PTA 110 Unit 1 2025 PDF

Unit 1 Objectives: Intro to the PT Profession and Communication The student will be able to… 1. Define and describe the profession of Physical Therapy (PT), including the profession’s mission, services, specialties, and common practice settings. 2. Identify key historical contributions to the g...

Unit 1 Objectives: Intro to the PT Profession and Communication The student will be able to… 1. Define and describe the profession of Physical Therapy (PT), including the profession’s mission, services, specialties, and common practice settings. 2. Identify key historical contributions to the growth of Physical Therapy 3. Describe the benefits and general responsibilities of the profession’s national organization: American Physical Therapy Association (APTA) 4. Describe the general responsibilities of the State Board of Physical Therapy Examiners 5. Identify and define terms associated with the PT profession: accountability, malpractice, prohibited practice, supervision, accreditation, licensure, professional ethics, patient’s rights, medical team, third party players. 6. Discuss the roles of PT professionals and support staff: Physical Therapist, Physical Therapist Assistant (PTA) and Physical Therapy Aide/Technician: evaluations, data collection, interventions, documentation, communications, and discharge planning. 7. Identify and explain the role of documentation for PT services 8. Describe the components of “SOAP” documentation format and its relation to the Problem Oriented Medical Record (POMR) 9. Identify information that would be classified as subjective, objective, assessment or planning. 10. Compare and contrast types of communication: verbal, non-verbal, and written communications, including how each contribute to effective service delivery. 11. Perform sample SOAP documentation exercises 12. Perform active listening and effective communication (verbal, written, non-verbal) during simulated clinical experiences. 13. Demonstrate adherence to professional ethical and legal standards throughout the remainder of the program. Unit 1: Intro to the Physical Therapy Profession Physical Therapy: o Art and Science contributing to the promotion of health and prevention of disease through understanding body movement o Functions in prevention, correction and alleviation of the effects of disease &/or injury APTA (American Physical Therapy Association) defines Physical Therapy (1986) as “Physical Therapy: (a) treatment by physical means (b) the profession which is concerned with health promotion, with prevention of physical disabilities, and with rehabilitation of persons disabled by pain, disease, injury; and which is involved with evaluating patients, with treating through use of physical therapeutic measures as opposed to medicines, surgery or radiation”. History of Profession: Developed in part as a result of two major events Formative and Development Years Major events 1. Early 1900s: Infantile Paralysis (Poliomyelitis) lead to shaping of PT as a profession 2. 1916 (WWI) lead to government recognition for a specialty in health care that primarily dealt with reconstruction of military personnel (1st PT Dept. at Walter Reed Hospital) Other events: ▪ 1921 founding of professions first national organization -“Americans Women’s Physical Therapeutic Association - AWPTA” (original name of APTA) ▪ 1922 renamed “American Physiotherapy Association” (males were allowed to join) ▪ 1900–1940 profession emerged as early PTs were called “Reconstruction Aides” and worked beside physicians Mary McMillan recognized as first US Physical Therapist and APTA President Early PTs were trained in muscle strengthening, massage, and corrective exercises Education focused on human anatomy & exercise treatments including hydrotherapy electrotherapy, mechanotherapy, active exercise, indoor/outdoor games, & massage Fundamental Years (1940 – 1970) major growth period for PT profession more formalized education for Physical Therapists another Polio outbreak and WWII leading to current concept of Rehabilitation for injured soldiers and children affected by polio as well as the general public 1943 Term “Physical Therapist” adopted by US Congress 1944 name change to American Physical Therapy Association  1960’s (early) emerging concept of Physical Therapy Assistant d/t profession growth with too few physical therapists to fill the growing demand. Initial terminology changed to Physical Therapist Assistant to directly assist the PT in service delivery 1967 Newly developed Medicare system added physical therapy services as a reimbursable skilled service 1969 First PTA graduates (15 total from 2 schools (Florida-Miami Dade College and St Mary's Campus of the College of St Catherine in Minnesota) Mastery, Adaptation and Vision Years (1980 – 2000) major accomplishment of PT profession and national organization High growth of physical therapy educational institutions 1977 Commission on Accreditation of PT Education (CAPTE) established to develop uniform educational standards for PT and PTA education 1997 BBA (Balanced Budget Act) goal was to eliminate Medicare deficit taking effect January 1999 ($1500 therapy cap for outpatient rehabilitation services) BBA created 1st time