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Components of Ethics for Physical Therapy Professionals Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition Evaluations and Treatment of the Cervical Spine, 2nd Edition
3 $55 PTNJ03CE-H
4
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1
Components of Ethics for Physical Therapy Professionals [3 contact hours]
Ethical behavior is a fundamental component of all healthcare professions, regardless of where or how they practice. The purpose of this course is to provide healthcare professionals a broad overview on the study of ethical behavior and action as it is applied to practice, education, and research. The course will define terms used in discussing ethics, describe general principles and values of ethics and standards of conduct, and explain a decision-making process for analyzing ethical issues and potential disciplinary actions or sanctions that might occur if unethical behavior is determined by professional and/or credentialing organizations. Case studies are included throughout to stimulate reflection and direct application to practice examples. This course is the 3-hour extended version of “Components of Ethics for Healthcare Professionals” that includes specific policies from the American Physical Therapy Association (APTA) outlining standards for ethics and professionalism for physical therapy professionals. 10 Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition [4 contact hours] Blood flow restriction training (BFRT) is an exercise technique that is transforming how we prescribe exercises therapy. By partially restricting blood flow to the muscles using specialized cuffs or bands, BFRT offers a range of benefits from muscle activation to advanced rehab training. Discover the benefits of blood flow restriction training with this course. From increasing muscle activation and muscle growth to enhancing strength and endurance. BFRT can even help reduce pain. BFRT is a science-based approach—over 800 articles published in the last 10 years—that can be safely prescribed to diverse populations from young to old, from patients to athletes. 18 Evaluations and Treatment of the Cervical Spine, 2nd Edition [3 contact hours] This course is intended for all healthcare professionals who care for clients who experience pain and dysfunction of the cervical spine. This course utilizes the most recent research for effective evaluation and treatment options for treating the cervical spine. Participants will learn methods for evaluating the cervical spine to classify the conditions and determine if it is safe to proceed with treatment. Participants will also learn the most effective treatment methods according to the most recent research.
Colibri Healthcare, LLC’s courses are approved by the New Jersey State Board of Physical Therapy Examiners.
FREQUENTLY ASKED QUESTIONS
License Expires
Hours Required
30 (A maximum of 10 hours are allowed through home-study)
License expires January 31 of even-numbered years
Mandatory Subjects ● 4 hours of jurisprudence and professional ethics. Licensees can complete any ethics course (distance learning or live) of 2.5 credits or more to meet the jurisprudence and professional ethics requirement. Included in this book is an ethics course which meets your requirement. ● Licensees must complete a 1.5-credit Jurisprudence Assessment Module offered by one of the sponsors listed on the New Jersey State Board of Physical Therapy Examiners’ website for the jurisprudence portion of the requirement. Are you a New Jersey board-approved provider? Colibri Healthcare, LLC’s courses are approved by the New Jersey State Board of Physical Therapy Examiners. Are my credit hours reported to the New Jersey board? No, the board performs random 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, email us at office@elitelearning.com, or call us toll-free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm EST, Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (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. Disclosures: Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer: The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
©2025: 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 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 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 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.
1
Components of Ethics for Healthcare Professionals: Summary
Components of Ethics for Healthcare Professionals (Mandatory) 3 Contact Hours
ACCESS THE FULL PRESENTATION
Scan the QR CODE ► to start video or visit https://qr2.mobi/EthicsHCPros
Author Elizabeth D. DeIuliis, OTD, OTR/L, CLA, FNAP, FAOTA
Ms. Deluliis has over 20 years of experience as a credentialed occupational therapy practitioner. She serves as a clinical associate professor and program director in the Department of Occupational Therapy at Duquesne University. She is a fellow in both the National Academies of Practice and the American Occupational Therapy Association (AOTA). Dr. DeIuliis has earned her academic leadership credential through AOTA's Academic Leadership Institute and has authored several textbooks; published numerous peer-reviewed articles; and presented at state, national, and international conferences on topics including professionalism, ethics, experiential learning pedagogies, and interprofessional education.
LEARNING OUTCOMES ● Define ethics terms, theories, principles, and sources of ethical issues common across healthcare professions and settings ● Recognize general ethical principles, standards of conduct, and basic enforcement procedures
● Recall a general decision-making process to resolve ethical questions/dilemmas across healthcare professions and settings
SELF-ASSESSMENT QUESTIONS
1.
Here is an example statement from a code of ethics document: "Providers shall respect the inherent dignity and worth of individuals." This statement is: a. A directive statement b. A nondirective statement c. A general statement d. All of the above The six-step model presented for analyzing ethical decision making aligns with: a. Metaethics
3.
