializing in Orthopedic Manual Physical Therapy alone.
Like the board certified specialists mentioned above, there is good evidence to support the superiority of the patient outcomes achieved by this group of physical therapists as well. In a study by Rodeghero et al in 2015, physical therapists trained in a Fellowship Program have demonstrated greater changes in patient function, efficiency of treatment, and patient outcomes than physical therapists not trained in a Fellowship Program.
Therefore, when you choose a physical therapist with Fellowship training, you are likely to experience better results over fewer visits than you would with a physical therapist without this additional education. To find a Fellow of the American Academy of Orthopaedic Manual Physical Therapists, please visit www.aaompt.org.
I hope that this information will provide you with a fairly comprehensive starting point and will enable you to find the best physical therapist and optimal physical therapy experience for your needs.
Further Information on Orthopedic Manual Physical Therapy
Click on any of the following links for more information:
Would you like a brief overview of the basics of orthopedic manual physical therapy?
Are you curious about the scientific mechanisms behind how orthopedic manual physical therapy works?
Have you ever wondered how pain works?
Do patients need an MRI or X-ray before beginning physical therapy?
How should one perform manual therapy for spondylolisthesis?
Dr. Damon Bescia is a fellowship-trained Doctor of Physical Therapy, board certified in orthopedics and sports physical therapy, who specializes in Orthopedic Manual Physical Therapy and serves Naperville and its surrounding communities by way of his Concierge Practice, providing private one-to-one orthopedic manual physical therapy for his clients. For more information, please visit https://www.NapervilleManualPhysicalTherapy.com.
Resnik, Linda, Dawei Liu, Vince Mor, and Dennis L. Hart. "Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes." Physical Therapy 88, no. 9 (2008): 989-1004.
Childs, John D., Julie M. Whitman, Phillip S. Sizer, Maria L. Pugia, Timothy W. Flynn, and Anthony Delitto. "A description of physical therapists' knowledge in managing musculoskeletal conditions." BMC Musculoskeletal Disorders 6, no. 1 (2005): 32.
Rundle R, Roberts J, Whitney G, Mankins S, Dille C, Donaldson M, Hassen A. A COMPARISON BETWEEN CIVILIAN AND MILITARY PHYSICAL THERAPISTS’KNOWLEDGE IN MANAGING MUSCULOSKELETAL CONDITIONS: A DESCRIPTIVE STUDY. International journal of sports physical therapy. 2016 Feb;11(1):115.
Rodeghero, Jason, Ying-Chih Wang, Timothy Flynn, Joshua A. Cleland, Robert S. Wainner, and Julie M. Whitman. "The impact of physical therapy residency or fellowship education on clinical outcomes for patients with musculoskeletal conditions." journal of orthopaedic & sports physical therapy45, no. 2 (2015): 86-96.