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Acute Care Physical Therapist Practice: It's Come a Long Way

Rebecca L. Craik
DOI: 10.2522/ptj.2012.92.12.1482 Published 1 December 2012
Rebecca L. Craik
R.L. Craik, PT, PhD, FAPTA, is Editor in Chief of PTJ and Professor and Chair, Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania.
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“Should Physical Therapists Practice in Acute Care Settings?” That was the 2007 topic for the Rothstein Debate, an annual event held at APTA's conference and exhibition and established to honor PTJ's esteemed Emeritus Editor in Chief Jules M. Rothstein (1945–2005).

Dianne Jewell, PT, PhD, FAPTA, was moderator. Anthony Delitto, PT, PhD, FAPTA, and Charles Magistro, PT, FAPTA, argued for and against the need for physical therapists in the acute care setting. On one side, the physical therapist was characterized as a sophisticated decision maker with a breadth of knowledge that spanned medicine and physiology; on the other side, the physical therapist was characterized as just another clinical staffer who “dragged” patients down the hall.

The session was filled to capacity with approximately 300 people; the tension was palpable, the debaters articulate—but tempers were kept in check. The debate was declared a draw. I still recall my surprise that day at learning about the paucity of research on acute care practice:

  • The clinical decision-making process touted as complex by the “pro” team had not been described in the literature.

  • Responsive outcome measures had not been agreed upon.

  • Clinical trials had not been conducted to compare different interventions in that setting.

  • Cost-effectiveness had not been examined.

In the 5 years since that debate, PTJ has published 8 articles related to acute care, along with 2 related podcasts. For example:

  • Gorman et al1 performed a practice analysis across the United States, describing knowledge, skills, and behaviors that reflect acute care practice.

  • In a qualitative study, Masley et al2 described clinical reasoning processes used by physical therapists for care delivery in the acute care setting.

  • In a population-based study, Freburger et al3 described demographic and diagnostic characteristics of patients discharged from 128 acute care hospitals in North Carolina who were treated by physical therapists; of the 2 million people treated, only 22.5% were seen by physical therapists.

APTA's Acute Care Section is now working on a petition to the American Board of Physical Therapy Specialties for acute care specialization.

We have come a long way in 5 years—and it is my opinion that the 2007 Rothstein Debate helped to stimulate these developments. Now, PTJ's 2-part special series on rehabilitation in the critical care setting takes a quantum leap, moving the discussion beyond one practice setting to the entire health care continuum.

I especially encourage you to read the Perspective by Harabin and Kiley,4 who provide an overview of critical care research opportunities at the National Heart, Lung, and Blood Institute at the National Institutes of Health. I am certain that there are similar opportunities for research funding related to critical care around the world.

The post–intensive care syndrome described in PTJ's critical care series underscores the need for rehabilitation beyond the acute care hospital “silo” and the need to coordinate and integrate care across the health care continuum. Many people who survive a critical illness have residual functional limitations and thus require physical therapist consultation and management in many settings. Physical therapists in just about any setting—ICU, hospital, subacute rehabilitation, inpatient rehabilitation, skilled nursing, home care, outpatient—are likely to see survivors of critical illness because the prevalence of functional limitations is so high.

The special series co-editor team of Patricia Ohtake, Dale Strasser, and Dale Needham has done a spectacular job of soliciting manuscripts, overseeing the review process, and keeping everyone on task. Thanks to their hard work and the dedication of the authors and reviewers, this series demonstrates the important role that physical therapy plays in our changing health care system.

Footnotes

  • Craikcast: Editor in Chief Rebecca Craik interviews Special Series Co-Editor Patricia Ohtake. Available at http://ptjournal.apta.org/content/92/12/suppl/DC1.

  • © 2012 American Physical Therapy Association

References

  1. ↵
    1. Gorman SL,
    2. Wruble Hakim E,
    3. Johnson W,
    4. et al
    . Nationwide acute care physical therapist practice analysis identifies knowledge, skills, and behaviors that reflect acute care practice. Phys Ther. 2010;90:1453–1467.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Masley PM,
    2. Havrilko C-L,
    3. Mahnensmith MR,
    4. et al
    . Physical therapist practice in the acute care setting: a qualitative study. Phys Ther. 2011;91:906–919.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Freburger JK,
    2. Heatwole Shank K,
    3. Knauer SR,
    4. Montmeny RM
    . Delivery of physical therapy in the acute care setting: a population-based study. Phys Ther. 2012;92:251–265.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Harabin AL,
    2. Kiley JP
    . How the National Heart, Lung, and Blood Institute (NHLBI) develops research priorities and supports critical care research. Phys Ther. 2012;92:1489–1493.
    OpenUrlAbstract/FREE Full Text
View Abstract
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Vol 92 Issue 12 Table of Contents
Physical Therapy: 92 (12)

Issue highlights

  • How the National Heart, Lung, and Blood Institute (NHLBI) Develops Research Priorities and Supports Critical Care Research
  • Intensive Care Unit–Acquired Weakness
  • Quantifying Physical Activity Levels of Survivors of Intensive Care
  • Activity on the Ward After the Intensive Care Unit
  • An Exercise Prescription Approach to Rehabilitation for Survivors of Critical Illness
  • Clinical Utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital
  • Predictors of Mortality and Length of Stay in a Surgical Intensive Care Unit
  • Repeatability of the Six-Minute Walk Test and Relation to Physical Function in Critical Illness
  • Neuromuscular Electrical Stimulation for Intensive Care Unit–Acquired Weakness Phase II Randomized Trial
  • The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial
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Acute Care Physical Therapist Practice: It's Come a Long Way
Rebecca L. Craik
Physical Therapy Dec 2012, 92 (12) 1482-1483; DOI: 10.2522/ptj.2012.92.12.1482

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Acute Care Physical Therapist Practice: It's Come a Long Way
Rebecca L. Craik
Physical Therapy Dec 2012, 92 (12) 1482-1483; DOI: 10.2522/ptj.2012.92.12.1482
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Subjects

  • Acute Care

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