Key Takeaways
- The APTA Code of Ethics has 8 principles centered on patient welfare, competence, professional judgment, and social responsibility
- Informed consent requires disclosing the nature of the treatment, risks, benefits, alternatives, and the right to refuse — patient must have capacity to consent
- PT scope of practice is defined by state Practice Acts; PTs can evaluate, diagnose movement dysfunction, and treat without physician referral in all 50 states (direct access)
- Documentation must include: patient history, examination findings, evaluation, diagnosis, prognosis, intervention plan, and outcomes using SOAP or similar format
- HIPAA protects patient health information; minimum necessary rule applies; patients have the right to access their records
- Evidence-based practice integrates best available research, clinical expertise, and patient values/preferences
- Cultural competence requires awareness of cultural beliefs, communication preferences, and healthcare values that may affect treatment
- PT supervision of PTAs: PTAs can perform selected interventions under PT direction; PTs are responsible for examination, evaluation, diagnosis, and plan of care
Professional Practice & Ethics
Professional practice questions on the NPTE test your understanding of ethical principles, legal requirements, documentation standards, and evidence-based practice. These questions often present clinical scenarios requiring ethical decision-making.
APTA Code of Ethics
The American Physical Therapy Association Code of Ethics consists of 8 principles that guide professional behavior:
| Principle | Core Concept |
|---|---|
| Principle 1 | Respect the rights and dignity of all individuals |
| Principle 2 | Be trustworthy and compassionate in providing patient care |
| Principle 3 | Be accountable for professional judgments and actions |
| Principle 4 | Demonstrate integrity in relationships with patients, colleagues, and the public |
| Principle 5 | Fulfill professional responsibility to promote the health of society |
| Principle 6 | Enhance expertise through continued professional development |
| Principle 7 | Accept responsibility for the exercise of sound professional judgment |
| Principle 8 | Participate in efforts to meet health needs of local, national, and global communities |
Core Values
The APTA also identifies 8 core values for physical therapists: accountability, altruism, collaboration, compassion/caring, duty, excellence, integrity, and social responsibility.
Informed Consent
Informed consent is both an ethical obligation and legal requirement:
Required Elements
- Nature of the proposed intervention — What will be done
- Expected benefits — Why it is recommended
- Material risks — Potential adverse outcomes
- Alternatives — Other treatment options available
- Right to refuse — Patient can decline without penalty
- Opportunity to ask questions — Must allow discussion
Key Consent Concepts
| Concept | Description |
|---|---|
| Capacity | Patient must have the mental ability to understand and make decisions |
| Voluntary | Consent must be given freely, without coercion |
| Minor patients | Parent or legal guardian provides consent (unless emancipated minor) |
| Emergency exception | Implied consent when patient is unable to consent and delay would cause harm |
| Ongoing process | Consent is not a one-time event — must be obtained for new interventions or significant changes |
Scope of Practice
Physical Therapist Scope
Physical therapists are autonomous practitioners with the authority to:
- Evaluate and examine patients
- Establish a physical therapy diagnosis (movement dysfunction)
- Develop a plan of care with goals and interventions
- Perform interventions
- Determine when to refer to other providers
- Practice via direct access in all 50 states (without physician referral)
PT vs. PTA Responsibilities
| Task | PT | PTA |
|---|---|---|
| Examination | Yes (PT only) | No |
| Evaluation | Yes (PT only) | No |
| Diagnosis | Yes (PT only) | No |
| Prognosis/Plan of Care | Yes (PT only) | No |
| Interventions | Yes | Yes (selected, under PT direction) |
| Outcome assessment | Yes | Can collect data, but PT interprets |
| Modify plan of care | Yes | No (can modify within established plan) |
| Discharge | Yes (PT only) | No |
Key Rule: The PT is ultimately responsible for all patient care, even when interventions are performed by a PTA.
Documentation Standards
SOAP Note Format
| Section | Content |
|---|---|
| S (Subjective) | Patient's report: chief complaint, pain level, functional concerns, goals |
| O (Objective) | Measurable findings: ROM, strength, vital signs, special tests, functional mobility levels |
| A (Assessment) | Clinical interpretation: progress toward goals, response to treatment, clinical reasoning |
| P (Plan) | Treatment plan: interventions, frequency, duration, goals, referrals, patient education |
Documentation Best Practices
- Document same day as the service
- Use objective, measurable language (not "patient is doing better" — instead "patient ambulated 200 feet with SPC, CGA, up from 100 feet last session")
- Include functional outcomes (what the patient can do, not just impairment measures)
- Document patient education provided
- Sign and date all entries
- Never falsify, backdate, or alter documentation
HIPAA Compliance
The Health Insurance Portability and Accountability Act protects patient health information:
- Minimum necessary rule: Only access/share the minimum information needed for the purpose
- Patient rights: Access their records, request corrections, know who has accessed their information
- Permitted disclosures without consent: Treatment, payment, healthcare operations, public health reporting, court orders
- Breach notification: Required within 60 days of discovering a breach
Evidence-Based Practice (EBP)
EBP integrates three components:
- Best available research evidence — Systematic reviews, RCTs, clinical practice guidelines
- Clinical expertise — The PT's experience, knowledge, and clinical judgment
- Patient values and preferences — What matters to the individual patient
Levels of Evidence (Hierarchy)
| Level | Study Type | Strength |
|---|---|---|
| I | Systematic review of RCTs, meta-analysis | Strongest |
| II | Randomized controlled trial (RCT) | Strong |
| III | Cohort study, case-control study | Moderate |
| IV | Case series, case report | Weak |
| V | Expert opinion | Weakest |
A physical therapist believes a patient would benefit from a specific manual therapy technique. Before performing the technique, the PT must:
Which of the following tasks can a Physical Therapist Assistant (PTA) perform independently?
In evidence-based practice, what represents the STRONGEST level of evidence?
Under HIPAA, the "minimum necessary" rule means:
As of 2024, physical therapists have direct access (can evaluate and treat without a physician referral) in:
Arrange the following levels of evidence from STRONGEST to WEAKEST:
Arrange the items in the correct order
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