Physical therapy


 * Associate Editors-In-Chief: Abhishek Singh, B.P.T [mailto:abhiksin7556@yahoo.co.in]

Overview
Physical therapy (or physiotherapy as it is known outside the U.S.) is a healthcare profession concerned with prevention, treatment and management of movement disorders arising from conditions and diseases occurring throughout the lifespan. Physical therapy is performed by either a physical therapist (PT) or a physical therapist assistant (PTA) acting under the direction of a PT. However, various non-PT health professionals (e.g., chiropractors, Doctors of Osteopathy) employ the use of some physical therapeutic modalities in practice. A program of physical therapy will typically also involve a patient's caregivers.

Physiotherapy or Physical Therapist or PT is a health care professional who examines, treat, advice & instruct person with movement dysfunction, bodily malfunction, physical disorder, healing and pain from trauma and disease, disability, physical and mental conditions, by using physical agents like exercise, mobilization, manipulation, hydrotherapy, mechanical, and electrotherapy.

PTs utilize a patient's history and physical examination in diagnosis and treatment, and if necessary, PTs will also incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyograms, nerve conduction velocity testing) may also be of assistance. PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, extended care facilities, patient homes, education or research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.

For decades, physical therapy practice has been the subject of criticism for its lack of a research base, and "most physical therapists continued to base practice decisions largely on anecdotal evidence." The World Confederation for Physical Therapy, has called on the profession to adopt and adhere to evidence-based practices formally based on the best available scientific sources.

History
Physicians like Hippocrates and Hector are believed to have been the first practitioners of a primitive physical therapy, advocating massage and hydrotherapy to treat patients in 460 B.C. The earliest documented origins of actual physical therapy as a professional group, however, date back to 1894 when four nurses in England formed the Chartered Society of Physiotherapy. Other countries soon followed and started formal training programs, such as the School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA)). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for Polio.

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed, which has played an important role in advancing manual therapy worldwide ever since. In the 1980s, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which finally gained FDA approval in the U.S. in 2002.

Physiotherapy modalities
PT’s uses individual’s history and do physical examinations in their diagnosis & setting a treatment protocol, and if necessary, will include the results of laboratory and imaging studies. Physiotherapist uses various modalities like-
 * Exercises like active, passive,aerobic,cardio,strengthening,stretching etc.
 * Hydrotherapy
 * Mobilization
 * Manipulation
 * Electrical Modalities like Ultrasonic Therapy, Laser, Microwave Diathermy, Interferential therapy, TENS (Transcutaneous Nerve Stimulator),Shock Wave Therapy and many more.

Active Exercise Motion derived from a part by doing voluntary contraction and relaxation of its controlling muscles. Active Assistive exercise voluntary contraction of muscles controlling a part, assisted by a therapist or by some other means. Aerobic Exercise a type of physical activity,which increases the heart rate and as a result use of oxygen is increased in order to improve the overall body condition.

Ballistic stretching's rapid, jerky movements employed in exercises,for stretching of muscles and connective tissue.

Buerger-Allen exercises- Perform to enhance blood circulation of the legs and feet. In this exercise the lower limb s are raised to 45-90 degree angle with some support for 2 to 3 minutes until skin blanches. After that the feet and legs are lowered or the patients adopt a high sitting posture for 5 to 10 minutes until redness appears, Followed by flat lying on bed for 10 minutes.

Cardiovascular Exercise are exercises to enhance cardiovascular system capacity. Done at least twice per week, with most programs conducted three to five or more times weekly. The contraction of major muscle groups must be repeated often enough to elevate the heart rate to a target level determined during testing. Used in cardiac rehabilitation, or as a preventive measure.

Corrective Exercise are exercises planned and performed to attain a specific physical benefit, such as maintenance of the range of motion, strengthening of weakened muscles, increased joint flexibility, or improved cardiovascular and respiratory function. Endurance Exercise Involvement of several large groups of muscles and is dependent on the delivery of oxygen to the muscles by the cardiovascular system; used in physical fitness programs as well as cardiovascular and pulmonary function testing.

Isokinetic exercise are dynamic muscle activity performed at a constant angular velocity. Isometric Exercise (Iso= Same, Metric-Length) Active exercise performed against constant resistance, without change in the length of the muscle.

