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What is the primary mission of the Federation of State Boards of Physical Therapy?
Which of the following entities governs the practice of physical therapy at the federal level?
What does CAPTE stand for?
How many focus areas are outlined by the Federation of State Boards of Physical Therapy?
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Which of the following is NOT one of the APTA Core Values?
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What role does the Commission on Accreditation in Physical Therapy Education (CAPTE) play in PT education?
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Which of these aspects is included in the focus areas of the Federation of State Boards of Physical Therapy?
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Which of the following best describes 'Inclusion' as an APTA Core Value?
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What is primarily the responsibility of a physical therapist regarding the services provided by a PTA?
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Which of the following tasks are PTAs prohibited from performing?
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Which component is NOT included in the Coursework for PTA education?
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In the context of PTA practice, what does 'selected components of intervention' refer to?
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What does APTA emphasize regarding the ethical and legal administration of physical therapy services?
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Which aspect of practice is part of the APTA Standards of Practice?
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How does the APTA Code of Ethics guide physical therapists in their practice?
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What is the primary focus of 'The Guide to Physical Therapist Practice'?
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What is required for direct supervision of a student physical therapist assistant?
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In which setting does Medicare require direct supervision for physical therapist assistants?
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What defines general supervision as required by Medicare for physical therapist assistants?
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What is a characteristic of direct personal supervision?
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What must physical therapists and physical therapist assistants comply with if their state's practice act is more stringent?
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Which of the following statements about direct supervision is false?
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What is the primary focus of physical therapy diagnosis?
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What type of tasks does direct personal supervision relate to?
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What is a sign that may be addressed in a physical therapy diagnosis?
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In what scenario does the supervising physical therapist not need to be present during patient encounters?
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Which entity is responsible for managing licensees and their applications in the field of physical therapy?
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What does the process of 'promulgation' refer to in the context of state regulation?
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Which of the following is NOT a key element of practice acts?
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Which term describes language that is clearly articulated in a Practice Act?
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Which of the following represents an example of a functional limitation?
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What is the role of the State Board in relation to complaints against licensees?
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What percentage of majorly depressed patients are estimated to commit suicide?
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Which symptom is NOT typically associated with depression?
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Which statement reflects an effective communication strategy when addressing a depressed patient?
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Which of the following is considered a red flag requiring medical referral?
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What is the recommended approach for asking questions to a patient?
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What is the primary function of policies within an organization?
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Which aspect does the Scope of Practice NOT typically cover?
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Which of the following is NOT a method for ensuring the implementation of policies?
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Which component is essential for continuing education as per the practice regulations?
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What distinguishes the role of state practice acts in healthcare from organizational policies?
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Which of the following entities is responsible for establishing baseline educational standards for physical therapist and physical therapist assistant education programs?
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What is the primary mission of the Federation of State Boards of Physical Therapy?
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Which APTA Core Value emphasizes the need for fairness and respect for diverse populations?
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Which focus area of the Federation of State Boards of Physical Therapy involves ensuring the reliability and validity of examinations?
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What type of supervision does Medicare require for physical therapist assistants in certain settings?
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What is one of the main responsibilities of the State Board regarding licensed physical therapists?
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Which of the following describes the Federation of State Boards of Physical Therapy's approach to state regulations?
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Which entity is recognized as the primary accrediting agency for entry-level physical therapy education programs in the United States?
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Which model emphasizes the integration of personal and environmental contexts in assessing health?
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What is the primary focus of the International Classification of Functioning, Disability, and Health (ICF)?
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Which of the following aspects is NOT included in the four major systems of the OAM Framework?
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How does the Social Model differ from the Medical Model in its approach to disability?
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What key shift did the ICF introduce to the understanding of health and disability?
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In the context of the biopsychosocial model, which aspect is integral to understanding a patient’s functionality?
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What does the OAM framework stand for in the context of patient evaluation?
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Which statement best describes the role of health care within the Medical Model?
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What aspect of physical therapy diagnosis is primarily focused on addressing dysfunction?
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Which of the following is NOT a typical focus area for the State Board of Physical Therapy?