When considering the ethical principle of nonmaleficence in healthcare practice, which of the following is MOST accurate? a. It requires taking positive action to help others b. It is less strict than the principle of beneficence c. It focuses primarily on fair resource distribution d. It is derived from the Hippocratic oath's "Do no harm" In the context of ethical decision-making, which step should be completed FIRST when faced with an ethical dilemma?
2.
4.
b. Normative ethics c. Teleology theory d. Deontology theory
a. Explore practical alternatives b. Complete the chosen action c. Gather relevant information d. Evaluate the outcome
ANSWERS: 1: a 2 : b 3: d 4 : c
2
Components of Ethics for Healthcare Professionals: Summary
COMMUNICATION APPROACHES IN CODES OF ETHICS
INTRODUCTION
Professional codes of ethics employ two distinct types of communication approaches: Directive and nondirective statements. Understanding these approaches is crucial for healthcare professionals to properly interpret and apply ethical guidelines. LEARNING TIP!
FOUNDATIONAL ETHICS CONCEPTS Ethics represents the systematic study of moral judgment and standards of conduct within the broader field of moral philosophy. The field encompasses two main subdivisions: Normative ethics, which focuses on determining morally right and wrong actions, and metaethics, which analyzes the theoretical foundations of moral theories. This understanding is crucial as ethics continues to evolve with societal changes and new healthcare challenges. This course delves into ethical theories, particularly deontological theory, which emphasizes duties and rights, and teleological theory, which focuses on consequences. These theories are examined through various lenses, including social norms, authority figures, religious orientations, traditional wisdom, and contemporary cultural contexts. Understanding these theoretical frameworks helps healthcare professionals navigate complex ethical decisions in their practice. PROFESSIONAL CODES AND STANDARDS Healthcare professionals are guided by codes of ethics that organize and articulate the most important ethical principles within their profession. A code of ethics is defined as a set of standards and principles of professional conduct that helps guide decision-making and behavior in professional settings. There are three distinct types of codes of ethics that serve different purposes in healthcare professions: 1. Aspirational codes encourage competent and moral behavior but do not provide specific guidelines for ethical conduct or sanctions for violations. These codes set forth ideals that practitioners should strive to achieve in their professional practice 2. Educational codes state what constitutes ethical behavior and may provide case examples as illustrations. While these codes define and explain ethical conduct, they typically do not include sanctions for failing to follow the code 3. Regulatory codes are the most comprehensive, as they spell out expected behavior, state specific guidelines for conduct, and provide detailed descriptions of sanctions for violations. These codes serve as enforceable standards with clear consequences for ethical breaches Most professional organizations maintain codes that combine elements of all three types, providing both aspirational goals and specific regulatory requirements. These codes must be regularly reviewed and updated to reflect changing societal values and new challenges in healthcare delivery.
Directive statements address required conduct and use specific language to indicate expected behaviors. These statements employ words such as: • Shall • Will • Must • Require • Responsible
Conversely, terms like do not , shall not , and will not indicate behaviors that must be avoided. For example, "Employees are prohibited from engaging in conflicts of interest and must disclose any potential conflict to the appropriate authorities" represents a directive statement. LEARNING TIP! Nondirective statements come in two forms: • Statements addressing permitted conduct, which often contain words such as may and not prohibited • Statements addressing recommended The course provides an illustrative example from the physical therapy code of ethics: "shall encourage colleagues with physical, psychological, or substance- related impairments that may adversely impact their professional responsibilities to seek assistance or counsel." This represents a directive statement due to its use of shall . Understanding these communication approaches helps healthcare professionals interpret the intent and requirements of their professional codes of ethics. When reviewing ethical guidelines, practitioners should pay particular attention to the specific language used, as it indicates whether an action is mandatory, recommended, or permitted. (but not required) behavior, which typically use words like should and should not
3
Components of Ethics for Healthcare Professionals: Summary
ETHICAL THEORIES AND SOURCES Ethical theories provide essential frameworks for understanding and evaluating moral dilemmas in healthcare. Two fundamental theories represent seminal knowledge in ethics literature: Deontological theory and teleological theory. Deontological theory is based on the concept of duties and rights . Under this framework, healthcare professionals have a duty to protect and fulfill their patients' rights, regardless of the consequences of those actions. For example, a patient's right to autonomy must be respected by the healthcare professional regardless of whether they agree with the patient's choices or whether the patient has cognitive deficits. According to the deontological approach, certain actions are inherently moral or immoral, regardless of their outcomes. Teleological theory, in contrast, is based on consequences or ends . Also referred to as consequentialist ethics, actions are evaluated based on their utilitarian value and seek the best outcome or least harmful consequences. For example, if two treatment techniques are equally effective according to current research, the healthcare professional should consider which technique will bring the most benefit and provide the best outcome for the client within their unique situation. Sometimes these two theories coincide. In those instances, the duty to act aligns with the best action. For example, in preventing a patient from falling, the duty to avoid harm (deontological) coincides with warning the patient about a slippery floor to prevent injury (teleological/consequential). However, these theories can sometimes produce opposing views. Consider a scenario where a patient requires painful stretching to prevent muscle contracture. The practitioner must weigh their duty to provide beneficial treatment against the consequence of causing pain, even if that pain serves a therapeutic purpose. The understanding of ethical behavior is derived from multiple sources: • Social norms that guide action through example • Authority figures who provide direction • Religious orientations that offer moral guidelines • Traditional wisdom transmitted by experienced practitioners who “know best” • Contemporary culture that shapes current ethical thinking This theoretical foundation helps healthcare professionals navigate complex ethical decisions while considering both their duties and the consequences of their actions. While ethics and laws are related, they serve distinct purposes in healthcare practice.
