Physiotherapy Define? Treated age groups? Specialities?
Non-patient care roles? Education level?
Slide 3
History of physiotherapy In 460 BC Hippocrates and Hector,later
Galenus First practioners of physical therapy. Used massage and
hydrotherapy. 18 th century orthopaedic developed Gymnasticons and
exs developed to treat gout 1813, Per Henrik Ling,(father of
Swedish gymnastics) Found Royal central institute of gymnastics
(RCIG),for massage,exs and manipulation Sjukgymnast someone
involved in gymnastic, for those who are ill.
Slide 4
1887 PTs official registration by Swedish National Board of
Health and Welfare. 1894 4 nurses, formed Chartered society of
physiotherapy. 1913 school of physiotherapy established by
university of Otago in New Zealand 1914 Reed college in Portland
These are the examples of institution that taught PT, they
graduated Reconstruction Aides
Slide 5
End of 19 century modern physical therapy was established.
American ortho surgeons,started to treat children with disability,
employed women(trained in physical education,massage and exs)
Promoted during polio outbreak in 1916 1917-1918 (1 st world war)
therapy performed widely and called as Rehabilitation therapy
People were named as Reconstruction Aide.
Slide 6
First school of physiotherapy at Walter reed Army Hospital at
Washington DC was formed as the out break of 1 st world war. 1921
first physical therapy research was published in PT Review. 1921-
Mary Mc Milan (physical therapy aide)formed AWPTA........later
called as APTA(American Physical Therapy Association) Mother of
Physical therapy due to her contribution.
Slide 7
1924 the Georgia Warm Spring foundation promoted physical
therapy in the treatment of polio. 1940s main physio practice was
massage, traction and exs. 1950s manipulation for spine practised
Moved beyond hospitals 1974 ortho speciality in physio was formed
in APTA International Federation of Orthopaedic Manipulative
therapy was established, Manual therapy popularised
Slide 8
1980s further development in physio was recorded Therapies
involved are: US therapy / Exercise therapy SWD / Wax therapy IFT /
Cryotherapy TENS Stimulations Laser IRR
Slide 9
ETHICS The branch of philosophy dealing with values relating to
human conduct, with respect to the rightness and wrongness of
certain actions and to the goodness and badness of the motives and
ends of such actions.
Slide 10
MEDICAL ETHICS Medical ethics is a system of moral principles
that apply values & judgement to the practice of medicine.
Physical therapists and physical therapist assistants should strive
to apply principles of altruism, excellence, caring, ethics,
respect, communication and accountability in working together with
other professionals to achieve optimal health and wellness in
individuals and communities.
Slide 11
Values in Medical Ethics Six of the values that commonly apply
to medical ethics : Autonomy - the patient has the right to refuse
or choose their treatment. Autonomy Beneficence - a practitioner
should act in the best interest of the patient. Non-maleficence -
"first, do no harm Non-maleficence Justice - concerns the
distribution of scarce health resources, and the decision of who
gets what treatment (fairness and equality). Justice Dignity - the
patient (and the person treating the patient) have the right to be
treated with dignity. Dignity Truthfulness and honesty -
Truthfulnesshonesty
Slide 12
Code of ethics for PT Principle #1: Physical therapists shall
respect the inherent dignity and rights of all individuals. (Core
Values: Compassion, Integrity) 1A. Physical therapists shall act in
a respectful manner toward each person regardless of age, gender,
race, nationality, religion, ethnicity, social or economic status,
sexual orientation, health condition, or disability. 1B. Physical
therapists shall recognize their personal biases and shall not
discriminate against others in physical therapist practice,
consultation, education, research, and administration.
Slide 13
Principle #2: Physical therapists shall be trustworthy and
compassionate in addressing the rights and needs of
patients/clients. (Core Values: Altruism, Compassion, Professional
Duty) 2A. Physical therapists shall adhere to the core values of
the profession and shall act in the best interests of
patients/clients over the interests of the physical therapist. 2B.
