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If you are considering becoming a physical therapist, or if you are already a physical therapist, it is very important to know what the physical therapy scope of practice actually is. “Scope of practice” refers to the things that you may do, the things that you are required to do, and the things that you may not do in your role as a physical therapist. Should you break any of these rules you will most likely have to face legal action.
Permitted Practices
As a physical therapist you will be allowed to do many things and there will be a number of responsibilities that will fall on your shoulders. In general the physical therapy scope of practice includes those things that you were taught in a formal physical therapy program, and nothing else. In a formal program you will be taught certain:
- Acts
- Tests
- Procedures
- Modalities
- Treatments
- Interventions
That make up the things that you will be required and permitted to do in your actual career as a physical therapist, anything else is not part of your scope of practice.
As a physical therapist you will be responsible for supervising those healthcare workers who are below you in terms of the hierarchy. Members of the healthcare system who you will be responsible for supervising within the physical therapy scope of practice include:
- Physical therapist assistants
- Physical therapy aides (all non-licensed individuals aiding in the provision of physical therapy services)
- PT students
- PTA student
You will also be required to engage in the training of these individuals to a certain degree and you will be held responsible for their actions.
In general there are more things that you can do than that you cannot do as a physical therapist. The things that you can do include the following:
You will be qualified to conduct tests of:
- Joint motion
- Muscle length and strength
- Posture and gait
- Limb length and circumference
- Activities of daily living
- Pulmonary function (measurements taken to determine lung volumes and lung capacities)
- Cardio vascular function (functioning of the heart and blood vessels)
- Nerve and muscle electrical properties
- Orthotic and prosthetic fit and function (this is basically the skill of creating and fitting artificial limbs for patients who have lost their real limbs for a variety of reasons)
- Sensation and sensory perception
- Reflexes and muscle tone
- Sensorimotor and other skilled performances
You will be qualified to engage in treatment procedures such as:
- Hydrotherapy (the use of exercises in a pool as part of treatment for conditions such as arthritis or partial paralysis)
- Shortwave or microwave diathermy
- Ultrasound, infra red and ultraviolet radiation
- Cryotherapy (the local or general use of low temperatures in medical therapy or the removal of heat from a body part)
- Electrical stimulation including transcutaneous electrical neuromuscular stimulation
- Massage
- Debridement (the process of removing nonliving tissue from pressure ulcers, burns, and other wounds)
- Intermittent vascular compression
- Iontophoresis (a technique of introducing ionic medicinal compounds into the body through the skin by applying a local electric current)
- Machine and manual traction of the cervical and lumbar spine
- Joint mobilization
- Machine and manual therapeutic exercise
Your scope of practice will include training in:
The use of orthotic, prosthetic and other assistive devices including crutches, canes and wheelchairs
In addition to the above your physical therapy scope of practice will include:
- Examining individuals so that you can determine what is wrong with them, what the outcome of their ailment is likely to be, and what you, as the physical therapist, can do that is within the specified physical therapy scope of practice.
- Alleviating impairment and functional limitation by creating and implementing therapeutic interventions that are specifically aimed at the treatment of the patient in question and that are within the scope of practice of a physical therapist.
- Preventing injury, impairment, functional limitation, and disability, which could include educating patients about how to best take care of themselves.
Responsibilities
The scope of practice for a physical therapist also highlights the things that you are responsible for doing once you are qualified and working in your official role as a physical therapist. These things include the following:
You will be required to create a plan of care for your patient. This plan needs to be comprehensive, and you must adjust it when the need to do arises. Adjustments to the plan depend on and could include things like:
- Entering and reviewing chart documentation
- Reexamining and reassessing the patient
- Revising the patient care plan if necessary
You also need to clearly specify which aspects of that plan can be delegated to other members of your team. You will also be responsible for determining which of the people under your supervision is in fact allowed and qualified to take on the tasks that can be delegated in the care plan. When tasks are delegated to one of the individuals over whom you have authority it will be your responsibility to ensure at all times that that person is being appropriately supervised. In practically all cases you will be required to supervise them yourself at all times.
In addition to the care plan it is also the job of the physical therapist to create and coordinate the discharge plan. This is the plan and schedule according to which the patient will eventually be allowed to leave therapeutic care and return to his or her own home environment where they will continue their recovery process.
