Logo World Confederation for Physical Therapy

DESCRIPTION OF PHYSICAL THERAPY

Why a Description?

The existence of WCPT (World Confederation for Physical Therapy) demonstrates the international dimension of Physical Therapy practice. The variety of its Member Organisations illustrates the diversity of needs and contexts of health care delivery throughout the Confederation.

In response to a motion at the 13° General Meeting to develop a description of physical therapy, WCPT initiated a consultative exercise with the intention of providing a foundation on which Member Organisations in different parts of the world could build a description of physical therapy relevant to their needs.

WCPT is committed to supporting Member Organisations - not stereotyping them. It is in this spirit that this description of physical therapy has been drawn up in response to the expressed need of members. It is intended as a Position Statement rather than a Declaration of Principle and is therefore open to be adopted fully, in part or further evidence upon which future practice will build. Nowhere is this more apparent than in our understanding of human movement which is central to the skills and knowledge of the physical therapist. Clearly the uniqueness of the contribution which physical therapy can make to health care in the next millenium remains to be fully defined. This statement is presented as the basis upon which subsequent reviews of the description will continue to be conducted in response to the development of knowledge in physical therapy and the profession's response to changing health needs of society.

Table of Contents

  1. What is Physical Therapy?
    1. The nature of physical therapy
    2. The nature of the physical therapy process
  2. Where is Physical Therapy Practised?
    1. The scope of physical therapy services
    2. Settings in which physical therapy is practised
  3. What Characterises Physical Therapy?
    1. Assumptions underlying the knowledge and practice of physical therapy
  4. Where are we now?
    1. Principles supporting the description of physical therapy

    REFERENCES

    Note

    The professional title and term used to describe the profession's practice vary and depend largely on the historical roots of the profession in the country of the WCPT Member Organisation.

    The most generally used titles and terms are "physical therapist" or "physiotherapist" and "physical therapy" or "physiotherapy": Physical therapist and physical therapy are used in this document but be replaced by WCPT Member Organisation in favour of those terms officially used by them and their members without any change in the meaning of the document.









    The nature of physical therapy (Torna all'inizio)

    Physical Therapy is providing services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Physical therapy includes the provision of services in circumstances where movement and function are threatened by the process of ageing or that of injury disease. Full and functional movement are at the heart of what it means to be healthy.

    Physical therapy is concerned with identifying and maximising movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapy involves the interaction between physical therapist, patients or clients, families and care givers, in a process of assessing movement and skills unique to physical therapists.

    The physical therapists' distinctive view of the body and its movement needs and potential is central to determining a diagnosis and an intervention strategy and is consistent whatever the setting in which practice is undertaken. These settings will vary in relation to whether physical therapy is concerned with health promotion, prevention, treatment or rehabilitation.

    The nature of the physical therapy process (Torna all'inizio)

    Physical therapy is the service only provided by, or under the direction and supervision of a physical therapist and includes assessment, diagnosis, planning, intervention and evaluation.

    Assessment includes both the examination of individuals or group with actual or potential impairments, functional limitations, disabilities, or other conditions of health by history taking, screening and the use of specific tests and measures and evaluation of the results of the examination through analysis and synthesis within a process of clinical reasoning.

    Diagnosis arises from the examination and evaluation and represents the outcome of the process of clinical reasoning. This may be expressed in terms of movement dysfunction or may encompass caregories of impairments, functional limitations, abilities/disabilities or syndromes.

    Planning begins with determination of the need for intervention and normally leads tothe development of a plan of intervention, including measurable outcome goals negotiated in collaboration with the patient/client, family or care giver. Alternatively it may lead to referral to another agrency in cases which are inappropriate for physical therapy.

    Intervention is implemented and modified in order to reach agreed goals and may include manual handling; movement enhancement; physical, electro-therapeutic and mechanical agents; functional training; provision of aids and appliances; patient related instruction and counselling; documentation and co-ordination, and communication. Intervention may also be aimed at prevention of impairments, functional limitations, disability and injuri including the promotion and maintenance of health, quality of life, and fitness in all ages and populations.

    Evaluation necessitates re-examination for the purpose of evaluating outcomes.

    The scope of physical therapy services (Torna all'inizio)

    Physical therapy is an essential part of the health services delivery system. Physical therapists practice independently of other health care providers and also within interdisciplinary rehabilitation/habilitation programs for the restoration of optimal function and quality of life in individuals with loss and disorders of movement. Physical therapists are guided by their own code of ethical principles. Thus, they may be concerned with one of the following purposes:

    • Promoting the health and well being of the individual and the general public/society.

    • Preventing impairments, functional limitations, and disabilities in individuals at risk of altered movement behaviours due to health or medically related factors, socio-economic stressors, and lifestyle factors.

    • Providing interventions to restore integrity of body systems essential to movement, maximise function and recuperation, minimise incapacity, and enhance the quality of life in individuals and groups of individuals, functional limitations, disabilities.

