The International Association for Physical Therapists working with Older People. Standards of Clinical Practice

Transcription

1 The Internatinal Assciatin fr Physical Therapists wrking with Older Peple Standards f Clinical Practice April 2013

2 The Internatinal Assciatin fr Physical Therapists wrking with Older Peple STANDARDS OF CLINICAL PRACTICE Cntents Page Backgrund 3 IPTOP s values and cre rles 5 The IPTOP Standards f Clinical Practice framewrk 7 A summary f the definitins f the standards 8 Clinical practice 10 Screening 10 Examinatin/assessment 11 Evaluatin 14 Diagnsis 15 Prgnsis 15 Interventins/treatment 16 Preventin 17 Inter-prfessinal cllabratin 18 Prfessinal develpment (definitins nly) 9 Innvatin Research participatin Prmtin f the prfessin Prfessinal leadership/mentring (definitins nly) 9 Supervisin/mentring Educatin Leading prjects Entrepreneurial /service develpment References 19 Figures: 1. The IPTOP Standards f Clinical Practice framewrk mdel 7 2. Interactins between the cmpnents f the ICF framewrk IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

3 The Internatinal Assciatin fr Physical Therapists wrking with Older Peple Backgrund STANDARDS OF CLINICAL PRACTICE The Internatinal Assciatin fr Physical Therapists wrking with Older Peple (IPTOP) is a recgnised subgrup f the Wrld Cnfederatin fr Physical Therapy (WCPT). WCPT exists t mve physical therapy frward s the prfessin is recgnised glbally fr its significant rle in imprving health and well-being. The prime purpse f physical therapists that practise with r specialise in the management f the lder adult, is t enable that persn t live well. In rder t manage impairments, activity limitatins, and participatin restrictins ccurring as part f, r in additin t, the ageing prcess, physical therapists practising in this field play a majr rle in cntributing t the educatin, knwledge, and skills necessary fr the lder persn t best manage their cnditin, physically, psychlgically, and scially. A persn-centred, cllabrative, interprfessinal apprach is required t manage a wide range f cnditins affecting this ppulatin, ensuring the aspects f dignity and respect are maintained as expected when practicing with any ppulatin r individual. Part f IPTOP s Missin Statement invlves furthering its members ability t prvide best practice physical therapy when examining/assessing and prviding interventins/treatment t lder peple and t advcate fr ptimal ageing. T that end, this dcument has arisen frm a need t help members achieve the IPTOP aim f: encuraging high standards f physical therapy practice with lder peple. When cnsidering hw a Clinical Standards dcument fr the membership might best be develped, IPTOP studied several mdels submitted frm the Assciatin s Member Organisatins, as well as cntent frm WCPT Plicy dcuments and ther WCPT subgrup wrk. The resulting IPTOP Standards f Clinical Practice is a blend f the relevant infrmatin gathered during the develpment prcess cnsidered f use t a physical therapist when practising clinically with lder adults. T whm d these Standards apply? These Standards f Clinical Practice have been prduced fr use by physical therapist clinicians practising with lder peple. They are a supplement t current standards published by the physical therapy prfessinal bdy in the practitiner s cuntry and t the WCPT 2011 Guideline fr standards f physical therapy practice 1. They are intended t prvide guidance fr physical therapists practising with lder peple in cuntries where specialist clinical netwrks in this field are develping, r d nt yet exist. Use f these Standards: These Standards may be used in the fllwing ways: Guidance fr the physical therapist clinician t use during their perid f clinical interventin/treatment with an lder persn [this aspect relates mre t the physical therapist s prfessinal behaviur and demnstratin f examinatin/assessment and interventin/treatment skills] As an educatinal tl fr senir staff when teaching junir staff and students abut the management f the lder persn [this aspect relates mre t the knwledge exhibited by the physical therapist] 3. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

4 A guide fr physical therapists when prmting the needs and interests f lder peple in brader cntexts [this aspect relates t bth knwledge fr advcacy and behaviur in prmting the needs f lder adults] The dcument als directs the physical therapist t surces f infrmatin prduced by the WCPT t which the reader might refer fr further guidance. Inapprpriate use f these Standards These Standards are nt intended fr use in the fllwing ways: T recmmend either service standards (which clarify expectatins f staff perfrmance r cmpetency in prviding an effective service) r educatin standards fr the physical therapist. That is the respnsibility f the rganisatin in which the physical therapist practises and is dependent n the health and educatin systems f their cuntry f practice Fr mre than a guide fr the physical therapist twards acceptable behaviur and knwledge when practising with the lder ppulatin. These IPTOP Standards f Clinical Practice are different than regulatry Cdes f Cnduct that gvern the practice f the physical therapist in the cuntry in which they practise Dcument citatin: Please cite the dcument as: The Internatinal Assciatin fr Physical Therapists wrking with Older Peple (IPTOP) (April 2013). Standards f Clinical Practice The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP] The Prject Grup members were: Bhanu Ramaswamy (IPTOP representative t the member rganisatin f the United Kingdm) - lead Lisa Dehner (IPTOP representative t the member rganisatin f the United States f America) Jan Tessier (IPTOP representative t the member rganisatin f Belgium) Jill McClintck (IPTOP Executive Vice-President) Acknwledgements: In additin t the wrk f the Prject Grup, IPTOP wuld like t acknwledge the cntributins frm IPTOP Executive members Jennifer Bttmley (President) and Nancy Prickett (Treasurer); Member Cuntry Representatives wh cllated respnses frm their membership, and in particular Glauca Gnçalves Mantellini (IPTOP representative t the member rganisatin f the Switzerland) and Hans Hbbelen (IPTOP representative t the member rganisatin f The Netherlands); individual member cntributins frm Gareth Cliffrd (Republic f Ireland), Gill Agar (UK) and the Secretariat f the WCPT; Russell Mather and Jnathan Willis frm Sheffield Hallam University wh designed the IPTOP Clinical Standards mdel. Special acknwledgement is made t the immeasurable inputs and cntributins frm Marilyn Mffatt (President f the WCPT) and Catherine Sykes (WCPT Secretariat) withut wh the dcument wuld nt be s well structured and infrmative. 4. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

