After many hours of thoughtful discussion and debate, APTA's House of Delegates (House) last week amended the position Physical Therapist Responsibility and Accountability for the Delivery of Care that was first adopted at the 2011 House. The position confirms that physical therapy is provided by, or under the direction and supervision of, a physical therapist (PT). Evaluation remains the complete responsibility of the PT.
In its deliberations, the House cited the ways that APTA's Vision 2020 and Standards of Practice for Physical Therapy support the position. However, the House noted that current APTA positions, standards, guidelines, policies, and procedures may be in conflict with the new position as some of them stipulate the use of specific personnel (ie physical therapist assistants and aides) rather than recognize the responsibility and accountability that accompany the independent judgment of contemporary physical therapist practice, which characterizes the autonomous professional. Thus, the position will take effect upon the implementation of necessary initiatives in education, practice, payment, regulation, and research, and adoption of requisite APTA positions, standards, guidelines, policies, and procedures.
In discussing this issue, the House also commented on the need for PTs to respond to changes resulting from health care reform, including new models of care that might provide opportunities for PT leadership. Accordingly, APTA will explore practice models that are responsive to the needs of society and adaptable to the changing health care environment. Steps toward the adoption of any new practice models will include:
Draft language adopted by the 2012 House will be available on the House Community next week. Final language for all actions taken by the June 2012 House will be available by September after the minutes have been approved.
Three motions adopted by the House of Delegates (House) illustrate the continued focus on improvements to APTA's governance and the importance of clarity in the roles of the House and Board of Directors (Board).
The House passed a motion calling upon the Board to amend APTA's Articles of Incorporation (Articles) prior to the 2013 House of Delegates so that the Articles reflect the Board's duty to manage APTA in compliance with the bylaws of the association. [RC-17]
The House also rescinded Principles of Governance (HOD P06-11-17-08), which the House passed last year and requested that the reports and recommendations of the Governance Review Task Force be made available on APTA's website. [RC-15] [RC-30]
To examine how the physical therapist assistant (PTA) can best support the physical therapist in the current and future health care environment, APTA will collaborate with appropriate stakeholders to conduct a feasibility study to determine whether or not transitioning the entry-level degree for the PTA to a bachelor's degree is indicated. In accordance with the motion adopted by the House of Delegates, the study will identify the following:
A report on the study will be submitted to the 2014 House, with an interim report to the 2013 House. [RC-20]
The House of Delegates passed a motion calling for APTA to identify and make available resource materials for physical therapists, physical therapist assistants, and physical therapist/physical therapist assistant students serving in the role of an expert or factual witness. Resources may include information on ethical obligations relative to acting as an expert or factual witness, references to existing APTA resources, and other materials such as the American Bar Association's Model Rules of Professional Conduct that can assist in providing general information on this topic. [RC-22]
The use of social media by physical therapists (PTs), physical therapist assistants (PTAs), and students for professional, work, educational, and personal purposes creates opportunities to communicate in a public forum, and with that the potential for conflicts in patient/client management, APTA's House of Delegates said last week in adopting the new position Standards of Conduct in the Use of Social Media. To use social media productively and avoid these conflicts, the new position calls on PTs, PTAs, and students who engage in social media activities to demonstrate appropriate conduct in accordance with the Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant. The standards also call for PTs, PTAs, and students who identify content that appears to be unprofessional to alert the colleague who posted it so that he or she can remove it or take other appropriate actions. Furthermore, the new position requires that PTs, PTAs, and students not misrepresent themselves, APTA or other organizations, educational institutions, clinical sites, or employers on social media. [RC-23]
An action taken by the House of Delegates (House) aims to promote the engagement of early-career individuals in the association and in their career development by encouraging components to create an early-career liaison position to their boards of directors and initiate other mechanisms to reach these 2 goals—including inclusion of early-career individuals on committees and special interest groups, nominations of these individuals to positions and organizations, promotion of events aimed at students and early-career individuals, and a formal mentoring process within the component. [RC-24]
The House adopted a related statement of action that encourages physical therapists and physical therapist assistants to use best practices for mentoring for early-career PTs and PTAs. [RC-21]
The House of Delegates passed a resolution calling for complimentary "read only" access to Hooked on Evidence for all health care practitioners and health care students world-wide in an effort to advance evidence-based practice by all physical therapists and physical therapist assistants.
In adopting Access to Hooked on Evidence, the House cited language in APTA's Vision 2020 that supports the use of evidence-based practice by all physical therapists. [RC-25]
Physical therapists (PTs) play a unique role in the emergency department (ED) setting, particularly given that 25%-28% of visits to EDs involve musculoskeletal conditions. Furthermore, early physical therapy in the recovery process has been shown to result in fewer days of missed work and shorter overall case duration in patients and clients with acute low back injuries and other musculoskeletal injuries.
While physical therapy practice is growing in EDs, it is still not recognized even among many PTs. Therefore, a House action calls for APTA to develop materials to support the role of PTs in EDs. Materials may include resources to help PTs assess readiness for practice in this setting, negotiate the value of the role of physical therapy in the ED, and promote PT professional services in the emergency care environment.
The new materials will augment current resources available to APTA members that include an Emergency Department Toolkit and a podcast series on PTs in EDs. [RC-26]
Quoting national and international statistics on coronary heart disease, diabetes, cancer, COPD, high blood pressure, cigarette smoking, and obesity, showing that these diseases are epidemic in their incidence, the House of Delegates adopted Physical Therapists as Expert Providers for Exercise and Physical Activity—recognizing physical therapists as health service delivery providers of choice to prevent or treat these noncommunicable diseases (NCDs) and their related risk factors.
