Scope of Practice and Statutory Definitions
Scope of Practice and Statutory Definitions
This domain tests the statutory boundary between physical therapy, PTA practice, and non-skilled support, plus direct-access limits.
Core rules
- “Physical therapy” is the examination, evaluation, diagnosis within the PT scope, and treatment of movement dysfunction and physical impairments. It includes therapeutic exercise, manual therapy, modalities, gait training, and patient education.
- A PT may evaluate and treat a patient without a referral in Missouri, but direct access is limited: if the patient is not progressing, the PT must refer to an appropriate licensed health care provider after 10 visits or 30 days, whichever comes first. Insurance may still require a referral.
- A PTA performs selected physical therapy interventions delegated by a PT and within the plan of care. The PTA does not perform the initial evaluation, establish or change the plan of care, or make the discharge decision.
- Support personnel and aides may perform non-skilled tasks such as transport, cleaning, and clerical work. They may not perform skilled PT interventions or modalities.
- Delegation must match the patient’s condition, the task’s complexity, and the delegate’s competence.
Worked example
A patient self-refers with ankle pain. The PT evaluates, treats, and documents. At visit 10 the patient has not improved. The PT must refer rather than simply continue for another month. If the PT instead has the PTA perform the initial evaluation, that is outside PTA scope even if the PTA has years of experience.
Traps
The most common error is treating “PTA” as a mini-PT. Experience does not expand statutory scope. Also watch the direct-access clock: it is visits or days, not “until the patient asks for a referral.” A physician referral does not transfer the PT’s responsibility for the plan.