For Physicians

Fall Prevention

Community-dwelling patients that may benefit from physical therapy intervention to prevent injurious falls include:

• Those over 80 years of age
• Those aged 65-97 with a history of a previous fall

In a meta-analysis including three well-designed randomized controlled trials, the effect of an exercise program consisting of muscle strengthening and balance retraining exercise showed reductions in fall related injury. The exercise program was delivered by or overseen by a physical therapist.

Benefits of Physical Therapy Treatment

A muscle strengthening and balance retraining program delivered by a physical therapist may result in:

• A reduction in fall-related injury in those greater than 80 years of age
• Reduction in injurious falls in those with a history of a previous fall
• A 35% overall reduction in falls and fall related injuries in community-dwelling older persons

References

Shoulder Dysfunction and Pain

The patient with shoulder dysfunction and pain may present with:

• Physical examination revealing dysfunction of the shoulder
• Acute (2-4 wks) symptoms
• Decreased function of the shoulder

In a randomized controlled trial published in the Annals of Internal Medicine, those fitting these criteria may benefit from the addition of physical therapy to primary care management.

Benefits of Physical Therapy

The addition of physical therapy to primary care management may result in:

• Significant improvements in shoulder disability at a follow up of 6 months.
• Significantly more patients reporting they feel cured at 1 year.
• Significantly less severe reports of pain at 6 months and 1 year.

References

Lumbar/Cervical Pain and Dysfunction

Patients who may benefit from physical therapy intervention include those:

• In which neck or back pain and stiffness has lasted greater than two weeks
• Symptoms are reproducible during physical examination

Benefits of Physical Therapy

Strong (level 1a) evidence has demonstrated patients fitting the criteria above may benefit from a combination of manual physical therapy and exercise. The benefits of these interventions may include:

• Significant improvements in function and pain reduction
• Decreased absences from work and improvement in disability
• When compared to those receiving primary care alone, nearly twice as many patients reported much improved or a resolution of pain

References

Knee Osteoarthritis

The patient with Knee OA may present clinically with:

• Knee pain
• Bony tenderness
• Crepitus
• Bony enlargement and morning stiffness < 30 minutes.

As part of Altman’s clinical criteria for identifying individuals with Knee OA, these signs and symptoms can be both sensitive (84%) and specific (89%). Those patients fitting this criteria may also do well with physical therapy intervention.

Benefits of Manual Physical Therapy and Exercise

Physical therapy for Knee OA has been shown to result in statistically significant improvements in:

• Function
• Pain
• Stiffness
• Distance walked

Physical therapy treatment has also been shown to reduce the need for knee replacement. In a randomized controlled trial (level I evidence) by Deyle et al., 5% of those receiving physical therapy treatment underwent knee replacement at 1 year compared to 20% in a placebo treatment group.

References