Isotonic Exercise(Iso= Same, Tonic= Tone) are active exercise with negligible change in the force of muscular contraction, with shortening of the muscle.

Kegel Exercises- Exercise for strengthening of pelvic floor and prevention urinary incontinence. Performed by a series of contractions and relaxations of perineal muscles. Done with the help of Kegel’s Exerciser.

McKenzie Exercise are exercise regimen used in the treatment of low back pain and sciatica, prescribed according to findings during mechanical examination of the lumbar spine and using a combination of lumbar motions, including flexion, rotation, side gliding, and extension. It is sometimes referred to as McKenzie extension exercises, but this is a misnomer because the regimen involves movements other than extension.

Muscle-Setting Exercise (Static Exercise) are voluntary contraction and relaxation of skeletal muscles static/constant muscle length or moving the associated part of the body.

Passive Exercise Movement or motion done to a body part or segment by another individual, machine or outside force or by voluntary effort of another segment of patient's own body.

Pelvic Floor Exercise-Combination of strength and endurance exercises of pelvic floor muscles (circumvaginal or perianal). These are used in stress urinary incontinence; the patient is taught to isolate and contract muscles 103 times daily.

Quadriceps Setting Exercise - Isometric exercise to strengthen (Quadriceps) muscles needed for ambulation. The patient is instructed to contract the quadriceps muscle while at the same time elevating and dorsiflexing the heel and pushing the knee toward the mat.

Range Of Motion (ROM) Exercises are exercises that move joint through its full range of motion, that is, to the highest degree of motion of which joint normally is capable; they may be either active or passive.

Examples of range of motion exercises:


 * Flexion: The bending of a joint in the body.(angle between the joint decreases)
 * Extension: A movement opposite to that of flexion in which a joint is in a straight position.
 * Rotation: Pivoting a body part around its axis, as in shaking the head.
 * Adduction: Moving toward the midline of the body or to the central axis of a limb.
 * Abduction: A movement of a limb away from the median plane of the body; the fingers are abducted by spreading them apart.
 * Circumduction: A combination of movements that cause a body part to move in a circular fashion.(combination of all movements like flexion,extension,abduction and adduction).
 * Supination: Extension of the forearm to bring the palm of the hand upward.
 * Pronation: Movement of the forearm in the extended position that brings the palm of the hand to a downward position.
 * Inversion: Movement of the ankle to turn the sole of the foot medially.
 * Eversion: Movement of the sole of the foot laterally.

Resistive Exercises-performed against an opposing force(as tolerated by a person) to increase muscle strength.Resistance applied may be either isometric,isotonic or isokinetic.

Static Stretching Exercise-placement of muscles and connective tissues at their maximum length by a constant force in the direction of lengthening.

Strengthening Exercises- also known as force increasing exercises, prescribed to a person who shows weakness in individual muscles or muscle groups. Performed with relatively high resistance, but with few repetitions(3 to 10) followed by 1-2 minutes of rest.It is performed daily in early stages of rehabilitation.

Electro Therapy
The therapeutic use of electricity to the human body as in the treatment of pain,paralysis or muscles weakness. Numerous modalities are in use like Ultrasonic therapy(UST),Transcutaneous Electrical Nerve Stimulation(TENS),Interferential Therapy(IFT),Laser,Shock wave Therapy,Diathermy[Long, Short, Micro](Continuous or pulse Mode),Traction(Cervical or Lumbar) and many more.

Ultrasonic Therapy (UST)
Defined as a high frequency acoustic energy,available in longitudinal waveforms in frequency range of .5 to 3.5 MHz. Most commonly used frequencies for treatment purpose in UST are .75 to 3.0 MHz(1 MHz = 1,000,000 cycles/second).

'Indications For UST'

i-Acute soft tissue injuries.

ii-Inflammation of joint capsules,tendons,bursa & ligaments associated with degenerative & inflammatory disorders like osteoarthritis,rheumatoid arthritis,repetitive stress injuries,gout.

iii-Wound Healing.

iv-Chronic Indurate Oedema.

v-Scar Tissue.

