Physical Therapists Have a Long History and Bright Future in Wound Care

Published on May 17, 2021 by Carole Jakucs, MSN, RN, PHN, CDCES

physical therapist treats veteran

When some think of wound care providers, they don’t typically think of of physical therapists (PTs). But many PTs are actively engaged in wound care and committed to making progress in the field.

So many PTs practice wound management that the American Physical Therapy Association (APTA) has a component group known as the Academy of Clinical Electrophysiology and Wound Management (ACEWM).

The ACEWM consists of nearly a thousand physical therapists and students interested in electrophysiology, biophysical agents, wound management, and neuromusculoskeletal ultrasonography. Within the ACEWM is another group known as the Wound Management Special Interest Group (WMSIG) whose focus is solely on wound management.

WCEI spoke with Patricia Larkin-Upton, PT, DPT, MS, CWS, CEEAA, vice chair of the ACEWM and WMSIG. Larkin-Upton collaborated with the WMSIG board of directors and the ACEWM president and vice president to provide insight into the history of these wound care organizations and some goals they have for the future.

Q: How did wound management evolve as one of the many functions of PTs?

A: During WWI, the British Army established the division of Special Hospitals and Physical Reconstruction. Its purpose was to help restore wounded soldiers back to duty or civilian life and help them function at their highest possible level.

The U.S. Army also began to rehabilitate wounded soldiers with injuries such as amputations, burns, fractures, open wounds, and spinal cord injuries. A new group of healthcare providers known as reconstruction aides was developed to assist in rehabilitating this population. This led to the profession of physical therapy.

Today, entry into the profession as a physical therapist requires a doctoral-level degree compared to only a few weeks of training for reconstruction aides during WWI.

Due to their extensive education in pathophysiology, kinesiology, anatomy, physiology, and functional movement, PTs are uniquely qualified to identify and address skin and soft tissue breakdown associated with injury or underlying health conditions.

Physical therapists, as part of an interdisciplinary team, minimize local and systemic functional and integumentary deficits associated with cardiovascular disorders such as venous or arterial insufficiency and lymphedema; endocrine and metabolic disorders such as diabetes musculoskeletal, neuromuscular, pulmonary, and multisystem disorders and diseases; and traumatic injuries including burns, amputations, and pressure injuries.

Extensive didactic and clinical entry-level and post-professional training, wound examination, evaluation, and intervention such as sharp debridement, compression and physical agents, offloading, and functional training are all included within the scope of physical therapists’ practice.

Q: How, when, and why did the Wound Management Special Interest Group (WMSIG) come into existence?

A: The Section on Electrophysiological and Electrokinesiological Measurements (SEEM) was established in1974. The Medicare non-coverage of electric stimulation for wounds rule in 1985 sparked increased engagement and patient advocacy among wound management-focused physical therapists.

The section became a natural home to APTA members interested in wound management.

In 1997, the Guide to Physical Therapist Practice was published. In it, ‘integumentary’ was recognized as one of the four primary physical therapist practice patterns.

In 1998, as member interest continued to increase, the WMSIG was established within the SEEM.

In 2005, the section recognized the strong emphasis on wound management by changing its name to the Section on Clinical Electrophysiology and Wound Management (SCEWM). Another name change in 2015 to the Academy of Clinical Electrophysiology and Wound Management (ACEWM), continued to reflect the strong influence of physical therapist involvement in wound management.

Q: Are there any new wound care/wound management guidelines within your organization and/or within the WC industry?

A: Yes. The ACEWM has a task force working on a diabetic foot ulcer clinical practice guideline that we hope will be ready for public review within the next year.

Regarding other wound care industry guidelines, the new National Pressure Injury Advisory Panel (NPIAP) Clinical Practice Guidelines were published in 2019. The APTA and ACEWM are collaborating organizations with the NPIAP.

Q: Are there any trends in wound management that you’d like to share with the readers?

A: We’d like to highlight physical therapists as movement experts and the critical role we play as part of the interdisciplinary wound care team.

Our educational background and training allow us to address biomechanical and mobility deficits that may contribute to wound development or result due to the presence of a wound.

Physical therapists reduce the risk for skin breakdown by addressing impairments of body functions and structures such as aerobic capacity, mobility, circulation, strength, joint mobility, and postural alignment.

Additionally, expertise in the application of interventions that positively impact skin health and wound healing, allow physical therapists to offer a holistic approach to wound management. We help patients return to function and attain a higher quality of life.

Q: What are some of your organization’s goals for 2021?

A: The ACEWM and WMSIG have several areas of focus and goals for the new year:

  • Support the continued use of telehealth. We’re excited about the recent opportunity for physical therapists to practice using telehealth. This has allowed many therapists to safely deliver physical therapy services to patients during the pandemic. We see this as a trend that will remain even after the pandemic.
  • Promote and encourage physical therapists to seek specialty certification in wound management and promote physical therapists as vital resources in wound management. We’re thrilled about the newly approved wound management clinical specialty certification to be offered through the American Board of Physical Therapy Specialties in 2022. We encourage all physical therapists who practice in wound management to consider application for this specialty exam.
  • Continue to facilitate the incorporation of contemporary skin and wound standards in entry-level physical therapist education programs. The ACEWM, in conjunction with the APTA, developed curriculum recommendations for entry-level physical therapist education programs that were first approved in 2007 with subsequent updates in 2014. The ACEWM expects to initiate the next update cycle in 2021.
  • Continue to encourage clinical and laboratory research through dissemination, mentorship, and collaboration.
  • Promote and facilitate inter-organization partnerships, collaboration, and communication to improve patient advocacy in wound management.

Take our engaging, evidence-based Wound Care Certification Courses for nurse, registered dietitians, physical therapists, and more professionals. Choose the format that suits you and get access to tools to help you ace your exam.

Carole Jakucs

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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