PHysical Therapy month; October
Physical therapy as we know it today was not always this streamlined. As several things start due to war so did physical therapy.
Back in World War I (1917), reconstruction aides (“re-aides”) were recognized part of the medical team to “reconstruct” the soldiers. From there physical therapy progressed as prior to WWI, physicians did not complete rehabilitative and preventative procedures as it was hard to define physical therapy with guidelines and standards; therefore, they were unable to conduct research. WWI Army standardized and stabilized the success of re-aides. The women that filled these positions were no longer needed federally, so they brought it to civilian practice. Although, this was not an easy transition — one that has continued to be an uphill battle in the medical field.
On April 16 1947, President Harry S. Truman, posing here with Major (later Col.)
Emma Vogel, far right, and other senior officers, signed Public Law 80-36,
establishing the Women’s Medical Specialist Corps (WMSC) in the U.S. as women dominated this field state-side as well as on the battlefield from 1920s-1930s. Resulting in the formation of the American Women’s Physical Therapy Association. Mary McMillan led the organization as the first president. In the late 1930s, the association became more inclusive to include the enlisted soldiers that provided assistance changing the name to the American Physiotherapy Association. Then, again, the name changed to the American Physical Therapy Association (APTA) in the 1940s.
Late in WWII, the Army recognized a need for trained assistants for the Physical Therapists (PTs) in the clinic. Previously, enlisted soldiers were trained to help in the clinics, but during WWII Were needed in combat roles. Therefore, in 1945, the Army officially approved the first formal program for a new classification “physical therapy technicians” - now called Physical Therapy Assistants (PTAs).
Following WWII, thousands of soldiers were treated for amputations, spinal cord injuries, and other injuries. As a result, some hospitals began to specialize in treating specific populations, allowing for study of effectiveness of patient care, including wound healing, prosthesis fitting, gait analysis, progressive resistance exercise, and constant current stimulation. Severe injuries that would have resulted in immobility during WWI now had a much better prognosis due to the addition of re-aides/PTs to the medical teams.
The military/federal sector is always the driver of change in our healthcare system - for good or bad that’s to be discussed another time. The military has allowed soldiers direct access to PT, meaning no referral from a physician, for neuromusculoskeletal disorders since the 1970s. Direct access on the civilian side did not become legal in all 50 states until 2015.
Now, maybe that drastic of a difference in timelines of direct access doesn’t seem as appalling to you as it does to me. Let’s talk about the progression of education requirements for PTs over the years for a moment.
What started as “re-aides” who provided rehab alongside physicians following combat injuries now is a highly trained and educated medical profession. The progress from aide training to associates, to a Bachelor’s degree was a quick transition. In the 1990s PT became a Master’s degree and by 2016 it became required nationally to complete a Doctorate to practice physical therapy. In addition to a Doctorate in Physical Therapy, in order to practice the PT must also pass a national medical board exam and obtain (and maintain) their license.
In addition to the growth of the PT field an Associates degree was created in the 1960s for PT assistants. PTAs are educated to assist with exercises and treatments during sessions, but are not trained to perform evaluations. Their education is basic and requires a drive to learn more through continuing education and from their supervising PTs. I have worked with some incredible PTAs over the years and hope that this part of our profession can continue to be valued for years to come.
If you’ve read my website you have an understanding of why The Persistence Project is cash-based, but for those of you who have not here is a little soapbox:
Medical insurance has been cutting reimbursement for PT for YEARS. At this point in time they are cutting reimbursement so much for the use of PTAs that these jobs are becoming harder and harder to find for those who are a PTA and it is adding more work onto PTs who are already so busy with patients/clients. This can lead to the offices that you see with 1 PT working with 2-4 patients/clients at a time. This is not sustainable and is why during the pandemic (2021) we lost over 22,000 PTs. In addition, to the decreased reimbursement and constant fight to show our worth as a profession there has been an increase in more severe cases due to the majority of people missing appointments or avoiding offices during the pandemic.
This month is to celebrate several things (as most months/days/weeks are these days), but let’s shine a little more light on Physical Therapy and share with everyone you know about your experience. If it was a bad one…. I suggest finding a new PT - you DO have the choice with direct access. If you’re unsure of how to do this please take a moment and check out choosept.com where some PTs have created profiles that you can choose from.
Physical Therapy has the power to aid you in preventing injuries as much as we can rehabilitate from injuries. Well, actually easier.. if you make the choice to go all in.
You have the choice right now on how you want to feel when you’re in your 70s and 80s (+). Choose mobility and strength 💪🏼
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