LEARNING TIP! Laws are defined by government and contain formal rules for resolving complex problems, while codes of ethics are defined by professional groups and organizations.
Laws state the minimum standard of behavior that must be met, while ethical codes present ideal or best behaviors. Additionally, laws are upheld by rules, regulatory authorities, and courts, whereas codes of ethics are upheld through professional standards, discussion, and persuasion. This distinction is important because healthcare professionals must navigate both legal requirements and ethical standards in their practice. Sometimes these align perfectly, but in other situations, what is legally permissible may not necessarily be the most ethical choice, or what seems ethically right may face legal constraints. Understanding this relationship helps practitioners make better decisions when faced with complex situations. CORE ETHICAL PRINCIPLES 1. Beneficence The principle of beneficence establishes healthcare professionals' fundamental obligation to act for patient benefi t. This requires genuine concern for well-being and proactive efforts to promote positive outcomes. This involves providing competent and compassionate care, advocating for patients’ needs, and striving to op- timize health outcomes . Beneficence manifests through: ○ Evidence-based interventions ○ Appropriate referrals ○ Health promotion activities ○ Professional competence maintenance ○ Patient advocacy 2. Nonmaleficence The "Do no harm" principle derived from the Hippo- cratic oath establishes a stricter standard than benefi- cence. This includes: • Avoiding potential risks: Nonmaleficence includes an obligation not to impose risks of harm even if the potential risk is without malicious or harmful intent. This involves minimizing risks and avoiding actions that could cause harm, while also considering the potential benefits and risks of medical interventions • Maintaining proper credentials • Following safety protocols
4
Components of Ethics for Healthcare Professionals: Summary
DISCIPLINARY ACTIONS AND PROFESSIONAL ACCOUNTABILITY
• Preventing negligence: The principle of nonmaleficence is closely tied to the concept of negligence in healthcare practice. Negligence occurs when a healthcare provider fails to use due care to protect a client from harm. Malpractice suits are most often based on acts of negligence. This negligence may be either intentional (when a person knowingly fails to use due care) or unintentional (when a person carelessly or inadvertently imposes harm). • Protecting and being mindful of vulnerable populations LEARNING TIP!
The healthcare field recognizes several levels of disciplinary actions that may be taken when ethical violations occur. Nondisciplinary actions serve as initial interventions and include verbal warnings, written warnings, and advisory opinions. These are typically used for minor infractions or first-time occurrences where education and guidance may be sufficient to correct the behavior. More serious violations may warrant formal disciplinary actions, which include reprimands; censures; probation; suspension; and in the most severe cases, revocation of credentials or licenses. LEARNING TIP!
Note: Scenarios that involve difficult end- of-life care decisions such as withholding and withdrawing life-sustaining treating, medically administered nutrition and hydration and in pain and other symptom control often involve complex decision making around beneficence and nonmaleficence.
A reprimand represents a formal written communication indicating disapproval of conduct, while censure takes this a step further by making the disapproval public. Censures identify the person’s name and are usually correlated to which ethical principles were not upheld. This is a formal written communication, and it is communicated publicly.
