More specific information about physical function and disability was also measured. The Functional Independence Measure (FIM) was used to measure functional gains for specific activities such as walking, stair climbing, and daily activities (e.g., eating, bathing, self-care).
The FIM is an 18-item, seven-level functional assessment. It is designed to see how much help is needed to perform basic life activities safely and effectively by a person with a disability. In this study specific attention was paid to walking speed and any difficulties with walking. The Physical Therapist recorded any changes in the gait (walking) pattern observed during the testing. Joint range-of-motion, walking speed, and number of stairs completed were also observed.
Of those physical activities and limitations evaluated, five measures of physical impairment and activity limitations were used to compare the two groups. These included 1) FIM score, 2) range of motion, 3) stair climbing, 4) problems with gait when walking, and 5) walking speed.
The results showed that when everyone in the two groups was matched equally, the results were better in the group that had Physical Therapy treatment. As expected, the group with met needs had better overall scores on all tests indicating improved outcomes. There were some ups and downs along the way.
For example, in the area of range of motion, patients with unmet needs generally had worse results than patients with met needs. Later in the follow-up (12 to 24 months), improvement was about the same between the two groups. In all other areas, patients with unmet needs were less likely to improve over any of the selected time periods (three to six months, six to 12 months, 12 to 24 months). The lack of improvement in the unmet needs group was most noticeable with physical activities and functional tasks.
Between Physical Therapists and orthopedic surgeons, Physical Therapists were more likely to recognize which patients would benefit the most from this type of treatment. There may be some specific reasons for this. For example, the patient's insurance status, the relationship between the therapist and the surgeon, and differences in conducting the physician's examination process may account for physician referral (or nonreferral).
The authors conclude that Physical Therapists are more likely to know when and how to recognize the need for a Physical Therapy referral in this group of patients. Currently, there is a need to educate physicians to identify who can benefit from Physical Therapy. Therapists need to provide continue studies such as these and provide standards for prescription of Physical Therapy services.
Renan C. Castillo, PhD, et al. Evidence of Beneficial Effect of Physical Therapy After Lower-Extremity Trauma. In Archives of Physical Medicine and Rehabilitation. October 2008. Vol. 89. 10. Pp. 1873-1879.