California Physical Therapy Ebook Continuing Education

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CALIFORNIA Physical Therapy Continuing Education

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Inside: Mandatory

Ethical Practice In Physical Therapy

26-hour Continuing Education Package $230 ELITELEARNING.COM/BOOK Complete this book online with book code: PTCA2624

WHAT’S INSIDE Chapter 1: Ethical Practice In Physical Therapy (Mandatory)

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[2 CC hours] This course covers the principles and standards of ethical practice for physical therapists and assistants and references the Codes of Ethics and Conduct Guides of the American Physical Therapy Association (APTA) and the Federation of State Boards of Physical Therapy (FSBPT). Ethical issues related to professional practice are discussed. Steps to identify potential conflicts and strategies for decision making to avoid and resolve ethical issues are included. THIS COURSE FULFILLS THE REQUIREMENT FOR ETHICS, LAWS, AND REGULATIONS Chapter 2: ACL Injury, Surgery, and Rehabilitation: A Science-Based and Evidence-Informed Approach 13 [2 CC hours] Given the modifications and advancements in ACL surgical procedures and the proliferation of research on interventions and outcomes, many clinicians find it difficult to keep apprised of the latest evidence and integrate this new information into their clinical practice. Decisions regarding which patients are appropriate for non-operative management of an ACL-deficient knee, how to safely progress patients through a criterion-based guideline, and when to provide recommendations for a safe return back to sports after ACL injury or reconstruction are challenging. Physical therapists and physical therapist assistants will be able to use the knowledge and skills outlined in this course with their patients after ACL injury or surgery to maximize patients’ responses to exercise at their current functional level while minimizing risk of injury to the healing tissue(s). Chapter 3: Acute Injury and Pain: A Strategy, Management and Rehabilitation Discussion for Physical Therapists 51 [3 CC hours] Millions of Americans suffer with pain every year. Pain, both chronic and acute, is quickly becoming an increasingly dire public health issue that costs employers, patients and insurance companies billions of dollars each year. This course discuss the management of acute injuries and methods and management of pain. Chapter 4: Conservative and Surgical Management of the Osteoarthritic Hand and Wrist, 3rd Edition 66 [2 CC hours] The course offers practitioners in-depth knowledge of several of the most common medical and evidence-based treatments for wrist and hand osteoarthritis and provides instruction for application of techniques in OT evaluation and intervention. Chapter 5: Differential Diagnosis for Headaches and Cervical Spine Pain 90 [3 CC hours] When evaluating head and neck pain in physical therapy, we must recognize that many conditions share similar signs and symptoms. This course presents information to help the evaluating clinician determine when a client’s symptoms may be the result of systemic or viscerogenic causes and when referral to another healthcare provider is indicated. In addition, this course presents a framework for differentiating and assigning the appropriate diagnosis for neuromuscular and/or musculoskeletal conditions. Chapter 6: Frozen Shoulder Management and Manual Treatment Strategies 130 [2 CC hours] Shoulder dysfunctions causing painful stiffness are endemic issues, causing clinical challenges and conflicting treatment guidelines. Common terminology of frozen shoulder and adhesive capsulitis share significant and long duration impairments. This advanced course reviews pathophysiology of these conditions, the natural history associated with idiopathic frozen shoulder and essential assessment findings. Based on updated scientific evidence, a review and compilation of available interventions of conservative, medical and invasive options is presented. The role of manual therapy methodology is featured. Due to variability in patient progress and manual therapy approaches, specific guidelines on type, timing, position and amplitude are investigated to standardize joint mobilization efforts. Finally, treatment program principles of patient education, suggested number of visits, daily clinical visit structure, management of plateaus and beneficial integration with medical/invasive procedures are discussed. The purpose of this course is to provide clinicians with an evidenced- based approach on [2 CC hours] Each year, over 250,000 people are hospitalized for hip fractures, and some of these individuals will never fully regain their prior level of function: they may require assistance to walk, and a few will even need to go to a nursing home. The physical therapist is an essential partner to assist patients in preserving, improving and maintaining the current levels of functioning within their daily lives. This course will provide an overview on the three main types of hip fractures, the differences between the approaches to surgical and non-surgical candidates for physical therapy, and prevention techniques that the physical therapist can share which will ensure a patient is knowledgeable about how to prevent future fall occurrences. ... CONTINUED ON NEXT PAGE treating frozen shoulder and associated conditions. Chapter 7: Hip Fractures: Treatment and Prevention 143

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PHYSICAL THERAPY CONTINUING EDUCATION

