Physical Therapist Assistants
What Do They Do?
This training module was developed through Lane Community College Physical Therapist Assistant Program for Clinical Instructors to enhance understanding of Physical Therapist Assistant education, scope of practice, and utilization. It is intended for Physical Therapists who may not have previous experience working with Physical Therapist Assistants or Student Physical Therapist Assistants, however, it is recommended as a quick review for both PTs and PTAs involved in any component of PTA clinical education. References are for the State of Oregon but links are provided for information for other states, as well.
This lesson was created with SoftChalk® software and can be viewed in most internet browsers including Firefox and Internet Explorer. A flash player may be required for some of the activities and can be downloaded for free through Adobe by clicking here. The only audio for this lesson is feedback sound effects on the self-assessment quiz questions embedded within the lesson.
In the busy world of physical therapy, free time is extremely limited. This lesson is concise and should not take more than 20 minutes. All documents and organizations referenced are hyperlinked. Watch for cues to click on hyperlinks as these are colored and underlined such as APTA website. Hyperlinks will open in a new window. Scroll over words in bold font for "text poppers" with additional information. Click on "Test Yourself" questions to test your knowledge of the material. Move the next page by clicking the arrow or page number at the top of the screen. Jump to specific topics using the sidebar to the right of the screen.
Upon completion of this course, the participant will be able to:
The physical therapist assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy. The physical therapist assistant is a graduate of a physical therapist assistant associate degree program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).1
The Normative Model of Physical Therapist Education2 sets a framework for Physical Therapist Assistant education 2-Year Associate Degree. Curriculum content includes includes both foundational content and physical therapy content. Foundational content describes foundational sciences and behavioral sciences, whereas physical therapy content describes performance expectations, behavior expectations, and clinical education experiences. Most PTA programs are offered through community or technical colleges.
All 50 states license Physical Therapists, however, the same is not true for Physical Therapist Assistants. PTAs may be licensed, certified, or registered as described in individual state practice acts. Colorado and Hawaii do not recognize the PTA with any of these three distinctions.3,4 Washington recently instituted licensure for PTAs.
The APTA 2009 PTA Member Demographic Prophile5 survey found females account for 79% of PTAs and males 21%. Nearly 25% of respondents have worked as PTAs for 10-15 years and nearly 33% earned a Bachelor Degree.
Scope of practice and utilization of PTAs is regulated by entities at many levels:
BOD G11-08-09-18 LINK
Minimum skills were defined as foundational skills that are indispensable for a new graduate physical therapist assistant to perform on patients/clients in a competent and coordinated manner under the direction and supervision of the physical therapist.
HOD P06-00-30-36 [Position] LINK
The physical therapist's scope of practice as defined by the American Physical Therapy Association Guide to Physical Therapist Practice includes interventions performed by physical therapists. These interventions include procedures performed exclusively by physical therapists and selected interventions that can be performed by the physical therapist assistant under the direction and supervision of the physical therapist. Interventions that require immediate and continuous examination and evaluation throughout the intervention are performed exclusively by the physical therapist. Such procedural interventions within the scope of physical therapist practice that are performed exclusively by the physical therapist include, but are not limited to, spinal and peripheral joint mobilization/manipulation, which are components of manual therapy, and sharp selective debridement, which is a component of wound management.
Oregon Administrative Rules describe prohibited acts for the Physical Therapist Assistant:
848-015-0030 Prohibited Acts
(1) A physical therapist assistant shall not:
(a) Perform an initial evaluation.
(b) Perform the required reassessment provided in OAR 848-040-0155. However, a physical therapist assistant may participate with the physical therapist in gathering data to be included in the required reassessment of a patient for whom the assistant has been providing treatment.
(c) Independently make modifications to the plan of care or objective goals. However, an assistant may collaborate with the physical therapist in making modifications or changes to the plan of care or goals based on the assistant's treatment of that patient and the patient's condition, progress or response to the treatment.
(d) Independently make the decision to discharge a patient from therapy. However, a physical therapist assistant may make recommendations regarding discharge to the supervising physical therapist based on the assistant's treatment of the patient.
(e) Perform high velocity manipulation of the spine or peripheral joints.
(2) As provided in ORS 688.020(2), no person shall practice as a physical therapist assistant unless that person is licensed under ORS 688. 090.
HOD P06-05-18-26 [Amended HOD 06-00-16-27; HOD 06-99-07-11; HOD 06-96-30-42; HOD 06-95-11-06; HOD 06-93-08-09; HOD 06-85-20-41; Initial HOD 06-84-16-72/HOD 06-78-22-61/HOD 06-77-19-37] [Position] Link
Physical therapists have a responsibility to deliver services in ways that protect the public safety and maximize the availability of their services. They do this through direct delivery of services in conjunction with responsible utilization of physical therapist assistants who assist with selected components of intervention. The physical therapist assistant is the only individual permitted to assist a physical therapist in selected interventions under the direction and supervision of a physical therapist.
