Physical Therapy in Medicine and Health Service

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Physical Therapy in Medicine and Health Service Essay

Physical therapy can be carried out in different programmes depending on the patient’s interest. Mostly, these programmes are chosen depending on their efficiency, resource constraints, time consumption and cost effectiveness. In that case, there is a huge comparison between the home based programme and supervised clinical therapy. There are specific limitations which show how these programmes are different from each other.Physical Therapy in Medicine and Health Service Essay


Basically, they do not show any significant difference in terms of recovery. The only difference is in terms of cost and time consumption. The home based programme is more effective than the clinical supervised therapy. It is relatively cheaper in terms of transport and it cuts off unnecessary movements. This centralises the patients’ mind hence giving them confidence for quick recovery. The two programmes are studied in details where researches and the data obtained from both fields help to differentiate the both programmes. The research shows a slight difference in the two programmes where the home based programme is more effective in terms of time consumption and cost effectiveness.

In a broad spectrum, home based therapy programme takes place in the client’s home rather than in the rapist clinic. Most of these programmes are provided by the community health organisation as well as private therapists who are requested to provide services at one’s home. The programme is considered by many people as it reduces expenses like transport cost in such clinics when bringing services to those in extreme illness, childcare, personal crises or even lack of finance.Physical Therapy in Medicine and Health Service Essay

Standard clinical therapy is a programme that provides its services from a specific office, clinic or hospital. It is conducted by therapists themselves. This programme is costly in terms of transport, time consumption and even resource utilization. The two programmes have almost the same treatment strategy to the patients with unnoticeable difference in service delivery and recovery rate. Patients choose a programme that one feels is better to satisfy his or her needs. As a matter of fact, these two programmes are both effective in their service delivery. The only difference is that the home based programme seems to be more effective in terms of cost effectiveness and time consumption as compared to the supervised clinical programme.Physical Therapy in Medicine and Health Service Essay

Therapy manoeuvres
Home based therapy programme is exercised and carried out at one’s home to speed up recovery rate where the place acts as a rehabilitation centre for the patient. It enables the patient to be independent and familiarise with their own daily duties reliable in the new environment. Basically, it involves the family members in the rehabilitation process. According to the Journal of International Medical Research (2008), patient suffering from ACL injuries not more than three months old who is ranging 18-35 years were selected.

Similarly, those who were involved in sport injuries, motor and vehicle accident that are able to give personal conclusion were selected. In post-operative rehabilitation, patients were sorted randomly either to attend home based or clinic.Physical Therapy in Medicine and Health Service Essay

Irrespective of the therapy programme chosen it shows the patient respondent well to both programs. However, the home based therapy programme patient give promising results in terms of time consumption and efficiency. The patients recover faster than the supervised therapy program. Similarly, they are able to carry on their standard chores within their locality.

Pros and cons
Comparatively, the home based programme is less expensive as the patients are not paying for the upkeep charges. By reducing the post operation activities it implies that the cost is greatly reduced. This is only possible in home based programme as the patient’s controls on how they are attended to. According to Knee Surg Sports Traumatol Arthros(2011), home based programme have clinical attendance after every three months of operation implying that the home based programme is cost effective and time conserving (John Grant et al, 2005).Physical Therapy in Medicine and Health Service Essay

In a broad spectrum, patients who participated in the home clinics cut off travel expense since every activity was carried out within their home places. Eventually, they travel to the hospital by the patient and relatives avoiding hence cutting off the expenses. Similarly, employee supervision was provided by the patient after the (ACL).

This implies that the patient is able to involve in the simple activities at home under family rehabilitation hence home based programme is more economical. Similarly, results of the study indicate that patients who are rehabilitee by therapist receive vocational training to help them develop confidence in their state as compared to those at home. Those who depend on their therapist for confidence take longer time to recover from (ACL) (Ugutmen et al, 2008).Physical Therapy in Medicine and Health Service Essay

Those involved in planning short term and long term goals in their life and free from therapist develop confidence independently hence takes less time to recover. This empowers personal confidence, hence they are able to appreciate their role in rehabilitative programme and empower personal efficiency. In the post-operative rehabilitation, Radom selection was done to the patient and assigned to the home based programme. They were guided to carry activities aimed at regaining their state of motion, improving their moving speed and retaining their strength. These were aimed to restore their initial motion state and reduce oedema and retain the ability and strength of the extensor muscle.Physical Therapy in Medicine and Health Service Essay

