There is no medical specialty more qualified to provide expert opinions on physical functioning than physical therapists. Physical therapy is the unfinished business of medicine. Physical therapy plays a pivotal role in the lives of patients who have sustained impairments leading to disability. The disability continuum pictured below illustrates the distinction between disease-pathology-impairment-disability- handicap concepts.
Physicians play a dominant role on the disablement continuum between disease and impairment while, physical therapists are the providers of choice when attempting to differentiate and manage conditions that range between impairment and handicap status. This is not to say that physicians and therapists do not treat along the entire continuum. It simply points out the greatest impact each professional group offers. Physicians make “medical diagnoses” which are typically disease, pathology and impairment-based.
Physical therapists on the other hand make “physical therapy diagnoses” generally descriptive of physical function or dysfunction in activities of daily living/ADLs, critical job demands, and among athletes.
The confluence of medical, legal and administrative policies & procedures produces conflict in virtually every insurance line when it comes to determining who is the best medical provider to ask a specific question or call as a medico-legal witness regarding a patient’s condition, work status, and physical function.
It is the intent of this communication to reinforce the importance of physical therapists within the medical matrix of providers and along the disability continuum. It is my strong belief that physicaltherapists are incredibly under-utilized by the following professionals who attempt to prevent, treat, manage and finance value-driven healthcare. Please note that there is a plethora of clinical documentation, legal precedence, and acceptance of the valuable professional knowledge, experience, judgement, insights and opinions that physical therapists have to offer. Again, physical therapists do not replace, supplant or displace the medical necessity for physician services. We simply augment what others do within the complex healthcare delivery model(s). Physical therapists are not “Medical Doctors” or “Doctors of Osteopathy”. Physical therapists are graduating increasingly with entry-level “Doctorates of Physical Therapy”. Or DPT. This will become the standard in the next several decades.
Clifton DW: Physical Rehabilitation’s Role in Disability Management. St Louis: Elsevier Pub., 2005, pg10
Duckworth D, Measuring disability: The role of the ICIDH, Disabil Rehab; 7:338-343, 1995
Guccione AA: Physical therapy diagnosis and the relationship between impairments and function. Phys Ther 71:499-504, 1991
Nagi SZ: Disability concepts revisited. In Pope AM, Tarlov AR (Eds): Disability in America: Toward a national agenda. Washington, D.C., National Academy Press, 1991, pp309-327.
World Health Organization: International Classification of Impairments. Disabilities and Handicaps: A Manual Relating to the Consequences of Disease, vol 41, Geneva, WHO, 1993 (originally published in 1980)
David W. Clifton, a licensed physical therapist and disability expert. He serves as CEO of DplusWC, a disability & workers’ compensation solutions company. David is considered by his peers as one of the founders of physical therapy peer review in the United States; having developed the nation’s first PT-specific Peer Review Organization/PRO (1982). Many physical therapy network companies and utilization review organizations follow his teachings.