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;) PT
Practice Acts!
Hopefully,
most U.S. readers of this newsletter are aware of the evolving PT
scope of
practice issue. If not, here's a brief summary.
In
2001, the APTA published
a 2nd edition of the Guide to Physical Therapist
Practice.
This Guide:
"more
clearly defines scope of practice; guides patterns of practice;
improves quality of care; promotes appropriate use of health care
services; and explains physical therapist practice to insurers,
policymakers, and other health care
professionals"
https://www.apta.org/products_services/online_shopping/newGuid
e
In and
of
itself, the Guide does not legally define the profession's scope of
practice. The Guide, however, does provide States with
"model
language" to be used for drafting State practice acts which then
serve to legally define a profession's scope of practice within their
domain of
concern.
The new APTA guidelines greatly expand
PT's domain of
concern to include the following: �functional
training in self care and in home, community or work
integration.�.
I think most of us recognize that training in these areas has been
the traditional domain of other professions, including occupational
therapy. While al professions, including OT, expand their
practice
domains over time, their is a limit as to what any profession can
legitimately
claim as theirs. While some PT authors have argued
that the above areas are
"traditional" domain for the PT profession, as aptly put by
the
AOTA:
"The
education, training and practice of physical therapy does not support
extension of their scope in the manner proposed
[
functional
training in self care and in home, community or work integration]
without recognizing the
inherent limits in physical therapy training and preparation in these
areas"
From:
AOTA, PT Scope Fact Sheet
This limits are clearly illustrated by Chuck Wilmarth (AOTA) in a
recent
e-mail message to the Florida OT Association List Serve:
"An article in PT Magazine
addressing physical therapy intervention with Parkinson's disease
[discusses] the patient's functional limitations in daily activities more
narrowly confined to addressing the need for
improvement in 'flexibility, balance control and movement
organization.'"
The AOTA is taking a stand against the expanding of
PT's
practice areas by providing State OT organizations with its own
version of
suggested model language to be used in PT practice acts..
The AOTA
model provides two different language recommendations:
"The
first recommendation would be to suggest that the phrase
"functional
training in self care and in home, community or work
reintegration"
be deleted from any proposed legislation". Or, if
this is not
successful {i.e. not accepted by the State PT agency}
then
add wording such as "testing
individuals with mechanical, physiological and developmental impairments,
functional limitations in
physical movement and mobility"
The
key to the second suggestion is that the emphasis is placed on PT
treating
'functional limitations' only as it relates to physical movement and
mobility.
While
these approaches MAY be successful, I am concerned that this is the
beginning of something very ominous. If the PT Practice
Guidelines
are used as promotional tools to physicians, providers and consumers
then
may people are going to be left thinking that PT's are experts in
function
and mobility. With the tremendous media exposure, name
recognition
and clout possessed by the PT profession, we are facing what may
turn out
to be an tremendous challenge to our professional
integrity.
Unfortunately,
the problem goes even deeper than legislation. Least
you think
that the PT profession is not promoting themselves as "daily
living" experts, here is a short expert from the APTA
Consumer Information web page:
Today, Betty is back
in
her garden. The skills she learned from her physical therapists
allow her to maneuver through the uneven ground of her
backyard.
She has the strength to stand on both legs without a walker or a
cane and pull dead vines from her morning glories. She can
even
carry the garden hose to water her vegetables. 'I feel so blessed
that I had that therapy,' she says"
While this may seem like a
'doom and
gloom' message, there is a light at the end of tunnel. Of course,
it
is up to each of us to search for and find that light. I hope that
future issues of this newsletter will indirectly provide both motivation
and direction on how occupational therapy can keep in place its
unique
contribution to health care.
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