Book Code: PTCA2624

Chapter 8: Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment 149 [2 CC hours] Knee OA is prevalent in today’s society with the active aging population. Physical therapists play an important role in

restoring function for these patients with nonsurgical and postoperative interventions. Chapter 9: Pharmaceuticals and Physical Therapy: Movement with Medication [4 CC hours] Physical therapy and pharmacology have operated alongside each other for thousands of years. This course will prioritize essential components regarding pharmaceutical principles and will discuss common pharmaceutical categories relative to application in physical therapy clinical settings. Chapter 10: Plantar Fasciitis: Diagnosis and Treatment [1 CC hour] The purpose of this course is to educate physical therapists about the most successful evaluation and treatment techniques available at this time. This course will cover the function of the plantar fascia, differential diagnosis of plantar fasciitis, special tests used, the most common risk factors to develop plantar fasciitis, a review of the most effective treatments and case studies to demonstrate practical application. Chapter 11: Therapeutic Yoga after Knee Replacement

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[1 CC hour] Knowledge of safe and effective evidence-based yoga poses for knee rehabilitation can assist physical therapists in prescribing therapeutic exercises after Total Knee Replacement. Chapter 12: Total Shoulder Arthroscopy and Reverse Total Arthroscopy: What Physical Therapists Need to Know 192 [2 CC hours] Shoulder arthroplasty is the treatment of choice for severe degenerative joint disease. It is important for physical therapists to understand complications that may occur following these types of surgical procedures. This course will discuss the components of physical therapy rehabilitation following a total shoulder replacement.

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Final Examination Answer Sheet

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.

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Book Code: PTCA2624

PHYSICAL THERAPY CONTINUING EDUCATION

FREQUENTLY ASKED QUESTIONS

What are the requirements for license renewal? Licenses Expire

CC Hours

Mandatory Subjects

30 (26 hours are allowed through home study)

Biennial renewal. Licenses are required to renew by the last day of their birth month every two years

2 hours Ethics, Laws, and Regulations 4 hours Basic Life Support

How much will it cost?

Course Title

CC Hours

Price

Chapter 1: Chapter 2:

Ethical Practice In Physical Therapy (Mandatory)

2 2

$24.00 $24.00

ACL Injury, Surgery, and Rehabilitation: A Science-Based and Evidence-Informed Approach Acute Injury and Pain: A Strategy, Management and Rehabilitation Discussion for Physical Therapists Conservative and Surgical Management of the Osteoarthritic Hand and Wrist, 3rd Edition

Chapter 3:

3

$36.00

Chapter 4: Chapter 5: Chapter 6: Chapter 7: Chapter 8: Chapter 9: Chapter 10: Chapter 11: Chapter 12:

2 3 2 2 2 4 1 1 2

$24.00 $36.00 $24.00 $24.00 $24.00 $48.00 $12.00 $12.00 $24.00

Differential Diagnosis for Headaches and Cervical Spine Pain Frozen Shoulder Management and Manual Treatment Strategies

Hip Fractures: Treatment and Prevention

Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment Pharmaceuticals and Physical Therapy: Movement with Medication

Plantar Fasciitis: Diagnosis and Treatment Therapeutic Yoga after Knee Replacement

Total Shoulder Arthroscopy and Reverse Total Arthroscopy: What Physical Therapists Need to Know

Best Value - Save $82.00 - All 26 Hours

26

$230.00

How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a California board-approved provider? Colibri Healthcare, LLC is an Approved Continuing Education (CE) Program through the California Physical Therapy Association (Approved CE Program status number CPTAAP-28). Are my credit hours reported to the California board? No. The California Board of Physical Therapy perform audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory subjects (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.

Licensing board contact information: Physical Therapy Board of California | Department of Consumer Affairs 2005 Evergreen Street, Suite 2600 I Sacramento, CA 95815 Phone: (916) 561-8200 I Fax: (916) 263-2560 Website: https://www.ptbc.ca.gov/

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PHYSICAL THERAPY CONTINUING EDUCATION

Book Code: PTCA2624

Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must provide your customer information and complete the evaluation. We offer three ways for you to complete. Choose an option below to receive credit and your certificates of completion. How to complete continuing education

Fastest way to receive your certificate of completion

Online • Go to EliteLearning.com/Book . Use the book code PTCA2624 and enter it in the example box that pops up then click GO . • If you already have an account created, sign in to your account with your username and password. If you do not have an account already created, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey. By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.

By fax • Fill out the answer sheet and evaluation found in the back of this booklet. Please include credit card information and e-mail address. Fax to (386) 673-3563 . • All completions will be processed within 2 business days of receipt and certificates e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.

