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Ethics and Jurisprudence for the Indiana Physical Therapy Professional (Mandatory)
PTIN02ET-H
Aging Process: What is Happening to the Body and What Does it Mean?
PTIN03AP-H
Differential Diagnosis for Physical Therapy: Introduction
PTIN04DD-H
Differential Diagnosis in Physical Therapy: Upper Extremity and Lower Quadrant
PTIN03UE-H
Evaluation and Treatment of the Shoulder Complex
PTIN04SC-H
Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter
PTIN02LQ-H
Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter
PTIN02UQ-H
Return to Sport: Running Injuries in Student-Athletes
PTIN02RU-H
INCLUDED IN THIS BOOK
1 Ethics and Jurisprudence for the Indiana Physical Therapy Professional (Mandatory) [2 contact hours] This course covers the principles and standards of ethical practice for physical therapists and assistants, as well as the Indiana Administrative Code §25-27 and the Indiana Practice Act (Title 844, Article 6). Both of these topics are mandatory for physical therapy professionals within the state of Indiana: Section I will present the theory, practice, and scope of ethics for the physical therapy professional. Section II will discuss the regulatory and legislative aspects; therefore, this course will satisfy the 2-hour mandatory requirement necessary. 19 Aging Process: What is Happening to the Body and What Does it Mean? [3 contact hours] This course is intended to instruct the professional of the physiological, structural and functional changes that occur in the body over time so that functional outcomes can be maximized. 28 Differential Diagnosis for Physical Therapy: Introduction [4 contact hours] As the profession of Physical Therapy has progressed, the importance of differential diagnosis and medical screening has increased, especially with the mandate of autonomous practice. This seminar will give the clinician the ability to screen the multiple body organ systems for diseases and syndromes that are not of musculoskeletal origin. The seminar further addresses effective mechanisms that result in client referrals to appropriate health care practitioners. Through lectures and case studies, the therapist will be able to determine the best course of action with a patient utilizing the best available assessment tools and measures and evidence-based practice to determine diagnosis, need for referral, or method of treatment. 41 Differential Diagnosis in Physical Therapy: Upper Extremity and Lower Quadrant [3 contact hours] This course is intended to instruct the professional on screening the multiple body organ systems for diseases and syndromes. 62 Evaluation and Treatment of the Shoulder Complex [4 contact hours] The course provides a general overview of the shoulder complex anatomy before moving into the primary purpose of the course, evaluation and treatment of the shoulder complex through entry-level introduction of manual evaluation techniques of the connective tissue surrounding the shoulder complex. 73 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter [2 contact hours] This course provides the clinician with an understanding of the treatment concepts, as well as specific techniques, in order to effectively incorporate Instrument-Assisted Soft Tissue Mobilizations (IASTM) to common musculoskeletal disorders of the lower quarter. 81 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter [2 contact hours] This course provides the clinician with an understanding of the treatment concepts, as well as specific techniques, in order to effectively incorporate Instrument-Assisted Soft Tissue Mobilizations (IASTM) to common musculoskeletal disorders of the upper quarter. 90 Return to Sport: Running Injuries in Student-Athletes [2 contact hours] This course focuses on commonly presented running injuries in student-athletes and how to effectively treat those injuries for return to sport. The course is designed for athletic trainers and allied health professionals who work in sport settings, particularly with youth and student-aged athletes.
Colibri Healthcare, LLC’s Ethics and Jurisprudence for the Indiana Physical Therapy Professional course is approved by the APTA Indiana. Colibri’s courses meet the standards for physical therapy continuing education activities in Indiana.