'Contraindications For UST'

i-Vascular Conditions like Thrombophlebitis or Phlebothrombosis.

ii-In Burger's disease,atherosclerosis,varicose veins or any other conditions where blood supply is poor or insufficient.

iii-Infected Lesion like Cellulites,Abscess or Carbuncles.

iv-Areas near Malignant Tumor.

v-Areas around Pregnant women uterus.

vi-Person with Metal or plastic Implants.

TENS
TENS or "Trans-cutaneous Electrical Nerve Stimulation" is a modern non invasive, drug free pain management electro therapeutic modality(electroanalgesia). Frequently used for acute or chronic pain in neck,back,joint pain of shoulder or knee etc, work or sports related injuries e.g. carpal tunnel syndrome,postural musculo-skeletal pain due to faulty work culture.

Types Of TENS


 * High Rate TENS-
 * Pulse Rate- 50-100 Hertz
 * Pulse Width- 50-100 µs(micro second)
 * Treatment Time-30-60 minutes/session or 7-9 hours(if required)
 * Uses- Acute & post operative pain, increased Muscle tone.
 * Low Rate TENS-
 * Pulse rate- 1-5 Hertz
 * Pulse Width- 150-300 µs
 * Treatment Time- 15-30 minutes/session
 * Uses- Chronic pain,Shows good results on tissues/skin of diabetic neuropathy,neuralgia where long pulse width is needed
 * Brief Intense TENS-
 * Pulse Rate- 80-150 Hertz
 * Pulse Width- 40-250 µs
 * Treatment Time- 10-20 minutes
 * Uses- Acute or chronic pain.
 * Burst Mode TENS-
 * Pulse Rate-50-100 hertz(delivered in bursts mode with 1-4 pulses/second)
 * Pulse Width-50-200 µs
 * Treatment Time- 25 minutes
 * Uses- Chronic muscle spasm, Neuro-musculo-skeletal pain like sciatica syndrome.

Indications For The Use Of TENS

i-Musculoskeletal Pain like joint pain from osteoarthritis or rheumatoid arthritis,post operative pain,posttraumatic pain.

ii- Neurogenic Pain like pain after spinal cord injury,trigeminal neuralgia,brachial plexus avulsion etc.

iii- Visceral Pain & dysmenorrhea.

iv- Headache,Migraine, Toothache.

Contraindications For The Use Of TENS

i-Person with metal or Plastic Implant.

ii-Over chest wall of cardiac patients.

iii-Over Larynx,eyes,pharynx or mucosal membrane.

iv-Head or neck region of patient with recent history of epilepsy or stroke.

Interferential Therapy (IFT)
It is a form of electrical treatment in which two medium frequency sinusoidal currents(4000 to 5000 Hz) are used to produce a low frequency current effect.

Principle

The IFT works on interference effect where 2 medium frequency currents cross in the patient's tissues.One current is kept constant at 4000 Hz, while frequency of another keep varying between 3900-4000 Hz. An interference effect at a "beat frequency"(difference between two medium frequency currents) is produced where the current cross(low frequency current effect produced at the desired point by changing the point of electrodes).

Indications For The Use Of IFT 

i- Pain Relief.

ii- Muscle Stimulation.

iii- Increased Blood Flow.

iv- Wound healing & tissue repair.

v- Reduction of oedema.

Contraindications For The Use Of IFT

i-Person with metal or Plastic Implant.

ii-Over chest wall of cardiac patients.

iii-Patients with skin problem eg skin cut,dermatitis.

iv-Pregnant women's uterus.

v- Malignant Tumor.

LASER
LASER stands for Light Amplification by the Stimulated Emission Of Radiation.

Compressed light of a wavelength from cold red part of the spectrum of electromagnetic radiation,it is monochromatic(single wavelength & color),Coherent(travel in a straight line) & polarized(concentrates its beam in defined location or spot).

LASER Regulation

Classified by the FDA's center for Devices and Radiological Health based on the Accessible Emission Limit.

Class Level Of LASER:-

I -laser radiation are not considered to be hazardous.

2 IIa levels of laser radiation are not considered to be hazardous if viewed for any period of time < 1*1000seconds,considered to be a chronic viewing hazard for any period of time > 1*1000seconds.

