What is physiotherapy?

What is Physiotherapy?

Physiotherapy is a healthcare profession that focuses on assessing, treating, and preventing physical dysfunction at a physiological and functional level through specialized interventions aimed at improving mobility, function, and quality of life. 1

Core Components of Physiotherapy

Assessment and Monitoring

• Physiotherapy assessment focuses on identifying deficiencies at physiological and functional levels rather than being primarily driven by medical diagnosis 1
• Assessments determine underlying problems amenable to physiotherapy intervention and guide appropriate treatment selection 1
• Monitoring of vital functions during treatment ensures interventions are both therapeutic and safe 1

Treatment Areas and Interventions

Physical Deconditioning and Musculoskeletal Complications

• Early mobilization and rehabilitation can reduce time to wean from mechanical ventilation and form the basis for functional recovery 1
• Active or passive mobilization and muscle training should be instituted early to prevent complications of immobility 1
• Positioning, splinting, and muscle stretching help preserve joint mobility and skeletal muscle length in patients unable to move spontaneously 1
• Resistance training with low-resistance multiple repetitions can augment muscle mass and force generation 1

Respiratory Conditions

• Physiotherapy interventions target improved ventilation, lung compliance, reduced airway resistance, and airway secretion clearance 1
• Body positioning and mobilization optimize oxygenation by improving ventilation and lung perfusion 1
• Various techniques are employed for airway clearance depending on the specific respiratory condition 1

Emotional Support and Communication

• Physiotherapists contribute to patients' psychological well-being through therapeutic touch, relaxation interventions, and education 1
• Massage can be used as an intervention for anxiety management and sleep promotion 1
• Patient education is an important component of treatment sessions 1

Treatment Modalities

• Manual therapies including massage and joint mobilization 2
• Exercise therapy including resistance training, aerobic exercises, and neuromuscular retraining 3
• Electrophysical agents and electrical stimulation 3
• Thermotherapy (heat and cold applications) 3
• Hydrotherapy 2, 4
• Specialized techniques such as strategy training, balance training, and gait training 4

Clinical Applications

• Critical illness: Addressing deconditioning, impaired airway clearance, atelectasis, and weaning failure 1
• Musculoskeletal conditions: Reducing pain and restoring optimal physical functioning in conditions like ankylosing spondylitis, rheumatoid arthritis, and osteoarthritis 2
• Neurological conditions: Improving motor function, balance, and gait in conditions like Parkinson's disease through various approaches including conventional physiotherapy, treadmill training, and strategy training 5, 4
• Functional motor disorders: Addressing illness beliefs, self-directed attention, and abnormal movement patterns through education and movement retraining 6

Treatment Progression

A typical physiotherapy protocol progresses sequentially through the following phases 3:

• Pain control
• Restoring range of motion
• Restoring strength
• Neuromuscular retraining
• Return to full activity

Clinical Pitfalls and Considerations

• Physiotherapy interventions must be tailored based on individual assessment rather than being condition-dependent 1
• For critically ill patients, the risk of mobilization should be carefully weighed against the risks of immobility and recumbency 1
• Patients with hemodynamic instability or high ventilatory support requirements may not be candidates for aggressive mobilization 1
• Evidence for specific physiotherapy techniques varies widely across different conditions, requiring careful selection of appropriate interventions 5, 4