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Which principle relates to the evolving nature of the scope of practice within physical therapy?
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Which legal element is typically included in practice acts for physical therapists?
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How are the elements of the Practice Act often described when they are not explicitly stated?
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What is the primary responsibility of a State Board mentioned in management of licensees?
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Which of the following actions is typically NOT performed by the State Board of Physical Therapy?
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What does the term 'silent' refer to in the context of practice acts?
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What is a primary benefit of utilizing a patient-centered interview in healthcare?
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Which aspect of communication significantly contributes to the majority of malpractice allegations?
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Which factor does NOT contribute to patient-centered care improving overall efficiency?
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How can the concept of 'Nature vs. Nurture' be applied to communication in healthcare?
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What is the primary concern if a patient presents with symptoms indicating a possible pulmonary embolism?
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Which of the following is NOT a component of the SINSS framework for taking a patient history?
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Which outcome is rooted in having a patient-centered healthcare approach?
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Which statement regarding depression screening is accurate?
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Study Notes
Governing Entities
- Federal, state, and local entities govern PT practice.
- National: CAPTE, FSBPT, and APTA
- Local: Facility policies and procedures
- State: State Board/Practice Acts
- Federal: Medicare, ADA, and HIPAA
CAPTE
- The Commission on Accreditation in Physical Therapy Education.
- The only accreditation agency recognized by the USDE and CHEA.
- Establishes baseline educational standards for PT/PTA programs.
FSBPT
- The Federation of State Boards of Physical Therapy.
- Mission: Protect the public by providing services and leadership to promote safe and competent physical therapy practice.
- Vision: Achieve high levels of public protection through strong foundations of laws and regulatory standards in physical therapy.
- Focus areas: Examinations, Membership, States' Rights, Education, Leadership, and Organizational Stability
APTA Code of Ethics
- Accessible on the APTA website.
APTA Guide for Professional Conduct
- Accessible on the APTA website.
APTA Standards of Practice
- Accessible on the APTA website.
- Ethical and Legal
- Administration of Physical Therapy Services
- Patient/Client Management
- Education
- Advocacy
- Research
- Community Responsibility
The Guide to Physical Therapist Practice
- Also known as "The Guide."
- Accessible online.
PTA Education and Scope of Work
- PTA coursework includes: Anatomy & Physiology, Exercise Physiology, Therapeutic Exercise, Biomechanics/Kinesiology, Neuroscience, Musculoskeletal, Integumentary, Cardiopulmonary, Behavioral Sciences, Communication, and Professional Issues/Ethics/Values.
- PTAs are prepared to perform "selected components of intervention and data collection, and assess the patient's/client's safety and response to the interventions provided under the direction and supervision of a PT."
- PTAs implement components of patient care, obtain data related to the treatments provided, and collaborate with the PT to modify care as necessary.
- The physical therapist is responsible for the services provided by the PTA.
- PTAs are not permitted to perform evaluations, assessment procedures, or certain complex procedures. They also do not design plans of care or develop treatment plans.
- PTAs do not possess an independent “scope of practice.”
Supervision
- The ability of the PTA to provide services shall be assessed on an ongoing basis by the supervising PT.
- Direct Supervision: The PT is physically present and immediately available for direction and supervision.
- Direct Personal Supervision: The PT is physically present and immediately available, and the direction and supervision is continuous throughout the time tasks are performed.
- General Supervision: The PT is not physically present, but is available by telecommunication.
- Medicare Supervision: PTAs require general supervision in all settings except private practice, which requires direct supervision.
PT Diagnosis
- PT diagnosis is not the medical condition/pathology.
- Identifies dysfunction at which intervention is focused to address.
- Addresses the impacted systems.
- Focuses on: Impairments, Functional Limitations, and Signs and Symptoms.
Reasons for Licensing Boards
- First and foremost, to protect the public.
- Promote safety and competence of licensees.
State Boards
- Manage licensees in their jurisdiction.
- Processes applications and fees.
- Monitors CEU/Continuing Competence requirements.
- Investigates complaints.
- Holds disciplinary hearings and takes action.
