PPI - MIDTERM 1 study guide.

1917

during WWI, women were recruited to rehabilitate injured soldiers through US army medical department, division of physical reconstruction as reconstruction aides

1918

first PT with the Army was Mary McMillan at Walter Reed general hospital

-she was trained and experienced through British hospitals prior to coming to US

-she headed this 1st school of PT

1921

formation of the 1st professional association "The American Women's Physical Therapy Association" (AMWPTA) with Ms. McMillan elected as president

-and first PT journal published in US

1922

name changed to American Physiotherapy Association (APA) and men were admitted

-1st annual conference

polio epidemic

Florence (Peterson) Kendall, trained at U of Minnesota and Walter Reed Army Hospital had worked with Veterans with nerve and muscle injuries

-by 1920's she began caring for patients with polio at Baltimore Children's Hospital School under direction of PT Henry Kendall

-many PTs at that time used conservative therapy, splinting, casting, and only minor exercises, believing that frequent handling and over-treatment would harm those with polio

polio, FDR & PT

other PTs were finding that conservative treatment led to misshapen limbs and experimented with exercises in heated pools, led by the efforts of Franklin D. Roosevelt who worked with a PT (Alice Lou Plasteridge) to heal his own polio paralysis

FDR 1926

with his PT, he established Georgia Warm Springs Foundation with his funding

1927

American Orthopedic Association recommended that it be designated a permanent hydrotherapeutic center

-today known as "Roosevelt Warm Springs Institute for Rehabilitation"

1935 new requirements

minimum standard educational requirements to enter PT program

-to use the term "registered" as part of prof title, anyone joining needed to pass a written exam in joint effort between APTA and with physician prof association

-document of registered PTs was known as "American Registry of PTs"

1940

beginning of shift in PT education programs from hospital to university

1941

summer of 1941, Emma Vogel (began as reconstruction aide) was trained by Mary McMillan at Reed College

-she initiated first War Emergency Training Course of WWII that led launch of many more PT programs

-was 6 mo didactic, then 6 mo supervised practice in military hospital

1943

Special Women's Medical Service Corps Program for African-Americans launches in AZ

1947

association renamed the American Physical Therapy Association (APTA)

-congress passed a law establishing Women's Medical Specialist Corps (WMSC) within the US Army providing full military recognition for women PTs serving in armed forces

1949

first edition of muscles testing and function published by Florence and Henry Kendall

-became a standard in the field

1950s

PTs transitioned from working under a physician in autonomous professionals

1954

the 1st national standardized competency examination (7hrs)

-PTs assisted Salk with testing polio vaccine

1960s

PT programs grew to 52
-first 2 year graduate program launched at Case Western Reserve

1965

medicare and medicaid was enacted under Lyndon Johnson

-Medicare coverage NOW allowed for PT coverage via gov benefits

1969

first 2 classes of PTAs graduate and enter workforce

1972

social security administration signed into law

1973

PT assistants became part of APTA
-first PhD program in PT was established (NYU)

1975

president Ford signed into law IDEA (education of all handicapped children act) so PTs could work in school systems

1978

accreditation for PT programs moved to within APTA not AMA

-established CAPTE

1980s

target to raise degree to a post-baccalaureate degree was set as 1991

-in 1981= WWI "reconstruction aides" made veterans

-in 1985= 1st 3 people take exams for specialist certification, all in cardiopulmonary

1990

ADA (american's w disabilities act) become LAW

1993

Creighton has first professional doctor of PT program

1995

1st guide to PT practice published

2000

licensing for PTs approved in all 50 states

2003

first PTAs graduate from advanced proficiency for PTA program

2005

PTCAS launched

2009

international summit on direct access w canada and world confederation for PT

2015

all 50 states have some form of direct access

2016

clinical doctorate (DPT) only degree conferred by CAPTE accredited entry level institutions

2017

PT Licensure compact* launches w 10 states
-developed by FSBPT and APTA

2018

new mission statement "transforming society by optimizing movement to improve human experience"

2021

100th anniversary of the APTA

state the steps required to practice as a PT in the U.S.