job decline since formation of profession for both PTs /PTAs APTA Vision 2020 (2000 - 2020) described the hopes for how physical therapy would be practiced in 2020 and the qualifications of those involved in PT practice All PT’s will graduate from Doctor of Physical Therapy Education programs (DPT) Autonomous Practice (per APTA “PT exercises independent, self-determined judgement and having ability to refer patients/clients to other health-care providers” Direct Access by consumers (patient / clients are able to receive physical therapy services directly w/o having to obtain a physician referral) Lifelong Education - obligated to engage in continual acquisition of knowledge, skills, & abilities Evidence Based Practice - application/integration of evidence to guide clinical decision making Professionalism - consistently demonstrate core values (accountability, altruism, compassion/caring, excellence, integrity, professional duty and social responsibility) APTA Vision Statement for the Physical Therapy (2013 – Present) A new vision was created as profession had already met many of Vision 2020 goals Transforming society by optimizing movement to improve the human experience “Physical Therapy will be better poised to positively impact societal health fitness and activity” APTA (American Physical Therapy Association)  Voluntary professional national organization for PTs, PTAs and students Established in 1920, as AWPTA to ensure those working in physical therapy would be following established standards for practice and education. Goals- educational standards conformity, practice standards, promoting advancement of the profession through research and legislation, and advocating for the rights of patients and others in society Each state has chapters which are its own level of APTA membership Sections focus on issues or concerns of members in particular practice settings (Acute Care, Outpatient, Education etc. Education Program guidelines/accreditation (Commission on Accreditation of PT Education – CAPTE) Promotion of profession and advocates for profession at federal, state and public levels Developed the Code of Ethics Establishes best practices Works in conjunction with State Boards of Physical Therapy Examiners as the profession governing bodies State Board of Physical Therapy Examiners Licensing board (to license PTs and PTAs to practice physical therapy in each State) 1951: creation of North Carolina Board of Physical Therapy Examiners (NCBPTE) 1985- revision replaced physician referral requirement for patient care with Direct Access Established and maintains minimum standards for the practice of physical therapy to protect the safety and welfare of the citizens of North Carolina (practice act) Determines the legal parameters of the Physical Therapy Profession for each corresponding state (NC Physical Therapy Scope of Practice) To investigate complaints regarding unauthorized practice of physical therapy licensees that violate State Practice Act (handles grievances, suspension/withdrawal of license) Advocates for public safety in the provision of physical therapy services 2009- NCBPTE began requiring continued competence for all licensees (PT/PTA) 2018- Physical Therapy Licensure Compact became effective. Enables a NC PT or PTA licensee to provide interstate practice of physical therapy services through mutual recognition of other member state licenses. Federation of State Board of Physical Therapy (FSBPT) Established in 1987 to promote safe and competent physical therapy practice Develops, maintains & administers National Physical Therapy Exam (NPTE) for PTs/ PTAs Works in conjunction with State Boards for NPTE administration Medical Team: includes healthcare professionals involved in patient’s care a) May change as the needs of the patient changes b) Depends on patient care setting. May include MD, RN, SW, OT, ST, PT, Voc. Rehab, RT, TR, Psychologist, Nutritionist, etc.… c) Assists in the quality of care for multiple patient components Components of PT Practice: 1. Examination- patient history; system assessment (ROM, strength, balance, coordination, sensation, posture, skin integrity, mobility->normal vs. abnormal 2. PTA can only re-measure for data collection purposes not initially measure 3. Evaluation - represents clinical judgments based on data collected in examination (PT) 4. Diagnosis - referring to PT related diagnosis defines patient problem areas, syndromes, impairments,(i.e.: medical dx =L hip fracture; PT dx =gait disturbance)(PT) 5. Prognosis - determine the potential and amount of function that might be attained includes the time frame for attainment (LTGs, STGs) (PT) 6. Intervention- therapy techniques, methods, protocols. Direct interaction & treatment of patient problems identified to affect change in status per plan of care (PT/PTA) 7. Assessment- explain the reasoning behind the decisions taken and clarify and support the analytical thinking behind the problem-solving process (PT/PTA) Provision of PT Services – how is this accomplished? 