POSSIBLY EFFECTIVE
Fall prevention. Most clinical research suggests that participating in physical therapy exercise reduces the risk or rate of falls in elderly adults. One analysis of results from two clinical studies suggests that physical therapy in combination with exercise reduces the number of fallers among older adults in hospital rehabilitation wards compared to exercise alone; however, it does not reduce the rate of falls (93917). Other clinical research shows that participating in exercise classes supervised by a physical therapist reduces the risk of falling in elderly adults recovering from recent hospitalization or bed rest who have poor physical function at baseline. However, in patients with high physical function at baseline, fall risk is increased (93925).
In addition to evaluating the effect of physical therapy in elderly patients who are hospitalized or were recently hospitalized, many studies have assessed the effects of physical therapy for fall prevention in community-dwelling elderly adults. Some research shows that in-home physical therapy helps prevent falls in these patients. Clinical research shows that participating in in-home physical therapist-designed exercise for 12 months reduces the rate of falls by 46% in community-dwelling elderly adults over 75 years-old (93924). However, sustained adherence to in-home exercise programs appears necessary to maintain the any benefit. Clinical research shows that any reduction in fall risk after 12 weeks of in-home physical therapy program is no longer apparent 12 weeks after exercise cessation (93918).
There is also evidence that physical therapy, administered in classes, helps prevent falls in community-dwelling, elderly adults. Clinical evidence shows that participating in physical therapist-designed exercise classes, along with ancillary in-home exercises, for 12-18 months reduces the rate of falls by 18% to 40% compared to control in community-dwelling, elderly adults (93919,93920). There is also evidence that participating in physical therapist-supervised exercise classes along with in-home exercises modestly reduces the rate of falls in women with osteoporosis (93922). Physical therapist-supervised exercise classes also appear to modestly reduce the risk of falls in community-dwelling elderly adults (93923). However, it is not clear if participating in exercise classes along with in-home exercise programs is more beneficial than in-home programs alone. Some clinical research suggests that participating in class sessions designed by physical therapists along with ancillary in-home programs is no more effective than participating in only in-home programs (93921).
Overall, it appears that physical therapy helps reduce falls in community-dwelling older individuals, especially those at risk of falling. Based on similar findings, some clinical practice guidelines recommend physical therapy and exercise for community-dwelling patients aged 65 years or older who are at high risk of falling (94130,94131). However, it is still not clear whether in-home programs or group classes are more beneficial. Also, it is not clear what frequency and intensity of exercise provides the most benefit. In addition, there is not enough evidence to know if physical therapy helps prevent falls in patients recently hospitalized or those living in assisted living facilities.
INSUFFICIENT RELIABLE EVIDENCE TO RATEAcute lymphoblastic leukemia. Preliminary research suggests that the combined use of physical therapy plus a home exercise program may be beneficial in children with acute lymphoblastic leukemia. Stretching, strengthening, and aerobic exercise may improve ankle dorsiflexion active range of motion and knee extension strength.
Asthma. Preliminary research has assessed the effects of chest physical therapy and physiotherapy breathing retraining in children and adults with severe and acute asthma. Some evidence suggests that these methods of physical therapy improve quality of life and lung function in these patients. However, other research shows no benefit.
Back pain. Preliminary research suggests both benefits and no effects of physical therapy techniques for back pain. Examples of specific techniques used include home-based exercise programs, mobilization and extension techniques, flexion exercise, breathing therapy, Masai barefoot technology, and the McKenzie method.
Cardiac syndrome X. Preliminary clinical research suggests that physical therapy may help improve cardiac syndrome X, which is a chronic pain disorder with exercise-induced chest pain.
Carpal tunnel syndrome. Preliminary clinical research suggests that physical therapy techniques such as carpal bone mobilization and median nerve mobilization may not be beneficial for carpal tunnel syndrome.