5 IPTOP s values and cre rles are based n principles bserved by the WCPT and by its Member Organisatins: As the internatinal vice f physical therapy WCPT's missin is t: Unite the prfessin internatinally Represent physical therapy and physical therapists internatinally Prmte high standards f physical therapy practice, educatin and research Facilitate cmmunicatin and infrmatin exchange amng member rganisatins, regins, subgrups and their members Cllabrate with natinal and internatinal rganisatins Cntribute t the imprvement f glbal health As the WCPT subgrup representing physical therapists practising with lder adults, IPTOP views ageing as a psitive event, therefre: Age must nt present a barrier t effective, evidenced-based physical therapy management Advancing age must nt negate the lder persn s rights 2 t make their wn decisins abut their physical therapy management and future plans Definitin f lder peple Fr the purpses f this dcument the fllwing definitin f lder peple is used 3. This is cnsistent with the definitin used by WCPT 4. Older peple are generally defined accrding t a range f characteristics including chrnlgical age, change in scial rle, and changes in functinal abilities. In high-resurced cuntries lder age is generally defined in relatin t retirement frm paid emplyment and receipt f a pensin, at 60 r 65 years. With increasing lngevity sme cuntries define a separate grup f ldest peple, thse ver 85 years. In lw-resurced cuntries, where shrter life spans are recrded, lder peple may be defined as thse ver 50 years. The age f 50 years was accepted as the definitin f lder peple fr the purpse f the WHO Older Adult Health and Ageing in Africa prject. Please nte: Fr the purpse f cnsistency with the reference t lder peple within its title, IPTOP will use the term lder adult, persn, r peple in this dcument. Given the abve definitin hwever, and in recgnitin f its internatinal membership, IPTOP acknwledges that different wrds and terms will be used by different rganisatins t describe the lder ppulatin. Fr examples the term ageing adults culd be used if encmpassing thse in transitin frm the age f 50 upwards whilst lder adults/peple intimates the persn has already entered ld age. This may als be the case with cnditins where earlier effects f ageing ccur, as bserved in peple with intellectual r ther disabilities at a faster pace than in the general ppulatin. Als, where clinicians frm different cuntries utilise distinctive terminlgy, bth have been used e.g. the terms examinatin/assessment and interventins/treatment, t permit a clearer understanding f the dcument. 5. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

6 Physical therapists have a unique cntributin in enhancing the quality f life f lder adults. Therefre, physical therapists practicing with lder adults shuld: Be skilled in health prmtin and activities that enable lder adults t live with the effects f physilgical ageing n functin and thse that prmte a healthy visin f lder age Optimise functinal independence and encurage engagement in preventive interventins in lder age fr as lng as pssible t prmte quality f life fr the individual Have a key rle in the remediatin f symptms that develp with pathlgical cnditins cmmnly seen in ageing Acknwledge and wrk with the cultural diversity and beliefs f the lder adult ppulatin with whm they practise, even if these are in cntradictin t the beliefs and values f the physical therapist Prmte and strive fr high standards f physical therapy clinical practice as supprted by research, educatin, and ethical cnsideratins Physical therapists are key prfessinals wh supprt cllabrative practice with internal and external parties t enhance the psitive management f lder adults. Therefre physical therapists will: Respect the cntributins f all invlved parties Cmmunicate with prfessinal physical therapists and ther prfessinal clleagues and with peple invlved in the management f lder adults in rder t understand and prvide the highest quality services fr the individual Play a key rle in designing services fr lder adults t ensure equitable access t all frms f health and scial services using the best evidence-based interventins/treatments Take int accunt the ageing prcess n the speed f recvery r gal achievement f the individual, plus remain aware that lder peple may need mre time fr assessment r treatments due t existing underlying pathlgies The term individual is used in this dcument as a generic term t refer t the lder persn r grups f lder adults wh may benefit frm physical therapist services, unless using a direct qute that utilises ther terminlgy. In this dcument, the term individual includes thse wh may be referred t as patients, clients, r service users. Please nte: The skill f the physical therapist practising with the lder ppulatin is in managing the multiple changes in the ageing bdy plus dealing with the cmpnents f the bi-psych-scial facets resulting in an verall cmplex picture; and understanding that managing the lder/ageing persn is nt usually abut ne islated prblem althugh this may be the nly prblem indicated in a referral. In this dcument, implementatin fllwing examinatin/assessment refers t the cmmunicatin and educatin techniques and chice f therapeutic strategy. Evaluatin (leading t the diagnsis) refers t the culminatin f the examinatin/assessment, which must factr in c-mrbidities and the unique bi-psych-scial factrs related t ageing. 6. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