1. Evaluation and treatment (direct patient interaction) 2. Administration and supervision (of PT personnel and interventions) 3. Consultation (with other health care disciplines (MD, nursing, social worker) 4. Preparation of records and reports research, documentation 5. Community awareness/projects with companies, organizations 6. Education clinical, academic, accreditation Clinical Settings: 1. Acute Care Inpatient hospital primary emphasis on patient medical care needs tx primarily in patient room, short length on caseload, focus on mobility tx frequency daily (qd) or 2x/day (bid) for 5 – 7 days/week) 2. Inpatient Rehabilitation Facility (IRF) Inpatient intensive therapy services over several wks. primary emphasis is on rehabilitation (OT, ST, PT) and improving function tx frequency (5 – 7 days/wk.), requires 3 hours therapy 5 out of every 7 days 3. Out-patient Rehabilitation (OP) Tx in a hospital/rehabilitation setting or a free-standing clinic Patients are transported to clinic only for treatment Clinic can be owned/ operated by PTs (private clinics) If part of a physician group (POPTS = Physician Owned Physical Therapy Setting APTA has voiced opposition to POPTS practice settings) tx frequency 2 – 3 days/week 4. Home Health for “homebound” patients Treatment is performed in the home or Assisted Living Facility (ALF) If do not qualify for homebound status, cannot receive HH services tx frequency 2 – 3 days/week 5. School System/Early Intervention delivery of therapy services to children (pediatrics) school aged population, therapist travels to different schools to perform treatment tx frequency 2 – 3 days/week 6. Extended Care Facility (ECF) o Skilled Nursing Facility (SNF) may be for long-term or short-term care o Subacute medical and therapy services o tx frequency 3- 5 x/week 7. Day Treatment Programs similar to OP, integrate treatment focusing on community re-entry therapy services (OT, ST, and PT) more common for neurological disorders that need multiple therapy services tx frequency 5 x/week World Health Organization (WHO): Developed the International Classification of Functioning, Disability and Health (ICF) model o provides framework of terminology of health conditions Body Functions o physiological and psychological functions of the body o i.e.: muscle strength, vision, hearing, orientation, language and vitals Impairments o problems in body function as a significant deviation or loss o i.e.: paresis, blindness, hearing loss, confusion, sensory loss, contractures and speech impairments Functional / Activity Limitations o difficulty in performing or executing tasks or actions judged relative to the “normal” expectation of the person o i.e.: walking, eating, conversation, reading, bathing and writing) Physical Therapy Professional Roles 1. Physical Therapist: PT is the identification sanctioned by the APTA Master degree or higher (APTA Vision 2020 = all PT at Doctoral level) Prior Bachelor degree PT’s have been “grandfathered-in” Must be licensed in all States Responsibilities: 1. Evaluation 2. goals setting 3. POC establishment a. supervision / treatment delegation to PTAs, Aides, & students. (On-site supervision required for aides/students) 4. Administration primary physical therapy practitioner with all duties related to the provision of physical therapy services 2. Physical Therapist Assistant: PTA is the identification sanctioned by the APTA o Associates degree (2 year degree) o 50 states require licensure or certification o Responsibilities:  assist with data collection (except in the initial evaluation)  treatment implementation  minor treatment modifications within the patient POC (plan of care)   participation in discharge planning  documentation of patient care and progress toward goals  Does not require on-site Supervision by PT but must be readily available  On – site Supervision of PT aides and students  3. Physical Therapy Aides (technicians): Trained on the job, duties vary from state to state, setting to setting. Must work under and have on-site Supervision by licensed PT & / or PTA Summary of PTA Scope of Practice: CANNOT evaluate a patient CAN observe and measure patient status if initially assessed by the PT CAN treat within their scope of practice and patient POC (plan of care) CAN change/modify interventions within the POC (& with discussion of primary PT) KNOW your state Scope of Practice! ** When to contact the PT: a patient is not reaching goals a patient has met their established goals patient presents with a new medical status patient has a change (decrease) in medical stability questions/concerns with POC (plan of care) need to change the POC if patient needs to be D/C suspicion of patient /client is victim of abuse or neglect ** In the event of a medical emergency or status change, PTA can decline to treat the patient until a PT has re-evaluated the patient for changes. These may include: chest pain lasting longer than a few minutes; abnormal vital signs; fainting; symptoms of stroke, etc. Documentation: PTA’s are responsible for documenting pt.’s status, progress, changes, education, interactions, therapy interventions and need for skilled therapy services Why is it important to document? 