WCPT Guidelines fr Physical Therapist Prfessinal Entry-Level Educatin
Missin Statement The Wrld Cnfederatin fr Physical Therapy wrks t imprve glbal health by: Representing the physical therapy prfessin internatinally Encuraging high standards f physical therapy research, educatin and practice Supprting cmmunicatin and exchange f infrmatin amng Regins and Member Organisatins f WCPT Cllabrating with internatinal and natinal rganisatins Date adpted: Apprved at the 16 th General Meeting f WCPT June 2007 Date fr review: 2011 Related WCPT Plicies: Declaratin f Principle: Educatin Psitin Statement: Descriptin f Physical Therapy Cpyright Wrld Cnfederatin fr Physical Therapy 2007 Page 2 f 49
Cntents Sectin 1: Intrductin... 5 1.1 Purpse... 5 1.2 Backgrund... 5 1.3 Target Audience... 6 1.4 Applicatin... 6 Sectin 2: The Nature f Physical Therapist Practice... 7 Sectin 3: The Nature f Physical Therapist Educatin... 8 Sectin 4: The Curriculum... 10 4.1 Intrductin... 10 4.2 Cntent... 10 4.3 Teaching, Learning and Assessment Strategies... 11 4.4 Skill Develpment... 11 Sectin 5: Physical Therapist Practice Expectatins... 12 5.1 Physical Therapist Practice... 12 5.1.1 Patient/Client Care/Management... 12 5.1.1.1 Assessment/Examinatin... 12 5.1.1.2 Evaluatin... 13 5.1.1.3 Diagnsis... 13 5.1.1.4 Prgnsis... 14 5.1.1.5 Plan f Care/Interventin/Treatment... 14 5.1.1.6 Interventins/treatments... 14 5.1.1.7 Re-examinatin/Determinatin f Outcmes... 15 5.1.1.8 Preventin, Health Prmtin, Fitness, and Wellness... 15 5.1.1.9 Evidence-Based Practice... 16 5.1.1.10 Management f Care/Interventin/Treatment Delivery... 16 5.1.2 Cmmunicatin... 17 5.1.3 Cnsultatin/Screening... 17 5.1.4 Critical Analysis/Clinical Reasning/Clinical Decisin Making... 17 5.1.5 Educatin... 17 Page 3 f 49
5.1.6 Management/Administratin/Supervisin... 18 5.1.7 Research... 18 5.2 Practice Settings... 18 5.3 Prfessinal Behaviurs... 19 5.3.1 Accuntability... 19 5.3.2 Altruism... 19 5.3.3 Cmpassin/Caring... 19 5.3.4 Cultural Cmpetence... 19 5.3.5 Ethical Behaviur... 19 5.3.6 Integrity... 20 5.3.7 Persnal/Prfessinal Develpment... 20 5.3.8 Prfessinal Duty... 20 5.3.9 Scial Respnsibility and Advcacy... 20 5.3.10 Teamwrk... 21 Appendix A Patient/Client Care/Management... 22 A) Examinatin/assessment/evaluatin... 22 B) Interventins/Treatments... 27 Appendix B Practice Settings... 37 Appendix C Glssary... 38 Appendix D Resurces/Bibligraphy... 44 Acknwledgements... 46 References... 47 Page 4 f 49
Sectin 1: Intrductin 1.1 Purpse The Wrld Cnfederatin fr Physical Therapy (WCPT) is a cnfederatin f natinal physical therapy assciatins. It was funded in 1951 and in 2007 has 101 Member Organisatins rganised in five gegraphic regins: Africa; Asia Western Pacific; Eurpe; Nrth America Caribbean; Suth America. Thrugh its Member Organisatins WCPT represents ver 270,000 physical therapists wrldwide. WCPT intends that these internatinal guidelines fr physical therapist 1 prfessinal entrylevel educatin are used wrldwide. They may be used fr curriculum planning, curriculum develpment, and in internal and external quality assurance prcesses and standards assessment. While the guidelines have been develped with input frm and specific reference t the Member Organisatins f WCPT, the intent is that they may be used by cuntries where physical therapy assciatins and educatin prgrammes d nt currently exist and where the prfessin is nt represented in WCPT. 1.2 Backgrund At the 15 th General Meeting f WCPT (2003), the fllwing mtin was passed: That WCPT develp internatinal guidelines fr physical therapist prfessinal educatin (entry level) that can be utilised wrldwide. The prcess shall include: Determining practice expectatins f the graduate f prfessinal physical therapist educatin prgrammes Develping curricular cntent guidelines fr prfessinal physical therapist educatin It is acknwledged that the develpment f the prfessin varies wrldwide and that fr sme cuntries, with a well-established, recgnised and regulated prfessin, mechanisms already exist t prvide quality assurance in physical therapy entry-level educatinal prvisin. Hwever, this is nt universal and must be brn in mind when reviewing the dcument. It is anticipated that different cuntries will use these curriculum guidelines t varying extents dependent n their needs. While sme aspects f these guidelines may already be implemented, ther aspects may include elements t which cuntries may strive t fulfil. It is the view f WCPT that all cuntries shuld be striving twards fulfilling the curriculum described in these guidelines. 1 Physical Therapy and Physitherapy: The prfessinal title and term used t describe the prfessin s practise vary and depend largely n the histrical rts f the prfessin in the cuntry f the WCPT Member Organisatin. The mst generally used titles and terms are physical therapist r physitherapist and physical therapy and physitherapy. Physical therapist and physical therapy are used in this dcument but may be replaced by WCPT Member Organisatins in favur f thse terms fficially used by them and their members withut any change in the meaning f the dcument. Page 5 f 49
These guidelines are infrmed by WCPT s existing plicy dcuments, such as the Descriptin f Physical Therapy, 1 Declaratins f Principles, 2-16 Psitin Statements, 17-25 and Endrsements. 26-28 These Endrsements als serve t place the curriculum guidelines in the cntext f internatinal plicy. 1.3 Target Audience These guidelines may be used by: physical therapy educatrs health and educatin authrities mnitring and regulatry bdies natinal physical therapy rganisatins WCPT Member Organisatins ptential WCPT Member Organisatins gvernment plicy makers thers, wh have an interest in prviding physical therapist prfessinal entry-level educatin prgrammes 1.4 Applicatin The guidelines may be used fr a variety f purpses. They prvide a means f describing the nature and characteristics f physical therapist prfessinal entry-level educatinal prgrammes. They represent general expectatins abut standards fr the award f qualificatins at an entry level and articulate attributes and capabilities that thse pssessing such qualificatins shuld be able t demnstrate. They are an imprtant external surce f reference fr designing and develping new physical therapist prfessinal entry-level educatinal prgrammes. They prvide general guidance fr articulating the learning utcmes assciated with the prgramme. Guidelines prvide fr variety and flexibility in the design f prgrammes and encurage innvatin within an agreed verall cnceptual framewrk. The guidelines als prvide a framewrk fr internal quality assurance prcesses. They enable the learning utcmes specified fr a particular prgramme t be reviewed and evaluated against agreed general expectatins abut standards. The guidelines may als infrm physical therapists, managers, service prviders, and thers delivering health services as it details the level f attributes and skills f physical therapists n entry int the prfessin. These guidelines are but ne f a number f surces f infrmatin that may be drawn upn fr the purpses f academic review and fr making judgments abut threshld standards being met (refer t the bibligraphy prvided at appendix D). Page 6 f 49
It is acknwledged that individual prgrammes/cuntries may mdify these guidelines and interpret them within the cntext f their situatin, whilst aiming t fulfil the learning utcmes these guidelines are designed t facilitate. Sectin 2: The Nature f Physical Therapy Practice In the cntext f health, health being a state f cmplete physical, mental and scial wellbeing and nt merely the absence f disease r infirmity (WHO 1948) 2, physical therapists prvide services t peple and ppulatins t develp, maintain, and restre maximum mvement and functinal ability thrughut the lifespan. Physical therapist practice includes the prvisin f services in circumstances where mvement and functin are threatened by the prcess f aging r that f injury, disrders, r diseases. Functinal mvement is central t what it means t be healthy. 1 Physical therapist practice is cncerned with identifying and maximising quality f life and functinal mvement ptential, within the spheres f prmtin, preventin, maintenance, interventin/treatment, habilitatin and rehabilitatin. This encmpasses physical, psychlgical, emtinal, and scial well being. Physical therapist practice invlves the interactin between physical therapist, patients r clients, families, care givers, ther health care prviders, and cmmunities, in a prcess f assessing mvement ptential and in establishing agreed upn gals and bjectives using knwledge and skills unique t physical therapists. 1 Physical therapists are qualified and prfessinally required t: Undertake a cmprehensive examinatin/assessment/evaluatin f the patient/client r needs f a client grup Frmulate a diagnsis, prgnsis, and plan Prvide cnsultatin within their expertise and determine when patients/clients need t be referred t anther healthcare prfessinal Implement a physical therapist interventin/treatment prgramme Determine the utcmes f any interventins/treatments Make recmmendatins fr self management The physical therapist s extensive knwledge f the bdy and its mvement needs and ptential is central t determining diagnsis and interventin/treatment strategies. The practice settings will vary in relatin t whether physical therapy is cncerned with health prmtin, preventin, maintenance, interventin/treatment, habilitatin, r rehabilitatin. 2 Preamble t the Cnstitutin f the Wrld Health Organizatin as adpted by the Internatinal Health Cnference, New Yrk, 19 June - 22 July 1946; signed n 22 July 1946 by the representatives f 61 States (Official Recrds f the Wrld Health Organizatin, n. 2, p. 100) and entered int frce n 7 April 1948. Page 7 f 49
