By Ryan Towns, DPT
Cadence Physical Therapy Co, Buffalo Grove
The outcome of a patient's physical therapy experience depends on the frequency per week of physical therapy visits.
In a study conducted by Bastan et al. (2017), there was 669 patients treated in physical therapy clinics for a variety of injuries. Of the patients who completed their plan of care; 62% came at least twice per week or more. There was no other significant correlation between successful discharge factoring in the following characteristics: gender, patient gender, patient age, amount of copay, PT experience, and several canceled appointments.
First, to fully understand the importance of maintaining the frequency of visits in outpatient PT, it is essential to discuss the pathophysiology of such injuries. One of the most common injuries to occur are muscle strains, stretching or tearing of muscle fibers. These strains can be classified based on the clinical impairment and severity of tear into 3 categories: mild (grade I), moderate (grade II), and severe (grade III).
• Grade 1 strain or mild tear - just a few muscle fibers are stretched or torn. This is with minor swelling and discomfort.
• Grade 2 or moderate strain- more severe muscle pain and tenderness. There is also mild swelling, noticeable loss of strength, and sometimes a bruise.
• Grade 3 - tears the muscle all the way through, sometimes causing a "pop" sensation. This is a serious injury that causes loss of muscle function.
Such injuries' healing process has 3 phases: destruction phase, repair phase, and remodeling phase.
• Destruction phase - the destruction of the tissue itself. Occurs during the 1st few days after injury.
• Repair phase - This is where the clean up of dead tissue and dry blood around the injury occurs. Then it will create new muscle fibers that usually occur within 5-6 days.
• Remodeling phase - new muscle fibers combine with the undamaged one. This is where Physical Therapy plays an important role. PT can guide the regenerating muscle tissue and the scar tissue to avoid clumping that usually causes tightening and shortening of the muscles.
For most musculoskeletal injuries, patients see the greatest and fastest improvements in physical therapy when they are scheduled for 2-3 visits per week for multiple reasons:
1. It allows enough time to improve the regrouping of muscle fibers and avoid any muscle deformity
2. The Doctor of Physical Therapy can closely monitor any changes in status or functional ability, maintain/reduce pain levels, prevent re-injury, and reduce costs of healthcare that might be needed for continued doctor's visits.
In a study conducted by Minetama et al. (2020), 124 spinal stenosis patients were selected and assigned to 3 groups for 6 weeks: 38 patients had physical therapy (PT) 1 time per week, 43 patients PT 2 times per week, and 43 only had a home exercise program.
The study results concluded that the group who received PT 2 times per week had the highest physical function questionnaire scores, lowest symptom severity, and least amount of gait disturbances compared to the other 2 groups. Therefore, receiving PT at least 2 times per week resulted in the most significant short-term improvements in symptom reduction and physical function.
In conclusion, the number of treatments a patient attends each week plays a significant part in determining their rehabilitation success. Scheduling new patients for 2-3 visits per week with consistent attendance will significantly increase successful outcomes upon discharge.
1. Bastan M, Toher R, Nula M, Harvey J (2017). Association among select clinical data and successful completion of a treatment plan in an outpatient orthopaedic physical therapy setting. Orthopaedic Practice; 29(4): 200-202.
2. Jarvinen TA, Jarvinen M, Kalimo H (2014). Regeneration of injured skeletal muscle after the injury. Muscles Ligaments Tendons J; 3(4): 337-345.
3. Minetama M, Kawakami M, Teraguchi M, Kagotani R, Mera Y, Sumiya T, Nakagawa M, Yamamoto Y, Matsuo S, Sakon N, Nakatani T, Kitano T, Nakagawa Y (2020). Therapeutic advantages of frequent physical therapy sessions for patients with lumbar spinal stenosis. SPINE; 45(11): E639-E646.