1. Quality/Continuity of Care 2. Legal record 3. Reimbursement – payment for services provided 4. Accurate, timely and proper identification Components of Documentation:  1. Data Collection Subjective & Objective information = information told to therapist and that is observed and/or measured by therapist 2. Problem list developed by the PT, based on data collection = specific impairments related to decreased function (not a medical diagnosis) 3. Outcomes/Goals determined by the PT, based on patient current status and prognosis/potential to improve function 4. STG - intermediate goals established to progress patient toward outcome /goals 5. LTG - the outcome goal or goals expected within a certain timeframe as a result of skilled physical therapy interventions 6. Record of treatment administered proof of what was performed during the delivery of physical therapy interventions SOAP Note format (for progress notes/evaluations) S: (Subjective) age, dx, PMH, co-morbidities, social Hx (more related to PT) What patient, family, nursing or others state, pain scales Patients chief complaint Interview gather information about patient history: (past and present) o what (is the problem) o where (is the problem) o why (disease/trauma) o when/how long (have had the problem) o PLOF (prior level of function) what was patient’s prior activity level O: (Objective) mentation: awake/alert, oriented to person/place/time Appearance ROM (active, passive, active assisted, end feels) and (include Tone for neuro pt.’s) Strength: MMT, wt. (#) Motor: synergies, primitive reflexes, coordination Balance: ▪ Static sitting/standing ▪ Dynamic sitting/standing Sensation: light touch, localization, sharp/dull, proprioception DTR’s: intact / Symmetrical Cranial nerves (with neuropatients) Vital signs Mobility:  ▪ Bed mobility – rolling, scooting, bridging, sit ↔ supine ▪ Transitions: sit ↔ stand ▪ Transfers: one surface to another, turning to sit, squat pivot ▪ Gait: Assistive device, distance, deviations ▪ Step negotiation (stair climbing) Any other observed/measured status (spasticity, wounds) state treatment intervention performed that day (if daily) past week (if weekly) pt. seen 5/5 skilled PT sessions for ROM, ther ex, and pre-gait/balance A: (Assessment) (What you think) general summary pt.’s main problems related to PT nursing recommendations or other services How function pertains to STG’s/LTG’s: achieved, progressing toward or partially achieved? All comments must be supported by evidence from Subjective or Objective documentation Identify need for further skilled PT services /skilled care PTA cannot discuss prognosis or potential P: (Plan) (POT= plan of treatment) PT frequency, duration, treatment plan What will concentrate on until next note or during next treatment daily note, P: see pt bid for tilt table to increase upright tolerance weekly note, P: PT 5x this week to initiate ambulation with straight cane, balance activities in standing “Continue POT” this is not appropriate and third party payers won’t reimburse Example of SOAP note: S: Pt. reports “mild” pain in low back O: Pt. seen (date) for 2/3 treatment sessions HR 110 bpm with activity AROM L shoulder flexion to 90° Log rolling Min +1 A Sit stand Mod +1 A A: Pt. has ↓’ed HR with activities by 5 bpm since last tx. Left shoulder AROM ’ed by 10° Pt. requires frequent verbal cues to for safety during transfers. Pt. is not progressing toward goal of ambulation 10’ with walker. Skilled PT services needed to improve safety awareness and decrease risk for falls P: 3x/wk. scheduled for endurance training, strengthening and mobility activities  Signature, credentials (SP TA), date Entry Corrections: Standard Procedure EMR – electronic medical record. Follow institutional policy guidelines Paper Files: Draw single line through inaccurate information, do not use white out as (original information must remain legible) Date and initial correction Enter the correct information in chronological sequence Read chart thoroughly before initial treatments, refer to chart for any status/ treatment changes. If there is something you don’t understand from chart, either ask or look it up! Additional Terminology for Documentation Problem-Oriented Medical Record (POMR): layout of an inpatient chart database/ patient background patient problems evaluations and treatment plans from various disciplines ongoing progress notes (SOAP) Discharge Summaries: PTAs can write a D/C progress note – clarifying and stating objective information only (from chart reviews). The PT is responsible for determining D/C, and for making any assessments regarding patient status and continued care. NCBPTE considers DC Summary as an evaluation at Discharge. Confidentiality: private information-> everything about the patient is confidential outside the medical team care providers directly involved in patient care! Don’t read a patient chart that you are not treating (unless have other good reason!) Don’t discuss a patient/chart with anyone except medical staff involved, and make sure you are in a private area (no cafeteria nor break room talk) Don’t give out information over the phone (no matter who they say they are, unless you have called someone specifically to discuss patient care) Don’t copy any part of the chart without written consent from patient/family (unless cleared by other entities for research, etc.) remove identifiable markers Don’t leave paperwork in public areas that