1. graduate from accredited PT or PTA educational program

2. pass the NPTE (this is your US licensure as a PT) (for PTAs it is the PTAE)

3. obtain state licensure after meeting professional standards and taking law exam (for California= CA law exam given by PT board of California)

explain the 3 levels of PT scope of practice

1. professional (based on the professions unique body of knowledge, education, evidence)

2. jurisdiction (legal, established by federal rules and state practice act including licensure)

3. personal (individual competence, learn in depth before completing something on patient)

CAPTE

Commission on Accreditation in Physical Therapy Education
-must graduate from a CAPTE accredited school to sit for the NPTE

NPTE

National Physical Therapy Examination
-administered through FSBPT

FSBPT

Federation of State Boards of Physical Therapy
-nonprofit organization whose members are US PT licensing boards
-owns and maintains the NPTE

PTBC

PT board of California

CLE

California law examination

ABPTS

American Board of Physical Therapy Specialties

physiotherapy

physical therapy

AMA

American Medical Association

APTA

American Physical Therapy Association

ADA

Americans with Disabilities Act

profession vs professional vs professionalism

profession= occupation requiring considerable training and specialized study, the body of qualified persons in an occupation of field

professional= conforming to the standards of a profession; professional ethics, engaging in a given activity as a source of livelihood or as a career, belonging to a profession, earns living from performing an activity requiring certain level of of education/skill/training

professionalism= methods, character, or standards

how can you demonstrate professionalism in the classroom and clinic ?

class= being on time, prepped w readings/assignments finished, follow directions/rules with no food or drinks in class, being attentive to professors and classmates, working effectively in groups, bring supplies and required reading material, be respectful, working on giving/responding to feedback

clinic= respecting patients, families, their languages, cultures and customs

define and differentiate between laws and regulations and who is the primary source of jurisprudence for PTs

laws= created by statutes which originate from legislative bills originally introduced by either Senate or Assembly

regulations= standards adopted as rules by the physical therapy board of California to implement, interpret, or make specific the law enforced or administered by the physical therapy practice act. must be approved by the office of administrative law, and filed w the secretary of state and signed by governor (regulations have same effect as law)

explain the 3 levels of APTA and what they consist of

1. chapters-represent each state & DC = CPTA-California Physical Therapy Association

2. sections/academies = focus on range of pt populations, practice & policy areas including pediatrics, geriatrics, sports, orthopedics, aquatics; etc

2. special interest groups (SIGS) = offered by both chapters (CPTA) and sections (pediatrics), these represents interests or career paths

state and describe the APTA Core Values for the PT and PTA and briefly describe each

Accountability= active acceptance of the responsibility for the diverse roles, obligations, and actions of the PT and PTA including self-regulation and other behaviors that positively influence patient an client outcomes, the profession and health needs of society

Altruism= primary regard for or devotion to the interest of patients and clients, thus assuming the responsibility of placing the needs of patients and clients ahead of the PT/PTA self interest

Collaboration= working together with patients and clients, families, communities, and professionals in health and other fields to achieve shared goals

Compassion= compassion is the desire to identify with or sense something of another ones experience; a precursor of caring

Caring= the concern, empathy, and consideration for needs/values of others

Duty= commitment to meeting ones obligations to provide effective PT services

Excellence= the provision of PT services occurs when the PT/PTA consistently use current knowledge and skills while understanding personal limits

Inclusion= when PT/PTA create welcoming/equitable environment

Integrity= steadfast adherence to high ethical principles/standards, being truthful, ensuring fairness, following through on commitment

Social responsibility= promotion of a mutual trust between the profession and larger public that necessitates responding to societal needs for health/wellness (community service)

describe, define, and distinguish between the 8 principles of medical ethics

1. medical paternalism
2. autonomy
3. beneficence
4. nonmaleficence
5. justice
6. veracity/honesty
7. confidentiality
8. fidelity/loyalty

define and differential between the terms: fraud, abuse and waste and apply to PT practice

fraud= intentional deception or misrepresentation that a person makes to gain a benefit for which they are not entitled (ex: knowingly billing for services that were not furnished, falsifying documentation, altering claims forms to receive higher pay)

abuse= payment for items/services that the provider is not entitled to and for which the provider has not knowingly/intentionally misrepresented facts to obtain payment (ex: misusing codes & billing, billing for services not medically necessary)

waste=incurring unnecessary costs as a result of deficient management practices, systems, or controls (ex: duplication of services already provided elsewhere, spending on services that lack evidence of producing better outcomes compared with less expensive alternatives)

describe the elements of Kidder's test for ethical dilemmas

1. legal test

2. stench test ("gut" reaction, feels wrong)

3. front-page test (would you like this decision on the front page of paper?)

