Plinths, parallel bars, exercise and electrotherapy equipment, how much floor area each needs, and where a district hospital list should stop and a specialist rehabilitation unit's list should begin.
Walk into a physiotherapy department that was equipped from a standard list and you can usually tell what happened. Three electrotherapy machines sit on a shelf, two of them unused. There is one plinth for four therapists. There is no clear floor. The purchasing was done by counting devices, when it should have been done by counting square metres and treatment positions.
Physiotherapy is the one clinical department where floor area is the main piece of equipment. Everything else is arranged around it.
A treatment position is one patient, one therapist, one plinth or mat, with enough space around it for the therapist to work from either side and for a curtain to close. Establish how many positions the department must run at once, from the referral load and the session length, and the equipment list writes itself from there.
Then divide the floor into three areas that should not overlap, because they interfere with one another when they do:
Ceiling mounted curtain track around the plinth area is a small line on a fit out quotation and it decides whether patients will undress for a proper assessment. Portable screens fall over, get borrowed and end up in a corner.
A fixed height plinth condemns the therapist to work at whatever height the welder chose. Height adjustment, hydraulic by foot pedal or electric, is the specification that keeps therapists working into their forties, and it is the item most often cut at tender because a fixed plinth looks like the same product for less money.
Beyond height, three differences matter. Width, because a plinth wide enough for a patient to lie on comfortably is often too wide for a therapist to reach across, so mobilisation work wants a narrower top than general treatment. Sections, because a two or three section top with an adjustable backrest and a breathing hole covers far more of the caseload than a flat table. And access from both sides, which means a plinth that is pushed against a wall to save floor space has lost half its usefulness.
A neurological or paediatric caseload needs at least one low mat platform as well: a wide, low, firm surface a patient can be worked with on the floor plane without either of you kneeling on concrete. This is the item district hospitals almost never buy and specialist units cannot manage without.
Specify parallel bars with adjustable height and adjustable width, because the same bars serve a tall adult after a stroke and a child with cerebral palsy, and fixed bars serve one of them badly. Length matters more than people expect: bars that allow only two or three steps do not let you assess a gait pattern, they let you assess a transfer.
Fix them to the floor. Free standing bars on a heavy base creep when a patient pulls hard, and the base is a trip hazard exactly where the patient's feet are. Put a full length mirror at one end so the patient can see their own alignment, and leave a clear turning area at each end wide enough for a wheelchair and an assistant.
The equipment that lasts is simple, mechanical and repairable locally: wall bars, a shoulder wheel, a finger ladder, pulley sets, weight cuffs and dumbbells in graded sizes, therapy balls, resistance bands, a static cycle with mechanical resistance, hand exercise equipment. None of it has a circuit board and none of it stops working in a power cut, which is a genuine specification advantage rather than a compromise.
Powered treadmills and electronically controlled cycles are a different proposition. They need a stable supply, they need service support, and they occupy a large footprint for one patient at a time. In a district hospital they are usually the wrong purchase. In a specialist unit running a cardiac or neurological rehabilitation programme with a measured protocol, they are the point of the department. The distinction is whether the machine's measurement is being used clinically or is just a display.
Electrotherapy is the equipment most departments buy first and it should usually be bought last. Transcutaneous nerve stimulation, interferential therapy, therapeutic ultrasound, shortwave diathermy, traction and heat modalities all have their place, and none of them substitutes for the exercise therapy that produces the durable result. A department that has four modality machines and one plinth has its priorities inverted.
If you are buying it, buy it properly:
A district hospital department is treating musculoskeletal pain, post fracture and post operative recovery, respiratory patients on the wards, and stroke patients in the early weeks. Its list should be plinths and mats first, an open gait area with parallel bars and stairs, simple exercise equipment, a small and well maintained modality selection, wheelchairs and walking aids, and a portable kit the therapist takes to the ward. Ward physiotherapy is a large part of the workload and it needs its own trolley, not borrowed equipment.
A specialist rehabilitation unit adds capabilities that require both space and staff: a larger gymnasium, standing frames and specialised seating, a therapy pool where the budget and the water treatment plant allow it, an orthotic and prosthetic workshop, driving or activities of daily living assessment areas, and assessment equipment whose measurements go into a programme rather than a note. It also adds the thing that most distinguishes it, which is length of stay, and therefore accommodation, catering and family training space.
The common procurement error is a district hospital buying a specialist unit's equipment list from a catalogue, then having neither the floor area nor the staff to use it. The reverse error, a specialist unit equipped as though it were an outpatient clinic, is rarer and easier to correct.