Professional responsibilities in physical therapy

Ethics and jurisprudence

• Core principles:
  • Autonomy: Respect the patient’s right to make their own decisions.
  • Beneficence: Always act in the patient’s best interest
  • Nonmaleficence: “Do no harm”—avoid interventions that cause unnecessary injury or suffering
  • Justice: Deliver care fairly and without discrimination
  • Veracity: Be honest in all interactions with patients and colleagues

Informed consent and confidentiality

• Informed consent includes:
  • Explanation of diagnosis, proposed treatment, risks, and alternatives
  • Opportunity for questions
  • Voluntary agreement without coercion
• HIPAA compliance:
  • Secure storage of records
  • Only share information with authorized personnel
  • Obtain consent before discussing patient info with third parties

Legal considerations

• Negligence: Failure to provide standard care that results in harm
• Malpractice: Professional misconduct or lack of skill leading to injury
• Abandonment: Inappropriate discontinuation of care without proper notice or referral
  • Avoid by: Providing a transition plan, proper documentation, and clear communication

Supervision guidelines

• PTA supervision:
  • PTA must follow the PT’s plan of care
  • PT must be available for consultation
  • Supervision laws vary by state; direct or general supervision may be required
• PT aide supervision:
  • Aides may perform non-skilled tasks under direct supervision

Delegation and communication

• Effective delegation:
  • Assign tasks based on the individual’s qualifications and legal scope
  • Ensure understanding of expectations
  • Monitor and provide feedback
• Professional communication:
  • Maintain professionalism in all written and verbal exchanges
  • Use SBAR (Situation, Background, Assessment, Recommendation) for concise clinical updates

Research concepts and evidence-based practice

Levels of evidence

Understanding levels of evidence helps clinicians evaluate the strength of research when applying findings to practice:

• Level 1a: Level 1a: Meta-analysis analyses systematic reviews of randomized controlled trials (RCTs)
• Level 1b: Individual randomized controlled trials
• Level 2a: Cohort studies (prospective)
• Level 2b: Case-control studies (retrospective)
• Level 3: Case series or low-quality cohort and case-control studies
• Level 4: Expert opinion without critical appraisal

Study types and research designs

• Descriptive: Case reports, case series
• Analytical:
  • Observational: Cohort (prospective), case-control (retrospective), cross-sectional
  • Experimental: Random control trials (gold standard)
• Qualitative: Thematic analysis, interviews, focus groups
• Quantitative: Uses numerical data to measure and test theories,

Statistical concepts

P-values

• A p-value < 0.05 typically indicates a statistically significant difference
• A lower p-value suggests stronger evidence against the null hypothesis

Confidence intervals (CI)

• A 95% CI means there’s a 95% chance the true value lies within that range
• Narrow CI = more precise results; wide CI = more variability

Reliability and validity

• Reliability: Consistency of a test (test-retest, interrater, intrarater)
• Intrarater: the same clinician performs the test-retest
• Interrater: different clinicians perform the test-retest
• Validity: Accuracy—does the tool measure what it’s intended to?
  • Construct validity, content validity, and criterion validity.

Sensitivity, specificity, predictive values

• Sensitivity: True positives — Rules out a condition (SnNOUT) Sensitivity: False negative – indicates the absence of a condition when it is actually present.
• Specificity: True negatives — Rules in a condition (SpPIN)
• Positive predictive value (PPV) — Likelihood that a positive test is correct
• Specificity: False positive – indicates the presence of a condition when it is actually absent.
• Negative predictive value (NPV) — Likelihood that a negative test is correct

Measurement scales

• Nominal: Categories without order (e.g., gender, blood type)
• Ordinal: Ordered categories (e.g., MMT grades, pain scale)
• Interval: Equal intervals, no true zero (e.g., temperature)
• Ratio: Equal intervals with a true zero (e.g., height, weight, time)

Hypothesis testing and data interpretation

• Null hypothesis (H₀): No difference or relationship
• Alternative hypothesis (H₁): A difference or relationship exists
• Type I error (α): False positive
• Type II error (β): False negative

Healthcare system and practice management

Reimbursement models

• Medicare: Federal program for individuals >65 or with disabilities
• Medicaid: State-run program for low-income individuals
• HMO (Health Maintenance Organization): Requires PCP referral, lower cost
• PPO (Preferred Provider Organization): More flexibility, higher premiums

Documentation standards

• SOAP notes: Subjective, Objective, Assessment, Plan
• ICD-10: Diagnosis coding
• CPT codes: Billing for procedures
• Documentation must be timely, accurate, legible, and support skilled care

Continuum of care

• Acute care: Immediate medical care (hospital)
• Subacute care: Less intensive than acute, but still requires skilled therapy
• Outpatient rehab: For patients well enough to live at home
• Home Health: Therapy provided in the patient’s home

Discharge planning and case management

• Begins early in care
• Factors include:
  • Patient’s home environment
  • Support system
  • Functional status
  • Need for durable medical equipment (DME)
  • Recommendations for follow-up services

Roles of Healthcare professionals

• PT/OT/ST: Provide specialized rehabilitative care
• Nurse: Monitor vital signs, administer medication
• Physician: Medical diagnosis and overall treatment plan
• Case manager: Coordinates discharge planning and resources
• Social worker: Helps with psychosocial support and community resources

Environmental accessibility and the ADA

Americans with disabilities act (ADA) guidelines

• Doorway width: Minimum 32 inches wide
• Hallway width: Minimum 36 inches wide
• Ramp slope: 1:12 (for every inch of rise, 12 inches of run)
• Thresholds: ≤ ½ inch for easy wheelchair navigation
• Bathroom access:
  • Grab bars: 33-36 inches high
  • Toilet seat height: 17-19 inches

Home and community modifications

• Install ramps or stairlifts
• Widen doorways
• Lower countertops
• Install grab bars and handheld showers

Workplace accommodations

• Adjustable desks
• Assistive tech (voice-to-text, screen readers)
• Flexible work schedules
• Accessible entrances and restrooms

Wheelchair accessibility features

• Turning radius: At least 60 inches
• Clear floor space: 30 x 48 inches minimum
• Reach range:
  • High: Max 48 inches
  • Low: Min 15 inches
• Accessible pathway: Free from obstacles, level, non-slip surface