Doing things you never imagined: Professional and ethical issues in the U.S. outpatient physical therapy setting during the COVID-19 pandemic.
Rebecca Edgeworth Ditwiler, Laura Lee Swisher, Dustin Dean Hardwick
PMID 36356408WHAT IT FOUND
Outpatient physical therapists reported that safety measures like masking and distancing compromised their ability to use touch and communicate empathy.
They faced ethical pressure to prioritize productivity over care quality, and struggled to manage patient conflicts over masks and vaccines.
Key findings
01Safety measures such as masks and physical distancing hindered verbal and non-verbal communication, reduced empathy, and restricted the use of manual therapy and touch, which participants viewed as essential to quality care.
02Financial pressures and productivity expectations exacerbated pre-existing ethical dilemmas, leading to concerns about double-booking, pushing telehealth for inappropriate candidates, and providing services beyond patient needs.
03Therapists experienced significant discomfort and moral distress due to politicized environments, including conflicts with patients and staff over masks, vaccines, and misinformation, often lacking clear organizational policies to guide these interactions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study only included physical therapists; no physical therapist assistants (PTAs) were recruited, so their experiences are missing. Findings are specific to the United States outpatient setting and may not apply to other countries or healthcare systems. Participants were recruited through professional networks, which may bias the sample toward those more engaged with professional associations. Virtual interviews may have limited the observation of non-verbal cues and affected the candor of responses.
Declared interests
The study was supported by the University of South Florida Center for Neuromusculoskeletal Research. The funders had no role in the study. No competing interests were declared.
The easy way to misread this
Do not interpret these findings as evidence that safety measures reduced clinical outcomes or patient recovery rates. The study reports therapists' perceptions of compromised care quality and ethical distress, not measured clinical efficacy or patient outcomes.