WAKEFIELD – Today, the continuum of health care often follows a positive pathway through the practice of physical therapy. It features successful recovery from surgery, joint replacement and injuries, and it provides aging patients with the renewed ability to maintain one’s balance in the aftermath of chronic health conditions and disabilities.

As Rhode Islanders age, as our aging demographic increasingly finds itself undergoing knee and hip replacements as a way to ensure mobility, physical therapists play a crucial role in the transition following recovery from orthopedic surgery.

In turn, the skills and techniques of physical therapists keep evolving, requiring the kind of expertise and techniques that were once the province of professional athletes.

Earlier this year, ConvergenceRI interviewed an in-patient physical therapist working in a rehabilitation facility. [See link below to the ConvergenceRI story, “The art of healing.”]

In this story, ConvergenceRI spoke with an out-patient physical therapist, Ellen Girouard, PT, DPT, who works for Ortho RI, interviewing her about the changing nature of the work of physical therapy.

ConvergenceRI; How is the profession changing for physical therapists as the patients age?    
GIROUARD : Physical therapy is constantly evolving with longer life expectancies, shifts in health trends, and advancing technology. As an outpatient PT, I focus on helping patients achieve personal goals, regain strength and mobility, and improve ergonomics.

Since 2020, technological advances like telehealth have been popularized for individuals who can’t make it into the clinic as often. Some clinics use various wearable devices to track patient’s progress or improve impairments.

We often collaborate with other health care providers to optimize a patient’s independence as they age. At Ortho RI, we are fortunate to have physicians, PAs, MAs, and patient navigators to help spearhead the best care for our patients.

A goal of mine is to bridge the gap between therapy and wellness programs, promoting mobility, strength, and balance for the aging community. Unfortunately, insurance limitations often hinder this, so I recommend resources like senior centers and the YMCA.

I am hopeful that in the future, physical therapists can drive models to offer ongoing needs for maintenance, falls risk, and longevity for individuals needing ongoing support once they are discharged from physical therapy.

ConvergenceRI: What is the difference between outpatient physical therapy and in-house physical therapy as a profession?     GIROUARD: “Outpatient Physical Therapy” focuses on rehabilitation for a variety of conditions, including acute injuries, post-surgical recovery, and chronic pain.

Patients typically attend 1-3 sessions per week, with the goal of maintaining progress through prescribed home exercises. Effective communication with physicians can streamline treatment plans; however, insurance limitations, authorization requirements, and co-pays often restrict the length of sessions.

To bypass these restrictions, some clinics offer cash-based services. At Ortho RI, we are advancing toward these types of programs to support individuals with injury prevention, performance enhancement, and long-term wellness in their activities, especially those who exceed the limits of insurance-based care.

“Inpatient Physical Therapy” is provided in hospitals or other health care facilities and focuses on recovery from severe illnesses, injuries, or surgeries. This type of therapy extends beyond orthopedics and may include rehabilitation for cardiovascular conditions, neurological disorders, and more.

Patients typically stay for several days to a couple of weeks, with treatments often occurring multiple times per day. Inpatient care includes not only physical therapy but also direct management by doctors, nurses, and specialists in occupational and speech therapy.

The goal of inpatient PT is to improve function, mobility, strength, and gait while preparing the patient for discharge. A multidisciplinary team collaborates to develop a discharge plan, which may involve transitioning to outpatient PT or short- or long-term rehabilitation facilities, depending on the patient’s support system and individual needs.

As the health care delivery system evolves, Ambulatory Surgery Centers [ASC], including one at Ortho RI, are gaining prominence. These centers help reduce health care costs by eliminating the need for inpatient stays for certain outpatient surgeries. The ASC offers a more efficient and convenient surgical experience, with patients discharged the same day.

This approach not only reduces the risk of infection but also improves patient comfort and overall experience, while allowing hospitals to focus on more urgent cases. At Ortho RI, patients undergoing orthopedic surgeries, such as total joint replacements or repairs, are discharged the same day and most begin outpatient PT 3-5 days post-operatively. From my experience, patients tend to recover well, as early movement is encouraged during the initial recovery stages.

ConvergenceRI: What is the most rewarding part of your job in working with patients?    
GIROUARD: The physical therapy profession is centered on building strong relationships and trust with patients from day one. While this can sometimes be challenging, I find it incredibly rewarding to connect with individuals on a personal level and tailor their rehabilitation goals accordingly.

I typically see patients 1-2 times per week, and over time, I witness both the highs and lows they experience in life and their recovery. This makes discharges bittersweet. It’s especially fulfilling when patients return years later, and we can pick up right where we left off. The most rewarding aspect of my job is being part of their journey, watching their progress, and helping them regain control of their lives.

At Ortho RI, we prioritize continuous learning, mentoring, and community involvement. We consistently explore new orthopedic research and take continuing education courses to integrate the latest techniques into our practice. I value how Ortho RI encourages the development of niches and new skill sets while fostering open collaboration across the clinical team.

