The quality of physical therapy is not consistent between clinicians or clinics.
There are numerous reasons causing the differences: the overall rehab process, the management, how the client pays for the service (insurance, Medicare, cash, etc.), the time available between the clinician and patient, the use of assistants, the number of patients per provider during an hour, the clinical skill set, and training of a specific physical therapist. This is far from an exhaustive list.
These issues result in a pervasive underperformance in rehab outcomes for clients.
The 3 major issues in physical therapy and rehab
When starting out on a rehab journey, you will not think about these problems – you just want to feel better.
But these issues matter and directly impact your outcome.
The major issues in physical therapy fall into 3 critical areas: Process, Patient-Provider Relationship, and Clinical Skill. Together, these drive the difference in experience and outcomes for a patient. For example, if one physical therapy clinic does not use assistants, monitors the clinical performance of their providers, and focuses on patient empowerment, while the other down the street accepts insurance while loading clinicians with 2-3 patients an hour with excessive use of physical therapy techs, thinking that the outcomes would be the same is nonsensical. The training and education of the clinician in the second scenario is not useful if there is no time or energy to use it.
As a consumer of physical therapy, you may not realize these issues that directly affect your experience and why a clinic that addresses them will deliver better results over and over again.
Process refers to everything that a healthcare provider and team does from the time you first interact to the end of your care at their facility.
The most surprising fact is that in the majority of healthcare facilities, a unified process does not exist. It is not defined, written out, or followed. The lack of a defined process means that every provider and support staff is a free agent following their own agenda. Errors are allowed to happen over and over. Successes are not systematically incorporated into the process so they can be repeated over and over again.
The process is the basis for a constantly improving system.
The patient-provider relationship is where the patient places their trust in the provider to help them to the best of their ability while providers trust the patient to follow the prescribed plan of care and report how they feel.
This relationship does not happen in a vacuum. There are numerous tools that can help deepen the relationship. There are also numerous clinical and business practices that sabotage it. The most obvious is practitioner overload which can be driven by poor clinical processes, too many patients at once, and poor managerial support.
A good bedside manner does not matter if you only get 15 minutes every few sessions.
Clinical skill is the first thing most of us think about if you are not having a great response in rehab.
We find it to be driven by the two other critical areas. Lack of a process and poor patient-provider relationships mean the clinician never receives actionable feedback. Instead, they operate on medical islands without a referral system, without knowledge of their results, and with minimal to no plan for improving their skills. This leads to the same diagnostic error, the same technique mistakes, and the same home plan that does not help.
Clinical skill development requires a systematic approach to fill in the gaps, otherwise, improvement is not going to happen.
Resolving the major issues in physical therapy and rehab
These issues require a systematic approach to the rehab journey.
- The process must be outlined and constantly reviewed.
- The patient-provider relationship must be honored, instead of cynically used to get more money.
- The clinical skill of each provider is driven by feedback mechanisms and clinical support systems.
As a patient, you can tell you are at a facility without these tools if:
- You have no time with your main provider.
- There is no professional interaction between the rehab staff.
- The physical therapist is unable to explain where you are on your rehab journey.
- You feel that no one understands your actual problem.
- The same issues, like starting the session late, keep happening.
- You feel that your case is passed around to different therapists and you need to explain your problem over and over again.
- You don’t feel like there is any progress in your pain or injury.
- You don’t feel like you building your ability to manage your own problem.