What’s the difference between going to a clinic for physical or occupational therapy and doing “in-home” therapy?
That’s a question that comes up from time to time. In fact, I recently had the opportunity to share some thoughts and insights about this topic with the good folks over at Forbes Health. Since this topic comes up from time to time, I figured I’d share the original article as well as some of the questions and answers that helped form it.
Below, I share the original questions that Forbes asked about in-home physical therapy as well as my unabridged answers. You can check out the full article here.
Questions from Forbes: In Home Physical Therapy
When it comes to in-home physical therapy appointments, many people have questions about the basics: who, what, how, etc. And, just like any other health services, questions come up about risks and benefits. In the questions that follow, I try to shed some light on each of those topics. Hopefully it helps clarify some of the details around in-home physical therapy.
Who performs in–home physical therapy?
Typically,
in–home PT is completed by either a PTA (
physical therapy assistant) or a PT (
physical therapist). If another discipline is involved (occupational therapy or speech therapy), then the treatment would be provided by an OT or SLP, respectively.
What does in–home physical therapy entail? What does an in–home
PT session look like?
In–
home PT falls into two categories: 1) traditional,
home-health therapy and 2)
mobile outpatient in–home therapy. For traditional,
home health therapy, usually covered for the first 100 days by medicare part A, treatment sessions typically entail a focus on functional mobility (getting around the
house safely) and ADLs (activities of daily living). Basically, this type of
home health PT aims to improve mobility, safety, and independence within the
home so that the person is able to take care of themselves as independently and safely as possible. It usually takes place following some recent hospitalization or healthcare event (like a knee surgery or heart surgery).
The second type of in–home PT falls under “mobile outpatient therapy”. This type of therapy differs from the first in that, unlike traditional home-health, this type of therapy focuses on more than self care and ADLs and may be started without some kind of healthcare event. For example, many outpatient PT clinics offer “in–home” therapy treatment as a convenience to their patients. They may address similar problems as would be addressed in outpatient therapy clinics, such as knee pain, or gait/balance, or even sports performance. However, this treatment takes place in the home (or at the office, or at a gym).
That being said, what a typical session looks like will be dependent upon which type of in–home therapy is being conducted. If it’s a traditional home-health visit, sessions typically include exercises and activities focused on improving functional mobility within the home, like getting from the bed to a chair or bathroom. It may also include focusing on daily tasks such as showering or dressing. If the visit falls under a mobile outpatient type of PT service, then treatment could focus on improving pain, increasing performance (strength, ROM, etc.) and even involve more advanced exercises and activities.
Are there any risks associated with in–home therapy?
I always advise patients and clients that the main risk with in–home therapy is selecting the wrong type. For example, if you’re an active, relatively healthy person and are experiencing knee pain or hip pain, a traditional in–home PT or home health service will not be the right fit for you. That type of care specializes in regaining basic self-care function and mobility, rather than increasing performance or focusing on specific orthopedic or musculoskeletal issues. In that case, you’d be better off going with mobile outpatient PT or selecting an outpatient clinic, where you get access to specific equipment like weight machines and the like. Most of the patients we see that have been unhappy with in–home PT fall into the latter category. They chose a home health service aimed at improving baseline function, but what they really needed was advanced and progressive mobility or strengthening training.
Another risk of in–home therapy would be the risk of medical complications. Now this is also a risk in outpatient clinics as well. Take for example, someone who just experienced a cardiac event (heart attack, etc.) and perhaps have other medical complications. There’s always a risk that therapy may exacerbate symptoms or trigger a decline in medical status, which would require evaluation by a doctor (or a trip to the ER). If you’re at a clinic, they may have access to necessary medical equipment, like BP monitors, etc. to monitor vitals and ensure that the person is not overworking or at risk of a negative event. If the clinic is associated with a hospital, they may even have access to doctors or be located nearby a local medical center in the event of a negative medical event. With in–home therapy, there’s always the risk of having to wait for an ambulance or something if a negative reaction occurs.
Now, this is probably a very small and outside risk. Most in–home therapy operations will track vitals just as they would in-clinic. But it’s a risk that bears mentioning.
Summary
Hopefully, these questions, as well as the Forbes Article helps clarify some of the questions around in-home vs. in-clinic therapy. I always tell people that the most important thing you can do is move. Whether you choose in-home therapy or go to a clinic, you gain so much by moving your body. Especially if you experience pain, have recently been hospitalized, or are experiencing balance issues, physical and occupational therapists specialize in helping you regain your strength, mobility, and confidence so you can continue to live an active and healthy life.
And, if you live nearby and want to learn more about how we can help you at ProActive Rehabilitation & Wellness, click this link to book an appointment.
