During my on-site visits to check on students’ progress during their clinical internships, I could not help but notice a consistent pattern among some of the therapists I observed.
In several of the skilled nursing facilities where my students were assigned for their clinical rotation, I observed that PTs and PTAs tended to use the same treatment framework. In general, the patients were:
- Assisted to transfer from wheelchair to bed.
- Assisted to lie down in supine.
- Asked to perform ankle pumps, heel slides, windshield wipers and short arc quads exercises.
- Assisted to get up from the bed.
- Assisted by the therapists to walk using their assistive device for several feet and returned to their wheelchairs.
- Taken to their next scheduled therapy session or returned to their rooms.
The only variations I saw were the number of exercise repetitions, amount of resistance used during these exercises, and the levels of assistance and cues provided to the patients during the sessions. And these were done with every single patient, regardless of diagnosis. This made me wonder what these therapists had learned in school. Certainly, these therapists did not graduate from the same school.
I had the same observation when I went to a number of acute care facilities to follow up on a different group of students. Therapists in this setting were using the same framework. The only noticeable differences were the therapists performing the exercises at a slower pace, and with fewer repetitions. In this setting, patients also were gait-trained for a shorter distance and with more assistance and cues from the therapists. Certainly, these therapists did not all graduate from the same school as the therapists I observed in the skilled nursing facilities.
I thought it would be different when I visited my students assigned to complete their clinical rotation in outpatient settings. However, I was disappointed. I observed a number of therapists in this setting using a slight variation of the framework that I described with the addition of using modalities: moist heat, electrical stimulation, ultrasound or massage. Then, they proceeded to stretch the patients, followed by — you guessed it right — ankle pumps, heel slides, windshield wipers and short arc quads exercises. Certainly, these therapists did not graduate from the same school as the therapists I observed in the skilled nursing and acute care facilities.
To make matters worse, I have seen the same phenomenon in other parts of the country. So, what is going on?
I know that in PT and PTA schools, instructors teach their students to be creative in their treatment approach. They also teach students to tailor their treatments to the needs of individual patients. The instructors even reinforce the learning process by having students attend local or national conferences where they can get exposure on contemporary and evidence-based treatments. However, it seems the skills they have acquired and mastered while in school become undone once they get to practice professionally. They become these tainted therapists, whose passion and love for what we do in physical therapy has started to be extinguished.
The tainting of these therapists is alarming because in my opinion, anybody can do what they are doing with their patients. I also am unsure about how they might be charging for their services.
Without knowing why these therapists might have changed or lost the creativity they once possessed, I cannot offer an antidote to reverse my observations. All I can offer are the following words from Charles Darwin: “It is not the strongest of the species that survives, or the most intelligent, but the one most responsive to change.”
I hope these therapists recognize the need for change, have the willingness to make the change, and find a way to reignite the creativity, skills and passion for physical therapy they used to have. It is vital not only for their survival but also for the survival of our profession.