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Book Code: PTCA2624

PHYSICAL THERAPY CONTINUING EDUCATION

Chapter 1: Ethical Practice in Physical Therapy (Mandatory) 2 CC Hours

By: Gordon Ward, MPT Learning objectives

Š Define the standards and principles for ethical practice from the American Physical Therapy Association Code of Ethics for Therapists and Assistants. Š List and explain the five roles of physical therapy. Š Identify and give examples of the scope of practice. Š State the purpose, mission, and vision of the Model Practice Act for Physical Therapy. Course overview This course covers the principles and standards of ethical practice for physical therapists and assistants and references the Codes of Ethics and Conduct Guides of the American Physical Therapy Association (APTA) and the Federation of State Boards of Physical Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gen- der identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can mani- fest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assump- tions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can Disclaimer The information provided in this activity is for continuing educa- tion purposes only and is not meant to substitute for the inde - pendent medical judgment of a healthcare provider relative to

Š Define dual- or multiple-role relationships between practitioners and clients and strategies to maintain boundaries. Š Identify and define the steps for ethical decision making using the RIPS Model.

Therapy (FSBPT). Ethical issues related to professional practice are discussed. Steps to identify potential conflicts and strategies for decision making to avoid and resolve ethical issues are included.

adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and aware- ness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Addi - tionally, implementing policies and procedures prioritizing equi- table treatment for all patients can play a pivotal role in reduc - ing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treat - ment regardless of their background or characteristics.

diagnostic and treatment options of a specific patient’s medical condition.

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materi- als presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable ef- forts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. INTRODUCTION The Legal Information Institute provides the following overview of the term ethics :

The Federation of State Boards of Physical Therapy (FSBPT) ad - ministers the National Physical Therapy Examination (NPTE), the examination that every graduate of a physical therapy or physical therapist assistant must pass to become a licensed physical thera - pist or licensed/certified physical therapist assistant in the United States (APTA, 2015a). The FSBPT governs practice through collaboration with state reg- ulatory boards and the APTA. Through the Model Practice Act, it outlines penalties or sanctions if ethical violations occur. The FSBPT provides the following statements on promoting safe- ty and competence: FSBPT strives to live by a clearly defined mission and vision. Our mission conveys the direction of our organization and our vision inspires us to achieve a common purpose. Our Mission : To protect the public by providing service and leadership that promote safe and competent physical therapy practice. Our Vision : To achieve a high level of public protection through a strong foundation of laws and regulatory standards in physical therapy, effective tools and systems to assess entry-

The word “ethics” is derived from the Greek word ethos (char - acter), and from the Latin word mores (customs). Together, they combine to define how individuals choose to interact with one another. In philosophy, ethics defines what is good for the individual and for society and establishes the nature of duties that people owe themselves and one another. Most professions have highly detailed and enforceable codes for their respective memberships. In some cases these are spoken of as “professional ethics.” Professional codes of eth - ics are likely to have some effect on judgments about profes- sional conduct in litigation. Generally, failure to comply with a code of professional ethics may result in expulsion from the profession or some lesser sanction (LII, 2017b). In the physical therapy profession, codes of ethics state the prin - ciples and rules of conduct to guide professional therapists and assistants to make decisions between right and wrong actions. Codes of ethics are used to protect the welfare of the patient and standardize practice for therapists following professional stan- dards.

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Book Code: PTCA2624

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level and continuing competence, and public and professional awareness of resources for public protection (FSBPT, 2017). The FSBPT continues to support research and evidence-based practice to advance the profession and provides information and support to state regulatory boards. The Model Practice Act is one tool developed by FSBPT: The Model Practice Act for Physical Therapy: A Tool for Public Protection and Legislative Change (MPA) is the preeminent standard and most effective tool available for revising and modernizing physical therapy practice acts. This [act] is en- acted for the purpose of protecting the public health, safety, and welfare, and provides for jurisdiction administrative con- trol, supervision, licensure, and regulation of the practice of physical therapy. The continuing movement to update physical therapy practice acts helps ensure that these documents provide the legal au- thority to fully protect the public while allowing for the effec- Glossary ● Altruism : The primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physical therapist’s self-interest (APTA, 2013a). ● Autonomy : Self-directing, freedom from the will of others, in- cluding moral independence (Merriam-Webster, 2017). ● Bright-line rule : An objective rule that resolves a legal issue in a straightforward, predictable manner. A bright-line rule is easy to administer and produces certain—though arguably, not always—equitable results (LII, 2017a). ● Dual or multiple relationships : A multiple relationship occurs when a therapist or assistant is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the therapist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person (American Psychological Association, 2017). ● Informed consent : Informed consent is a process, not just a form. Information must be presented to enable persons to voluntarily decide whether to participate. It is a fundamental

