CHICAGO—Clinicians need to know when and how to provide rehabilitation services for their patients, either within the clinic or office setting or by referral to physical or occupational therapists. Understanding rehabilitation principles and the basic exercises for common rheumatic and orthopedic conditions can help improve patient management.
Working with physical and occupational therapy professionals is an integral part of the job of a healthcare provider in a rheumatology practice. Many providers, however, want clarification about when a patient should be referred to a physical therapist and when the patient could be helped with rehabilitation therapy in the clinic setting.
Another factor influencing services recommended is access to physical or occupational therapy. Many patients are unable to undergo professional therapy because of time, cost, or other impediments to access. For example, some insurance policies will not cover physical therapy services until a patient has finished a treatment program of medications or home exercises. In these situations, rehabilitative help in the clinic may be the only option for those who need immediate therapy for a common condition.
Clinicians must make key decisions about the types and duration of physical and occupational therapy recommended. For this reason, rheumatologists should know how to write a prescription for rehabilitation therapy, how to explain precautions to patients doing physical therapy at home, how to demonstrate specific exercises that can be performed in the clinician’s office, and when to refer the patient to a specialist.
These and other issues about rehabilitation services were addressed in the ARHP Concurrent Session, Rehabilitation for the Clinician, at the 2011 ACR/ARHP Annual Scientific Meeting on November 6, 2011. [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.] The session’s presenters, Donna K. Everix, MPA, BS, PT, a physical therapist and electronic health record physician liaison at Mills-Peninsula Health Services in Burlingame, Calif., and Victoria A. Merrell, PA-C, MPT, a physician assistant and former physical therapist from Encinitas, Calif., outline their goals at the beginning:
- Understand when to refer a patient to formal rehabilitation therapy;
- Recognize and explain precautions for home exercising;
- Demonstrate specific exercises, including red flags for specific conditions;
- Examine concerns about patient compliance; and
- Review appropriate progress in exercise programs.
Writing a Therapy Order
A clinician’s therapy order often instructs a therapist to evaluate a patient’s condition and then begin appropriate treatment. In some cases, the clinician may prescribe specific treatments. A typical order can include the following directions:
- Evaluate and treat; and
- Specific treatment recommendations:
- Modalities (ice, heat, ultrasound, electrical stimulation, iontophoresis, phonophoresis);
- Joint or soft tissue mobilization;
- Patient education (posture, body mechanics, joint protection, activities of daily living modification);
- Therapeutic exercises (range of motion, stretching, strengthening, aerobic conditioning, balance training);
- Aquatic therapy;
- Gait training, fitting with assistive device;
- Splinting, bracing orthotics;
- Ergonomics; and
- Exercises specific to preparing for work or sports activities.
Identify Conditions that Warrant Referral to Therapy
There are certain diagnoses that require an order for therapy:
- Adhesive capsulitis;
- Partial rotator cuff tear;
- Meniscal/ligamentous knee injury;
- Postsurgery situation;
- Osteoporosis; and
- Complex regional pain syndrome.
Patients with these conditions benefit from ongoing physical therapy and evaluation.
