Physiotherapy versus Physical Therapy

This article outlines the similarities and differences between Physiotherapy and Physical Therapy.

From time to time in the Priory Clinic our clients ask us to outline the differences between physical therapy and physiotherapy in Ireland. Having established the physical therapy profession and spent more than three decades delivering treatment while working alongside both professions, here are some of the differences we see.

An important point to mention at the outset is that roles that are filled in Ireland by physical therapists are filled elsewhere by physiotherapists. So the way the professions have been organised differ widely from one state to the next. There is no single international standard for either profession, both evolving to meet perceived needs. The self-styled World Confederation for Physical Therapy (WCPT) regulates members allowing membership to only one (largest) organisation per country. In Ireland that falls to the group representing chartered physiotherapists with entry being closed to physical therapists.

The first difference we see is educational: traditionally physiotherapists graduated from mainstream universities and physical therapists did not. That has changed in the last decade and now students of both professions complete recognised degree courses, with anoptionin the case of physical therapists to proceed to honours level. While there are similarities across a number of subjects, physical therapists focus a great deal more on soft-tissue problems and very little on cardio, respiratory and neurological problems ordinarily treated in a hospital.

Secondly there is a difference in approach. Physical therapy education focuses primarily on hands-on treatment, whereas electrical modalities have long been a mainstay of physiotherapy. That need not necessarily be the case as some physiotherapists may eschew the traditional values and prefer to develop hands-on skills to more closely resemble a physical therapist. Equally, there is nothing to prevent a physical therapist from using interferential, electrical, ultrasound or laser treatment to replace hands-on treatment. So the differences are also greying in that area.
Thirdly, there is a different emphasis in approach; physical therapists are trained to make every consultation and treatment patient-centred. This manifests itself in a few ways; a longer visit with more time spent on history-taking, more emphasis in discussing the injury or problem with a patient, more emphasis on looking at the holistic picture. Physical therapists also emphasise the importance of engaging the patient fully in the treatment plan and to do this they must first try to explain their diagnosis and agree a solution or treatment plan. Of course nothing prevents a physiotherapist from embracing these values (if they did not already) and we always hope that physical therapists don’t let them slide. But much about the hospital setting and waiting lists pressurises physiotherapists to conclude treatments without the space to utilise a truly patient-centred approach.
From a health insurance perspective plans vary but these days it seems what little cover there is, applies evenly for either approach. Both physiotherapy and physical therapy qualified in the past for tax relief as medical expenses.

Since 2000 the momentum towards regulating physiotherapy by statute has ebbed and flowed. When it eventually happens, as seems likely, and if physiotherapists fail to appropriate the physical therapy title, both will have space to evolve as competitors on either side of the regulatory divide.
Traditionally, GP’s are more familiar with physiotherapists and may not be aware of, or even understand the distinction between both approaches. However, it is fair to say that where both are qualified with recognised awards, albeit in working with different styles, GP’s are comfortable supporting the decision of the patient as to which is best for them. Then there is the fact that physiotherapists seem to be trained primarily for hospital-work and physical therapists for private practice. This is important in practical terms because the range of problems seen in each environment is quite different. Stroke victims for example are a significant part of a hospital client list but rarely appear in private clinics. The same can be said of those recovering from surgeries or respiratory disorders. So the range of common problems within a hospital and outside are quite different. People with back pain, which tends to be episodic and recurring rarely find the prospect of an emergency ward appealing and most first seek treatment outside. So back problems and sports injuries will be a much higher percentage of the problems treated outside a hospital than within. In developing a physical therapy course the emphasis is on making it fit-for-purpose and ensuing students are equipped for private practice - a skill set evidently absent in graduate physiotherapists who rarely begin their working lives outside a hospital.