Indications for Physical Therapy
Physical therapy is indicated for patients with deconditioning, impaired airway clearance, atelectasis, muscle weakness, joint stiffness, and communication difficulties, as these are evidence-based targets for physiotherapy intervention. 1
Primary Indications by Body System
Musculoskeletal Conditions
- Deconditioning and physical deconditioning 1
- Muscle weakness and joint stiffness 1
- Nerve and muscle involvement in systemic diseases like Polyarteritis Nodosa 1
- Hand and wrist involvement requiring hand therapy exercises 1
- Foot and ankle involvement requiring bracing, orthoses, or taping 1
- Rehabilitation following musculoskeletal injuries 2
- Management of chronic pain conditions 1
Neurological Conditions
- Post-stroke rehabilitation to improve mobility and functional independence 1
- Vestibular rehabilitation for balance and dizziness disorders 1
- Oculomotor vision treatment for visual-motor deficits 1
- Management of persistent post-concussion symptoms 1
Respiratory Conditions
- Impaired airway clearance 1
- Atelectasis prevention and treatment 1
- Respiratory muscle strengthening 1
- Pulmonary rehabilitation for chronic respiratory diseases 1
Oncology-Related Indications
- Symptom management throughout cancer treatment and survivorship 1
- Management of treatment-related side effects 1
- Rehabilitation for patients with brain tumors at all stages of disease 1
- Lymphedema management following lymphadenectomy 1
Rheumatological Conditions
- Rheumatoid arthritis with hand involvement 1
- Juvenile idiopathic arthritis with polyarthritis 1
- Management of hypermobility spectrum disorders 3
Timing of Physical Therapy Intervention
Acute Phase
- Early mobilization post-stroke 1
- Post-surgical rehabilitation 1
- Acute pain management 1
- Emergency department intervention for non-life-threatening musculoskeletal conditions 4
Chronic Phase
- Long-term management of chronic conditions 1
- Maintenance of function in progressive diseases 1
- Prevention of secondary complications 1
Specific Therapeutic Approaches
Exercise-Based Interventions
- Aerobic exercise for patients with rheumatoid arthritis 1
- Aquatic exercise for patients with joint pain or mobility limitations 1
- Resistance exercise for strength building 1
- Mind-body exercises (yoga, Tai Chi, qigong) 1
Manual Therapy
- Mobilization and manipulation for neck and back pain 1
- Manual treatment for cervical and thoracic spine dysfunction 1
Specialized Techniques
- Vestibular rehabilitation for balance disorders 1
- Hand therapy for patients with hand involvement 1
- Gait training and balance exercises 1
Prescription Guidelines
A proper physical therapy prescription should include 2:
- Specific diagnosis
- Type, frequency, and duration of therapy
- Clear goals of therapy
- Safety precautions
Effectiveness Considerations
The effectiveness of physical therapy interventions may depend on:
- Symptom duration (patients with symptoms <1 month show greater functional improvement than those with symptoms >6 months) 5
- Age of the patient 5
- Type of exercises included in the program (strengthening, flexibility, and mobilization/manipulation exercises contribute significantly to functional improvement) 5
Special Populations
Elderly Patients
- Focus on improving balance and functionality 1
- Weight-bearing aerobic activities four days per week 1
- Progressive resistance training two to three days per week 1
Patients with Diabetes
- Medical evaluation before beginning an exercise program 1
- Monitoring for hypoglycemia, especially in patients taking insulin 1
- Consideration of peripheral neuropathy when prescribing weight-bearing exercises 1
Children with Cancer
- Tailored rehabilitation programs based on cancer type and treatment phase 1
- Consideration of academic accommodations and pain management strategies 1
Physical therapy should be initiated early in the disease course when appropriate, as early intervention may lead to better outcomes and prevent secondary complications. The specific approach should be determined based on the patient's condition, functional limitations, and treatment goals.