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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| Sara Guzman, MPT |
“I definitely see O&P practitioners as partners, not competitors,” says Sara Guzman, MPT, program coordinator for physical therapy, Rehabilitation Unit, Southside Hospital, Bay Shore, New York. “I don’t feel physical therapists are encroaching on O&P’s scope of practice, but I think we’re getting frustrated with practitioners who produce poor-quality work or have long turnover times.
“We are under tremendous pressure from insurance companies to get people out of the hospital,” she continues, adding that physical therapists no longer have two or three weeks to assess patients as they used to. “We all have a responsibility to educate each other for the good of patient care that is getting harder for all of us to render as time goes on.”
Guzman discusses patients’ diagnoses, problems, the goals
involved with using a prosthesis or orthosis, and the prognosis and
expected functional levels with the prosthetist or orthotist before
they see the patient together. They both then meet with the patient
and discuss what would work best for that patient.
Noting that physical therapists have a large influence on which
O&P practices patients are referred to, Guzman says, “What I
want from a company is competent practitioners, good response and
turnover time, and respect for my knowledge of my patients and my
patients’ needs.”
Prosthetic Care: Not an Issue
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| Robert Gailey, PhD, PT |
With almost two decades of experience working with prosthetists all over the country, both receiving and providing referrals, Robert Gailey, PhD, PT, University of Miami School of Medicine, Department of Orthopaedics, Division of Physical Therapy, says, “I have never heard of a physical therapist attempting to fabricate prostheses at any level. Physical therapists have little or no opportunities for prosthetic education or experience, and therefore prosthetists do not need to worry about encroachment. The only physical therapists I know that have an interest in prosthetic fabrication have successfully completed a certificate program in prosthetics.” Consequently, prosthetists should be looking to create a positive working relationship with physical therapists, he points out. “Amputees are looking for comprehensive care. Having a prosthetist and a physical therapist who share a common interest in their rehabilitation is not only good rehabilitative practice, but is also an excellent way to build a referral base.”
Orthotic Care: More PT Involvement
However, orthotic care is different, primarily because of the
physical therapists’ access to fabrication, Gailey says. He divides
orthotics into three general categories.
The first category comprises custom
high-temperature plastics and durable materials such as metals and
carbon fibers. “Few, if any, physical therapists have
the education, equipment, or space to justify the fabrication of
these types of custom orthotics,” he notes.
The second category covers low-temperature
plastics and centrally fabricated orthoses, including
low-temperature hand and upper-limb orthoses and custom foot or
shoe inserts that require castings or foam impressions. “Most of
these orthotics are fabricated by physical therapists that
specialize in a particular area of rehabilitation and offer the
fabrication of these orthotics as a service rather than as a means
of generating additional income,” Gailey explains, adding, “The
time for fabrication, ordering, and fitting often yields less
revenue than would be received with traditional therapeutic
treatments. In the majority of instances, therapists have taken
additional continuing education and have become skilled in the
ability to furnish a limited selection of orthotic appliances.”
The third category comprises prefabricated,
off-the-shelf orthoses. This type of product is commonly provided
for convenience or because of economic considerations. However,
physical therapists are not the only practitioners who have adopted
this means of providing orthotic devices, Gailey points
out. “Today, orthotics manufacturers and sales people are
constantly trying to find new distribution sources, including
physical therapists.”
Do therapists fabricate some specialized orthotics? “Sure they do,” Gailey says, adding, “And many of them are extremely skilled, with the anatomical and biomechanical knowledge necessary to provide excellent care.” Access to a certified orthotist is difficult in many parts of the country, he points out. “Thus physical therapists are placed in a situation where they must use prefabricated or centrally fabricatedorthotics.”
Are therapists interested in encroaching on prosthetics and orthotics? “I don’t believe so,” Gailey says. “Physical therapists have little interest in custom high-temperature orthoses or in working with metals and difficult materials such as carbon fiber. The orthotic devices that most physical therapists fabricate can be time-consuming and provide reimbursement. The majority of custom orthotics and complicated cases are – and probably will continue to be – fabricated by certified orthotists.”
An effective strategy would be to educate physical therapists
about the services that orthotists provide and how there can be
improved patient care and more profit for both disciplines if
practitioners focus on their own area of expertise and set up a
complementary referral system, Gailey says.
“My personal belief is that prosthetics and orthotics should be
fabricated by prosthetists and orthotists and therapy should be
performed by physical therapists, unless the therapist has the appropriate skills or
is filling a void in services,” he stresses. “I have spent my
career trying to define the line between the two professions while
promoting and demonstrating how we can prosper together.
“I personally do not adjust prosthetics or fabricate orthotics,”
he continues. “I believe that if I did, patients would become
confused as to what my responsibility on the rehabilitation team
is. I have given lectures around the world on how the two
disciplines can create a complementary scenario by providing
services that offer patients the best possible outcome.”
Gailey firmly concludes, “We need to be allies – not
adversaries.”