Therapy Research
Phase two of the post-operative was aimed at gaining full muscle extension probably 900 through close chain exercise. In the third phase, patients returned into their normal exercise to retain their initial state of motion. Fourth phase patients were encouraged to get involved in sporting activities. The patients returned into the sporting activities and finally in contact sports. The first three stages were used to evaluate patient’s condition provided with complete home exercise manual aided by diagrams to carry on the exercise in the right manner.Physical Therapy in Medicine and Health Service Essay

Those who were categorised to attend the supervised program were excluded from the activities as to come up with a significant difference to quantify the results. Surprisingly, successful outcomes of the state of motion, strength and sagittal plane laxity and functional outcome showed closely results to those of standard based programme. The study validates short term outcomes that indicates that many of the home based programme were able to regain clinical acceptance state of motion and goals by the third month of post-operative time which is accompanied by cost-effective analysis that is performed together with the randomized clinical trial.Physical Therapy in Medicine and Health Service Essay

It demonstrates that home based program is time effective as compared to supervised programme. A strong pre-operative efficiency linked to the resulting surgery and rehabilitation results into the preinjured state. Specific outcome measures incorporates these variation directed toward sports and recreation (Ugutmen et al, 2008).

Results from the two programmes was analysed and compared using two tales t-test. After performance of arthroscopic minscetomy, sixteen patients in other clinics had meniscal tears ten hard lateral meniscal tears while the rest had both menial and lateral tears. Half of the patients were allocated to the home based programme while the other half were allocated to the supervised therapy programme. All of the patients from any of the group were lost to follow up and none of them was excluded from the study. After analysing the results, there was no significant difference between the results obtained from the two programmes. Both groups showed that there was reduction in their ability to move with improvement after the fourth week. Thigh atrophy was not so unique between the two groups.Physical Therapy in Medicine and Health Service Essay

Factors affecting ACL recovery
Clinical rehabilitation is one of the main factors affecting the ACL recovery. Different rehabilitation programmes can be put into place to aid in ACL reconstruction, but should aim at healing the wound first, gaining full extension, controlling leg sweating and having leg control before starting to tackle increased flexion, mounting a functional pace, tackling daily living activities and then joining competitive sports. The most important components of the home based rehabilitation activities are descriptive manual aided with pictures for a particular activity, scrutinised assortment of the accommodating patients and consisted follow-up with the physical therapist.

These combinations of events give the patient confidence in themselves and even a strong bondage between the assistive group and the patient, something that is very important to the patient for quick recovery. The patient is also given the ability to make his own choice and judgement on the activities to be carrient out something that is not in the standard clinical programme. This makes the home based programme more reliable in resource utilization.Physical Therapy in Medicine and Health Service Essay

The patients should be given proper education on the importance of physical therapy before undergoing whether home or clinical based rehabilitation for the ACL reconstructive surgery. Based on the results, home based rehabilitative programme is as reliable as the clinical based and time and cost effective. This is because most of the actions are done within the patient premises and no transport charges to be incurred.

Most importantly, ACL reconstruction with the home based rehabilitation programme for a patella-bone with tendon-bone outograft continued for a period of more than two years of the surgery. The study clearly indicates that home based group reported disease specific quality of life as compare to the clinical based one. Although in the statistics, the difference is so insignificant, because it was less than clinically relevance. Despite the ignorance of the difference, home based programmes seems to look it on the save side as compared to the clinical programme.Physical Therapy in Medicine and Health Service Essay

There is no significance difference between the groups for the secondary outcomes for knee extension and flexion range of motion, sagittal plane laxity, and quadriceps strength ratio or hamstring strength ratio. The limitation in the current study needs to be acknowledged. According to Advances in Physiotherapy (2009), the reaction rate is 68%, with only 51% of the patients accessible for full clinical follow-up. The specific activity level or proportion of patients returning to preinjured sports is not included. The disease-specific consequence measure incorporates these variables and is preferentially weighted toward the sport and recreation domain. The difference in scores between the two groups is statistically significant in analysing the resorts of the two studies (Ravena et al, 2009).Physical Therapy in Medicine and Health Service Essay

Despite being statistically significant, the mean scores at follow-up do not meet the priority definition of a clinically relevant ACL reconstruction. Importantly, the minimal clinical difference is difficult to achieve in a subjective patient-based outcome measure, and there is a general lack of agreement on how to correctly calculate this value. Given the co-author’s experience with the development and clinical use of the score over the past 10 years, a 15-point difference is considered conservative and clinically relevant. Distribution-based methods to determine the value have also been published and normally reported as the edge of essentiality.