3. Autonomy Patient autonomy emphasizes the right to make in- formed healthcare decisions, including: ○ Informed consent processes: The patient has the right to informed consent, which is a necessary part of the process that leads to the patient agreeing to accept services ○ Right to refuse treatment: Autonomy is often referred to as the self-determination ethical principle. This principle emphasizes the importance of patient consent, confidentiality, and the right to refuse treatment ○ Privacy protection ○ Confidentiality maintenance: Confi-dentiality refers to the duty of healthcare providers to safeguard the privacy and confidentiality of patient information, ensuring that sensitive medical and personal details are not disclosed without the patient’s consent or unless required by law. This includes protecting patient records, maintaining confidentiality in communications, and disclosing patient information only with appropriate consent or when required by law ○ Self-determination respect 4. Justice The principle of justice ensures fair and equitable treat- ment through:
Probation involves placing specific conditions on continued practice for a defined period, often requiring the practitioner to demonstrate compliance with certain requirements or to complete additional training. Suspension temporarily removes the practitioner's right to practice, while revocation permanently terminates their credentials or license. PROFESSIONAL DOCUMENTATION AND RECORD-KEEPING Proper documentation serves as a cornerstone of ethical practice in healthcare. Healthcare professionals must maintain accurate, timely, and complete records that reflect all aspects of patient care. This includes detailed treatment plans, progress notes, assessment results, and any relevant correspondence. The documentation must be sufficient to allow another qualified professional to understand the nature and course of treatment provided. In writing up the results of a patient assessment that will be submitted for reimbursement, it is important for the practitioner to ensure that documentation is in accordance with applicable laws. In today's digital age, special consideration must be given to the security and confidentiality of electronic health records, with practitioners needing to implement appropriate safeguards to protect patient information.
○ Nondiscriminatory practices ○ Resource allocation fairness ○ Cultural competence ○ Access to services ○ Professional standards adherence
5
Components of Ethics for Healthcare Professionals: Summary
ETHICAL DECISION-MAKING IN PRACTICE
Research Ethics and Evidence-Based Practice The ethical conduct of research and implementation of evidence-based practice requires careful attention to several principles. Researchers must protect participants’ rights through informed consent, maintain confidentiality, and ensure fair subject selection. When implementing evidence-based interventions, practitioners must balance scientific evidence with individual patient preferences and circumstances. This includes considering both the benefits and potential risks of interventions, and communicating these clearly to patients. Professional Boundaries and Relationships Maintaining appropriate professional boundaries is essential for ethical practice. Healthcare professionals must navigate complex relationships with patients, colleagues, and other stakeholders while upholding professional standards. This includes avoiding dual relationships, maintaining appropriate self-disclosure, and professionally managing their social media presence. The increasing use of digital communication platforms has added new dimensions to boundary maintenance. Documentation and Record-Keeping Ethical documentation practices are fundamental to healthcare delivery. Records must be accurate, timely, and complete while protecting patient privacy and confidentiality. Electronic health records have introduced new considerations regarding data security, access controls, and information sharing. Healthcare professionals must ensure their documentation practices comply with both legal requirements and ethical standards. The model emphasizes that ethical decision making is a systematic process that requires careful consideration at each step. The final evaluation step is considered particularly critical for developing ethical reasoning skills and preparing for future ethical dilemmas.
Healthcare professionals must regularly navigate complex ethical situations requiring careful analysis and thoughtful decision making. The following six-step model provides a structured approach. First, practitioners must gather all relevant information to fully understand the situation. This includes reviewing patient histories, consulting relevant policies and guidelines, and considering all stakeholder perspectives. Next, they must identify whether the issue truly represents an ethical dilemma and which ethical principles are involved. The third step involves analyzing the problem through various ethical frameworks, such as deontological (duty-based) and teleological (consequence-based) approaches. This analysis should consider core principles like beneficence, nonmaleficence, autonomy, and justice. Fourth, practitioners must explore practical alternatives, weighing the potential benefits and drawbacks of each option. The fifth step involves implementing the chosen action, while the final step requires evaluation of both the process and the outcome to inform future decision making. SPECIAL TOPICS IN HEALTHCARE ETHICS Telehealth and Digital Ethics The rapid evolution of healthcare delivery through digital platforms has introduced new ethical considerations. Healthcare professionals must carefully navigate privacy, confidentiality, and security concerns when providing telehealth services. The COVID-19 pandemic accelerated the adoption of virtual care delivery, highlighting the importance of maintaining ethical standards across digital platforms. Practitioners must ensure secure communication channels, obtain appropriate informed consent for telehealth services, and maintain professional boundaries in virtual environments. Cultural Competency and Ethical Practice Cultural competency has become increasingly recognized as a crucial component of ethical healthcare delivery. Healthcare professionals must develop awareness of their own cultural biases, gain knowledge about diverse populations, and acquire skills for cross- cultural communication. This includes understanding how cultural values and beliefs influence healthcare decisions, respecting diverse perspectives on autonomy and decision making, and ensuring equitable access to care across different cultural groups.
