Physical Therapy in the Wound Clinic

Editor’s Note: In response to requests for information on how to incorporate physical therapists into outpatient wound care, Today’s Wound Clinic surveyed readers seeking feedback on this topic. The purpose of the anonymous survey was to gain a better understanding of how wound care clinics may be utilizing therapists. The results to our survey are included here. Thanks to those who participated!*

Question 1: What is your present clinical setting of employment? (Choose best answer.)

A. Acute care hospital (15%)
B. Long-term care (11%)
C. Extended-care facility (2%)
D. Hospital-based wound care center (42%)
E. Outpatient clinic – physical therapy facility (13%)
F. Other (18%)

Question 2: What is your role? 

A. Nurse (12%)
B. Physician (9%)
C. Podiatrist (3%)
D. Physical therapist (36%)
E. Clinic director (6%)
F. Manager/supervisor (15%)
G. Administrative (6%)
H. Other (13%)

Question 3: How many years of wound care experience do you have?

A. 0-5 (12%)
B. 6-10 (22%)
C. 11-15 (14%)
D. More than 15 (52%)

Question 4: Are you under a capitated or an accountable care organization model?

A. Yes (30%)
B. No (70%) 

Question 5: Do you work in a setting with other team members? (If yes, select all that apply.)

A. Physician (73%)
B. Physician’s assistant (25.4%)
C. Nurse practitioner (49.2%)
D. Nurse (75.4%)
E. Podiatrist (38.5%)
F. Physical therapist (43.4%)
G. Occupational therapist (35.2%)
H. Orthotist/prosthetist (12.3%)
I. Vascular surgeon (36.9%)
J. Infectious disease (31.1%)
K. Other (11.5%)
L. No (8.2%)

Question 6: Which of the following types of interventions are performed in your wound clinic? 

A. Gait evaluation and training (40%)
B. Seating evaluation (35.8%)
C. Therapeutic exercises (39.2%)
D. Functional mobility (37.5%)
E. Lymphedema treatment (45.8%)
F. Pressure injury prevention (72.5%)
G. Ultrasound [traditional] (25%)
H. Low-frequency ultrasound [contact] (19.2%)
I. Low-frequency ultrasound [noncontact] (25%)
J. Sharp debridement [not surgical or excisional] (86.7%)
K. Electrical stimulation (33.3%)
L. Total contact cast (66.7%)
M. Offloading (72.5%)
N. Compression [multilayer] (90%)
O. Unna’s boot (66.7%)
P. Hyperbaric oxygen therapy (40.8%)
Q. Orthotic fitting (23.3%)
R. Pulse lavage (31.7%)
S. Negative pressure wound therapy (86.7%)
T. Other (11.7%)

Question 7: Does your wound clinic utilize a physical therapist?

A. No (31%)
B. Consultant basis only (9%)
C. Yes, housed in wound clinic (34%)
D. We refer to outpatient physical therapy facility (18%)
E. Other (9%) 

Question 8: Does your physical therapist have wound-specific credentials?

A. No (46%)
B. Yes, certified wound specialist [CWS] (35%)
C. Yes, wound care certified [WCC] (2%)
D. Yes, certified lymphedema therapist [CLT](6%)
E. Yes, other (11%)

Question 9: Do you work in a setting where both nurses and physical therapists treat wounds?

A. Yes (37%)
B. No (63%)

Question 10: What percentage of time does physical therapy spend in wound care in your facility?

A. 0-25% (61%)
B. 26-50% (5%)
C. 51-75% (4%)
D. 76-100% (30%)

Question 11: Which of the following interventions are performed by a physical therapist in your facility? 

A. Gait evaluation and training (61.4%)
B. Seating evaluation (37.7%)
C. Therapeutic exercises (57.9%)
D. Functional mobility (54.4%)
E. Lymphedema treatment (36.8%)
F. Pressure injury prevention (43.0%)
G. Ultrasound (traditional) (21.9%)
H. Low-frequency ultrasound [contact] (17.5%)
I. Low-frequency ultrasound [noncontact] (23.7%)
J. Sharp debridement [not surgical or excisional] (47.4%)
K. Electrical stimulation (38.6% )
L. Total contact cast (31.6%)
M. Offloading (43%)
N. Compression [multilayer] (45.6%)
O. Unna’s boot (26.3%)
P. Hyperbaric oxygen therapy (8.8%)
Q. Orthotic fitting (15.8%)
R. Pulse lavage (28.1%)
S. Negative pressure wound therapy (41.2%)
T. Other (8.8%)
U. None (25.4%)

Question 12: Does the physical therapist complete (document) a plan of care in your facility?

A. Yes, under a physical therapy plan of care (50%)
B. Yes, under the physician plan of care (6%)
C. No, no plan of care for physical therapy is established (28%)
D. Other (6%)
E. Unsure (10%)

Question 13: How is your facility billing for physical therapy services? 

A. Not sure (66.7%)
B. Other (33%)

Question 14: How is your facility billing for physical therapy services? 

A. Not sure (51.9%)
B. Under place-of-service code 02 [telehealth] (1.9%)
C. Under place-of-service code 11 [office] (4.7%)
D. Under place-of-service code 15 [mobile unit] (1.9%)
E. Under place-of-service code 22 [on-campus outpatient] (18.9%)
F. Under place-of-service code 31 [skilled nursing facility] (7.5%)
G. Under place-of-service code 32 [nursing home] (5.7%)
H. Under place-of-service code 62 [comprehensive outpatient rehabilitation facility] (6.6%)
I. Other (21.7%)

*Note: The original survey was 16 questions long. Two questions were open-ended and are not listed in these results. If you would like to see those specific results, send an email request to jdarrah@hmpglobal.com

As part of our August edition on Podiatry and Offloading in the Wound Clinic, TWC asked our readers: “What are your go-to products/modalities for offloading in the wound clinic?”

Here are the Top 5 results. Thanks to all those who participated! 

1. Total Contact Casting
2. Offloading Boots and Shoes
3. Felt and Felted Foam
4. Insoles
5. Wedges