Direction and supervision are essential in the provision of quality physical therapy services. The degree of direction and supervision necessary for assuring quality physical therapy services is dependent upon many factors, including the education, experiences, and responsibilities of the parties involved, as well as the organizational structure in which the physical therapy services are provided.
Regardless of the setting in which the physical therapy service is provided, the following responsibilities must be borne solely by the physical therapist:
The physical therapist remains responsible for the physical therapy services provided when the physical therapist's plan of care involves the physical therapist assistant to assist with selected interventions. Regardless of the setting in which the service is provided, the determination to utilize physical therapist assistants for selected interventions requires the education, expertise, and professional judgment of a physical therapist as described by the Standards of Practice, Guide to Professional Conduct, and Code of Ethics.
In determining the appropriate extent of assistance from the physical therapist assistant (PTA), the physical therapist considers:
• The PTA's education, training, experience, and skill level.
• Patient/client criticality, acuity, stability, and complexity.
• The predictability of the consequences.
• The setting in which the care is being delivered.
• Federal and state statutes.
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Typical Task for the Therapist |
Typical Task for the PTA |
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Establish differential diagnosis for patients across the life span based on evaluation and results of examination and medical/psychosocial information. |
Assist with data collection; assist in performing components of tests and measures. |
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Communicate or discuss diagnosis or clinical impressions with other practitioners. |
Communicate observations and data collection with the therapist and with patient/client, family, and other healthcare workers as appropriate. |
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Determine patient/client prognosis based on evaluation and results of examination and medical/psychosocial information. |
Progress patient/client through the plan of care as established or delegated by the PT. |
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Collaborate with patients/clients, families, payers, other healthcare workers to determine realistic/acceptable plan of care. |
Offer suggestions to the PT based on the observations of patient/client status and performance. |
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Establish goals and functional outcomes that specify expected time duration. |
Discuss indicators in patient/client status/performance related to goals that may results in need for PT to change the plan of care. |
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Define achievable patient/client outcomes within available resources. |
Consider the influence of reimbursement policies on outcomes. |
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Deliver and manage plan of care that complies with administrative policies and procedures of the practice environment. |
Follow established policies and procedures of the clinical setting. |
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Monitor and adjust the plan of care in response to patient/client status. |
Request patient/client re-examination or revisions to interventions when the patient/client status warrants it. |
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The following four levels of supervision are recognized by the APTA and are consistent with language used in the Clinical Performance Instrument.
HOD P06-00-15-26 [Position] Link
The American Physical Therapy Association recognizes the following levels of supervision:
General Supervision: The physical therapist is not required to be on site for direction and supervision, but must be available at least by telecommunications.
Direct Supervision: The physical therapist is physically present and immediately available for direction and supervision. The physical therapist will have direct contact with the patient/client during each visit that is defined in the Guide to Physical Therapist Practice as all encounters with a patient/client in a 24-hour period. Telecommunications does not meet the requirement of direct supervision.
Direct Personal Supervision: The physical therapist or, where allowable by law, the physical therapist assistant is physically present and immediately available to direct and supervise tasks that are related to patient/client management. The direction and supervision is continuous throughout the time these tasks are performed. Telecommunications does not meet the requirement of direct personal supervision.
Medicare generally has the strictest supervision requirements for assistants, aide, and students. Several resources providing detailed information regarding reimbursement for services and supervision of assistants, aides, and students are available through the following Federal Issues and Resources link. A comprehensive chart is available to APTA Members on this same link. Some state practice acts mandate more stringent supervision and supercedes Medicare regulations. Some of these resources are available only to APTA member.
A brief condensed summary of this PTA Supervisions Chart11 for common settings:
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Setting |
Supervision of PTAs |
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Comprehensive Outpatient Rehabilitation Facility (CORF) |
Services must be performed by or under supervision of a qualified PT, PT must be available for consultation on premisis or via telephone communication |
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Home Health Agency (HHA) |
General Supervision - initial direction and periodic inspection by PT, not required to be on premises during PTA intervention |
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Hospital Inpatient Services |
PT services must be performed by or under supervision of a PT, no supervision specified; defer to state practice act |
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Hospital Outpatient Services |
PT services must be performed by or under supervision of a PT, no supervision specified; defer to state practice act |
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Physical Therapy Private Practice Office (PTPP) |
Personal Supervision - a PT must be physically present during interventions provided by PTA |
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Skilled Nursing Facility (SNF) |
General Supervision - initial direction and periodic inspection by PT, not required to be on premises during PTA intervention |
HOD P06-00-19-31 [Amended HOD 06-96-20-35; HOD 06-95-20-11] [Position] Link
Student physical therapist assistants, when participating as part of a physical therapist assistant education curriculum, and when acting in accordance with the American Physical Therapy Association policy and applicable state laws and regulations, are qualified to perform selected physical therapy interventions under the direction and direct supervision of either the physical therapist alone or the physical therapist and physical therapist assistant. The physical therapist is responsible for patient/client management. Direct supervision means the physical therapist is physically present and immediately available for direction and supervision. The physical therapist will have direct contact with the patient/client during each visit that is defined in the Guide to Physical Therapist Practice. Telecommunications does not meet the requirement of direct supervision.