tive regulation of the profession. The sixth edition adds three duties of the Board giving them the power to do background checks, report to an Exam, Licensure and Disciplinary Data- base (ELDD), and collect workforce data. It also adds back- ground checks for all PT/PTA applicants (FSBPT, 2016). The APTA provides the following statement concerning ethics and professionalism: Physical therapists and physical therapist assistants should strive to apply principles of altruism, excellence, caring, eth- ics, respect, communication and accountability in working to- gether with other professionals to achieve optimal health and wellness in individuals and communities (APTA, 2015b). The APTA Ethics and Judicial Committee (EJC) provide PTs/PTAs with educational materials, articles, interpretations, and opinions on professional ethics topics to promote ethical practice and deci - sion making. mechanism to ensure respect for persons through provision of thoughtful consent for a voluntary act. The procedures used in obtaining informed consent should be designed to edu- cate the subject population in terms that they can understand. Therefore, informed consent language and its documentation must be written in lay language, that is, understandable to the people being asked to participate. The written presentation of information is used to document the basis for consent and for the subjects’ future reference. Informed consent documents must be revised if any processes change or risks are identi- fied during the course of therapy (Health and Human Services, 2017). ● Fiduciary duty : The highest standard of care. It involves acting in good faith and honesty in the best interest of the patient. Maintaining confidentiality is part of this duty (LII, 2017c). ● Personal bias : Subliminal obstacles that can undermine im - partial decision making. A personal bias commonly introduces unwarranted opinions and feelings into contemplation of an issue, making it hard to come to an objective and neutral deci- sion (Quizlet, 2017). ● Veracity : The principle that one should tell the truth, that hon - esty is the best policy (LaSalle, 2005).

SCOPE OF PRACTICE

The APTA provides the following definition of scope of practice and clarification of association role: Scope of practice has three components: Professional, juris- dictional, and personal. The professional scope of practice of physical therapy is de - fined as practice that is grounded in the profession’s unique body of knowledge, supported by educational preparation, based on a body of evidence, and linked to existing or emerg- ing practice frameworks. APTA shall take the role as the prima- ry organization for determining whether particular practices fall within the professional scope of practice of physical ther - Purpose The Guide for Professional Conduct (Guide) provides interpre - tation for some subsections of the APTA Code of Ethics for the Physical Therapist (Code) for professional conduct (APTA, 2013a). The APTA House of Delegates in June of 2009 adopted a revised Code, which became effective on July 1, 2010, and was updated in 2013 (APTA, 2013c). The Guide provides a framework for physical therapists, assistants, and students with the focus on ethics and professional conduct. These guidelines are subject to change by the Ethics and Judicial Committee (EJC) as the dynamics of the profession change and

apy. APTA shall prepare such determinations in collaboration with appropriate stakeholders. APTA shall also be a resource for stakeholders to address inquiries regarding jurisdictional and personal scope of practice for physical therapists. The Model Practice Act governing the specific physical thera- pist’s license establishes jurisdictional scope of practice, and the rules adopted pursuant to that act. Personal scope of practice consists of activities for which an individual physical therapist is educated and trained, and that he or she is competent to perform (APTA, 2015c).

THE APTA CODE OF ETHICS FOR THE PHYSICAL THERAPIST AND GUIDE FOR PROFESSIONAL CONDUCT

new patterns of health care delivery are developed and accepted by the professional community and the public (APTA, 2013c). Interpreting ethical principles The EJC provides interpretation on specific areas of the Code of Ethics in the Guides for therapists and assistants. The Code was designed as a stand-alone document, so not all subsections require interpretation. The Code and Guide cannot cover every ethical issue that the therapist or assistant may cover, but the APTA and FSBPT websites contain additional educational tools and resources beyond the Code and Guide to assist in ethical decisions and practice.

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The APTA Code of Ethics Preamble to the Code

