Standards of Practice for Physical Therapy and the Criteria.

PREAMBLE

The physical therapy profession is committed to providing an optimal level of service delivery and to striving for excellence in practice. The House of Delegates of the American Physical Therapy Association, as the formal body that represents the profession, attests to this commitment by adopting and promoting the following Standards of Practice for Physical Therapy. These Standards are the profession's statement of conditions and performances that are essential for provision of high-quality physical therapy. The Standards provide a foundation for assessment of physical therapy practice.

The Criteria for the Standards, promulgated by APTA's Board of Directors, are italicized beneath the Standards to which they apply.

I. LEGAL/ETHICAL CONSIDERATIONS

   A. Legal Considerations

   The physical therapist complies with all the legal requirements of
   jurisdictions regulating the practice of physical therapy.

   The physical therapist assistant complies with all the legal requirements
   of jurisdictions regulating the work of the assistant.

   B. Ethical Considerations

   The physical therapist practices according to the Code of Ethics of the
   American Physical Therapy Association.

   The physical therapist assistant complies with the Standards of Ethical
   Conduct for the Physical Therapist Assistant of the American Physical
   Therapy Association.

II. ADMINISTRATION OF THE PHYSICAL THERAPY SERVICE

   A. Statement of Mission, Purposes, and Goals

   The physical therapy service has a statement of mission, purposes, and
   goals that reflects the needs and interests of the patients and clients
   served, the physical therapy personnel affiliated with the service, and the
   community.

   The statement of mission, purposes, and goals:

   * Defines the scope and limitations of the physical therapy service.

   * Identifies the goals and objectives of the service.

   * Is reviewed annually.

   B. Organizational Plan

   The physical therapy service has a written organizational plan.

   The organizational plan:

   * Describes relationships among components within the physical therapy
   service and, where the service is part of a larger organization, between
   the service and other components of that organization.

   * Ensures that the service is directed by a physical therapist.

   * Defines supervisory structures within the service.

   * Reflects current personnel functions.

   C. Policies and Procedures

   The physical therapy service has written policies and procedures that
   reflect the operation of the service and that are consistent with the
   mission, purposes, and goals of the service.

   The written policies and procedures:

   *  Are reviewed regularly and revised as necessary.

   * Meet the requirements of state law and external agencies.

   * Apply to, but are not limited to:
      * Clinical education
      * Clinical research
      * Interdisciplinary collaboration
      * Criteria for access to care
      * Criteria for initiation and
      continuation of care
      * Criteria for referral to other
      appropriate health care
      providers
      * Criteria for termination of
      care
      * Equipment maintenance
      * Environmental safety
      * Fiscal management
      * Infection control
      * Job/position descriptions
      * Competency assessment
      * Medical emergencies
      * Care of patients and clients, including guidelines
      * Rights of patients and clients
      * Personnel-related policies
      * Improvement of quality of care and performance of
      services
      * Documentation
      * Staff orientation
   D. Administration

   A physical therapist is responsible for the direction of the physical
   therapy service.

   The director of physical therapy service:

   * Ensures compliance with local, state, and federal requirements.

   * Ensures compliance with current APTA documents, including Standards of
   Practice for Physical Therapy and the Criteria, Code of Ethics, Guide for
   Professional Conduct, Standards of Ethical Conduct for the Physical
   Therapist Assistant, and Guide for Conduct of the Affiliate Member.

   * Ensures that services are consistent with the mission, purposes, and
   goals of the physical therapy service.

   * Ensures that services are provided in accordance with established
   policies and procedures.

   * Reviews and updates policies and procedures.

   * Provides for training that ensures continued competence of physical
   therapy support personnel.

   * Provides for continuous in-service training on safety issues and for
   periodic safety inspection of equipment by qualified individuals.

   E. Fiscal Management

   The director of the physical therapy service, in consultation with staff
   and appropriate administrative personnel, is responsible for planning for,
   and allocation of, resources. Fiscal planning and management of the service
   are based on sound accounting principles.

