What should be included in a prescription for continuing physical therapy?

Essential Components of a Physical Therapy Prescription for Continuing Care

A comprehensive physical therapy prescription for continuing care should include patient information, specific therapy details, FITT-PRO parameters, assessment information, and communication elements to ensure optimal patient outcomes.

Core Components

• Include complete patient information: full name, date of birth, contact information, and relevant medical record numbers 1
• Specify the type of therapy needed, including interventions or modalities to be used (e.g., aerobic exercise, resistance training, flexibility exercises) 1
• Include FITT-PRO parameters:
  • Frequency: How often therapy should occur (e.g., 2-3 times weekly) 1
  • Intensity: Target exertion level (e.g., moderate intensity, Borg RPE 12-15) 2
  • Type: Specific exercises or interventions 1
  • Time: Duration of each session (e.g., 30-60 minutes) 1
  • Progression: Guidelines for advancing the program as the patient improves 1

Assessment Information

• Include relevant functional assessment results as baseline measurements (pain, range of motion, balance, walking ability) 1
• Document relevant medical history and comorbidities that may affect therapy 1
• Note previous physical therapy interventions and their outcomes 1
• Include current capabilities and limitations 1

Disease-Specific Considerations

• For cardiovascular conditions: Include exercise test results, target heart rate ranges, and monitoring requirements 1
• For musculoskeletal conditions: Specify weight-bearing restrictions, movement limitations, and pain management approaches 1
• For neurological conditions: Include assessment of sensorimotor function and cognitive abilities 1
• For pulmonary conditions: Note respiratory function parameters and oxygen requirements 1
• For ankylosing spondylitis and similar conditions: Specify whether land-based or aquatic therapy is preferred 2

Exercise Prescription Elements

• Aerobic training: Specify mode, intensity, frequency, and duration 2
• Resistance training: Include frequency, intensity, sets, and specific exercises for major muscle groups 2
• Flexibility training: Note frequency, duration of stretches, repetitions, and target muscle groups 2
• Balance and functional training: Specify exercises that address specific functional limitations 1
• For patients with specific conditions like ankylosing spondylitis, emphasize active physical therapy interventions (supervised exercise) over passive interventions (massage, ultrasound, heat) 2

Communication Elements

• Include instructions for interdisciplinary coordination between the physical therapist and other healthcare team members 1
• Specify a follow-up plan, including timeline for reassessment and criteria for discharge or program modification 1
• Provide guidelines for a home exercise program to be performed outside of formal therapy sessions 2, 1
• Include patient-specific goals that are meaningful to the patient 3, 4

Goal Setting Elements

• Document specific, measurable, achievable, relevant, and time-bound (SMART) goals 3
• Include both short-term and long-term goals 3
• Ensure goals are developed collaboratively with the patient to increase adherence and motivation 5, 4
• Focus on functional outcomes rather than just impairments 1

Common Pitfalls to Avoid

• Avoid vague prescriptions with general statements like "evaluate and treat" without specific parameters 1
• Don't neglect to provide guidelines for advancing the program as the patient improves 1
• Include safety parameters such as vital signs monitoring requirements or exercise termination criteria 1
• Don't assume patients know what constitutes an achievable goal; provide guidance in goal-setting 6
• Avoid focusing solely on impairments rather than functional outcomes 1

Sample Format

• Patient Information: Name, DOB, Medical Record Number, Contact Information
• Diagnosis and Relevant Medical History
• Therapy Goals: Functional outcomes to be achieved
• Treatment Parameters: FITT-PRO specifications
• Precautions/Contraindications
• Home Exercise Program Guidelines
• Follow-up Plan and Timeline
• Physician Contact Information 2, 1