3-II levels of laser radiation are considered to be a chronic viewing hazard.

4- IIIa levels of laser radiation are considered to be, depending upon the irradiance, either an acute intrabeam viewing hazard or chronic viewing hazard, and an acute viewing hazard if viewed directly with optical instruments.

5- IIIb levels of laser radiation are considered to be an acute hazard to the skin and eyes from direct radiation.

6- IV levels of laser radiation are considered to be an acute hazard to the skin and eyes from direct and scattered radiation.

Types Of LASER

4 types of LASER-

1-Crystal & glass (solid -rod) - Synthetic Ruby.

2-Gas (Chamber) - HeNe, Argon, CO2.

3-Semi conductor(Diode channel) -Gallium Arsenide.

4-Liquid (Dye)- Organic dye as Lasing medium

Indications For the Use Of LASER
i-Soft Tissue Injuries.

ii-Pain.

iii-Osteoarthritis & rheumatoid arthritis.

iv-Fracture.

v-Open Wound.

vi-Diabetic & Pressure ulcer.

Contra Indications For the Use Of LASER

i-Application over or around eyes.

ii-Malignant or cancerous cells.

iii-Pregnant women uterus.

iv-Over and around Thyroid or endocrine glands.

v- Epiphyseal Plates in children.

vi-Over vagus nerve.

vii- Over cardiac region.

viii- Patients who have been previously treated with photo sensitizers.

Shock Wave Therapy
Shock Wave Therapy or Extracorporeal Shock Wave Therapy- involves direct bursts of high pressure sound waves at the affected area.Useful in the treatment of Tennis Elbow,Plantar Fascitis,Calcaneal Spur etc.

Characteristics Of Shock Wave Therapy

-Peak Pressure - typically 50-8- MPa(MegaPascals){according to ogden et al 2001} and 35-120 MPa {according to speed,2004}.

-Fast Pressure Rise- usually less than 10 ns(nanoseconds).

-Short duration -Usually about 10 µs(microseconds).

-Narrow effective beam- 2-8 mm(millimeter) diameter.

Indications For Shock Wave Therapy

i-Tennis & golfer elbow.

ii-Plantar Fascitis.

iii- Calcaneal Spur.

iv-Jumper's Knee.

v- Achilles Tendon.

vi-Calcifying Tendinitis of Shoulder.

Contraindications For Shock Wave Therapy

i- Epiphyseal Region should be avoided.

ii-Malignant or cancerous cells.

Specialty areas
Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific practice. While there are many specialty areas in physical therapy, the following are the five most common specialty areas in physical therapy:

Cardiopulmonary
Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of patients with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing patient endurance and functional independence. Manual therapy is utilized in this field to assist in clearing lung secretions experienced in patients with cystic fibrosis. Patients with disorders including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis are only a few examples of those who would benefit from cardiovascular and pulmonary specialized physical therapists.

Geriatric
Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.

Neurological
Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common problems of patients with neurological disorders include paralysis, vision impairment, poor balance, inability to ambulate, and loss of functional independence. Therapists work with patients to improve these areas of dysfunction.

Orthopedic
Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system as well as rehabilitate patients post orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post operative joints, acute sports injuries, arthritis, and amputations. Joint mobilizations, strength training, hot/cold packs, and electrical stimulation (e.g., cryotherapy, iontophoresis, electrotherapy ) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging treatment in this field is the use of sonography to guide treatments like muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric
Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, and torticollis are a few of the patients treated by pediatric physical therapists.


 * Another PT specialty area is Integumentary (treatment of conditions involving the skin and related organs).

United States
In the U.S., physical therapists must have a graduate degree from an accredited physical therapy program before taking the national licensing examination. Federal law also requires physical therapists to pass the National Physical Therapy Examination after graduating from an accredited physical therapist educational program before they can practice. Also physical therapists must apply for a state license to practice. Each state regulates licenses for physical therapists independently.

According to the American Physical Therapy Association, there were 210 accredited physical therapist programs in 2008–of those 23 offered the Master of Physical Therapy, and 187 offered the Doctor of Physical Therapy (DPT) degree. Most programs are in transition to a DPT program.

