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Am Fam Physician. 2008;78(11):1239

Author disclosure: Nothing to disclose.

Original Article: The Physical Therapy Prescription

Issue Date: December 1, 2007

to the editor: The article on the physical therapy prescription provided an insightful look at techniques used by physical therapists. However, prescriptions to physical therapists do not necessarily require specifics on the type, frequency, and duration of treatment. Physical therapists have independent knowledge and expertise in examination and evaluation and their experience can be valuable in collaborating with physicians on appropriate treatment interventions and a plan of care.

By law, physical therapists must perform an examination and evaluation before initiating treatment, whether the patient has been referred from a physician or seen via “direct access” in cases where no referral is required. The initial examination is a comprehensive screening and testing process that leads to a diagnostic classification. Physical therapists synthesize the findings from the patient history, systems review, and tests and measures to establish a diagnosis and prognosis. They also determine if consultation with another health care professional is necessary and design an individualized plan of care.1

The education and clinical experience required to become a licensed physical therapist includes anatomy, biomechanics, business and practice management, clinical applications, clinical interventions, clinical and behavioral sciences, evidence-based practice, histology, kinesiology, neuroscience, pathology, patient/client management, pharmacology, physiology, practice patterns, professional practice, professionalism and ethics, radiology/imaging research, and screening.2 The current minimum physical therapist educational requirement is a master's degree; more than 87 percent of educational programs now confer a doctor of physical therapy (DPT) degree.

In designing the plan of care, physical therapists analyze and integrate the clinical implications of the severity, complexity, and acuity of the pathophysiology. Decisions about interventions are contingent on the timely monitoring of patient response and progress made toward achieving the anticipated goals and expected outcomes.1

The American Physical Therapy Association has developed an online database (titled “Hooked on Evidence”) to assist physical therapists in recognizing the quality and availability of evidence in physical therapist practice and to formulate appropriate treatment interventions.

When prescribing physical therapy, physicians should consider relying on physical therapists' knowledge and discretion in the design and application of appropriate therapeutic interventions. Although it is important for physicians to know about the techniques used by physical therapists, it is also critical that physicians appreciate and utilize physical therapists' expertise and knowledge of neuromusculoskeletal injuries and disabilities to ensure the best outcomes for patients.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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