built upon the five roles of the physical therapist (manage- ment of patients/clients, consultation, education, research, and administration), the core values of the profession, and the multiple realms of ethical action (individual, organizational, and societal). Physical therapist practice is guided by a set of seven core values: accountability, altruism, compassion/car - ing, excellence, integrity, professional duty, and social respon- sibility. Throughout the document the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, edu- cate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life (APTA, 2013c). Interpretation The 2010 revision of the Code of Ethics contains the word shall , and the principles should be interpreted as mandatory ethical obligations. The Preamble states: “No Code of Ethics is exhaus- tive nor can it address every situation.” The Preamble also states that physical therapists “are encouraged to seek additional advice or consultation in instances in which the guidance of the Code may not be definitive.” Potential sources for advice and counsel include third parties and the myriad resources available on the APTA website. Inherent in a physical therapist’s ethical decision- making process is the examination of his or her unique set of facts relative to the Code (APTA, 2013a). 2C. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed deci- sions about physical therapy care or participation in clinical research. 2D. Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care. 2E. Physical therapists shall protect confidential patient/client in- formation and may disclose confidential information to ap- propriate authorities only when allowed or as required by law. Interpretation: Altruism (APTA, 2013a). Principle 2A reminds physical therapists to adhere to the profession’s core values and act in the best interest of patients/clients over the interests of the physical therapist. Often this is done without thought, but some- times it is a conscious decision. For example, the physical thera- pist may need to decide between leaving on time and staying at work longer to see a patient who was 15 minutes late for an appointment. Interpretation: Patient Autonomy (APTA, 2013a). The purpose of Principle 2C is to respect patient autonomy. A physical thera - pist shall communicate to the patient/client the findings of his or her examination, evaluation, diagnosis, and prognosis. A physi- cal therapist shall use sound professional judgment in informing the patient/client of any substantial risks of the recommended ex- amination and intervention and shall collaborate with the patient/ client to establish the goals of treatment and the plan of care. A physical therapist shall respect the patient’s/client’s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal. Principle #3: Physical therapists shall be accountable for making sound professional judgments. ( Core values : Excellence, integrity. ) 3A. Physical therapists shall demonstrate independent and objec- tive professional judgment in the patient’s/client’s best inter- est in all practice settings.

The APTA Preamble states as follows: The Code of Ethics for the Physical Therapist (Code of Ethics) delineates the ethical obliga- tions of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association (APTA, 2013c). The purposes of the Code of Ethics are to: 1. Define the ethical principles that form the foundation of physi- cal therapist practice in patient/client management, consulta- tion, education, research, and administration. 2. Provide standards of behavior and performance that form the basis of professional accountability to the public. 3. Provide guidance for physical therapists facing ethical chal- lenges regardless of their professional roles and responsibili- ties. 4. Educate physical therapists, students, other health care pro - fessionals, regulators, and the public regarding the core val- ues, ethical principles, and standards that guide the profes- sional conduct of the physical therapist. 5. Establish the standards by which the American Physical Therapy Association can determine if a physical therapist has engaged in unethical conduct. (APTA, 2013a) Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Eth- ics may not be definitive (APTA, 2013c). The Preamble is followed by this explanation: No code of ethics is exhaustive nor can it address every situ- ation. Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive. The Code of Ethics is The following information from the principles and subcategories of the APTA Code of Ethics (APTA, 2013c) has been summarized and should be viewed in its entirety on the APTA website con - tained on the reference page. The interpretations from the Guide (APTA, 2013a) have been included. Remember, not all subsections have interpretations, but additional clarification can be found on the APTA and FSBPT websites. Principle #1: Physical therapists shall respect the inherent The Code of Ethics for the physical therapist Principles 1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, reli- gion, ethnicity, social or economic status, sexual orientation, health condition, or disability. 1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administra - tion. Interpretation: Respect (APTA, 2013a). Principle 1A addresses the display of respect toward others. There is no universal consen - sus about what respect looks like in every situation. For example, direct eye contact may be respectful and courteous in some cul - tures and inappropriate in others. The therapist should assess the appropriateness of behavior in various situations. Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. (Core values: Altruism, compassion, professional duty.) 2A. Physical therapists shall adhere to the core values of the pro - fession and shall act in the best interests of patients/clients over the interests of the physical therapist. dignity and rights of all individuals. ( Core values : Compassion, integrity. ) 2B. Physical therapists shall provide physical therapy services with compassionate and caring behaviors that incorporate the in- dividual and cultural differences of patients/clients.