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Programs abroad
As with many aspects of the profession, physical therapy training varies considerably across the world. As a rule, physical therapy studies involve a minimum of four years of tertiary education. Some examples are described here.


 * In the United Kingdom, university degrees tend to be three rather than four years in length, as British students historically specialise earlier in their education than in most other developed countries. In order to qualify, students are required to complete 1000 hours of clinically based learning: this typically takes place in the final two years; however, some courses also have clinical placement in the first year.  Thirty-five universities and tertiary level institutions train physiotherapists in the UK. The vast majority of physiotherapists work within the National Health Service, the state healthcare system.


 * In Turkey, the Physiotherapy (BPT) education is provided by physiotherapy schools in universities (Hacettepe University, Dokuz Eylül University, İstanbulUniversity, Baskent University, Pamukkale University, Dumlupınar University, Süleyman Demirel University) after high school education. Education takes 4 years or 5 years with preb classes. MSc and Ph.D. education is given by institutes of medical sciences.


 * In Bangladesh, the Bachelor of Physiotherapy (BPT) course is provided by the Medicine Faculty of University of Dhaka. There are two affiliated institute who provides 4 years of Professional education including one year mandatory internship. Those are Bangladesh Health Professions Institute (BHPI) situated at Savar and the another one is National Institute of Traumatology Orthopaedic and Rehabilition, situated at Dhaka. Bangladesh Physiotherapy Association and Bangladesh Physiotherapy Society are two professional body of Physiotherapy here. Recently Bangladesh Physiotherapy Association has got the Professional Recognistion from WCPT at 2007, Vancouver. Presently BPA Members are working for the Registered Interest Group of IFOMT to develop Orthopaedic Manipulative Therapy skills in here. But its a great Regrat that in Bangladesh Government still dont take any step for Posts of Physiotherapits.


 * In Pakistan there are 8 colleges offering Bsc. Physiotherapy and 2 colleges offering Msc in PT.physical therapist have a good scope in government and private hospitals and they are awarded 17 grade pay scale.


 * In Australia, where physical therapy is called physiotherapy, a few different programs are available. The physiotherapy degree can be undertaken over a four-year period with the early components being predominantly theoretical including basic anatomy, biology, physics, psychology, kinesiology, goniometry and physiology. In the latter half of the degree students partake in practical components focusing on musculoskeletal physiotherapy, neuromuscular physiotherapy (notably Souvlis pain mechanisms), paediatric physiotherapy, geriatric physiotherapy, cardiothoracic physiotherapy, and women's health.  The program generally progresses with an increasingly clinical focus and usually the final year involves practical placements at clinics, and research.  These programs are usually offered to those with no prior degree and graduate with the (B.Physio) degree.


 * In Canada, entry-level physiotherapy education is offered at 13 universities. Many of these university programs are at the Master's level, meaning that applicants must have already completed an undergraduate degree prior to applying.  (All entry-level programs in Canada are slated to be at the Masters level by 2010.)  Many universities also offer graduate programs in physiotherapy, rehabilitation, or related disciplines at the masters or doctoral level.  Many physiotherapists may advance their education at these levels in such Clinical Practice Areas as cardiorespirology, geriatrics, neurosciences, orthopaedics, pediatrics, rheumatology, sports physiotherapy, and women's health.


 * In New Zealand, there are currently two schools of physiotherapy offering four-year undergraduate programs. Many New Zealand physiotherapists work in the private health care system as musculoskeletal physiotherapists and the curriculum reflects the need to prepare graduates for autonomous practice.  Students follow an educational program similar to Australia with an emphasis on biomechanics, kinesiology and exercise.  Postgraduate study typically involves three years of subject specific learning.


