Physical Therapy Practice (practice, ethical and legal issues)

Professional Responsibilities - Supervision of the PTA, ethics terms, physical therapy practice

What is the role of the PT?

• Responsible for examination, evaluation, diagnosis, prognosis (POC), and intervention (the 5 elements)

• Responsible for initial eval, establishing POC, progress, and discharge notes

What is the role of the PTA?

• Apply intervention (within the POC) under the supervision of a PT

• Documents daily Rx

What are things a PTA cannot do?

• Specify and/perform conclusive assessment procedures

• Alter the POC

• Recommend equipment or architectural alterations

• Sign progress/discharge notes that alter the POC

Can a PTA handle acute physiological changes?

Yes, they can

What are the things a PTA should always be able to do?

• Provide info regarding the rationale for Rx

• Recognize when an intervention is outside their scope of practice

• Recognize when a question should be redirected to the PT

• Communicate effectively with the PT

Who can be over a PT clinic?

Only a PT, not even a physician

Can a PT tech perform billable services?

No, they cannot

What is an examination?

The process of obtaining a history, performing a systems review. And selecting and administering tests and measures to gather data about the patient

What is an evaluation?

A dynamic process in which the physical therapist make clinical judgments based on data gathered during the examination

What is diagnosis?

Both the process and the end result of evaluating examination data (ex. Broken right tibia)

What is a prognosis?

Determination of the the optimal improvement that may be obtained through intervention and the amount of time to reach that level

What is an intervention?

Purposeful and skilled interaction of the PT/PTA with the patient using various physical therapy procedures and techniques to produce a condition that is consistent with the diagnosis and prognosis

What is an outcome?

Results of patient management, which include the impact of physical therapy interventions

What is general supervision?

The most common form of supervision of PTAs; the PT is not required to be physically present but only on-call (or through telecommunications)

What is direct supervision?

The PT is physically present (telecommunication does not fit this); required by PTAs in private setting

What supervision level is suitable for a PT or PTA student?

Direct supervision

What is direct personal supervision?

PT or PTA is physically present to supervise aides tasks (telecommunication does not meet this requirement)

What supervision is necessary for a physical therapy aide/tech?

Direct personal supervision

A PT or PTA (in tandem with a PT) can supervise a PTA/PT student.

True (under direct supervision)

A physical therapist, even under general supervision, must be available via telecommunications.

True

What is primary care?

Integrated, accessible healthcare services by clinicians who are responsible for addressing a wide range of healthcare needs

What is secondary care?

• Includes musculoskeletal, neuromuscular, cardiovascular, and integumentary conditions that other practitioners may initially treat

• Care for people after being referred to acute care, outpatients, rehabilitation, home health, etc.

What is tertiary care?

• Provided in response to requests by other health care practitioners for consultation and specialized services (ex. SCIs and closed head trauma)

• Performed in highly specialized, complex, tech-based settings

What are examples of accreditations for medical facilities?

• The Joint Commission

• Commission on Accreditation of Rehabilitation Facilities (CARF)

• Can be earned by hospitals, doctor’s offices, nursing homes, provider’s of home care services

Under Medicare, all practice settings are required to provide at least general supervision (with the exception of private settings).

True - Private settings require direct supervision

Can a PTA and patient plan short term goals?

No, that can only be done by the pt and PT

Prior to modifying a treatment technique, what MUST the PTA do FIRST?

Ensure that the modification is included in the plan of care

Which of the following options MOST accurately describes the main role of the PTA?

application of intervention

Which of the following is outside of the scope of practice for a physical therapist assistant?

Recommend wheelchairs or other assistive devices to persons

A PTA can educate family members and caretakers to perform relevant interventions for a patient.

True

What are the main components of physical therapy?

• Examination - obtaining patient history, performing a systems review, administering tests and measures

• Evaluation - a dynamic process where a PT makes clinical judgements using information from the examination; another provider may need to be contacted

• Diagnosis - the process and result of the exam and eval, which the PT organizes the info into categories to determine prognosis and intervention strategies

• Prognosis - determination of optimal improvement that may be attained through intervention

• Intervention - skilled interaction of the PT/PTA with the patient to produce changes in the condition consistent with the diagnosis and prognosis

• Outcomes - the results of patient management

Autonomy

Requires that the wishes of competent individuals must be honored; aka self-determination

Nonmaleficence

The obligation, that above all else, health care providers do no harm

Physical therapists must directly supervise PTAs they are responsible for (or supervising).

False. A PT may utilize general supervision of a PTA