Standards of practice for physical therapy and the accompanying criteria.

PREAMBLE 

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 of Practice for Physical Theraphy 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 individuals served, the physical therapy personnel affiliated with the service, and the community.

Criteria The statement:

* Defines the scope and limitations of the service.

* Lists the goals and objectives of the service.

* Is reviewed annually.

B. Organizational Plan

The physical therapy service has a written organizational plan.

Criteria The plan:

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

Criteria

The policies and procedures, which are reviewed regularly and revised as necessary, address pertinent information including (but not limited to) the following:

* Clinical education.

* Clinical research.

* Interdisciplinary collaboration.

* Criteria for access to, initiation of, continuation of, referral of, and termination of care.

* Equipment maintenance.

* Environmental safety.

* Fiscal management.

* Infection control.

* Job/position descriptions.

* Competency assessment.

* Medical emergencies.

* Patient/client care policies and protocols.

* Patient/client rights.

* Personnel-related policies.

* Quality/performance improvement.

* Documentation.

* Staff orientation.

The policies and procedures meet the requirements of state law and external agencies.

D. Administration

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

Criteria The director:

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

* Ensures compliance with current APTA documents, including Standards of Practice for Physical Therapy, Guide for Professional Conduct, and Guide for Conduct of the Affiliate Member

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

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

* Reviews and updates policies and procedures.

* Provides training that assures 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 is based on sound accounting principles.

Criteria The fiscal management plan includes:

* Preparation and monitoring of a budget that provides for optimum use of resources.

* Accurate recording and reporting of financial information.

* Conformance with legal requirements.

* Cost-effective utilization of resources.

* A fee schedule that is consistent with cost of services and that is within customary norms of fairness and reasonableness.

F. Quality/Performance Improvement

The physical therapy service has a written plan for continuous improvement of the performance of services provided.

Criteria The plan:

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

* Provides a mechanism for documentation of performance improvement.

* Is consistent with requirements of external agencies, if 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.

Criteria The service:

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

* Provides staff expertise that is appropriate to the patient/clients served.

* Provides for appropriate staff-to-patient/client ratios.

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

H. Staff Development

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

Criteria The plan:

* Provides for consideration of self-assessments, individual goal setting, and organization needs in directing continuing education and learning activities.

* Includes strategies for long-term learning and professional development.

I. Physical Setting

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

Criteria The physical setting:

* Meets all applicable legal requirements for health and safety.

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

Criteria The collaboration includes:

* An interdisciplinary team approach to patient/client care.

* Interdisciplinary patient/client and family education.

* Interdisciplinary staff development and continuing education.

III. PROVISION OF SERVICES

A. Informed Consent

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

Criteria The information provided to the patien/client should include the following:

* A clear description of the proposed intervention/treatment.

* A statement of material (decisional) risks associated with the proposed intervaention/treatment.

* A statement of expected benefits of the proposed intervention/treatment.

* A comparison of the benefits and risks possible both with and without intervention/treatment.

* An explanation of reasonable alternatives to the recommended intervention/treatment.

Informed consent requires:

* Consent by a competent adult.

* Consent by a parent/legal guardian as the surrogate decision maker when the adult patient/client is not competent or when the patient/client is a minor

The patient's/client's acknowledgment of understanding and consent before the intervention/treatment proceeds.

B. Initial Examination and Evaluation

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

Criteria The examination:

* Is documented, dated, and signed by the physical therapist who performed the examination.

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

* Incorporates appropriate objective tests and measures to facilitate outcome measurement.

* Documents sufficient data to establish a plan of care.

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

C. Plan of Care

The physical therapist establishes and provides a plan of care for the individual based on the results of the examination and evaluation and on patient/client needs.

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

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

Criteria The plan of care includes:

* Realistic goals and expected functional outcomes.

* Intervention/treatment, including its frequency and duration.

* Documentation that is dated and signed by the physical therapist who established the plan of care.

D. Intervention/Treatment

The physical therapist provides, or delegates and supervises, the physical therapy intervention/treatment consistent with the results of the examination and evaluation and plan of care.

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

Criteria The intervention/treatment is:

* Provided under the ongoing personal care or supervision of the physical therapist.

* Provided in such a way that delegated responsibilities are commensurate with the qualifications and legal limitations of the physical therapy personnel involved in the intervention/treatment.

* Altered in accordance with changes in individual response or status.

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

* Interdisciplinary when necessary to meet the needs of the patient/client.

Documentation of the services provided includes:

* Date and signature of the physical therapist and/or of the physical therapist assistant when permissible by law.

E. Reexamination and Reevaluation

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

Criteria The physical therapist:

* Periodically documents, dates, and signs the patient/client reexamination and modifications of the plan of care.

F. Discharge/Discontinuation of Treatment or Intervention 

The physical therapist discharges the patient/client from physical therapy intervention/treatment when the goals or projected outcomes for the patient/client have been met.

Physical therapy intervention/treatment shall be discontinued when the goals are achieved, the patient/ client declines to continue care, the patient/client is unable to continue, or the physical therapist determines that intervention/treatment is no longer warranted.

Criteria Discharge documentation shall include:

* The patient's/client's status at discharge and functional outcomes/goals achieved.

* Dating and signing of the discharge summary by the physical therapist

* When a patient/client is discharged prior to goal achievement, the patient's/client's status 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 assistant participates in the education of physical therapist assistant students and other student health professionals.

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.

Criteria

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 physical therapist patient/client management.

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.

Criteria

The physical therapist demonstrates community responsibility by participating in community and community agency activities; educating the public, including prevention and health promotion activities; formulating public polity; or providing pro bono physical therapy services.