4. mom test (would your mother make this choice?)

5. professional ethics test (does it violate professional core values or code of ethics)

state and describe the elements of the APTA code of ethics for the PT/PTA

different than federal and state laws- rules ad ethics, can vary per state and profession

HCP

health care practitioner/providers

HIPAA

health insurance portability and accountability act

ICF

International Classification of Functioning, Disability, and Health

WHO-FIC

world health organization- family of international classifications

POC

plan of care

describe and define ICF

ICF= primary disablement model used in PT

-use of disablement in terms and concepts

-standard, consistent, universal, neutral language for diagnosis and classification for all clinicians & researchers & describing how people function in everyday lives

-need to state relationship between impairment & function clearly- can't leave it to be implied

ICF model

-moves beyond diagnosis and structural issues to consequences of disorder & impact upon persons life (understand patients function vs just their disease) w

what are the two umbrella terms in the ICF model?

function and disability

-they incorporate body functions. structures, activity, participation

-they are the result of the interaction between the persons health condition and both personal and environmental factors

who was the ICF endorsed by ?

endorsed by WHO in 2001, APTA in 2008 (Biosychological model)

ICF model parts 1 and 2

part 1= functioning and disability

-body functions and structures

-activities and participation

part 2= contextual factors

-environmental factors

-personal factors

disability (ICF)

defined as dysfunction in 1 or more of these three levels:

1. impairment of body structures (limbs/organs) or functions (physiologic/psychological)

2. limitations in activities (execution of tasks)

3. restrictions of participation (involvement in life situations)

physical therapist may do what?

co-manage
consult
manage
refer

conclusion of care (discharge) planning

-important to start at beginning of episode of care, can also be within prognosis component

-determine outcome tools for baseline and ending

consumers of PT services

-patients= individuals who receive PT services for disease, disorder, condition, impairment, activity limitation or participation restriction

-clients= engage the services of a PT and who can benefit from PTs consultation, interventions, advice, health promotion, fitness, wellness, prevention services. clients may include: businesses, school systems, and other whom PTs provide service to.

-communities= groups of people that may or may not be spatially connected but who share common interests, concerns, identities

-populations= groups of people connected by their demographics and other factors; ex: ethnicity, socioeconomic status, population density

order of patient and client management model

1. examination
2. evaluation
3a. diagnosis
3b. prognosis
4. intervention
5. outcomes

what happens in an examination ?

PT conducts exam that includes=
-history (subjective and systems review)
-physical examination (tests and measures)

what is included in subjective history ?

comprehensive questioning process or completion of a patient self-administered questionnaire, and through a review of health records.

what are red flags found in patient history and physical exam that suggest the presence of a serious pathology ?

signs/symptoms found within documentation
-ex: stroke red flags= F.A.S.T

what is the most common PT note format ?

"SOAPE"
S- subjective (patient history including: HPI, MOI, DOI, PMH, C/C, PLOF, L/S, living conditions & patients goals)

O-objective (reviewing systems and performing tests/measures)

A-assessment (based on S & O, PT determines impairments, patient functional status- including activity limitations/participation restrictions)

P- plan (based on examination data, PT determines PT diagnosis, prognosis- includes goals, intervention plan)

E- education (education provided and to whom, future planned education)

what does physical examination begin with ?

begins with the systems review then follow up with any needed elements:

-cardiovascular and pulmonary systems

-integumentary systems

-musculoskeletal systems

-neuromuscular systems

-neurologic system

-communication ability, affect, cognition, language, ability to read, and learning style

-movement

why do PTs use measurements ?

-to identify impairments & potential causes of impairments in the body structures & functions, activity limitations, participation restrictions

what are the results of tests and measures ?

-inform risk identification & prevention and health promotion activities
-contribute to outcome assessment
-help PT determine change in the individuals status

tests and measures are a component of the physical exam used to ?