contain patient information (schedules) Never enter/sign a patient note for someone else if you’re not involved in treatment HIPAA- Health Insurance Portability and Accountability Act (1996) (Federal protection for patients’ health information privacy) A US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers Privacy & Confidentiality Privacy refers to the right of an individual to keep his or her health information private. Confidentiality refers to the duty of anyone entrusted with health information to keep that information private HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT– HIPAA Summary Access to medical records: allows patients the right to view their medical records with access within 30 days of request. Notice of privacy practices: notify patients of how their health information may be used and their rights to privacy. Limits use of personal medical information: limits how health providers/insurers can use information that can identify a patient (but not information necessary to effectively treat a patient). Patients can sign a waiver to share information for reasons outside relevant medical treatment. Prohibition of marketing: restrictions on patient information for marketing purposes. Stronger state laws: provides a minimum standard for all states regarding patient confidentiality, however, states can provide additional privacy protections. Confidential communication: patients can request how their information is shared between provider and patient (number to call, whether to leave message Complaints: patients can file a formal complaint regarding privacy practices Please visit the following link for detailed facts regarding HIPAA. http://www.hhs.gov/ocr/privacy/index.html FAILURE TO COMPLY WITH PATIENT CONFIDENTIALITY LAWS can result in dismissal from clinical internships, legal prosecution (fines), and expulsion from the PTA program! Communication: (Introduction – more to come in PTA 222 Professional Interactions) 1. Verbal = use terms listener can understand (lay vs. medical) a) with patient’s make brief/simple instructions/statements in lay terms b) Maintain eye contact, be aware of tone … sound like you mean!! c) Be aware of volume & adjust to individual needs (Not all elderly are HOH) 2. Non-verbal = facial expressions, gestures, posture, and body movements a) observe & respond to patient’s non-verbal communication and monitor your own 3. Written Communication = Education for home programs, letters to MD/teachers, etc. a) Brief, concise, specific language appropriate to reader b) If part patient education demonstrate, have patient return demonstration and provide visual (written/diagrams) instructions!! (ex: HEP) Common Barriers to Communication: noisy/busy treatment area language used (medical, foreign) tone/volume lack of time to explain individual biases and values medical conditions (speech and/or hearing impairments) lack of feedback Active Listening: make sure to check with the speaker to make sure you understand very important to make sure avoid miscommunication with others!! Inappropriate Communication: Anything you say that is against the law or unprofessional Avoid personal information unless it pertains to patient care Avoid soliciting social activities from patients Avoid comments/jokes that may offend patient, family or any listener within earshot (jokes are inappropriate for the work place) Do not tolerate/encourage these behavior from patients, supervisors, colleagues Inappropriate Touching: Therapist (your) intentions should always be made evident! Caution must be taken to ensure patient is not made to feel uncomfortable Clearly communicate what therapist will be doing with the patient and why PT professionals deal with “sensitive” areas of the body … when handled professionally, this is not a problem. If a patient appears uncomfortable, stop/avoid and possibly modify treatment … also, communication is very important Communication: Patient / Client Rapport  Therapeutic relationship between a clinician and patient begins with the first meeting. Developing a helping professional characteristics will be critical to delivering optimal patient care. Punctuality: o attending to patients in a timely fashion shows respect for patient and his/her time Friendliness: o A PTA introducing themselves to a patient should smile and include their name and title. o when initially working with a patient more formal communication is generally appropriate. Formality may change as therapist/patient relationship develops. Culturally Sensitive: o The PTA should recall how certain ethnic groups communicate in order to ensure respectfulness. o Example: Many Mexican Americans and Native Americans consider sustained eye contact to be rude. Communicative: o Patients will have an expectation of clear explanations, in a language that the patient can understand. o use “Laymen’s Terms” to explain all interventions performed, as well as being able to describe the benefits or risks of treatment when appropriate. o what factors should a PTA consider when determining the patient’s level of understanding? ▪ Age ▪ Cognitive function ▪ Level of sensory impairment ▪ Speaking with a patient using medical terms that they do not understand can be