7 Bth the implementatin and evaluatin will take int accunt influencing envirnmental factrs, fr example a persn s lcatin as this impacts greatly n what, hw, and why implementatin is ffered. The IPTOP Standards f Clinical Practice framewrk cncentrates n the three interrelated cre rles f a physical therapist practising with lder adults (Figure 1): 1. Clinical practice includes screening, examinatin/assessment, evaluatin, diagnsis, prgnsis, interventins/treatment, preventin and prfessinal cllabratin (definitins prvided bth in summary, and in full with descriptins and standards by which t measure practice) 2. Prfessinal develpment includes innvatin, research participatin t further educatin, and prmtin f the prfessin (definitins nly) 3. Prfessinal leadership/mentring - includes educatin, leading prjects (innvative cncepts), and entrepreneurial and service develpment wrk (definitins nly). Please nte: Cre rles 2 and 3 are administered differently accrding t the regulatins and systems available t the physical therapist in the cuntry in which they practise, hence the prvisin f a definitin nly. The lder adult remains central t the framewrk, and cmmunicatin is a key element thrughut all practice areas, enabling physical therapists t demnstrate their knwledge, skills and ethical behaviurs. Figure 1: IPTOP Standards f Clinical Practice mdel 7. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

8 Standards f Clinical Practice fr physical therapists wrking with lder peple/adults: A summary f definitins. Clinical practice Screening - Screening is the cnsented shrt prcess by which the physical therapist systematically evaluates whether the individual wuld benefit frm examinatin/assessment and interventin/treatment frm a physical therapist see page 10 fr details. Examinatin/assessment - Is a cmprehensive and specific testing prcess perfrmed by the physical therapist that leads t a diagnstic classificatin r, as apprpriate, t a referral t anther practitiner. The examinatin has three cmpnents: The individual s histry, the systems reviews, and the tests and measures see page 11 fr details. Evaluatin - Is a dynamic prcess in which the physical therapist makes clinical judgments based n data gathered during the examinatin/assessment. It is the prcess that necessitates reexaminatin fr the purpse f evaluating utcmes t identify prgressin t gal achievement r need fr mdificatin and change f the management plan see page 14 fr details. Diagnsis - Is a prcess that arises frm the examinatin/assessment and evaluatin and represents the utcme f the prcess f clinical reasning. It may be expressed in terms f mvement dysfunctin r may encmpass categries f impairments, functinal limitatins, abilities/disabilities, r syndrmes see page 15 fr details. Prgnsis (including Management Plan) - Prgnsis is the determinatin by the physical therapist f the predicted ptimal level f functin and the amunt f time needed t reach that level. Plan includes statements that specify the anticipated gals and the expected utcmes, predicted level f ptimal imprvement, specific interventins t be used, and prpsed duratin and frequency f the interventins required t reach the gals and utcmes. The verall management plan als includes the anticipated discharge planning see page 15 fr details. Interventins/treatment - Is the purpseful interactin f the physical therapist with the individual, and when apprpriate, with thers invlved in management f the individual, using varius physical therapy prcedures and techniques. T prduce changes in the cnditin, these might include therapeutic exercise; functinal training in self-care and hme management; functinal training in wrk, cmmunity, and leisure integratin r reintegratin; manual therapy techniques; prescriptin, applicatin, and, as apprpriate, fabricatin f devices and equipment; airway clearance techniques; integumentary repair and prtectin techniques; electrtherapeutic mdalities; physical agents and mechanical mdalities. It is the sum f all interventins prvided by the physical therapist t a patient/client during an episde f service delivery see page 16 fr details. Preventin Is activity directed tward: (1) achieving and restring ptimal functinal capacity; (2) minimising impairments, functinal limitatins, and disabilities; (3) maintaining health (thereby preventing further deteriratin r future illness); and (4) creating apprpriate envirnmental adaptatins t enhance independent functin see page 17 fr details. Inter-prfessinal cllabratin is c-rdinatin f management, infrmatin sharing, disseminatin, and advice between ther service prviders t ensure cntinuity in the interventins/treatment aimed at maintaining r imprving the quality f the ageing individual s cnditin see page 18 fr details. 8. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

9 Prfessinal develpment Innvatin - The prcess by which the physical therapist cntributes t the develpment and imprvement f the physical therapy field, but mre specifically t the practice f physical therapy with the lder ppulatin t ensure that imprvements f quality, effectiveness and efficiency thrugh best practice are intrduced /implemented. Research participatin - The prcess by which the physical therapist participates in the preparatin and/r implementatin f research in the field f lder peple. This shuld be accessible and utilised within clinical practice. Prmtin f the prfessin - The prcess by which the physical therapist prmtes the prfessin t thers t utline the benefits f physical therapy with the lder ppulatin. Prfessinal leadership/mentring Supervisin/mentring - the use f knwledge and skills f a physical therapist specialised in practising with lder peple t mnitr, guide, cunsel and advise thers fr example carers, junir staff, students, thus assisting them t develp prfessinally in the management f the lder ppulatin, and persnally as a physical therapist. Educatin the delivery, assessment and evaluatin f learning experiences in clinical settings and educatin sites such as institutinal, industrial, ccupatinal, acute settings, primary health care, and cmmunity settings. Educatin infrms n all aspects f the lder adult s management cmprising f examinatin/assessment, evaluatin, diagnsis, prgnsis/plan f care, and interventins/treatments including preventin, health prmtin, and wellness prgrammes. Where a physical therapist shares their knwledge and experience t cntribute t the decisinmaking and prfessinal develpment f clleagues and ther health prfessinals t better understand physical therapy in the cntext f management f the lder ppulatin. Leading prjects - the expertise f the physical therapist t manage (innvative) prjects that prmte the prfessin and physical therapy fr the lder ppulatin. The prcess invlves the stages f prject planning, implementatin, evaluatin, alteratins (if suggested by the evaluatin), and disseminatin. Entrepreneurial /service develpment - the identificatin and utilisatin f develpments and pprtunities relating t 'marketable' services fr lder peple. As the purpse f such develpment is t make services mre sustainable (and prfitable), physical therapists will prmte all develpments in a business-like ethical manner and with integrity. 9. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