   The fiscal management plan:

   * Includes a budget that provides for optimal use of resources.

   * Ensures accurate recording and reporting of financial information.

   * Ensures compliance with legal requirements.

   * Allows for cost-effective utilization of resources.

   * Uses a fee schedule that is consistent with the cost of physical therapy
   services and that is within customary norms of fairness and reasonableness.

   F. Improvement of Quality of Care and Performance

   The physical therapy service has a written plan for continuous improvement
   of quality of care and performance of services.

   The improvement plan:

   * Provides evidence of ongoing review and evaluation of the physical
   therapy service.

   * Provides a mechanism for documenting improvement in quality of care and
   performance.

   * Is consistent with requirements of external agencies, as applicable.

   G. Staffing

   The physical therapy personnel affiliated with the physical therapy service
   have demonstrated competence and are sufficient to achieve the mission,
   purposes, and goals of the service.

   The physical therapy service:

   * Meets all legal requirements regarding licensure and certification of
   appropriate personnel.

   * Ensures that the level of expertise within the service is appropriate to
   the needs of the patients and clients served.

   * Provides for appropriate ratios of personnel to patients.

   * Provides for appropriate ratios of support personnel to professional
   personnel.

   H. Staff Development

   The physical therapy service has a written plan that provides for
   appropriate and ongoing staff development.

   The staff development plan:

   * Includes self-assessment, individual goal setting; and organizational
   needs in directing continuing education and learning activities.

   * Includes strategies for lifelong learning and professional and career
   development.

   I. Physical Setting

   The physical setting is designed to provide a safe and accessible
   environment that facilitates fulfillment of the mission, purposes, and
   goals of the physical therapy service. The equipment is safe and sufficient
   to achieve the purposes and goals of physical therapy.

   The physical setting:

   * Meets all applicable legal requirements for health and safety.

   * Meets space needs appropriate for the number and type of patients and
   clients served.

   The equipment:

   * Meets all applicable legal requirements for health and safety.

   * Is inspected routinely.

   J. Interdisciplinary Collaboration

   The physical therapy service collaborates with all appropriate disciplines.

   The collaboration:

   * Uses an interdisciplinary team approach to the care of patients and
   clients.

   * Provides interdisciplinary instruction of patients, clients, and
   families.

   * Ensures interdisciplinary professional development and continuing
   education.

III. PROVISION OF SERVICES

   A. Informed Consent

   The physical therapist has sole responsibility for providing information to
   the patient and for obtaining informed consent in accordance with
   jurisdictional law before initiating intervention.

   The information provided to patients:

   * Clearly describes the proposed intervention.

   * Delineates material (decisional) risks associated with the proposed
   intervention.

   * Identifies expected benefits of the proposed intervention.

   * Compares the benefits and risks possible both with and without the
   proposed intervention.

   * Explains reasonable alternatives to the proposed intervention.

   Informed consent:

   * Requires consent of a competent adult.

   * Requires consent of a parent/legal guardian as the surrogate decision
   maker when the adult patient is not competent or when the patient is a
   minor.

   * Requires the patient, client, or legal guardian to acknowledge
   understanding of the intervention and to give consent before intervention
   is initiated.

   B. Initial Examination and Evaluation

   The physical therapist performs and documents an initial examination and
   evaluates the data to identify problems and determine the diagnosis prior
   to intervention.

   The physical therapist examination:

   * Is documented, dated, and appropriately authenticated by the physical
   therapist who performed it.

   * Identifies the physical therapy needs of the patient or client.

   * Incorporates appropriate tests and measures to facilitate outcome
   measurement.

   * Produces data that are sufficient to allow evaluation, diagnosis,
   prognosis, and the establishment of a plan of care.

   * May result in recommendations for additional services to meet the needs
   of the patient or client.

   C. Plan of Care

   The physical therapist establishes and provides a plan of care for the
   patient based on evaluation of the examination data and patient needs.

   The physical therapist involves the patient and appropriate others in the
   planning, implementation, and assessment of the intervention program.

