Elizabeth Osantowski

PTH 870
06/01/2020

Interdisciplinary Project – Individual

1. Position: PMR / Physiatry

2. What does this service/discipline contribute to interdisciplinary team

management of the complex neuro patient? (you may choose to specify some
diagnoses as examples); you may consider commenting on involvement at
various settings in the continuum.
a. A Physiatrist contributes non-invasive treatment plans that include aspects
of care such as assistive devices, various therapies, massage, exercise,
pain medications, and injections to an interdisciplinary team management
of a complex neuro patient.1 Physiatrists are essential to the
interdisciplinary team management because they perform an evaluation,
diagnosis, and management of neuromusculoskeletal and disabling
conditions and direct rehab and recovery to prevent injury and disease. 2
Physiatrists are vital in optimizing outcomes and function early and
throughout the continuum of patient care. 2

3. What is their educational background? Licensure/Registration?

a. Their educational background includes attending medical school + 4
additional years of postdoctoral residency training (residency consists of 1
year studying fundamental clinical skills and three 3 specifically on
physical medicine and rehabilitation) and then they must pass a written
and oral exam to be board certified.3 Additionally, they can do further
education as an internship in subspecialty of physiatry including
Musculoskeletal rehabilitation, Pediatrics, Spinal cord injury, Sports
medicine, Traumatic brain injury, and Pain medicine. 3

4. What issues/systems/impairments does this discipline specialize in?

a. PMR treat a wide variety of medical conditions affecting the brain, spinal
cord, nerves, bones, joints, ligaments, muscles, and tendons. 4

5. What tests/measures/procedures might they do with a patient? -particularly

highlight any common objective test and it’s interpretation
a. Procedures a physiatrist might conduct include EMG/Nerve Conduction
Studies, Ultrasound guided procedures, Fluoroscopy guided procedures,
Injections of spine, Discography, Disc Decompression and
Vertebroplasy/Kyphoplasty, Nerve Stimulators, Blocks and Ablation
procedures—Peripheral and Spinal, Injections of joints, Prolotherapy,
Spasticity Treatment (Phenol and Botulinum toxin injections, intrathecal
baclofen pump trial and implants), Nerve and Muscle Biopsy, Manual
Medicine/Osteopathic Treatment, Prosthetics and Orthotics,

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 Elizabeth Osantowski
PTH 870
06/01/2020

Complementary-alternative medicine (i.e. acupuncture, etc.),

Disability/impairment assessment, and Medicolegal consulting. 4 These
tests will provide the results that should help guide your physiatrist’s
recommendation for treatment.1

6. What patient/family education would they be responsible for?

a. PMR’s are responsible for educating the patient and family of their
musculoskeletal dysfunctions and how they plan to help the patient
become functional and pain-free.5

7. Are there any community programs or benefits to the community at a broader

level that this discipline is active in? (ex from PT: direct access, Medicare cap)
a. Two community programs I found related to PMR include the Association
of Academic Physiatrists (AAP) and American Academy of Physical
Medicine and Rehabilitation (AAPM&R). AAP is a professional society
dedicated to mentorship, leadership, and discovery of leaders in academic
physiatry.6 American Academy of Physical Medicine and Rehabilitation is
a national program of physiatrists, similar to the APTA. This community
provides information on the latest changes in the US like the COVID-19
pandemic.7 For example, AAPM&R provides information and resources to
physiatrists on telehealth, private practice management, and regulation
changes.7

8. How can PT support this discipline? Are there areas that PT may overlap? Would
a co-treatment be appropriate and what might that look like?
a. Physiatrists are similar to physical therapists as they evaluate and treat
injuries, illnesses, and disability, and are experts in designing
comprehensive, patient-centered treatment plans. 8 The difference
between the disciplines is that Physiatrists will make and manage the
medical diagnoses and prescribe therapies while physical therapists
perform and execute the therapy. PT can support this discipline through
their execution of the treatment plan. These two professions can
collaborate to co-treat the patient to ensure the patient is receiving
appropriate treatment for their diagnoses.2 The physiatrist would prescribe
physical therapy and the PT would then execute the treatment plan and
report back to the physiatrist on patient progress.2