 * In the Philippines, physical therapy programs are generally 5 years in length and award the B.S. Physical Therapy degree upon graduation. The program consists of 2 years of general education, 2 years of physical therapy subjects, and a final year of internship & research/thesis. Some schools require students to complete a full 12 months of internship while other schools only require 10. During the internship year, students are required to fulfill clinical affiliations with hospitals, outpatient clinics, and other healthcare facilities. Due to the healthcare structure in the Philippines, clinics and therapy departments are often headed by a Physiatrist who writes out specific treatment orders for the PT to follow, and majority of the treatments are cash-based since not a lot of people have health insurance. Recently, the M.S. Physical Therapy postgraduate program has been made available by the University of Santo Tomas (Manila, Philippines). Once a student graduates from the BSPT program, he/she is then required to pass a national licensure exam administered by the Professional Regulation Commission. The said paper-based exam is a grueling 2 day ordeal which consists of approximately 730 questions. It is only administered twice a year and the names of those who pass the exam are published in several national newspapers. Those who pass the exam become licensed PTs and are then entitled to add the initials PTRP (Physical Therapist Registered in the Philippines) after their name.


 * In South Africa the degree (B.PhysT, B.Sc Physio or B.Physio) consists of four years of general practice training, involving all aspects of Physiotherapy. Typically, the first year is made up of theoretical introduction.  Gradually, time spent in supervised practice increases until the fourth year, in which the student generally spends about 80% in practice.  In the fourth year, students are also expected to complete Physiotherapy research projects, which fulfills the requirements of an Honours degree.  Professional practice and specialization can only be entered into after a state governed, compulsory year of community service is completed by the student after graduation.


 * In the United Arab Emirates the Bachelor Of Physiotherapy (BPT) consists of a 4 year undergraduate degree program. In the first year of the program they are introduced to pre-clinical subjects such as Anatomy, Physiology, Biochemistry, Human Behaviour & Socialisation & Basic Medical Electronics & Computers. The students also get hands on experiences in cadaveric dissections while learning Human Anatomy during the first year of the program. The students progressively are introduced to supervised clinical practice and the integrated curriculum offers the best learning experiences in addition to extensive inhouse elearning programs. The course offers Case Based Learning experiences and focusses on Evidence Based Practices. The program culminates with a six month internship ending with a research project work.


 * In Spain a physiotherapy student is required to complete 3 years of training after having passed a university entrance exam. After completing a physiotherapy program, another exam can be taken to work for the public health system of an autonomous community, or a graduate can work for private hospitals, clinics, etc. There are 43 universities with physiotherapy faculties in Spain.


 * In the Republic of Ireland, Physiotherapy is available as an undergraduate course in four universities, Trinity College, University College Dublin, Royal College of Surgeons and University of Limerick. Courses are four years in length with clinical practice in the final two years.  Students are required to complete 1000 hours of clinical practice before graduation.


 * In India, universities offer undergraduate program of physiotherapy with four years of academic and clinical program and 6 months of compulsory internship. There are over 250 collages offering undergraduate program in physiotherapy (BPT) and more than 50 collages offering masters in Physiotherapy (MPT) with 2 years duration. PhD in Physiotherapy is offered in some universities of the states Maharashtra, Karnataka and Tamil Nadu.


 * In Sri Lanka, Physiotherapy is available as a Diploma course for 2 years in School of Physiotherapy & Occupational Therapy, which is affiliated to the National Hospital of Colombo from 1957. After the 6 months of classroom training students are sent to hospitals for clinical practice. During the 80's foreign students from Australia, Belgium have studied at the Physiotherapy School. From the year 2005 Medical Faculties of University of Peradeniya & University of Colombo have started the undergraduate course for 4 years.-->

Evidence-based practice
For decades, physical therapy practice has been the subject of criticism for its lack of a research base. In a late 1990s survey of English and Australian physical therapists, fewer than five percent (5%) of survey respondents indicated that they regularly reviewed scientific literature to guide practice decisions. Despite an overall positive attitude towards evidence-based practice, most physical therapists utilized treatment techniques with little scientific support. Although numerous calls have been made for a shift toward the use of research and scientific evidence to guide practice decisions, at least throughout the 1990s, "most physical therapists continued to base practice decisions largely on anecdotal evidence."

To overcome these limitations, the World Confederation for Physical Therapy, the American Physical Therapy Association (APTA), and a number of authors have called on the profession to adopt and adhere to evidence-based practices formally based on the best available scientific sources.

Journals and publications
Physical therapists have access to a wide range of publications and journals. Some are dedicated solely to physical therapy topics, while others (e.g., various orthopedic and surgical journals) cover a broader range of health-improvement topics, including physical therapy.