The Art and Science of Physical Therapy
When I was applying for a scholarship in the Graduate program in Physical Therapy at Regis University, applicants were asked to expound upon the idea that Physical Therapy was both an Art as well as a Science. As part of the medical profession, the practice of Physical Therapy has a strong scientific background. We rely upon what we know to be true through reading deeply in the body of knowledge of musculoskeletal and physical medicine that has been discovered, accumulated over generations and proven through the years. We keep up with the latest research and evidence in the field, reading scientific journals and papers. And in our practices, we use the scientific method when treating patients and assessing how effective treatments are in addressing our patients’ needs.
Over the past two decades or more, pressure has been placed on practitioners in all medical disciplines to provide evidence for the treatments that are being provided. This well-meaning directive appears to be in the best interest of moving the field forward, providing patients with treatments that are supported by science, and in providing the best care while limiting medical costs. Insurance companies began to demand that evidence supporting treatment interventions was provided before they would agree to hold up their end of the bargain and pay for the treatments that the medical provider deemed most beneficial to the patient’s well-being. In practice, this limited practitioners to only those treatments that have been studied and proven through research to have a significant effect upon a patient’s condition. In essence, by demanding proof, our system of insuring that people get medical care when they need it, was going to pay only for the well-researched and documented treatments, effectively leaving out and denying any medical care that had not been investigated sufficiently.
This approach has put medical treatment in a box, allowing providers to use only a portion of the tools that they have available to them. There are many effective treatments that just haven’t been proven by research yet. The emphasis on science, while well-meaning, has limited doctors and therapists, beholden to insurance companies for payment, to treating only the one body part for which a diagnosis has been given, without considering how other body parts can affect the portion of the anatomy that has been diagnosed as a problem. We have been led to ignore the inter-relationships within the body and to avoid treatment of the person as a whole being.
When the practice of evidence-based therapy becomes an over-disciplined approach, applying only treatments that research deems valuable, it leaves out the third tool of scientific practice, the application of the scientific method in the clinic. It limits our thinking to what is inside the box. When we identify a problem, come up with a theory about what is causing that problem, apply an intervention and realize a positive effect, regardless of whether that theoretical solution has been supported by peer-reviewed scientific literature or not, we are using the scientific method. Only when the solution is seen to be successful repeatedly do we ascribe a cause and effect relationship.
Unfortunately, the emphasis on Science has left the Art of Physical Therapy out in the cold to whither away, unnourished by the rich but tightly monitored payment system. One might say that the Art of Physical Therapy comes in looking both inside and outside of the box of what is known, considering what is possible and applying scientific knowledge and methods to arrive at a novel solution that can be determined to be a reliable treatment. Cases that don’t appear to be responding to treatment, or that don’t appear to have a cause that can be explained by the best technological or clinical tests, measures or imaging require thinking outside the box. Tough cases can require an artful application of the principles of science. If Physical Therapy is to remain a strong and balanced approach, it needs art every bit as much as it needs science.
#Physical Therapy#physiotherapy#evidence based practice#Regis University#Health Care#Art and Science of Physical Therapy
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