Physical therapists shall provide physical therapy services with
compassionate and caring behaviors that incorporate the individual
and cultural differences of patients/clients. 2C. Physical
therapists shall provide the information necessary to allow
patients or their surrogates to make informed decisions about
physical therapy care or participation in clinical research.
Slide 14
2D. Physical therapists shall collaborate with patients/clients
to empower them in decisions about their health care. 2E. Physical
therapists shall protect confidential patient/ client information
and may disclose confidential information to appropriate
authorities only when allowed or as required by law.
Slide 15
Principle #3: Physical therapists shall be accountable for
making sound professional judgments. (Core Values: Excellence,
Integrity) 3A. Physical therapists shall demonstrate independent
and objective professional judgment in the patients/clients best
interest in all practice settings. 3B. Physical therapists shall
demonstrate professional judgment informed by professional
standards, evidence (including current literature and established
best practice), practitioner experience, and patient/client
values.
Slide 16
3C. Physical therapists shall make judgments within their scope
of practice and level of expertise and shall communicate with,
collaborate with, or refer to peers or other health care
professionals when necessary. 3D. Physical therapists shall not
engage in conflicts of interest that interfere with professional
judgment. 3E. Physical therapists shall provide appropriate
direction of and communication with physical therapy assistants and
support personnel
Slide 17
Principle #4: Physical therapists shall demonstrate integrity
in their relationships with patients/clients, families, colleagues,
students, research participants, other health care providers,
employers, payers, and the public. (Core Value: Integrity) 4A.
Physical therapists shall provide truthful, accurate, and relevant
information and shall not make misleading representations. 4B.
Physical therapists shall not exploit persons over whom they have
supervisory, evaluative or other authority (eg, patients/clients,
students, supervisees, research participants, or employees). 4C.
Physical therapists shall discourage misconduct by health care
professionals and report illegal or unethical acts to the relevant
authority, when appropriate.
Slide 18
4D.Physical therapists shall report suspected cases of abuse
involving children or vulnerable adults to the appropriate
authority, subject to law. 4E. Physical therapists shall not engage
in any sexual relationship with any of their patients/clients,
supervisees, or students. 4F. Physical therapists shall not harass
anyone verbally, physically, emotionally, or sexually.
Slide 19
Principle #5: Physical therapists shall fulfill their legal and
professional obligations. (Core Values: Professional Duty,
Accountability) 5A. Physical therapists shall comply with
applicable local, state, and federal laws and regulations. 5B.
Physical therapists shall have primary responsibility for
supervision of physical therapist assistants and support personnel.
5C. Physical therapists involved in research shall abide by
accepted standards governing protection of research
participants.
Slide 20
5D. Physical therapists shall encourage colleagues with
physical, psychological, or substance-related impairments that may
adversely impact their professional responsibilities to seek
assistance or counsel. 5E. Physical therapists who have knowledge
that a colleague is unable to perform their professional
responsibilities with reasonable skill and safety shall report this
information to the appropriate authority. 5F. Physical therapists
shall provide notice and information about alternatives for
obtaining care in the event the physical therapist terminates the
provider relationship while the patient/client continues to need
physical therapy services.
Slide 21
Principle #6: Physical therapists shall enhance their expertise
through the lifelong acquisition and refinement of knowledge,
skills, abilities, and professional behaviors. (Core Value:
Excellence) 6A. Physical therapists shall achieve and maintain
professional competence.
Slide 22
6B. Physical therapists shall take responsibility for their
professional development based on critical self-assessment and
reflection on changes in physical therapist practice, education,
health care delivery, and technology. 6C. Physical therapists shall
evaluate the strength of evidence and applicability of content
presented during professional development activities before
integrating the content or techniques into practice. 6D. Physical
therapists shall cultivate practice environments that support
professional development, lifelong learning and excellence.
