Exam 1 (lectures 1-5)

What are the 6 roles of a PT?

1. patient/client management

2. educator

3. researcher

4. administrator

5. advocate

6. consultant

What are the characteristics of a profession?

1. distinct and specialized body of knowledge

2. expertise proved by licensure

3. autonomy to make altruistic decisions

4. affective neutrality

5. enforceable code of ethics

6. peer-reviewed standards and defined scope of practice

7. professional organization

PT Code of Ethics

APTA document; sets enforceable standards and aspirational ethical commitments for PTs and PTAs; protects the public, guides difficult decisions, and supports accountability

1. autonomy

2. beneficence (do good)

3. nonmaleficence (do no harm)

4. justice (fairness)

5. veracity (truth)

6. fidelity (loyalty)

professional scope

practice grounded in the profession’s unique body of knowledge, educational preparation, evidence, and existing or emerging frameworks

jurisdictional scope

legal scope established by the State Practice Act, regulations, and licensing-board rules

personal scope

activities for which an individual PT is educated, trained, currently competent, and able to perform safely

In what areas is PT practice emerging?

1. population health, prevention, promotion

2. primary care and entry point-provider roles

3. telehealth, digital health, remote patient monitoring

4. ordering/interpreting imaging where permitted

5. emergency department practice and medical screening

6. dry needling, blood-flow restriction training, concussion management, health life span management

Quintuple Aim

1. enhancing patient experiences

2. improving population health

3. reducing care costs

4. improving provider well-being

5. advancing health equity

professionalism

conduct, skills, and qualities expected of someone in a professional role

professional socialization

professional evolution toward doctoral education, direct access, autonomous judgment, specialization, evidence-based practice, and stronger self-regulation

What influences the dynamics/evolution of PT scope of practice?

changes in education, technologies, legislations & regulations

telehealth

use of info and comms tech to provide health-related services at a distance

telemedicine

delivery of a health care service using electronic comms, info tech, or other electronic/tech means to bring services to the distant site of the patient

evidence-based practice

integrates best available evidence, clinician expertise, and patient values/circumstances due to variations in care and lack of outcomes

ex: journals, clinical practice guidelines, clinical prediction rules, standardized outcome measures

clinical practice guidelines

synthesizes evidence and recommends care for a defined condition or population

clinical prediction rules

combines clinical findings to estimate probability or guide decisions

Professional Behaviors Assessment Tool

professional behaviors deemed necessary for success in PT practice

1. critical thinking

2. communication skills

3. problem solving

4. interpersonal skills

5. responsibility

6. professionalism

7. use of constructive feedback

8. stress management

9. commitment to learning

professional development

the ongoing self-assessment, acquisition, and application of knowledge, skills, and abilities for continuing competence

lifelong learning

systematic maintenance and improvement of knowledge, skills, and abilities thru one’s professional career or working life

continuing competence

the ongoing possession and application of contemporary knowledge, skills, and abilities within one’s role and scope of practice

1. clinical reasoning

2. interprofessional skills and communication

3. clinical skills

4. system based practice

5. knowledge for practice

6. critical inquiry skills

movement system

the collection of systems that interact to move the body or its component parts

medical diagnosis

made by a physician using tools (x-rays, MRIs, bld tests) to identify the specific structural pathology of the injure/disease tissue and guide pharm/surgical/overall disease mangement

ex: full-thickness rotator cuff tear

movement system diagnosis

made by a PT thru biomedical analysis, functional observation, and specific movement pattern testing to identify the way a person moves poorly and its system-wide cause to dictate interventions needed to resolve the dysfunction

ex: force production deficit

Guide to Physical Therapist Practice

APTA document; describes PT practice for non-PTs to understand common terminology, patient/client management framework, tests/measures and interventions; supports comms across settings

PT Core Values

APTA document; accountability, altruism, collaboration, compassion and caring, duty, excellence, inclusion, integrity, social responsibility