FREQUENTLY ASKED QUESTIONS
License Expires
CE Hours Required
Mandatory Subjects
22 (All hours are allowed through home study)
2 hours of Ethics and Indiana Jurisprudence
June 30th of even-numbered years
Are you a Indiana board-approved provider? Colibri Healthcare, LLC’s Ethics and Jurisprudence for the Indiana Physical Therapy Professional course is approved by the APTA Indiana. Colibri’s courses meet the standards for physical therapy continuing education activities in Indiana. Are my credit hours reported to the Indiana board? No. The board 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, 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. 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, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions 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 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 awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing 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 treatment regardless of their background or characteristics. 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. ©2024: 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 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
Ethics and Jurisprudence for the Indiana Physical Therapy Professional 2 Contact Hours
ACCESS THE FULL ONLINE PRESENTATION
Scan the QR CODE to start online presentation or visit https://uqr.to/inethics
Author Gordon (Bud) Ward, Jr., PT, MPT
Senior healthcare director, licensed physical therapist, writer, consultant with over 20 years of experience building and leading talented teams, leadership positions in multiple healthcare settings including military, hospital, corporate rehabilitation, and private practice
LEARNING OUTCOMES • Define the standards and principles for ethical practice from the American Physical Therapy Association Code of Ethics for Therapists and Assistants • List and explain the five roles of physical therapy • Identify and give examples of the scope of practice • State the purpose, mission, and vision of the Model Practice Act for Physical Therapy
• Define dual- or multiple-role relationships between practitioners and clients and strategies to maintain boundaries • Identify and define the steps for ethical decision making using the RIPS model • Discuss the Indiana Administrative Code as it pertains to the physical therapy professional • Summarize the legislative and regulatory components of the Indiana Practice Act
S ELF-ASSESSMENT QUESTIONS
3. There are ___ principles in the Code of Ethics for Physical Therapists. a. 3 b. 5 c. 8 d. 10 4. ______ includes understanding personal limits, integrating judgment and the patient/ client perspective, embracing advancement, challenging mediocrity, and working toward development of new knowledge. a. Caring and compassion
1. The following definition refers to: means activities that do not require the clinical decision making of a physical therapist or the clinical problem solving of a physical therapist assistant. a. Competence b. Tasks c. State d. General supervision 2. Autonomy is defined as: a. Self-directing freedom and especially moral independence b. Primary regard for or devotion to interest of patients/clients c. Responsibility to act in the best interest of patient or organization d. The principle that one should tell the truth
b. Inclusion c. Integrity d. Excellence
ANSWERS: 1: B
2 : A
3 : C
4 : D
2 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
RESEARCH AND EVIDENCE-BASED PRACTICE The Model Practice Act A tool developed by the FSBPT for physical therapy 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 enacted for the purpose of protecting the public health, safety, and welfare, and it provides for jurisdiction administrative control, supervision, licensure, and regulation of the practice of physical therapy. The Indiana APTA provides the following statement concerning ethics and professionalism: “Physical therapists and physical therapist assistants should strive to apply principles of altruism, excellence, caring, ethics, respect, communication and accountability in working together with other professionals to achieve optimal health and wellness in individuals and communities.” 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. • Autonomy : Self-directing freedom and especially moral independence. • Bright-line rule : An objective rule that resolves legal questions in a straightforward, predictable manner. A bright-line rule is easy to administer and produces certain—though arguably, not always—equitable results. • 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).
INTRODUCTION The word “ethics” is derived from the Greek word ethos (character), 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.
LEARNING TIP! In the physical therapy profession, codes of ethics state the principles 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 standards. The Federation of State Boards of Physical Therapy (FSBPT) administers the National Physical Therapy Examination (NPTE). • Safety 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-level and continuing competence, and public and professional awareness of resources for public protection.