Physical therapists perate as independent practitiners, 3 as well as members f health service prvider teams, and are subject t the ethical principles f WCPT. 3 They are able t act as first cntact practitiners, and patients/clients may seek direct services withut referral frm anther health care prfessinal. 1, 7 Physical therapy is an established and regulated prfessin, with specific prfessinal aspects f clinical practice and educatin, indicative f diversity in scial, ecnmic, cultural, and plitical cntexts. But it is clearly a single prfessin, and the first prfessinal qualificatin, btained in any cuntry, represents the cmpletin f a curriculum that qualifies the physical therapist t use the prfessinal title and t practice as an independent prfessinal. There may be unique gegraphic factrs in a cuntry r regin that will influence physical therapist practice and educatin. [Cuntry r regin t insert anything apprpriate fr their needs] Sectin 3: The Nature f Physical Therapy Educatin WCPT recgnises the fact that there is cnsiderable diversity in the scial, ecnmic, cultural, and plitical envirnments in which physical therapist educatin is cnducted thrughut the wrld. WCPT recmmends that physical therapist entry-level educatinal prgrammes be based n university r university level studies, f a minimum f fur years, independently validated and accredited as being at a standard that accrds graduates full statutry and prfessinal recgnitin. 2 WCPT acknwledges that there is innvatin and variatin in prgramme delivery and in entry-level qualificatins, including first university degrees (Bachelrs/Baccalaureate/Licensed r equivalent) 4, Masters and Dctrate entry qualificatins. What is expected is that any prgramme shuld deliver a curriculum that will enable physical therapists t attain the knwledge, skills, and attributes described in these guidelines. Prfessinal educatin prepares physical therapists t be autnmus practitiners. 7 Physical therapist entry-level educatinal prgrammes integrate thery, evidence and practice alng a cntinuum f learning. This begins with admissin t an accredited physical therapy prgramme and ending with retirement frm active practice. 2 The gal f physical therapy educatin is the cntinuing develpment f physical therapists, wh are entitled, cnsistent with their educatin, t practice the prfessin withut limitatin in accrdance with the definitin f physical therapist practice in individual cuntries. The curricula fr physical therapy educatin shuld be relevant t the health and scial needs f the particular natin. 3 Practitiner the term practitiner encmpasses all rles that a physical therapist may assume such as patient/client care, management, research, plicy maker, educatr, and cnsultant. 4 The Licensed degree in sme parts f the Wrld can be referred t as a Licentiate/Licencié/Licenciatura/Licentiat r similar translatin. It equates t a first level university degree. Page 8 f 49
The term accredited is used in relatin t physical therapy educatin t describe a prgramme, which is regularly evaluated accrding t established educatinal standards. The first prfessinal qualificatin shuld represent cmpletin f a curriculum that qualifies the physical therapist fr practice as an independent autnmus prfessinal. An integral cmpnent f the curriculum fr the first prfessinal qualificatin is direct clinical experience under the supervisin f apprpriately qualified physical therapists r ther relevant prfessinals. As skills and experience increase, clinical educatin invlves access t increasing levels f respnsibility. The curriculum shuld equip physical therapists t practice in a variety f health care settings including, but nt limited t, institutinal, industrial, ccupatinal, and primary health care that encmpass urban and rural cmmunities. Cnsideratin shuld als be given t preparing physical therapists t wrk in envirnments that reflect the delivery mdels that perate in different cuntries. The curriculum and cntinuing prfessinal develpment (CPD) pprtunities shuld prepare physical therapists with knwledge f educatinal appraches t facilitate the supervisin, educatin, and transference f skills t thers. Life-lng learning and a cmmitment t prfessinal develpment is an attribute f a cmpetent physical therapist. Physical therapists shuld be equipped fr evidence-based practice. 5 Knwledge and understanding f research methdlgies shuld be included in physical therapist prfessinal entry-level educatinal prgrammes. 6 Physical therapist prfessinal entry-level educatinal prgrammes shuld be cnducted by physical therapists and ther apprpriately qualified educatrs able t transfer knwledge and skills abut physical therapist examinatins/assessment/ evaluatins, and interventins/treatment and their utcmes, including the critical analysis f theries and methds f physical therapy. Educatrs shuld have apprpriate qualificatins and/r experience in teaching and learning. They shuld als have an awareness and understanding f the culture in which they are teaching. In additin, they shuld include a variety f appraches t student assessment (e.g., frmative and summative). Basic and fundatinal sciences (e.g., anatmy, histlgy, physilgy, pathlgy imaging, pharmaclgy, etc), behaviural and scial sciences (e.g., psychlgy, ethics, scilgy), mvement sciences (e.g., kinesilgy, bimechanics, exercise science) and research methdlgy shuld be taught by individuals with apprpriate educatin and/r credentials in the area. Page 9 f 49
The gals, cntent, frmat, and evaluatin f the physical therapist prfessinal entrylevel educatin prgrammes are the respnsibility f the faculty but shuld invlve the active participatin f the natinal physical therapy assciatin. Physical therapist prfessinal entry-level educatinal prgrammes acknwledge that the requirements f the prfessinal and statutry regulatry bdies need t be incrprated int the design f prgrammes. 11, 18 Thus, higher educatin institutins and service prviders are encuraged t wrk cllabratively in the design and delivery f their curricula. Physical therapist prfessinal entry-level educatinal prgrammes shuld make clear their system f academic awards/credit rating in rder t facilitate transferability and recgnitin in ther cuntries. Physical therapist prfessinal entry-level educatinal prgrammes need t adequately prepare and equip physical therapists t practice in a variety f settings able t deliver services in bth urban and rural cmmunities, acknwledging their rles as facilitatrs and educatrs f ther 2, 10 health persnnel necessary fr the attainment f physical therapy and patient/client gals. Physical therapist prfessinal entry-level educatinal prgrammes need t equip students with the necessary cmmunicatin and decisin-making skills t wrk in cllabratin with their patients/clients, carers, ther prfessinals, and clleagues. Physical therapist prfessinal entry-level educatinal prgrammes need t prmte as apprpriate multiprfessinal and interprfessinal learning experiences and practice. Thus, the verall aim f physical therapist prfessinal entry-level educatinal prgrammes is t educate physical therapists wh are knwledgeable, self-assured, adaptable, reflective, humanistic, and service-riented and wh, by virtue f critical thinking, life-lng learning, and ethical values, render independent judgments cncerning patient/client needs. Sectin 4: The Curriculum 4.1 Intrductin The curriculum incrprates cnsideratin f the changing rles and respnsibilities f the physical therapist practitiner and the dynamic nature f the prfessin and the health care delivery system. A review f the curriculum ccurs n a regular basis. 4.2 Cntent The physical therapist prfessinal curriculum includes cntent and learning experiences in the bilgical and physical sciences necessary fr initial practice f the prfessin (e.g., anatmy/cellular bilgy, histlgy, physilgy, exercise physilgy, exercise science, bimechanics, kinesilgy, neurscience, pathlgy, imaging, and pharmaclgy). The physical therapist prfessinal curriculum includes cntent and learning experiences in the scial/behaviural/technlgical sciences necessary fr initial practice f the prfessin (e.g., applied psychlgy, applied scilgy, cmmunicatin, ethics and Page 10 f 49
