Choosing a physiotherapist – a checklist to be sure you are in the right hands

How do you know you are receiving the best physiotherapy service available?

Nice is not necessarily good.

There are a lot of physiotherapists and others healthcare providers offering a service to ‘fix’ your problem.

The wrong choice can be costly or even harmful.

We have some tips on what you should look for when choosing a physiotherapist

A recent systematic review, which is a study about a collection of many studies, found 11 consistent recommendations for qualities that define best-practice for managing musculoskeletal pain. As such, I thought I would provide a summary of these recommendations for you to compare with the services you are receiving (or looking for). Hopefully your therapist ticks most, if not all, these boxes.

Recommendations

1. Care should be patient centered

• • Treatment should be focused on your individual needs and goals.

2. Therapists should be screening for serious pathology and/or red flag conditions

• • Sometimes (not often) your pain may be attributed to something that requires medical attention.
  • Your therapist should be asking specific questions to attempt to rule this out.

3. Psychosocial factors should be assessed or monitored

• • More recently, research has highlighted the impact psychological variables, such as depression or anxiety, that can affect your course of recovery from pain.
  • If not explicitly asking about this, your therapist should be vigilant for signs of psychological distress and address these signs when warranted.

4. Advise against radiological imaging (X-Ray, CT scans, MRI) unless serious pathology is suspected, there is unsatisfactory response to conservative care or unexplained progression of signs and symptoms, or it is likely to change management

• • Routine medical imaging can waste healthcare resources and is often unwarranted for you to improve.
  • Conversely, it is important your therapist recognizes the above 3 exceptions for when it may be warranted rather than trudging along with the same ineffective treatment.

5. Therapists should perform a physical examination which may include a neurological screen, mobility and/or muscle strength tests

• • This one is self-explanatory. If your therapist doesn’t do a thorough assessment, how will they know what is wrong and how will they treat what they don’t know?!

6. Evaluate patient progress with the use of outcomes measures

• • How can you track progress if nothing is being tracked?!
  • This can be done through continual re-assessment via clinical tests and questionnaires.

7. Educate and inform patients about their condition and management options

• • Patients often want to know 3 things: What is wrong, how long will it take to get better, and what can I do to get it better.
  • Your therapist should educate you on the diagnosis, prognosis, and treatment options available to manage your condition.

8. Include physical activity and/or exercises as part of a management plan

• • We know through research that “passive” treatment i.e. having something done to you rather than you doing something for yourself doesn’t provide great outcomes on their own.
  • Although passive modalities may have a time and place, they should be an adjunct to an exercise-based program.

9. Use manual therapy as an adjunct to other evidence-based treatments

• • This goes in-line with the above recommendation. Manual therapy can involve massage, assisted-stretching, joint mobilization or manipulation etc.
  • If that is the only thing you receive at your treatment sessions, you could be getting a better service elsewhere.

10. Unless specifically indicated, offer evidence-based conservative treatment prior to surgery

• • Surgery is often an intervention that many patients believe will provide a quick fix. However, under most scenarios, conservative management can have just as good of an effect with less risk, time, and healthcare resources.

11. Facilitate continuation or resumption of work

• • Individuals that return to work in some capacity, even while in pain, do better than those who don’t.
  • Your physiotherapist should also advise you on any temporary modifications needed to do this.

As you can see, there was no mention of a state-of-the-art facility, specific/specialized intervention (other than exercise), or mention of guru-type experience. If your therapist is hitting most/all of these topics, you can be confident you are in the right hands.

References:

Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., … & O’Sullivan, P. P. (2019). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med, bjsports-2018.