Referrals
What ages can a PT treat?
NICU to Hospice: NICU they are helping to maintain ROM.
Prevent contractures, sensory integration positioning. Hospice assists with pain management through stretching, prevention of pressure ulcers, and sometimes wound care.
When would you refer a patient to PT without complaints of pain?
Balance, vertigo, SCL, posture concerns, work place training
What level of schooling do therapists coming out of school have?
PT started as a certificate, but is now a Doctorate program. Involves numerous years of clinical dx, treatment, and clinicals.
PT’s are actually trained to read x-rays and MRIs, understand medications, and see a patient without them ever being seen by a physician.
What is a frequent complaint PT's hear from their patients regarding their MD?
"They don't listen to me and they don't have time for me."
What body systems give us our sense of balance? And how would you assess that?
Proprioception (knowing where your joints are and how they move), Visual (knowing how you are oriented compared to your surroundings), and Vestibular (inner ear).
Can a PT treat a patient without a referral from a physician?
Depending on the state, PT’s are trained to dx and treat. Wyoming allows direct access, but with restrictions.
What can PT's do to treat vertigo?
Work with repositioning the crystals in the inner ear. If BPPV, they can screen for pathology
Name three settings that PT's work in.
Rehab hospital, outpatient, inpatient, schools, home health, ER, work injury settings, nursing homes- think disability, impairment, handicap
Cost is a frequent patient complaint. In a world where insurance is limited with coverage, how can the PT and MD best work together to decrease patients expenditures?
Consider PT referral before expensive diagnostics.
LBP: Studies show they are very likely to get better with PT and MRI is not necessary.
What role might a PT play when asking about medications a patient is taking?
Screen for medications that may increase chance of injury, give common side effects, increase their risk of falling or change their response to exercise.
(flouroquinolones - tendon injuries, prolonged cortiocosteroid use - tendon or bone injuries, NSAIDs - GI distress, opioids - constipation, polypharmacy - fall risk, beta blockers - decreased HR with exercise)
T/F: A referral must detail exactly what the physician would like the PT to do.
False: This actually does the patient some injustice as it may not cover all of the treatments that the patient could benefit from. A simple “eval and treat” allows the therapist the freedom to do what they are trained to do by deciding which treatments are best.
Name three chronic conditions that a PT can help treat?
COPD, Parkinson's, RA, MS (improving ROM, strength, endurance, etc.)
T/F: Dry needling and acupuncture are the same.
False: Acupuncture is traditional Chinese medicine that focuses on stimulating parts of the body. Dry Needling is Western medicine and focuses on removing trigger points to decrease pain, increase ROM, and even improve strength.
The language we use is powerful. What is an example of patient first language?
"My patient with shoulder pain is coming in at noon" vs "I have a shoulder coming in at noon." Other things to think about: Chronic vs persistent, "black hole in my brain" "my knee exploded"
T/F: It is important to understand a patient's previous surgical history.
True! Previous history of surgery on the same body part may give us clues to healing timelines. Surgical history can also tell us if a patient might have other restrictions such as from scar tissue from previous abdominal surgeries that may be contributing factors to conditions like back pain.
Who might a PT refer a patient to and why?
Back to their MD if they are not making progress, they may require imaging at that point or advanced medical care. SLP or OT if a patient talks about other difficulties they have with daily activities (swallowing, remembering things). Psychologist - pt may have underlying depression/mental health issues that require intervention.
How can a PT help treat a wound?
Debridement and dressing changes, assisting with removing the source of the wound, compression for venous insufficiency, and wound vac usage.
T/F: With Lumbar stenosis, there is no difference in outcomes between PT and surgery, and there are fewer and less severe complications associated with PT.
True.
What are some lifestyle factors that may contribute to patient pain?
Physical Therapists spend a lot of time educating! Stress, diet, income, fear associated with pain, family environment can all contribute to making a patient’s pain better or worse. We don’t just treat the symptoms, we educate on all of these things as well.
T/F: A PT will be more successful if the patient has imaging prior to their visit.
False: PT’s are trained in special testing to help diagnose the cause of the patient’s symptoms. Often, we see that the imaging can confuse the patient more because their imaging doesn’t correspond with their symptoms—i.e., their L5/S1 disk bulge likely isn’t causing their hip pain. But once they see the bulge, they tend to obsess over it.
What practitioners can refer to PT in Wyoming?
MD, DO, FNP, PA, DC, Dentist
What is the PT's role in running assessment?
Look at strength, ROM, alignment up the chain to address any deficits, analyze running form, and give appropriate drills to address abnormalities. Shoe/ foot assessment.
How many hours of continuing education are required for maintaining a PT license?
30 hours every 2 years. 15 of these can be non-face to face, the other 15 must be in person.
How can you create patient buy-in on the first visit?
Education and empowerment - Help the patient understand what is going on and what they can do to be an active part in their recovery. Talk about patients goals. Provide a treatment that first day that helps reduce their pain or increase their mobility.
- Ergonomics are a big deal! Name some occupations and how a worker from them might present with an overuse/repetitive use injury.
Office worker - neck pain, carpal tunnel; Construction/electrician - neck pain, lateral epicondylitis; Delivery drivers (UPS, Fedex) - low back pain, knee pain