3 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
The APTA Code of Ethics for the Physical Therapist and Guide for Professional Conduct The Guide for Professional Conduct (Guide) provides interpretation for some subsections of the APTA Code of Ethics for the Physical Therapist (Code) for professional conduct. The APTA House of Delegates in June of 2009 adopted a revised Code, which became effective on July 1, 2010, and was updated in 2019. 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 new patterns of health care delivery are developed and accepted by the professional community and the public. The purposes of the Code of Ethics are to: 1. Define the ethical principles that form the foundation of physical therapist practice in patient/client management, consultation, 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 challenges regardless of their professional roles and responsibilities. 4. Educate physical therapists, students, other health care professionals, regulators, and the public regarding the core values, ethical principles, and standards that guide the professional 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. The Code of Ethics for the Physical
• 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 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 educate 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. The consent document should be revised when deficiencies are noted or when additional information will improve the consent process. • Fiduciary duty : The responsibility to act in the best interest of a person or organization. • Personal bias : The action of supporting or opposing a particular person or thing in an unfair way, because of allowing of personal opinions to influence. • Veracity : The principle that one should tell the truth, that honesty is the best policy. SCOPE OF PRACTICE & CODE OF ETHICS Scope of practice has three components: professional, jurisdictional, and personal. The professional scope of practice of physical therapy is defined 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 emerging practice frameworks. APTA shall take the role as the primary organization for determining whether particular practices fall within the professional scope of practice of physical therapy. 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.
Therapist Principles
The following information from the principles and subcategories of the APTA Code of Ethics has been summarized and should be viewed in its entirety on the APTA website contained on
4 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
the reference page. The interpretations from the Guide 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 dignity and rights of all individuals. Principle 2 : Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. Principle 3 : Physical therapists shall be accountable for making sound professional judgments. Principle 4 : Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other healthcare providers, employers, payers, and the public. • Interpretation: Exploitation: The statement is clear: Sexual relationships with their patients/clients, supervisees, or students are prohibited. This component of Principle 4 is consistent with Principle 4B. 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 attraction toward a patient, he or she must sublimate those feelings in order to avoid sexual exploitation of the patient. Principle 5 : Physical therapists shall fulfill their legal and professional obligations. Principle 6 : Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors. Principle 7 : Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society. Principle 8 : Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally.
LEARNING TIP! Interpretation: 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.
Definition of “Physical Therapy” : Physical therapy means the care and services provided by or under the direction and supervision of a physical therapist, and includes any of the following: • Examining, evaluating, and conducting testing on patients with mechanical, physiological, or developmental impairments, functional limitations and disabilities, or other health and movement related conditions in order to determine a physical therapy diagnosis. • Alleviating impairment, functional limitations and disabilities by designing, implementing, and modifying treatment interventions that may include: therapeutic exercise, functional training, manual therapy techniques, therapeutic massage, prescription, application, and fabrication of devices and equipment, airway clearance techniques, integumentary repair and protection techniques, wound care and debridement, physical agents or modalities, patient related instruction, and dry needling (after completing board approved continuing education and company with applicable board rules). • Reducing the risk of injury, impairment, functional limitation, and disability, including the promotion and maintenance of health, wellness, fitness, and quality of life in all age populations. • Engaging in consultation, administration, education, and research.
5 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
APTA Guide for Conduct of the Physical Therapist Assistant Purpose : 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 Assistant (Standards) of the American Physical Therapy Association. The APTA House of Delegates in June of 2009 adopted the revised Standards, which became effective on July 1, 2010, and were updated in 2019. Interpreting Ethical Standards : The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee (EJC). The interpretations are set forth according to topic. These interpretations are intended to assist a physical therapist assistant in applying general ethical standards to specific situations. They address some, but not all, topics addressed in the Standards and should not be considered inclusive of all situations that could evolve. Preamble to the Standards : 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 assistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients/clients to achieve greater independence, health, and wellness, and enhanced quality of life. No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive.