frustrating for the patient, however, so can speaking in too simplistic of language. Patient Focused: o Includes making treatments/interventions entirely focused on patient. o PTA should not appear rushed or hurried, and avoid distraction-even in a crowded gym area. Knowledgeable:  o Patient has right to ask questions about their diagnosis/treatment (will ask!) o PTA should be prepared by reading the evaluation, asking the patient pertinent questions, and communicating understanding. o Will you always know the correct answer? o What should the PTA do when confronted with a questions beyond their knowledge? Trustworthy: o The patient should believe that their best interest is always being regarded Helpful: o PTA can and will be asked to perform tasks that are technically not part of his/her job. o Example: before leaving an acute care patient’s room, the patient requests the PTA to bring them a glass of water. o PTA should always take into consideration the needs of the patient!! The therapeutic relationship between a patient and clinician can develop very quickly- both poorly and productively. The key to building this relationship in the right direction will be effective communication, along with a development of trust and comfort. When the PTA shows interest in the patient in regards to outcomes and as a person, the PTA displays caring and compassion. Both of these are expected in the therapeutic relationship. Physical Therapist and Physical Therapist Assistant Relationship Why is the relationship between the PT and PTA important? Just like the overall medical team, it is imperative for the PT/PTA tandem to work as a cohesive team to achieve optimal patient care Each member of the PT/PTA team may have varying degrees of understanding in regards to each other’s role. Example: New graduate PT working alongside a PTA with 20+ years of experience. Education: It is important for both clinicians to understand the education of each member, including the initial physical therapy degree. It may be necessary to discuss with the PT what specific skills have been taught, as well as what the PTA has learned in continuing education courses. State Laws:  It is not uncommon for the PT to be uneducated on the specifics for PTA scope of practice. It is imperative that there is understanding between clinicians on state laws and administrative rules for ethical patient care. What is the appropriate action for a PTA when encountering a situation that may violate state laws? Also be aware that scope of practice can vary from state to state, and should be followed accordingly Personal Attributes: Aside from level of education and knowledge, each team member will bring strengths and weaknesses. Open communication should be utilized to explore and understand the expectations of each team member- PT and PTA. Early communication/understanding of expectations and areas of improvement will help prevent misunderstandings, and lay foundation to build a trusting relationship. How can this apply to clinical education? Discharging a Patient /client from Physical Therapy Care: Ultimately, the PT is responsible for determination of D/C … PTA has valued input into this decision based on treatment and progression. D/C may be recommended if… o patient transfers from the setting o goals are achieved/maximum function achieved o progress is minimal/potential declines o contraindications are identified or change in medical status Evidence Based Practice What is evidence based practice? Originated from physician need to improve the quality of patient care through clinical practice and research Requires healthcare practitioners to consider current best evidence in combination with clinical knowledge and skill APTA (American Physical Therapy Associations) defines EBP as: “EBP includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision-making.” Why is evidence based practice important? Improves the quality of patient care  It helps standardize aspects of care Assuring that the best possible patient outcomes are achieved Vision 2020- why is this important? Components of evidence based practice in physical therapy: Examination-Evaluation-Diagnosis-Prognosis-Intervention-Outcome should all be supported by evidence based research. Which of these can the PTA have involvement in? (think back to scope of practice) The PTA has a responsibility to stay current on research literature that addresses interventions o PTA should be able to clearly communicate with the PT or patient about the purpose of an intervention, the risks/benefits, and the evidence to support it. o Can the PTA recommend alternative interventions if the patient is not responding to current treatment? o Yes, but be able to tell why it would be beneficial! o Should the PTA be aware of supporting evidence in other aspects of patient care (examination, evaluation, etc.)