Slide 23
Principle #7: Physical therapists shall promote organizational
behaviors and business practices that benefit patients/clients and
society. (Core Values: Integrity, Accountability) 7A. Physical
therapists shall promote practice environments that support
autonomous and accountable professional judgments. 7B. Physical
therapists shall seek remuneration as is deserved and reasonable
for physical therapist services. 7C. Physical therapists shall not
accept gifts or other considerations that influence or give an
appearance of influencing their professional judgment
Slide 24
7D. Physical therapists shall fully disclose any financial
interest they have in products or services that they recommend to
patients/clients. 7E. Physical therapists shall be aware of charges
and shall ensure that documentation and coding for physical therapy
services accurately reflect the nature and extent of the services
provided. 7F. Physical therapists shall refrain from employment
arrangements, or other arrangements, that prevent physical
therapists from fulfilling professional obligations to
patients/clients.
Slide 25
Principle #8: Physical therapists shall participate in efforts
to meet the health needs of people locally, nationally, or
globally. (Core Value: Social Responsibility) 8A. Physical
therapists shall provide pro bono physical therapy services or
support organizations that meet the health needs of people who are
economically disadvantaged, uninsured, and underinsured. 8B.
Physical therapists shall advocate to reduce health disparities and
health care inequities, improve access to health care services, and
address the health, wellness, and preventive health care needs of
people.
Slide 26
8C. Physical therapists shall be responsible stewards of health
care resources and shall avoid overutilization or underutilization
of physical therapy services. 8D. Physical therapists shall educate
members of the public about the benefits of physical therapy and
the unique role of the physical therapist.
Slide 27
Key Ethical Principles Principle of beneficence Principle of
the common good Principle of distributive justice Principle of
double effect Principle of formal and material co-operation
Principle of human dignity Principle of informed consent Principle
of integrity and totality Principle of proportionate and
disproportionate means
Slide 28
Principle of religious freedom Principle of respect for
autonomy Principle of respect for persons Principle of stewardship
Principle of subsidiarity Principle of toleration
Slide 29
Principle of beneficence Traditionally understood as the "first
principle" of morality, the dictum "do good and avoid evil" lends
some moral content to this principle. The principle of beneficence
is a "middle principle as it is partially dependent for its content
on how one defines the concepts of the good and goodness.the
goodgoodness
Slide 30
The Principle of Nonmaleficence, as "first, do no harm," is
often considered to be a corollary to the principle of beneficence.
In this respect, it shares the same characteristics of beneficence
and is considered as a middle principle. Considered in its own
right, nonmaleficence is sometimes interpreted to imply that if one
cannot do good without also causing harm, then one should not act
at all (in that particular circumstance)
Slide 31
nonmaleficence not simply as "doing no harm," but as "doing no
evil," which is closer to its etymological roots
Slide 32
Principle of the common goods In general, the common good
consists of all the conditions of society and the goods secured by
those conditions, which allow individuals to achieve human and
spiritual flourishing
Slide 33
the principle of the common good is corollary to principle of
subsidiarity. According to this understanding, the principle of the
common good has three essential elements:subsidiarity 1) respect
for persons; fundamental rights 2) social welfare; (access to basic
goods such as cloth,food,medical,work and education) 3) peace and
security. (public authority should ensure the security of the
society and its individual members)
Slide 34
Principle of distributive justice Distributive justice requires
that everyone receive equitable access to the basic health care
necessary for living a fully human life as there is a basic human
right to health care.access Benefits and burdens should also be
distributed in a just manner. Benefits and burdens
Slide 35
Principle of double effect Double effect refers to two types of
consequences which may be produced by a single action, [7] and in
medical ethics it is usually regarded as the combined effect of
beneficence and non-maleficence. [8] [7] [8] A commonly cited
example of this phenomenon is the use of morphine or other
analgesic in the dying patient. [9] Such use of morphine can have
the beneficial effect of easing the pain and suffering of the
patient, while simultaneously having the maleficent effect of
hastening the death of the patient through suppression of the
respiratory system.analgesic [9]
Slide 36
Examples of double effect ; Administering vaccine (medical)
Pregnancy and abortion In war(bomb)
Slide 37
Principle of formal and material co- operation Moralists have
long recognized that under many circumstances, it would be
impossible for an individual to do good in the world, without being
involved to some extent in evil. the principles of cooperation are
actually a constellation of moral criteria: Formal co-operation
Immediate material co-operation Mediate material co-operation
Slide 38
Formal Cooperation. Formal cooperation occurs when a person or
organization freely participates in the action(s) of a principal
agent, or shares in the agents intention, either for its own sake
or as a means to some other goal Immediate Material Cooperation.
