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Acute Care Physical Therapist Practice: It's Come a Long Way

Rebecca L. Craik

“Should Physical Therapists Practice in Acute Care Settings?” That was the 2007 topic for the Rothstein Debate, an annual event held at APTA's conference and exhibition and established to honor PTJ's esteemed Emeritus Editor in Chief Jules M. Rothstein (1945–2005).

Dianne Jewell, PT, PhD, FAPTA, was moderator. Anthony Delitto, PT, PhD, FAPTA, and Charles Magistro, PT, FAPTA, argued for and against the need for physical therapists in the acute care setting. On one side, the physical therapist was characterized as a sophisticated decision maker with a breadth of knowledge that spanned medicine and physiology; on the other side, the physical therapist was characterized as just another clinical staffer who “dragged” patients down the hall.

The session was filled to capacity with approximately 300 people; the tension was palpable, the debaters articulate—but tempers were kept in check. The debate was declared a draw. I still recall my surprise that day at learning about the paucity of research on acute care practice:

  • The clinical decision-making process touted as complex by the “pro” team had not been described in the literature.

  • Responsive outcome measures had not been agreed upon.

  • Clinical trials had not been conducted to compare different interventions in that setting.

  • Cost-effectiveness had not been examined.

In the 5 years since that debate, PTJ has published 8 articles related to acute care, along with 2 related podcasts. For example:

  • Gorman et al1 performed a practice analysis across the United States, describing knowledge, skills, and behaviors that reflect acute care practice.

  • In a qualitative study, Masley et al2 described clinical reasoning processes used by physical therapists for care delivery in the acute care setting.

  • In a population-based study, Freburger et al3 described demographic and diagnostic characteristics of patients discharged from 128 acute care hospitals in North Carolina who were treated by physical therapists; of the 2 million people treated, only 22.5% were seen by physical therapists.

APTA's Acute Care Section is now working on a petition to the American Board of Physical Therapy Specialties for acute care specialization.

We have come a long way in 5 years—and it is my opinion that the 2007 Rothstein Debate helped to stimulate these developments. Now, PTJ's 2-part special series on rehabilitation in the critical care setting takes a quantum leap, moving the discussion beyond one practice setting to the entire health care continuum.

I especially encourage you to read the Perspective by Harabin and Kiley,4 who provide an overview of critical care research opportunities at the National Heart, Lung, and Blood Institute at the National Institutes of Health. I am certain that there are similar opportunities for research funding related to critical care around the world.

The post–intensive care syndrome described in PTJ's critical care series underscores the need for rehabilitation beyond the acute care hospital “silo” and the need to coordinate and integrate care across the health care continuum. Many people who survive a critical illness have residual functional limitations and thus require physical therapist consultation and management in many settings. Physical therapists in just about any setting—ICU, hospital, subacute rehabilitation, inpatient rehabilitation, skilled nursing, home care, outpatient—are likely to see survivors of critical illness because the prevalence of functional limitations is so high.

The special series co-editor team of Patricia Ohtake, Dale Strasser, and Dale Needham has done a spectacular job of soliciting manuscripts, overseeing the review process, and keeping everyone on task. Thanks to their hard work and the dedication of the authors and reviewers, this series demonstrates the important role that physical therapy plays in our changing health care system.

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