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3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including cur- rent literature and established best practice), practitioner ex- perience, and patient/client values. 3C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care profes - sionals when necessary. 3D. Physical therapists shall not engage in conflicts of interest that interfere with professional judgment. 3E. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel. Interpretation: Professional Judgment (APTA, 2013a). Princi - ples 3, 3A, and 3B state that it is the physical therapist’s obliga- tion to exercise sound professional judgment based on his or her knowledge, skill, training, and experience. Principle 3B describes the physical therapist’s judgment informed by three elements of evidence-based practice. In the patient/client management role, once a physical therapist accepts an individual for services, he or she shall be responsible for the examination, evaluation, and diagnosis of that individual; the prognosis and intervention; reexamination and modification of the plan of care; and the maintenance of adequate records, including progress reports. A physical therapist shall establish the plan of care and shall provide and/or supervise and direct the ap - propriate interventions. A physical therapist has primary respon - sibility for the physical therapy care of a patient and shall make independent judgments regarding care consistent with accepted professional standards. If the diagnostic process reveals findings outside the scope of the physical therapist’s knowledge, experience, or expertise, or that indicate the need for care outside the scope of physical therapy, the physical therapist shall inform the patient/client and shall refer the patient/client to an appropriate practitioner. A physical therapist shall determine when a patient/client will no longer benefit from physical therapy services. When a physical therapist’s judgment is that a patient will receive negligible ben- efit from physical therapy services, the physical therapist shall not provide or continue to provide services if the primary reason for doing so is the financial self-interest of the physical therapist or his or her employer. A physical therapist shall avoid overutilization of physical therapy services. See Principle 8C. Interpretation: Supervision (APTA, 2013a). Principle 3E de - scribes circumstances where sound professional judgment is re- quired through the appropriate direction of and communication with physical therapist assistants and support personnel. Further information on supervision via applicable local, state, and federal laws and regulations (including state practice acts and administra- tive codes) is available. See Principles 5A and 5B. Principle #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. ( Core value: Integrity. ) 4A. Physical therapists shall provide truthful, accurate, and rel - evant information and shall not make misleading representa- tions. 4B. Physical therapists shall not exploit persons with whom they have supervisory, evaluative, or other authority (e.g., pa- tients/clients, students, supervisees, research participants, or employees). 4C. Physical therapists shall discourage misconduct by healthcare professionals and report illegal or unethical acts to the rel- evant authority, when appropriate. 4D. Physical therapists shall report suspected cases of abuse in - volving children or vulnerable adults to the appropriate au- thority, subject to law.

4E. Physical therapists shall not engage in any sexual relationship with any of their patient/clients, supervisees, or students. 4F. Physical therapists shall not harass anyone verbally, physically, emotionally, or sexually. Interpretation: Integrity in Relationships (APTA, 2013a). Prin - ciple 4 addresses the need for integrity in relationships and is not limited to relationships with patients/clients, but everyone physical therapists come into contact with professionally. Dem - onstrating integrity could encompass working collaboratively with the health care team and taking responsibility for one’s role as a member of that team. Interpretation: Reporting (APTA, 2013a). When considering the application of when appropriate under Principle 4C, keep in mind that not all allegedly illegal or unethical acts should be reported immediately to an agency/authority. The determination of when to do so depends upon each situation’s unique set of facts and applicable laws, regulations, and policies. Depending on those facts, it might be appropriate to communi- cate with the individuals involved. Consider whether the action has been corrected, and, in that case, not reporting may be the most appropriate action. Note that when an agency/authority does examine a potential ethical issue, fact finding will be its first step. The determination of ethicality requires an understanding of all of the relevant facts but may still be subject to interpretation. The EJC Opinion titled “Topic: Preserving Confidences: Physi- cal Therapist’s Reporting Obligation with Respect to Unethical, Incompetent, or Illegal Acts” provides further information on the complexities of reporting (APTA, 2010). Interpretation: Exploitation (APTA, 2013a). The statement is fairly clear: sexual relationships with their patients/clients, super- visees, or students are prohibited. This component of Principle 4 is consistent with Principle 4B. Next, consider this excerpt from the EJC Opinion titled “Topic: Sexual Relationships with Patients/Former Patients”: A physical therapist stands in a relationship of trust to each patient and has an ethical obligation to act in the patient’s best interest and to avoid any exploitation or abuse of the patient. Thus, if a physical therapist has natural feelings of at- traction toward a patient, he or she must sublimate those feel - ings in order to avoid sexual exploitation of the patient (APTA, 2013a). One’s ethical decision-making process should focus on whether the patient/client, supervisee, or student is being exploited. In this context, questions have been asked about whether one can have a sexual relationship once the patient/client relationship ends. To this question, the EJC has opined as follows: The Committee does not believe it feasible to establish any bright-line rule for when, if ever, initiation of a romantic/sexual relationship with a former patient would be ethically permis - sible. The Committee imagines that in some cases a romantic/sexual relationship would not offend if initiated with a former patient soon after the termination of treatment, while in others such a relationship might never be appropriate (APTA, 2013a). Principle #5: Physical therapists shall fulfill their legal and professional obligations. ( Core values : Professional duty, accountability. ) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations. 5B. Physical therapists shall have primary responsibility for super - vision of physical therapist assistants and support personnel. 5C. Physical therapists involved in research shall abide by accept - ed standards governing protection of research participants. 5D. Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel.

