Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral

Abstract Background and PurposeOpponents of direct access to physical therapy argue that physical therapists may overlook serious medical conditions. More information is needed to determine the ability of physical therapists to practice safely in direct-access environments. The purpose of this study was to describe the ability of physical therapists to make decisions about the management of patients in a direct-access environment. Subjects. Of a random sample of 1,000 members of the Private Practice Section of the American Physical Therapy Association, 394 participated. Methods. A survey included 12 hypothetical case scenarios. For each case, participants determined whether they would provide intervention without referral, provide intervention and refer, or refer before intervention. The percentage of correct decisions for each group of scenarios was calculated for each participant, and participants were classified as having made correct decisions for 100% of cases or less for each group. Three sets of logistic regressions were completed to determine the characteristics of the participants in relation to the decision category. Results. The average percentages of correct decisions were 87%, 88%, and 79% for musculoskeletal, noncritical medical, and critical medical conditions, respectively. Of all participants, approximately 50% made correct decisions for all cases within each group. The odds of making 100% correct decisions if a physical therapist had an orthopedic specialization were 2.23 (95% confidence interval=1.35–3.71) for musculoskeletal conditions and 1.89 (95% confidence interval=1.14–3.15) for critical medical conditions. Discussion and Conclusion. Physical therapists with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions.

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The Human Movement System: Our Professional Identity

Physical Therapy ◽

10.2522/ptj.20130319 ◽

2014 ◽

Vol 94 (7) ◽

pp. 1034-1042 ◽

Cited By ~ 39

Author(s):

Shirley A. Sahrmann

Keyword(s):

Physical Therapy ◽

Physical Therapists ◽

Human Movement ◽

The Body ◽

Physiological System ◽

Musculoskeletal Conditions ◽

Clear Identification ◽

Movement System ◽

American Physical

The 2013 House of Delegates of the American Physical Therapy Association adopted a vision statement that addresses the role of physical therapy in transforming society through optimizing movement. The accompanying guidelines address the movement system as key to achieving this vision. The profession has incorporated movement in position statements and documents since the early 1980s, but movement as a physiological system has not been addressed. Clearly, those health care professions identified with a system of the body are more easily recognized for their expertise and role in preventing, diagnosing, and treating dysfunctions of the system than health professions identified with intervention but not a system. This perspective article provides a brief history of how leaders in the profession have advocated for clear identification of a body of knowledge. The reasons are discussed for why movement can be considered a physiological system, as are the advantages of promoting the system rather than just movement. In many ways, a focus on movement is more restrictive than incorporating the concept of the movement system. Promotion of the movement system also provides a logical context for the diagnoses made by physical therapists. In addition, there is growing evidence, particularly in relation to musculoskeletal conditions, that the focus is enlarging from pathoanatomy to pathokinesiology, further emphasizing the timeliness of promoting the role of movement as a system. Discussion also addresses musculoskeletal conditions as lifestyle issues in the same way that general health has been demonstrated to be clearly related to lifestyle. The suggestion is made that the profession should be addressing kinesiopathologic conditions and not just pathokinesiologic conditions, as would be in keeping with the physical therapist's role in prevention and as a life-span practitioner.

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BACK TO THE GRASS ROOT

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.3.2/010 ◽

2014 ◽

Vol 3 (2) ◽

pp. 41-43

Author(s):

Ali Farhad ◽

Saad Saleem ◽

Zainab Abdul Razzak

Keyword(s):

Physical Therapy ◽

Physical Therapists ◽

Physical Therapist ◽

Direct Access ◽

Self Assessment ◽

Professional Advancement ◽

Health Networks ◽

Grass Root

Profession is, not to squeak like a grateful and apologetic mouse, but to roar like a lion out of pride1. Throughout a professional vocation, professionals change the span of their skill, through becoming more specific, through inspiring into recently emergent areas of professional work, or by taking on administration or enlightening positions. They will also be continually developing the quality of their work in a number of areas, beyond the level of proficiency of one’s ability or skill. Professional advancement inculcates a process of incessant development, long-term knowledge, and augmentation, which allow professionals to get better in their practices so as to better serve patients, clients, associations, the profession, and society2. A physical therapist has an enduring professional accountability for maintaining proficiency through ongoing self-assessment, education, and augmentation of information and skills. Physical Therapy, by 2020, will offer such Physiotherapist who are doctors of Physical Therapy and who may be board–licensed experts3. Clients will have direct access to Physical Therapists in all milieus for patient/client management, expectation, and wellness services. Physiotherapist will be practitioners of choice in clients’/patients’ health networks and will hold all rights of autonomous practice4. Physical Therapists may be assisted by Physical Therapy assistants, who are erudite and qualified to provide Physical Therapist–directed and controlled, components of intervention. Physical Therapy profession in Pakistan is rising with a great pace. Every passing minute brings extraordinary revolution in this field and now it is a high time to have some institution takes the responsibility on its shoulder to curtail the nourishing elements of quackery and bring autonomy and sovereignty to the field.