10 Standards f Clinical Practice fr physical therapists wrking with lder peple/adults: Definitin, descriptin and standards 1. Clinical practice IPTOP recmmends the use f the mdel frm the Wrld Health Organizatin s Internatinal Classificatin f Functining, Disability and Health (ICF) (WHO 2001) as a framewrk fr practice with lder peple. The bi-psych-scial apprach enables health prfessinals t cnsider the functining f the individual irrespective f the number and type f health cnditins and t guide screening, assessment, gal setting and treatment planning (Figure 2). The ICF framewrk cnsiders functining in the cntext f envirnmental and persnal factrs. Examples f envirnmental factrs, acting either as barriers r facilitatrs t the level f functining, include the attitudes f family and carers, availability f persnal supprt, medicatins and the physical envirnment. Persnal factrs such as levels f educatin, mtivatin r cnfidence are recgnised in the ICF mdel, but nt classified 5, 6. Figure 2. Interactins between the cmpnents f the ICF framewrk 6 Screening Definitin: Screening is the cnsented shrt prcess by which the physical therapist systematically evaluates whether the individual wuld benefit frm examinatin/assessment and interventin/treatment frm a physical therapist. Please nte: Screening is nt a service prvided by physical therapists in all cuntries, and may be cnsidered part f a triage rle r a prcess by which a physical therapist determines the pririty f patients' treatments based n the severity f their cnditin. The individual may have self-referred fr physical therapy services r may have been referred by anther prfessinal. Descriptin: Includes the fllwing: The physical therapist cnducts a shrt appraisal using infrmatin available frm different surces. Fr example, they may questin the individual (either face-t-face r by electrnic means), including a discussin abut their illness belief and health prmtin interventins They may chse t use a specific screening checklist if ne is prvided and apprpriate t the service 10. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

11 Discussin f the findings f the physical therapy screening with the individual if they are available, and, if the request was thrugh a referral prcess, will discuss findings with the referring prfessinal r caregiver in accrdance with regulatry Cdes f Cnduct that gvern the practice f the physical therapist in the cuntry in which they practice Standards (als see Evaluatin belw): The physical therapist screening the lder persn: Gains cnsent t cnduct the screening and t share infrmatin gathered with relevant thers Cllects apprpriate infrmatin with regard t the individual s presenting prblems, functinal limitatins and assciated envirnmental factrs fr example supprt needed May chse t use a screening checklist, pssibly supplemented with anther functinal screening tl, ideally validated fr use with lder persns and physical examinatin Organises the infrmatin int symptms and signs in rder t identify patterns f presentatin and t recgnise any abnrmalities Pses relevant questins t detect red flags and if identified, respnds apprpriately fr example nward referral fr further investigatin Arrives at a cnclusin with respect t a need fr further physical therapy input Infrms the individual f the cnclusins f the screening, advising them n pssible next steps explaining the benefits, ptential disadvantages, and expected time f interventin Infrms and asks fr timely advice frm ther prfessinals if required Supprts the screening prcess with best evidence regarding the lder ppulatin Ensures that dcumentatin is dated and apprpriately authenticated by the physical therapist that carried ut the screening in line with prfessinal and service plicy guidelines prvided 7. Examinatin/assessment Definitin: Is a cmprehensive and specific testing prcess perfrmed by the physical therapist that leads t a diagnstic classificatin r, as apprpriate, t a referral t anther practitiner. The examinatin has three cmpnents: The individual s histry; the systems reviews; the tests and measures. Descriptin: Includes the fllwing: Examinatin/assessment f the individual with their cnsent 8 by btaining a histry frm them and frm ther relevant surces Examinatin/assessment f the individual by perfrming systems reviews that may include screens f the cardivascular/pulmnary, musculskeletal, neurmuscular, and integumentary system, and examinatin f cmmunicatin, emtinal state, cgnitin, language, and learning style Examinatin/assessment f the individual by selecting and administering culturally and ageapprpriate tests and measures Use hypthetic-deductive strategies such as evidence infrmed decisin making, and utilisatin f reliable and valid tests and measures whenever pssible and available, t determine the specific selected tests and measures Frmulate a shrt list f ptential diagnses r actins frm the earliest findings (histry and systems review) abut the individual Perfrm specific tests and measures that reduce the selected number f tests and measures, especially where the persn is frail Tests and measures may include, but are nt limited t thse that assess: Aerbic capacity/endurance Anthrpmetric characteristics Arusal, attentin, and cgnitin 11. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

