Supervision, Delegation, and PTA Scope of Practice
This domain tests the vertical relationship between the PT, the PTA, and unlicensed staff. Items typically describe a task and ask who may perform it and under what level of supervision.
Who holds the responsibility
The PT performs the initial examination and evaluation, establishes the diagnosis and plan of care, decides what to delegate, and remains accountable for the outcome. Delegation is a professional judgment based on patient complexity, stability, and the PTA's training - not a staffing convenience.
What a PTA may and may not do
- May: implement interventions in the plan, adjust within parameters the PT set, collect and report objective data, educate per the plan, document care, and report changes in status.
- May not: perform the initial evaluation, establish or change the diagnosis, independently alter the plan of care, or make the discharge decision. The discharge evaluation stays with the PT.
Supervision levels
Direct/on-site supervision means the PT is physically present in the setting and immediately available. General supervision means the PT is reachable and sees the patient at defined intervals. Which applies depends on the setting, the patient's acuity, and the regulation; in every case the PT must remain informed of the patient's status.
Aides
Aides never perform skilled interventions. Their work is transport, clerical tasks, cleaning, and equipment setup.
Worked example
A PTA is progressing a patient after knee replacement. The patient reports new calf pain and swelling. The PTA stops the session, documents the complaint and objective findings, and notifies the PT the same day; the PT examines and refers. Continuing and increasing resistance would be both unsafe and outside PTA scope. By contrast, increasing band resistance within the parameters the PT set in the plan is proper delegation.
Traps
Assuming the PTA can perform the reevaluation and have the PT sign later; treating phone availability as sufficient in every setting; allowing aides to chart skilled care; having a PT delegate a patient the PT has never evaluated; assuming a plan of care written months ago needs no review.