Meet Maintenance Physical Therapy
When an individual experiences significant injury or illness, a course of physical therapy is one of the most effective components of their recovery. Traditional or restorative physical therapy, the type of therapy most people are familiar with, focuses on – as the name implies, restoring the individual’s functionality immediately following the onset of the condition. Maintenance therapy differs from traditional, restorative, therapy in that improvement is not expected and return to the prior level of function is not anticipated. Generally, in these circumstances, a recent or clear incident of onset is not obvious, but chronic disease and/or disability is front and center. This course of therapy is intended to stabilize or slow the natural course of deterioration with a progressive condition or to prevent potential sequelae that may occur.
Maintenance therapy is frequently the appropriate course for medically complex patients. These services are typically delivered at a decreased frequency but with a much longer duration. For example, restorative therapy may be recommended 2-3 times a week for a month, while maintenance therapy might be recommended once a week in perpetuity.
The need for maintenance therapy does not depend on the patient’s restoration potential, but on whether skilled care is required (along with underlying reasonableness and necessity of the services). The clinical diagnosis on its own does not determine the appropriateness of a maintenance course of therapy, though many individuals suffering from chronic diseases such ALS or multiple sclerosis would benefit, as would some patients with complex orthopedic injuries, chronic pain or status post stroke for instance. When the therapeutic interventions cannot be safely and effectively carried out by the patient themselves or with the assistance of unskilled caregivers, maintenance therapy is useful.
At its core, maintenance therapy aims to support individuals to live as independently as possible, to stabilize or slow the progression of a chronic condition, and ensure their highest quality of life possible. Without this approach, certain individuals, especially those that are facing more medically complex conditions, are more likely to face functional decline and increased dependence on their support systems.
Medically Complex Individuals
A medically complex individual is one who has a condition which is emergent, persistent, and is substantially debilitating. These individuals often require constant care and support from a variety of specialists to address a diverse range of issues. Take someone with a complex chronic disease (CCD), who requires the attention of multiple healthcare providers, facilities, and possibly community or home-based care. Other potential examples include (but are not limited to) those who have spinal cord injuries (SCI), a traumatic brain injury, burns, chronic pain, ALS, Parkinson’s, and multiple sclerosis.
When to Use Restorative Therapy, Maintenance Therapy, or Both
If it is anticipated that the individual will improve and regain the same or similar functional level as before injury or illness, a course of restorative therapy will likely be the sole recommendation. Once discharged, with goals met, these individuals are expected to remain stable and are provided a home exercise program that can be carried out by a caregiver or the individual themselves independently.
However, if the individual is not expected to improve or regain their prior function, skilled maintenance therapy care works to stabilize this individual and slow their deterioration, as well as help preserve the recovered level of functionality. This may be especially prevalent in medically complex individuals, who may also periodically suffer adverse incidents or exacerbations that require additional courses of restorative therapy. In such cases, individuals may require alternating restorative and maintenance therapy. Because these individuals require frequent but varying levels of care and support, it is important to evolve and modify the programs with clinical judgement as needed.
A Comprehensive and Long-Term Plan
A medically complex individual would often benefit from a life care plan, which is a document that organizes and provides a concise roadmap for current and future care elements for an individual that has experienced catastrophic injury, or with other chronic healthcare needs. This plan would work to detail whether restorative therapy, maintenance therapy, or a combination of both would be the best course of treatment for the individual.
Every individual presents differently and has unique needs. By working closely with the individual’s doctors, current therapists, and other relevant specialists, a plan incorporating restorative and/or maintenance therapy can be created to support the individual’s immediate and long-term needs. With this comprehensive plan, each individual can achieve their maximum functionality and independence, and access the best quality of life that’s available to them.