Week 10: Legal, Ethical, Moral Issues/ Appraising Research

3 pillars for Ethical issues

Evidence, ethics, law

principle 1-COE

physical therapists shall respect the dignity and rights of all individuals

principle 2-COE

physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients and clients

principle 3-COE

physical therapists shall be accountable for making sound professional judgements

principle 4-COE

physical therapists shall demonstrate integrity in their relationship with patients and clients, familites, colleagues, students, research participants, other health care providers, employers, payers, and the public

principle 5-COE

physical therapists shall fufill their legal and professional obligations

Principle 6-COE

physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, ability, and professional behaviors.

Informed consent is related to which 2 principles

1 and 2

informed consent is used to accept what types of terms

nature of technique, reasonable alternatives, risks/benefits/uncertanties, soft tissue techniques

Consent is use to build

rapport and trust

Ethic and legal ideas

practicing within the PT scope of practice, within specific training, technique is known to benefit condition, technique performed competently, modifying POC if not benefitting

Ethical and Moral standards in terms of what we "say"

what these soft tissue techniques can/cannot due, have reasonable outcomes and don't promise magical results

Ethical and Moral impacts

set expectations for those with chronic/widespread pain, pts may request/demand certain techniques despite lack of effectiveness, patients may not want soft tissue done but wont tell you, certain religious/cultural beliefs may prohibit touching

delegation of soft tissue techniques: patient considerations

patient's expectations, patient's beliefs, patient's comfort level

Delegation of soft tissue techniques: practitioner considerations

your comfort level and the overall team approach at specific clinic, PTA training/knowledge, insurance coverage, PT/PTA team comfort

Delegation of Soft Tissue techniques: Pathology considerations

if the cases are simple, complex, unpredictable

-is there potential harm with applied soft tissue techniques

Touching in terms of patient considerations

we touch many people, but our patients dont know that.

-always get verbal consent each session

-explain why and goals

For opposite sex patients, what are some patient considerations

if you are in a private treatment space, have another representative there (same sex as pt)

if not an option, take extra steps to cover self legally (crack door, use curtains)

EBP is made of

clinical expertise, best research evidence, patient values and preferences

Researches place in the clinic (3B)

demonstrate professional judgement informed by professional standards, evidence, practitioner experience, and patient and client values

core values with research

excellence and integrity

Physical therapists should achieve and maintain ____ according to 6A

professional competence

6B in terms of professional development

physical therapists shall take responsibility for their professional development based on critical-self assessment and reflection on changes in physical therapist practice, education, health care delivery, and tech.

6C about appraising research

physical therapists shall evaluate the strength of evidence and applicability of content presented during professional development activities before integrating the content or techniques into practice

-look inward and examine self.

Evidence based research

not just peer-reviewed, not viewed as binary, the term is overused and misunderstood

clinical expertise (questions to ask yourself) in terms of being evidence based

do you know what you are doing? are you not skimping out on interventions that are more likely to be beneficial?

what question to ask for available research in terms of being evidence based

does research support what you are doing

what questions to ask for patient values and preferences in terms of being evidence based

does the patient fit the technique? (perception, severity/irritability, time available)

6D code of ethics

physical therapists shall cultivate practice environments that support professional development, lifelong learning, and excellence

Inherent difficulty with physical therapy research

effect of one thing on another is teh change of 1 or more intervening variables cause on the second, difficulty on establishing a control (Sham MT, Sham needling)

Lack of evidence to support does not equal

evidence to refute

4A

physical therapists shall provide truthful, accurate, and relevant info and shall not make misleading representations

Filtered information comes from which 3 types of research

systemic review, critically appraised topics, critically appraised individual articles

Good research

hard to produce, rarely or never gives definitive conclusions

research with limitations

still contributes something

Easy ways out of research (not recommended)

blindly trusting research, cherry-picking, carelessly disregard research

When should you be cautious of articles

with overly broad or conclusive statements purporting evidence based practice, and take the time to evaluate the research yourself to reach your own conclusions.

why do things not have to be physical and mechnical

the placebo effect is all it may take for a patient to reach their goals

-then can move to exercise and movement to help