Episode 3 – Superficial Moist Heat

A physical therapist prepares to administer superficial moist heat to help improve a patient’s mobility prior to a treatment session. Which scenario would require the therapist to add extra towel layers to prevent a burn from occurring?

1. Hot pack over the cervical paraspinals with the patient in sitting
2. Hot pack over the rhomboids with the patient in hooklying
3. Hot pack over the patella with the patient in supine
4. Hot pack under the feet with the patient in sitting
 

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders Team with the opportunity to explore challenging multiple choice examination questions with students actively preparing for the licensing examination.

My name is Scott Giles and I will be your host for today’s journey. 

Today the plane is headed to the mysterious land called Non-Systems. It’s an eclectic place consisting of a variety of small but important topics. Our focus for today will be on Therapeutic Modalities.

Let’s check in with the Federation of State Board of Physical Therapy and see what we can learn about this category.

Therapeutic Modalities
This category refers to the underlying principles for the use of therapeutic modalities as well as the justification for the selection and use of various types of therapeutic modalities, including consideration of current best evidence, in order to support appropriate and effective patient/client management for rehabilitation, health promotion, and performance across the lifespan.

• Thermal modalities 
• Iontophoresis 
• Electrotherapy modalities (e.g., neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), functional electrical stimulation (FES), interferential therapy, high-voltage pulsed current) 
• Ultrasound modalities 
• Mechanical modalities (e.g., mechanical motion devices, traction devices) 
• Biofeedback 
• Intermittent compression

Today’s question will deal with superficial heat which of course is a thermal modality. 

Ready? Let’s go! 

A physical therapist prepares to administer superficial moist heat to help improve a patient’s mobility prior to a treatment session. Which scenario would require the therapist to add extra towel layers to prevent a burn from occurring?

1. Hot pack over the cervical paraspinals with the patient in sitting
2. Hot pack over the rhomboids with the patient in hooklying
3. Hot pack over the patella with the patient in supine
4. Hot pack under the feet with the patient in sitting

This is a question where you have to be incredibly careful to answer the question that is being asked and avoid the temptation to answer the question based on your preferred scenario for administering superficial heat. For example, maybe you were taught to avoid having a patient lie directly on a hot pack (option 2) or you feel that placing a hot pack under a patient’s feet in sitting is simply weird (option 4). 

You clearly have a right to form an opinion. However, as therapists we often modify the treatment procedure based on the unique nuances of a given patient’s situation. In this particular question, we know virtually nothing about the patient or their diagnosis. The only kernel offered is that superficial moist heat is being applied to improve a patient’s mobility prior to a treatment session. 

The question is specifically asking …. Which scenario would require the therapist to add extra towel layers to prevent a burn from occurring? My advice to you is to simply consider each of the options as potentially viable and answer only the question that is asked.

Let’s explore each of the options:

Option 1 - Hot pack over the cervical paraspinals with the patient in sitting
A patient positioned in sitting with the hot pack draped over the cervical paraspinals would not require the addition of extra towel layers since no excessive pressure would be placed on the hot pack. 

Option 2 - Hot pack over the rhomboids with the patient in hooklying
One of the unique challenges with this option may be the term hooklying. Failure to comprehend this term makes the question very difficult to evaluate. 

Hooklying refers to a position where the patient is lying in supine with their hips and knees bent and the feet flat on the floor with the arms positioned at their side.

A patient positioned in hooklying with the hot pack placed under the thoracic region (i.e., rhomboids) would require the addition of extra towel layers. The weight of the patient’s trunk on top of the hot pack could remove some of the water from the hot pack and increase the risk for a burn. An acceptable modification would be to add extra towel layers to reduce the intensity of heat to the treatment area. Traditionally 6-8 towel layers is recommended when utilizing a hot pack. 

Option 3 - Hot pack over the patella with the patient in supine
A patient positioned in supine with the hot pack draped over the patella would not require the addition of extra towel layers since no excessive pressure would be placed on the hot pack.

Option 4 - Hot pack under the feet with the patient in sitting
A patient positioned in sitting with the hot pack placed under their feet would not require the addition of extra towel layers. While there would be some added pressure through the feet on the hot pack, it would be a minimal amount of pressure and far less than Option 2. Additionally, the patient could easily unweight their feet off of the hot pack in this position if it becomes too hot at any point.

Sure the question is a little off the beaten path, but trust me, you will encounter plenty of outliers on the actual examination. Your objective is purely to select the best option to each question. 

The correct answer is Option 2.

Let’s explore the all student data:

8% of students selected Option 1, Hot pack over the cervical paraspinals with the patient in sitting
61% of students selected Option 2, Hot pack over the rhomboids with the patient in hooklying, the correct response
8% of students selected Option 3, Hot pack over the patella with the patient in supine
23% of students selected Option 4, Hot pack under the feet with the patient in sitting

In my opinion the correct response rate is extremely low given the relative difficulty level of the question. I feel some students were hurt by not knowing the term hooklying but I am convinced that others became too focused on their personal preference and in the process ended up eliminating the correct response for non-academic reasons. 

System Classification
This question is a Non-Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is a Therapeutic Modality question which represents approximately 3% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Pages 724-727 from our review book PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/v3ooZpzT7NA?si=dBOWnDGb_j0kPwAv.