5.4 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.

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APTA Code of Ethics

The American Physical Therapy Association Code of Ethics consists of 8 principles that guide professional behavior:

Core Values

The APTA also identifies 8 core values for physical therapists: accountability, altruism, collaboration, compassion/caring, duty, excellence, integrity, and social responsibility.

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Informed Consent

Informed consent is both an ethical obligation and legal requirement:

Required Elements

1. Nature of the proposed intervention — What will be done
2. Expected benefits — Why it is recommended
3. Material risks — Potential adverse outcomes
4. Alternatives — Other treatment options available
5. Right to refuse — Patient can decline without penalty
6. Opportunity to ask questions — Must allow discussion

Key Consent Concepts

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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

Key Rule: The PT is ultimately responsible for all patient care, even when interventions are performed by a PTA.

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Documentation Standards

SOAP Note Format

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

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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

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Evidence-Based Practice (EBP)

EBP integrates three components:

1. Best available research evidence — Systematic reviews, RCTs, clinical practice guidelines
2. Clinical expertise — The PT's experience, knowledge, and clinical judgment
3. Patient values and preferences — What matters to the individual patient

Levels of Evidence (Hierarchy)

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The 2026 Code of Ethics and Ethical Decision-Making

Effective January 1, 2026, the APTA House of Delegates adopted a single Code of Ethics for the Physical Therapy Profession, combining the former Code of Ethics for the Physical Therapist and the Standards of Ethical Conduct for the Physical Therapist Assistant into one document and modernizing it for issues such as artificial intelligence and emerging technology. The longstanding ethical framework still rests on the same core principles — respect for dignity, trustworthiness, accountability, integrity, professional development, and social responsibility — so the eight-principle structure remains the most useful study scaffold.

Four bioethical principles underpin nearly every NPTE ethics scenario: autonomy (the patient's right to make their own decisions), beneficence (act in the patient's best interest), nonmaleficence ("do no harm"), and justice (fair, equitable treatment). When a question pits two principles against each other, patient welfare and safety generally take precedence.

Negligence, Liability, and Mandatory Reporting

Malpractice (professional negligence) requires four elements: a duty to the patient, a breach of the standard of care, causation linking the breach to harm, and actual damages. Practicing outside one's scope or competence, ignoring contraindications, or inadequate documentation can establish breach. PTs are also mandatory reporters of suspected child or elder abuse and must report in good faith.

Delegation, Supervision, and Billing Integrity

The PT delegates to support personnel based on the task's complexity and the patient's stability. PTAs may not perform examinations, evaluations, the diagnosis, the prognosis, the plan of care, or discharge, and supervision requirements (general, direct, or direct personal) vary by state practice act and payer. Tasks delegated to aides/technicians must be non-skilled and performed under direct, on-site supervision. Billing must reflect services actually rendered; upcoding, billing for unsupervised services, and documenting time not spent are fraud under the False Claims Act.

Standardized Tests: Reliability and Validity

Evidence-based practice requires understanding measurement properties. Reliability is consistency (test-retest, inter-rater, intra-rater); validity is whether a test measures what it intends (content, criterion, construct).

Sensitivity is a test's ability to correctly identify those with the condition (a highly sensitive test, when negative, helps rule out — "SnNout"), while specificity correctly identifies those without it (a highly specific test, when positive, helps rule in — "SpPin"). The minimal clinically important difference (MCID) is the smallest change a patient perceives as beneficial, distinguishing a statistically significant change from a meaningful one when interpreting outcome measures.