For me, I am working on developing a program to promote injury prevention, performance, and longevity with the running population. This level of support isn’t common in most PT clinics, and I’m grateful for it. Our rehab department, despite being spread across various locations, collaborates seamlessly and supports each other through mentorship and occasional office outings.

ConvergenceRI: Is there a way to share practice developments across a broader spectrum of physical therapists in Rhode Island? If you could design such a learning group, what would it look like?    
GIROUARD: At Ortho RI, we prioritize continuous learning through monthly clinical education nights and weekly staff meetings where we discuss evidence-based practices, stay updated on current research, and refine treatment techniques.

As an orthopedic practice, we’re able to collaborate and share insights in patient care with physicians, physician assistants, occupational therapists, and nurse practitioners with expertise in different specialties within orthopedics.

We’ve developed a year-long on-boarding plan for new graduates to help bridge the gap between their studies and becoming entry-level PTs. Additionally, several therapists take on clinical students for weeks or months, bringing fresh perspectives and challenging our team to stay current with their practice.

Over the last several years, Ortho RI has hosted an Open House where we invite clinical students and PTs from across Rhode Island to learn from specialists in our clinical team. Guests can experience physical therapy specific treatments including dry needling, blood flow restriction, running analysis, and spinal manipulation.

We also have an educational portion where our surgeons will share on current topics in surgical intervention. This year Dr. Roald Llado and Dr. Peter Pizzarello join us for a demo of robotic-assisted TKA with Styker Mako technology with a Q&A on everything [about] total knee replacements.

On a broader scale, our Director of Rehab Services, Tracy Gannon, now serves as president of the R.I. Chapter of the APTA [American Physical Therapy Association], advocating for our profession amidst challenges like authorization, co-pays, and more.

As a team, some therapists at Ortho RI are actively working to shape the future of the profession, addressing issues such as Medicare reimbursements and insurance carrier challenges to improve the trajectory for current and future physical therapists. We are hopeful in the future we will hold more events to collaborate with therapists across the state and country.

ConvergenceRI: What is the hardest part of your job?    
GIROUARD: Burnout is a growing issue in physical therapy due to high patient volumes, emotional toll, and stress. I often find it can be difficult managing patient expectations, especially for chronic pain, as progress often takes longer than anticipated.

While we strive to help everyone return to their active lifestyles, there are times when physical therapy may not be the right solution, and other interventions, such as surgery, may be necessary. This can make for a long and challenging journey for both the PT and the patient.

Insurance limitations, such as authorization changes and high co-pays, are other barriers we face daily. Limitations here can make optimizing patient care difficult. Adaptability and focusing on quality care over quantity helps with success within the early stages of rehab and reduce frustration with limitations we are given.

ConvergenceRI: How do you manage the expectations of patients, yourself, and your career?    
GIROUARD : For “patients,” I emphasize that patients are in control of their recovery, and I’m here to guide them. Progress can be slower than expected, but honest communication about timelines is key. Treatment often requires adjustments along the way, whether it's fine-tuning or utilizing our clinical team. Our rehab group is a great resource, and we frequently refer patients to specialists within the rehab and clinic teams who have expertise in specific areas.

For “myself,” trying to balance my personal life with my passion for developing the “Running Performance Clinic,” leadership, mentorship, and clinic management is a constant challenge.

While there’s always room for improvement, I strive for a healthy work/life balance and value the opportunity to travel and disconnect to refresh. Daily exercise and spending quality time with family, friends, coworkers and my dog are essential to me, and I try to prioritize both as much as possible throughout the week.

And, with “my career,” I embrace change and growth, particularly in exploring cash-based services to improve career satisfaction and patient outcomes. Running has always been a passion of mine, having competed in Cross Country at Simmons University and run several full and half-marathons. I’m now a certified Running Coach through UESCA and have mentored under renowned running PT specialists, Chris Johnson and Nate Carlson.

I’m excited to continue developing the Running Performance Clinic at Ortho RI. This model eliminates insurance limitations and focuses on keeping runners' injury-free while enhancing performance. My approach includes a 3D gait analysis with wearables, customized training plans, nutrition and shoe wear education, and bridging the gap between traditional rehab and strength conditioning for runners.

My goal is to help both casual and competitive runners of all sports improve their longevity. I’m also looking forward to more community outreach, including injury prevention education at local running communities and high schools.

ConvergenceRI: What questions should I have asked that you would like to discuss?    
GIROUARD: Advocacy is crucial for the physical therapy profession. With the doctoral degree now required, but reimbursement rates not improving, there’s a disconnect between education costs and starting salaries.

I believe involvement in organizations like the APTA is key to improving conditions for PTs. The more PTs we get involved, the brighter the PT profession looks. Each state offers a yearly membership to the APTA and offers ways for individuals to participate to make a difference.