-confirm or reject a clinical hypothesis regarding factors that contribute to making the individuals current level of function less than optimal
-support the PTs clinical judgements about the diagnosis, prognosis, and development of an effective management plan

how many categories of tests and measures are there ?

26

what are outcome measures and what can they measure ?

when standardized tests and measures are used to determine change in outcome status during and at the end of an episode of care

May measure:

-functional status, impairments in body functions/structures, adverse outcomes & complications, morbidity & mortality, individuals self-reported outcomes, individuals satisfaction w the care/services received

PTs interpret/synthesize the history & physical exam findings to ?

-establish diagnosis from which to develop a management plan

-determine rehab prognosis (not medical), including goals for PT management

-develop management plan or plan of care if indicated

-develop a working diagnosis list as part of process used to determine whether a referral to or consultation w another health care provider is indicated

examination vs evaluation

examination= process of collecting data, synthesizing data, analyzing data, interpreting data

evaluation= process of collecting clinical decision making that occurs following the examination

**BOTH allow for determining the diagnosis, prognosis, plan of care **

what are the diagnosis classifications ?

-ICD-10= used by physicians & billing by PTs

-ICF= used by PTs for movement system categorization

-movement systems

what is prognosis ?

-the PTs determination of the predicted optimal level of improvement in function over designated time frame

- prognosis typically includes a prediction of levels of improvement during the episode in PT in determining goals/outcomes

-can be influenced by contextual factors

management plan/plan of care (POC)

-framework of PT services provided to individuals, groups/populations, based on best available evidence, clinical expertise, individuals wants/needs

-may include a POC which consists of: individuals goals, prognosis, interventions to be used including duration and frequency, summary of plans for referral or consultations to other providers

plan of care (POC)

-based on data gathered from exam and on Dx and prognosis determined by PT

-POC identified persons goals as a result of implementing the pan

example of goals for a PTs patient

"patient will ambulate for 100 ft with no assistive device using step-through gait pattern in 3 weeks in order to walk to the mailbox each day"

NOT= "gait training 20 min, stretch training with ther ex including clams x10, SLR x10, squats x10"

what is the intervention plan?

a conclusion/summary statement that relays the framework for the actual intervention approaches and techniques during patient or client encounters

why do PTs use interventions?

-to remediate impairments in all major body systems
-improve function performance
-promote improved health/wellness that lead to optimized activity, participation, quality of life

examples of procedural interventions

-adaptive & assistive technology
-manual therapy
-biophysical agents
-motor function/movement training
-functional training
-respiratory & ventilatory techniques
-therapeutic exercise
-integumentary repair & protection techniques

intervention plans specifics

frequency= how often PT services are provided to the patient or client (2 times per day, 3 times per week, daily)

duration= the amount of time the episode of care will cover (4 weeks, 8 weeks, 6 months)

outcomes

-the actual results of implementing the management plan that indicate the impact on functioning
-PTs report outcomes to demonstrate progress, for payment purposes, and to know whether goals have been met

re-examination

-includes the application of selected items from the history & physical examination and comparing them with the initial examination findings

-may be indicated more than once during a single episode of care and often is performed over the course of a disease/disorder/condition

conclusion of the episode of care

indicates the status of anticipated goals & expected outcomes in a single episode of care

-discharge vs. discontinuation

what is the difference of discharge vs discontinuation ?

discharge= is ending services provided in a single episode of care

-discharge assessment is performed in discharge note or summary to compare w initial status and provide record of pts final objective and subjective changes in status

-typically, goals/outcomes met!!

discontinuation= the process of ending services in the episode of care when:

-patient declines to continue/refuses care

-patient unable to participate due to identified barriers (medical condition, financial)

-PT determines that patient will no longer benefit from care

what is the "vehicle" that unites each of the components of the initial examination into a cohesive document ?

the use of the ICF model

the board vs the CPTA

board=
-mandate of consumer protection is the highest priority
-protection of public is paramount
-licensure is mandated

CPTA=
-primary mission is to represent members of the PT profession
-membership is voluntary

PTA

-PT is responsible for all care to the patient and all actions of the PTA

-PTA has responsibility to make sure they are being supervised correctly

-if the PTA provides care in the absence of proper supervision= violation has occurred