Three Pillars of Physical Therapy

The American Physical Therapy Association advocates for three pillars in true evidence based practice. These three pillars include – available evidence, clinical knowledge, and patient preferences.

1. Best Available Evidence – The Physical Therapy profession has exploded with research in the past 16 years since I’ve been practicing. The good news is that there is more information available to validate the treatments we offer as PT’s. However, each therapist needs to be skilled in evaluating the evidence to truly decide if this new evidence should be implemented into their practice. For example, I remember being on the elliptical at the gym one day when I was reading a journal article about use of the Epley maneuver to treat BPPV (dizziness). I almost fell off said elliptical when I read the Epley maneuver had proved ineffective for the 22 patients in the study. WHAT?!? I have effectively treated patients for 16 years with the Epley maneuver! I was forced to do some soul searching as to what the best treatment options were for my patients with dizziness which leads to pillar #2.

2. Clinical Knowledge – In the Physical Therapy profession, experience counts a great deal. It’s like a car mechanic with years of experience who can diagnose what is going on with my car just by the sounds I make over the phone! When you have “been there and done that” you have a wealth of experience with similar conditions to decide what the problem is with each patient and if your treatment plan is working. Newer clinicians often operate under a mentor who they can discuss cases with and decide on the best treatment options for each patient.

3. Patient Preference – Each patient comes into the clinic with their own life experiences and values. They may have received Physical Therapy services before and have clear expectations of what works for them (or doesn’t work for them!). I once had a patient who wrote a letter to my boss because I was unable to perform ultrasound on her because my clinic did not have an ultrasound machine. She was frustrated when I tried to refer her to a clinic (without charging her for the evaluation) that would be better suited to meet her needs. Instead, my bosses sent me the one ultrasound machine in the company and I used it on her until she realized that it was not improving her treatment. Then the ultrasound machine went back into storage! Patient preference includes knowing what each patient’s goals for treatment are and this should be discussed at the initial evaluation. There is actually some research to support this as I wrote my PhD dissertation on goal setting with patients at the initial evaluation.

These three pillars are at the core of Physical Therapy for everyBODY. I am dedicated to keeping up on current research to improve each patient’s capacity to return to their desired activity level.