Diet and nutrition are key components of many conditions managed by physical therapists. What's more, nutrition can directly affect recovery and function while an individual is under a physical therapist's care. It makes sense, then, for physical therapists to be concerned with and address nutritional intake and eating patterns of their patients and clients. Nutrition is part of the professional scope of practice for physical therapists.
APTA's position is that it is "the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice." (House of Delegates P06-15-22-17)
However, because each state has its own jurisdictional scope of physical therapy practice, PTs should check their state practice act, which may be silent on nutrition. If that is the case, PTs need to turn to state laws governing nutritional practice, which like physical therapy practice acts are adopted by each state. Some states do not allow any person to give nutrition advice other than a registered dietitian. Others allow any person to give nutrition advice but only allow registered dietitian nutritionists (RDNs) to charge or bill insurance. PTs should check their state's laws on nutrition for confirmation.
In addition, each PT should consider his or her personal scope of practice before engaging in nutrition and diet services.
Questions to Consider Related to the PT's Role in Nutrition and Diet
Is nutritional education a reimbursable physical therapist procedure?
If the information a physical therapist provides is substantial in content and time, falls within the patient's plan of care, and is documented, it is possible that nutrition education reasonably could be charged as patient education (for example, self-care). However, check their state's laws on nutrition and contact your third party-payers to confirm.
May a physical therapist advertise nutrition services or use the designation "nutritionist"?
Unless you or someone on staff is licensed or holds a certificate in diet and nutrition, and is covered by professional liability insurance, it would not be advisable to advertise services that you may not be eligible to deliver.
The Center for Nutrition Advocacy provides links to state laws and other information regarding the use of nutrition tools in clinical practice. Here are 5 scenarios in which health care professionals legally can use nutrition tools in practice:
- You are licensed as a nutritionist/dietitian. You are a nutritionist and/or dietitian whose academic training, professional credential, and professional experience meet the law's specifications to be licensed in your state.
- Your health care license includes nutrition. Your profession is licensed in your state, and your defined scope of practice includes language outlining the use of specific nutrition tools—such as dietary counseling, supplements, and herbal therapy—as part of your practice.
- Your health care license is exempt from nutrition law. Your profession is licensed in your state, and the nutrition law contains an exemption for "licensed health professionals" in general or for your profession specifically to freely use nutrition tools, or to use nutrition tools as an adjunct to your primary profession.
- You are exempt from licensure. Your profession or work in the community is not licensed in your state, but you are identified in the state nutrition law as being exempt from requiring a nutrition license to use some or all stated nutrition tools.
- Nutrition care is not criminalized. The nutrition licensure law in your state does not criminalize people who do not have the license; instead, it protects the use of the titles "nutritionist" and/or "dietitian," or there is no licensure law for nutrition.
May a physical therapist test for nutritional deficiencies or basic blood values for nutrients?
Only in states and territories where physical therapists have legal jurisdiction to order labs would it be permissible to order tests for blood values.
May a physical therapist provide nutritional consultation?
If a physical therapist is certified or licensed in nutrition and dietetics, then nutrition consultation may be within the clinician's personal scope of practice. For jurisdictional scope of practice, PTs should check physical therapy and nutrition state laws and licensing boards for any nutrition consulting parameters.
When should a physical therapist refer to a specialist for nutritional education?
Per the APTA House position, the role of the physical therapist in diet and nutrition "includes appropriate referrals to nutrition and dietary medical professionals when the required advice and education lie outside the education level of the physical therapist."
For instance, a PT should refer out when the required education is beyond general information that can be found in the public domain, or involves information that is outside of dietary guidelines (see Related Resources below) or related guidelines by such entities as the Academy of Nutrition and Dietetics, American Institute for Cancer Research, and the American Hospital Association. Clients who require extensive meal planning, specific values for any macro- or micronutrients should be referred out, as should patients with specific disease processes or who are on specific medications that are directly affected by dietary manipulations.
Various professionals provide nutrition consultation as part of their practice. These include physicians, nurses, dietitians, and nutritionists, and their roles and scope vary based on geographic location, practice setting, and state laws and regulations. APTA recommends networking with a local nutritionist or dietitian in your area who may be familiar with your patient population. See Referral Resources below for links to referral sources.
APTA recommends using the Dietary Guidelines for Americans provided by the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion. (An executive summary is available here.)
Additional recommendations include:
Find a registered dietitian nutritionist at Eatright.org of the Academy of Nutrition and Dietetics.
The goal of Dietitians for Professional Integrity is to promote unbiased, evidence-based nutrition info.
The Link between Nutrition and Pain Is too Strong to Ignore in Your PT Practice (post on APTA's Narrow the Gap blog)
Educational and licensure requirements to become a registered dietitian nutritionist
(per Academy of Nutrition and Dietetics)
- Earn a bachelor's degree in clinical nutrition, food service systems management,
dietetics, foods and nutrition, or a related field
- Complete a dietetic internship program
- Pass a competency exam
- Earn the RDN credential
- Earn a state license