Standards of Ethical Conduct for the Physical Therapist Assistant Interpretation : The Standards of Ethical Conduct for the Physical Therapist Assistant were amended in 2010 and updated in 2019. The APTA notes that the standards contain the word shall and describes them as mandatory ethical obligations. Standards and Interpretations Standard 1 : Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals. Standard 2 : Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. Standard 3 : Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations. Standard 4 : Integrity of Relationships: Physical therapist assistants shall demonstrate integrity in their relationships with patients/ clients, families, colleagues, students, other health care providers, employers, payers, and the public. Standard 5 : Physical therapist assistants shall fulfill their legal and ethical obligations. Standard 6 : Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. Standard 7 : Physical therapist assistants shall support organizational behaviors and business practices that benefit patients/clients and society. Standard 8 : Physical therapist assistants shall participate in efforts to meet the health needs of
people locally, nationally, or globally. Multiple and Dual Relationships Consideration
Though the standards and principles clearly state that sexual relationships between therapist and client are prohibited, not all multiple and dual relationships are unethical. Relationships can occur outside of the therapeutic setting in the general community, work settings, church,
6 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
• Altruism is 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. • Collaboration is working together with patients and clients, families, communities, and professionals in health and other fields to achieve shared goals. Collaboration within the physical therapist-physical therapist assistant team is working together, within each partner’s respective role, to achieve optimal physical therapist services and outcomes for patients and clients. • Compassion and Caring is the desire to identify with or sense something of another’s experience—a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others. • Duty is the commitment to meeting one’s obligations to provide effective physical therapist services to patients and clients, to serve the profession, and to positively influence the health of society. • Excellence includes understanding personal limits, integrating judgment and the patient/ client perspective, embracing advancement, challenging mediocrity, and working toward development of new knowledge. • Inclusion occurs when the physical therapist and physical therapist assistant create a welcoming and equitable environment for all. Physical therapists and physical therapist assistants are inclusive when they commit to providing a safe space, elevating diverse and minority voices, acknowledging personal biases that may impact patient care, and taking a position of anti-discrimination. • Integrity is steadfast adherence to high ethical principles or professional standards: truthfulness, fairness, doing what you say you will do, and speaking forth about why you do what you do. • Social responsibility is the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness.
school, social functions, children’s activities, or recreational settings, for example. Decision- making strategies will be discussed in the next section, but there are a few considerations when identifying dual and multiple relationships and potential harm to patients. The therapist must consider the following: • The therapist must decide if the relationship could impair judgment, objectivity, or effectiveness in treatment or attaining the patient’s health goals. This includes the ability of the patient to follow the treatment plan and retain autonomy. • Could the therapist lose his or her objectivity, which would interfere with his or her ability to perform duties as a therapist? • The therapist must decide if the relationship would be exploitive or harmful to the patient. • When thinking about the potential for harm or exploitation, the therapist might consider whether any reasonable professional therapist would enter into the relationship in question. If there is any doubt, the relationship should be avoided. • The therapist should consider whether the relationship promotes the health and welfare of the client and improves the collaborative, active participation in the patient’s care plan. If there is any doubt that the relationship will promote the patient’s health and welfare, including emotional health, the relationship should not continue. • A final consideration is whether the outcome of the relationship would promote trust between the profession and the public at large. If the public knew of the relationship, would it be viewed in a positive way? APTA Core Values The decisions about relationships can be informed directly by the APTA core values: • Accountability is active acceptance of the responsibility for the diverse roles, obligations, and actions of the physical therapist, including self-regulation and other behaviors that positively influence patient/ client outcomes, the profession, and the health needs of society.
7 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
ETHICAL DECISION MAKING The Realm-Individual Process-Situation (RIPS) Model The RIPS Model of Ethical Decision Making includes elements of Rushworth Kidder’s work on ethical decision making. The RIPS Model assumes that approaching an ethical situation should include consideration of: 1. Individual : the good of the patient and the rights, duties, relationships, and behaviors between individuals, including the therapist, client, and others. 2. Organizational or institutional : the good of the organization and focuses on structures and systems that will facilitate organizational or institutional goals. 3. Societal : the common good; the most complex realm. The RIPS Model includes strategies to identify the ethical dilemma and the personal factors that influence the therapist’s decision, including moral issues. The components of RIPS are as follows: • Environmental Context : realm- individual, organizational/institutional, societal. • Individual process : ethical sensitivity, judgment, motivation, or courage. • Situation : ethical issue or problem, dilemma, distress, moral temptation. Four Steps to Ethical Decision Making Step 1 : Recognize and define the ethical issues. Step 2 : Reflect upon and interpreting the information gathered in Step 1 Step 3 : Decide the right thing to do. This step aims to resolve an ethical dilemma where two conflicting options seem to be right. Kidder (1995) suggested three possible courses of action: 1. Rule based : Follow the rules, duties, obligations, or ethical principles in place. 2. Ends based : Weigh the consequences, good, or harm that will result for all stakeholders. 3. Care based : Resolve dilemmas according to relationships and concern for others. Step 4 : Implement, evaluate, reassess.