Cerebral palsy. Based on available research, it is unclear if physical therapy is beneficial for children with cerebral palsy. Numerous physical therapy techniques have been used to treat movement/motor disorders associated with cerebral palsy, including hippotherapy (physical therapy utilizing the movement of a horse), sensory-perceptual-motor training, neurodevelopmental physical therapy, and functional physical therapy.
Chronic obstructive pulmonary disease (COPD). Preliminary clinical research suggests that certain physical therapy techniques may help improve tolerance to exercise and quality of life for COPD patients. Examples of manual respiratory physical therapy techniques include postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique.
Complex regional pain syndrome. Preliminary clinical evidence suggests that physical therapy may have a better effect than occupational therapy or no treatment for the reduction of pain in some patients with complex regional pain syndrome.
Dementia. Some preliminary clinical evidence suggests that physical therapy techniques may improve balance and mobility in patients with Alzheimer's disease or dementia. However, results from one study shows no benefit of physical therapy in dementia patients with additional mobility problems.
Fibromyalgia. Preliminary clinical evidence suggests that physical therapy does not result in more improvements compared to hypnotherapy used for symptoms of fibromyalgia.
Foot drop. Preliminary clinical evidence shows that physical therapy with biofeedback may enhance strength in patients with post-stroke foot drop.
Fractures. Preliminary clinical evidence suggests that physical therapy appears to be beneficial as a method of shortening the duration of healing time from hip fracture recovery after surgery, improving quality of life, or as preparation for hip replacement surgery in the elderly. Home-based programs, gait retraining programs, high vs. low-intensity programs, early vs. late interventions, and multicomponent rehabilitation have all been studied.
Frozen shoulder. Preliminary clinical evidence suggests that intensive physical rehabilitation treatment including passive stretching and manual mobilization (stretching group) may help with symptoms of frozen shoulder.
Heart failure. Preliminary clinical evidence suggests that physical therapy including supervised and home-based exercise training can enhance exercise capacity in patients with chronic heart failure.
Incontinence. Some research suggests that physical therapy techniques may improve symptoms of incontinence and also improve dysfunctional voiding in children.
Kashin-Beck disease. Preliminary clinical evidence suggests that physical therapy may be better than multivitamins for helping with symptoms of Kashin-beck disease.
Knee pain. Some research suggests that physical therapy techniques are more effective compared to placebo controls for the treatment of patellofemoral pain syndrome.
Low back pain. Preliminary clinical evidence suggests that physical therapy techniques plus passive motion may improve function, reduce pain, and improve muscle strength and range of motion for patients with low back pain due to sacroiliac joint dysfunction (SIJD).
Lymphedema. Preliminary clinical evidence suggests that physical therapy techniques may not improve symptoms of lymphedema when compared to control treatments or other therapies. Physical therapy techniques that have been employed include complex physical therapy (CPT), self-home maintenance therapy (bandage/wearing of elastic garment and exercise), and pneumatic compression.
Myofascial pain. Preliminary clinical evidence suggests that there may be no difference between arthroscopic surgery, arthrocentesis, and physical therapy with regards to the effects of these treatments on temporomandibular pain and function impairment in patients with myofascial pain.
Neck pain. Preliminary clinical evidence suggests that manual physical therapy may be better than general medical care and traditional physiotherapy in conditions involving neck pain. Physical therapy has been studied for acute neck pain, cervical radiculopathy, cervicobrachial pain syndrome, and neck pain due to whiplash injury among other conditions. Techniques studied in combination with conservative physical therapy include gymnastics, strengthening exercises, electrotherapy, thermotherapy, massage, manipulation, cervical traction, and tissue mobilization.
Neurological trauma. Preliminary clinical research suggests both benefits and no effects of physical therapy techniques for gait (movement) disorders in patients with chronic traumatic brain injury. Physical therapy techniques used included treadmill training and weight-bearing gait training.
Osteoarthritis. Some research suggests that physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Some research compared physical therapy to a sham group (subtherapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee. Some physical therapy techniques used in the studies include: infrared, short-wave diathermy-pulsed patterns, interferential therapy, and sling suspension system. Some research suggests that manual physical therapy may also help with osteoarthritis of the hand and hip.
