What a Fellowship-trained physical therapist does differently for your results
Not every physical therapist has the same training, and a large study of patient outcomes suggests the difference can show up in how much you improve and how quickly.
If you have been through physical therapy before and the relief did not last, or you are deciding who to trust with a shoulder, back, knee or hip problem, this is worth understanding before you book.
What fellowship training is
Fellowship is the highest level of clinical training in physical therapy. After a doctorate, and often a residency, a therapist completes a structured program of advanced coursework and mentored one-on-one patient care in a specialty such as orthopaedic manual therapy. Very few therapists complete one.
The focus of that training is the skill set that matters most when your pain has not responded to the usual approaches. This includes hands-on examination, precise manual treatment, and clinical reasoning that finds the true source of a problem instead of treating only the spot that hurts.
What the research shows
In 2015, Rodeghero and colleagues published a study in the Journal of Orthopaedic & Sports Physical Therapy that compared patient outcomes by therapist training. They analyzed data from 25,843 patients with musculoskeletal conditions treated by 363 therapists over one year, drawn from a national outcomes database. The therapists were sorted into three groups: no residency or fellowship training, residency training, and fellowship training. The researchers controlled statistically for other factors that could skew the results.
Patients treated by Fellowship-trained therapists achieved greater improvement in function and greater efficiency, meaning more improvement per visit, than patients in the other groups. They were also more likely to achieve larger treatment effects. In the study's summary of results, patients were 40% more likely to reach improvements 4 to 5 times greater than the minimum change considered meaningful when they were treated by a Fellowship-trained therapist.
Residency training alone did not show the same advantage in this study. This is a useful reminder that not all advanced training is the same, and that the details of a therapist's education matter.
What the research does not show
This was an observational study. It shows an association between fellowship training and better outcomes and does not prove that the training caused them. The authors also state that it is unknown whether the statistical differences would be clinically meaningful for every patient. This is one large study, and more research would strengthen the conclusion.
Still, the finding is consistent with what fellowship training is designed to build, which is sharper hands-on assessment, more precise treatment and better clinical reasoning. There is evidence that suggests this translates into care that is more effective and more efficient.
What this means for you
The person treating you matters as much as the technique. At Enhance Physical Therapy, every visit is 60 minutes, one-on-one, with a Fellowship-trained therapist from start to finish. You are not handed to an aide and you are not sharing the therapist's attention with other patients.
Our approach has three steps. We find the true source of your pain, which is often not where it hurts. We restore movement with skilled manual therapy. Then we train your body so the problem does not return, in order to get you back to what you love with fewer wasted visits.
Schedule a visit
If you have tried other care and the relief did not last, you are welcome to see how a different approach feels. Schedule a visit and we will find the source and build a plan together.
Dr. Doug Ashton, DPT, FAAOMPT
Owner, Enhance Physical Therapy
Reference
Rodeghero J, Wang YC, Flynn T, Cleland JA, Wainner RS, Whitman JM. The impact of physical therapy residency or fellowship education on clinical outcomes for patients with musculoskeletal conditions. Journal of Orthopaedic & Sports Physical Therapy, 2015. PMID 25579690. https://doi.org/10.2519/jospt.2015.5255
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