Change is consistently close to a wide range of disease-specific and global patient-oriented rating scales. Previously, the identified SD of the ACL would be the mean difference between the groups in this study. Falling between the priorities opinion-based on the distribution based value. It is feasible that the current study may demonstrate a clinical difference in the rehabilitation groups. Furthermore, the work is clearly required to determine the questionnaire.Physical Therapy in Medicine and Health Service Essay

Patient’s comments regarding their feelings about the pros and cons of participating in a limited administered post-operative rehabilitation program had been a beneficial tally to this study. There are main areas for future work which include exploring the psychological issues of self-efficacy and motivation. This plays an important role in the success of the supervised rehabilitation program and the delineation (Erik, 2011).

An anterior cruciate ligament injury is the over-stretching, partial tearing, or complete tearing of the anterior cruciate ligament (ACL) in the knee. Surgical reconstruction of the ACL to repair the tear, and proper physical rehabilitation to strengthen the injured knee are used to bring the patient’s knee back to its pre-injured state.Physical Therapy in Medicine and Health Service Essay

Several research studies were done in order to determine if a home-based physical therapy program after anterior cruciate ligament reconstruction would be just as successful as a standard physical therapy program. These findings have concluded that there is no significant difference between the home-based program and the supervised physical therapy program, suggesting that a home-based approach can be a viable option in terms of time constraints cost-effectiveness and effective resource utilization.

Physical therapists are members of a health care team, specially trained to improve movement and flinction, relieve pain, and expand movement potential. Through evaluation and individualized treatment programs, physical therapists can both treat existing problems and provide preventive health care for people with a variety of needs (Physical Therapy-Improving 1). Physical therapists are very knowledgeable and skillful concerning the human body. Physical therapy is a complex, but rewarding field to pursue as a career. Specialization, working conditions, job outlook, salaries, and education requirements need to be taken into consideration when contemplating a career as a physical therapist.Physical Therapy in Medicine and Health Service Essay

Physical therapists can…show more content…
Physical therapists develop specific programs for each patient’s needs. They may apply therapeutic exercise, ultrasound, massage, and applications of heat and cold to alleviate pain and restore normal function to the body. The physical therapist is able to evaluate a patient’s joint motion, muscle strength, endurance, functional abflity, muscle tone, reflexes, and stability of walking. The physical therapist also assesses the need and use of braces and artificial limbs, function of the heart and lungs, integrity of sensation and perception, and performance of activities required in daily living. (“A Future” 18). Another important part of the job of a physical therapist is to maintain careful documentation. The documentation is mainly used to keep a record of rehab used, to reflect back on improvement, and to provide legal records.Physical Therapy in Medicine and Health Service Essay

On the other hand, to just become a physical therapy assistant, all that is required is graduation from a physical therapist program and passing a national or state exam. When it comes to physical therapists’ salaries, it depends on a lot on of factors, like their job location, how much experience they have and their employer. “A Physical Therapist evaluates, diagnoses, and treats patients with disorders that limit their abilities to move or function normally in daily life. This career may be a good fit for people who have good interpersonal skills & desire to help others with their physical limitations” ( For an individual to make more money as a physical therapist, they would have to get the highest level of education and then work their way up promotions and become program director or a clinic manager. It varies on what the highest position there is at their place of employment. For physical therapy assistants the national average median salary was about $45,650 annually.Physical Therapy in Medicine and Health Service Essay

SCIPS (2006) defined Physiotherapy as “a science-based health care profession which emphasises the use of physical approaches in the promotion, maintenance and restoration of an individual’s physical, psychological and social well-being through various interventions, supported and influenced by evidence of clinical effectiveness and practitioners may work independently or as members of the health care team.”Physical Therapy in Medicine and Health Service Essay

Physiotherapy and rehabilitation services in Oman is still in the young phases where most of our practices follows the traditional method, and evidence based approach involves reading international journals, research papers and attendance to seminars, conferences and postgraduate courses. The services have not been accompanied by a comparable increase in systematic evidence. Few practices have been evaluated either for their efficacy in carefully controlled circumstances or for their effectiveness in typical clinical situations, however to keep abreast with our clinical approach and to attain clinical effectiveness in our services, we need to develop strategies and audits to identify areas of improvement and ways of implementing effective and evidence based care.