INDIANA JURISPRUDENCE
Introduction The Indiana Code §25-27, as well as Indiana Administrative Code, Title 842, Article 1, also known as the Indiana Practice Act, are the licensure laws and administrative rules that govern physical therapists and physical therapist assistants in the state of Indiana. It is important to occasionally review these laws and rules, as they can change with each legislative session. Because these laws and regulations are fundamental to the scope of the physical therapist, it is important to understand them. In the following discussion you will find specifications for licensure information, including application for original licensures, renewals, and suspensions. A large portion of the jurisprudence is dedicated to the standards of professional conduct and competent practice. In the following sections you will find excerpts of these legislative laws. Section 1: Definitions 1. “Physical therapy” means care and services provided by or under the direction and supervision of a physical therapist that includes any of the following: a. Examining, evaluating, and conducting testing on patients with mechanical, movement-related conditions in order to determine a physical therapy diagnosis. b. Alleviating impairments, functional limitations, and disabilities by designing, implementing, and modifying treatment interventions that may include therapeutic exercise, functional training in home, community, or work integration or reintegration that is related to physical movement and mobility, manual therapy, including soft tissue and joint mobilization or manipulation, therapeutic massage, prescription, application, and fabrication of assistive, adaptive, orthotic, protective, and supportive devices and equipment, including prescription and application of physiological, or developmental impairments, functional limitations, and disabilities or other health- and
8 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
prosthetic devices and equipment, airway clearance techniques, integumentary protection and repair techniques, debridement and wound care, physical agents or modalities, mechanical and electrotherapeutic modalities, and patient related instruction. c. Using solid filiform needles to treat completing board approved continuing education and complying with applicable board rules. However, a physical therapist may not engage in the practice of acupuncture (as defined in IC 25-2.5-1-5) unless the physical therapist is licensed under IC 25-2.5. d. Reducing the risk of injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and wellness in populations of all ages. e. Engaging in administration, consultation, education, and research. neuromusculoskeletal pain and dysfunction (dry needling), after 2. “Physical therapist” means a person who is licensed under this chapter to practice physical therapy. 3. “Physical therapist assistant” means a person who is certified under this chapter; and assists a physical therapist in selected components of physical therapy treatment interventions. 4. “Board” refers to the Indiana board of physical therapy. 5. “Physical therapy aide” means support personnel who perform designated tasks related to the operation of physical therapy services. 6. “Person” means an individual. 7. “Sharp debridement” means the removal of foreign material or dead tissue from or around a wound, without anesthesia and with generally no bleeding, through the use of a sterile scalpel, scissors, forceps, tweezers or other sharp medical instruments; in order to expose healthy tissue, prevent infection, and promote healing.