12 Assistive technlgy and adaptive devices Circulatin (arterial, venus, lymphatic) Cranial and peripheral nerve integrity Envirnmental, hme, and wrk (jb/schl/play) access and barriers Ergnmics and bdy mechanics Gait, lcmtin, and balance Integumentary integrity Jint integrity and mbility Mtr functin (mtr cntrl and mtr learning) Muscle perfrmance Orthtic, prtective, and assistive technlgies, including Activities t Daily Living (ADL) Pain Psture Prsthetic requirements Range f mtin Reflex integrity Self-care and hme management Sensry and prpriceptive integrity Ventilatin and respiratin/gas exchange Wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin Standards. The physical therapist: With cnsent t prceed, starts the assessment/examinatin by taking a histry, perfrming the systems review, and administering selected tests and measures, ensuring that the expectatins f the lder individual are ascertained. Takes the lder individual s histry that may include btaining the fllwing data: General demgraphics (age, sex, race/ethnicity, primary language, educatin) Scial histry (cultural beliefs and behaviurs, family and caregiver resurces, scial interactins/activities/supprt systems) Emplyment - Wrk/Jb (current and prir wrk, cmmunity, and leisure actins r activities) Living envirnment (hme, cmmunity characteristics, devices and equipment, prjected discharge destinatin) General health status self-reprt, family reprt, caregiver reprt (general health perceptin, physical functin, psychlgical functin, rle functin, scial functin) Scial/health practice (behaviural and health risks, level f physical fitness) Family histry (familial health risks) Medical/surgical histry (cardivascular, endcrine/metablic, gastrintestinal, gynaeclgical, integumentary, musculskeletal, neurmuscular, bstetrical, psychlgical, pulmnary, prir hspitalizatins, prir surgeries, pre-existing medical and ther health related cnditins) Current cnditins/chief cmplaints (cncerns leading t seek physical therapist services, current therapeutic interventins, mechanisms f injury r disease, nset and pattern f symptms, expectatins and gals fr the therapeutic interventins, emtinal respnse t current clinical situatin, previus ccurrence f chief cmplaints, prir therapeutic interventins) Functinal status and activity level (current and prir functinal status in self-care and hme management including activities f daily living and physical activity levels) Medicatins (medicatins fr the current cnditin, medicatins previusly take fr current cnditin, medicatins fr ther cnditins). Gauge cncrdance and difficulties taking medicatins. Other clinical tests (labratry and diagnstic tests, review available recrds, review ther 12. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

13 clinical findings) Perfrms a quick systems review that may include brief assessment f the fllwing systems: Cardivascular/pulmnary systems (bld pressure, heart rate, respiratry rate, and assessing fr edema) Musculskeletal system (grss range f mtin, grss strength, grss symmetry, height, weight) Neurmuscular system (grss crdinated mvements, fr example balance, lcmtin, transfers, and safe transitins between mvements frm ne place t anther) Integumentary system (the presence f any scar frmatin, the skin clur, and the skin integrity) Includes in the systems review an assessment f cmmunicatin, behaviural/emtinal state, cgnitin, language, and learning style Selects and administers tests and measures that may include: Aerbic capacity/endurance assessment f aerbic capacity during functinal activities and during standardised tests; cardivascular signs and symptms during exercise r activity; pulmnary signs and symptms f distress during exercise r activity Anthrpmetric characteristics may include assessment f bdy cmpsitin; bdy dimensins; and edema Arusal, attentin, and cgnitin may include assessment f arusal; attentin; cgnitin; cmmunicatin; cnsciusness; rientatin; and recall Assistive technlgies and adaptive devices may include assessment f devices and equipment; cmpnents; remediatin f impairments, functinal limitatins, disabilities, activity limitatins, and participatin restrictins; and safety Circulatin (arterial, venus, lymphatic) may include assessment f signs, symptms and physilgical respnses t psitins Cranial and peripheral nerve integrity may include assessment f mtr and sensry distributin f nerves; respnse t neural prvcatin; respnse t stimuli; and electrphysilgical testing Envirnmental, hme, and wrk (jb/play/study) barriers may include assessment f: Current and ptential barriers; and physical space and envirnment Ergnmics and bdy mechanics may include assessment f dexterity and crdinatin during wrk; functinal capacity during wrk; safety during wrk; specifics f wrk cnditins; wrk tls, devices, equipment; and bdy mechanics during self-care, hme management, wrk, cmmunity, and leisure (with and withut assistive, adaptive, rthtic, prsthetic, prtective, and supprtive devices and equipment) Gait, lcmtin, and balance may include assessment f static and dynamic balance; balance during functinal activities; gait and lcmtin during functinal activities with and with devices r equipment; and safety during gait, lcmtin, and balance Integumentary integrity may include assessment f activities, psitin, pstures, devices, and equipment that prduce r relieve trauma t skin; burn; signs f infectin; and wund and scar characteristics Jint integrity and mbility Mtr functin (mtr cntrl and mtr learning) may include assessment f: dexterity, crdinatin, and agility; hand functin; cntrl f mvement patterns; and vluntary pstures Muscle perfrmance may include assessment f muscle strength, pwer, and endurance; and muscle tensin Orthtic, prtective, and supprtive devices may include assessment f cmpnents, alignment, and fit; use during functinal activities and sprt-specific activities; remediatin f impairments, functinal limitatins, disabilities, activity limitatins, and participatin restrictins; 13. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