Immediate material cooperation occurs when the cooperator
participates in circumstances that are essential to the commission
of an act, such that the act could not occur without this
participation.
Slide 39
Mediate Material Cooperation. Mediate material cooperation
occurs when the co-operator participates in circumstances that are
not essential to the commission of an action, such that the action
could occur even without this cooperation. Mediate material
cooperation in an immoral act might be justifiable under three
basic conditions: If there is a proportionately serious reason for
the cooperation (i.e., for the sake of protecting an important good
or for avoiding a worse harm); the graver the evil the more serious
a reason required for the cooperation; The importance of the reason
for cooperation must be proportionate to the causal proximity of
the co-operator's action to the action of the principal agent (the
distinction between proximate and remote); The danger of scandal
(i.e., leading others into doing evil, leading others into error,
or spreading confusion) must be avoidedscandal
Slide 40
Principle of human dignity Every human being should be
acknowledged as an inherently valuable member of the human
community and as a unique expression of life. Respect Human
Rights
Slide 41
Principle of informed consent Informed consent in ethics
usually refers to the idea that a person must be fully informed
about and understand the potential benefits and risks of their
choice of treatment. An uninformed person is at risk of mistakenly
making a choice not reflective of his or her values or wishes. It
does not specifically mean the process of obtaining consent, nor
the specific legal requirements, which vary from place to place,
for capacity to consent
Slide 42
Patients can elect to make their own medical decisions, or can
delegate decision-making authority to another party. If the patient
is incapacitated, laws around the world designate different
processes for obtaining informed consent, typically by having a
person appointed by the patient or their next of kin make decisions
for them. The value of informed consent is closely related to the
values of autonomy and truth telling.next of kinautonomy A
correlate to "informed consent" is the concept of informed refusal.
informed
Slide 43
Principle of integrity and totality These principles dictate
that the well-being of the whole person must be taken into account
in deciding about any therapeutic intervention or use of
technology. Therapeutic procedures that are likely to cause harm or
undesirable side effects can be justified only by a proportionate
benefit to the patient.benefit Example (x- rays, scans)
Slide 44
Principle of proportionate and disproportionate means Often
used synonymously with the term "ordinary/extraordinary means the
principle holds that one is obligated to preserve his or her own
life by making use of ordinary means, but is under no obligation to
use extraordinary means. In other words, when a medical
intervention or "means" is proportionate, one has a general
obligation--all things considered--to accept the treatment. When
the medical intervention constitutes a disproportionate means, then
one is no longer obliged to undergo the treatment. Since judgments
that a given
Slide 45
Principle of religious freedom All persons have a right to
religious freedom, which has its foundation in human dignity.human
dignity This principle implies that competent individuals should
never be forced to act in a manner contrary to their religious
beliefs and that they have the right to refuse participation in any
treatment or procedure that is contrary to their conscience, nor
should they be restrained from acting in accordance with their own
beliefs, within due limits.competentconscience
Slide 46
When a competent patient refuses a medical or surgical
procedure on the basis of religious convictions, then those
treatments which otherwise might be considered proportionate means
by others may legitimately be considered disproportionate means for
religious reasons. In such cases, it may be appropriate to remind
the patient of the risks involved in foregoing treatment. If such
efforts fail, however, it would be considered a violation of this
principle to coercively administer the procedure. It also would be
generally inappropriate to seek a court order so as to force the
patient to submit to the procedure.
