PHARMACOLOGIC COMPONENTS OF PHYSICAL THERAPY AND PATIENT MANAGEMENT
In Florida, state law gives physical therapists the right to administer topical medications. Pursuant to a physician’s prescription for the patient, a physical therapist may retain custody of that patient’s nonscheduled legend topical medications and administer those medications to that patient. All prescription medications used in physical therapy treatment shall be properly dispensed by a Florida licensed pharmacist and administered only to the patient for whom the prescription was authorized (FLBPT, 2021).
It is within the physical therapists’ professional scope of practice to administer and store medication to facilitate outcomes of physical therapy patient management. Physical therapists use medications for treatment of musculoskeletal conditions such as plantar fasciitis, tendonitis/bursitis, rheumatoid arthritis, and enthesopathic conditions. The specific medication used depends on the treatment goals. Goals that may benefit from the concomitant use of medications include, but are not limited to:
- Reducing pain
- Reducing inflammation
- Promoting integumentary repair and/or protection
- Facilitating airway clearance and/or ventilation respiration
- Facilitating functional movement
(APTA, 2018b)
Administering Iontophoresis Medications
The most common drug administered by iontophoresis in physical therapy is dexamethasone, an anti-inflammatory medication used to treat localized inflammation occurring in conditions such as tendonitis or bursitis. Other common iontophoresis medications include:
- Acetic acid, which decreases calcium deposits in musculoskeletal tissue and is indicated for conditions such as adhesive capsulitis (frozen shoulder), calcific tendonitis, or myositis ossificans
- Chlorine, a negatively charged ion used to treat scar tissue and keloid scars
- Calcium chloride, which helps decrease muscle spasm that may accompany a home exercise program to maintain muscle function
- Iodine, which improves local blood flow to tissues and may be used to treat sclerotic conditions such as frozen shoulder
- Magnesium sulfate, used to treat muscle spasm
- Hyaluronidase, used to treat soft tissue edema or swelling following surgery or injury to help manage edema in the acute or chronic stages of healing
- Tap water, using either positive or negative electrode, during hand or foot immersion bath to treat hyperhidrosis
(Sears, 2020)
Medication Management
Physical therapists must keep their skills and knowledge current to ensure patient safety. This includes knowledge of and ability to monitor for intended effects, side effects, and adverse drug reactions related to a patient’s medication regimen.
Physical therapists may serve as the first provider for patients and as the first provider following discharge. Addressing medications in a drug regimen review and medication reconciliation are an integral part of physical therapy practice to help ensure appropriate patient care is delivered and optimal clinical outcomes are obtained.
Changes made in medication regimens may impact functional status and/or ability. An important concern is functional decline associated with diminished ability to perform instrumental activities of daily living and decreased physical functioning. Physical therapy practitioners are well positioned to help monitor, identify, and communicate associated findings related to medications to appropriate providers (Adamski et al., 2019).
Like other clinicians, the physical therapist should be familiar with the list of high-risk/high-alert medications for the facility where employed and should be watchful for potential injury, especially when a patient is receiving an anticoagulant such as warfarin or heparin. Physical therapists must recognize that medication absorption can be affected by modalities such as exercise or hot and cold applications.