14 and safety during use Pain may include assessment f type, lcatin, and severity (irritability, intermittent/cnstant, quality, pattern, duratin, time, cause); sreness; and nciceptin Psture may include assessment f static and dynamic pstural alignment and psitin Prsthetic requirements may include assessment f cmpnents, alignment, fit, and ability t care fr prsthesis; use during functinal activities and sprt-specific activities; remediatin f impairments, functinal limitatins, disabilities, activity limitatins, and participatin restrictins; residual limb r adjacent segment; and safety during use Range f mvement may include assessment f functinal range f mvement; jint active and passive mvements; muscle length; and sft tissue extensibility and flexibility Reflex integrity may include assessment f deep and superficial reflexes; pstural reflexes and reactins; primitive reflexes and reactins; and resistance t passive stretch Self-care and hme management may include assessment f activities f daily living [ADL] and instrumental activities f daily living [IADL] fr self-care and hme management; ability t gain access t hme envirnment; and safety during self-care and hme management Sensry integrity may include assessment f cmbined/crtical sensatins; and deep sensatins Ventilatin and respiratin/gas exchange may include assessment f pulmnary signs f respiratin/gas exchange; pulmnary signs f ventilatry functin; and pulmnary symptms Wrk (jb), cmmunity, and leisure integratin r reintegratin may include assessment f ability t assume r resume wrk, cmmunity and leisure activities; ability t gain access t wrk; cmmunity and leisure envirnments; and safety in wrk, cmmunity and leisure activities and envirnments Adjusts the duratin and intensity f the examinatin/assessment (histry, systems review, and tests and measures) accrding t the cnditin f the lder individual, understanding that it may take several sessins t cmplete a full examinatin/assessment Gathers infrmatin abut previus interventin r care frm thers fr any similar issues. Ascertains whether physical therapy interventin/treatment is apprpriate and safe Determines whether the lder individual s prblem(s) are amenable t interventins/treatment by the physical therapist practicing with lder adults Discusses the results f the examinatin/assessment with the lder individual and ther apprpriate advcates Recrds the examinatin/assessment prcess accrding t the criteria set by the Cdes f Practice f the physical therapists cuntry f practice Ensures that dcumentatin is dated and apprpriately authenticated by the physical therapist that carried ut the assessment/examinatin in line with prfessinal and service plicy guidelines prvided Evaluatin Definitin: Is a dynamic prcess in which the physical therapist makes clinical judgments based n data gathered during the examinatin/assessment. It is the prcess that necessitates re-examinatin fr the purpse f evaluating utcmes t identify prgressin t gal achievement r need fr mdificatin and change f plan. Standards: The physical therapist: Might prceed, fllwing the examinatin/assessment in any f fur ways: 1) give advice t the lder individual and/r referrer n hw t cntinue; 2) prceed t develp the diagnsis, prgnsis and plan; 3) recmmend a cnsultatin with anther prfessinal; r 4) determine that treatment 14. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

15 wuld be ineffective Underpins the analysis and interpretatin with the highest available evidence regarding the lder ppulatin Interprets the data in a theretically sund manner t frm a diagnsis Diagnsis Definitin: Is a prcess that arises frm the examinatin/assessment and evaluatin and represents the utcme f the prcess f clinical reasning. It may be expressed in terms f mvement dysfunctin r may encmpass categries f impairments, functinal limitatins, abilities/disabilities, r syndrmes. Diagnsis is bth a prcess and a label. The diagnstic prcess perfrmed by the physical therapist includes integrating and evaluating data btained during the examinatin/assessment t describe the individual s cnditin in terms that will guide the prgnsis, the plan f care, and interventin strategies. Physical therapists use diagnstic labels that identify the impact f a cnditin n functin at the level f the system (especially the mvement system) and at the level f the whle persn 2. Descriptin: Includes the fllwing: Frmulatin f a diagnsis utilising a prcess f clinical reasning that results in the identificatin f existing r ptential impairments, activity limitatins, participatin restrictins and envirnmental factrs Incrpratin f additinal infrmatin frm ther prfessinals, as needed, in the diagnstic prcess Knwing that the diagnsis may be expressed in terms f mvement dysfunctin r may encmpass categries f impairments, activity limitatins, participatin restrictins and envirnmental factrs If the diagnstic prcess reveals findings that are nt within the scpe f the physical therapist s knwledge, experience r expertise, referring the individual t anther apprpriate practitiner Standards. The physical therapist: Fcuses n prviding a diagnsis fllwing evaluatin f the lder individual s mvement, bth qualitatively and quantitatively thrugh apprpriate tests and measurements May fllw accepted practice f sharing their knwledge and experience f the diagnsis with clleagues within and utside f physical therapy with the permissin f the lder individual t demnstrate expertise in dealing with an lder peple with cmplex presentatins Prgnsis (Including Plan) Definitin: Prgnsis is the determinatin by the physical therapist f the predicted ptimal level f functin and the amunt f time needed t reach that level. Smetimes, if the individual has a prgressive cnditin, the physical therapist may nt anticipate an imprvement, but expect the individual s cnditin t remain static, r expect t manage their deteriratin. Plan includes statements that specify the anticipated gals and the expected utcmes, predicted level f ptimal imprvement, specific interventins t be used, and prpsed duratin and frequency f the interventins that are required t reach the gals and utcmes. The plan includes the anticipated discharge plans. Descriptin: Includes the fllwing: Prgnsis includes Determining the individual s prgnses and identify the mst apprpriate interventin strategies fr physical therapist management 15. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

