Physiotherapy Best Practice
How to 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.
- Care should be patient centered
- Treatment should be focused on your individual needs and goals.
- 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.
- 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.
- 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.
- 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?!
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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.