Slide 47
If the patient for whom the medically necessary treatment is
being refused on the grounds of religious freedom is a child or
infant and his or her life is at stake, guardianship might be
sought on the grounds that the parents are failing in their moral
and legal obligation to provide normal care for their
child.guardianship Probate courts frequently override surrogate
decisions made on behalf of minors to forgo life-sustaining
treatment on the basis of religious convictions. Exceptions are
made in the cases of "mature minors." In the case of a child or
infant, it should also be noted that the physician and hospital run
the risk of legal liability if they do not provide treatment and
the child or infant dies as a consequencesurrogate decisions
Slide 48
Principle of respect for autonomy Autonomy is given a central
place or primary status in the prevailing modern liberalism of
contemporary society, as reflected in Oregons Measure 16 that
legalized physician-assisted suicide.Oregons Measure
16physician-assisted suicide However, the principle of respect for
autonomy implies that autonomy has only a standing, that is, it can
be overridden by competing moral considerations. For example, if an
individuals choices endanger public health, potentially harm
others, or require a scarce resource, that individuals autonomy may
justifiably be restricted.
Slide 49
Principle of respect for persons All individual human beings
are presumed to be free and responsible persons and should be
treated as such in proportion to their ability in the
circumstances
Slide 50
Principle of stewardship Stewardship requires us to appreciate
the two great gifts that a wise and loving God has given: the
earth, with all its natural resources, and our own human nature,
with its biological, psychological, social and spiritual
capacities.
Slide 51
Principle of subsidiarity subsidiarity requires those in
positions of authority to recognize that individuals have a right
to participate in decisions that directly affect them, in accord
with their dignity and with their responsibility to the common
good. dignity Decisions should be made at the most appropriate
level in a society or organization, that is, one should not
withdraw those decisions or choices that rightly belong to
individuals or smaller groups and assign them to a higher
authority.
Slide 52
Principle of toleration A greater good or set of goods would be
lost if the evil action were not tolerated; or, if greater evils
would occur were the original evil not tolerated.
Slide 53
PROFESSIONALISM IN PHYSIOTHERAPY PROFESSIONAL BEHAVIOR PT
applicants are expected to act professionally in all of their
dealings with PTCAS(physical therapy centralised application
service) and the physical therapist programs.
Slide 54
CORE VALUES The APTA has identified seven core values that
define the critical elements of professionalism in physical
therapy.core values Accountability Altruism Compassion/Caring
Excellence Integrity Professional Duty Social Responsibility
Slide 55
Accountability - Accountability is active acceptance of the
responsibility for the diverse roles, obligations, and actions of
the physical therapist including self-regulation and other
behaviors that positively influence patient/client outcomes, the
profession and the health needs of society. Responding to
patients/clients goals and needs. Seeking and responding to
feedback from multiple sources. Acknowledging and accepting
consequences of his/her actions. Assuming responsibility for
learning and change. Adhering to code of ethics, standards of
practice, and policies/procedures that govern the conduct of
professional activities. Communicating accurately to others
(payers, patients/clients, other health care providers) about
professional actions. Participating in the achievement of health
goals of patients/clients and society. Seeking continuous
improvement in quality of care. Maintaining membership in APTA and
other organizations. Educating students in a manner that
facilitates the per suit of learning.
Slide 56
Altruism - Altruism is the primary regard for or devotion to
the interest of patients/clients, thus assuming the fiduciary
responsibility of placing the needs of the patient/client ahead of
the physical therapists self interest. Placing patients/clients
needs above the physical therapists. Providing pro-bono services.
Providing physical therapy services to underserved and
underrepresented populations. Providing patient/client services
that go beyond expected standards of practice. Completing
patient/client care and professional responsibility prior to
personal needs.
Slide 57
Compassion/ Caring - Compassion is the desire to identify with
or sense something of anothers experience; a precursor of caring.