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Administration and Management Skills Needed by Physical Therapist Graduates in 2010: A National Survey

Physical Therapy ◽

10.2522/ptj.20060003 ◽

2007 ◽

Vol 87 (3) ◽

pp. 261-281 ◽

Cited By ~ 5

Author(s):

D Sue Schafer ◽

Rosalie B Lopopolo ◽

Kathleen A Luedtke-Hoffmann

Keyword(s):

Physical Therapy ◽

Skill Acquisition ◽

Financial Analysis ◽

Physical Therapists ◽

Physical Therapist ◽

Management Skills ◽

Health Care Environment ◽

Doctor Of Physical Therapy ◽

Skill Groups ◽

American Physical

Background and Purpose Administration and management (A&M) skills are essential to physical therapist practice. This study identified which A&M skills will be most critical for future Doctor of Physical Therapy (DPT) graduates to possess upon entry into clinical practice. Subjects and Methods Using a 7-point scale, 435 randomly selected American Physical Therapy Association members (physical therapists) rated 121 A&M skills based on expectation of the level of independence required by a new DPT graduate. Results No differences among respondents based on role, work setting, or experience were found, so the data were combined for factor analyses, producing 16 A&M skill groups. The most independence was expected in skills related to self-management, compliance with rules, ethical behavior, and insurance coding. Skills requiring the most assistance were marketing and strategic planning, financial analysis and budgeting, and environmental assessment. Discussion and Conclusion This study has identified the level of independence for the A&M skills needed by new DPT graduates, provided empirical evidence suggesting which A&M skills should be included in DPT curricula, and suggested a pattern of A&M skill acquisition that applies first to the new therapist and the patient, then to the organization, and finally to the health care environment.

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Referral for Imaging in Physical Therapist Practice: Key Recommendations for Successful Implementation

Physical Therapy ◽

10.1093/ptj/pzab013 ◽

2021 ◽

Author(s):

Aaron Paul Keil ◽

Charles Hazle ◽

Amma Maurer ◽

Connie Kittleson ◽

Daniel Watson ◽

...

Keyword(s):

Physical Therapy ◽

Diagnostic Imaging ◽

Physical Therapists ◽

Physical Therapist ◽

The United States ◽

Successful Implementation ◽

Program Accreditation ◽

Therapy Program ◽

Normative Practice ◽

American Physical

Abstract In recent years, the use of diagnostic imaging in physical therapist practice in the United States (US) has gained considerable interest. In several countries around the world and in the US military, patient direct referral for diagnostic imaging has been considered normative practice for decades. US physical therapy program accreditation standards now stipulate that diagnostic imaging content must be included in physical therapist educational curricula. The American Physical Therapy Association (APTA) has made efforts to pursue practice authority for imaging referral. A recent review of state practice acts and other statutory language concluded that many states have no prohibitions against physical therapists referring for imaging studies. Additionally, physical therapists can now pursue certification as musculoskeletal sonographers. In light of these advances, and with a growing number of PTs serving patients who have not yet seen another healthcare provider, it may be helpful for those who have been actively involved in the use of imaging in PT practice to provide their collective recommendations to serve as a guideline to those interested in incorporating this practice privilege. The purpose of this perspective article is to provide an overview of the key elements necessary for effective implementation of referral for imaging in physical therapist practice while emphasizing the cornerstone of effective communication.