6
Components of Ethics for Healthcare Professionals: Summary
SIX STEP MODEL FOR ETHICAL DECISIONS 1. Get the story straight ○ Gather all relevant information and facts
○ Understand the full context ○ Identify stakeholders involved ○ Review applicable laws, regulations, and professional codes ○ Take time to collect all pertinent details without bias 2. Identify the type of ethical problem ○ Determine if it's truly an ethical dilemma versus a legal issue ○ Identify which ethical principles are involved ○ Reference professional codes of ethics, workplace rules, and state regulations 3. Use ethics theories or approaches to analyze the problem ○ View the issue through different ethical lenses like: ■ Deontological approach: Focus on rights and duties ■ Teleological approach: Focus on consequences ■ Utilitarian approach: Focus on producing the most good/least harm ○ Apply relevant ethical principles: Beneficence, nonmaleficence, autonomy, justice 4. Explore the practical alternatives ○ Assess different possible courses of action ○ Consider consequences, benefits, and drawbacks of each option ○ Weigh effects on patient and others involved (practical, emotional, spiritual, financial) ○ Evaluate how each option aligns with ethical principles 5. Complete the action ○ Choose and implement the most ethically justifiable course of action ○ Recognize that an optimal solution may not exist ○ Accept that some ethical dilemmas cannot be perfectly resolved 6. Evaluate the process and outcome ○ Reflect on results and consequences ○ Assess if the chosen action effectively addressed the issue ○ Consider lessons learned for future situations ○ Ask questions like: ■ What went well? ■ What was most challenging? ■ What was learned? ■ What could be done differently next time?
The case highlights the importance of: • Maintaining current credentials • Using proper documentation practices • Individualizing patient care • Using evidence-based methods • Complying with professional standards • Understanding potential consequences of ethical violations
The final outcome would depend on factors such as: • Duration of violations • Number of violations • Previous corrective actions • Juan's response to the investigation • Any legal implications
7
Components of Ethics for Healthcare Professionals: Summary
JUAN'S ETHICS INVESTIGATION CASE STUDY
Background: Juan, a healthcare professional and five-year member of his discipline's professional organization, received a letter from the Ethics Review Committee chairperson indicating he was under investigation for possible code of ethics violations. The complaint was initially filed by Juan's state regulatory board after being reported by his direct supervisor.
Key Issues Under Investigation: 1. License status ○ Investigation into whether Juan practiced with an expired license ○ Required to provide evidence of current license and timely renewals over past three years ○ Potential violation of competence, education, and training standards 2. Documentation concerns ○ Missing or incomplete records and reports ○ Required to provide evidence of timely documentation filing ○ Potential violation of documentation and reimbursement standards 3. Evaluation and treatment planning ○ Using nearly identical evaluations and intervention plans for multiple clients ○ Changing only dates on documentation ○ Required to provide samples of individual evaluations and care plans ○ Violation of individualized care standards 4. Treatment techniques ○ Questions about safety and effectiveness of treatment methods ○ Required to provide evidence of peer-reviewed research supporting his techniques ○ Concern over lack of evidence-based practice Potential Outcomes : The Ethics Review Committee could implement any of the following actions: 1. Dismissal of charges : ○ If no violations are found ○ Written notification that charges are dismissed 2. Reprimand ○ Formal written communication indicating disapproval ○ Private communication 3. Censure ○ Formal written communication made public ○ Reported to regulatory agencies 4. Probation ○ Public reporting with specific end point ○ May include requirements like:
■ Submitting continuing education certificates ■ Providing documentation of compliance ■ Meeting specific terms set by the committee 5. Suspension ○ Removal of membership for a designated period of time ○ Public sanction ○ Notification to other regulatory agencies ○ Could affect license to practice 6. Revocation
○ Permanent removal of membership ○ Never eligible to rejoin organization ○ Public sanction ○ Notification to other regulatory agencies ○ Could result in license revocation
8
Components of Ethics for Healthcare Professionals: Summary
FINAL EXAM QUESTIONS
1.
The study of ethics is a branch of: a. Political science
8.
An ethical guideline that reads, “The professional shall act with compassion and respect with every person” is an example of what kind of statement? a. Directive
b. Philosophy c. Psychology d. Sociology
b. Nondirective c. Aspirational d. Educational
2.
Teleological theory is concerned primarily with: a. Duty b. Obligations c. Consequences d. Rights Which kind of ethics is concerned with determining what is morally right or wrong? a. Metaethics
9.
An ethical guideline that reads, “The professional should attend continuing education on an annual basis” is an example of what kind of statement? a. Directive
3.
b. Nondirective c. Aspirational d. Educational 10. Which of the following ethical principles requires the healthcare professional to act with genuine concern for the well-being and safety of their patients by providing competent and compassionate care? a. Beneficence b. Nonmaleficence c. Autonomy d. Justice 11. Which of the following ethical principles aligns with the Hippocratic oath? a. Beneficence b. Nonmaleficence c. Autonomy d. Justice 12. Malpractice suits are most often based on acts of: a. Fidelity b. Veracity c. Negligence d. Justice 13. Being mindful of vulnerable populations is important for healthcare professionals due to what ethical principle? a. Beneficence b. Nonmaleficence c. Autonomy d. Justice
b. Normative ethics c. Utilitarian ethics d. Deontology theory
4.