Minimum Required Skills of PT Graduates at Entry Level

APTA document; describes minimum abilities expected of a new grad entering practice; helps programs and the public understand entry-level expectations of PT practice

International Classification of Functioning, Disability, and Health (ICF) Model

provides a common language and scientific basis for understanding health and functioning by comparing conditions and settings; views disability and functioning as dynamic interactions among heath condition, body structure/function, activity limitations, participation restrictions, environmental factors, and personal factors

Biomedical Model

focuses on pathology, tissue damage, impairment, and correction of biological abnormalities; health = absence of diseaes

Biopsychosocial Model

supports individualized patient-centered care; that health and disability result from interaction among biological, psychological, and social factors

Patient/Client Management Model

1. examination

2. evaluation

3. diagnosis and prognosis

4. referral/consultation/comanaging

5. plan of care and intervention

6. outcomes

7. reexamination

continuum of care

transitional care; coordinated services across prevention, acute illness/injury, post-acute recovery, rehab, long-term support, community participation, and end-of-life needs

preventive/primary care

risk reduction, screening, wellness, early identification, and health promotion

acute care

inpatient; short-term hospital care for urgent illness, surgery, stabilization, and complex medical needs; most expensive

post-acute care

inpatient services after hospitalization: LTCH, home health, IRF, subacute rehab, LTC

long-term care hospital (LTCH)

ongoing management, supported living, school, workplace, wellness, and community participation

home health

homebound pts with MD-ordered/supervised skilled services

inpatient rehab facility (IRF)

3hrs of therapy/5 days/week or 15 hrs in 7 consecutive day periods

ex pts: CVA, TBI, MS, PD, MD, trauma

subacute rehab

1-2 hrs/day in a skilled nursing facility

long term care (LTC)

residential/custodial/ADLs nursing homes; pt can’t return home

outpatient care

day rehab, private practice, hospital-based outpatient services

transitional care

continuum of care; coordination during movement between settings to reduce gaps, adverse events, and readmission

Improving Medicare Post-Acute Care Transformation (IMPACT) Act

promotes standardized assessment data across post-acute settings

unrestricted direct access

evaluation and treatment without referral restrictions or limitations

direct access with provisions

evaluation and/or treatment allowed with condition limits (time, visits, diagnosis, provider notification, referral requirements)

Disability Rights Movement

reframed disability as a civil-rights and social justice issue rather than a personal medical problem and passed several disability rights legislations

1. Rehabilitation Act of 1973, Section 504

2. IDEA

3. ADA

4. ADA Amendments Act

5. Fair Housing Act protections

   1. Air Carrier Access Act

Rehab Act of 1973, Section 504

prohibits disability discrimination in programs or activities receiving federal financial assistance

Individuals with Disabilities Education Act (IDEA)

guarantees eligible children a free appropriate public education and related services in the least restrictive environment

Americans with Disabilities Act (ADA)

broad civil rights law; prohibits discrimination in employment, state/local government, public accommodations, transportation, etc. to level the playing field for PWDs

ADA Amendments Act

broadened interpretation of disability and reinforced inclusivity

Fair Housing Act protections

prohibits disability discrimination in housing and supports reasonable accommodations/mods

Air Carrier Access Act

protects passengers with disabilities from discrimination in air travel

disability

a physical or mental impairment that substantially limits one or more major life activity; 1/5 Americans with disability live in poverty; half of PWDs are of age to work but do not

ableism

systematized discrimination, antagonism, or exclusion of disable people based on the belief that ‘normal’ ability/thought/policy/systems is superior/right

Medical Model

locates disability in the individual’s disease, impairment, or abnormality; emphasizes diagnosis, treatment, cure

Social Model

locates disability in societal and environmental barriers, exclusion, design, attitudes

Political-Relational Model

recognizes embodied impairment experiences and unequal social/political relationships

accessible design

a site, building, facility, or part of these that complies with the minimum accessibility standards set by the Americans with Disabilities Act, architectural barriers act, or building code

universal design

considers wide spectrum of human abilities with aim to exceed minimum standards to meet the needs of the greatest number of people

spread

ability of a single characteristic to evoke inferences about the person as a whole

diagnostic overshadowing

attribution of symptoms to an obvious pre-existing diagnosis rather an a potential other condition → misdiagnosis