The position holds that APTA seeks participation in the development and/or update of physical activity or exercise guidelines for these NCDs. [RC-27]
While there are many resources that define entry-level and minimum standards, a doctoring profession should have standards of excellence that reflect exceptional practice. To that end, the House passed a motion calling for a study of the feasibility of developing mechanisms to recognize centers of clinical excellence. An interim report will be provided to the 2013 House with a final report to the 2014 House. The final report will include costs, interests, and the effect on the profession and the public of developing these mechanisms. [RC-28]
A new position adopted by the House of Delegates calls for physical therapists (PTs) and physical therapist assistants (PTAs) to be involved with and leaders of safe patient handling programs at the local, state, and federal levels, and to lead by example—appropriately supporting and employing the concepts of safe patient handling during patient care.
The Role of Physical Therapy in Safe Patient Handling also endorses several concepts related to access to safe patient handling equipment and departmental policies and training in safe patient handling procedures. [RC-29]
Last week the House of Delegates amended the following positions:
Last week, APTA's House of Delegates (House) participated in a visioning session as part of the process to revise the association's Vision Sentence for Physical Therapy 2020 and Vision Statement for Physical Therapy 2020. Stemming from a 2011 House motion, the objective is to look beyond 2020 and clearly articulate the profession's commitment to society.
During the session, the House discussed 9 design principles or "images" of physical therapy ranging from the physical therapist's role in human movement and performance, evidence-based practice, and innovative contributions of the profession to meeting the diverse needs of society and developing and applying new technologies.
In April, the Board of Directors took part in a similar visioning session. As part of the process to revise the vision, APTA is conducting focus groups with members, interviews with thought leaders, and an environmental scan survey. Later this year the Vision Task Force will submit a draft of the new vision to the Board for its review. The new vision will go to the 2013 House for its consideration.
APTA joined representatives from several major health care organizations Tuesday on Capitol Hill to participate in a panel briefing on what the expiration of Medicare extenders will mean to health care for patients and providers in rural areas. The briefing was sponsored by the American Hospital Association and hosted by Reps Cathy McMorris Rodgers (R-WA) and Mike Thompson (D-CA).
"The therapy cap has a disproportionate impact on older, more chronically ill beneficiaries and those from underserved areas, including rural areas," said APTA Senior Government Affairs Director Mandy Frohlich in remarks delivered Tuesday on behalf of the association. She went on to say "data indicates that there is a higher prevalence of chronic disease in rural areas, and beneficiaries with chronic conditions are most likely to hit the therapy cap."
APTA believes that extension of the therapy cap exceptions process into 2013 is imperative if patients are to continue to have access to the vital care they need. However, the real fix is in reform of the payment system. APTA has begun crafting a reformed payment system for outpatient physical therapy services that it believes will strike a balance between ensuring access to services while improving accuracy of payment.
"The impact of this briefing was significant as more than 100 Hill staff were in attendance," said APTA Vice President of Public Policy, Practice, and Professional Affairs Justin Moore. "APTA represented the more than 40 organizations involved in the therapy cap coalition and continues to serve as the leader on this issue and in the rehabilitation community."
Two systematic reviews by Frank et al published in the May issue of Journal of Rehabilitation Medicine provide an overview of the effectiveness of conceptual approaches, additional therapies, and basic techniques used in lower limb physical therapy in children with cerebral palsy (CP).
For both systematic reviews, the authors searched 5 electronic databases, extracting literature published between 1995 and 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health (ICF). Three independent evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system.
One systematic review included 37 studies that used conceptual approaches (neurodevelopmental treatment [NDT], conductive education, Vojta therapy, sensory integration, functional training and goal-oriented therapy) and 21 studies that focused on additional therapies (aquatic therapy and therapeutic horseback riding). Level II evidence was found for the effectiveness of therapeutic horseback riding on posture and for NDT and functional training on gross motor function. Goal-oriented therapy and functional training were effective on the attainment of functional goals and participation. With level IV evidence, NDT was effective on all levels of ICF. (J Rehabil Med. 2012;44:396-405.)
The other systematic review examined basic techniques and included 83 studies divided into the following categories: stretching; massage; strengthening; electrical stimulation; weight-bearing; and balance, treadmill, and endurance training. Interventions targeting problems at body function and structure level generally influenced this level without significant overflow to activity level and vice versa. The more recent studies evaluating strength training mainly demonstrated level II evidence for improved gait and gross motor function. There was limited evidence for specific information on intensity, duration, and frequency of training. (J Rehabil Med. 2012;44:385-395.)
(Bonita) Lynn Beattie, PT, MPT, MHA, vice president of Injury Prevention at the National Council on Aging (NCOA), and lead for the National Falls Free© Initiative, represented APTA at the 2012 Transforming Fall Management Practices Conference, May 22-24. Beattie welcomed 191 attendees on behalf of APTA and its more than 80,000 members. She noted the growing activities of the 70-member NCOA-led Falls Free© Coalition, of which APTA is an active member, and of the 41 state coalitions on falls prevention. Beattie pointed out APTA's strong focus in the area in falls prevention and that it would devote 3 days of programming to falls prevention during PT 2012 in Tampa. She also acknowledged that many state chapters are similarly engaged with their state coalitions in promoting awareness, education and training of providers, and investment in evidence-based interventions that link health care providers to community resources and falls prevention programs. Beattie invited attendees to join their state and local coalitions.
The annual conference, held in Clearwater, Florida, is provided by the VISN 8 Patient Safety Center of Inquiry and the Tampa Veterans Administration Research and Education Foundation. Sponsoring organizations included APTA, Gainesville Geriatric Research Education and Clinical Center, and the National Center for Patient Safety.