Which kind of ethics is concerned with the concepts of duties and rights? a. Metaethics
b. Normative ethics c. Utilitarian ethics d. Deontology theory
5.
Unlike codes of ethics, the law: a. May be aspirational b. Guides problem resolution c. Is defined by government d. Lists professional standards
6.
When understanding norms that shape ethical behavior, which example is transmitted from older generations by “knowing best”? a. Authority figures b. Religions c. Cultural customs d. Transitional wisdom There are three main types of codes of ethics: aspirational, educational, and: a. Regulatory b. Federal
7.
c. Local d. Moral
9
Components of Ethics for Healthcare Professionals: Summary
14. An example of justice is:
20. All data and information obtained from or about recipients of services, students, research participants, colleagues, or employees should be treated as: a. Public information b. Confidential information c. Electronic-access-only information d. Directory information 21. Censure due to an ethical violation means that: a. There was no true breach of a code of ethics; however, the behavior is not completely in keeping with its principles b. The state regulatory board must issue a letter stating that conditions such as completing a rehabilitation program have been met c. A formal public expression of disapproval will appear in a publication d. A professional will have their membership suspended for a specified period of time 22. If a healthcare professional shares information with their family members or friends about a client’s personal history or treatment plan without the client’s permission, the healthcare professional may be violating the concept of: a. Confidentiality b. Autonomy c. Nonmaleficence d. Morals 23. The final step in the six-step model to make ethical decisions is which of the following?
a. Providing services in a fair and equitable manner b. Ensuring that confidentiality of information is maintained c. Recording and reporting client information accurately d. Taking responsibility for professional development 15. Dealing with end-of-life decisions involves complex ethical decision making around which ethical principles? a. Beneficence and nonmaleficence b. Nonmaleficence and due care c. Justice and beneficence d. Informed consent and justice 16. In conducting a research study, researchers are expected to avoid inflicting harm or injury on the research participants in order to fulfill the ethics principle of: a. Autonomy b. Justice c. Veracity d. Nonmaleficence 17. In writing up the results of a patient assessment that will be submitted for reimbursement, it is important for the practitioner to: a. Take appropriate steps to facilitate meaningful communication b. Establish a collaborative relationship with the recipient of the service c. Ensure that documentation is in accordance with applicable laws d. Educate the public about the value of occupational therapy 18. The process whereby patients agree to receive services is known as: a. Confidentiality b. Public Policy c. Informed consent d. Self-Rule 19. The right to refuse services is an example of the principle of:
a. Completing the action b. Exploring alternatives c. Evaluating the process and outcome d. Identifying the ethical problem
TO ACCESS THE FINAL EXAM TO THIS COURSE ►
a. Fidelity b. Veracity c. Procedural justice d. Autonomy
Course content code: PTNJ03CE-H
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 10
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy,
ACCESS THE FULL VIDEO PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/BFR_Training
2nd Edition 4 Contact Hours
Author Pieter L. de Smidt, PT, DPT, MDT, MTC
Dr. Pieter L. de Smidt has 36 years of experience as a physical therapist. He holds certifications in McKenzie Mechanical Diagnosis and Therapy (Cert. MDT), manual therapy (MTC), and sports therapy (STC). With his post-professional doctorate in physical therapy, he specialized in the management of musculoskeletal injuries of the spine and extremities. Dr. de Smidt uses an evidence-based, integrated approach of manual therapy and exercise that includes instrument assisted soft tissue mobilization (IASTM), cupping, dry needling, and joint mobilization. His main professional goal is to bridge the gap between rehab and fitness and to empower clients to embrace a healthy lifestyle.
LEARNING OUTCOMES ● Learn about the science behind BFRT ● Learn about the research that supports use of BFRT ● Learn about safety precautions for BFRT ● Learn how to determine the limb occlusion pressure (LOP) and understand why knowing the LOP is important in the use of BFRT
● Discuss the different types of BFRT ● Understand indications and contraindications for BFRT ● Understand how to program BFRT during exercise therapy
SELF-ASSESSMENT QUESTIONS
1.
What is blood flow restriction training (BFRT)? a. A technique that fully blocks blood flow to muscles during exercise b. A technique that partially restricts blood flow to muscles during exercise c. A technique that increases blood flow to muscles during exercise d. A technique that has no effect on blood flow during exercise What are some of the potential benefits of BFRT? a. Increased muscle mass and strength b. Enhanced aerobic capacity c. Reduced pain d. All of the above
3.
