Editorial, J Physiother Rehabil Vol: 5 Issue: 11
Health Policy Implications for Physical Therapy
Department of Agricultural and Food Economics, National Research University, Warsaw, Poland
*Corresponding author: Mariola Kwasek, Department of Agricultural and Food Economics, National Research University, Warsaw, Poland, E-mail: Richard_Strange @yahoo.com
Received date: 02 November, 2021; Accepted date: 23 November, 2021; Published date: 30 November, 2021
The Canadian Physiotherapy Association offers a curriculum of continuing education courses in orthopedics and manual therapy. The program consists of 5 levels (7 courses) of training with ongoing mentorship and evaluation at each level. The orthopedic curriculum and examinations take a minimum of 4 years to complete. However, upon completion of level 2, physiotherapists can apply to a unique 1- year course-based Master's program in advanced orthopedics and
manipulation at the University of Western Ontario to complete theirtraining. This program accepts only 16 physiotherapists annually since2007. Successful completion of either of these education streams and their respective examinations allows physiotherapists the opportunity to apply to the Canadian Academy of Manipulative Physiotherapy (CAMPT) for fellowship. Fellows of the Canadian Academy of manipulative Physiotherapists (FCAMPT) are considered leaders in the field, having extensive post-graduate education in orthopedics and manual therapy. FCAMPT is an internationally recognized credential, as CAMPT is a member of the International Federation of Manipulative Physiotherapists (IFOMPT), a branch of the World Confederation of Physical Therapy (WCPT) and the World Health Organization (WHO).
Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.
In contrast, the Veterans Administration is relatively active in using telemedicine for people with disabilities. There are several programs that provide annual physical exams or monitoring and consultation for veterans with spinal cord injuries. Similarly, some state Medicaid programs (for poor people and people with disabilities) have pilot programs using telecommunications to connect rural practitioners with subspecialty therapists. A few school districts in Oklahoma and Hawaii offer school-based rehabilitation therapy using therapy assistants who are directed by a remote therapist. The National Rehabilitation Hospital in Washington DC and Sister Kenny Rehabilitation Institute in Minneapolis provided assessment and evaluations to patients living in Guam and American Samoa. Cases included post-stroke, post-polio, autism, and wheel-chair fitting. In 2001, O. Bracy, a neuropsychologist, introduced the first web based, rich internet application, for the telerehabilitation presentation of cognitive rehabilitation therapy. This system first provides the subscriber clinician with an economical means of treating their own patients over the internet. Secondly, the system then provides, directly to the patient, the therapy prescription set up and controlled by the member clinician. All applications and response data are transported via the internet in real time. The patient can login to do their therapy from home, the library or anywhere they have access to an internet computer. In 2006, this system formed the basis of a new system designed as a cognitive skills enhancement program for school children. Individual children or whole classrooms can participate in this program over the internet. Although obvious limitations exist, telerehabilitation applications for the assessment of swallowing function have also been used with success. Lalor, Brown and Cranfield (2000) were able to obtain an initial assessment of the nature and extent of swallowing dysfunction in an adult via a videoconferencing link although a more complete evaluation was restricted due to the inability to physically determine the degree of laryngeal movement. A more sophisticated telerehabilitation application for the assessment of swallowing was developed by Perlman and Witthawaskul (2002) who described the use of real-time videofluoroscopic examination via the Internet. This system enabled the capture and display of images in real-time with only a three to five second delay. There has been considerable research into the assessment and treatment of dysphagia via telerehabilitation, including cost analyses, leading to the establishment of sustainable telerehabilitation services. Motor training exercises are the most commonly implemented modality. In motor training exercises, a provider guides a patient through performing different motions and activities in order to regain strength and function. Motor training through telerehabilitation has consistently been shown to produce equivalent functional outcomes compared with in-person therapy. However, many patients require inperson therapy initially before transitioning to telerehabilitation. Goal setting has been used in remote areas where cost and provider availability prohibit access to physical therapy. Patients work with a therapist to set personal goals and track their progress through sessions. Goal setting telerehabilitation has been shown to produce increased patient satisfaction and improvement in activities of daily living compared with a control group receiving no therapy. Virtual reality therapy involves the use of a sensor to detect movement and a virtual environment displayed on either a screen or headset. Patients perform therapeutic movements that correspond to tasks within the virtual environment. This provides an immersive environment for the patient and allows computerized monitoring of patient progress. Studies that compared virtual reality with motor training exercises have shown equal or better outcomes with virtual reality. Robotic therapy typically involves the use of hand and foot strengthening robots which provide resistance training and assist the patient with performing movements. Robotic devices can also obtain precise data on patient movements and usage statistics and transmit them to providers for evaluation. Robotic therapy has even been combined with virtual reality telerehabilitation to create a virtual environment which responds to robotic movements. Robotic telerehabilitation studies have shown patient improvement from baseline but equivalent functional outcomes compared with motor training exercises. Community therapy is used to deliver education and therapy to patients remotely, either through group exercise sessions or through kiosks. Community therapy tends to have lower patient compliance than individualized therapy, but can deliver similar results if appropriately utilized.