- Administers jurisprudence exams.
- Promulgate regulations.
- Interpret practice acts.
- Work with other state boards.
- Hold regularly scheduled public meetings.
Law (Statute) vs. Regulation
- Law/Statute: Practice Act goes through a legislative process and varies by state.
- Regulation: Promulgated by the Licensing Board, varies by state.
"Silent" Practice Acts
- Not everything in the Practice Act will be explicit.
- Can be open to interpretation.
- If in doubt, contact the State Board for clarification/guidance.
Scope of Practice
- Evolves based on emerging evidence, practice patterns, advocacy, and legislative action.
- Key examples: Direct Access, Dry Needling/Intramuscular Manual Therapy, Requesting Diagnostic Imaging, Telehealth, and Manipulation.
Key Elements of Practice Acts
- Direct Access
- Supervision of PTAs, aides, and students
- Continuing competency requirements
- Code of Ethics
- Standards of Practice
- Documentation requirements
- Disciplinary actions/Fines
Conflicting Rules
- The most stringent rule governs, usually the state practice act.
Addressing Depressed Patients
- Impaired concentration may prohibit productive clinic visits.
- Use phrases such as, "You appear to be down in the dumps today..." or "You appear to be having a rough day..."
- Directly inquire, "Are you considering harming yourself or taking your life?"
Communication Pearls
- Use open-ended to closed-ended questions (Funnel).
- Avoid biased questions.
- Avoid jargon.
- One question at a time.
- Slow and deliberate questions.
- Brief questions.
- Use parallel thought.
- Use the patient's words.
- Avoid making assumptions, clarify if unclear.
Special Questions/Review of Systems
- General Health
- Screen for disease (questionnaires)
- Medications
- Unexplained weight change
- Bowel or bladder changes
- Fevers, chills, night sweats
- Dizziness/syncope
- Red flags vs. Yellow flags.
Take Home Points
- The review of systems assists in determining the type and vigor of the exam.
- Helps clarify or determine more serious pathology.
- Examples:
- Weight loss = cancer
- Fevers = infection
- Night sweats = TB
- Bowel/Bladder changes = spinal cord/cauda equina.
- Medical referral is required for potentially serious issues.
### Governing Entities
- National, state and local entities govern the practice of physical therapy.
- National: Medicare, ADA, HIPAA
- State: State Board/Practice Acts.
- Local: facility policies and procedures.
### CAPTE
- The Commission on Accreditation in Physical Therapy Education
- It is the only recognized accreditation agency for physical therapy education programs
- It establishes the baseline educational standards for PT/PTA education programs.
### Federation of State Boards of Physical Therapy (FSBPT)
- Their mission: To protect the public by promoting safe and competent physical therapy practice.
- Their vision: To achieve a high level of public protection through strong laws and regulatory standards in physical therapy, effective tools and systems to assess ongoing competence, and awareness of public protection resources.
- FSBPT has six main focus areas: examinations, membership, states' rights/responsibilities and professional standards, education, leadership, and organizational/financial stability.
Other Elements to Guide Physical Therapy Practice
- Local, facility, and employer policies and procedures are critical.
- Policies are principles, rules, and guidelines that influence and guide major decisions and actions within an organization.
- Procedures are the day-to-day methods used to put policies into action.
- Policies and Procedures can involve equipment maintenance and calibration, personnel evaluations, emergency response, and documentation.
### State Practice Act and State Board
- They specify parameters for legal practice within a given jurisdiction, known as the scope of practice.
- The scope of practice involves areas such as direct access, manipulation, dry needling, diagnostic imaging, and supervision.
- The State Board manages licensees by processing applications for licensure, monitoring continuing education requirements, investigating complaints, holding disciplinary hearings, administering jurisprudence exams, and promulgating regulations (not statutes).
Contextual Models
- The Medical Model views health as a personal problem with diagnosis as the primary focus.
- Healthcare is viewed as the solution in this model with the goal of changing the individual's behavior.
- The Social Model views health as a societal problem caused by interactions between conditions.
