Standards of Practice for Physical Therapy and the Criteria.

The Standards of Practice for Physical Therapy are promulgated by APTA's House of Delegates; Criteria for the Standards are promulgated by APTA's Board of Directors. Criteria are italicized beneath the Standards to which they apply. To view the most recent version of the Standards of Practice for Physical Therapy and the Criteria, visit the APTA Web site at www.apta.org. OR: To obtain a copy of the most recent version of the Standards of Practice for Physical Therapy and the Criteria, contact APTA at 800/399-2782, ext. 3395.

The physical therapy profession is committed to providing an optimum 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.

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 federal and state law and external agencies.

* Apply to, but are not limited to:

- Clinical education

- Clinical research

- Multidisciplinary 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/clients, including guidelines 

- Rights of patients/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 physical therapist responsible for the direction of the 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, Guide to Physical Therapist Practice, 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 training of physical therapy support personnel that ensures continued competence for their job description.

* 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 physical therapy staff and appropriate administrative personnel, participates in 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 demonstrate 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/clients served.

* Provides appropriate professional and support personnel to meet the needs of the patient/client population.

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 career development.

* Includes mechanisms to foster mentorship activities.

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 the service.

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. Multidisciplinary Collaboration

The physical therapy service collaborates with all appropriate disciplines.

The collaboration when appropriate:

* Uses a multidisciplinary team approach to the care of patients and clients.

* Provides multidisciplinary instruction of patients and clients and families.

* Ensures multidisciplinary professional development and continuing education.

III. PROVISION OF SERVICES

A. Informed Consent

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

In obtaining the informed consent of the patient or client, the physical therapist:

* Clearly describes the proposed intervention, and delineates the expected benefits and material (decisional) risks as known with the proposed intervention.

* Compares known benefits and risks with and without the proposed intervention, and explains reasonable alternatives to the intervention.

Patient or client informed consent obtained by the physical therapist:

* Requires consent of a competent adult.

* Requires consent of a parent or 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 was 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 or client based on the evaluation of the examination data and patient or client 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 or client, 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 anticipated goals and expected 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 directs 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 the services, and changes in the status of the patient or client 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 direction and supervision of the physical therapist.

* Is provided in such a way that directed and supervised responsibilities are commensurate with the qualifications and the legal limitations of the physical therapist assistant.

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

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

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

* Documentation of the intervention is consistent with the Guidelines for Physical Therapy Documentation.

* 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 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 or client 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 or client declines to continue care, the patient or client is unable to continue receiving care, or the physical therapist determines that intervention is no longer warranted.

Discharge documentation:

* Includes the status of the 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 or client management provided by the physical therapist.

The physical therapist supports collaborative and multidisciplinary research.

The physical therapist:

* Ensures that his or his knowledge of research literature related to practice is current.

* Ensures that the rights of study subjects are protected, and the integrity of research is maintained.

* Participates in the research process as appropriate to individual education, experience, and expertise.

* Educates physical therapists, physical therapist assistants, students, other health professionals, and the general public about the outcomes of physical therapist practice.

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.

Adopted by the House of Delegates, APTA, June 1980.

Amended June 2000, June 1999, June 1996, June 1991, June 1985.