values, management, finance, teaching and learning, law, infrmatin cmmunicatin technlgy [ICT], clinical reasning, evidence-based practice, and applied statistics), including labratry r ther practical experiences. The physical therapist prfessinal curriculum includes cntent and learning experiences in the clinical sciences (e.g., cntent abut the cardivascular, pulmnary, endcrine, metablic, gastrintestinal, geniturinary, integumentary (skin), musculskeletal, and neurmuscular systems and the medical and surgical cnditins frequently seen by physical therapists). The physical therapist prfessinal curriculum includes cntent, learning experiences, and clinical educatin experiences fr each student that encmpass: management f patients/clients with an array f cnditins (e.g., musculskeletal, neurmuscular, cardivascular/pulmnary, integumentary) acrss the lifespan and the cntinuum f care practice in multiple settings pprtunities fr invlvement in interdisciplinary care 4.3 Teaching, Learning and Assessment Strategies The strategies and methds utilised in the curriculum fr teaching, learning, and assessment are determined by the institutin, but shuld reflect the learning utcmes assciated with the physical therapist prfessinal curriculum. An integrative apprach t the applicatin f thery and practice is supprted. Fundamental t the basis upn which students are prepared fr their prfessinal career is the prvisin f prgrammes f academic study and practice-based learning, which lay the fundatin fr career-lng prfessinal develpment and lifelng learning, t supprt best prfessinal practice and the maintenance f prfessinal standards. Examples f teaching and learning strategies fr delivering the curriculum may include didactic teaching in subject matter-based areas, cmpetency-based learning in didactic and clinical areas, and prblem-based learning. Student-centred learning shuld encurage students t take n increasing respnsibility fr identifying their wn learning needs. Graduates shuld be autnmus learners with develped lifelng learning skills and an ability t engage in cntinuing prfessinal develpment. 4.4 Skill Develpment The diverse nature f physical therapy practice requires a range f cmplex skills that shuld be develped lngitudinally thrughut the curriculum. Characteristically these skills shuld be intrduced and then develped thrugh practice n peers, with their cnsent, prir t applicatin in the clinical cntext. Students shuld practise bservatin, palpatin, and analysis f human perfrmance in classrm/labratries in the university/higher educatin institutin prir t experiences in the clinical cntext. Page 11 f 49
Sectin 5: Physical Therapist Practice Expectatins The curriculum that includes the characteristics inherent in a practicing prfessinal physical therapist is designed t prepare students t meet the fllwing physical therapist practice expectatins: 5.1 Physical Therapist Practice 5.1.1 Patient/Client Care/Management 5.1.1.1 Assessment/Examinatin Examine patients/clients by btaining a histry frm them and frm ther relevant surces [See Appendix A fr further details]. Examine patients/clients by perfrming systems reviews that may include screens f the fllwing [See Appendix A fr further details]: Cardivascular/pulmnary systems Musculskeletal system Neurmuscular system Integumentary system Cmmunicatin, emtinal state, cgnitin, language, and learning style Examine patients/clients by selecting and administering culturally apprpriate and acrss the life span (nenate, paediatric, adlescent, adult, senescence) tests and measures. Use hypthetic-deductive strategies t determine the specific selected tests and measures. Frmulate a shrt list f ptential diagnses r actins frm the earliest clues (histry and systems review) abut the patient/client. Perfrm specific tests and measures that reduce the selectin f the tests and measures. Utilise reliable and valid tests and measures whenever pssible and available. Tests and measures may include, but are nt limited t, thse that assess [See Appendix A fr further details]: Aerbic capacity/endurance Anthrpmetric characteristics Arusal, attentin, and cgnitin Page 12 f 49
Assistive technlgy and adaptive devices Circulatin (arterial, venus, lymphatic) Cranial and peripheral nerve integrity Envirnmental, hme, and wrk (jb/schl/play) access and barriers Ergnmics and bdy mechanics Gait, lcmtin, and balance Integumentary integrity Jint integrity and mbility Mtr functin (mtr cntrl and mtr learning) Muscle perfrmance Neurmtr develpment and sensry integratin Orthtic, prtective, and assistive technlgies, including Activities t Daily Living (ADL) Pain Psture Prsthetic requirements Range f mtin Reflex integrity Self-care and hme management Sensry and prpriceptive integrity Ventilatin and respiratin/gas exchange Wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin 5.1.1.2 Evaluatin Evaluate findings frm the assessment/examinatin (histry, systems review, and tests and measures) t make clinical judgments regarding patients/clients. 5.1.1.3 Diagnsis Frmulate a diagnsis utilising a prcess f clinical reasning that results in the identificatin f existing r ptential impairments, activity limitatins, participatin restrictins and envirnmental factrs. Page 13 f 49
Incrprate additinal infrmatin frm ther prfessinals, as needed, in the diagnstic prcess. Knw that the diagnsis may be expressed in terms f mvement dysfunctin r may encmpass categries f impairments, activity limitatins, participatin restrictins and envirnmental factrs. If the diagnstic prcess reveals findings that are nt within the scpe f the physical therapist s knwledge, experience r expertise, refer the patient/client t anther apprpriate practitiner. 5.1.1.4 Prgnsis Determine patient/client prgnses and identify the mst apprpriate interventin strategies fr patient/client care/management. 5.1.1.5 Plan f Care/Interventin/Treatment Deliver and manage a plan f care/interventin/treatment that is cnsistent with legal, ethical, and prfessinal bligatins and administrative plicies and prcedures f the practice envirnment. This may include cnsent t plan f care/interventin/treatment. Cllabrate with patients/clients, family members, payers (e.g., scial system, insurance cmpanies, patient self-pay), ther prfessinals, and ther individuals t determine a plan f care/interventin/treatment. Determine specific interventins with measurable utcme gals assciated with the plan f care/interventin/treatment. Establish a physical therapy plan f care/interventin/treatment that is safe, effective, and patient/client-centred. Determine patient/client gals and utcmes within available resurces and specify expected length f time t achieve the gals and utcmes. Mnitr and adjust the plan f care/interventin/treatment in respnse t patient/client status. Refer t anther agency/health practitiner cases, which are inapprpriate fr physical therapy. 5.1.1.6 Interventins/treatments Prvide, whenever pssible, evidence-based physical therapy interventins/treatments t achieve patient/client gals and utcmes. Interventins/treatments may include [See Appendix A fr further details]: Page 14 f 49
C-rdinatin, cmmunicatin, and dcumentatin Patient/client-related instructin Therapeutic exercise Functinal training in self-care and hme management Functinal training in wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin Manual therapy techniques Prescriptin, applicatin, and, as apprpriate, fabricatin f devices and equipment Airway clearance techniques Integumentary repair and prtectin techniques Electrtherapeutic mdalities Physical agents and mechanical mdalities Prvide physical therapy interventins/treatments aimed at preventin f impairments, activity limitatins, participatin restrictins, and injury including the prmtin and maintenance f health, quality f life, and fitness in all ages and ppulatins. Determine thse cmpnents f interventins that may be directed t supprt persnnel. Respnd effectively t patient/client and envirnmental emergencies in ne s practice setting. 5.1.1.7 Re-examinatin/Determinatin f Outcmes Re-examine patient/client thrughut the episde f care/interventin t evaluate the effectiveness f interventins/treatments and utcmes. Adjust plan f care/interventin/treatment in respnse t findings. Use valid and reliable utcme measures instruments, where available. Evaluate and recrd utcmes at the end f an episde f care/interventin/treatment. 5.1.1.8 Preventin, Health Prmtin, Fitness, and Wellness Prvide physical therapy services fr preventin, health prmtin, fitness, and wellness t individuals, grups, and cmmunities. Page 15 f 49
Prmte health, quality f life, independent living and wrkability by prviding infrmatin n health prmtin, fitness, wellness, disease, impairment, activity limitatins, participatin restrictins, and health risks related t age, gender, culture, and lifestyle within the scpe f physical therapist practice. 5.1.1.9 Evidence-Based Practice Use evidence t infrm practice and t ensure that the services rendered and the care/interventin/treatment prvided t patients/clients, their carers, and cmmunities is based n the best available evidence, taking int cnsideratin be liefs and values and the cultural cntext f the lcal envirnment. Use infrmatin technlgy t access surces f infrmatin t supprt clinical decisins and nt use techniques and technlgies that have been shwn t be ineffective r unsafe. Critically evaluate surces f infrmatin related t physical therapist practice, research, and educatin and apply knwledge frm these surces in a scientific manner and t apprpriate ppulatins. Cnsistently integrate the best evidence fr practice frm surces f infrmatin with clinical judgment and patient/client values t determine the best care/interventin/treatment fr a patient/client. Be prepared t cntribute t the evidence fr practice. 5.1.1.10 Management f Care/Interventin/Treatment Delivery Prvide first-cntact care/interventin/treatment thrugh direct access t patients/clients, wh have been determined thrugh the examinatin and assessment prcesses t need physical therapy care/interventin/treatment. Prvide services t patient/client referred by ther practitiners t ensure that service is cntinuus. Assess ptential risks fr the patient/client and the physical therapist in the practice envirnment. Manage supprt staff effectively and efficiently. Understand the changing and diverse cntext within which physical therapy services are delivered. Knw quality assurance framewrks and hw they are utilised/applied. Page 16 f 49
