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Physical Therapists: Partners or Competitors?
By Miki Fairley When we posed this question, we were deluged with responses
from orthotists, prosthetists,
physical therapists, and practitioners who are both certified
prosthetists/orthotists and physical therapists. This article
includes views from prosthetists and orthotists. Next month we will
cover views expressed by physical therapists and O&P
practitioners who are also physical therapists.
Overall, the emphasis is definitely on partnership, not
competition. Several prosthetists/orthotists commented that the
expertise of both professionsand teamwork between themis essential
for the optimal functional outcome for the patient.
Areas of concern embrace education, training, and
communication"speaking the same language." Interestingly,
encroachment did not surface often as an issue. In fact, the
comment came up several times that a reason physical therapists may
be doing more bracing is not that they are seeking more ways to
increase revenue, but that they aren't satisfied with what
orthotists are providing. Of course, there are legitimate
differences of opinion as to what is the best treatment methodology
in a particular case.
One certified orthotist pointed out an inequity in
reimbursement, noting that physical therapists can bill according
to the L-Code reimbursement, plus the physical therapy charge,
while orthotists and prosthetists can bill only the L-Code amount,
since their services are included in the code.
Here are some of the responses:
Christopher Huff, CO, and Mike Bolton, BOCO ,
own Advanced Orthotics and Prosthetics, Troy, New York, and share
office space with Troy Physical Therapy.
The two orthotists enjoy a strong working relationship with the
physical therapists, says Huff. "We complement each other to
benefit the patient." For instance, if a patient needs increased
range of motion, the orthotists contact the doctor and recommend
physical therapy. The physical therapist can contact the orthotists
for an evaluation for bracing.
Being under the same roof brings some advantages, says Huff.
They can answer any question a patient might have regarding O&P
or physical therapy and make adjustments and changes quickly
without the patient having to travel.
The orthotists assist the physical therapists by discussing how
orthotic intervention may benefit the patient, along with the pros
and cons of each type of orthosis.
"I know some PT's are doing their own bracing," Huff says,
adding, "I believe this is due to their not getting the proper
correction or support they want for their patients. So they decide
they can just do it themselves."
Huff feels physical therapists are qualified to fit
prefabricated braces and has no problem with that. "If they try a
prefabricated brace that does not work, we can evaluate the patient
to determine if a custom-fabricated orthosis will give them what
they are looking for."
Huff notes that the physical therapist often spends more time
with the patient than the orthotist does and "may see something we
don't."
Huff discusses his evaluation and treatment goal with the
therapist, welcoming the therapist's input.
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Rob Kistenberg, CP, FAAOP |
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Rob Kistenberg, CP, FAAOP ,
O&P Clinical Technologies, Gainesville, Florida, is another
practitioner strongly committed to working with physical
therapists. "For prosthetists, it is critical that we have a good
relationship with physical therapists," he says. New amputees need
physical therapy to regain balance and strength and to learn how to
walk again correctly, Kistenberg points out. "We also recommend
physical therapy for long-time amputees getting a new prosthesis if
they have a specific muscle weakness or gait deviations."
Kistenberg usually will accompany the patient to his first or
second physical therapy appointment so that the physical therapist
will have a good understanding of the prosthesis. Physical
therapists don't receive much prosthetic instruction in their
education, he notes. "The prosthetic education that they get is
very basic and doesn't keep them up to date with the latest
products and technology. If it's a prosthetic problem, I can adjust
it on the spot, and if it's a strength or balance problem, I'm
there to help diagnose that with the physical therapist."
O&P Clinical Technologies offers inservices to physical
therapists, family physicians, and others in any
prosthetic/orthotic topic in which they have an interest. "Patient
care is certainly enhanced when PTs are comfortable with the
components and level of technology being used," says Kistenberg.
"We try to make sure they are up to date with what we do. This has
both a marketing and education component."
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Photo Courtesy of Amputee Coalition of America. Photoghrapher Jose Pico. |
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Gary Horton, CO, FAAOP , Horton's
Orthotic Lab, Little Rock, Arkansas, invites physical therapy
students from the University of Central Arkansas, located about 30
miles from Little Rock, each semester to his facility. After giving
the students an overview of orthotics and prosthetics, he leads a
complete tour, then provides a period for discussion and
questions.
"After they finish their training and start to practice, we
begin seeing referrals from them because they remember us from
these tours," Horton says. Discussing physical therapists, Horton
comments, "You get a little bit of the competitor,' and more of the
partner.' I know a lot of orthotists are skeptical and see them as
encroaching in orthotics, but this is a very small percentage of
physical therapists, in my opinion."
Horton believes that very few physical therapists go into
orthotics for financial gain. "I think some of them get into it
because they feel they can't get adequate orthoticsbut this is a
small percent. Some of them really and truly believe they can do a
better job."
A big help, according to Horton, is "the old-fashioned
cliché of good communication. They often see many of us as
just being hardware salesmen. We need to let therapists know what
we can add as a team member and how we can affect patient outcomes.
My method is to meet your therapist and let them know what we
doit's not just selling plastics and metalit's assisting with
evaluations and developing a patient treatment plan. It's being a
colleague, not a competitor."
