Intro to PTA
The Final Exam is 75 multiple choice questions covering chapters 1-14, excluding Chapter 8. Please make sure to read each chapter and use the PowerPoints and end-of-chapter questions to guide your studying. Below is a list of common topics for each chapter. Use this list as a guide to focus your studying but understand this might not be a comprehensive list. All information from each chapter listed is fair game for the final exam.
Chapter 13:
Evidence Based Practice: implementation of interventions that are based on results supported by scientific literature
Inter- vs Intra-rater reliability
Inter-rater reliability: the consistency of scores in the same measurements taken by multiple clinicians
Intra-rater reliability: the consistency of scores taken by one clinician at different times
Dependent vs Independent variable
Dependent variable: the end result being compared between the two groups after receiving the intervention
Independent variable: the intervention being studied or manipulated by the researcher; what makes the experimental group different from the control group
Systematic review: analyze multiple case studies already performed in a subject area, classifying them in terms of quality and outcomes
Randomized controlled trials: a study in which subject areas are randomly assigned either to an experimental group that receives a given intervention or to a control group that receives no intervention
Meta Analysis: compares the same variable studied in multiple articles in an attempt to quantify the results
Cohort group: one or more groups of similar subjects are followed over a period of time to see whether differences develop based on exposure to another variable
Case studies
Case control studies: subjects for a study are selected based on having a particular condition, then retroactively studied to determine whether there were other common factors that predisposed them to that condition
Case series studies: Comparing a few individuals with similar individual presentations or outcomes
Individual case studies: one patient's history, conditions, and outcomes are analyzed
Chapter 1:
Historical events leading to PT
WWI
Polio outbreak
Autonomous practice, direct access
Autonomous practice: exercising independent, self-determined judgement, and having the ability to refer patients/clients to other health-care providers and other professionals
Direct access: patients/clients are able to receive PT services directly, without having to obtain a referral from another health-care provider to do so
Clinical decision making, directing tasks to a PTA, professional
APTA Vision statement: Transforming society by optimizing movement to improve the human experience
Guiding principles to achieve the vision:
Identity
Quality
Collaboration
Value
Innovation
Consumer-centricity
Access/equity
advocacy
Core values for the PT and PTA: Core values guide our behaviors to provide the highest quality of PT services. These values imbue the scope of our activities. The core values retain the PT as the person ultimately responsible for providing safe, accessible, cost-effective, and evidence-based services; and the PTA as the only individual who assists the PT in practice, working under the direction and supervision of the PT.
Accountability
Altruism
Collaboration
Compassion and caring
Duty
Excellence
Inclusion
Integrity
Social responsibility
Mary McMillan
Considered the "first PT" in America
1981: appointed to lead a group of women being trained as "reconstruction aides"
Included hydrotherapy, exercise, and massage to promote healing and strengthening
Upon completion of training the women were sent to Europe to work on soldiers injured in the war
After war began working on children w/ polio back in the US and the field expanded from there
Nancy Watts
1971: published articles of factors that PT should consider
Advocated against using only a checklist of skills permissible for the PTA
Encouraged the supervising PT to use a process of decision-making and direction, considering the skills and abilities of each PTA relative to several factors
The complexity of the task, the amount of decision-making vs doing involved with the task, and the risks involved
The stability of the patient and criticality of the consequences if an error in task performance were to be made
The purpose of the task in relation to treating the patient's problem vs contributing to the patient's sense of well-being and satisfaction with the overall provision of the services
The experience, areas of specialization, and unique body of knowledge possessed by both the PT and the PTA
Catherine Worthingham
Former APTA president
In 1965 Believed training of PTAs needed to "be faced quickly and in a manner that is in the best interests of the patient and our developing profession"
Need for PT grew in 1967 and the first PTA program was created due to PT now being considered a reimbursable skilled service by Medicare
Chapter 2:
ICF model: health and disability are classified in a manner that is not mutually exclusive
The focus is less on the condition and more on the impact of the associated functional loss on one's activity and ability to participate in society