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5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities with rea - sonable skill and safety shall report the information to the appropriate authority. 5F. Physical therapists shall provide notice and information about alternatives for obtaining care in the event the physical thera- pist terminates the provider relationship while the patient/ client continues to need physical therapy services. Interpretation: Colleague Impairment (APTA, 2013a). The cen - tral tenet of Principles 5D and 5E is that inaction is not an op - tion for a physical therapist when faced with the circumstances described. Principle 5D states that a physical therapist shall en - courage colleagues to seek assistance or counsel. Principle 5E addresses reporting information to the appropriate authority. 5D and 5E both require a factual determination by the therapist. This may be challenging in the sense that the therapist might not know or it might be difficult to determine whether someone, in fact, has a physical, psychological, or substance-related impair- ment. In addition, it might be difficult to determine whether such impairment may be adversely affecting his or her professional re- sponsibilities. Moreover, once the therapist makes these determinations, the obligation under 5D centers not on reporting, but on encourag- ing the colleague to seek assistance. However, the obligation un- der 5E does focus on reporting. Note that 5E discusses report- ing when a colleague is unable to perform, whereas 5D discusses encouraging colleagues to seek assistance when the impairment may adversely affect his or her professional responsibilities. So 5D discusses something that may be affecting performance, whereas 5E addresses a situation in which someone is clearly unable to perform. The two situations are distinct. In addition, it is important to note that 5E does not mandate to whom the therapist should report and gives the therapist discretion to determine the appro- priate authority. Principle #6: Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors. ( Core value : Excellence. ) 6A. Physical therapists shall achieve and maintain professional competence. 6B. Physical therapists shall take responsibility for their profes - sional development based on critical self-assessment and reflection on changes in practice, education, health care de- livery, and technology. 6C. Physical therapists shall evaluate the strength of evidence and applicability of content presented during professional de- velopment activities before integrating the content or tech- niques into practice. 6D. Physical therapists shall cultivate practice environments that support professional development, lifelong learning, and ex- cellence. Interpretation: Clinical Competence (APTA, 2013a). 6A requires a physical therapist to maintain professional competence within one’s scope of practice throughout one’s career. Maintaining com- petence is an ongoing process of self-assessment; identification of strengths and weaknesses; acquisition of knowledge and skills based on that assessment; and reflection on and reassessment of performance, knowledge, and skills. Numerous factors—includ- ing practice setting, types of patients/clients, personal interests and the addition of new evidence to practice—will influence the depth and breadth of professional competence in a given area of practice. Interpretation: Professional Growth (APTA, 2013a). 6D elabo - rates on the physical therapist’s obligations to foster an environ- ment conducive to professional growth even when not supported by the organization. The essential idea is that it is the physical

therapist’s responsibility, whether or not the employer provides support. Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society. ( Core values : Integrity, accountability. ) 7A. Physical therapists shall promote practice environments that support autonomous and accountable professional judg- ments. 7B. Physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services. 7C. Physical therapists shall not accept gifts or other consider- ations that influence or give an appearance of influencing their professional judgment. 7D. Physical therapist assistants shall ensure that documentation for their interventions accurately reflects the nature and ex- tent of the services provided. 7E. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services pro- vided. Interpretation: Charges and Coding (APTA, 2013a). Principle 7E provides that the physical therapist must make sure that the process of documentation and coding accurately captures the charges for services performed. Where charges cannot be deter- mined because of payment methodology, physical therapists may review the House of Delegates policy titled “Professional Fees for Physical Therapy Services.” Additional resources on documen - tation and coding include the House of Delegates policy titled “Documentation Authority for Physical Therapy Services and the Documentation and Coding and Billing” on the APTA website. Principle #8: Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. ( Core value : Social responsibility. ) 8A. Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. 8B. Physical therapists shall advocate to reduce health dispari - ties and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people. 8C. Physical therapists shall be responsible stewards of health care resources and shall avoid overutilization or underutiliza- tion of physical therapy services. 8D. Physical therapists shall educate members of the public about the benefits of physical therapy and the unique role of the physical therapist. Interpretation: Pro Bono Services (APTA, 2013a). The key word in Principle 8A is or. If a physical therapist is unable to provide pro bono services, he or she can fulfill ethical obligations by sup- porting organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. In addition, physical therapists may review the House of Delegates guidelines titled “Guidelines: Pro Bono Physical Therapy Servic- es.” Additional resources on pro bono physical therapy services are available on the APTA website. 8A also addresses supporting organizations to meet health needs. In terms of supporting organizations, the principle does not spec- ify the type of support required. Physical therapists may express support through volunteerism, financial contributions, advocacy, education, or simply promoting their work in conversations with colleagues.