Understand perfrmance indicatrs and utcme measures derived frm a range f scientific and measurement appraches. Understand the scial and ecnmic factrs that impact n health and the delivery f health services. 5.1.2 Cmmunicatin Expressively and receptively cmmunicate in a culturally cmpetent manner with patients/clients, family members, caregivers, practitiners, interdisciplinary team members, cnsumers, payers, and plicymakers. Cmmunicate with thers using written, verbal, and nn-verbal mdes. Recgnise the barriers t effective cmmunicatin and strategies fr vercming these. Prvide mentrship fr students and clleagues utilising a range f cmmunicatin skills. Cmmunicate in a way that maintains the patient s/client s cnfidentiality. Dcument practice using, where pssible, internatinally accepted data standards such that data is useful nt nly fr clinical care but als research, administratin and statistics. 5.1.3 Cnsultatin/Screening Prvide cnsultatin within bundaries f expertise t businesses, schls, gvernment agencies, ther rganisatins, r individuals. Determine when patients/clients need further examinatin r cnsultatin by a physical therapist r referral t anther health care prfessinal. 5.1.4 Critical Analysis/Clinical Reasning/Clinical Decisin Making Use clinical judgment and reflectin t identify, mnitr, and enhance clinical reasning t minimise errrs and enhance patient/client utcmes. Cnsistently apply current knwledge, thery, and prfessinal judgment while cnsidering the patient/client perspective in patient/client care/management. 5.1.5 Educatin Effectively educate individuals and grups. Prvide mentrship fr students and clleagues utilising a range f teaching skills. Engage in apprpriate self-directed learning. Page 17 f 49
5.1.6 Management/Administratin/Supervisin Direct and supervise human resurces t meet patient s/client s gals and expected utcmes. Participate in management f a physical therapist practice. Participate in establishing a practice business plan. Participate in activities related t resurce management, marketing, and public relatins. Manage practice in accrdance with regulatry and legal requirements. Assure safety in practice envirnment, including risk assessment. Understand the impact f health and scial care plicies n prfessinal practice. Use Infrmatin Cmmunicatin Technlgy (ICT) and infrmatin management systems t maintain patient/client recrds. Understand the rles f the ther health practitiners and cncepts f multiprfessinal practice. Identify, justify and negtiate t secure additinal resurces as required t deliver cmprehensive services necessary t meet the needs f patients/clients, their families and carers r ppulatins. 5.1.7 Research Have knwledge f the varied research methdlgies. Identify questins arising frm practice that may serve as stimuli fr future research. Be an infrmed cnsumer f the research literature. Cntribute t prfessinal practice thrugh research (e.g., present a single case study, literature review, pster presentatin). 5.2 Practice Settings Understand the rle f physical therapists and the scpe f physical therapy practice in multiple practice settings. Appendix B prvides further details. Page 18 f 49
5.3 Prfessinal Behaviurs 5.3.1 Accuntability Adhere t legal practice standards, including all statutry authrities (e.g., federal, state, lcal, reginal, prvincial and institutinal regulatins) related t patient/client care and fiscal management. Be aware f the cst burden f physical therapy services. Practice in a manner cnsistent with Ethical Standards established by WCPT r by the Member Organisatin. Encurage membership in the natinal physical therapy rganisatin. Participate in rganisatins and effrts that supprt the rle f the physical therapist in furthering the health and wellness f the public. Make clinical and billing decisins based n the best interests f the patient/client and nt the payer. 5.3.2 Altruism Place patient s/client s needs abve the physical therapist s needs. Incrprate free/vluntary/pr bn services (e.g., vluntary service verseas, riding prgrammes fr thse with disabilities, free services t the hmeless) int practice. 5.3.3 Cmpassin/Caring Exhibit caring, cmpassin, and empathy in prviding services t patients/clients. Prmte active invlvement f the patient/client in his r her care/interventin/treatment. Respect the patient s/client s right t refuse physical therapy care/interventin/treatment. 5.3.4 Cultural Cmpetence Identify, respect, and act with cnsideratin fr patients /clients differences, values, preferences, beliefs, and expressed needs in all prfessinal activities. Manage patients/clients and interact with clleagues in a manner that is nndiscriminatry and nn-ppressive. Understand the impact f health and scial care plicies n prfessinal practice. 5.3.5 Ethical Behaviur Understand the ethical issues that infrm and shape physical therapy practice. Page 19 f 49
Knw the prfessinal, statutry, and regulatry cdes f practice. Abide by the prfessinal cde f cnduct, values, and beliefs. Maintain the principles and practice f patient/client cnfidentiality. 5.3.6 Integrity Demnstrate integrity in all interactins with patients/clients, family members, caregivers, ther health care prviders, students, ther cnsumers, and payers (e.g., scial system, insurance cmpanies, patient self-pay). Adhere t cdes f prfessinal cnduct. 5.3.7 Persnal/Prfessinal Develpment Manage uncertainty, change, and stress. Implement effective time-management and wrklad planning. Identify individual learning needs. Cnstruct and implement a persnal develpment plan. Reflect and mdify behaviur in the light f experience and advice. Set realistic gals related t persnal develpment. Recgnise the significance f cntinuing prfessinal develpment. 5.3.8 Prfessinal Duty Demnstrate prfessinal behaviur in all interactins with patients/clients, family members, caregivers, ther prviders, students, ther cnsumers, and payers. Participate in self-assessment t imprve the effectiveness f care/interventin/ treatment. Participate in peer assessment activities. Participate in activities that supprt the develpment f the prfessin and patient/client services. Participate in prfessinal rganisatins (e.g., natinal physical therapy rganisatin, WCPT). Understanding f the rles f ther prfessins pertinent t physical therapist practice. Acknwledge crss-prfessinal bundaries and emply apprpriate referral prcedures. 5.3.9 Scial Respnsibility and Advcacy Advcate fr the health and wellness needs f sciety. Page 20 f 49
Advcate fr the prfessinal cmpetence f physical therapists in a changing health delivery envirnment. Participate and shw leadership in cmmunity rganisatins and vlunteer service. Advcate fr the prfessin thrugh decisin-makers and key stakehlders (e.g., t include, but nt be limited t, legislative, regulatry, plitical, payer). Understand the sequelae f humanitarian situatins, including trture and natural, technlgical r pandemic disasters, and intervene when and as apprpriate. Understand the sequelae f civil r criminal vilence (including dmestic vilence) and intervene when and as apprpriate. 5.3.10 Teamwrk Understand the rles f different health and scial care prfessinals invlved in the management f patients/clients. Wrk with ther prfessinals t ensure patient/client-centred services and the prvisin f seamless services. Refer t ther prfessinals as indicated by patient/client needs. Page 21 f 49
Appendix A Patient/Client Care/Management The areas f examinatin/assessment/evaluatin (histry, systems review, and tests and measures) and interventins that may be used in curriculum develpment may include but are nt limited t: A) Examinatin/assessment/evaluatin Histry may include btaining the fllwing data: General demgraphics (age, sex. race/ethnicity, primary language, educatin) Scial histry (cultural beliefs and behaviurs, family and caregiver resurces, scial interactins/activities/supprt systems) Emplyment - Wrk/Jb/Schl/Play (current and prir wrk, cmmunity, and leisure actins, tasks, r activities) Grwth and develpment (develpmental histry, hand dminance) Living envirnment (living envirnment, cmmunity characteristics, devices and equipment, prjected discharge destinatin) General health status self-reprt, family reprt, caregiver reprt (general health perceptin, physical functin, psychlgical functin, rle functin, scial functin) Scial/health habits (behaviural and health risks, level f physical fitness) Family histry (familial health risks) Medical/surgical histry (cardivascular, endcrine/metablic, gastrintestinal, gynaeclgical, integumentary, musculskeletal, neurmuscular, bstetrical, psychlgical, pulmnary, prir hspitalizatins, prir surgeries, pre-existing medical and ther health related cnditins) Current cnditins/chief cmplaints (cncerns leading t seek physical therapist services, current therapeutic interventins, mechanisms f injury r disease, nset and pattern f symptms, expectatins and gals fr the therapeutic interventins, emtinal respnse t current clinical situatin, previus ccurrence f chief cmplaints, prir therapeutic interventins) Functinal status and activity level (current and prir functinal status in self-care and hme management including activities f daily living and instrumental activities f daily living) Medicatins (medicatins fr the current cnditin, medicatins previusly take fr current cnditin, medicatins fr ther cnditins) Other clinical tests (labratry and diagnstic tests, review available recrds, review ther clinical findings) Page 22 f 49