One of your main responsibilities as a physical therapist is to ensure that each and every time you see a patient you provide that patient with the necessary care and intervention strategies required to help them as effectively as possible. In addition to this you also need to determine which assistants will be the most beneficial to have with you during a treatment session. The primary responsibility here is to ensure that you provide your patient with adequate care and that this care is administered safely and to the best of your ability. You are entirely responsible for the care of your patient. In order to have a patient under you care you need to have first-hand knowledge of that patient’s condition. This means that you need to actually deal with each and every patient that comes to you on a personal basis. There is no situation in which you can delegate everything to an assistant. You must be aware of everything related to the care of your patient, including information such as how much your patient is being charged for the treatment.
A big responsibility you will have is to be available to your physical therapist assistants at all times. There should be no time when they are working as an assistant when they are unable to contact you either directly in person or telephonically for advice and assistance.
Remember that you will only be able to supervise and delegate work to assistants and so on who are engaged in physical therapy. You will not, for example, be able to give orders to an LPN in a hospital setting. In cases where the care of a patient has been delegated to an assistant or aide you will be required to assess and review their care every thirty days at the bare minimum.
You will also be responsible for ensuring that every aspect of patient care is documented and recorded in the finest detail. This documentation is crucial for the continuing care of your patient and therefore it cannot be forgotten or left out.
Prohibited Practices
There are a number of things that you absolutely cannot do if you are a physical therapist. The reason why job descriptions will usually include an account of your scope of practice is that this is required in ensuring that you do not do anything that could cause harm or damage to your patient or client. As a physical therapist you may not:
- Employ acts that are beyond the scope of the practice of physical therapy
- Employ tests that are beyond the scope of the practice of physical therapy
- Employ procedures that are beyond the scope of the practice of physical therapy
- Employ modalities that are beyond the scope of the practice of physical therapy
- Employ treatments that are beyond the scope of the practice of physical therapy
- Employ interventions in the treatment of patients that are beyond the scope of the practice of physical therapy
Of course it is highly likely that you will find yourself in situations where the patient requires a form of treatment that is in fact outside your scope of practice. In situations such as that you will simply be required to refer the patient to an expert with the capabilities of dealing with that particular aspect of patient health.
The physical therapy scope of practice is not limited to controlling your own behavior. In cases where you have other health professionals working under you, you will also be required to ensure that they do not contravene any of the rules and regulations that control the actions of physical therapists. No matter how convincing their argument may be you, as the physical therapist in charge, will be held responsible for anything that goers wrong and for the violations of the code of conduct of physical therapists if you knowingly allow a physical therapist under your supervision to perform a procedure or act or administer a treatment that is not within the physical therapy scope of practice. In addition you will also be held partially responsible should you have been unaware of the person’s intention to violate the physical therapy scope of practice. The prohibited act that we are referring to here is the act of allowing anyone in your supervision to contravene the physical therapy scope of practice in any way at all and for any reason at all.
One of the important prohibited activities that you should keep in mind as a physical therapist ahs to do with x-rays. It is not within the physical therapy scope of practice to order x-rays. That being said there are a few things that you as a physical therapist can do when it comes to x-rays. These things are the following:
- A physical therapist may review x-rays
- A physical therapist may also request radiologic consultations
Other than that there is very little that you can do with x-rays as a physical therapist. A very important thing to keep in mind is that you are not qualified to perform or apply roentgen rays or radioactive materials. In simple English this means that you are not allowed at any point during your career as a physical therapist to administer an x-ray yourself. You will be qualified to analyze an x=ray that has been administered by another person who has the required skills and qualifications to do so. You will be trained in looking at an x-ray and using it in the diagnosis and treatment of your patient, but this will be done alongside an actual x-ray administrator with more knowledge than you.
After reading the above you should have a far clearer idea of what is expected of you as a physical therapist in terms of the physical therapy scope of practice. All of these things should be covered in your initial training, but may potential physical therapists find it very useful to know what their job will entail right from the outset. It also helps for you to be prepared for the work environment and work responsibilities that you will have once you are a qualified physical therapist. If you do something that is not within the physical therapy scope of practice you may cause injury to your client.