Biopsychosocial model of health: differing physical, psychological, and societal factors overlap during any given health condition, and therefore will uniquely influence each person's level of function
Common practice settings
Acute care: in the hospital
Focuses on improving the patient's strength, endurance, and tolerance for being out of bed, progressing to more advanced functional mobility activities as the patient's abilities allow
Specializations: cardiac rehabilitation, inpatient rehabilitation, wound care, emergency department physical therapy
Outpatient: likely to work with patients with a variety of musculoskeletal and, less commonly neuromuscular disorders
Specializations: sports medicine, gender/women's health/pelvic health, aquatic therapy, industrial medicine, and performing arts therapy
Skilled nursing facilities (SNF), Extended care facilities (ECF), transitional care units (TCU), and subacute rehab facilities
Types of residential and rehabilitation units available for older adults, patients with chronic medical needs, and/or patients who need ongoing rehabilitation before returning to a more independent living setting
Homecare: for patients who need PT but have limited ability to access outpatient services because of mobility limitations or medical conditions
Hospice: for patients who have a terminal illness and who are no longer receiving ongoing treatment to cure their diagnosis
Maximize their quality of life for the time they have left by improving activity limitations
Pediatric (Specialty clinics): focused on maximizing the child's motor control and overall functional mobility level by improving strength, flexibility, balance, and coordination
Floating/travelling:
Floating: working for agencies or facilities that use PTAs in a variety of settings and locations
Travelling: organization that provides staffing for a variety of facility types located across a larger geographic region or even throughout the country, with assignments lasting anywhere from weeks to months
Academia: working on a campus functioning as faculty assistants or personnel responsible for classroom content or clinical placement
Chapter 3:
Effective communication qualities for PTA to communicate with PTs and other staff
preferred PT-PTA relationship
Developed by both
Familiarity with each other's educational background
Understanding of the differences and similarities of each other's skills and knowledge
Awareness of and trust in each other's skills and knowledge base
Strategies for effective communication with each other and with others on the health care team
Expectations
Learn about understand and complement each other's skills and aptitudes to benefit fully from each other and provide the best service for patients
Challenges
Determining what both of them need to do to ensure that they are interacting in the best way possible to meet clinical demands and achieve the best patient outcomes
Deciding on the strategies they will use to ensure their partnership works most effectively
Roles of the PT
Providing patient care in the primary, secondary, or tertiary settings to those who have changes in health or function because of illness, injury. Disease, or other causes
Practicing as the principal care provider or in collaboration with other health care professionals
Addressing factors or behaviors that put individuals or populations at risk for decreased functional capacity
Promoting health and wellness by providing preventive services
Serving as a consultant, educator, administrator, or researcher
Directing and supervising the PT department and all support personnel, including PTAs and PT aides
Education is more focused on patient-client management
Extensive training in scientific theory and application of specific tests and measures
Roles of the PTA
Help with data collection for examination
Interventions is the only component of patient/client management that the PTA directly contributes to
Produces changes in the patient's status and leads to achieving goals and outcomes
Main focus of the entry-level PTA (widely covered during schooling)
PTA is going to be more focused on interventions than is PT school therefore making PTAs valuable to the PTA
Education with a strong emphasis in interventions and a good basis of science
Taught how to explain the evaluative decision making process of the PT
Being able to make decisions regarding the patient's status
Decisions made within a given intervention session
Understanding the difference between: Examination, Evaluation, Prognosis, Diagnosis
Specific roles for the PT only (with the exception of examination)
Examination: obtaining and reviewing the patient's history, performing a systems review (gross assessment of the individual's musculoskeletal, cardiopulmonary, neurological, and integumentary status), and performing various tests and measures to collect meaningful data on the patient's functional abilities
Evaluation: Interpreting and making informed decisions regarding the information and data collected to determine the individual's appropriateness for PT; this info also guides the establishment of the diagnosis, prognosis, and plan of care
Diagnosis: one or more labels that describe the impact of the activity limitations and participation restrictions identified compared with optimal functional levels, especially in terms of the movement system.