16 Plan includes Delivering and managing a plan that is cnsistent with legal, ethical, and prfessinal bligatins and administrative plicies and prcedures f the practice envirnment. This may include cnsent t plan and intervene/treat. Cllabrating with the individual, family members, payers (e.g., scial system, insurance cmpanies, self-payment by the individual), ther prfessinals and apprpriate invlved persns t determine a plan Determining specific interventins/treatments with measurable utcme gals assciated with the plan Establishing a physical therapy plan that is safe, effective, and persn-centred Determining individual s gals and utcmes within available resurces and specifying expected length f time t achieve the gals and utcmes Mnitring and adjusting the plan in respnse t the status f the individual Referring t anther agency/health practitiner cases which are inapprpriate fr physical therapy Standards. The physical therapist: Creates a treatment plan with SMART (specific, measurable, achievable, relevant, timely) bjectives Frmulates shrt-, mid- and lng-term plans in cllabratin with the lder individual, family members and inter-prfessinal team as apprpriate Recrds the agreed expected utcmes accrding t the criteria set by the Cdes f Practice f the physical therapists cuntry f practice Bases the treatment plan and gals n the highest available evidence regarding the lder ppulatin Interventins/treatment Definitin: Is the purpseful interactin f the physical therapist with the individual, and when apprpriate, with thers invlved in their management using varius physical therapy prcedures and techniques. This might include therapeutic exercise; functinal training in self-care and hme management; functinal training in wrk, cmmunity, and leisure integratin r reintegratin; manual therapy techniques; prescriptin, applicatin, and, as apprpriate, fabricatin f devices and equipment; airway clearance techniques; integumentary repair and prtectin techniques; electrtherapeutic mdalities; physical agents and mechanical mdalities t prduce changes in the cnditin. Is the sum f all interventins prvided by the physical therapist t the individual during an episde f service delivery 2. Descriptin: Includes the fllwing: Prviding whenever pssible, evidence-based physical therapy interventins/treatments t achieve the individual s gals and utcmes. Interventins/treatments may include: Crdinatin, cmmunicatin and dcumentatin Persn-related instructin Therapeutic exercise Functinal training in self-care and hme management Functinal training in wrk (jb/play), cmmunity, and leisure integratin r reintegratin Manual therapy techniques Prescriptin, applicatin, and as apprpriate, fabricatin f devices and equipment 16. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

17 Airway clearance techniques Integumentary repair and prtectin techniques Electrtherapeutic mdalities Physical agents and mechanical mdalities Prviding physical therapy interventins/treatments aimed at preventin f impairments, activity limitatins, participatin restrictins, and injury including the prmtin and maintenance f health, quality f life, and fitness in lder persns Determining thse cmpnents f interventins that may be directed t supprt persnnel Respnding effectively t the individual s and envirnmental emergencies in the practice setting Standards: The physical therapist: Determines a timetable and strategies fr the interventins/treatment, discusses and plans it with the individual, and achieves mutual agreement fr all Selects interventins/treatment including apprpriate exercises fr the persn s age and physical cnditin, and uses interventins/treatments cnsidered mst effective t bring abut change Prvides r recmmends a practice envirnment, pssibly in the lder individual s wn envirnment, in which the desired activity can take place and/r be facilitated Infrms, advises, and/r assists the lder individual in implementing the interventins/treatment int their lifestyle and hme activities, including any assistive prducts and technlgy 2 s that they can functin as independently and safely as pssible Tailrs the interventins/treatment with any ther prfessinal(s) invlved with the lder individual Evaluates the results f the interventins/treatment regularly with the lder individual and applies treatments n that basis Ensures cntinuity by making a relevant transfer t anther service r by instructing the lder individual abut further self-management Ensures that dcumentatin is dated and apprpriately authenticated by the physical therapist prviding the interventins/treatment Bases interventins/treatment where pssible and when available n evidence that is infrmed by existing research, prtcls, r guidelines related t the lder ppulatin, mixing the infrmatin with the experience and expertise f the physical therapist and the circumstances f the individual Fcuses interventins/treatment when there is a cmplexity f issues arising frm the bi-psychscial dmains influencing the individual s life n educatin f the lder persn abut their cnditin and teaches them hw t best manage by finding an ptimal frm f participatin in sciety Mtivates the lder individual t make changes in their behaviur in adapting t their unique situatin where full recvery may nt be an ptin. Advises and assists the lder individual in btaining tls that fster self-reliance Undertakes preventive interventins in all instances Acts as an advcate fr the lder individual and/r fr the lder adult ppulatin t ptimise their chices twards healthy behaviur and lifestyles Advises the individual n Medicatins management, and in cuntries where drug prescriptin is an allwable part f physical therapy interventin /treatment, manages and prescribes medicatins accrding t legislatin Preventin Definitin: Is activity directed tward: (1) achieving and restring ptimal functinal capacity; (2) minimising impairments, functinal limitatins, and disabilities; (3) maintaining health, thereby 17. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