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Guide to Physical Therapist Practice

Physical Therapy ◽

10.1093/ptj/77.11.1163 ◽

1997 ◽

Vol 77 (11) ◽

pp. 1163-1650 ◽

Cited By ~ 41

Keyword(s):

Health Care ◽

Physical Therapy ◽

Professional Education ◽

Health Care Services ◽

Physical Therapists ◽

Physical Therapist ◽

Daily Practice ◽

Care Services ◽

Provision Of Services ◽

American Physical

Preface All health care professions are accountable to the various publics that they serve. The American Physical Therapy Association (APTA) has developed Guide to Physical Therapist Practice (“the Guide”) to help physical therapists analyze their patient/client management and describe the scope of their practice. The Guide is necessary not only to daily practice but to preparation of students. It was used as a primary resource by the Commission on Accreditation in Physical Therapy Education (CAPTE) during its revision of evaluative criteria for physical therapist professional education programs and is an essential companion document to The Normative Model of Physical Therapist Professional Education, Version 97. Specifically, the Guide is designed to help physical therapists (1) enhance quality of care, (2) improve patient/client satisfaction, (3) promote appropriate utilization of health care services, (4) increase efficiency and reduce unwarranted variation in the provision of services, and (5) promote cost reduction through prevention and wellness initiatives. The Guide also provides a framework for physical therapist clinicians and researchers as they refine outcomes data collection and analysis and develop questions for clinical research.

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“Choose Physical Therapy” for Neonatal Abstinence Syndrome: Clinical Management for Infants Affected by the Opioid Crisis

Physical Therapy ◽

10.1093/ptj/pzz039 ◽

2019 ◽

Vol 99 (6) ◽

pp. 771-785 ◽

Cited By ~ 3

Author(s):

Dana B McCarty ◽

Jennifer R Peat ◽

Shannon O'Donnell ◽

Elisabeth Graham ◽

William F Malcolm

Keyword(s):

Physical Therapy ◽

Parent Education ◽

Physical Therapists ◽

Physical Therapist ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Safe Alternative ◽

Pharmacological Management ◽

Opioid Crisis ◽

American Physical

Abstract In response to the opioid crisis, the American Physical Therapy Association has strongly advocated for physical therapy as a safe alternative to pharmacological pain management through the “#ChoosePT” campaign and the dedication of a PTJ special issue to the nonpharmacological management of pain. Physical therapists not only play an important role in the rehabilitation of the nearly 2 million adolescents and adults addicted to prescription opioids but also provide care to infants born to mothers with various drug addictions. This Perspective article explores the incidence, pathophysiology, and risk factors for neonatal abstinence syndrome and describes the clinical presentations of withdrawal and neurotoxicity in infants. Discipline-specific recommendations for the physical therapist examination and plan of care, including pharmacological management considerations, are outlined. Nonpharmacological management, including supportive care, feeding, parent education, social aspects of care, and follow-up services, are discussed from a physical therapy perspective. Finally, this article reviews developmental outcomes in infants with neonatal abstinence syndrome and reflects on challenges and future directions of research in this area.

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Preface

Physical Therapy ◽

10.1093/ptj/77.11.1167 ◽

1997 ◽

Vol 77 (11) ◽

pp. 1167-1170

Keyword(s):

Health Care ◽

Physical Therapy ◽

Professional Education ◽

Health Care Services ◽

Physical Therapists ◽

Physical Therapist ◽

Daily Practice ◽

Care Services ◽

Provision Of Services ◽

American Physical

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Navigating the Intersection Between Persistent Pain and the Opioid Crisis: Population Health Perspectives for Physical Therapy

Physical Therapy ◽

10.1093/ptj/pzaa031 ◽

2020 ◽

Vol 100 (6) ◽

pp. 995-1007

Author(s):

Todd E Davenport ◽

Andra C DeVoght ◽

Holly Sisneros ◽

Stephen Bezruchka

Keyword(s):

Physical Therapy ◽

Population Health ◽

Physical Therapists ◽

Physical Therapist ◽

Opioid Use Disorder ◽

Persistent Pain ◽

Opioid Use ◽

Individual Level ◽

American Physical ◽

The Impact

Abstract The physical therapy profession has recently begun to address its role in preventing and managing opioid use disorder (OUD). This topic calls for discussion of the scope of physical therapist practice, and the profession’s role, in the prevention and treatment of complex chronic illnesses, such as OUD. OUD is not just an individual-level problem. Abundant scientific literature indicates OUD is a problem that warrants interventions at the societal level. This upstream orientation is supported in the American Physical Therapy Association’s vision statement compelling societal transformation and its mission of building communities. Applying a population health framework to these efforts could provide physical therapists with a useful viewpoint that can inform clinical practice and research, as well as develop new cross-disciplinary partnerships. This Perspective discusses the intersection of OUD and persistent pain using the disease prevention model. Primordial, primary, secondary, and tertiary preventive strategies are defined and discussed. This Perspective then explains the potential contributions of this model to current practices in physical therapy, as well as providing actionable suggestions for physical therapists to help develop and implement upstream interventions that could reduce the impact of OUD in their communities.

