Standards of practice, supervision, and delegation to physical therapist assistants and support personnel
What this domain tests
This domain tests who may perform which task, how much supervision is required, and where the PT's non-delegable responsibility begins and ends. Questions often use a task that sounds routine but is actually evaluative.
Core rules and concepts
- The PT performs the initial examination and evaluation, establishes the diagnosis and plan of care, and remains responsible for the patient's therapy. The PT must review the plan at appropriate intervals and determine discharge.
- A PTA may carry out selected interventions and adjust parameters within the established plan when allowed by Board rules and the PT's delegation. The PTA must report changes in condition to the supervising PT.
- Supervision levels depend on the patient, the intervention, and the PTA's competence. Direct supervision generally means the PT is on the premises and immediately available. General supervision generally means the PT is available by telecommunications but not necessarily on site. Know the current rule's definitions rather than assuming one level fits every setting.
- Unlicensed support personnel may perform non-skilled tasks such as transporting patients, preparing equipment, clerical work, and maintaining treatment areas. They may not perform skilled physical therapy interventions or make clinical decisions.
Worked example
A PTA is asked to see a new patient with neck pain and begin traction. The PTA may not perform the initial evaluation or independently set up a plan for traction. The PT must examine the patient, establish the plan, and delegate only the interventions the PTA is competent to provide. The PTA may implement traction under the required supervision and must report any new numbness or weakness.
Traps that cost marks
Do not delegate evaluation, diagnosis, plan development, or discharge to a PTA. Do not let aides apply modalities or run skilled exercise programs. Do not assume supervision means the PT has no continuing duty to review the patient.
Exam focus
Classify the task: evaluative, skilled intervention, or non-skilled support. Then match the person and supervision level.