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  • PTNow Blog: A Good Guideline That Could Be Better

    Is it about time interdisciplinary practice guidelines got a little more guidance from physical therapists (PTs)?

    That's one of the questions asked in the latest PTNow blog, which discusses the idea that even when a guideline is accurate and useful for PTs, direct PT involvement in its development can only make it better.

    Case in point: the American Academy of Neurology (AAN) concussion guideline now being reviewed for inclusion in CPG+, the APTA initiative that evaluates and rates externally developed practice guidelines using a team of PT experts. The CPG+ team provides a guideline rating, highlights, and “Check Your Practice” tips.

    The AAN guideline fares well—and is even declared a "must read" by 1 reviewer—but the fact that PTs weren't involved in its creation leads to bigger questions.

    Check out the PTNow blog, consider the questions, and join the conversation.

    From the House of Delegates: House Actions Could Increase Reach of Physical Therapy

    Physical therapy should be empowered to assume its appropriate place in a quickly evolving health care system, and should be made available as widely as possible—that was the common thread running through several motions approved by the 2014 APTA House of Delegates.

    During its session June 9-11 in Charlotte, North Carolina, the House approved motions that ranged from position statements supporting the idea that physical therapists (PTs) should be considered "entry point" health care providers (RC 7-14) to another backing the idea that PTs should be included in the list of professionals able to make determinations on disability status for people applying for special license plates (RC 17-14). Delegates also approved motions supporting the use of telehealth technologies (RC 8-14) as well as refinements in the language of existing policies that make it clear that PTs—and the association—are committed to responding to disparities in access and serving a diverse population (RC 5-14, RC 6-14). Viewed in combination, the motions support the profession as an integral part of front-line care that should be widely accessible.

    By a wide margin, the House approved an amended position statement that clearly defines PTs as "entry point providers into the health care system" and reinforces the PT’s ability to provide screening, evaluation, diagnosis, prognosis, intervention, coordination of care, prevention, and wellness and fitness, as well as referral to outside providers when indicated. According to a support statement that accompanied the motion proposal, the idea behind the refined position is to "move external stakeholders—insurers and physician groups—beyond simply tolerating or permitting direct access, to a level of endorsing, embracing, and encouraging the use of PTs as entry-level providers."

    At a more nuts-and-bolts level, the House also approved a new APTA position in support of PTs being included in states' lists of providers authorized to determine mobility status for individuals "for purposes of disability parking placards or license plates," as well as in regional transit authorities as providers able to make paratransit decisions. Currently, in 49 states and the District of Columbia, PTs are not on lists of qualified professionals for these decisions—lists that in some cases include podiatrists, chiropractors, naturopaths, Christian Science practitioners, midwives, and police. The new APTA position could assist chapters seeking to get states and transit authorities to officially acknowledge the PT's ability to make such mobility decisions.

    The House also sought to expand the reach of physical therapy through technology by the adoption of a resolution supporting the provision of physical therapy via telehealth when provided in ways that are consistent with professional ethics, standards, guidelines, and federal, state, and local regulations. The resolution adopted by the House echoes a position adopted by the APTA Board of Directors in 2001.

    A priority for the profession of physical therapy continues to be access for all individuals in need of care despite disparities, according to a support statement that accompanied the motion. "Telehealth technology can transform health care delivery by removing time constraints for local practice, often times providing enhancement for real-time care."

    The resolution states that telehealth "is used to overcome barriers of access to services caused by inaccessibility … unavailable resources, or impaired patient or client mobility," and that the technology "offers the potential to provide physical therapist services where health disparities exist." Provided that PTs deliver the service competently and ethically, document the use of telehealth, and obtain informed consent from patients and clients, APTA now officially views telehealth as "an appropriate model of service delivery for the profession of physical therapy."

    The House also voted to add more precision of language around what has been a longstanding tenet of PT practice and APTA membership—that everyone deserves care, and that the association is an inclusive organization. In tweaks to 2 separate policies, Delegates voted through consent agenda to include the words "sex," "gender identity," and "gender expression" among the lists of characteristics that will not be the basis for discrimination in both PT practice and APTA operations. Both policies still include race, creed, color, gender, age, national origin, sexual orientation, disability, and health status as characteristics that should not be a barrier to PT treatment or association membership and rights.

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.

    From the House of Delegates: Help in Responding to 'Productivity' Issues on Its Way

    By this time next year, physical therapists (PTs) and physical therapists assistants (PTAs) may have a few more tools at their disposal when it comes to talking with employers and others about productivity and performance.

    This year's House of Delegates (House) voted overwhelmingly to identify and develop resources that will help PTs and PTAs negotiate successfully around productivity and performance in ways that ensure the provision of quality physical therapy care. The motion was approved during the 2014 session held June 9-11 in Charlotte, North Carolina.

    According to the statement supporting the motion, the need for more analysis and tools has arisen in the face of a changing health care climate that has created "uncertainties" that have caused some employers to turn to "productivity" measures as the primary measure of PT and PTA performance. These productivity measures may not be realistic and generally do not reflect the value of PT care and the patient related outcomes of PT practice.

    "At such times, PTs and PTAs need not just ethical courage to stand up for what is right, but also tools and resources to fortify them to engage vigorously and effectively in the dialogue and negotiations with administrators/employers and consultants who are pressuring [them] to adopt productivity measures or practices that may represent sincere but archaic or misguided notions of the nature and role of PT practice," according to the supporting statement.

    The motion adopted by the House could result in the development of resources for PTs and PTAs who, according to the support statement, "seek to balance their clinical, ethical, and professional responsibilities against the demands inherent in the employment relationship." The 2015 House will receive a progress report on the efforts [RC-16].

    APTA members can view videos of all open sessions of the 2014 House of Delegates online. Final language for all actions taken by the House will be available by September after the minutes have been approved.