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  • From PTJ: PTs, PTAs, Students Report High Rates of Inappropriate Sexual Behavior by Patients

    Inappropriate sexual conduct happens everywhere, and physical therapy settings aren't immune to the problem, according to a new article e-published ahead of print in Physical Therapy (PTJ) that looks at instances in which patients are the perpetrators of the conduct. The article is based on a survey of 892 physical therapists (PTs), physical therapist assistants (PTAs), and physical therapy students which found that 84% had experienced inappropriate patient sexual behavior (IPSB) at some point during their careers or training, and that 47% experienced IPSB within the past year. (Editor's Note: Articles e-published ahead of print are not the final version. The final version of this article will be published in the November issue of PTJ.)

    The study, which authors describe as the largest of its kind to focus on IPSB among PTs, PTAs, and students, found that there has been little progress on the issue since a similar 1997 study of PTs only, in which prevalence of IPSB over the length of a career averaged 81% to 86%. The high rates "warrant practitioner and student education, as well as workplace policy and support," authors write.

    Authors define IPSB as instances in which a patient engages in any of a range of behaviors, "from leering and sexual remarks to deliberate touch, indecent exposure, and sexual assault." For the purposes of the current study, IPSB was categorized into 3 groups: mild (such as being leered at or being given a romantic gift), moderate (including sexually suggestive gestures or being propositioned for sexual activity) and severe, which includes indecent exposure, physical touch, harassment outside the workplace, and forced sexual activity.

    Mild IPSB at some point during their careers was reported among 77% of respondents, with "patient made a sexually flattering or suggestive remark" experienced by 68.8% of those who encountered that level of IPSB. "Patient stared at you or your body parts in a way that made you feel uncomfortable" was experienced by just over half of the respondents (55.5%) who experienced mild IPSB. More than 1 in 3 (34.6%) reported patients asking for dates.

    Among the 58% of respondents who reported moderate IPSB, 52% reported instances in which a patient "made [an] overtly sexual remark or joke, asked you questions or commented on your sex life, or shared a sexual fantasy about you." Close to 31% of the respondents reported a patient making sexually suggestive gestures, and 11.2% said that they were propositioned for sex by their patients.

    Severe forms of IPSB were reported by 37.2% of respondents, with 20.3% of that group saying that a patient had purposefully touched or grabbed them in "private areas" or in "a clearly sexual manner." Among this group, 7.7% reported instances in which patients followed, watched, or harassed a respondent, while 0.9% reported experiencing threats of forced sexual activity or an attempt at forced sexual activity, and 0.3% reported being forced to submit to sexual activity.

    Some of the risk factors authors identified for IPSB among physical therapy clinicians include fewer years of direct patient contact, routinely working with patients with cognitive impairment (PWCI), female practitioner gender, and male patient gender. Of those risk factors, clinical experience was the most predictive risk factor, followed by managing patients with PWCI.

    The study found that women were more than twice as likely as men to have experienced IPSB, and clinicians who treated mostly male patients had a 400% greater chance of exposure to IPSB. Additionally, being new to the profession also put respondents at higher risk: 58% of physical therapy students experienced IPSB, compared with 42% of physical therapy professionals.

    Still, authors point out, these risk factors only account for up to 15% of the total variance, meaning that the possibility of a PT, PTA, or student experiencing IPSB during any given year is a very real one for nearly all areas of the profession.

    In a related PTJ podcast interview with Editor in Chief Alan Jette, PT, PhD, FAPTA, to be released in November, Jill S. Boissonnault, PT, PhD, and Ziádee Cambier, PT, DPT, 2 of the study's coauthors, discussed the characteristics of IPSB and management strategies to mitigate or address the issue.

    Physical, sexual, psychological, and racial abuse are all serious issues for health care providers, but, Cambier notes, “it makes sense to separate them out for more in-depth research” because there are “real differences” in risk factors and responses to the particular type of abuse.

    While workplace training can “help people prepare” for IPSB, says Cambier in the podcast, it does not prevent the events from happening. Establishing clearly stated workplace policies and supports may help to prevent or address IPSB, including options and procedures for staff such as:

    • When employees can have a second staff member in the room
    • When and how to transfer patients or terminate care
    • How to issue warning letters
    • How to use behavioral contracts

    Most important, Boissonnault states in the podcast, is training supervisors to offer support. The study includes responses to open-ended questions that show varying levels of attention to IPSB among supervisors, from 1 respondent who reported feeling "very supported by my clinical instructor and other staff" to others who felt that when they reported IPSB, they were not taken seriously by supervisors, not helped, or even punished for reporting the inappropriate behavior.

    Some respondents even reported instances in which the supervisor tacitly or actively participated in IPSB, including 1 male clinical instructor who did not intervene when a patient commented on the respondent's physical appearance, and actually joined another patient in giving the respondent dating advice.

    "He definitely didn't have enough training on the topic," the respondent wrote. "When I discussed my experiences with 2 female classmates, I found that every 1 of us had been harassed on our summer internships."

    APTA has taken a strong position on sexual harassment, and provides a webpage to help members recognize harassment and understand their rights.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • This is obviously timely given the current news cycle. Beyond that, however, we are a profession that works in close physical contact with our patients. That is not an excuse for tolerating such behavior; rather it suggests the need for more vigilance and training as this article suggests. We have long had a practice of firm responses to patients who cross the line, whether that be verbal abuse, racially insensitive remarks, or sexually suggestive inappropriateness. It is often younger staff who aren't quite sure what to do in response, but they know they have the support from ownership and experienced clinicians who do respond to patients in these situations. Responses can range from educating those who, for whatever reason, don't perceive crossing lines, specific warnings, to immediately terminating an episode of care in a few instances. I does happen too often. Still, the article prompts me to consider that even more training would be appropriate in our own clinic. Blair Packard, PT, East Valley Physical Therapy and Aquatic Rehabilitation, Mesa, Arizona.

      Posted by Blair Packard -> AFX_A on 11/1/2017 11:33 PM

    • Nice work DR. Ziádee! So glad to see your continued work in this area. Great combo with Dr. Jill et al. I am glad this is coming to forefront now. Very proud to have been part of your Doctoral team. Lifetime Learning is critical for optimal success - that’s my opinion. Cheers, Dr. Mary Ann 😊✨

      Posted by Dr. Mary Ann Wilmarth on 11/4/2017 9:02 PM

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