DPT Clinical Education

Physical therapists provide patients or clients with information on the diagnosis, prognosis, treatment options, and risks and benefits of treatment options. Respecting patient and client autonomy in decision-making, “informed consent occurs when communication between a patient and provider results in the patient’s authorization or agreement to undergo a specific intervention.”

Physical therapists perform an initial examination of a patient or client that is comprehensive, consistent with and supported by evidence, and considers the individual factors and characteristics unique to the patient or client.

Performance of this EPA is predicated on the practitioner possessing the ability to perform a history, review of systems, and examination, including systems review and tests and measures accurately, as well as the knowledge of normative data to analyze and interpret outcomes.

Physical therapists establish a diagnosis for each patient or client encounter that reflects identified signs, symptoms, and/or impairments in body structures and function. Performance of the EPA is predicated on the ability to organize and interpret all relevant information that is part of the diagnostic process (obtaining relevant history, performing systems review, and selecting and administering specific tests and measures). 

Physical therapists formulate a management plan that includes a plan of care. Performance of this EPA is predicated on the ability to obtain information through the history and physical exam to formulate a diagnosis. Developing a plan of care is an iterative process based on the best available evidence that requires synthesis of medical, ethical, legal, and economic factors, as well as knowledge of the strengths and limitations of the patient or client, physical therapist, team, and facilities. 

Physical therapists implement a plan of care that is predicated on the development of a plan of care (by oneself or another physical therapist) that addresses problems and activity limitations identified through examination and evaluation. 

Physical therapists select, prescribe, and implement interventions targeted to established goals and based on the available evidence, examination findings, diagnosis, and prognosis. Physical therapists must also adhere to the personal, professional, and jurisdictional scope of practice and institutional, state, and federal guidelines. 

Physical therapists provide an evidence-based comprehensive home program based on a given patient’s or client’s presentation, symptoms, activity limitations and participation restrictions to address their stated goals of rehabilitation. This program considers health promotion and wellness needs, the patient’s or client’s goals, comorbidities, available resources, and stage of healing. Instructions are provided in the appropriate mode (written or electronic) at a level commensurate with the patient’s or client’s preferred learning style, language, and education level. 

Physical therapists are accountable to provide accurate, focused, and context-specific documentation of each patient or client encounter in either written or electronic formats. The patient or client record is a legal document that is a critical form of communication that supports the ability to provide continuity of care to patients or clients. 

At any point in an episode of care, or in a long-term or ongoing physical therapist-patient or client relationship, a physical therapist may use the knowledge from assessments performed to refer patients and clients to other professionals when they require intervention or assessment, including the need for emergent care. This may include consultation with or referral to other health care professionals or a physical therapist colleague with advanced expertise, or additional postprofessional education or certification (eg, board-certified clinical specialist).

Physical therapists inform, educate and train others, including patients and clients, caregivers, communities, families, significant others, and other health care providers, as a component of practice. The physical therapist teaches in a way that can be appreciated by the learners (eg, cognition, knowledge, language) and considers domains of learning (cognitive/knowledge, psychomotor/skills, affective/attitudes). 

Physical therapists supervise physical therapist assistants, aides, technicians, and junior learners (eg, high school/college/PT students). Proper supervision ensures safe and effective delivery of physical therapy services. The physical therapist maintains responsibility for patient and client management at all times, consistent with jurisdictional rules and laws governing supervision. 

Physical therapists assess and interpret the outcomes of a plan of care and determine whether continued physical therapy is indicated or if the patient's episode of care should be concluded. Performance of this EPA is predicated on the practitioner possessing the ability to relate the patient's current ability and performance to normative data while considering results of the evaluation and all established goals.

The physical therapist concludes an episode of care (ie, discharge, transition) when the goals and outcomes for the patient or client have been achieved, when the patient or client is unable to further progress toward goals, or when the physical therapist determines that the patient or client will no longer benefit from physical therapy. Conclusion of a single episode of care may not, in some circumstances, signal the end of a patient- or client-provider relationship (ie, the patient may continue services for another diagnosis).

Physical therapists, in collaboration with the patient or client, determine discharge recommendations for a patient or client that are supported by evidence and individual outcome data from the patient or client encounters and consider the individual factors and characteristics unique to the patient or client. This recommendation may include optimal settings for physical therapist services and equipment needed by the patient or client.

Physical therapists identify opportunities for improvement within all aspects of care, identify patient safety incidents, and offer solutions to address them. All care situations involve chances for errors to occur that can affect the patient’s health or the course of care. Identifying, responding to, analyzing, documenting, and addressing avoidable process failures is important to protect and promote patient safety.

Physical therapists' roles in prevention and promotion of health, wellness, and fitness range from encouraging healthy behaviors in individuals without conditions to helping individuals with chronic conditions engage in physical activity. Physical therapists conduct screening(s) to determine the need for primary, secondary, or tertiary prevention services; further examination, intervention, education, or consultation by a physical therapist; or referral to another practitioner.

The physical therapist evaluates access to services and utilizes billing procedures that are in compliance with governing rules and regulations, and consistent with the ethics of the profession. 

The application of systematic triage systems in the delivery of therapy services to patients while maintaining the highest level of quality is essential. A physical therapist recognizes and triages services based on resources, patient need, urgency, and complexity. 

Effective and efficient handoff communication is critical for patient care. Handoff communication ensures that patients continue to receive high-quality and safe care through transitions of responsibility from one health care team or practitioner to another. Handoffs are also foundational to the success of many other types of interprofessional and intraprofessional communication, including discharge from one provider to another and from one setting to another. Handoffs may occur between settings (eg, hospital to outpatient/homecare; pediatric to adult caregiver) or within settings (eg, floor to ICU; day treat to outpatient, inpatient rehab to day treat; school system to outpatient). 

Physical therapists often are the first health care providers to initiate physical activity, assess patient response to movement, move with a patient, stress the cardiac system, and may witness a patient decompensate or have a significant change in status. The ability to promptly recognize a patient who requires urgent or emergent care, initiate evaluation and management, and seek help is essential. Physical therapists may be the initial health care provider to recognize a change in a patient’s status during these events in any setting. Early recognition and intervention provide the greatest chance for optimal outcomes in patient care. This EPA calls for simultaneously recognizing the need and initiating a call for assistance.