8. “Spinal manipulation” means a method of skillful and beneficial treatment by which a physical therapist uses direct thrust to move a joint of the patient’s spine beyond its normal range of motion, but without exceeding the limits of anatomical integrity. 9. “Tasks” means activities that do not require the clinical decision making of a physical therapist or the clinical problem solving of a physical therapist assistant. 10. “Competence” is the application of knowledge, skills, and behaviors required to function effectively, safely, ethically, and legally within the context of the patient’s role and environment. 11. “Continuing competence” is the process of maintaining and documenting competence through ongoing self-assessment, development, and implementation of a personal learning plan and subsequent reassessment. 12. “State” means a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico. 13. “Direct supervision” means that a physical therapist or physical therapist assistant is physically present and immediately available to direct and supervise tasks that are related to patient management. 14. “General supervision” means supervision provided by a physical therapist who is available by telecommunication. 15. “Onsite supervision” means supervision provided by a physical therapist who is continuously onsite and present in the department or facility where services are provided. The supervising therapist must be immediately available to the person being supervised and maintain continued involvement in the necessary aspects of patient care. 16. “Conduct testing” means standard methods and techniques used to gather data about a patient, including, subject to section 2.5(c) of this chapter, electrodiagnostic and electrophysiologic tests and measures. The term does not include x-rays.
9 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
17. “Physical therapy diagnosis” means a systematic examination, evaluation, and testing process that culminates in identifying the dysfunction toward which physical therapy treatment will be directed. The term does not include a medical diagnosis. Section 2: Unlawful Practices Except as otherwise provided in this chapter, it is unlawful for a person or business entity to do the following: 1. Practice physical therapy without first obtaining from the board a license authorizing the person to practice physical therapy in this state. 2. Profess to be or promote an employee to be a physical therapist, physiotherapist, doctor of physiotherapy, doctor of physical therapy, or registered physical therapist or to use the initials “P.T.,” “D.P.T.,” “L.P.T.,” or “R.P.T.,” or any other letters, words, abbreviations, or insignia indicating that physical therapy is provided by a physical therapist, unless physical therapy is provided by or under the direction of a physical therapist. 3. Advertise services for physical therapy or physiotherapy services, unless the individual performing those services is a physical therapist. a. It is unlawful for a person to practice physical therapy other than upon the order or referral of a physician, podiatrist, psychologist, chiropractor, dentist, nurse practitioner, or physician assistant holding an unlimited license to practice medicine, podiatric medicine, psychology, chiropractic, dentistry, nursing, or as a physician assistant, respectively. It is unlawful for a physical therapist to use the services of a physical therapist assistant except as provided under this chapter. b. It is unlawful for a person to profess to be or to act as a physical therapist assistant or to use the initials “P.T.A.” or any other letters, words, abbreviations, or insignia indicating that the person is a physical therapist assistant without first obtaining from the board a certificate authorizing
the person to act as a physical therapist assistant. It is unlawful for the person to act as a physical therapist assistant other than under the general supervision of a licensed physical therapist who is in responsible charge of a patient. However, nothing in this chapter prohibits a person licensed or registered in this state under another law from engaging in the practice for which the person is licensed or registered. These exempted persons include persons engaged in the practice of osteopathic medicine, chiropractic, or podiatric medicine. c. This chapter does not authorize a person who is licensed as a physical therapist or certified as a physical therapist assistant to evaluate any physical disability or mental disorder except upon the order or referral, practice medicine, surgery, dentistry, optometry, osteopathic medicine, psychology, chiropractic, or podiatric medicine or prescribe a drug or other remedial substance used in medicine. Section 2.5: Evaluations and Treatment Without a Referral A physical therapist may evaluate and treat an individual during a period not to exceed 42 calendar days beginning with the date of the initiation of treatment without a referral from a provider. However, if the individual needs additional treatment from the physical therapist after 42 calendar days, the physical therapist shall obtain a referral from the individual’s provider. A physical therapist may not perform spinal manipulation of the spinal column or the vertebral column unless the physical therapist is acting on the order or referral of a physician, an osteopathic physician, or a chiropractor and the referring provider has examined the patient before issuing the order or referral. A physical therapist who conducts testing using electrophysiologic or electrodiagnostic testing must obtain and maintain the American Board of Physical Therapy Specialties Clinical Electrophysiologic Specialist Certification.
