PTs Who Specialize in Wound Care Play an Important Role

Wound care management teams involve different clinical specialties depending on the patient’s comorbidities and particular needs. Clearly, physical therapists (PTs) with specialized education can play a vital role in any wound care team.

Many PTs are actively engaged in wound care and committed to keeping up with the latest evidence-based practices 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).

About a thousand physical therapists and students interested in electrophysiology, biophysical agents, wound management, and neuromusculoskeletal ultrasonography form the ACEWM. Within the academy is another group known as the Wound Management Special Interest Group (WMSIG), which naturally focuses on wound management.

Relias 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 these wound care organizations and their priorities in the next few years.

Her insights can help you ensure that the physical therapists in your organization are up to speed on the latest developments in the fields of therapy and wound care.

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

A: During WWI, the British Army established a division to help restore wounded soldiers to duty or civilian life and help them function at their highest possible level.

The U.S. Army also began to rehabilitate wounded soldiers who had 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 these populations. This led to the physical therapy profession.

Today, physical therapists entering the profession need a doctoral degree. With 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) form?

A: The Section on Electrophysiological and Electrokinesiological Measurements was established in 1974. The Medicare noncoverage of electric stimulation for wounds rule in 1985 sparked increased engagement and patient advocacy among wound management-focused physical therapists.

The section became a 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 section.

After a few name changes, the section became known as the Academy of Clinical Electrophysiology and Wound Management (ACEWM) in 2015.

Q: What new wound care and wound management guidelines have been developed within your organization and the industry?

A: An ACEWM task force has been 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 latest National Pressure Injury Advisory Panel (NPIAP) Clinical Practice Guidelines were published in 2019. The APTA and ACEWM are collaborating organizations with the NPIAP.

Q: What trends are surfacing related to wound management and PTs?

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 appear 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 this year?

A: The ACEWM and WMSIG have several areas of focus in the near future:

• 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 continue 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 this year.
• Continue to encourage clinical and laboratory research through dissemination, mentorship, and collaboration.
• Promote and facilitate inter-organizational partnerships, collaboration, and communication to improve patient advocacy in wound management.

With Larkin-Upton’s insights in mind, consider exploring resources that can support your therapy team’s expertise in evidence-based wound care.