Caring is the concern, empathy, and consideration for the needs and
values of others. Understanding the socio-cultural, psychological
and economic influences on the individuals life in their
environment. Understanding an individuals perspective. Being an
advocate for patients/clients needs. Communicating effectively,
both verbally and non-verbally, with others taking into
consideration individual differences in learning styles, language,
and cognitive abilities, etc.
Slide 58
Designing patient/client programs/interventions that are
congruent with patient/client needs. Empowering patients/clients to
achieve the highest level of function possible and to exercise
self-determination in their care. Focusing on achieving the
greatest well-being and the highest potential for a patient/client.
Recognizing and refraining from acting on ones social, cultural,
gender, and sexual biases. Embracing the patients/clients emotional
and psychological aspects of care. Attending to the
patients/clients personal needs and comforts. Demonstrating respect
for others and considers others as unique and of value.
Slide 59
Excellence - Excellence is physical therapy practice that
consistently uses current knowledge and theory while understanding
personal limits, integrates judgment and the patient/client
perspective, embraces advancement, challenges mediocrity, and works
toward development of new knowledge. Demonstrating investment in
the profession of physical therapy. Internalizing the importance of
using multiple sources of evidence to support professional practice
and decisions. Participating in integrative and collaborative
practice to promote high quality health and educational outcomes.
Conveying intellectual humility in professional and interpersonal
situations.
Slide 60
Using evidence consistently to support professional decisions.
Demonstrating a tolerance for ambiguity. Pursuing new evidence to
expand knowledge. Engaging in acquisition of new knowledge
throughout ones professional career. Sharing ones knowledge with
others. Contributing to the development and shaping of excellence
in all professional roles.
Slide 61
Integrity - Steadfast adherence to high ethical principles or
professional standards; truthfulness, fairness, doing what you say
you will do, andspeaking forth about why you do what you do.
Abiding by the rules, regulations, and laws applicable to the
profession. Adhering to the highest standards of the profession
(practice, ethics, reimbursement, Institutional Review Board [IRB],
honor code, etc). Articulating and internalizing stated ideals and
professional values. Using power (including avoidance of use of
unearned privilege) judiciously. Resolving dilemmas with respect to
a consistent set of core values. Being trustworthy.
Slide 62
Taking responsibility to be an integral part in the continuing
management of patients/clients. Knowing ones limitations and acting
accordingly. Confronting harassment and bias among ourselves and
others. Recognizing the limits of ones expertise and making
referrals appropriately. Choosing employment situations that are
congruent with practice values and professional ethical standards.
Acting on the basis of professional values even when the results of
the behavior may place oneself at risk.
Slide 63
Professional Duty - Professional duty is the commitment to
meeting ones obligations to provide effective physical therapy
services to individual patients/clients, to serve the profession,
and to positively influence the health of society. Demonstrating
beneficence by providing optimal care. Facilitating each
individuals achievement of goals for function, health, and
wellness. Preserving the safety, security and confidentiality of
individuals in all professional contexts. Involved in professional
activities beyond the practice setting. Promoting the profession of
physical therapy. Mentoring others to realize their potential.
Taking pride in ones profession.
Slide 64
Social Responsibility - Social responsibility is the promotion
of a mutual trust between the profession and the larger public that
necessitates responding to societal needs for health and wellness.
Advocating for the health and wellness needs of society including
access to health care and physical therapy services. Promoting
cultural competence within the profession and the larger public.
Promoting social policy that effect function, health, and wellness
needs of patients/clients. Ensuring that existing social policy is
in the best interest of the patient/client. Advocating for changes
in laws, regulations, standards, and guidelines that affect
physical therapist service provision.
Slide 65
Promoting community volunteerism. Participating in political
activism. Participating in achievement of societal health goals.
Understanding of current community wide, nationwide and worldwide
issues and how they impact societys health and well-being and the
delivery of physical therapy. Providing leadership in the
community. Participating in collaborative relationships with other
health practitioners and the public at large. Ensuring the blending
of social justice and economic efficiency of services.