Political and Social Issues That Have Shaped Physical Therapy Education over the Decades, The

Journal of Physical Therapy Education, Winter 2003 by Echternach, John L

The purpose of this article is to describe the social and political events that have had a major influence on the shaping of physical therapy education since the beginning of the profession. This theme was developed by looking at the early history of the development of the field in the United States followed by an examination of the effects of World War I and the Great Depression on development of the education of the physical therapist. Following this, there is an exploration of the effects of World War II and the postwar period on the further development of the education of the physical therapist related to the social and political changes occurring in the nation. During the 1960s, there was a great deal of change in the nation's political, cultural, and social values, and these changes were explored in relationship to the physical therapy profession's educational changes. From the 1970s to the 1990s, rapid changes were taking place in terms of accreditation and education of the physical therapist, and these changes are discussed. During this time, increased legislative activity leading to direct access occurred, and the initiative to develop a postbaccalaureate degree as the primary method for education for the physical therapist began. The postbaccalaureate degree discussion finally led to the development of the Doctor of Physical Therapy (DPT) degree being adopted as a goal for the profession. In the late 1990s and at the beginning of the 21st century, changes took place in physical therapist practice requiring the profession to deal for the first time with a potential surplus of physical therapists. Also discussed is the concept of strategic adaptation and the successes and failures of the adaptations that the profession has made. Finally, there is a discussion of the transition to the DPT degree and the continuing changes that are occurring in the field of physical therapy.

Key Words: Physical therapy education, Political and social issues.

INTRODUCTION

Social and political events have had a major influence on higher education institutions and activities during the time period that physical therapy emerged and developed as a health care profession. Many have made the observation that survival of institutions and professions is related to how well change is managed. In general, higher education has continuously changed over the past 100 years as universities and colleges in this country have adapted to the needs of a society requiring more access to higher education as well as accommodating the needs of emerging professions and occupations. Progress in these areas often seems to be made both grudgingly and slowly, but viewed over the long run, the changes are remarkable and impressive.

Lawrence1 has suggested that in medicine and other health care professions, the most important roles have traditionally been practice, research, and teaching. The teaching role referred to here is the role of preparation of those who want to enter the professions represented by health care. The Flexner report on medical education of 1914 caused a revolution in medical education that has influenced thinking in all health care professions.2 The Flexner report set the general framework for health care professions education and stressed the importance of the education of the health care professional and the importance of a relationship between professional education and universities.

It is a daunting task to explain the political and social issues that have shaped physical therapy education. I am not a political scientist nor a historian, and certainly not a sociologist. I am a physical therapist with significant experience in both the clinical practice and higher education aspects of physical therapy; therefore, the perspective presented will basically be one that is, in many ways, personal and anecdotal.

EARLY HISTORY OF THE FIELD

We begin with the historical perspective. The role of the physical therapist as a practitioner began to grow in this country out of the posture and scoliosis clinics established by physicians at the turn of the 19th to the 20th century.3,4 These physicians sought assistance from women with backgrounds in physical education to assist them. During this time, poliomyelitis epidemics occurred, and orthopedic surgeons, primarily in the New England area, expressed a need for help in caring for patients with poliomyelitis after the acute stage of their illness. This need was met primarily by employing women who were physical educators who provided prograins of exercise and what we would now call rehabilitation. During this period, hospital departments in Boston and Philadelphia were established for the management of orthopedic problems in addition to poliomyelitis.4

WORLD WAR I TO THE GREAT DEPRESSION

Although physical therapy was being recognized as an important service, a great deal of growth did not occur until World War I. The war was a key factor in the development of the profession.1-6 During WWI, the Army took on the role of educating women as reconstruction aides. Physicians were the primary force in recognizing that soldiers and other military personnel with front-line and battlefield injuries would need a great deal of assistance in reaching their full potential as their wounds and injuries healed. Reconstruction aides trained by the Army at Walter Reed Hospital and also at Reed College in Oregon among others formed the backbone of what was to become the profession of physical therapy. Reed College was among the first institutions to offer education to women who desired this training and who were not prepared directly by the Army.7