? Steps in the evidence based process: 1- Formulate a focused clinical question o The clinical question will provide a focused basis for finding relevant information in literature o PICO system ▪ P- Patient ▪ I-Intervention ▪ C- Control ▪ O- Outcome 2- Locate the evidence o PubMed o Google Scholar 3- Critically appraise the evidence o Is the study relevant to my clinical question? ▪ Don’t assume that the first article will address your needs  ▪ Should include subjects that are similar to your patient in age, diagnosis and clinical condition ▪ Several articles should be reviewed prior to choosing, an abstract makes this much more time efficient. o Is the quality of the study high enough to be helpful? ▪ Refer to the hierarchy pyramid for research evidence ▪ Peer reviewed/meta analyses 4- Apply the evidence to patient care o Shared Decision Making patient care- both the clinician and the patient should have components of decision making in regards to the patients plan o The clinician should be able to formulate, carry out, and support the reasoning behind particular interventions. They should also be able to present alternatives when the patient declines or does not respond to the intervention (would a patient with a lifelong fear of water be approving of aquatic therapy even if presented research?) 5- Evaluate the process o Was the process helpful in answering the clinical question? o If the process was not helpful, what might be done differently? o What could make the process more efficient in the future? o What was the patient’s outcome? EBP Terminology: Hypothesis- the starting point for an investigation based on limited evidence Reliability- referring to consistency for a test in regards to time, items, and researchers. Intra vs Inter Rater o Intra rater reliability- referring to how consistent a single individual is at measurement o Inter rater reliability- referring to how consistent different individuals are a achieving the same measurement or test Validity- referring to the soundness or accuracy of a conclusion or measurement Specificity- in terms of medical diagnosis, the ability of a test to correctly identify those without a disease Sensitivity- in terms of medical diagnosis, the ability of a test to correctly identify those with a disease Bias- disproportionate weight in favor of or against an idea or thing  Populations and Samples Research Design o Randomized Controlled Trials o Experimental vs Control groups Vulnerable Populations Vulnerable Patient/ Clients: A patient who is or may be for any reason unable to protect and take care of him or herself, against significant harm or exploitation. The identified vulnerable patients will be under close monitoring at all times during their hospitalization to minimize risks of health care services. List of Potential vulnerable patients / environments o Pediatrics (infant and children) o Disabled individuals o Geriatrics (elder and frail) o Child abuse / neglect o Domestic violence o Sexual assault / abuse o Elder Abuse / neglect (physical, verbal, financial) PTs and PTAs have an ethical duty to treat vulnerable populations while addressing the rights and dignity of the victim, confidentiality, compliance with governing laws and acceptance of responsibility PTA Action Steps related to Suspected Abuse 1. Inform supervising PT of suspected abuse 2. Work together with other healthcare providers to promote patient/client safety 3. Keep accurate documentation with precise information 4. Always dial 911 in emergencies The Five types of abuse, according to the United States Department of Justice. The U.S. DOJ "defines domestic violence as a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner." Physical Abuse: Hitting, slapping, shoving, grabbing, pinching, biting, hair pulling, etc. are types of physical abuse. This type of abuse also includes denying a partner medical care or forcing alcohol and/or drug use upon him or her.  Sexual Abuse: Coercing or attempting to coerce any sexual contact or behavior without consent. Sexual abuse includes, but is certainly not limited to, marital rape, attacks on sexual parts of the body, forcing sex after physical violence has occurred, or treating one in a sexually demeaning manner. Emotional Abuse: Undermining an individual's sense of self-worth and/or self- esteem is abusive. This may include, but is not limited to constant criticism, diminishing one's abilities, name-calling, or damaging one's relationship with his or her children. Economic Abuse: Is defined as making or attempting to make an individual financially dependent by maintaining total control over financial resources, withholding one's access to money, or forbidding one's attendance at school or employment. Psychological Abuse: Elements of psychological abuse include - but are not limited to - causing fear by intimidation; threatening physical harm to self, partner, children, or partner's family or friends; destruction of pets and property; and forcing isolation from family, friends, or school and/or work. Sources: National Domestic Violence Hotline, National Center for Victims of Crime, and WomensLaw.org. Direct questions for victims of abuse I am concerned about your symptoms, especially because they may be caused by someone hurting you. Has someone been hurting you? Your bruises look painful. Did someone hurt you? Introduction to terminology associated with the healthcare professions: Accountable: being responsible for what has been done, explainable in PT profession; each person is responsible for own professional actions and cannot violate the rules. Malpractice: to