PWD health dispariy experiences

less access to preventive/primary care, inaccessible facilities/equipment/transportation/comms, diagnostic overshadowing, delayed treatment, higher rates of chronic conditions, underrepresentation in professional settings, reduced autonomy in comms, barriers (financials, employment, housing, insurance)

health literacy

whether people can find, understand, evaluate, and use health info and services; limited health literacy can impair understanding, informed consent, medication use, appointment follow-through, decision-making; 40% of Americans struggle with health literacy

individual factors in health literacy

education, language, cognition, sensory function, stress, pain, culture, prior health experience, numeracy, digital skills

systemic factors in health literacy

complex forms, jargon, rushed visits, fragmented care, inaccessible materials, unclear websites, poor interpreter access, inconsistent instructions, difficult insurance/referral processes

strategies to improve patient-education materials

1. 5^th/6^th grade reading level

2. short sentences with few syllable words

3. large font & organized info

4. active voice and plain language

5. teach-back to check understanding

6. open-ended questioning

   1. hand signals, visual cues, listening carefully

teach-back method

technique to improve comprehension and reduce chance of misinformation

1. explain a component of place of care with plain language and mindfulness of amount of info given

2. assess pt’s understanding by asking them to paraphrase

   1. introduce next component if pt understands or repeat 1 & 2 if they don’t

American Physical Therapy Association (APTA)

national professional membership organization for PTs, PTAs, and SPTs; seeks to improve health and quality of life by advancing PT practice, education, research, advocacy, standards, and public understanding

APTA vision

“Transforming society by optimizing movement to improve the human experience”

guiding principles: identity, quality, collaboration, value, innovation, consumer-centric, access/equity, advocacy

APTA organizational structure

1. Board of Directors - elected by HOD

2. HOD - policy makers

3. related organizations - research funding, academic scholarships

4. program boards/commissions - board certification, fellowship, program accreditation

5. board appointed committees

6. member groups

   1. components (18 sections & academics, 51 chapters)

   2. institutional groups (ACAPT - council of academics)

   3. engagement groups (council, student assembly, PTA caucus)

National APTA

develops national policy, federal advocacy, professional standards, ethical documents, public campaigns, payment resources, research and practice resources, specialty infrastructure, national education, and member services

State chapters

advocate on state practice acts and regulations, comm with state boards and legislators, provide local education/networking, respond to state payment issues, build grassroots advocacy relationships

academics/sections and SIGs

advance specialty knowledge thru journals, guidelines, education, conferences, mentoring, and communities of practice

legislation

bills and laws enacted by legislative bodies

regulation

detailed rules created by authorized agencies to implement and enforce laws

professional advocacy

efforts to influence policy affecting patients, access, payment, quality, scope of practice, education, research, and the profession

Social Determinants of Health (SDOH)

modifiable risk factors that lead to one’s health and well-being

basic activities of daily living (BADLs)

toileting, feeding/eating, bed mobility, dressing, bathing/showering, transfers, functional mobility, personal device care, personal hygiene, sexuality

instrumental activities of daily living (IADLs)

related to ICF activity limitations; care of others, care of pets, comms management, driving and community mobility, financial management, health management and maintenance, home establishment and management, meal prep and cleanup, religious and spiritual activities, safety and emergency maintenance, shopping, electronic ADLs

___ is the indicator with the highest gap.

Employment

defensive medicine

waste of resources and finances on procedures/exams/extra medicine just in care/to be sure

CAPTE

commission on accreditation of physical therapy education

What are the 4 human movement systems that PTs deal with?

musculoskeletal, neuromuscular, cardiopulmonary, integumentary systems

State Practice Act

laws for direct access

Signs are ___ and symptoms are ___.

objective; subjective (what the pt describes they experience)