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EXPECTATIONS FOR THE EDUCATION OF PHYSICAL THERAPISTS AND PHYSICAL THERAPIST
ASSISTANTS REGARDING DIRECTION AND SUPERVISION
As the regulator of quality education in physical therapy, the Commission on Accreditation in Physical
Therapy Education (CAPTE) is in the unique position of being responsible for establishing and enforcing
minimal standards for the education of entry-level physical therapists (PTs) and physical therapist assistants
(PTAs). To ensure the ongoing safety of the public who are served by graduates of these education
programs, CAPTE must be cognizant of, and responsive to, professional policies, position papers, best
practices, relevant evidence, as well as existing and emerging trends in clinical practice when revising and
enforcing its Standards and Required Elements related to curricular content. The Standards and Required
Elements for physical therapist (PT) and physical therapist assistant (PTA) programs include expectations
that students will be educated on their respective roles, responsibilities and limitations. CAPTE recognizes
that these roles are subject to change based on multiple factors including, but not limited to, recent or
potential changes in educational degree level, revisions to state practice acts, the emergence of new
therapeutic interventions and clinical evidence, the implementation of new legislative and reimbursement
policies for health care, shifting trends and expectations for employment, and opportunities for the
development of advanced clinical competencies after graduation.
The primary function of CAPTE is to ensure compliance with minimal educational standards, not to define the
scope of practice/work for physical therapy practitioners. CAPTE has historically used the Patient/Client
Management Model (PCMM) delineated in the Guide to Physical Therapist Practice
1
as the framework for
describing the process of patient care in both sets of Standards and Required Elements. As indicated in this
Guide, the elements of Examination, Evaluation, Diagnosis, Prognosis, Plan of Care, and Outcomes are the
sole responsibility of the PT. Interventions may be provided by either the PT or the PTA who acts under the
direction and supervision of the PT. The Standards and Required Elements for PT education programs
require evidence that the PT graduate is able to:
7D25 Determine those components of the plan of care that may, or may not, be directed to the physical
therapist assistant (PTA) based on (a) the needs of the patient/client, (b) the role, education, and training of
the PTA, (c) competence of the individual PTA, (d) jurisdictional law, (e) practice guidelines policies, and (f)
facility policies.
At its 2000 House of Delegates meeting, The American Physical Therapy Association (APTA) adopted a
position which states that PTs should not direct PTAs to perform any interventions that require constant
examination including procedures such as “spinal and peripheral joint mobilization, which are components of
manual therapy, and sharp selective debridement, which is a component of wound management.”
4
An
analysis of practice performed by the Federation for State Boards of Physical Therapy (FSBPT) suggests
that these procedures are being performed by a significant number of licensed PTAs.
3
In jurisdictions where
the physical therapy practice act does not limit the types of interventions that can be performed by PTAs, the
decision to direct these or other interventions to PTAs is based on the professional judgment of the
supervising PT. Thus, CAPTE expects education programs for PTs to include curricular content (i.e., course
objectives, learning experiences, and assessment of learning) that addresses the reasoning process used by
graduates to perform this supervisory role. In addition, CAPTE expects educational programs to prepare PT
students to determine those components of interventions that may be directed to the physical therapist
assistant.
These considerations should include the level of skill and training required to perform the
procedure, the level of experience/advanced competency of the individual PTA, the practice setting in which
the procedure is performed, and the type of monitoring needed to accurately assess the patient’s response
to the intervention. In addition, acuity and complexity of the patient’s condition and other clinical factors
should be considered when directing PTAs to safely and competently perform any intervention. CAPTE also
expects PTA educational programs to prepare PTA students to recognize components of interventions that
are beyond their scope of work.
Likewise, CAPTE expects education programs for the PTA to select the appropriate depth and breadth of
knowledge and skill needed to perform interventions that are consistent with the PTA’s responsibilities.
These skills not only include specific intervention procedures but also the data collection skills needed to
monitor and assess a patient’s response to an intervention. These data collection skills are outlined in the
Standards and Required Elements. Regardless of the relative simplicity or complexity of the procedure itself,
CAPTE also believes that those interventions which require more extensive foundational knowledge, manual