18 preventing further deteriratin r future illness and (4) creating apprpriate envirnmental adaptatins t enhance independent functin. Primary preventin is the preventin f disease in a susceptible r ptentially susceptible ppulatin thrugh such specific measures as general health prmtin effrts. Secndary preventin includes effrts t decrease the duratin f illness, severity f diseases, and sequelae thrugh early diagnsis and prmpt interventin. Tertiary preventin includes effrts t limit the degree f disability and prmte rehabilitatin and restratin f functin in patients/clients with chrnic and irreversible diseases. Descriptin: Includes the fllwing: Prviding physical therapy services fr preventin, health prmtin, fitness, and wellness t grups, and cmmunities Prmting health, quality f life, independent living, and wrkability by prviding infrmatin n health prmtin, fitness, wellness, disease, impairment, activity limitatins, participatin restrictins, and health risks related t age, gender, culture, and lifestyle, all f which are delivered within the scpe f physical therapist practice Standards: The physical therapist Bases preventin strategies n the highest available evidence regarding lder peple and n the evidence-based primary preventin prgrammes suggested by reliable health rganisatins Identifies the need fr time allcated t deliver preventive advice Develps primary preventin prgrammes in rder t preserve ptimal ability (capacity) f the lder individual Prvides persn-riented preventive advice, adapted t the ability f the lder individual in terms f cntent and delivery methd Fcuses n primary and secndary preventin interventins/treatment, and where pssible, n preventing further damage t smene wh already has impairment and disability (tertiary preventin), which may require mnitring frm a discipline ther than physical therapy Screens individuals t determine which preventin appraches will be best fr the lder persn (e.g., individual, grup) Develps appraches t the target audience's requirements, s that lder individuals cntinue t participate and adhere t the preventin prgram Uses knwledge, experience, and expertise t match the capabilities and future needs f the target grup Evaluates the effectiveness f the preventive advice given and makes alteratins when necessary t gain maximal effectiveness Encurages integratin f health prmtin during everyday life tasks f the lder individual Develps r uses specific educatinal materials t supplement their input and advice Prvides advice t caregivers in the implementatin f primary preventin prgrammes and prvides supplementary advice and materials as necessary Ensures that dcumentatin is dated and apprpriately authenticated by the physical therapist that recrded a plan fr preventative interventins Inter-prfessinal cllabratin Definitin: Is c-rdinatin f management, infrmatin sharing, disseminatin, and advice between physical therapists r ther service prviders t ensure cntinuity in the interventins/treatment aimed at maintaining r imprving the quality f the ageing individual s cnditin. Descriptin: Includes the fllwing: 18. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

19 The lder individual ften presents with multiple cnditins and prblems that rely n the assistance f several prfessinals simultaneusly. In these cases, the physical therapist using specific skills and knwledge in a manner that adds quality t the life f the lder persn wrks clsely, either cncurrently r cnsecutively with ther disciplines. In sme circumstances, the physical therapist takes n the rle f c-rdinatr f care. In sme cases, the physical therapist may fster relatins with ther sectrs in which lder peple are invlved in the imprvement f care f lder peple. Fr example, a physical therapist practising in an acute setting wh versees the transfer f lder adults between services specifically fr lder peple. Standards: The physical therapist, with the cnsent f the individual t share infrmatin: Cnsults with ther disciplines and /r clleagues in a timely manner t cntribute t the interventin fr the lder individual Discusses the interventins/treatment gals with ther disciplines and applies the infrmatin t the cnsultatin prcess Evaluates input with ther disciplines and /r clleagues, t mnitr the effect f the multidisciplinary apprach Prvides instructins t ther disciplines and /r clleagues where apprpriate If c-rdinating with ther prfessinals, requests and prvides feedback thrugh a cllabrative prcess Ensures that any dcumentatin related t the cllabratin is dated and apprpriately authenticated by the physical therapist that recrded the cmmunicatin While IPTOP cnsiders the Prfessinal develpment and Prfessinal leadership/mentring areas f practice t be an essential part f the develpment f prfessinal practice and the implementatin f high standards f clinical practice, the standards wuld nt differ frm thse f a therapist practicing within anther field f physical therapy. Fr this reasn, nly definitins f the terms and expectatins are prvided in the dcument (see page 9) and therapists are requested t utilise the infrmatin prvided by their prfessinal bdy in their practitiner s cuntry and t the plicy dcuments prvided by the WCPT. 19. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]

20 References: 1. WCPT (2011). Guideline fr standards f physical therapy practice. Accessed at: 2. Wrld Cnfederatin fr Physical Therapy. Plicy statement: Patients /clients rights in physical therapy. Lndn, UK: WCPT; (Access date 19 March 2012) 3. Wrld Cnfederatin fr Physical Therapy. WCPT Glssary: Terms used in WCPT s plicies and resurces. Lndn, UK: WCPT; Wrld Health Organizatin. Definitin f an lder r elderly persn. Geneva, Switzerland: WHO; (Access date 22nd Nvember 2010) 5. Mittrach R, Grill E, Walchner-Bnjean M, Scheuringer M, Bldt C, Huber E, Stucki G (2008). Gals f physitherapy interventins can be described using the Internatinal Classificatin f Functining, Disability and Health. Physitherapy; 94; Wrld Health Organizatin (WHO) (2001) Internatinal Classificatin f Functining, Disability and Health. Geneva: Wrld Health Organizatin 7. Wrld Cnfederatin fr Physical Therapy. Plicy statement: Physical therapy recrds management: recrd keeping, strage, retrieval and dispsal. Lndn, UK: WCPT; ( Accessed 19 March 2011.) 8. Wrld Cnfederatin fr Physical Therapy. Plicy statement: Infrmed cnsent. Lndn, UK: WCPT; ( Accessed 19 March 2011.) 20. IPTOP Standards f Clinical Practice v 1.2_ The Internatinal Assciatin fr Physical Therapists wrking with Older Peple [IPTOP]