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Book Code: PTCA2624

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Scope of practice: Guidelines for physical therapist scope of practice (APTA, 2014) Scope of practice is limited to the care and services provided by or under the direction and supervision of a physical therapist and includes the following four points:

○ Ventilation and respiration/gas exchange. ○ Work (job/school/play), community, leisure integration or reintegration (including instrumental activities of daily liv- ing). 2. Alleviating impairment and functional limitation by designing, implementing, and modifying therapeutic interventions that include, but are not limited to the following: ○ Coordination, communication, and documentation. ○ Patient/client-related instruction. ○ Therapeutic exercise. ○ Functional training in self-care and home management (in- cluding activities of daily living and instrumental activities of daily living). ○ Functional training in work (job/school/play) and commu- nity and leisure integration or reintegration activities (in- cluding instrumental activities of daily living, work harden- ing, and work conditioning). ○ Manual therapy techniques (including mobilization/ma- nipulation). ○ Prescription, application, and, as appropriate, fabrication of devices and equipment (assistive, adaptive, orthotic, protective, supportive, and prosthetic). ○ Airway clearance techniques. ○ Integumentary repair and protection techniques. Electro- therapeutic modalities. ○ Physical agents and mechanical modalities. ○ Dry needling. 3. Preventing injury, impairment, functional limitation, and dis- ability, including the promotion and maintenance of health, wellness, fitness, and quality of life in all age populations. 4. Engaging in consultation, education, and research.

1. Examining (history, system review, and tests and measures) in- dividuals with impairment, functional limitation, and disability or other health-related conditions to determine a diagnosis, prognosis, and intervention; tests and measures may include the following:

○ Aerobic capacity/endurance. ○ Anthropometric characteristics. ○ Arousal, attention, and cognition. ○ Assistive and adaptive devices.

○ Circulation (arterial, venous, lymphatic). ○ Cranial and peripheral nerve integrity. ○ Environmental, home, and work (job/school/play) barriers. ○ Ergonomics and body mechanics. ○ Gait, locomotion, and balance. ○ Integumentary integrity. ○ Joint integrity and mobility. ○ Motor function (motor control and motor learning). ○ Muscle performance (including strength, power, and en- durance). ○ Neuromotor development and sensory integration. ○ Orthotic, protective, and supportive devices. ○ Pain. ○ Posture. ○ Prosthetic requirements. ○ Range of motion (including muscle length). ○ Reflex integrity. ○ Self-care and home management (including activities of daily living and instrumental activities of daily living). ○ Sensory integrity.

CODE OF ETHICS FOR PHYSICAL THERAPY ASSISTANTS

APTA Guide for Conduct of the Physical Therapist Assistant Purpose

Standards and should not be considered inclusive of all situations that could evolve. This Guide is subject to change, and the EJC will monitor and timely revise the Guide to address additional topics and Stan - dards when necessary and as needed. Preamble to the standards The Preamble states as follows: The Standards of Ethical Conduct for the Physical Therapist Assistant (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 as - sistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assis- tants to enable patients/clients to achieve greater indepen- dence, 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 guid- ance of the Standards of Ethical Conduct may not be defini- tive (APTA, 2013d). The revisions were written, and the word shall added, to make the standards and ethical directives clearer so they could be under - stood without additional explanation: The Preamble states that “No document that delineates ethi- cal standards can address every situation.” The Preamble also states that 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 de- finitive.” Potential sources for advice or counsel include third parties and the myriad resources available on the APTA web -

This Guide for Conduct of the Physical Therapist Assistant (Guide) is intended to serve physical therapist assistants in interpreting the Standards of Ethical Conduct for the Physical Therapist As - sistant (Standards) of the American Physical Therapy Association. The APTA House of Delegates in June of 2009 adopted the re- vised Standards, which became effective on July 1, 2010, and were updated in 2013. The Guide provides a framework to inform the physical thera - pist assistants on issues related to professional conduct. These guidelines are subject to change as the dynamics of the profes- sion change and as new patterns of health care delivery are de- veloped and accepted by the professional community and the public (APTA, 2013b). Interpreting ethical standards The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee (EJC) (APTA, 2013b). The interpretations are set forth according to top- ic. These interpretations are intended to assist a physical therapist assistant in applying general ethical standards to specific situa- tions. They address some, but not all, topics addressed in the

Standards of Ethical Conduct for the Physical Therapist Assistant The following is from the APTA documents on ethical conduct

(APTA, 2013d). Interpretation

The Standards of Ethical Conduct for the Physical Therapist Assis - tant were amended in 2010 and updated in 2013. The APTA notes that the standards contain the word shall and describes them as mandatory ethical obligations (APTA, 2013b).

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