Must be relative to the tests and measures performed in the examination and within the PTs scope of practice
Prognosis: a prediction about the amount of improvement anticipated as a result of the PT intervention, as measured by the development of goals and expected outcomes within a given timeframe
Understanding the APTA's PTA Clinical Problem Solving Algorithm:
Chapter 4:
Supervision-levels, criteria, types
Az practice act
General: PT must be reachable, but not required to be on-site
PTAs (after 2000 hours) about a year of on-site supervision before being able to work under general supervision
On-site: PT must be at the facility
PTA students
PTAs under 2000 hours
Aides/techs
Other assistive personnel
APTA
General: PT must be reachable, but not required to be on-site
PTA
Direct: PT must be on site
Student PTA
Direct personal: PT must be on site and working with assistive personnel
Aide/tech
Difference between Licensure, Registration, Regulation, Certification
Registration: lowest level of regulation
Generally thought of as least restrictive
Used when the risk to the public is generally low
Usually no requirement for specific training or education
Consists of providing the state with one's name and address
Certification: works under someone who is licensed
Higher level of regulation
Certification usually requires some type of specific education and passing an examination as a way of demonstrating a minimum level of competence
Licensure: highest level of regulation
Highest level of oversight
Used when the risk to the public is thought to be the greatest
Subject to discipline by a state board if they fail to meet regulatory standards
State Statutory and Federal Statutory Laws
Numerous federal laws and state laws
State statutory laws are commonly referred to as the state practice act
Written and passed by that state legislature
Developed to protect the public and ensure competence
Some states are more restrictive than others
Law specific to that state
Federal statutory laws: something no matter what state you're in everyone has to follow
Federation of state boards
Direction and supervision
Direction: assigning portions of intervention or other tasks to the PTA
Plan of care
Supervision: ensuring the PTA performs their assigned duties properly
Person is overseeing somebody to do the direction
Chapter 5:
Basic ethical concepts
Autonomy: the right of people to have choices and to make their own decisions regarding those choices
Justice: dealing with all people in the same fair manner
Duty: responsibilities owed to others
Nonmaleficence: do no harm
Beneficence: doing good
Fidelity: keeping commitments made to others
Veracity: the obligation to be truthful in words and actions
Moral character: having the courage to act on the decisions one makes
Common theoretical models
Right ethics (human rights): conduct is right when it supports the fundamental morally valid entitlement of others, often divided into liberty rights and welfare rights
Duty ethics (deontological): individuals should always act in prescribed manner based on rights of and duties to others
Utilitarian Theory (consequences): actions should produce the most good for the most people
Act utilitarian (actions): identify all the possible actions in a situation, and choose the one that maximizes good overall
Rule utilitarian (rules): actions are right when they conform to rules that maximize good
Virtue ethics (character traits): individuals should strive to demonstrate desirable patterns of behaviors (virtues) instead of undesirable ones (vices)
Religious ethics (world view): moral judgements are justified based on guidance and commandments of a higher power
Pragmatism Theory (context): looks at individual situations and paradigms; find the best way to honor all involved values
Types of ethical problems
Patient rights/patient welfare concerns: issues related to informed consent, sexual misconduct of providers, discrimination against patients, and using human subjects in research
Professional issues: concerns regarding appropriate competence, utilization of services, supervision of support personnel, safety of the work environments, and reporting misconduct
Business/economic issues: issues related to cost justification and fraud prevention, concerns with appropriate advertising, product endorsements, and business relationships
RIPS model for Ethical Decision Making--how is it used; what does each part mean
·
REALM
In which realm is the problem occurring?
INDIVIDUAL PROCESS
What behavior needs to be demonstrated?