    Settings in which physical therapy is practised(Torna all'inizio)

    Physical therapy is delivered in a variety of settings which allow for it to achieve its purpose.

    Treatment and Rehabilitation usually occur in community and acute care settings which may include but are not confined to the following:

    • Hospices
    • Hospitals
    • Nursing Homes
    • Rehabilitation Centres/Residential Homes
    • Physical Therapist Private Office/Practice/Clinic
    • Out-Patient Clinics
    • Community Settings: Primary Health Care Centres: Individual Homes: Field Settings
    • Education and Research Centres

    Prevention and Health Promotion are more likely to occur in the following settings although they often form an integral part of treatment and rehabilitation offered within other care settings.

    • Fitness Centres/Health Clubs/Spas
    • Occupational Health Centres
    • Schools
    • Senior Citizen Centres
    • Sports Centres
    • Workplace/Companies
    • Public settings (i.e. Shopping Malls) for health promotion

    Assumptions underlying the knowledge and practice of physical therapy (Torna all'inizio)

    The following assumptions are embedded in this description and reflect the central issues of physical therapy.

    Movement
    The capacity to move is an essential element of health and well-being. Movement is dependent upon the integrated, co-ordinated function of the human body at a number of different levels.
    Movement is purposeful and is affected by internal and external factors.
    Physical therapy is directed towards the movement need and potential of the individual

    Individuals
    Individuals have the capacity to change as a results of their responses to physical, psychological, social and environmental factors.
    Body, mind and spirit contribute to individuals' views of themselves and enable them to develop an awareness of their own movement needs and goals.
    Ethical principles require the physical therapist to recognise the autonomy of the patient or legal guardian in seeking his or her services.

    Interaction
    Interaction aims to achieve a mutual understanding between the physical therapist and the patient/client/family or care giver and forms an integral part of physical therapy.
    Interaction is a pre-requisite for a positive change in body awareness and mobement behaviours that may promote health and well-being.
    Interaction often involves partenership within inter-disciplinary teams, in determining the needs and formulating goals for physical therapy intervention and recognises the patient/client/family and care givers as being active participants in this process.

    Professional Autonomy
    Professional education prepares physical therapists to be autonomus practitioners.
    Professional autonomy is possible for individual physical therapists as they practice with patients/clients/family and care givers to reach a diagnosis which will direct their physical therapy interventions.

    Diagnosis
    Diagnosis within physical therapy is the result of a process of clinical reasoning which results in the identification of existing or potential impairments, functional limitations and abilities/disabilities.
    The purpose of the diagnosis is to guide physical therapists in determining the prognosis and identifying the most appropriate intervention strategies for patients/clients and in sharing information with them.
    In carrying out the diagnostic process, physical therapists may need to obtain additional information from other professionals.
    If the diagnostic process reveals findings that are not within the scope of the physical therapist's knowledge, experience or expertise, the physical therapist will refer the patient/client to another appropriate practitioner.

    Principles supporting the description of physical therapy (Torna all'inizio)

    In order to make explicit the underlying values upon which this internetional description of physical therapy is based there follows a list of principles which are recognised as important by WCPT.
    WCPT believes a description must:

    • respect and recognise the history and roots of the profession
    • build on the reality of contemporary practice and the growing body of research
    • allow for variation in: cultures, values and beliefs; health needs of people and societies; and structure of health systems around the world
    • use terminology that is widely understood and adequately defined
    • recognise internationally accepted models and definitions (e.g. World Health Organisation definition of health)
    • provide for the ongoing growth and development of the profession and for the identification of the unique contribution of physical therapy
    • acknowledge the importance of the movement sciences within physical therapy curricula at all levels
    • emphasise the need for practice to be evidence based whenever possible
    • appreciate the inter-dependence of practice, research and education within the profession
    • recognise the need to continuously review the description as the profession changes in response to the health needs of society and the development of knowledge in physical therapy
    • anticipate that work will flow from this description through utilisation of the document to assist in the development of curricula and identification of areas for research









    REFERENCES (Torna all'inizio)

    • American Physical Therapy Association: Guide to Physical Therapist Practice, Physical Therapy 77 November 1997
    • Cott CA, Finch E., Gasner D., Yoshida K., Thomas SG., Verrier MC(1995): The Movement Continuum of Physical Therapy, Physiotherapy Canada 47:87-95
    • Higgs J., Jones M. (eds)(1995): Clinical Reasoning in the Health Professions, Butterworth-Heinemann, Oxford
    • Standing Liaison Committee of Physiotherapists in the European Union: The Practice of Physiotherapy in the European Union, 1996
    • Tornebohm H.(1991): What is worth knowing in Occupational therapy? American Journal of Occupational Therapy, Vol.45 N° 5 p.451-454
    • World Heath Organisation (WHO): International Classification of Impairments, Disabilities and Handicap, 198