Systems review may include brief assessment f the fllwing systems: Cardivascular/pulmnary systems bld pressure heart rate respiratry rate assessing fr edema Musculskeletal system grss range f mtin grss strength grss symmetry height weight Neurmuscular system grss crdinated mvements, e.g. balance, lcmtin, transfers, and transitins Integumentary system the presence f any scar frmatin the skin clur the skin integrity Systems review may include assessment f cmmunicatin, behaviural/emtinal state, cgnitin, language, and learning style Tests and measures may include: Aerbic capacity/endurance, may include assessment f: aerbic capacity during functinal activities and during standardised tests cardivascular signs and symptms during exercise r activity pulmnary signs and symptms during exercise r activity Anthrpmetric characteristics may include assessment f: bdy cmpsitin bdy dimensins edema Page 23 f 49
Arusal, attentin, and cgnitin may include assessment f: arusal attentin cgnitin cmmunicatin cnsciusness rientatin recall Assistive technlgies and adaptive devices may include assessment f: devices and equipment cmpnents remediatin f impairments functinal limitatin disabilities safety Circulatin (arterial, venus, lymphatic) may include assessment f: signs symptms physilgical respnses t psitins Cranial and peripheral nerve integrity may include assessment f: mtr and sensry distributin f nerves respnse t neural prvcatin respnse t stimuli electrphysilgical testing Envirnmental, hme, and wrk (jb/schl/play) barriers may include assessment f: current and ptential barriers physical space and envirnment Ergnmics and bdy mechanics may include assessment f: dexterity and crdinatin during wrk Page 24 f 49
functinal capacity during wrk safety during wrk specifics f wrk cnditins wrk tls, devices, equipment bdy mechanics during self-care, hme management, wrk, cmmunity, and leisure (with and withut assistive, adaptive, rthtic, prsthetic, prtective, and supprtive devices and equipment) Gait, lcmtin, and balance may include assessment f: static and dynamic balance balance during functinal activities gait and lcmtin during functinal activities with and with devices r equipment safety during gait, lcmtin, and balance Integumentary integrity may include assessment f: activities, psitin, pstures, devices, and equipment that prduce r relieve trauma t skin burn signs f infectin wund and scar characteristics Jint integrity and mbility may include assessment f: jint integrity and mbility jint play mvements Mtr functin (mtr cntrl and mtr learning) may include assessment f: dexterity, crdinatin, and agility hand functin cntrl f mvement patterns vluntary pstures Muscle perfrmance may include assessment f: muscle strength, pwer, and endurance muscle tensin Neurmtr develpment and sensry integratin may include assessment f: Page 25 f 49
acquisitin f mtr skills ral mtr functin phnatin, and speech sensrimtr integratin including pstural, equilibrium, and righting reactins Orthtic, prtective, and supprtive devices may include assessment f: cmpnents, alignment, and fit use during functinal activities and sprt-specific activities remediatin f impairments, functinal limitatins, and disabilities safety during use Pain may include assessment f: type, lcatin, and severity (irritability, intermittent/cnstant, quality, pattern, duratin, time, cause) sreness nciceptin Psture may include assessment f: static and dynamic pstural alignment and psitin Prsthetic requirements may include assessment f: cmpnents, alignment, fit, and ability t care fr prsthesis use during functinal activities and sprt-specific activities remediatin f impairments, functinal limitatins, and disabilities residual limb r adjacent segment safety during use Range f mtin may include assessment f: functinal range f mtin jint active and passive mvements muscle length sft tissue extensibility and flexibility Reflex integrity may include assessment f: deep and superficial reflexes pstural reflexes and reactins Page 26 f 49
primitive reflexes and reactins resistance t passive stretch Self-care and hme management may include assessment f: activities f daily living [ADL] and instrumental activities f daily living [IADL] fr self-care and hme management ability t gain access t hme envirnment safety during self-care and hme management Sensry integrity may include assessment f: cmbined/crtical sensatins deep sensatins Ventilatin and respiratin/gas exchange may include assessment f: pulmnary signs f respiratin/gas exchange pulmnary signs f ventilatry functin pulmnary symptms Wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin may include assessment f: ability t assume r resume wrk, cmmunity, and leisure activities ability t gain access t wrk cmmunity, and leisure envirnments safety in wrk, cmmunity, and leisure activities and envirnments B) Interventins/Treatments Crdinatin, cmmunicatin, and dcumentatin may include: Address required functins Admissin and discharge planning Case management Cllabratin and crdinatin with agencies Cmmunicatin acrss settings Cst-effective resurce utilisatin Data cllectin, analysis, and reprting Dcumentatin Page 27 f 49
Interdisciplinary teamwrk Referrals t ther prfessinals Patient/client-related instructin may include: Instructin, educatin, and training f patients/clients, and caregivers Therapeutic exercise may include: Aerbic capacity/endurance cnditining r recnditining aquatic prgrammes gait and lcmtr training increased wrklad ver time mvement efficiency and energy cnservatin training walking and wheelchair prpulsin prgrammes Balance, crdinatin, and agility training develpmental activities training mtr functin (mtr cntrl and mtr learning) training r retraining addressing required functin neurmuscular educatin r re-educatin perceptual training psture awareness training sensry training r retraining standardised, prgrammatic, cmplementary exercise appraches task-specific perfrmance training vestibular training Bdy mechanics and pstural stabilisatin bdy mechanics training pstural cntrl training pstural stabilisatin activities psture awareness training Flexibility exercises muscle lengthening range f mtin Page 28 f 49
stretching Gait and lcmtin training develpmental activities training gait training implement and device training perceptual training standardised, prgrammatic, cmplementary exercise appraches wheelchair training Neurmtr develpment training develpmental activities training mtr training mvement pattern training neurmuscular educatin r re-educatin Relaxatin breathing strategies mvement strategies relaxatin techniques standardised, prgrammatic, cmplementary exercise appraches Strength, pwer, and endurance training fr head, neck, limb, pelvic-flr, trunk, and ventilatry muscles active assistive, active, and resistive exercises (including cncentric, dynamic/istnic, eccentric, iskinetic, ismetric, and plymetric) aquatic prgrams standardised, prgrammatic, cmplementary exercise appraches task-specific perfrmance training Functinal training in self-care and hme management may include: Activities f daily living [ADL] training bathing bed mbility and transfer training develpmental activities Page 29 f 49
dressing eating grming tileting Barrier accmmdatins r mdificatins Device and equipment use and training assistive technlgies and adaptive devices r equipment training during activities f daily living [ADL] and instrumental activities f daily living [IADL] rthtic, prtective, r supprtive device r equipment training during self care and hme management prsthetic device r equipment training during ADL and IADL Functinal training prgrams back schls simulated envirnments and tasks task adaptatin travel training Instrumental activities f daily living [IADL] training caring fr dependents hme maintenance husehld chres shpping structured play fr infants and children yard wrk Injury preventin r reductin injury preventin educatin during self-care and hme management injury preventin r reductin with use f devices and equipment safety awareness training during self-care and hme management Functinal training in wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin may include: Barrier accmmdatins r mdificatins Device and equipment use and training Page 30 f 49
assistive technlgies and adaptive device r equipment training during IADL rthtic, prtective, r supprtive device r equipment training during IADL prsthetic device r equipment training during IADL Functinal training prgrammes back schls jb caching simulated envirnments and tasks task adaptatin task training travel training wrk cnditining wrk hardening Instrumental activities f daily living [IADL] training cmmunity service training invlving instruments schl and play activities training including tls and instruments wrk training with tls Injury preventin r reductin injury preventin educatin during wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin injury preventin educatin with use f devices and equipment safety awareness training during wrk (jb/schl/play), cmmunity, and leisure integratin r reintegratin Leisure and play activities and training Manual therapy techniques may include: Acupressure Manual lymphatic drainage Manual tractin Massage cnnective tissue massage therapeutic massage Page 31 f 49
Mbilisatin/manipulatin sft tissue (thrust and nn-thrust) spinal and peripheral jints (thrust and nn-thrust) Passive range f mtin Prescriptin, applicatin, and, as apprpriate, fabricatin f devices and equipment may include: Adaptive devices envirnmental cntrls hspital beds raised tilet seats seating systems Assistive devices canes crutches lng-handled reachers percussrs and vibratrs pwer devices static and dynamic splints walkers wheelchairs Orthtic devices braces casts she inserts splints Prsthetic devices (lwer-extremity and upper-extremity) Prtective devices braces cushins helmets Page 32 f 49