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Physical Therapist Practice in the Intensive Care Unit: Results of a National Survey

Physical Therapy ◽

10.2522/ptj.20140417 ◽

2015 ◽

Vol 95 (10) ◽

pp. 1335-1344 ◽

Cited By ~ 30

Author(s):

Daniel Malone ◽

Kyle Ridgeway ◽

Amy Nordon-Craft ◽

Parker Moss ◽

Margaret Schenkman ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

Physical Therapy ◽

Acute Care ◽

National Survey ◽

Physical Therapists ◽

Physical Therapist ◽

Community Hospitals ◽

American Physical

Background Early rehabilitation improves outcomes, and increased use of physical therapist services in the intensive care unit (ICU) has been recommended. Little is known about the implementation of early rehabilitation programs or physical therapists' preparation and perceptions of care in the United States. Objective A national survey was conducted to determine the current status of physical therapist practice in the ICU. Design This study used a cross-sectional, observational design. Methods Self-report surveys were mailed to members of the Acute Care Section of the American Physical Therapy Association. Questions addressed staffing, training, barriers, and protocols, and case scenarios were used to determine perceptions about providing rehabilitation. Results The response rate was 29% (667/2,320). Staffing, defined as the number of physical therapists per 100 ICU beds, was highest in community hospitals (academic: median=5.4 [range=3.6–9.2]; community: median=6.7 [range=4.4–10.0]) and in the western United States (median=7.5 [range=4.2–12.9]). Twelve percent of physical therapists reported no training. Barriers to providing ICU rehabilitation included insufficient staffing and training, departmental prioritization policies, and inadequate consultation criteria. Responses to case scenarios demonstrated differences in the likelihood of consultation and physical therapists' prescribed frequency and intensity of care based on medical interventions rather than characteristics of patients. Physical therapists in academic hospitals were more likely to be involved in the care of patients in each scenario and were more likely to perform higher-intensity mobilization. Limitations Members of the Acute Care Section of the American Physical Therapy Association may not represent most practicing physical therapists, and the 29% return rate may have contributed to response bias. Conclusions Although staffing was higher in community hospitals, therapists in academic and community hospitals cited insufficient staffing as the most common barrier to providing rehabilitation in the ICU. Implementing strategies to overcome barriers identified in this study may improve the delivery of ICU rehabilitation services.

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A Global View of Direct Access and Patient Self-Referral to Physical Therapy: Implications for the Profession

Physical Therapy ◽

10.2522/ptj.20120060 ◽

2013 ◽

Vol 93 (4) ◽

pp. 449-459 ◽

Cited By ~ 36

Author(s):

Tracy J. Bury ◽

Emma K. Stokes

Keyword(s):

Physical Therapy ◽

Online Survey ◽

Response Rate ◽

Physical Therapists ◽

Physical Therapist ◽

Medical Profession ◽

Good Practice ◽

Clinical Effectiveness ◽

Direct Access ◽

Policy Makers

BackgroundInternational policy advocates for direct access, but the extent to which it exists worldwide was unknown.ObjectiveThe purpose of this study was to map the presence of direct access to physical therapy services in the member organizations of the World Confederation for Physical Therapy (WCPT) in the context of physical therapist practice and health systems.DesignA 2-stage, mixed-method, descriptive study was conducted.MethodsA purposive sample of member organizations of WCPT in Europe was used to refine the survey instrument, followed by an online survey sent to all WCPT member organizations. Data were analyzed using descriptive statistics, and content analysis was used to analyze open-ended responses to identify themes.ResultsA response rate of 68% (72/106) was achieved. Direct access to physical therapy was reported by 58% of the respondents, with greater prevalence in private settings. Organizations reported that professional (entry-level) education equipped physical therapists for direct access in 69% of the countries. National physical therapy associations (89%) and the public (84%) were thought to be in support of direct access, with less support perceived from policy makers (35%) and physicians (16%). Physical therapists' ability to assess, diagnose, and refer patients on to specialists was more prevalent in the presence of direct access.LimitationsThe findings may not be representative of the Asia Western Pacific (AWP) region, where there was a lower response rate.ConclusionsProfessional legislation, the medical profession, politicians, and policy makers are perceived to act as both barriers to and facilitators of direct access. Evidence for clinical effectiveness and cost-effectiveness and examples of good practice are seen as vital resources that could be shared internationally, and professional leadership has an important role to play in facilitating change and advocacy.

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