Physical Therapy Who are the preferred providers?
Physical Therapists Physical Therapist Assistants Supported by aides and other office specific workers
Historical Perspective Physical therapist 1921 first Women s Physical Therapeutic Association 1930 s admitted men 1940 s name changed to APTA 1950 s 39 programs 1978 established specialist certification program Current: 210 US programs 21 at MPT/MSPT & 189 at DPT level (CAPTE April 2008) Physical Therapist Assistant 1964 Task Force 1967 2 programs started 1969 first graduation from St Mary s in MN & Miami Dade in FL 1971 Nancy Watt s article 1980-2000 clarifications within House of Delegates 2005 APTA develops certificate to recognize advanced proficiency Current: > 233 programs (CAPTE April 2008)
Role of PT Assistants Technically trained in the skill set needed to support the Physical Therapist Measurement using standardized techniques Direct intervention Patient-related instruction Onsite assessment of response Addressed within the Guide to Physical Therapist Practice
APTA Education Consensus on Delegation based on 1997 document Consider PTA education, training, experience, & skill level Patient status (criticality, acuity, stability, complexity), predictability of consequences, and frequency of re-evaluation that will be needed State regulations; Potential liability; Mission for PT services within the setting May delegate elements of exam process to PTA - IF this will not compromise ability to reach diagnosis or decision regarding intervention
Quick look at Watt s Taxonomy Level 1 standardized & routine Level 2 stable application based on guidelines Level 3 variations in treatment occur but not rapidly or unexpectedly Level 4 rapid modifications needed with interpretation ongoing Level 5 evaluative, requiring decisions and oversight during administration to assess Level 6 applications to group patterns Level 7 applications to theoretical development
CAPTE Position Paper Evaluative criteria that address the relationship between physical therapists and physical therapist assistants http://www.apta.org/am/template.cfm?sectio n=general_information&contentid=46607 &TEMPLATE=/CM/ContentDisplay.cfm
From CAPTE Position Paper on PT-PTA preferred relationship The elements of Examination, Evaluation, Diagnosis, Prognosis, Plan of Care, and Outcomes are the sole responsibility of the physical therapist. The physical therapist is responsible for determining those aspects of intervention that may be directed to the physical therapist assistant for each individual patient depending upon patient acuity, stability, and complexity. When interventions require continuous examination for safe and effective application <> they may not be delegated to the physical therapist assistant. <> such as, but not limited to, suctioning, joint mobilization, sharp debridement, instrumental activities of daily living training, and other components of interventions listed in Appendix E of the Normative Model of Physical Therapist Assistant Education, Version 99
Continuing, from CAPTE position paper The physical therapist initiates and modifies the treatment program; the physical therapist assistant may modify specific treatment procedures in response to patient status. The physical therapist assistant may engage in specific, limited data collection activities in order to assess the patient s response to the intervention, but for this purpose only. At all times the physical therapist assistant works under the direction and supervision of the physical therapist.
State Law The PT Practice Act within each state provides legal guidelines within the PT Practice Act The PT Affiliated Credentialing Board (PTACB) is within the Medical Examining Board for State of WI PT 5.01 Practice and supervision of physical therapist assistants and unlicensed personnel provided as 1 page handout http://www.legis.state.wi.us/rsb/code/pt/pt005.pdf
Background & Training
Parallels between PT and PTA Normative model for PT Education Normative model for PTA Education Program Accreditation by CAPTE Program Accreditation by CAPTE Guide for Professional Conduct (Code of Ethics) for PT Standards of Ethical Conduct for PTA
PT and PTA PT Licensure required for Physical Therapists in all states in US 250 item exam Provides supervision consistent with federal & state requirements - effective for patient care status Provides supervision consistent with state requirements and ethical standards of care PTA Licensure exam required in 42 states; 45 require graduation from accredited program; some don t regulate 200 item exam Recognizes appropriate & inappropriate delegation advocates for best practice Abides by role & supervisory requirements consistent with state requirements & ethical standards
Comparison UW-L and Western physical therapy programs Degree conferred Clinical Doctorate of Physical Therapy Length of program 3 years (9 semesters) Duration of clinical experiences Year 1: 2 weeks Year 2: 4 weeks Year 3: 36 weeks Degree conferred Associate Degree as Physical Therapist Assistant Length of Program 2 years (5 semesters) Duration of clinical experiences Year 1: 1 week Year 2: 15 weeks
Prerequisites Bachelor s Degree (or dual degree Senior in Biology or Physics at UW-L) Courses (Biology, Anat & Physiology, Chemistry, Physics, Psychology, Sociology, Statistics) Graduate Record Exam Background check Job Shadowing Letters of Reference Admitted through application process (example, > 200 applicants in 2007 for 45 available seats ) High School Diploma or equivalent Courses in High school (Biology, Chemistry) Placement testing (ACT, ASSET or COMPASS) Background check Admitted via wait list All admission criteria met (including online orientation, immunization record, CPR certification) Priority admission possible for A&P coursework
Sample of Course Topics Human Anatomy, Neuroanatomy, Physiology, Pathophysiology, Pharmacology, Exercise Science, Radiology Professionalism & Ethos of Care, Clinical Teaching, Health Care Admin, Health & Wellness Biomech & Kinesiology, Instrumentation, Statistics, Research, EBP Examination, Intervention, Physical Agents, Cardiopulmonary, Integument, Orthopedics x3 ( Spine, LE, UE), Neurologic x2 (Adult, Pediatric) Fieldwork, Internship x3 General Anatomy &Physiology Written Communication, Speech, Psychology, Developmental Psychology Professional issues, Technical Reporting Kinesiology x2 Therapeutic Exercise, Therapeutic Modalities, Neurologic Rehab, Musculoskeletal Rehab, Cardio & Integument, Lifespan Rehab Clinical Practice x3
Link to Programs & Courses www.uwlax.edu www.westerntc.edu/ http://www.uwlax.edu/sah /html/gradprograms.htm http://perth.uwlax.edu/pt/p df/dpt%20curriculum%2 0outline%204-9-08.pdf http://www.westerntc.edu/ ClassInformation/Cluster Detail.aspx?CLUSTER_I D=6 http://www.westerntc.edu/ ClassInformation/Progra minformation.aspx?pro GRAM_NBR=105241
Plans for Interactive Lab Introduction Awareness Opportunity for interaction Preparation for unique & shared roles Team Members within Health Care
Goals for the Interactive Lab Students will value the preferred relationship between the PT and PTA. The PT & PTA student will cooperatively discuss completion of a treatment session within the plan of care as written. The PT & PTA student will seek clarification on any confusing aspects of communication, roles, and responsibilities. PT and PTA students will recognize the educational rigor of each other s educational background. PT & PTA students will display mutual respect during the communication process.
Planned Agenda Before the interactive lab session Informed consent form Pre-Activity Survey Lecture-Discussion with these slides During the Interactive lab session Meet & Greet Learn about each other s program, training, expectations, and concerns Discuss each patient on your caseload at Healthy Sweat Clinic for this date Sharing experiences & training with each other Whole group discussion Following the interactive lab session Post-Activity Survey
References APTA CAPTE (Commission on Accreditation of Physical Therapy Education) resources at website. www.apta.org FSBPT (Federation of State Boards of Physical Therapy) website. www.fsbpt.org Plack MM et al. Collaboration between physical therapists and physical therapist assistants: fostering the development of the preferred relationship within a classroom setting. J of Phys Therapy Education. 2006;20(1):3-13. Watts NT. Task analysis and division of responsibility in physical therapy. Phys Ther. 1971;51:23-30.