What percentage of 1 repetition maximum (1RM) is typically used for resistance exercises with BFRT? a. 20-40% b. 50-70% c. 80-100% d. There is no specific percentage used How long does it typically take to see benefits from BFRT? a. 1-2 weeks b. 2-4 weeks c. 8-12 weeks d. 6 months or more
4.
2.
ANSWERS: 1: b 2 : d 3: a 4 : b
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 11
LEARNING TIP! Some of the key benefits that have been demonstrated through research include: • Increased muscle mass • Improved strength • Enhanced aerobic capacity • Faster recovery • Reduced pain • Potential improvements in bone health • Possible aid in weight loss • Improvements in tendon mechanical and morphological properties
INTRODUCTION
INTRODUCTION TO BLOOD FLOW RESTRICTION TRAINING
Blood flow restriction training (BFRT) is an exercise technique that is transforming how exercise therapy is prescribed in physical therapy and other fields . BFRT involves partially restricting blood flow to muscles during exercise using specialized cuffs or bands. This restriction causes muscles to experience fatigue, swelling, and oxygen depletion more quickly than during normal exercise. The body responds to this restriction by sending messages to the brain that the limbs are not getting enough oxygen, which triggers responses from the endocrine system. This temporary decrease in oxygen levels, while safe when applied properly, is essential for BFRT to produce its beneficial effects. BFRT has been shown through extensive research to be safe and effective when used appropriately. Over 800 scientific articles have been published on BFRT in the last 10 years alone, demonstrating its efficacy and safety for diverse populations ranging from young athletes to older adults. HISTORY OF BFRT BFRT has been around for decades, starting as early as the 1970s in Japan (known as KAATSU). More research started coming out in the 1990s and KAATSU started to become more widely practiced by the 2000s. It was brought to the U.S. in 2011 when the military began using it for rehabilitation of veterans. By 2018, the APTA stated BFRT was within the scope of practice for physical therapists. It was then made more popular by the body building world for its role in “muscle pumping.” Benefits of Blood Flow Restriction Training BFRT offers a wide range of potential benefits when used as an adjunct to low intensity resistance exercise (LIRE) or aerobic exercise (AE).
Benefits can be seen as quickly as 2-4 weeks. Importantly, these benefits can often be achieved using much lower loads by creating metabolic stress. Metabolic stress induces physiologic adaptations without causing any of the normal muscle damage from the mechanical stress of high intensity resistance training. Traditionally, strength gains require loading of 75-100% of 1 rep max. With BFRT, these results can be achieved with as low at 20-40% 1 rep max . This makes BFRT particularly valuable for populations that may not be able to tolerate high-load training, such as those recovering from injury or surgery. Disuse of muscles and inability to load after injury or surgery can lead to a 12% reduction in strength each week, making BFRT even more valuable in this population. THE SCIENCE BEHIND BFRT The two primary mechanisms thought to drive the benefits of BFRT are: 1. Metabolite-induced fatigue 2. Cell swelling BFRT creates an environment of low oxygen availability, causing the activation of type II muscle fibers and anaerobic metabolism. This leads to a build-up of metabolites in the muscle, which stimulates several physiological changes required for muscle and bone strengthening. LEARNING TIP!
The hypoxic (low oxygen) environment created by BFRT, combined with the accumulation of metabolites, stimulates neural afferents. This causes a significant increase in growth hormone and other anabolic factors.
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 12
Studies have shown dramatic increases in growth hormone levels after BFRT sessions-one study reported a 290-fold increase compared to baseline. BFRT has been shown to affect several key physiological pathways and factors: • Increased activation of the mTOR pathway, which is crucial for protein synthesis and muscle growth • Increased levels of human growth hormone (HGH) • Increased insulin-like growth factor 1 (IGF-1) • Decreased levels of myostatin, a protein that normally limits muscle growth • Increased vascular endothelial growth factor (VEGF), which promotes the growth of new blood vessels Compared to traditional high-intensity resistance training, BFRT with low-load exercise produces similar or greater increases in these anabolic factors while causing minimal tissue damage. This allows for faster recovery and the potential for more frequent training sessions. TYPES OF BLOOD FLOW RESTRICTION TRAINING There are several ways BFRT can be applied: • Passive BFRT . This involves applying blood flow restriction without exercise, primarily to promote cell swelling and potentially improve tissue healing, such as after surgery. • BFRT during aerobic exercises (BFRT-AE) . This combines blood flow restriction with low-intensity aerobic activities like walking or cycling to improve aerobic capacity and muscle strength. • BFRT during resistive exercises (BFRT-RT) . This involves using blood flow restriction during low-load resistance training to improve muscle mass and muscle strength. All types of BFRT can potentially contribute to building muscle strength and mass, though BFRT-RT is typically most effective for this purpose. • Intermittent BFRT (I-BFRT) . This approach involves alternating periods of blood flow restriction and normal blood flow, either during exercise or rest periods, commonly used for weight loss. Safety and Precautions While BFRT has been shown to be safe by many when applied correctly, including Odinesson & Finsen, 2006; Clark et al., 2011, and Poton & Polito, 2016, it is crucial to understand the proper application and potential risks.