Jim Rogers, CPO, FAAOP , Orthotic and
Prosthetic Associates, Chattanooga, Tennessee, traces the evolution
of the present environment of O&P relative to physical
therapy.
Commenting that many of his colleagues may see their
relationship with physical therapists, especially those in
pediatric practice, as one of competition, rather than partnership,
Rogers notes that "my perspective is from 28 years of
relationship-building with physical therapists, and 18 years of
marriage to one."
Rogers has seen the relationship between the professions change
considerably, he says, due to many factors: the O&P
profession's perceived failure to provide quality pediatric
services, geographical concerns, lack of vision on the part of
O&P regarding whether the field provides a product or a
service, and finally, the pressures of providing care in a managed
healthcare environment.
In the early 80s, physical therapists began to specialize,
Rogers continues. "Pediatric and neurological specialists evolved
and generally possessed a body of knowledge that the average
O&P professional did not have. Orthotic design began evolving
as an adjunct to therapya functional facilitatorrather than the
purely orthopedic solution to unnecessary movement, as most
orthotists had been taught."
As a result, Rogers says, tension developed between the physical
therapy community and the orthopedic community and, subsequently,
between the physical therapy community and the orthotic community.
"Orthotists who saw the big picture recognized the opportunity to
learn and be an integral part of a change in philosophy and
treatment patterns involving children. They listened, learned, and
provided solutions. Their practice and their pocketbooks were
enhanced. Those who did not respond developed a circle the wagons'
mentality and began to build a gulf between the professions.
"The lack of vision, or should I say timing,' with regards to
O&P is a much more complex issue," Rogers continues. "We have
always chosen to hold on to what we have instead of attempting to
define and distinguish our unique contributions to the
rehabilitation of individuals with disabilities. This has led to
the feeling that PTs, athletic trainers, physicians, and even sales
reps have encroached' on our territory." Some items provided by
orthotists are now accessible to the public through a variety of
avenues that bypass O&P facilities, Rogers notes.
"O&P should have long ago decided that we provide a unique
service that simply includes products and put our efforts into
defining our profession scientifically and distinguishing ourselves
from other allied health professionals. I think our national
organizations are now focused and doing a fairly good job of
attending to these issues and the greater needs of our
profession."
What the average practitioner needs to do is to "forge ahead by
building partnerships with other professionals who enhance our care
and help provide optimal outcomes," Rogers says, adding that
O&P professionals can increase their referral base by educating
physical therapists about the difference O&P services can make
in the lives of disabled persons. "Inservices, dual educational
sponsorships, support groups, health fairs and community service
projects aimed at informing the public are only some of the ways we
can enhance this relationship to our economic benefit and the
benefit of our patients."
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Randall Alley, CP |
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Occupational therapy is another area in which
rapport is needed between O&P professionals and therapists.
Randall Alley, CP , director, Business Development
and Clinical Research, Hanger P&O, and chairman-elect of the
Upper Limb Prosthetics Society of the American Academy of
Orthotists and Prosthetists (AAOP), is currently leading a massive
project with Diane Atkins, OTR, an occupational therapist noted for
her expertise in working with amputees and limb-deficient persons,
to generate a national directory of occupational therapists who are
either interested in or who specialize in upper extremity
prosthetics.
Alley also is working with the American Occupational Therapy
Association (AOTA) to initiate a "phys-dis" group within their
organization that responds directly to the relationship and
interactions between O&P professionals and occupational
therapists.
Alley and Atkins also will be writing an article for
O.T. Practice about this project. They also plan to give a
presentation at next year's Academy meeting in San Diego on working
together to provide the initial assessment of persons needing upper
extremity prostheses in the hopes of improving outcomes by
combining an OT and a prosthetist from the outset.
A second priority is to create a standardized physical
assessment form and guidelines, so that everyone is on the same
page when they first see a patient, Alley says. "Finally, I am
encouraging the Academy to bring about a greater awareness of the
need for prosthetists and therapists to come together and initiate
a better sharing of knowledge through written materials and
practical experience. 
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Arizona Couple Shows Patient Advantages of O&P, PT Partnership
- March 2006
Feature
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Physical Therapists: Colleagues or Combatants?
- March 2006
Feature
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PT 'Direct Access' —Why Is It Considered a Threat?
- July 2005
Feature
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PT Direct Access: Threat to O&P?
- September 2003
Should physical therapists have “direct access” to patients—being able to provide physical therapy
services without a physician’s prescription?
With or without the passage of “direct access”
legislation, should physical therapists be allowed to provide orthotic and prosthetic services and devices, without additional education, training, licensing, and/or certification, as part of their scope of practice?
Feature
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It’s All About Education, Training, and Experience
- June 2003
Perspective
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Physical Therapists: Are They Encroaching on O&P?
- April 2003
Are the two disciplines complementary or competitive? How much do they overlap? Here, two physical therapists with wide experience in working with prosthetic and orthotic patients give their views.
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Prosthetists: A Physiotherapist’s Perspective
- March 2003
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Table Of Contents - October 2002
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