prtective taping Supprtive devices cmpressin garments crsets elastic wraps mechanical ventilatrs neck cllars serial casts slings supplemental xygen supprtive taping Airway clearance techniques may include: Breathing strategies active cycle f breathing r frced expiratry techniques assisted cugh/huff techniques autgenic drainage paced breathing pursed lip breathing techniques t maximise ventilatin (e.g., maximum inspiratry hld, stair case breathing, manual hyperinflatin) Manual/mechanical techniques assistive devices chest percussin, vibratin, and shaking chest wall manipulatin suctining ventilatry aids Psitining psitining t alter wrk f breathing psitining t maximise ventilatin and perfusin pulmnary pstural drainage Page 33 f 49
Integumentary repair and prtectin techniques may include: Debridement nnselective enzymatic debridement wet dressings wet-t-dry dressings wet-t-mist dressings Debridement selective debridement with ther agents (e.g. autlysis) enzymatic debridement sharp debridement Dressings hydrgels vacuum-assisted clsure wund cverings Oxygen therapy supplemental tpical Tpical agents cleansers creams misturisers intments sealants Electrtherapeutic mdalities may include: Bifeedback Electrtherapeutic delivery f medicatins intphresis Electrical stimulatin electrical muscle stimulatin (EMS) electrical stimulatin fr tissue repair (ESTR) Page 34 f 49
functinal electrical stimulatin (FES) high vltage pulsed current (HVPC) neurmuscular electrical stimulatin (NMES) transcutaneus electrical nerve stimulatin (TENS) Physical agents and mechanical mdalities may include: Physical agents Athermal agents pulsed electrmagnetic fields Crytherapy cld packs ice massage, ice brushing vapclant spray Hydrtherapy cntrast bath pls pulsatile lavage whirlpl tanks Light agents infrared laser ultravilet Sund agents phnphresis ultrasund Thermtherapy dry heat ht packs paraffin baths Mechanical mdalities Acupuncture, dry needling Page 35 f 49
Cmpressin therapies cmpressin bandaging cmpressin garments taping ttal cntact casting vaspneumatic cmpressin devices Gravity-assisted cmpressin devices standing frame tilt table Mechanical mtin devices cntinuus passive mtin (CPM) Tractin devices intermittent psitinal sustained Page 36 f 49
Appendix B Practice Settings T reflect physical therapist practice multiple practice settings may be used in curriculum develpment and may include but are nt limited t: Cmmunity based rehabilitatin prgrammes Cmmunity settings including primary health care centres, individual hmes, and field settings Educatin and research centres Fitness clubs, health clubs, gymnasia and spas Hspices Hspitals Nursing hmes Occupatinal health centres Out-patient clinics Physical therapist private ffice, practice, clinic Prisns Public settings (i.e. shpping malls) fr health prmtin Rehabilitatin centres and residential hmes Schls, including pre-schls and special schls Senir citizen centres Sprts centres/sprts clubs Wrkplace/cmpanies Page 37 f 49
Appendix C Glssary Accuntability is the active acceptance f the respnsibility fr the diverse rles, bligatins, and actins f the physical therapist including self-regulatin and ther behaviurs that psitively influence patient/client utcmes, the prfessin and the health needs f sciety. 29 Activities f daily living (ADL) are the self-care cmmunicatin and mbility skills (e.g. bed mbility, transfers, ambulatin, dressing, grming, bathing, eating, and tileting) required fr independence in everyday living. 30 Activity is the executin f a task r actin by an individual. 31 Activity limitatin is the difficulty an individual may have in executing an activity. 31 Assistive technlgy refers t prducts, devices r equipment, whether acquired cmmercially, mdified, r custmized, that are used t maintain, increase, r imprve the functinal capabilities f individuals with disabilities. These may include adaptive, assistive, rthtic, prsthetic, prtective, and supprtive devices and equipment. 32 Altruism is the primary regard fr r devtin t the interest f patients/clients, thus assuming the fiduciary respnsibility f placing the needs f the patient/client ahead f the physical therapist s self interest. 29 Assessment is a prcess that includes bth the examinatin f individuals r grups with actual r ptential impairments, activity limitatins, disabilities, participatin restrictins, r ther cnditins f health by histry taking, screening and the use f specific tests and measures and evaluatin f the results f the examinatin thrugh analysis and synthesis within a prcess f clinical reasning. 33 Assistive devices are a variety f implements r equipment used t aid patients/clients in perfrming mvements, tasks, r activities and may include crutches, canes, walkers, wheelchairs, pwer devices, lng-handled reachers, and static and dynamic splints. 30 Autnmy is the ability f a reflective practitiner t make independent judgments; pen t initiate, terminate, r alter physical therapy treatment. 30 Benchmark statement is an initiative undertaken under the aegis f the Quality Assurance Agency (UK) t describe the nature and characteristics f higher educatin prgrammes in a specific subject, while representing general expectatins abut the standards fr an award f qualificatins at a particular level and articulating the attributes and capabilities that thse pssessing such qualificatins shuld be able t demnstrate. 33-34 Caring is the cncern, empathy, and cnsideratin fr the needs and values f thers. 29 Clients are: a) individuals wh are nt necessarily sick r injured but wh can benefit frm a physical therapist s cnsultatin, prfessinal advice, r services, r b) businesses, schls systems, and thers t whm physical therapists ffer services. 30 Page 38 f 49
Clinical guidelines are statements develped thrugh systemic prcesses t assist practitiners and individuals in making decisins abut apprpriate frms f health care in particular clinical areas, taking accunt f individual circumstances and need. 33 Clinical reasning/clinical decisin making is the critical and analytical thinking assciated with the prcess f making clinical decisins, 33 and is an interactive mdel in which hyptheses are generated early in an encunter based n initial cues drawn frm bservatin f the patient/client, a letter f referral, the medical recrd, r ther surces. 30 Clinical sciences are the areas f study including physical therapeutic sciences, medical sciences, and ther sciences applied t physical therapy practice. 33 Cmmunicatin is a prcess by which infrmatin is exchanged between individuals thrugh a cmmn system f symbls, signs, r behaviur. 30 Cmmunity Based Rehabilitatin (CBR) is a strategy within cmmunity develpment fr the rehabilitatin, equalizatin f pprtunities, and scial integratin f all peple with disabilities. CBR is implemented thrugh the cmbined effrts f disabled peple themselves, their families and cmmunities, and the apprpriate health, educatin, vcatinal and scial services. 35 Cmpassin is the desire t identify with r sense smething f anther s experience; a precursr f caring. 30 Cmpetence is the pssessin f the requisite knwledge, abilities, and qualities t be a physical therapist. 30 Cnsultatin is the rendering f prfessinal r expert pinin r advice by a physical therapist. The cnsulting physical therapist applies highly specialised knwledge and skills t identify prblems, recmmend slutins, r prduce a specified utcme r prduct in a given amunt f time n behalf f a patient/client. 36 Cntinuing prfessinal develpment (CPD) is the prcess thrugh which individuals undertake learning, thrugh a brad range f activities, that maintains, develps, and enhances skills and knwledge in rder t imprve perfrmance in practice. 37 Cre skills are the basic essential skills required by a physical therapist. 33 Cultural cmpetence is a set f cngruent behaviurs, attitudes and plicies that cme tgether in a system, agency, r amng prfessinals that enables effective wrk in crsscultural situatins. Culture refers t integrated patterns f human behaviur that include the language, thughts, cmmunicatins, actins, custms, beliefs, values, and institutins f racial, ethnic, religius r scial grups. Cmpetence implies having the capacity t functin effectively as an individual and an rganisatin within the cntext f the cultural beliefs, behaviurs and needs presented by cnsumers and their cmmunities." 30 Diagnsis is a prcess that arises frm the examinatin and evaluatin and represents the utcme f the prcess f clinical reasning and may be expressed in terms f mvement dysfunctin r may encmpass categries f impairments, functinal limitatins, Page 39 f 49