Some key safety considerations include: • Proper screening of patients for contraindications • Using the correct cuff pressure based on individual limb occlusion pressure (LOP): ○ Wider cuffs are generally safer as they require less pressure • Gradual progression of training intensity and duration • Monitoring for signs of excessive discomfort or adverse reactions Risk factors for
Developing Venous Thromboembolism
Signs and Symptoms of VTE
• Cyanosis • Edema • Erythema • Pitting edema • Superficial dilation of veins • Tenderness to palpation/warmth • Positive clinical signs such as Homan’s test
• Previous VTE • Cardiovascular disease • BMI >25 kg/m 2 • Family history of VTE • Varicose veins • >40 years old • Having multiple risk factors
Contraindications
• Pregnancy • Extremities with dialysis port • Sickle cell anemia • Open fracture/wounds and/or poor wound healing • Severe crush injury • Venous thrombo- embolism • Excessive swelling in post-surgical limb • Known clotting risk • Severe hypertension • Acidosis • Infection within extremity
• Increased intracranial pressure • Cancer • Previous revascular- ization of limb • Lymphedema • Vascular graft • History of mastectomy or axillary node dissection (avoid on affected arm) • Those in hemodialysis who have arterial or venous fistulas
Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition: Summary 13
Exercise pressures are then set as a percentage of LOP, typically: • 30-50% of LOP for upper body exercises • 60-80% of LOP for lower body exercises • Generally, higher pressures are used with lower resistance levels Tips for Taking LOP: • Have patients relax the muscle • Do not talk • Take in the same position in which the exercise will be performed (or least intense if in multiple positions) • A pulse ox can be used for the upper body but not the lower • This should not change much over an 8 week period of time, so there is no need to reassess every session unless there is swelling How to take LOP: • Place the cuff as proximal as possible. Find the pulse with the doppler, listening for 20 seconds. Inflate the tourniquet in 10-15 mmHg increments. Stop once the pulse cannot be located. Slowly deflate the cuff. When the pulse is heard again, this is the LOP: ○ For the upper extremity, use the radial artery ○ For the lower extremity, use the posterior tibial or dorsalis pedis Resistance training with BFRT typically uses loads of 20-40% of one repetition maximum (1RM), much lower than traditional strength training. Aerobic exercise with BFRT is usually performed at low intensities, around 40% of VO2 max or 45% of the heart rate reserve. ACSM suggests using the heart rate to estimate the percent of VO2 max as follows: • 40% VO2 max = 55% HR max • 60% VO2 max= 70% HR max • 80% VO2 max= 85% HR max • 85% VO2 max= 90% HR max Proper Intensity of BFRT Resistance Training: • Use 3-4 sets of an exercise, starting with lower reps (10) and progressing to high reps (75) • Initially use longer rest periods (90 seconds) and progress to less rest (30 seconds) • Use a total session duration of 10-20 minutes • This can be used several times per week, up to 2 times per day • Progressions:
GUIDELINE: NO BFRT IF MORE THAN 4 POINTS • History of DVT • Acute sickness or fever • Blood pressure >180/100mmHg • Early postoperative period • High class arrhythmia or coronary ischemia 5 points • Pregnancy 4 points • Varicose veins 3 points
• Prolonged inactivity • A-Fib or heart failure • Blood pressure: 160-179/95-99mmHg
• Age >60 years • BMI >30 kg/m 2 • Malignancy • Hyperlipidemia • Estrogen therapy • Age 40-58 years • Women • BMI 25-30 kg/m 2
2 points
1 point
Rhabdomyolysis Rhabdomyolysis is very rare after exercise with BFRT, but it is important to be aware of the signs and symptoms. Symptoms start 48-72 hours after exercise, reporting muscle pain, weakness, and myoglobinuria (tea colored urine) due to muscle breakdown releasing high amounts of myoglobin in the blood. Application and Programming LEARNING TIP!
Determining the appropriate cuff pressure is crucial for safe and effective BFRT. It is important to note that brands of cuffs will vary in width, number of bladders, and availability of the cuff to optimize pressure. The cuff width is a significant factor for determining safe pressure.
The pressure should be moderate in order to reduce arterial blood flow, but not occlude the vessels. This is typically done by measuring the limb occlusion pressure (LOP) - the minimum pressure required to completely occlude blood flow to a limb. This is done using a doppler.
○ Start with passive BFRT for cell swelling ○ Progress to aerobic exercises/return to sport/HIIT with BFRT
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