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Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
Section 3.1: Practice of Certain Occupations or Professions and First Aid This chapter does not prohibit any of the following: 1. The practice of any occupation or profession for which a person is licensed, certified, or registered in Indiana by a state agency. The persons who are exempted by this subdivision include persons licensed, certified, or registered to practice osteopathic medicine, chiropractic, or podiatric medicine. 2. The practice of any health care occupation or profession by a person who is practicing within the scope of the person’s education and experience. 3. The performance of any first aid procedure incidental to a person’s employment or volunteer duties. 4. The performance of an emergency first aid procedure by any person. 5. The provision of the following by a chiropractor licensed under IC 25-10: a. Physical therapy modality services b. Physical rehabilitation services f. Physiotherapy, as included in the chiropractic licensure examination Section 3.3: Exemptions from the Licensure or Certification Requirements 1. A person in an entry level professional education program approved by the board who is satisfying supervised clinical education requirements related to the person’s physical therapist education while under onsite supervision of a physical therapist. 2. A physical therapist who is practicing in the armed forces of the United States, U.S. Public Health Service, or U.S. Department of Veterans Affairs under federal regulations for jurisdiction licensure of health care providers. However, if the person, while federally c. Therapeutic procedures d. Tests and measurements e. Therapeutic devices employed as a physical therapist, engages in the practice of physical therapy outside the
course and scope of federal employment, the person must obtain a license under this chapter. 3. A physical therapist who is licensed in another state or credentialed to practice physical therapy in another country, if the person is teaching, demonstrating, or providing physical therapy services in connection with an educational seminar. However, the exemption under this subdivision may not exceed 60 days in a calendar year. 4. A physical therapist who is licensed in another state or credentialed in another country if the person by contract or employment is providing physical therapy to patients affiliated with or employed by established athletic teams, athletic organizations, or performing arts companies temporarily practicing, competing, or performing in Indiana. However, the exemption under this subdivision may not exceed 60 days in a calendar year. 5. A physical therapist who is licensed in another state and who provides physical therapy during a declared local or national disaster or emergency. However, the exemption may not exceed sixty (60) days following the declaration of the emergency. To be eligible for the exemption the physical therapist must notify the board of the person’s intent to practice. 6. A physical therapist licensed in another state who is forced to leave the person’s residence or place of employment due to a declared local or national disaster or emergency and due to the displacement seeks to practice physical therapy. However, the exemption may not exceed 60 days following the declaration of the emergency. To be eligible for the exemption the physical therapist must notify the board of the person’s intent to practice. 7. A physical therapist assistant who is licensed or certified in another state and assisting a physical therapist engaged specifically in activities related to subdivision (2), (3), (4), (5), or (6).
11 Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
Section 4: Indiana Physical Therapy Board
services of a testing company or agent to prepare, conduct, and score examinations. The board shall adopt rules concerning a continuing competency requirement for the renewal of a license for a physical therapist and certificate for a physical therapist assistant. Section 6: Evidence of Qualification Each applicant for a license as a physical therapist or certification as a physical therapist assistant must present satisfactory evidence that the applicant: 1. Does not have a conviction for a crime that has a direct bearing on the applicant’s ability to practice competently. 2. Has not been the subject of a disciplinary action initiated by the licensing agency of another state or jurisdiction on the grounds that the applicant was unable to practice as a physical therapist or physical therapist assistant without endangering the public. Sections 6.1 and 6.3: Applying for a License as a Physical Therapist or Physical Therapy Assistant An applicant for a license as a physical therapist or a certificate as a physical therapy assistant must do the following: 1. Complete the application process, including payment of fees. 2. Submit proof of graduation from a professional physical therapist or physical therapist assistant education program accredited by a national accreditation agency approved by the board. 3. Pass an examination approved by the board. 4. Submit to a national criminal history background check. 5. Meet any other requirements established by board rule. Sections 6.2 and 6.4: Applicants for a Physical Therapy or Physical Therapist Assistant License Who Have Been Educated Outside the United States An applicant for a license as a physical therapy assistant OR certificate as a physical therapist assistant who has been educated outside the United States must do the following:
LEARNING TIP! The board is comprised of
the following five members: three physical therapists, one physical therapist assistant, and one member who is a resident of the state and who is not associated with physical therapy in any way other than as a consumer.