be held accountable for wrong-doing emphasis on public safety honest and safe treatment of the public (it is up to you what kind of PTA you will be!!) Prohibited Practice: Determined by the state practice acts (under the NCBPTE Scope of Practice) what cannot be done by the professional (designates what the PT vs. PTA vs. PT tech can/cannot do within state laws) Supervision: direction or management determined by the state practice acts, may vary depending on practice setting, insurance re-imbursement, etc. (you should never perform any treatment you do not feel comfortable or safe doing!!) Accreditation: Department of APTA (CAPTE) inspects/evaluates all PT Educational Programs ensure a certain level of quality education to qualify for the national licensing examination, must graduate from an accredited PTA education program (NCC is accredited) Licensure: certificate showing one is permitted by LAW to do something the PTA license examination is a standardized, national test … multiple choice you will hear more about this exam as you progress through the program! Professional Ethics: Refer to handouts on the PT Code of Ethics and Standards of Ethical Conduct for the PTA … you must learn these as independent study for the first test and throughout the program (and ultimately your career!!) Patient’s Rights: all patients have rights Health Insurance Portability and Accountability Act (HIPAA, 1996) confidentiality of patient medical information also important is the right of patient for informed consent (inform pt of vital information for any procedures benefits, risks, complications, possible harm, etc.) Direct Access: ability for a person to receive Physical Therapy services without a physician’s referral NC has direct access; however, insurance companies won’t reimburse without MD order or signed plan of care Third Party Payer: insurance company most of our re-imbursement is from here requires measurable/justifiable progress to receive payment. Unit 1: Appendix 1 Code of Ethics for Physical Therapists PREAMBLE This Code of Ethics of the American Physical Therapy Association sets forth principles for the ethical practice of physical therapy. All physical therapists are responsible for maintaining and promoting ethical practice. To this end, the physical therapist shall act in the best interest of the patient/client. This Code of Ethics shall be binding on all physical therapists. PRINCIPLE 1 A physical therapist shall respect the rights and dignity of all individuals and shall provide compassionate care. PRINCIPLE 2 A physical therapist shall act in a trustworthy manner towards patients/clients, and in all other aspects of physical therapy practice. PRINCIPLE 3 A physical therapist shall comply with laws and regulations governing physical therapy and shall strive to effect changes that benefit patients/clients. PRINCIPLE 4 A physical therapist shall exercise sound professional judgment. PRINCIPLE 5 A physical therapist shall achieve and maintain professional competence. PRINCIPLE 6 A physical therapist shall maintain and promote high standards for physical therapy practice, education and research. PRINCIPLE 7 A physical therapist shall seek only such remuneration as is deserved and reasonable for physical therapy services. PRINCIPLE 8 A physical therapist shall provide and make available accurate and relevant information to patients/clients about their care and to the public about physical therapy services. PRINCIPLE 9 A physical therapist shall protect the public and the profession from unethical, incompetent, and illegal acts. PRINCIPLE 10 A physical therapist shall endeavor to address the health needs of society. PRINCIPLE 11 A physical therapist shall respect the rights, knowledge, and skills of colleagues and other health care professionals. Unit 1: Appendix 2 Standards of Ethical Conduct for the Physical Therapist Assistant Preamble The Standards of Ethical Conduct for the Physical Therapist Assistants (Standards of Ethical Conduct) delineate the ethical obligations of all physical therapist assistants as determined by the House of Delegates of the American Physical Therapy Association (APTA). The Standards of Ethical Conduct provide a foundation for conduct to which all physical therapist assistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients/clients to achieve greater independence, health and wellness, and enhanced quality of life. No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive. STANDARD 1 Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals. STANDARD 2 Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. STANDARD 3 Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations. STANDARD 4 Physical therapist assistants shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, other healthcare providers, employers, payers, and the public. STANDARD 5 Physical therapist assistants shall fulfill their legal and ethical obligations. STANDARD 6 Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. STANDARD 7 Physical therapist assistants shall support organizational behaviors and business practices that benefit patients/clients and society. STANDARD 8 Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally. Effective July 1, 2010