Physical Therapy Axioms: Physical Therapy Maximizing Recovery and Reducing Claims Costs

This article was cowritten by Bill Zachry and Timothy Hui, PT, DPT.

I.  Restoring Function

• Quality physical therapy restores function and mobility, enabling a faster return to work and daily activities.
• Early intervention using physical therapy prevents long-term disability and chronic pain.
• Quality-focused physical therapy with patient engagement results in shorter disability durations, better mobility, and lower claims costs.
• Patients who do not adhere to their physical therapy regimen are more likely to experience delayed recovery and require additional surgeries.
• Quality physical therapy can help some patients avoid surgery by addressing underlying issues and promoting natural healing processes.

II. Personalized Treatment Plans

• Each injured worker requires a personalized physical therapy plan tailored to their injury, medical history, and psychological and physical condition. Usually, the physical therapist and the treating physician agree on the PT plan.
• Standardized physical therapy protocols should be adjusted based on individual progress and response to treatment.

III. Evidence-Based Practice

• Physical therapy should be grounded in evidence-based practices, utilizing treatments and exercises proven effective for specific injuries.
• Regularly updating physical therapy protocols based on the latest research ensures the highest quality of care.

IV. Communication and Collaboration

• Effective communication between the treating doctor, the physical therapist, the claims adjuster, and the injured worker is crucial for successful outcomes.

V.  Optimizing Outcomes

• Early mobilization and activity prevent complications such as muscle atrophy and joint stiffness.
• Patient engagement and education enhance compliance and outcomes.
• Goal-oriented therapy provides motivation and a clear path to recovery.
• An accurate physical description that includes specific weights and frequencies of lifting, pushing, pulling, etc., of the job helps focus the treating doctor and the physical therapist on specific recovery goals.
• Addressing psychological factors, such as fear of re-injury or depression, is crucial in physical therapy.
• While a PT can address fear or barriers to physical progress, relaxation skills, and some basic coping skills, such as balanced thoughts with painful activity, the PT provider should not be tasked with addressing psychological issues such as depression and anxiety.
• Kinesiophobia, or the fear of pain or reinjury, can be a significant barrier to recovery, leading to delayed progress, decreased compliance, and increased risk of chronic pain.
• Acute pain management strategies are essential, including manual therapy, exercises, and modalities.
• It is difficult for PT providers to deal with chronic pain issues.
• Physical touch and manual therapy techniques used by the physical therapist can profoundly impact patients psychologically. They promote feelings of comfort, trust, and relaxation, which can enhance the healing process and improve treatment outcomes. While true, manual therapy is not appropriate in all cases, and this should be decided by the PT.
• Manual therapy can make patients reliant on therapists.  For certain diagnoses, treatment should be more focused on education and exercise.
• Good PT providers help promote feelings of comfort, trust, and relaxation with active listening and education.

VI. Physical Therapy Challenges

Access Barriers

• Remote or rural locations may need more access to physical therapy services, making it easier for workers to receive care.
• Lack of transportation or mobility issues can prevent workers from accessing physical therapy services.
• Language differences between the worker and physical therapist can create communication challenges, hindering effective care.
• Uncertainty about reimbursement for travel costs can deter workers from participating in their physical therapy program.
• Networks that pay the PT providers below the fee schedule do not always have access to the best providers.

Authorization and Scheduling Delays

• Payer approvals can be slow, causing delays in treatment and potentially leading to worsening conditions.
• Gaps between authorized physical therapy sessions can delay or even prevent complete recovery.
• Conflicting work schedules can make it challenging for workers to attend physical therapy sessions, especially if they have non-traditional work hours.
• Arbitrary Visit Limits: California’s workers’ compensation system limits physical therapy visits to 15, which may be insufficient for complex injuries like shoulder surgery, leading to premature discharge and potential re-injury.
• The requirement for evidence to justify additional physical therapy visits beyond the initial 15 can cause delays in authorization, impede physical therapy continuity of care, and hinder recovery.
• Low-cost DME required for a home exercise program is denied or not authorized in a timely manner.

Psychological and Educational Barriers

• Fear of being labeled as “injured” or “weak” can prevent workers from seeking physical therapy, especially in industries with cultural norms around “toughness.”
• Inadequate understanding of the importance and benefits of physical therapy can lead to delayed or foregone care.
• Addressing Kinesiophobia through education, reassurance, and gradual exposure to pain-free movements can help overcome this barrier.
• Psychological barriers of depression, anxiety, inability to cope with flares, hypervigilance, inability to pace, etc. can prevent PT gains and lead to poor outcomes.

Adherence and Outcome

• Injured workers who do not adhere to their physical therapy regimen are more likely to experience delayed recovery and require additional surgeries.
• Measuring success through functional outcomes, patient satisfaction, and cost-effectiveness ensures physical therapy recovery and reduced claims costs.
• Achieving full recovery can reduce claims costs by minimizing the need for ongoing medical treatment, reducing permanent impairment ratings, and facilitating a faster return to work.
• Some workers do not fully engage in their rehabilitation because it will reduce their financial recovery for the claim. This highlights the need for careful monitoring and encouragement to ensure diligent adherence to their treatment plan.
• Even if patients are not referred to a physical therapist, they must adhere to their home exercise program as their doctor prescribes. This plays a significant role in preventing delayed recovery, promoting physical therapy healing, and reducing the need for additional medical interventions.

VII. Ethical Considerations

• Informed consent, privacy, ethical treatment practices, and cultural competence are essential in physical therapy.