The governor shall make each appointment for a term of 4 years. A member of the board may not serve more than 8 years in a 10-year period. Each physical therapist and physical therapist assistant appointed must have an unrestricted license or certificate issued under this chapter, have five or more years’ experience in the actual practice of physical therapy immediately preceding appointment, and be a resident of the state and actively engaged in this state in the practice of physical therapy during incumbency as a member of the board. The affirmative vote of a majority of the members appointed to the board is required for the board to take action on any measure. The board shall meet at least quarterly. Section 5: Determination of Qualifications, Administration of Examinations, and Standards for Competent Practice The board shall do the following: 1. Pass upon the qualifications of physical therapists who apply for licensure and physical therapist assistants who apply for certification. 2. Provide all examinations either directly or by delegation. 3. Determine the applicants who successfully pass examinations. 4. License and certify qualified applicants. 5. Adopt rules concerning the competent practice of physical therapy to the board. The board shall adopt rules establishing standards for the competent practice of physical therapy. They may approve and utilize the
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Ethics and Jurisprudence for the Indiana Physical Therapy Professional: Summary
1. Complete the application process, including payment of fees. 2. Provide satisfactory evidence that the applicant’s education is substantially equivalent to the education of a physical therapist assistant educated in an accredited entry level program as determined by the board by any of the following: a. Provide evidence of graduation outside the United States from a professional education program accredited by the same accrediting agency that the board approves for programs within the United States. b. Provide evidence of graduation from a physical therapist OR physical therapist assistant education program that prepares the applicant to engage as a physical therapist assistant without restriction. c. Provide evidence that the applicant’s school is recognized by its own ministry of education. d. Undergo a credentials evaluation as directed by the board to determine if the candidate meets uniform criteria for educational requirements established by rule. 3. Complete any additional education required by the board. 4. Pass a board-approved English proficiency examination if the applicant’s native language is not English. 5. Pass an examination approved by the board. 6. Submit to a national criminal history background check. 7. Complete supervised clinical practice with a restricted license if required by rule. 8. Meet any other requirements established by rule. Section 7: Examination; Re-examination To be eligible to sit for the examination, an applicant must meet the qualifying standards of any testing company or national organization employed to administer the examination and requirements adopted by rule. The board shall provide for examinations within Indiana
for the licensure of physical therapists and the certification of physical therapist assistants. The board may employ a testing company or a national organization to administer the examination. The physical therapist examination must test the applicant’s entry level competence related to physical therapy theory, examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation. The physical therapist assistant examination must test the applicant’s requisite knowledge and skills in the technical application of physical therapy services. An applicant for a license to practice physical therapy or for a certificate to act as a physical therapist assistant may take the respective examination not more than six times. An applicant for licensure or certification must agree to abide by any security and copyright provisions related to the examination. If the board determines that an applicant has violated the agreement or engaged in or attempted to engage in any other conduct that subverts or undermines the integrity of the examination process or validity of examination results, the board may disqualify the applicant from taking or retaking the examination. The disqualification by the board may be permanent or for a specified period of time. A determination by the board may be appealed. The board shall report any violation of security and copyright related to the examination or subversion or attempts to subvert the national examination to the Federation of State Boards of Physical Therapy. Section 8: Issuance of License; Renewal; Reinstatement; Temporary Nonrenewable Permit; Retirement from Practice The board shall license as a physical therapist or certify as a physical therapist assistant each applicant who successfully passes the examination provided for in this chapter and is otherwise qualified as required by this chapter. All licenses and certificates issued by the board expire on the date of each even-numbered year specified by the Indiana professional licensing agency. A penalty fee set by the board shall be in effect for any reinstatement within 3 years from the original date of expiration. An expired license
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