SITUATION
Type of ethical situation
Individual: focusing on the rights of the patient, duties of individuals, and relationships between people
Moral Sensitivity: being able to identify a situation with ethical overtones
Issue/problem: a value is challenged
Organizational/ institutional: dealing with policies and systems that support an institution
Moral Judgement: being able to analyze a situation and make an appropriate decision
Dilemma: 2 alternative courses of action may each be considered right
Societal: relating to the common good of all
Moral Motivation: distinguishing which moral factors are more relative than others
Distress: right course of action is clear but can't or not allowed to do it
Moral courage: being ready to take action in stressful situations "in order to uphold something of great moral value" or being "deeper than action itself... flowing from a generous and caring heart"
Temptation: a benefit exists for doing wrong instead of right
Silence: values are challenged but no one is addressing it or taking action
Purview of the APTA Ethics and Judicial Committee--who is this and how does it work
APTA EJC is charged with educating members about ethical practice and documents that regulate it
Responsible for processing reported code of ethical behavior violations and making final decisions on disciplinary action involving members
Dismissing the charges
Issuing a written reprimand
Suspending the violator's APTA membership privileges
Expelling the violator from the association
Chapter 6:
Patient Rights
Selection of a PT of one's own choosing to the extent that it is reasonable and possible
Access to information regarding practice policies and charges for services
Knowledge to the identity of the PT and other personnel providing or participating in the program of care
Expectation that the referral source has no financial involvement in the service. If that is not the case, knowledge of the extent of any involvement in the service by the referring source
Involvement in the development of anticipated goals and expected outcomes, and the selection of interventions
Knowledge of substantial risks of the recommended examination and intervention
Participation in decisions involving the PT plan of care to the extent reasonable and possible
Access to information concerning his or her condition
Expectation that any discussion or consultation involving the case will be conducted discretely and that all communications and other records pertaining to the care, including the sources of payment for treatment, will be treated as confidential
Expectation of safety in the provision of services and safety in regard to the equipment and physical environment
Timely information about impending conclusion of the episode of care and continuing care retirements
Refusal of PT services
Information regarding the practice's mechanism of the initiation, review, and resolution of patient/client complaints
Empathy: a process in which providers go beyond just being able to put themselves in their patients' situation to being able to perceive a patients' frame of reference
Sympathy: taking pity or feeling bad for someone
Accountability: active acceptance of the responsibility for the diverse roles, obligations and actions inherent in one's role as a PT or PTA
Advocacy: the process of asserting oneself to represent the needs of a particular group or individual
Empowerment: enabling patients to take an active leadership role in their health-care decisions
Rapport: the sense of connection between providers and their clients
Informed Consent
Explanation of findings of the examination/evaluation, identification of the PT diagnosis, description of the interventions that will be delivered to treat the diagnosis, and discussion of the risks, benefits, and alternatives to the intervention described
Opportunity for the patient to ask questions about examination/evaluation, diagnosis, prognosis, or proposed interventions
A formal request for permission to proceed with the plan of care
3 part communication technique
Restatement: after the speaker says something, the listener says it back to the speaker, often in the form of a question, without adding any interpretation at this point
Reflection: the listener then not only comments on the content of what the speaker says but also adds their interpretation of what was meant by the words
Clarification: the listener then gives the speaker the opportunity to correct their interpretation of the speaker's words
Chapter 7:
Cultural pre-competence: acknowledging the presence of similarities and differences among cultures; recognizing weaknesses in one's own skill set
Competence/fluency: processing a set of skills and/or resources to use to function effectively in interactions with those of varying cultural backgrounds
Proficiency/humility: valuing diversity, continuously striving to gain a better understanding and appreciation of other cultures; making changes in one's approach and attitudes as a result of self-examination and ongoing education
Health-care disparities: a situation in which a person has a greater likelihood of developing a certain medical condition and/or better medical outcomes merely as a result of belonging to a certain ethnic or cultural group
Related to race, gender, and ethnicity
Differences in education level, neighborhood of residence, accessibility of healthcare, and other factors with a socioeconomic component
Bias: being more favorable towards one thing
Stereotype: making the assumptions about what others should be or do based on a group into which people have placed them without taking individuals' characteristics into account
Systemic Racism: intentional or normalized systems and procedures routinely advantage the dominant culture(s) while producing cumulative and chronic adverse outcomes for those in the nondominant cultures