abilities/disabilities, r syndrmes. 33 Diagnsis is bth a prcess and a label. The diagnstic prcess perfrmed by the physical therapist includes integrating and evaluating data that are btained during the examinatin t describe the patient/client cnditin in terms that will guide the prgnsis, the plan f care, and interventin strategies. Physical therapists use diagnstic labels that identify the impact f a cnditin n functin at the level f the system (especially the mvement system) and at the level f the whle persn. 36 Disability is the umbrella term fr impairments, activity limitatins, and participatin restrictins that results frm the interactin between an individual s health cnditin and the persnal and envirnmental cntextual factrs. Persnal factrs are the particular backgrund f an individual s life an living, and cmprise features f the individual that are nt part f a health cnditin r health states, such as: gender, race age, fitness, lifestyle, habits, cping styles, scial backgrund, educatin, prfessin, past and current experience, verall behaviur pattern, character style, individual psychlgical assets, and ther characteristics, all r any f which may play a rle in disability in any level. Envirnmental factrs are external factrs that make up the physical, scial and attitudinal envirnment in which peple live and cnduct their lives. This utcme f disability can be described at three levels: bdy (impairment f bdy functin r structure), persn (activity limitatins measured as capacity), and sciety (participatin restrictins measured as perfrmance). 31 Disease is a pathlgical cnditin r abnrmal entity with a characteristic grup f signs and symptms affecting the bdy and with knwn r unknwn aetilgy. 36 Dysfunctin is the disturbance, impairment, r abnrmality f functin f an rgan. 36 Evaluatin is a dynamic prcess in which the physical therapist makes clinical judgments based n data gathered during the examinatin. 36 It is the prcess that necessitates reexaminatin fr the purpse f evaluating utcmes t identify prgressin t gal achievement r need fr mdificatin and change f plan f care. 33 Evidence-based practice is physical therapist practice that requires integrating individual clinical expertise with the best available external clinical evidence frm systematic research; prficiency and judgment that individual clinicians acquire thrugh clinical experience and practice. Evidence includes randmised r nn-randmised cntrlled trials, testimny r thery, meta-analysis, case reprts and anecdtes, bservatinal studies, narrative review articles, case series in decisin making fr clinical practice and plicy, effectiveness research fr guidelines develpment, patient utcmes research, and cverage decisins by health care plans. 30 It is the use f evidence t infrm practice and t ensure that the services delivered t patients/clients, their carers, and cmmunities is based n the best available evidence. 33 Examinatin is a cmprehensive and specific testing prcess perfrmed by the physical therapist that leads t a diagnstic classificatin r, as apprpriate, t a referral t anther practitiner. The examinatin has three cmpnents: the patient/client histry, the systems reviews, and tests and measures. 36 Page 40 f 49
First cntact practitiner is a prfessinal persn t whm the patient/client may directly access as first cntact. 33 Gals are the intended results f patient/client management. Gals indicate changes in impairment, activity limitatins, participatin restrictins, r disabilities and changes in health, wellness, and fitness needs that are expected as a result f implementing the plan f care/interventin/treatment. Gals shuld be measurable and time limited (if required, gals may be expressed as shrt-term and lng-term gals.) 36 Health prmtin is the cmbinatin f educatinal and envirnmental supprts fr actins and cnditins f living cnducive t health. The purpse f health prmtin is t enable peple t gain greater cntrl ver the determinants f their wn health. 38 Imaging are all techniques used t view the inner bdy, such as, rentgengrams, sngraphy, magnetic resnance imaging, CT scans, PET scans. Impairment are prblems in bdy functin r structure as a significant deviatin r lss; are the manifestatin f an underlying pathlgy; can be temprary r permanent, prgressive, regressive r static, intermittent r cntinuus, slight thrugh t severe. 31 Independent practitiners see prfessinal autnmy. Infrmatin Cmmunicatin Technlgy (ICT) is the phrase used t describe a range f technlgies fr gathering, string, retrieving, prcessing, analysing, and transmitting infrmatin. Instrumental activities f daily living (IADL) are thse activities, such as, caring fr dependents, hme maintenance, husehld chres, shpping, and yard wrk. Interventin is the purpseful interactin f the physical therapist with the patient/client, and, when apprpriate, with ther individuals invlved in patient/client care, using varius physical therapy prcedures and techniques (including therapeutic exercise; functinal training in selfcare and hme management; functinal training in wrk, cmmunity, and leisure integratin r reintegratin; manual therapy techniques; prescriptin, applicatin, and, as apprpriate, fabricatin f devices and equipment; airway clearance techniques; integumentary repair and prtectin techniques; electrtherapeutic mdalities; physical agents and mechanical mdalities) t prduce changes in the cnditin. 36 Lifelng learning is the prcess f cnstant learning and develpment that incrprates cntinuus prfessinal develpment, in which all individuals need t engage in a time f rapid change. 33 Manual therapy techniques are the skilled hand mvements intended t imprve tissue extensibility; increase range f mtin; induce relaxatin; mbilise r manipulate sft tissue and jints; mdulate pain; and reduce sft tissue swelling, inflammatin, r restrictin. 36 Mentrship is the prvisin f mdel perfrmance by persns with wisdm frm whm advice and guidance can be sught. 33 Page 41 f 49
Mbilisatin/manipulatin is a manual therapy technique cmprising a cntinuum f skilled passive mvements t the jints and/r related sft tissues that are applied at varying speeds and amplitudes, including a small amplitude/high velcity therapeutic mvement. 36 Multidisciplinary is ne r mre disciplines wrking cllabratively. 33 Nn-discriminatry practice is prfessinal practice within which individuals, teams, and rganisatins actively seek t ensure that n-ne (including patients/clients, carers, clleagues, r students) is either directly r indirectly treated less favurably than thers are, r wuld be, treated in the same r similar circumstances, n the grunds f age, clur, creed, criminal cnvictins, culture, disability, ethnic r natinal rigin, gender, marital status, medical cnditin, mental health, natinality, physical appearance, plitical beliefs, race, religin, respnsibility fr dependants, sexual identity, sexual rientatin, r scial class. 33 Participatin is invlvement in a life situatin. 31 Participatin restrictins are prblems an individual may experience in invlvement in life situatins. 31 Patients are individuals wh are the recipients f physical therapy and direct interventins. 30 Payers are all surces f payment fr physical therapy services, such as, scial health system, insurance payment, patient/client self-pay. Planning is a prcedure that begins with determinatin f the need fr interventin and nrmally leads t the develpment f a plan f interventin, including measurable utcme gals negtiated in cllabratin with the patient/client, family r caregiver. Alternatively it may lead t referral t anther agency in cases, which are inapprpriate fr physical therapy. 33 Plan f care are statements that specify the anticipated gals and the expected utcmes, predicted level f ptimal imprvement, specific interventins t be used, and prpsed duratin and frequency f the interventins that are required t reach the gals and utcmes. The plan f care includes the anticipated discharge plans. 36 Practice management is the crdinatin, prmtin, and resurce (financial and human) management f practice that fllws regulatry and legal guidelines. 30 Preventin are activities that are directed tward (1) achieving and restring ptimal functinal capacity, (2) minimising impairments, functinal limitatins, and disabilities, (3) maintaining health (thereby preventing further deteriratin r future illness), (4) creating apprpriate envirnmental adaptatins t enhance independent functin. Primary preventin: Preventin f disease in a susceptible r ptentially susceptible ppulatin thrugh such specific measures as general health prmtin effrts. Secndary preventin: Effrts t decrease the duratin f illness, severity f diseases, and sequelae thrugh early diagnsis and prmpt interventin. Tertiary preventin: Effrts t limit the degree f disability and prmte rehabilitatin and restratin f functin in patients/clients with chrnic and irreversible diseases. 36 Pr bn is the prvisin f services free f charge fr the public gd. Page 42 f 49
Prblem slving is an exercise and prcess that enables students t integrate their existing knwledge and develp their learning t frmulate a slutin t a presented questin r issue and that shuld deepen students learning, as well as develping their cnceptual and methdlgical skills, thereby enhancing their verall apprach t prfessinal practice. 33 Prfessinal autnmy is the pwer t make decisins regarding the management f the patient/client based n ne s wn prfessinal knwledge and expertise. 33 Prgnsis is the determinatin by the physical therapist f the predicted ptimal level f imprvement in functin and the amunt f time needed t reach that level. 36 Re-examinatin is the prcess f perfrming selected tests and measures after the initial examinatin t evaluate prgress and t mdify r redirect interventins. 36 Quality assurance is a system f recgnised prcedures fr establishing standards and includes prcedures fr reaching standards. 33 Screening is the activity f determining the need fr further examinatin r cnsultatin by a physical therapist r fr referral t anther health prfessinal. 36 Standards f practice are the principles established by the physical therapy prfessin r incrprated int natinal rules and laws and cmprise the ethical rules and principles that frm an bligatry part f prfessinal practice. 33 Tests and measures are specific standardised methds and techniques used t gather data abut the patient/client after the histry and systems review have been perfrmed. 36 Treatment is the sum f all interventins prvided by the physical therapist t a patient/client during an episde f care. 36 Wellness is an active prcess f becming aware f and making chices tward a mre successful existence. 39 Page 43 f 49
