Information for Other Health Care Providers
Do you have questions or need information for your patients/clients regarding acute care physical therapy services? The Acute Care Section is happy to provide information created specifically for other health care providers such as physicians, physician assistants, nurse practitioners and other nurses, and other allied health professionals specific to acute care physical therapy.
If you are a patient or family member of a patient, please visit our Consumer Page for more information.
When should I consider a physical therapy referral?
Acute care physical therapists, and physical therapist assistants, will work with you, your patient, and the entire healthcare team to maximize their function, improve their strength and endurance, and prevent many complications of prolonged bedrest and immobility. Please consider a physical therapy referral if any of the following are present in your patient:
- Prolonged bedrest or immobilization, or anticipation of prolonged bedrest or immobilization.
- Changes from pre-admission levels or over the last 3-6 months in activities of daily living, ambulation ability, balance, or strength.
- Advocacy for discharge needs, including family/caregiver training.
- New need for assistive devices such as a brace, orthotics, cane, crutches, or a walker, including appropriate sizing and training in safe use.
- Discharge planning recommendations that may include the anticipated need for rehabilitation, durable medical equipment, or home care services.
A referral for physical therapy may need to be accompanied by a medical diagnosis (in some states). Upon your referral, a physical therapist will examine your patient and evaluate the need for continued physical therapy, including the development of a physical therapy plan of care.
Current Research Supporting Acute Care Physical Therapy
Exciting research supporting acute care physical therapy has been published in the last year. One study by Smith et al1 explored the role of physical therapist recommendations on discharge planning, and the effect of following those recommendations on hospital readmission rates in 762 patients in a large academic medical center.
"Overall, physical therapists' discharge recommendations were implemented 83% of the time. Patients were 2.9 times more likely to be readmitted when the therapist's discharge recommendation was not implemented and recommended follow-up services were lacking (mismatch with services lacking) compared with patients with a match."
"This study supports the role of physical therapists in discharge planning in the acute care setting. Physical therapists demonstrated the ability to make accurate and appropriate discharge recommendations for patients who are acutely ill."
Another study by Hu et al2 found that early and intensive rehabilitation, including physical therapy, benefited patients with severe stroke and improved outcomes such as walking.
"Rehabilitation commencement time and intensity, after adjusting for admission functional status and severity of stroke, remained to be important predictors of stroke functional outcomes. This study supported the recommendation to commence rehabilitation early and intensively and provided evidence that this claim can be extended to acute stroke patients admitted to an ICU."
In persons with acute respiratory failure, physical therapist led exercise improved function, reduced sedation, decreased length of stay in the ICU, and decreased overall length of stay in the hospital, per a study out of John Hopkins by Needham et al.3
"Compared with before the quality improvement project, benzodiazepine use decreased markedly, with lower median daily sedative doses. Patients had improved sedation and delirium status. There were a greater median number of rehabilitation treatment per patient with a higher level of functional mobility. Hospital administrative data demonstrated that across all MICU patients, there was a decrease in intensive care unit and hospital length of stay by 2.1 and 3.1 days, respectively."
1. Smith BA, Fields CJ, Fernandez N. Physical therapists make accurate and appropriate discharge recommendations for patients who are acutely ill. Phys Ther. 2010;90(5):693-703. Epub 2010 Mar 18.
2. Hu MH, Hsu SS, Yip PK, Jeng JS, Wang YH. Early and intensive rehabilitation predicts good functional outcomes in patients admitted to the stroke intensive care unit. Disabil Rehabil. 2010;32(15):1251-1259.
3. Needham DM, Korupolu R, Zanni JM, Pradhan P, Colantuoni E, Palmer JB, Brower RG, Fan E. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536-542.
More Information for Healthcare Providers
The Acute Care Section and our members want to consult with you on your patient's care. The earlier an acute care physical therapist is consulted, the less deconditioning may occur in patients, the sooner appropriate discharge recommendations can be made, and the more rehabilitation your patient and their family can experience.
Or visit Move Forward PT for more information about how physical therapy can augment your patient/client health care team.