9. Review of 3 journal articles involving something of interest in current literature

from your discipline: summarize the articles, critique the articles, and give clinical
relevance from the articles. This review should be in bullet point format. ~1/2
page typed per article, minimum

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 Elizabeth Osantowski
PTH 870
06/01/2020

a. Article 1: “Physiatrist referral preferences for postacute stroke

rehabilitation”9
i. Summary:
1. Stroke is the leading cause of serious long-term disability in
US.9 There is controversy on the type of rehab facility where
a patient should receive their rehabilitative care, but options
include inpatient rehabilitation facilities (IRFs), skilled nursing
facilities (SNFs), long-term acute care hospitals (LTACHs),
home therapy, and outpatient therapy. 9 Factors to consider
when determining poststroke rehab include the severity and
nature of neurological and functional deficits, medical
comorbidities, provider and facility relationships, insurance
coverage, cost, geographical proximity and location of
available facilities, and patient and family preference. 9
2. The purpose of this article is to determine if there is variation
among physiatrists in referral preferences for postacute
rehabilitation for stroke patients based on physician
demographic characteristics or geography. 9
3. The study was conducted through surveying the physiatrists
attending the American Academy of Physical Medicine and
Rehabilitation Annual Assembly on November 13–16, 2014
in San Diego, CA.9 Participants were approached in common
areas of the conference (e.g., coffee area, corridors) and
asked to complete the survey on paper or tablet. 9 Surveys
included demographic information of the physiatrist like
trainee status, board certification, academic affiliation, extent
of active involvement in the care of stroke patients, practice
affiliation(s), state of practice, age, and number of years in
practice.9
4. There is substantial practice variation for certain cases but
did not vary with any identified practitioner variables or
geographic region.9 However, there was a referral pattern for
favoring inpatient rehab facilities.9
ii. Critiques:
1. Limited sample population chosen
2. Did not determine a gold standard of the appropriate
discharge destination for the patients represented in the
vignettes
iii. Clinical relevance:
1. There are more poststroke rehab in inpatient facilities, so
those whose desire is to work in this setting while treat more
people of this diagnosis.

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 Elizabeth Osantowski
PTH 870
06/01/2020

b. Article 2: “The Effect of Required Physiatrist Consultation on Surgery

Rates for Back Pain”10
i. Summary:
1. Spine surgery rates are increasing without evidence of
decrease in the burden of disease.10 Since physiatrist utilize
non-invasive treatment regimens, they might be able to
provide patients with a different perspective on treatment
options compared to surgery.10
2. The purpose of the study was to determine whether an
insurer rule requiring physiatrist consultation before
nonurgent surgical consultation would affect surgery
referrals and surgery rates.10
3. The study was conducted by requiring insurer patients to
have a consultation with a physiatrist in the specified
geographic region.10 Statistics from 2006-2007 and 2008-
2010 were compared.10 In addition, they used telephone
survey of patients to assess patient satisfaction. 10
4. The results indicated an increase of 70% referrals to a
physiatrist with a decrease of 48% of surgical referrals. 10 In
total, the number of spine operations dropped 25% within the
region.10 For those who were surveyed, 74% were satisfied
or very satisfied with the physiatry consultation.10 In
comparison, the satisfaction rates of those who underwent
previous spine surgery were 40% satisified.10
ii. Critiques:
1. Although the statistics showed a decrease of surgical
referrals for spinal fusion rates, there was still an increase of
55% to 63% of all surgical procedures (not just spinal).
Should this study be expanded to all surgical procedures
and reassessed?
2. There were substantial shifts in the market share in the
region, which may have impacted the results of the study.
3. Does the data shift with evaluating 1 year compared to 2
years statistics? How did this influence the results of the
study?
iii. Clinical Relevance:
1. Physical therapy will be executing the treatment plan from
the physiatrist to treat spinal dysfunctions, which this study
may increase the rates of that population in physical therapy.

