The healthcare specialty of physical therapy involves patient instruction and treatment modalities all designed to increase patient mobility and independence in activities of daily living (ADLs). Physical therapy can be provided on either an inpatient or outpatient basis with different goals of treatment depending upon a patient's status. Further, inpatient physical therapy is provided in one of two clinical situations: acute care and longer-term rehabilitative care. Almost every sub-specialty of medicine — not just orthopedics — can utilize inpatient physical therapy services, including general post-operative care, neurology, geriatrics and burn medicine. This form of treatment involves increasing patient mobility, safety and independence while decreasing the length of inpatient stays and complications secondary to immobility or inactivity.
Many times, the immediate goal of inpatient physical therapy is practice and instruction in basic postural repositioning. A bedridden patient may be unable to reposition himself in bed and require both an overhead triangle bar and reminders to bend his knees and push with his heels while using the assistive device. In a more common scenario, a postoperative or weakened patient must be instructed in the step-by-step and gradual process of a pivot-and-turn transfer from bed to chair. Inpatient physical therapy is also utilized to assist patients, as necessary, in their first postoperative attempts to ambulate beyond the confines of their hospital rooms. Ambulation aids such as canes, quad canes and walkers are often first introduced to patients after their physicians' referrals for inpatient physical therapy.
Immobility can lead to many serious complications, including the development of blood clots in the lower extremities; pneumonia; and decubitus ulcers, or pressure sores. In other situations, permanent complications — such as contractures or decreased range of motion — may arise if a patient does not receive necessary inpatient physical therapy treatment within a limited recovery window. It is for these reasons that burn patients and neurological injury victims undergo frequent stretching and range-of-motion exercises almost immediately after their injuries. Without this activity, tendons and areas of scar tissue permanently contract and decrease mobility, range-of-motion and mobility.
Inpatient physical therapy is also closely involved with recovery from orthopedic fractures and joint replacement surgeries. Before surgery, physical therapists usually conduct an assessment of the patient's preoperative functional abilities. They also prepare the patients for what to expect after surgery and what area muscle exercises to begin as soon as they are able. Inpatient physical therapy helps prepare joint replacement patients for discharge by assessing postoperative functional abilities, making home health care referrals as necessary, and arranging for outpatient physical therapy treatment to begin after discharge.