   The physical therapist, in consultation with appropriate disciplines, plans
   for discharge of the patient, taking into consideration the level of goal
   attainment, and provides for appropriate follow-up or referral.

   The plan of care:

   * Is based on the examination, evaluation, diagnosis, and prognosis.

   * Identifies realistic long-term and short-term goals and expected
   functional outcomes.

   * Describes the proposed intervention, including frequency and duration.

   * Includes documentation that is dated and appropriately authenticated by
   the physical therapist who established the plan of care.

   D. Intervention

   The physical therapist provides, or delegates and supervises, the physical
   therapy intervention in a manner that is consistent with the examination
   data, the evaluation, and the plan of care.

   The physical therapist documents, on an ongoing basis, services provided,
   responses to services, and changes in status of the patient relative to the
   plan of care.

   The intervention:

   * Is based on the examination, evaluation, diagnosis, prognosis, and plan
   of care.

   * Is provided under the ongoing direct care or supervision of the physical
   therapist.

   * Is provided in such a way that delegated responsibilities are
   commensurate with the qualifications and legal limitations of the physical
   therapy support and professional personnel involved in the intervention.

   * Is altered in accordance with changes in response or status.

   * Is provided at a level that is consistent with current physical therapy
   practice.

   * Is interdisciplinary when necessary to meet the needs of the patient or
   client.

   Documentation of the intervention:

   * Is dated and appropriately authenticated by the physical therapist or,
   when permissible by law, by the physical therapist assistant, or both.

   E. Reexamination and Reevaluation

   The physical therapist continually reexamines the patient, reevaluates the
   data, and modifies the plan of care or discontinues the plan of care
   accordingly.

   The physical therapist reexamination:

   * Is documented, dated, and appropriately authenticated by the physical
   therapist who performs it.

   * Includes modifications to the plan of care.

   F. Discharge/Discontinuation of Intervention

   The physical therapist discharges the patient from physical therapy
   intervention when the goals and projected outcomes have been attained.

   Intervention is discontinued when the goals and expected functional
   outcomes are attained, the patient declines to continue care, the patient
   is unable to continue receiving care, or the physical therapist determines
   that intervention is no longer warranted.

   Discharge documentation:

   * Includes the status of patient or client at discharge and the goals and
   functional outcomes attained.

   * Is dated and appropriately authenticated by the physical therapist who
   performed the discharge.

   * Includes, when a patient or client is discharged prior to attainment of
   goals and functional outcomes, the status of the patient or client and the
   rationale for discontinuation.

IV. EDUCATION

   The physical therapist is responsible for individual professional
   development. The physical therapist assistant is responsible for individual
   career development.

   The physical therapist participates in the education of physical therapist
   students, physical therapist assistant students, and students in other
   health professions.

   The physical therapist educates and provides consultation to consumers and
   the general public regarding the purposes and benefits of physical therapy.

   The physical therapist educates and provides consultation to consumers and
   the general public regarding the roles of the physical therapist and the
   physical therapist assistant.
      The physical therapist:

      * Educates and provides consultation to consumers
      and the general public regarding the roles of the
      physical therapist, the physical therapist assistant,
      and other support personnel.

V. RESEARCH

   The physical therapist applies research findings to practice and
   encourages, participates in, and promotes activities that establish the
   outcomes of patient/client management provided by the physical therapist.

   The physical therapist supports collaborative and interdisciplinary
   research.

VI. COMMUNITY RESPONSIBILITY

   The physical therapist demonstrates community responsibility by
   participating in community and community agency activities, educating the
   public, formulating public policy, or providing pro bono physical therapy
   services.
      The physical therapist:

      * Participates in community and community agency
      activities.

      * Educates the public, including prevention education
      and health promotion.

      * Helps formulate public policy

      * Provides pro bono physical therapy services.

Standards:

Adopted by the House of Delegates, June 1980 Amended June 1985, June 1991, June 1996

Criteria:

Adopted by the Board of Directors, March 1993 Amended March 1989, March 1991, March 1993, November 1994, March 1995, March 1997