Privilege: one group is assumes their cultural norms and expectations are accepted and supported without having to confirm that to be the case
Microaggressions: the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile derogatory, or negative messages to target persons based solely upon their marginalized group membership
Spirituality: a cultural component that can be fluid throughout life; an internal process used to develop a sense of wellness and to help find meaning and purpose in life
Chapter 9:
Understand how PTAs are represented in the APTA (historically and currently)
When PTAs first joined the APTA there was controversy about if PTAs belonged or should have their own association
First, PTAs were able to hold a temporary membership known as the affiliate membership (the term affiliate was eliminated in 2005)
PTA SIG was created and PTAs could now be automatically enrolled to this subgroup when they joined the APTA (formation of national assembly, RBNA in 1998)
2005 RBNA dissolved and PTA caucus was created by the board of directors and approved by the house of delegates (in 2021 the OTA caucus was recognized and granted 2 full votes
In sum PTAs never really had equal representation and involvement as the PTs until 2021
Purpose of APTA
Engage and empower members to be a leading voice in the healthcare industry
Advocates for positive change
Raises public awareness
Advances evidence based practice
Supports the continued growth of members
Develops the next generation
Based on the APTA, interventions that only PTs can perform
Spinal and peripheral joint mobilization/manipulation
Sharp selective wound debridement
The complexity of the skills and ongoing evaluative component required as the skills are being delivered led to the APTAs determination that they were beyond the scope of the PTAs educational preparation and role, even with additional experience and education
Advancement/Acknowledgments available to PTAs
PTAs can attend state conferences and continuing education workshops alongside PTs
Able to participate in most chapter committees and work groups
Can be involved in APTA activities at the national level
Can attend the APTAs primary annual conference, the combined sections meeting, which offers continuing education, networking opportunities, and courses specific to PTAs
Involvement in the APTA by joining committees, task forces, or work groups that are seeking PTA representation
Governance structure of the APTA
Chapters: each state's own level of APTA membership
Sections and academics: issues and concerns of members working in a particular practice setting or with a certain patient population/diagnosis
Presidents and officers elected by the membership of that body
House of delegates: highest legislative body
Each chapter elects voting delegates to represent it in the House
Each section/academy can elect 2 voting members to represent them in the House
Meets once a year to debate, vote on positions, and elect the board of directors
Board of Directors: appoints members to various standing committees, advisory councils, and task forces
Responsible for creating a plan that ensures financial and business deals of the APTA are handled appropriately
Members include the association's president and vice president, the speaker and vice speaker of the House, the treasurer, the secretary, 9 at-large elected board members, and one appointed public member
Takes orders from the House and the board brings policy suggestions for the House to vote on
Chapter 10:
Understand terms as related to Physical Therapy:
Fraud: when someone is suspected of having knowingly misrepresented the truth or concealed facts at the detriment of others
Assault: fear or anticipation of being harmed through the application of force or unwanted physical contact
Battery: the actual impermissible application of physical contact or force
Sexual Misconduct: any sexual contact, sexual assault, or sexual battery between a patient and a healthcare provider
Sexual Harassment: unwelcome verbal or physical conduct of a sexual nature that:
Implies that submitting to it must occur as a condition of employment or employment decisions
Causes unreasonable interference with one's work performance or creates an intimidating, hostile, or offensive work environment
False Imprisonment: intentionally doing something to unlawfully restrict a patient's movement
What is
Standard of Care: care that would be provided by another "similarly situated" PTA under similar circumstances
Duty of Care: begins at the time the PT examines the patient and establishes that the intervention required is within the PTs scope of practice and level of expertise
Types of Laws:
Criminal Law: deals with offenses against the society
Established through statutory laws (laws made by the state or federal government)
Penalty: jail time or a fine
Ex: fraudulent billing, embezzlement, or forcibly administering treatment
Has to be proven beyond a reasonable doubt in order to be found guilty
Civil Law: laws that relate to private offenses, one individual against another, and the punishment for violation of a civil law is usually in the form of monetary damages or a fine
More flexible than criminal law because it is based on the judge's opinion of the situation
Common Law: case law, is determined by the judge's ruling that established a precedent
Can only be changed by higher level court decisions
Tort Law: civil court actions dealing with malpractice and personal injury
Preponderance of evidence (at least 50%)
Clear and convincing evidence (at least 75%)
Administrative Law: deals with rules and regulations that apply to government agencies, including those that oversee professions and other fields that provide services to the public