The essay will demonstrate the action plan by using the quotes of Graham (1996) on clinical effectiveness. The impact of guidelines, auditing and cost- effectiveness will also be discussed within sections of this essay.Physical Therapy in Medicine and Health Service Essay

Clinical Effectiveness
NHS Quality Improvement Scotland (NHS QIS 2005) described clinical effectiveness as the extent to which specific clinical interventions do what they are intended to do, i.e. maintain and improve the health of patients securing the greatest possible health gain from the available resources. They further described clinical effectiveness as critical thinking about actions, questioning whether it has the desired result, and about making positive changes to practice. They also continued to describe clinical effectiveness by using the same quotes as Graham 1996.Physical Therapy in Medicine and Health Service Essay

National Health Service (2009) aimed to achieve clinical effectiveness strategy by developing a culture where clinical effectiveness is seen as being integral to the day-to-day provision of clinical care. Furthermore, through the development of an integrated work programme, setting out the structures, priorities, and implementing and monitoring national guidance, standards and policy.Physical Therapy in Medicine and Health Service Essay

Evidence -Based Practice.
Evidence-Based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients (Belsey J, Snell T(2009).


Hospital (2005) in their review of rehabilitating physiotherapy stated that evidence-based practice is currently becoming a basic ethical stand in physiotherapy – and other fields of healthcare. The purpose of evidence-based practice is to make any decision-making on diagnosis and treatment proceeds from proven knowledge in the field concerned.Physical Therapy in Medicine and Health Service Essay

Herbert R et al (2005) in their review of practical evidence-based physiotherapy pointed out that research alone is not enough, it is most effective when patients, health professionals and policy makers bring to their decisions a range of values, preferences, experiences and knowledge.

Clinical effectiveness as quoted by Graham (1996) “the right persons, doing the right thing, the right way, in the right place, at the right time with the right result”
The philosophy in this essay involves team members collecting knowledge of the available service, and then using evidence from a wide range of sources to inform the outcome, linked to the priorities facing the profession. Also develop frameworks to guide ongoing development such as competency framework, and an integrated care pathway, through implementation of patient care knowledge. The process for development will be timely and detailed, and will be actively disseminated using strategic planning to promote implementation and later will be evaluated. Success for the development of clinical effectiveness and evidence-based care would be for the team to experience a constructive and enabling process that contributes to their continuing professional development and progression of research knowledge and skills.Physical Therapy in Medicine and Health Service Essay

The following sections will apply the parameters of Graham’s quote to the practice of physiotherapy and rehabilitation through clinical effectiveness.

The right persons-(competence)
Epstein and Hundert (2002) defined professional competence as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served”Physical Therapy in Medicine and Health Service Essay

The therapist has to be fully qualified and competent to be able to make decisions for therapeutic interventions, identify and analyse the patients’ condition, a particular clinical problem, should be able to identify and define standards relevant to clinical work, and have the knowledge of the subsequent intervention that might improve outcome.

The right thing (evidence based practice resources)
Graham (1996) quoted that evidence-based practice is about ‘doing the right things right’, and Muir Gray (1997) supported the emphasis on the process rather than on the result.Physical Therapy in Medicine and Health Service Essay

Evidence can be gathered from a range of resources including published guidelines, journals articles, conferences, books, peer reviews, client feedbacks and other recourses from libraries. In order to attain the evidence based practice resources the social value must be identified and the impact of provider values on access to services and quality of care should be understood.

