Physical therapists' perceptions of the roles of the physical therapist assistant

Navigating the Grey Zone of Physiotherapy Assistant Autonomy in Home Care: Perspectives of Physiotherapists and Physiotherapy Assistants

Purpose: To explore perspectives and experiences regarding the autonomy of physiotherapist assistants (PTAs) among physiotherapists and PTAs providing home care services in Ontario since the introduction of PTAs into home care rehabilitation teams. Method: For this qualitative study, we conducted semi-structured interviews with 10 physiotherapists and 5 PTAs working in home care. We analyzed interview transcripts using the DEPICT model. Results: Participants described navigating a grey zone characterized by a lack of clarity about acceptable levels of PTA autonomy. Four interrelating factors shaped the extent to which PTAs practiced with autonomy: system influences (number of physiotherapy visits, professional guidelines), patient complexity (status, comorbidities), perceived PTA competence (skills, training), and the physiotherapist–PTA relationship (trust, communication). Conclusions: New practice models in home care have impacted the role of both physiotherapists and PTAs. Home care agencies should facilitate emerging professional relationships and address autonomy-related challenges, such as trust and competence, to promote high-quality client-centred care.

Postgraduate physiotherapy training: interest and perceived barriers to participation in a clinical master's degree programme

PURPOSE

To (1) assess whether physiotherapists in a large Canadian province support the offering of a clinical master's degree programme; (2) identify what sector of this population is interested in participating in a clinical master's degree programme; (3) identify the most common personal/professional reasons for enrolling; (4) identify the type of programme that would appeal; and (5) assess barriers to participation in such a programme.

METHODS

The survey and accompanying cover letter explaining the study were sent by postal mail to all 2,552 physiotherapists registered with the College of Physical Therapists of British Columbia (CPTBC).

RESULTS

The response rate was 17%; 90% of respondents support offering this type of physiotherapy degree in BC, and 14% reported that they were likely to enrol. Orthopaedics/manual therapy (41%) was the clinical area of most interest.

CONCLUSIONS

There is strong support for a clinical master's degree in orthopaedic manual therapy in BC. There is greater support for a part-time programme with an inter-professional component, using a combination of e-learning and classroom teaching to reduce travel time and time away from family.

State regulation and the delivery of physical therapy services

OBJECTIVE

The study purpose was to examine the relationship between state regulations of physical therapists (PT) and three dependent variables: physical therapist assistant (PTA) utilization more than 50 percent of the time during the treatment episode (high PTA utilization), number of visits, and patient self-reported functional health status (FHS) at discharge. We evaluated regulations governing licensure of PTAs, PT/PTA ratio, frequency of PT re-evaluation, and PTA supervision.

DATA SOURCE

The analytic sample included 63,900 patients from 38 states drawn from 395 clinics who participated in the Focus on Therapeutic Outcomes Inc. (Knoxville, TN) database in 2000 and 2001.

STUDY DESIGN

Using a Bayesian modeling approach with the Markov Chain Monte Carlo estimation method, we fitted separate multilevel multivariate regression models predicting high PTA utilization, number of visits, and discharge FHS.

DATA COLLECTION METHODS

Patients completed FHS surveys at intake and discharge. Clinicians recorded the number of visits and percentage of time a patient spent with each provider.

PRINCIPAL FINDINGS

After controlling for patient, therapist, and clinic characteristics, the presence of state regulations regarding PTA supervision was not associated with the likelihood of high PTA utilization. High PTA utilization and regulations requiring full-time onsite supervision were associated with more visits, whereas regulation of PT/PTA ratio was associated with fewer visits. Supervisory regulations were associated with better discharge FHS. High PTA utilization and use of therapy aides were associated with more visits per episode and lower discharge FHS.

CONCLUSIONS

The use of care extenders in place of PTs is likely to result in less efficient and lower quality care in outpatient rehabilitation.

Physiotherapy and osteoporosis: practice behaviors and clinicians’ perceptions—a survey

Physiotherapists typically use a variety of modes to treat their clients, including manual therapy. The literature cautions against the use of manual therapy in individuals with osteoporosis, (Musculoskeletal Manipulation: Evaluation of the Scientific Evidence, Charles C Thomas Publisher, Springfield, IL; Common Vertebral Joint Problems, 2nd Edition, Churchill Livingstone, New York; Maitland's Vertebral Manipulation, 6th Edition, Butterworth-Heinemann, Boston; Br. J. Sports Med. 37 (2003) 195-196) yet clinical experience (Br. J. Sports Med. 37 (2003) 195-196) and published cases (J. Manip. Physiol. Ther. 15(7) (1992) 450-454) suggest that these techniques are still being used by at least some clinicians. The purpose of this study was to measure the most common treatment modes used by a random sample of physiotherapists practicing in the province of British Columbia (BC) in the treatment of individuals with osteoporosis. To assess whether physiotherapists in BC have concerns about the use of manual therapy in individuals with osteoporosis, particularly whether physiotherapists have concerns about fracture as a complication of treatment. This cross-sectional study of 171 physiotherapists in BC used a questionnaire developed by the physiotherapist in the Osteoporosis Program at the BC Women's Health Centre (a part of the Children's & Women's Health Centre of BC). The response rate (67/171) was 39%. Ninety-seven per cent of respondents reported using strength exercises and postural reeducation, while 45% reported using manual therapy in this population. Ninety-one per cent of respondents reported having concerns about the use of manual therapy. Vertebral fracture and rib fracture were the most commonly reported concerns. These findings suggest that most physiotherapists practicing in BC, Canada use evidence-based methods (i.e. strength training) when treating individuals with osteoporosis, a large number use manual therapy, and most have concerns about its use. Physiotherapists are most concerned about fractures, in particular vertebral fracture, but injury to other musculoskeletal tissues is also of concern. Studies of safety and effectiveness of manual therapy in this population are needed to guide clinical practice.