Reflections on Physical Therapy (Response to an Opinion Article)

Dan Fleury (PT, DPT, OCS, Diploma Osteopractic, FAAOMPT) – a PT at Portsmouth Physical Therapy and the Vice President of our organization – penned this tremendous piece on physical therapy in response to a recent article he had read that expressed doubts about physical therapy as a whole. It’s something that we felt we just had to share, as we agree in earnest. You may find the article referenced in this piece by clicking here.

“”As a physical therapist that has seven years of advanced education and countless hours of post professional training including specialty and fellowship designations, reading this article brought me through a range of emotions.

Fear: The inaccuracy and heterogeneity of which the author refers to physical therapy interventions may deter a patient from receiving the proper level of care, leading to a potential worsening of a condition. Further, as physical therapists we have direct access, meaning that a patient can come directly to a physical therapist without first seeking medical intervention. Acting as a first line evaluator, if something falls outside of our expertise we are mandated to refer that patient to a more qualified provider. I have countless stories of individuals with fractures, infections, and cardiac conditions, each of whom came to physical therapy in a direct manner with the belief that their injuries were musculoskeletal in nature. The care for these patients was then quarterbacked by the physical therapists, so that the patient could receive the proper referral and level of care required. This article is dangerous to a reader who may be simply scanning the page and who may not understand the depth of physical therapy training and application.

Anger: I fully admit I was angry when I first read the piece. I was angry that someone had taken partial information, added in a few bad patient experiences, and folded it into a testimonial against physical therapy. As I read, I was refuting and scoffing under my breath at some of the comments made and over generalizations glorified. I had to look it a few more times before fully understanding what I was reading, taking a mental note that the article was an opinion that required some reconfiguring and response.

Acceptance and Enlightenment: After first going over the piece few times, I read it one last time and removed myself from the equation — meaning I read it as if the author was talking about a practice other than my own – and then it hit me! Although largely inaccurate, the article shed light on a huge issue we have in physical therapy — Practice Variation! Jack O Dwyer wasn’t necessarily referring to my specific practice, he was referring to the profession and therein lies some of truth in the article. Removing emotion allowed me to see the big picture and he was absolutely right! As a matter of fact, the issues he brings to light in the article are the entire reason my group exists. A large portion of our patients have experienced the same issues before self-discharging from their current physical therapist, or reporting back to their referring provider their displeasure and, in turn, being discharged and re-referred to us. I actually laughed at my self-reflecting on the previous week’s case load when almost 75% of my evaluations started with “well I had PT and it didn’t work”, or “I had 26, 30, 40 PT visits and I never got better”. Unfortunately, this is the reality, but fortunately for me and my group, these patients that fail elsewhere come to us. Being independent and not owned by a hospital or physician group we are often referred the very difficult or the once-failed physical therapy cases, and we do an outstanding job. How do I know? We measure outcomes using a sophisticated third party outcomes system that is both risk adjusted and comparative. ( We measure our effectiveness and efficiency versus the international average and internally in comparison to our peers. We use the shortcomings to drive our robust continuing education and mentorship programs.

Physical therapy consumers need to be savvy. Do your research your therapist and understand why you are being referred to a particular physical therapist or practice. Is there a financial relationship? Is there an intuitional relationship? Ask questions of your referring provider to find out if you’re being referred to the most highly qualified, highly educated, outcomes focused, evidence based physical therapist in your area and then conduct your own research. Ask your therapist how they measure patient success, satisfaction, and visit utilization. Ask questions around your therapist’s continued education, such as “How many courses do you take per year? What was the last course they have taken?” As a patient, you have a choice where you receive your care. Use both the article written by Jack O’Dwyer and my response here to help you be a smarter healthcare consumer.

I do appreciate Jack’s article as it brings to light some very real issues and without it, I would not have been inspired to clarify. – Dan Fleury””

We’re proud to be physical therapists, proud of Dan’s words, and proud to be a network of top Physical Therapy Practices Committed to Clinical Excellence.