Ex: OSHA violations in the clinic or violations of the state practice act
Centers for Medicare and Medicaid services
CDC and prevention
Penalties: determined by the state board
Healthcare Malpractice and Negligence
Negligence: failure to perform at a minimally acceptable level established to protect the public
Healthcare malpractice: any action by a health-care provider that results in an adverse outcome and liability on the part of the provider
To claim malpractice these 4 elements must be proved:
Legal duty of care was owed to the plaintiff
Legal duty of care was breached or violated
The breach of duty caused injury to the plaintiff
The plaintiff suffered recognizable damages
Chapter 11:
Terms:
Copayment: the amount or percentage that the patient must pay for a given office visit or prescription
Deductible: the amount the patient must pay before insurance payments begin
Prior authorization: when a patient is not elegible for coverage they must get the provider to contact the third-party payer(insurance) to approve the service prior to delivery
Merit-based incentive payment system:
Patient driven payment model:
Patient driven grouping model:
Medicare: federally funded insurance for 65+, people with permanent disabilities, or end-stage kidney disease
Part A: hospital insurance
No payment upon enrollment
Covers hospitalization and may cover part of SNF, homecare, and hospice
Part B: medical insurance
Covers up to 80% of services (physician visits, lab testing, imaging, and assistive devices
Cost is dependent upon income
Patient Protection and Affordable Care Act (ACA)
A mandate passed by congress in 2010 for all health plans to cover 10 categories of essential health benefits, with rehabilitative and habilitative services as one of them
Varies from state to state
Health Care Reforms "triple aim"
Decreasing costs, improving health, and making the individual patient's perception of their healthcare experience a more positive one
Quadruple aim: consideration of provider resilience and burnout is also factored into healthcare reform needs
Chapter 12: Leadership development for physical therapist assistants
Leadership development for PTAs
Leadership needs in physical therapy
Professional Behaviors for the 21st Century Assessment Tool
Critical thinking: the ability to question logically; identify, generate and evaluate elements of logical argument; recognize and differentiate facts appropriate or faulty inferences, and assumptions; and distinguish relevant from irrelevant information.
Communication skills: the ability to communicate effectively for varied audiences and purposes
Problem solving: the ability to recognize and define problems, analyze data, develop and implement solutions, and evaluate outcomes
Interpersonal skills: the ability to interact effectively with patients, families, colleagues, other healthcare professionals, and the community in a culturally aware manner
Responsibility: the ability to be accountable for the outcomes of personal and professional actions and to follow through on communities that encompass the profession within the scope of work, community, and social responsibilities
Professionalism: the ability to exhibit appropriate professional conduct and to represent the profession effectively while promoting the growth/development of the PT profession
Use of constructive feedback: the ability to seek out and identify quality sources of feedback, reflect on and integrate the feedback, and provide meaningful feedback of the physical therapy profession
Effective use of time and resources: the ability to manage time and resources effectively to obtain the maximum possible benefit
Stress management: the ability to identify sources of stress to develop and implement effective coping behaviors
Commitment to learning: the ability tp self-direct learning to include the identification of needs and sources of learning; and to continually seek and apply new knowledge, behaviors, and skills
Chapter 14: Beginning your career, postgraduation advanced learning, and skill development
Lifelong learning: the systematic maintenance and improvement of knowledge, skills, and abilities through one's professional career or working life
Standard #6 of ethical conduct
How to become a Clinical Instructor
Recommended to have at least one year of experience
Must have the knowledge and desire to teach incoming PTAs
Continuing education: Participation in educational opportunities reflecting a commitment to lifelong learning
PTAs must meet a certain amount of CEs to maintain licensure (in the amount of required contact hours or CEUs (1 CEU is typically worth 10 hours)
In AZ 10 contact hours are required every 2 years
Advanced skills, Advanced Proficiency Pathway
Under the APTA and only offered to PTAs
Allows PTAs to develop and demonstrate advanced proficiency
Obtain official recognition of their expertise in a particular area of PT that's beyond that of the entry-level clinician
Once accepted into the APP the PTA has 5 years to complete
60 hours of coursework related to the specific pathway chosen
a minimum of 2,000 hours of clinical work in the selected content area
Formal submission document
Skilled areas
Acute care
Cardiopulmonary
Geriatrics
Neurology
Oncology
Orthopedics
Pediatrics
Wound management
APTA and career development
Not necessary to know for the exam
NPTE
180 question
4 sections (45 questions each and 1 hour per section)
Data collection (musculoskeletal system, cardiovascular system) typically 23-34 questions
Conditions/diseases (pathology) typically 35-53 questions
Interventions (therapeutic exercise, neuromuscular reeducation, manual therapies...) typically 34-50 questions
Non-specific domains (AD fittings, modalities, safety...) typically 22-32 questions
40 of the questions are not scored (trial questions)
Passing score: minimum of 600/800
