The document outlines the evolution and scope of the physiotherapy profession, highlighting its recognition by the World Health Organization as an independent practice distinct from paramedical services. It traces the historical roots of physical therapy from ancient practitioners to modern-day practices, emphasizing the diverse settings in which physical therapists operate and their role in promoting, preventing, and rehabilitating human movement. The text also discusses the qualifications and responsibilities of physiotherapists, including their ability to provide comprehensive care and engage in research and health policy development.

1. Orientation to Physiotherapy
World Health Organization (WHO) has classified Physiotherapyas an IndependentPractice and out of
Paramedical stream
PHYSIOTHERAPISTS-(International Standard Classification of Occupations ISCO Code 2264)
DEFINITION:
"Physiotherapists assess, plan and implementrehabilitative programs thatimprove or restore human motor
functions, maximize movementability,relieve pain syndromes,and treator prevent physical challenges
associated with injuries,diseases and other impairments.They apply a broad range ofphysical therapies and
techniques such as movement,ultrasound,heating,laser and other techniques.They may develop and
implementprogrammes for screening and prevention ofcommon physical ailments and disorders"
International Standard Classification of Occupations(ISCO) is a tool for organizing jobs into a clearly defined
setof groups according to the tasks and duties undertaken in the job.
According to this code Physiotherapy is classified into a seperate entity and not clubbed with Paramedical
services
History
Physicians like Hippocrates and later Galen are believed to have been the first practitioners of
physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat
people in 460 BC.
The earliest documented origins of actual physical therapy as a professional group date back
to Per Henrik Ling, "Father of Swedish Gymnastics," who founded the Royal Central
Institute of Gymnastics (RCIG) in 1813 for manipulation, and exercise. The Swedish word
for physical therapist is sjukgymnast = someone involved in gymnastics for those who are ill.
In 1887, PTs were given official registration by Sweden's National Board of Health and
Welfare. Other countries soon followed. In 1894, four nurses in Great Britain formed
the Chartered Society of Physiotherapy. 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."Since the profession's inception, spinal
manipulative therapy has been a component of the physical therapist practice.
Modern physical therapy was established towards the end of the 19th century due to events
that had an effect on a global scale, which called for rapid advances in physical therapy. Soon
following American orthopedic surgeons began treating children with disabilities and began
employing women trained in physical education, and remedial exercise. These treatments
were applied and promoted further during the Polio outbreak of 1916. During the First World
War, women were recruited to work with and restore physical function to injured soldiers,
and the field of physical therapy was institutionalized. In 1918 the term "Reconstruction
Aide" was used to refer to individuals practicing physical therapy. The first school of
physical therapy was established at Walter Reed Army Hospital in Washington, D.C.,
following the outbreak of World War I. 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 American Women's Physical

2. Therapeutic 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.Around the
time that polio vaccines were developed, physical therapists became a normal occurrence in
hospitals throughout North America and Europe.In the late 1950s, physical therapists started
to move beyond hospital-based practice to outpatient orthopedic clinics, public schools,
colleges/universities health-centres, geriatric settings (skilled nursing facilities), rehabilitation
centers 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 orthopaedics. In the same year, the International Federation of Orthopaedic
Manipulative Physical Therapists was formed,which has ever since played an important role
in advancing manual therapy worldwide.
The foundation of Physiotherapy was laid in India in 1952 following a major epidemic of
poliomyelitis in Mumbai & soon in 1953 the first school & centre for Physiotherapy was
established in Mumbai as a joint collaborative project of Government of India, State
Government, & the then Bombay Municipal Corporation (BMC) with technical support by
World Health Organization (WHO). Slowly but steadily Physiotherapy formed a firm base
with the formation of its own association, The Indian Association of Physiotherapists (IAP),
in 1962.
Physical therapists have different titles in different countries: in many countries they are
called physiotherapists. Some countries have their own version of the word physical therapist,
such as kinesiologist. They are all part of the same profession.
Physical therapists provide services that develop, maintain and restore people’s maximum
movement and functional ability. They can help people at any stage of life, when movement
and function are threatened by ageing, injury, diseases, disorders, conditions or
environmental factors.
Physical therapists help people maximise their quality of life, looking at physical,
psychological, emotional and social wellbeing. They work in the health spheres of promotion,
prevention, treatment/intervention, habilitation and rehabilitation.
Physical therapists are qualified and professionally required to:
 undertake a comprehensive examination/assessment of the patient/client or needs of a
client group
 evaluate the findings from the examination/assessment to make clinical judgments
regarding patients/clients
 formulate a diagnosis, prognosis and plan
 provide consultation within their expertise and determine when patients/clients need to be
referred to another healthcare professional
 implement a physical therapist intervention/treatment programme
 determine the outcomes of any interventions/treatments
 make recommendations for self-management.

