Kylie Gatenby

“Direction and supervision are essential in the provision of quality physical therapy services. The degree of direction and supervision necessary for assuring quality physical therapy services is dependent upon many factors.” These include: - Education - Experience - Responsibilities of Involved Parties - Organizational Structure (Clynch 65)

 Not legally binding.  Represents the “best practice.” ◦ PT is directly responsible for services provided when plan of care involves the PTA. ◦ Utilization of PTA in select interventions requires the education, expertise, and professional judgment of a PT. ◦ The PTA may perform selected physical therapy interventions under the direction and supervision of a PT. (Clynch 64-67)

 Has developed specific definitions for three types of supervision. ◦ General Supervision: PT is not required to be in the same building as the PTA while the PTA delivers interventions. ◦ Direct Supervision: Requires the on-site presence of the PT and daily interaction between the PT and each patient/client. ◦ Direct Personal Supervision: Requires the PT (or where allowable by state law, a PTA) to be physically present and immediately available to continuously direct and supervise the person who is performing the tasks. (Clynch 67-68)

They have developed documents and other resources to help PTs and PTAs understand the complexities of direction and supervision.  Examples include: Clinical Decision-Making Algorithm, APTA PTA Direction Algorithm, and the PTA Supervision Algorithm.  These help the PT decide which interventions and when the PTA should perform them. Also the level of supervision required for specific interventions. (Clynch 68-70)

 Legally binding.  Some may coincide with APTA guidelines.  Some are more restrictive than others on utilization of the PTA.  Some states may not address the topic of direction and supervision, APTA standards are then used.  State practice acts specify the type of supervision needed for PTAs. (Clynch 64, 67)

 Utah’s Practice Act includes: ◦ A licensed PTA is authorized to practice physical therapy;  Under the on-site supervision or general supervision of a licensed physical therapist.  Within the scope of practice of a licensed physical therapist assistant.  Adhere to standards of ethics described in the APTs Code of Ethics and Guide for Professional Conduct.  May not be supervised by any person other than a licensed physical therapist. (Website 1)

 Utah’s Practice Act Rule includes: ◦ A physical therapist’s supervision of a physical therapist assistant or a physical therapy aide shall meet the following conditions:  A full-time physical therapist can supervise no more than three full-time supportive personnel unless approved.  A physical therapist shall provide treatment to a patient as least every 10 th treatment day but no longer than 30 days from the day of the physical therapist’s last treatment day, whichever is less. (Website 2)

 These can affect the PTAs ability to deliver and document certain services.  Even if it is legal for a PTA to perform tasks, it may not match the requirements set by the third-party payer. ◦ Unlikely to receive payment for services and could possibly be charged with fraud.  An example would be the Medicare system. They require PTAs to have graduated from an accredited program and passed a licensure examination. They also require certain levels of supervision depending on the practice setting. (Clynch 69-71)

Clynch, Holly M. The Role of the Physical Therapist Assistant: Regulations and Responsibilities. Philadelphia: F.A. Davis Company, Print