Appendix D Resurces/Bibligraphy APTA (2001) Guide t Physical Therapist Practice. Secnd Editin. American Physical Therapy Assciatin. Physical Therapy 81;1:9-744 APTA (2004) Evaluative Criteria fr Accreditatin f Educatin Prgrams fr the Preparatin f Physical Therapists (Adpted Octber 26, 2004 and effective January 1, 2006; revised 10/05) APTA: Washingtn, USA. Black Lattanzi J, Purnell L, Eds (2006) Develping Cultural Cmpetence in Physical Therapy Practice. FA Davis: Philadelphia, USA. Chartered Sciety f Physitherapy (2002) Curriculum Framewrk fr Qualifying Prgrammes in Physitherapy. CSP: Lndn, UK. [http://www.csp.rg.uk] Chartered Sciety f Physitherapy (2002) Validatin Prcedures. CSP: Lndn, UK. [http://www.csp.rg.uk] Chartered Sciety f Physitherapy (2005) Cre Standards f Physitherapy Practice. CSP: Lndn, UK. [http://www.csp.rg.uk] Chartered Sciety f Physitherapy (202) Rules f Prfessinal Cnduct fr Chartered Physitherapists. CSP: Lndn, UK. [http://www.csp.rg.uk] Eurpean Regin Wrld Cnfederatin fr Physical Therapy (2003) Audit Tl fr use with the Eurpean Cre Standards f Physitherapy Practice. ER-WCPT: Geneva, Switzerland. Eurpean Regin Wrld Cnfederatin fr Physical Therapy (2003) Eurpean Physitherapy Service Standards. ER-WCPT: Geneva, Switzerland. German Assciatin f Physitherapy www.zvk.rg - Gesetze und Verrdnungen Training and examinatin rder Health Prfessins Cuncil (2003) Standards f Prficiency fr Physitherapy. HPC: Lndn, UK. [http://www.hpc-uk.rg/publicatins/standards/] Health Prfessins Cuncil (2004) Standards f Educatin and Training. HPC: Lndn, UK. [http://www.hpc-uk.rg/publicatins/standards/] Indian Assciatin f Physitherapy. Minimum Standards Required Fr The Cnduct Of Bachelrs Degree Prgramme In Physical Therapy. Available frm http://www.physitherapyindia.rg/criteria.htm Lipsn J., Dibble S, Eds. (2005) Culture and Clinical Care. UCSF Nursing Press: San Franscisc, USA. Main C., McCallin A., Smit N. (2006) Cultural safety and cultural cmpetence: what des this mean fr physitherapists? New Zealand Jurnal f Physitherapy 34(3):160-6 Page 44 f 49
Sarmient M., Cruz I. y Mlina V. (2004) Nivelación y glbalización Curricular de la Fisiterapia y Kinesilgía en América Latina, Diagnóstic Curricular de la Fisiterapia en Clmbia. Cnfederación Mundial de Fisiterapia: Bgtá, Clmbia. Sarmient M., Cruz I. y Mlina V. (2004) Nivelación y glbalización Curricular de la Fisiterapia y Kinesilgía en América Latina, Fase I diagnóstic. Cnfederación Mundial de Fisiterapia: Bgtá, Clmbia. The Physitherapy Bard f New Zealand (1999) Registratin Requirements cmpetencies and learning bjectives. The Physitherapy Bard f New Zealand: Wellingtn, New Zealand. Nte: Readers are advised t check with WCPT s Member Organisatins fr ther relevant dcumentatin and fr revisins and updates t the dcuments mentined abve. This list is by n means exhaustive but illustrative f the range f dcuments available that might be f use Page 45 f 49
Acknwledgements WCPT acknwledges with appreciatin the Member Organisatins and individuals wh cntributed t the develpment f these guidelines. The dcument wes a lt t the input frm many surces, which we hpe have been fully identified in the references. Hwever, WCPT acknwledges the majr cntributins f the fllwing dcuments t this prcess: APTA (2001) Guide t Physical Therapist Practice. Secnd Editin. American Physical Therapy Assciatin. Physical Therapy 81;1:9-744 APTA (2004) Evaluative Criteria fr Accreditatin f Educatin Prgrams fr the Preparatin f Physical Therapists (Adpted Octber 26, 2004 and effective January 1, 2006; revised 10/05) APTA: Washingtn, USA. [http://www.apta.rg/am/template.cfm?sectin=general_infrmatin&template=/cm/ CntentDisplay.cfm&CntentID=19980] APTA (2004) Nrmative Mdel f Physical Therapist Prfessinal Educatin: Versin 2004. APTA: Washingtn, USA. Eurpean Regin f the Wrld Cnfederatin fr Physical Therapy (2003) Eurpean Physitherapy Benchmark Statement. ER-WCPT: Brussels, Belgium. [http://www.physi-eurpe.rg/dwnlad.php?dcument=51&dwnladarea=6] The Quality Assurance Agency (QAA) fr Higher Educatin (2001) Benchmark statement: health care prgrammes phase 1 Physitherapy. QAA; Glucester, UK. [http://www.qaa.ac.uk/academicinfrastructure/benchmark/health/physi.pdf] WCPT (2003) Descriptin f Physical Therapy, Declaratins f Principle and Psitin Statements. WCPT: Lndn, UK. [http://www.wcpt.rg/plicies/index.php] Page 46 f 49
References 1. Wrld Cnfederatin fr Physical Therapy (2007) Descriptin f Physical Therapy. WCPT: Lndn, UK. 2. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Educatin. WCPT: Lndn, UK. 3. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Ethical Principles. WCPT: Lndn, UK. 4. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Trture. WCPT: Lndn, UK. 5. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Evidence Based Practice. WCPT: Lndn, UK. 6. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Research. WCPT: Lndn, UK. 7. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Autnmy. WCPT: Lndn, UK. 8. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Infrmed Cnsent. WCPT: Lndn, UK. 9. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Prtectin f Title. WCPT: Lndn, UK.. 10. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Primary Health Care. WCPT: Lndn, UK. 11. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Standards f Physical Therapy Practice. WCPT: Lndn, UK. 12. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Quality Care. WCPT: Lndn, UK. 13. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Private Practice. WCPT: Lndn, UK. 14. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Patients /Clients Rights in Physical Therapy. WCPT: Lndn, UK. 15. Wrld Cnfederatin fr Physical Therapy (20071995) Declaratin f Principle: Relatinships with Other Health Prfessinals. WCPT: Lndn, UK. 16. Wrld Cnfederatin fr Physical Therapy (2007) Declaratin f Principle: Human Resurce Planning. WCPT: Lndn, UK. Page 47 f 49
17. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Cmmunity Based Rehabilitatin. WCPT: Lndn, UK. 18. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Regulatin and Reciprcity. WCPT: Lndn, UK. 19. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Specialisatin. WCPT: Lndn, UK. 20. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Supprt persnnel fr Physical Therapy Practice. WCPT: Lndn, UK. 21. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Physical Therapy fr Older Peple. WCPT: Lndn, UK. 22. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: High Risk Infectius Diseases. WCPT: Lndn, UK. 23. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Physical Therapists as Exercise Experts Acrss the Life Span. WCPT: Lndn, UK. 24. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Female Genital Mutilatin (FGM). WCPT: Lndn, UK. 25. Wrld Cnfederatin fr Physical Therapy (2007) Psitin Statement: Standards f Practice. WCPT: Lndn, UK. 26. Wrld Cnfederatin fr Physical Therapy (2007) Endrsement: The UN Cnventin n the Rights f the Child. WCPT: Lndn, UK. 27. Wrld Cnfederatin fr Physical Therapy (2007) Endrsement: The UN Standard Rules n the Equalisatin f Opprtunities fr Persns with Disabilities. WCPT: Lndn, UK. 28. Wrld Cnfederatin fr Physical Therapy (2007) Endrsement: The Internatinal Federatin f Sprts Physitherapy Guideline n Dping. WCPT: Lndn, UK. 29. APTA (2003) Prfessinalism In Physical Therapy: Cre Values Self-Assessment. APTA: Washingtn, USA. 30. APTA (2004) Nrmative Mdel f Physical Therapist Prfessinal Educatin: Versin 2004. APTA: Washingtn, USA. 31. Wrld Health Organizatin (WHO) (2001) Internatinal Classificatin f Functining, Disability and Health. WHO: Geneva, Switzerland. [Knwn as the ICF] 32. The Assistive Technlgy Act f 1998 (29 U.S.C. 3001 et seq.) Washingtn DC, USA. [http://www.sectin508.gv/dcs/at1998.html] 33. Eurpean Regin f the Wrld Cnfederatin fr Physical Therapy (2003) Eurpean Physitherapy Benchmark Statement. ER-WCPT: Brussels, Belgium. Page 48 f 49
34. The Quality Assurance Agency (QAA) fr Higher Educatin (2001) Benchmark statement: health care prgrammes phase 1 Physitherapy. QAA; Glucester, UK. [http://www.qaa.ac.uk/academicinfrastructure/benchmark/health/physi.pdf] 35. Internatinal Labur Organizatin, United Natins Educatinal, Scientific and Cultural Organizatin and the Wrld Health Organizatin (2004) CBR: a strategy fr rehabilitatin, equalizatin f pprtunities, pverty reductin and scial inclusin f peple with disabilities: jint psitin paper 2004. WHO; Geneva, Switzerland. [http://www.il.rg/public/english/emplyment/skills/dwnlad/jintpaper.pdf] 36. APTA (2001) Guide t Physical Therapist Practice. Secnd Editin. American Physical Therapy Assciatin. Physical Therapy 81;1:9-744 37. Chartered Sciety f Physitherapy (2005) Cntinuing Prfessinal Develpment. [Dwnladed frm http://www.csp.rg.uk/lifelnglearning/cpd.cfm 21 March 2005] 38. Green LW, Kreuter MW. (1991) Health Prmtin Planning, 2 nd editin. Muntain View, CA: Mayfield Publishers. 39. Natinal Wellness Organizatin (2003) A Definitin f Wellness. Natinal Wellness Institute, Inc: Stevens Pint, WI, USA. Page 49 f 49