PT–PTA Rehab Team: Continuum of Care
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As a doctor of physical therapy student, I owe much of my success in school to the help of my fellow classmates. We spend more time together in classes, at the gym, and at the library than we do in our own homes. Whether that means delving into confusing class material or being each other's test dummies for Grade V manipulations, we support each other wholeheartedly throughout our program. Each of my classroom colleagues contributes something valuable, unique, and instrumental to the success of our cohort.
Similarly, physical therapists cannot succeed alone in the clinic or hospital. We work with a team of health care providers to bring the best possible care to our patients. During one of my clinical visits, I was shocked to see one PT's schedule, seeing 3 patients in 30 minutes. A packed schedule like this could only be possible with the help of PTAs, "the only individual(s) permitted to assist a PT in selected interventions" according to APTA's policies on supervision of PTAs. After seeing the teamwork between my CI and the PTAs in the clinic and reading resources provided by APTA, I realized that working with PTAs allows us to maximize rehabilitation outcomes of our patients.
The PT is responsible for conducting the examination and evaluating and forming the diagnosis and prognosis of the patient, then determining the interventions needed to help achieve the patient's goals. The intervention phase is where the PTA comes in. Unlike rehab techs and aides, PTAs complete rigorous academic and clinical education that provides them with the knowledge and critical thinking skills to follow a PT's plan of care. They perform interventions, collect data, and modify the interventions to fit the patient's abilities and ensure their safety. PTA Scope of Practice: Skilled PT Service Providers, a Pulse blog article provides more information about the scope of practice or work for PTs and PTAs. In terms of interventions provided by the PTA, be aware that their scope of work is dependent on your state's practice act. Understanding what is within the PTA's scope of work is the first step toward being an efficient team providing optimal rehabilitation outcomes for our patients.
PTs should understand the scope of PTA education as well as their personal skill set. Through an extensive curriculum, PTAs receive training to provide rehabilitation techniques, therapeutic procedures and interventions, documentation, gait analysis, and much more. Additionally, you may decide to use an intervention based on the PTAs specific skill set, depending on their clinical background and whether they have completed continuing education courses or an APTA Advanced Proficiency Pathway (APP) in an area, such as acute care, cardiovascular/pulmonary, geriatrics, home health, oncology, orthopaedics, pediatrics, or wound management. PTs are responsible for supervising the PTA and must ensure all safety parameters are met and understood by each team member working with a patient.
As a PTA works with the patient, they can document the patient's progress as well as any modifications made during the course of care. PTAs have the problem-solving skills to modify the interventions to ensure the patient's safety, comfort, and progress toward the patient's goals. Throughout this process, the PTA and PT remain in constant communication through documentation review as well as continuous discussion with each other and the patient. If at any point the patient's safety is questioned or they are not making progress toward their goals, the PT and PTA should openly discuss these issues and come up with a plan of action together to address them. The PT may choose to reevaluate the patient, redirect the PTA, or provide an intervention themselves.
Understanding these basics in the continuum of care is important to ensure the best outcomes for our patients with our collaborative efforts. If there's anything I've learned in physical therapy school, it's that there are many gray areas in our practice. To address these areas, APTA has provided a more in-depth decision-making algorithm to help guide PTs when supervising PTAs. PTs are not alone in providing optimal care for our patients. We have the help of PTAs to achieve the best quality outcomes for our patients. After all, we're #BetterTogether.
Eleyn Fangonilo, SPT, is a member of the APTA Student Assembly Interprofessional Collaboration Project Committee.