Rebecca Broughton (2001) stated that clinical guidelines are systematically developed statements designed to help practitioners and patients decide on appropriate healthcare. It stated that guidelines reduce unacceptable or undesirable variations in practice and provide a focus for discussion among health professionals and patients. Furthermore, Van der Wees P and Mead J(2004) in their study on framework for clinical guideline development in physiotherapy concluded that clinical guidelines are a valuable resource for effective clinical practice and are important tools for clinical effectiveness and evidence based practice, and has the potential to improve the quality of patient care.Physical Therapy in Medicine and Health Service Essay

The right way (skills and competence)
The team will work collaboratively to deliver a new policy as per the needs through an evidence based approach system and evaluate new policy in the context of local and national priorities and critically review the nature of evidence in the context of the working environment.

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The right way to develop skills and competence and the necessary step will be observed such as; time to develop the services, required post training for the therapists, duration of training and resources such as current equipment, the evidence based researched journals and the financial implication. Protocols or specification must be developed and updated by ensuring staff development such as participation in Continuing Medical Education (CMEs) and ensuring confidence of current knowledge and skills through evidence based practice. Patient’s dignity and privacy must be equally maintained in all contexts of intervention.Physical Therapy in Medicine and Health Service Essay

The right place (location of treatment/services)
This will involve team work to audit and identify the geographical regions that need developing and observe the clinical practice, thus includes identifying priority areas of work to deliver the strategy, The performance will be audited to measure the quality of care the patient experienced including the effectiveness of implementing the best available evidence and then benchmarked against pre-set standards, changes will then be implemented where needed.

The clinical audit process seeks to identify areas for service improvement, develop and carry out action plans to rectify or improve service provision and then to re-audit to ensure that these changes have an effect. (Wikipedia).Physical Therapy in Medicine and Health Service Essay

The right time (provision of treatment/services)
The team will determine and assess the clinical needs of care and interventions so as to develop the appropriate delivery of services as per the requirements and assess the cost effectiveness of the service delivery. The status of the current services, the type of patients, clinical intervention, time process, duration of treatment and location should be reviewed.

Hurley et al (2009) in their study on effectiveness and clinical applicability of integrated rehabilitation programs for knee osteoarthritis showed that correct integrated rehabilitation programmes involving exercise and self-management are more clinically and cost effective and may be the best way of managing the large and increasing number of people suffering chronic knee pain.Physical Therapy in Medicine and Health Service Essay

Another example from Santos et al (2004) in their project implementing clinical evidence in the management of coronary care provided a foundation for the development of a management strategy by using a multidisciplinary team approach, involving updating guidelines and resources. A positive outcome of the project was a reduction in hospital admission.

An example in our local services was seen in a study of rehabilitation and management of elderly individuals following stroke which required an integrated approach from a multidisciplinary team. This minimised readmission of chronic cases and proved cost effective.Physical Therapy in Medicine and Health Service Essay

Cost-effectiveness analysis should be done to address and ensure the efficient use of recourses and compare the financial costs of therapies whose outcomes can be measured purely in terms of health effect. (Alan Haycox 2009). Ceri. P. (2001) stated that one such method for measuring the extent of health gains is the quantity adjustment life year (QALY).

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The right result (clinical effectiveness/ maximising health gain)
The results should be identified and reported to assess the benefits and patients’ satisfaction. The appraised research has to have valid and relevant information in the overall results that could be of clinical benefit safe, effective, cost beneficial and when used on the general population will make a difference. Hence health care authorities should develop appropriate use of evidence-based, standardized processes and centers of excellence to support easy reach of health care through a multidisciplinary care team of physiotherapy and rehabilitation.Physical Therapy in Medicine and Health Service Essay

This essay has discussed the mechanism of clinical effectiveness and evidence based practice in the context of physiotherapy and rehabilitation service. The essay has reflected on the needs and future expectations in the provision of a safe and effective care on a national scale.

It has been found that in the context of providing effective rehabilitation, the implementation of up-to-date guidelines, auditing and cost evaluation are all paramount for the assessment of clinical effectiveness.Physical Therapy in Medicine and Health Service Essay

In conclusion, clinical effectiveness in physiotherapy and rehabilitation services uses an integrated approach and can be thought of as the sum of the right person; as being the competent skilled therapist, backed with the right evidence, protocols and guidelines (the right way). In addition, an efficient well equipped environment. An ongoing review of such intervention and approach is required to evaluate and further improve the results of the provided service. Physical Therapy in Medicine and Health Service Essay