A comprehensive chart of Medicare supervision for students is available to the public through the following link: Student Supervision and Medicare.
The APTA issued a summary and interpretation of guidelines for services provided by students for Medicare B:
Therapy Students
Only the services of the therapist can be billed and paid under Medicare Part B. The services performed by a student are not reimbursed even if provided under "line of sight" supervision of the therapist; however, the presence of the student "in the room" does not make the service unbillable.
EXAMPLES:
Therapists may bill and be paid for the provision of services in the following scenarios:
• The qualified practitioner is present and in the room for the entire session. The student participates in the delivery of services when the qualified practitioner is directing the service, making the skilled judgment, and is responsible for the assessment and treatment.
• The qualified practitioner is present in the room guiding the student in service delivery when the therapy student and the therapy assistant student are participating in the provision of services, and the practitioner is not engaged in treating another patient or doing other tasks at the same time.
• The qualified practitioner is responsible for the services and as such, signs all documentation. (A student may, of course, also sign but it is not necessary since the Part B payment is for the clinician's service, not for the student's services).
Physical therapist assistants and occupational therapy assistants are not precluded from serving as clinical instructors for therapy students, while providing services within their scope of work and performed under the direction and supervision of a licensed physical or occupational therapist to a Medicare beneficiary.
Documentation: APTA recommends that the physical therapist or physical therapist assistant complete documentation.
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This is an excellent one-page summary of the thought process of a Physical Therapist Assistant. It has been laminated and disseminated to all students in the Lane Community College PTA Program. In times of questions, students are first redirected to this resource to foster clinical thinking skills. Following the pathway ensures scope of practice, communication, and, moreover, patient safety. Diamond-shaped boxes with red text represent decisions to be made. All paths of insufficient information to proceed lead to communication with the PT. Click the link to find a full-size copy of the Problem Solving Algorithm
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Generic abilities were developed for Physical Therapists and are equally applicable to Physical Therapist Assistants, therefore, included in in PTA education. Link
Generic abilities are attributes, characteristics or behaviors that are not explicitly part of the profession's core of knowledge and technical skills, but are nevertheless required for success in the profession. Ten generic abilities were identified through a study conducted at University of Wisconsin-Madison in 1991-92. The ten abilities and definitions developed are:
The ratio of PTs to PTAs varies widely across geographic areas, directly affecting utilization. Many underserved areas without a PTA Program in the vicinity may not have available PTA applicants for hire. On the opposite end of the spectrum, some sites may use a model for cost savings utilizing multiple PTAs supervised by a single PT to manage a much larger caseload. Check your state practice act for regulations regarding number of PTAs and/or other support staff that can be supervised by one clinician.3 Oregon has no such regulations at this time.6
Since Physical Therapists and Physical Therapist Assistants are the only healthcare providers licensed to perform skilled physical therapy interventions, it only makes sense to work together as a team for practice protection and quality patient care, especially as Physical Therapist move into a doctoring profession. When was the last time you went to your Primary Care Physician, a Dentist, a Pharmacist, or Optometrist without an assistant performing selected portions of the service?
As with any successful relationship, communication is key. All pathways of the previously mentioned Problem Solving Algorithm lead back to PTA communication with the PT. For continuity of care, patient safety, and attainment of treatment goals, active communication must take place on both sides. Depending on setting, communication may come in the form of daily face-to-face meetings, impromptu discussions in the office, chart notes, telecommunications, text messaging, or other formal or informal means.
State requirements for continuing education on continuing competence varies. For Oregon licensure renewal, Physical Therapist must complete 24 hours of continuing education, including a pain course, within a 2-year reporting period. Physical Therapist Assistants must earn 12 continuing education units or hours in the 2-year reporting period. One hour of direct contact equals one continuing education unit.6 Most courses are open to PTAs, even a few specifically offered for PTAs.
In 2005, the APTA began Recognition of Advanced Proficiency for the Physical Therapist Assistant16 as an opportunity to demonstrate achievement in skills, education, leadership, and experience in the areas of Musculoskeletal, Neuromuscular, Geriatric, Pediatric, Cardiovascular/Pulmonary, and/or Integumentary. For more information about the program or to download and application, use this link.
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Change is the only constant in healthcare. Keeping up with changes at each level and organization can be challenging.
On behalf of Lane Community College Physical Therapist Assistant Program, faculty, and students, thank you for your support and interest in clinical education. Without you, this program would not be possible.
Please contact your respective Academic Coordinator of Clinical Education with questions regarding clinical education. Refer to hyperlinked documents within this module, as well as the school Clinical Education Manual, for further information.