3. In addition to clinical practice, other activities encompassed in the physical therapy
profession include research, education, consultation and administration. Physical therapy is
provided as a primary care treatment or alongside, or in conjunction with,
other medical services. In some jurisdictions, such as the United Kingdom, physical
therapists have the power to prescribe medication
The World Confederation for Physical Therapy (WCPT) advocates that the profession of
physical therapy is responsible for articulating the profession’s scope of practice and defining
the roles of physical therapists. National physical therapy associations are responsible for
defining physical therapy and physical therapists’ roles relevant to their nation’s health
service delivery needs, ensuring that they are consistent with accepted international
guidelines set out by WCPT. National physical therapy associations have a responsibility to
seek support for legislation/regulation/recognition which defines the distinctive and
autonomous nature of physical therapy practice, including the profession’s scope of practice.
The scope of physical therapy practice is dynamic and responsive to patient/client and
societal health needs. With the development of knowledge and technological advances,
periodic review is required to ensure that scope of practice reflects the latest evidence base
and continues to be consistent with current health needs. Research is continually providing
new evidence upon which practice will be built.
The scope of physical therapist practice is not limited to direct patient/client care, but also
includes:
 public health strategies
 advocating for patients/clients and for health
 supervising and delegating to others
 leading
 managing
 teaching
 research
 developing and implementing health policy at the local, national and international levels
Physical therapists operate as independent practitioners , as well as members of health service
provider teams, and are subject to the ethical principles of WCPT. They are able to act as
first contact practitioners, and patients/clients may seek direct services without referral from
another health professional.
Physical therapists are guided by their own code of ethical principles.Thus, they may have
any of the following purposes:
 promoting the health and wellbeing of individuals and the general public/society,
emphasising the importance of physical activity and exercise