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 Elizabeth Osantowski
PTH 870
06/01/2020

c. Article 3: “Physiatric Approaches to Pain Management in Osteoarthritis: A

Review of the Evidence of Effectiveness”11
i. Summary:
1. Osteoarthritis is highly prevalent in the general population
and is one of the leading causes of pain and physical
disability.11 There are numerous nonpharmacological
interventions to manage the pain of patients with OA
including education and self-management, weight reduction,
various forms of exercises, physical agents and modalities,
complementary therapies, manual therapy, unloading
strategies (braces and orthotics), and balneotherapy. 11
2. The purpose of this study is to assess the evidence of
effectiveness of nonpharmacological interventions pertaining
to physiatry to identify the best practices for pain
management of OA.11
3. The study was conducted through a comprehensive
literature review, systematic review, overview of systematic
reviews, and subsequent trials between January 1, 2005 to
May 15, 2011.11
4. The results show education and self-management improve
pain in knee OA; weight reduction for management of pain is
important and growing evidence; exercise is supported to
reduce knee OA; heat or cold modalities are inconclusive;
TENS are inconclusive; therapeutic ultrasound is effective;
low level laser therapy is not effective; complementary
therapies like acupuncture are effective in knee OA but not
hip OA; yoga is effective for knee OA; manual therapy is
effective in hip OA, but not knee OA; knee braces and foot
orthotics are effective in decreasing pain from knee OA;
balneotherapy is effective; splints reduce hand pain;
shortwave diathermy is not effective.11
ii. Critiques:
1. How they conducted the study / gathered their information
through systematic and nonsystematic reviews
2. What was the inclusion criteria across all the studies? And
were they similar or assessed?
3. Did not focus on one specific diagnosis of OA, but rather any
OA throughout the body
iii. Clinical Relevance:
1. Since OA is the leading cause of pain and physical disability,
PT’s will be utilizing noninvasive treatment regimens on
numerous patients with this diagnosis.

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 Elizabeth Osantowski
PTH 870
06/01/2020

References:
1. Washington Township Medical Foundation. Physiatry Tests. Washington
Township Medical Foundation website. Accessed June 1, 2020.
https://www.mywtmf.com/Services/Physical-Medicine-Rehabilitation/Tests.aspx
2. American Academy of Physical Medicine and Rehabilitation. What is the
difference between physical therapy and Physiatry. American Academy of
Physical Medicine and Rehabilitation website. Accessed June 1, 2020.
https://www.aapmr.org/career-center/medical-student-resources/a-medical-
students-guide-to-pm-r/what-is-the-difference-between-physical-therapy-and-
physiatry
3. Brzusek, DA. Physiatrist Education and Training. Spine Universe, 2020.
Accessed June 1, 2020. https://www.spineuniverse.com/treatments/physiatrist-
education-training
4. American Academy of Physical Medicine and Rehabilitation. What is a
Physiatrist? AAPM&R website. Accessed June 1, 2020.
https://www.aapmr.org/about-physiatry/about-physical-medicine-
rehabilitation/what-is-physiatry
5. Staehler, R. What Is a Physiatrist? Spine Health. Updated September 29, 2011.
Accessed June 1, 2020. https://www.spine-health.com/treatment/spine-
specialists/what-a-physiatrist
6. Association of Academic Physiatrists. Home for Physiatry. Association of
Academic Physiatrist website. Accessed June 1, 2020. https://www.physiatry.org/
7. American Academy of Physical Medicine and Rehabilitation. Home page.
American Academy of Physical Medicine and Rehabilitation website. Accessed
June 1, 2020. https://www.aapmr.org/home
8. American Academy of Physical Medicine and Rehabilitation. About Physiatry.
American Academy of Physical Medicine and Rehabilitation website. Accessed
June 1, 2020. https://www.aapmr.org/about-physiatry
9. Cormier DJ, Frantz MA, Rand E, Stein J. Physiatrist referral preferences for
postacute stroke rehabilitation. Medicine (Baltimore). 2016;95(33):e4356.
Doi:10.1097/MD.0000000000004356
10. Fox J, Haig AJ, Todey B, Challa S. The Effect of Requires Physiatrist
Consultation on Surgery Rates for Back Pain. Spine. 2013;38(3):E178-E184.
Doi:10.1097/BRS.0b013e31827bf40c
11. Oral A, Ilieva E. Physiatric approaches to pain management in osteoarthritis: a
review of the evidence of effectiveness. Pain Manag. 2011;1(5):451‐471.
doi:10.2217/pmt.11.46.