Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

My 83-year-old aunt broke her shoulder last summer. She went to a physical therapist for six months straight. She has had a marvelous recovery. But my aunt had to repeatedly ask her doctor for a referral and fight with the insurance company to cover the cost. Would more older people get better results after injuries like this if they could get this kind of treatment?

Answer:

It's possible and even probable that many patients would recover faster and improve more with physical therapy, but it hasn't been proven yet. In today's health care environment, the burden of proof is on the health care professional. Insurance companies are looking for evidence to show that a long-term rehab program (more than six weeks) is needed. Physical therapists are stepping up to the plate when it comes to conducting research to document the results of their work. But more high-quality studies are needed that do not overestimate the results of treatment. Many times studies are published that do not provide a complete set of data collected on each patient population examined. This makes it hard to compare the results of the study with other studies presented in the literature. When two different types of treatment are compared, it's not uncommon for patients in one group to switch to the other group. Switching treatment is referred to as the cross over effect. Providing evidence-based guidelines can be difficult when this happens. Some conditions are more likely to generate a physical therapy referral. For example, orthopedic surgeons often prescribe physical therapy after a severe injury to the leg and/or foot. But physical therapy may not be justified for someone who just had a partial meniscectomy (removal of knee meniscus or cartilage). Most states have direct access laws now. This means the consumer can see the physical therapist without a physician's exam first. Therapists are trained to recognize when patients need a medical referral. The therapist consults with physicians (and other appropriate health care providers) when it's indicated. Patients as consumers are in charge of their health. Your aunt is a good example of someone who understands what she needs and insists on getting it. This may become a more common practice as the aging baby boomers (adults born between 1946 and 1964) seek more medical care. 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.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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