Osteogenesis imperfecta. Preliminary clinical evidence suggests that a supervised physical therapy program may improve aerobic capacity and muscle force and reduce fatigue in children with osteogenesis imperfecta, a genetic disorder in which bones are abnormally fragile and may fracture easily.
Parkinson's disease. Some preliminary clinical research suggests that physical therapy in addition to medications may improve balance, postural control, walking, and reduce falls in the short-term in patients with Parkinson's.
Pneumonia. Preliminary clinical evidence shows that chest physiotherapy techniques such as postural drainage, external help with breathing, percussion, and vibration are not better that receiving deep breathing training in the treatment of pneumonia.
Prematurity. In premature infants, improvements were seen in weight gain, growth, bone mineral content, bone mineral density, bone area, and bone mass following physical therapy. However, some clinical evidence shows that physical therapy does not appear to help motor performance in preterm low birth weight infants and may increase the risk of fractures.
Pregnancy-associated complications. Preliminary clinical evidence shows that stabilizing physical therapy exercises may be more effective than a regimen without these exercises in the treatment of pelvic girdle pain, functional status, and quality of life in pregnant patients.
Rheumatoid arthritis (RA). Some research shows that long-term high-intensity weight-bearing exercise programs may result in improved bone density in rheumatoid arthritis.
Shoulder pain. Preliminary clinical evidence suggests that manual physical therapy may be better than general medical care and traditional physiotherapy in conditions involving shoulder pain. Physical therapy has been studied for shoulder pain, shoulder dysfunction, adhesive capsulitis, quadriplegic shoulder pain, cervicobrachial pain syndrome, shoulder impingement syndrome, and healing after rotator cuff repair among other conditions. Techniques studied in combination with conservative physical therapy include gymnastics, strengthening exercises, electrotherapy, thermotherapy, massage, cervical traction, and tissue mobilization.
Sprains. Preliminary clinical evidence shows that physical therapy techniques may help with healing of acute ankle ligament sprains and acute hamstring sprains. Certain physical therapy techniques, such as progressive agility, trunk stabilization exercises, and icing, may be more beneficial than static stretching, but results are unclear.
Stroke. Preliminary clinical evidence shows that physical therapy may strengthen weakened muscle groups through repetitive motion, increase overall function including cognitive function, and improve gait and walking in patients undergoing stroke rehabilitation.
Surgical recovery. Some research suggests that physical therapy may be beneficial for recovery after surgery. For example, physical therapy may benefit recovery after anterior cruciate ligament (ACL) reconstruction, traumatic dislocation of the knee, and knee replacement surgery. Physical therapy techniques also may be beneficial following cardiopulmonary bypass surgery, abdominal surgery, and other surgical procedures, such as breast cancer surgery. Several studies do not show any difference between various chest physiotherapy treatments, such as incentive spirometry, intermittent positive pressure breathing (IPPB), or deep breathing exercises.
Tendinopathy. Some preliminary clinical research suggests that early stages of tendonopathies may benefit from orthosis and structured physical therapy exercises. However, physical therapy may not reduce symptoms some types of tendinopathy. Some preliminary clinical research suggests that physical therapy not be effective for reducing symptoms of lateral epicondylitis (tennis elbow). However, physical therapy techniques such as cold pack use, progressive strengthening, or stretching exercises may reduce the recurrence of this condition.
Tinnitus. Preliminary clinical research suggests that acupuncture offers more benefit for reducing the severity of tinnitus and improving quality of life than physical therapy.
Vertigo. Preliminary clinical research shows that physical therapy may help reduce symptoms of vertigo (specifically, benign paroxysmal positional vertigo).
Vestibular disorder. Preliminary clinical evidence shows that vestibular rehabilitation physical therapy may reduce dizziness and imbalance in patients with vestibular disorders.
More evidence is needed to rate physical therapy for these uses.
Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