4.  preventing impairments, activity limitations, participatory restrictions and disabilities in
individuals at risk of altered movement behaviours due to health factors, socio-economic
stressors, environmental factors and lifestyle factors
 providing interventions/treatment to restore integrity of body systems essential to
movement, maximise function and recuperation, minimise incapacity, and enhance the
quality of life, independent living and workability in individuals and groups of
individuals with altered movement behaviours resulting from impairments, activity
limitations, participatory restrictions and disabilities
 modifying environmental, home and work access and barriers to ensure full participation
in one’s normal and expected societal roles
PTs use an individual's history and physical examination to arrive at a diagnosis and establish
a management plan and, when necessary, incorporate the results of laboratory and imaging
studies like X-rays, CT-scan, or MRI findings. Electrodiagnostic testing
(e.g., electromyograms and nerve conduction velocity testing) may also be used. PT
management commonly includes prescription of or assistance with specific exercises, manual
therapy and manipulation, mechanical devices such as traction, education, electrophysical
modalities which include heat, cold, electricity, sound waves, radiation, assistive devices,
prostheses, orthoses and other interventions. In addition, PTs work with individuals to
prevent the loss of mobility before it occurs by developing fitness and wellness-oriented
programs for healthier and more active lifestyles, providing services to individuals and
populations to develop, maintain and restore maximum movement and functional ability
throughout the lifespan. This includes providing therapeutic treatment in circumstances
where movement and function are threatened by aging, injury, disease or environmental
factors. Functional movement is central to what it means to be healthy. Physical therapy is a
professional career which has many specialties
including musculoskeletal, orthopedics, cardiopulmonary, neurology, endocrinology, sports
medicine, geriatrics, pediatrics, women's health, wound
care and electromyography. Neurological rehabilitation is in particular a rapidly emerging
field. PTs practice in many settings, such as private-owned physical therapy
clinics, outpatient clinics or offices, health and wellness clinics, rehabilitation
hospitals facilities, skilled nursing facilities, extended care facilities, private homes, education
and research centers, schools, hospices, industrial and this workplaces or other occupational
environments, fitness centers and sports training facilities.
Physical therapists also practice in the non-patient care roles such as health policy, health
insurance, health care administration and as health care executives. Physical therapists are
involved in the medical-legal field serving as experts, performing peer review
and independent medical examinations.
Education varies greatly by country. The span of education ranges from some countries
having little formal education to others having doctoral degrees and post doctoral residencies
and fellowships.
The nature of the physical therapy process
Physical therapy is the service provided only by, or under the direction and supervision of, a
physical therapist. It includes examination/assessment, evaluation, diagnosis, prognosis/plan,
intervention/treatment and re-examination.
Examination/assessment includes:

5.  the examination of individuals or groups with actual or potential impairments, activity
limitations, participation restrictions or abilities/disabilities by history-taking, screening
and the use of specific tests and measures
 the evaluation of the results of the examination and/or the environment through analysis
and synthesis within a process of clinical reasoning to determine the facilitators and
barriers to optimal human functioning
Diagnosis and prognosis arise from the examination and evaluation and represent the
outcome of the process of clinical reasoning and the incorporation of additional information
from other professionals as needed. This may be expressed in terms of movement dysfunction
or may encompass categories of impairments, activity limitations, participatory restrictions,
environmental influences or abilities/disabilities.
Prognosis begins with determining the need for intervention/treatment and normally leads to
the development of a plan, including measurable outcome goals negotiated in collaboration
with the patient/client, family or caregiver. Alternatively, it may lead to referral to another
agency or health professional in cases that are inappropriate for physical therapy.
Intervention/treatment is implemented and modified in order to reach agreed goals and may
include:
 therapeutic exercise
 functional training in self-care and home management
 functional training work, community and leisure
 manual therapy techniques (including mobilisation/manipulation)
 prescription, application, and, as appropriate, fabrication of devices and equipment
(assistive, adaptive, orthotic, protective, supportive and prosthetic)
 airway clearance techniques
 integumentary repair and protection techniques
 electrotherapeutic modalities
 physical agents and mechanical modalities
 patient-related instruction
 coordination, communication and documentation
Intervention/treatment may also be aimed at prevention of impairments, activity limitations,
participatory restrictions, disability and injury including the promotion and maintenance of
health, quality of life, workability and fitness in all ages and populations.
Re-examination necessitates determining the outcomes.
Settings in which physical therapy is practised
Physical therapy is delivered in a variety of settings, which allow it to achieve its purpose.
Prevention, health promotion, treatment/intervention, habilitation and rehabilitation take
place in multiple settings that may include, but are not confined to, the following:
 community based rehabilitation programmes
 community settings including primary health care centres, individual homes, and field
settings
 education and research centres

6.  fitness clubs, health clubs, gymnasia and spas
 hospices
 hospitals
 nursing homes
 occupational health centres
 out-patient clinics
 physical therapist private offices, practices, clinics
 prisons
 public settings (eg shopping malls) for health promotion
 rehabilitation centres and residential homes
 schools, including pre-schools and special schools
 senior citizen centres
 sports centres/clubs
 workplaces/companies
References: Available upon request