- This model integrates persons with disabilities into society rather than changing the individual and requires social action to achieve this.
- The Biopsychosocial Model considers the whole person and integrates personal and environmental contexts.
- It links function to biological, psychological, social, and environmental factors:
- The ICF (International Classification of Functioning, Disability, and Health) adopted by the World Health Organization in 2001 is an example of the Biopsychosocial Model.
- The ICF was endorsed in 2008 by the APTA and incorporated into the 2010 Guide to PT Practice.
- It incorporates social and environmental factors into health and disability, focusing less on the disability and more on its impact. It contributes to a comprehensive population health measurement framework.
Why Licensing Boards Exist?
- Primarily to protect the public by promoting safety and competence of licensees.
What Does the State Board Do?
- Manage licensees in their jurisdiction.
- Process applications and fees for license.
- Monitor Continuing Education Unit (CEU) or Continuing Competence requirements.
- Investigate complaints and share information with other states.
- Hold disciplinary hearings.
- Manage disciplinary action.
- Administer jurisprudence exams.
Key Terms
- Law (Statute): A practice act is a statute that goes through the legislative process and varies by state.
- Regulation: Promulgated by the Licensing Board and varies by state.
Direct Access, Dry Needling, Diagnostic Imaging, and Telehealth
- Not everything in the Practice Act will be explicit and terminology can vary from state to state.
- Explicit areas are clearly articulated in the Practice Act language.
- Silent areas are not specified in the Practice Act language and open to interpretation - requiring guidance from the state board.
- The scope of practice evolves through emerging evidence, practice patterns, advocacy, and legislation.
Key Elements of Practice Acts
- Direct Access
- Supervision of PTAs, aides, and students.
- Continuing competency requirements.
- Code of Ethics.
- Standards of Practice.
- Documentation requirements.
- Disciplinary actions/fines.
Communication Models
- SBAR (Situation-Background-Assessment-Recommendation) communication model provides structure and focus for important communication.
- I PASS THE BATON is a communication technique to prevent errors by ensuring information transfer is complete.
Why Take a History?
- Histories are essential for gathering diagnostic information.
- The goal is to build rapport, understand communication barriers, learn about the patient's learning style, assess the patient's goals, and identify potential barriers to treatment.
Why Take a History? The SINSS Framework
- Severity: The intensity of the symptoms, such as pain levels.
- Irritability: How easily the symptoms are aggravated by activity or movement.
- Nature: The perceived quality of pain, such as sharp, aching, or burning.
- Stage: The progression of the symptoms over time, such as improving, worsening, or stable.
- Stability: How consistent the symptoms are, such as fluctuating, persistent, or intermittent.
Patient-Centered Interview
- Use an illness experience approach focused on:
- Who is the patient?
- What does the patient want?
- How does the patient experience illness?
- What are the patient's perceptions?
- What are the patient's feelings?
Patient-Centered Interview Outcomes
- Improved communication: Patient-centered communication improves patient and provider satisfaction, enhances outcomes, increases efficiency, decreases patient anxiety, and reduces malpractice claims.
- Time: Patient-centered communication does not require more time than traditional biomedical approaches.
### Patient-Centered Interview vs. Litigation
- Malpractice allegations are often due to communication issues.
- Providers are more likely to be sued if they are perceived as uncaring or compassionate.
- Effective communication is just as important as the content of the communication.
Patient-Centered Interview: Nature vs. Nurture
- Patient-centered interviewing skills can be taught, learned, and retained.
### Summary: Patient-Centered Care
- Enhances patient and provider satisfaction, improves outcomes, increases efficiency, and decreases malpractice claims.
- It can be taught, learned, and retained.
- It doesn't take longer than traditional methods.
Two Questions to Screen for Depression
- During the past month, have you been bothered by feeling down, depressed, or hopeless?
- During the past month, have you often been bothered by little interest or pleasure in doing things?
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Description
This quiz covers the various governing bodies that regulate physical therapy practice, including federal, state, and local entities. Key organizations such as CAPTE, FSBPT, and APTA are discussed, along with their functions and importance in maintaining standards and ethics in the profession.
