The Profession of Physical

Therapy
Definition and Development
 Objectives

 After the discussion, the student will be

able to:
 Define physical therapy
 Describe the characteristics of a profession
 Describe a brief history of the profession of
physical therapy locally and internationally and
the major factors that influenced its growth and
development
 Outline

 Definition
 Physical Therapy as a Profession
 Historical Development
 Origins
 Worldwide Developments
 Local History
 Definition(s)

 World Confederation of Physical Therapy

(WCPT)
 Philippine Physical Therapy Association
(PPTA)
 American Physical Therapy Association
(APTA)
 Definition: WCPT

 Physical therapy provides services to individuals

and populations to develop, maintain, and restore
maximum movement and functional ability
throughout the lifespan.
 This includes providing services in circumstances
where movement and function are threatened by
ageing, injury, diseases, disorders, conditions or
environmental factors.
 Functional movement is central to what it means to be
healthy.
 Definition: WCPT

 Physical therapy is concerned with identifying

and maximising quality of life and movement
potential within the spheres of promotion,
prevention, treatment/intervention, habilitation
and rehabilitation.
 This encompasses physical, psychological, emotional,
and social wellbeing.
 Definition: WCPT
 Physical therapy involves the interaction between the
physical therapist, patients/clients, other health
professionals, families, care givers, and communities
in a process where movement potential is assessed and
goals are agreed upon, using knowledge and skills
unique to physical therapists.
 Definition: WCPT

 Principles supporting the description of physical

therapy
 WCPT has developed this international description of
physical therapy based on the following principles,
which it encourages its member organisations to use in
defining the scope of physical therapy practice
nationally.
 Definition: WCPT
 WCPT advocates that a description must:
 respect and recognise the history and roots of the profession
 build on the reality of contemporary practice and the
growing body of research
 allow for variation in: cultures, values and beliefs; health
needs of people and societies; the structure of health
systems around the world
 use terminology that is widely understood and adequately
defined
 recognise internationally accepted models and definitions
(eg World Health Organization definition of health, World
Health Organisation International Classification of
 Definition: WCPT
 WCPT advocates that a description must:
 provide for the ongoing growth and development of the
profession and for the identification of the unique
contribution of physical therapy
 acknowledge the importance of the movement sciences
within physical therapy curricula at all levels
 emphasise the need for practice to be evidence-based
whenever possible
 appreciate the inter-dependence of practice, research and
education within the profession
 Definition: WCPT
 WCPT advocates that a description must:
 recognise the need to review continuously the description as
the profession changes in response to the health needs of
society and the development of knowledge in physical
therapy
 anticipate that work will flow from this description as it is
used to assist in the development of curricula and
identification of areas for research
 Definition: PPTA

 Physical therapy is providing services to

people to develop, maintain and restore
maximum movement and functional ability
throughout the lifespan.
 Physical therapy is concerned with identifying
and maximizing movement potential within the
spheres of promotion, prevention, treatment and
rehabilitation.
 Definition: PPTA

 Physical therapy is the service provided

only by, or under the direction or
supervision of a physical therapist.
 The clinical practice of physical therapy
includes assessment, diagnosis, planning,
intervention and re-evaluation.
 Definition: PPTA

 Assessment includes both the examination

of individuals or groups with actual or
potential impairments, functional
limitations, disabilities or other conditions
of health by history taking, screening and
the use of specific tests and measures and
evaluation of the results of the examination
through analysis and synthesis within a
process of clinical reasoning.
 Definition: PPTA

 Diagnosis arises from the examination and

evaluation and represents the outcome of
the process of clinical reasoning. This is
expressed in terms of movement
dysfunction and encompasses categories of
impairments, functional limitations,
abilities/disabilities or syndromes.
 Definition: PPTA

 Planning begins with determination of the

need for intervention and normally leads to
the development of a plan of intervention,
including measurable outcome goals
negotiated in collaboration with the patient
or caregiver.
 Definition: PPTA

 Intervention is implemented and modified

in order to reach agreed goals and may
include manual handling, movement
enhancement, physical, electrotherapeutic
and mechanical agents, functional training,
provision of aids and appliances, patient-
related instruction and counseling,
documentation and coordination, and
communication.
 Definition: PPTA
 Intervention may also be aimed at prevention of
impairments, functional limitations, disability
and injury including the promotion and
maintenance of health, quality of life, and
fitness in all ages and populations.
 Re-evaluation necessitates re-examination,
including assessment, diagnosis and
planning, for the purpose of evaluating
outcomes.
 Definition: APTA

 Physical therapists are health care

professionals who maintain, restore, and
improve movement, activity, and health
enabling an individual to have optimal
functioning and quality of life, while
ensuring patient safety and applying
evidence to provide efficient and effective
care.
 Definition: APTA

 Physical therapists evaluate, diagnose, and

manage individuals of all ages who have
impairments, activity limitations, and
participation restrictions.
 Definition: APTA

 In addition, physical therapists are involved

in promoting health, wellness, and fitness
through risk factor identification and the
implementation of services to reduce risk,
slow the progression of or prevent
functional decline and disability, and
enhance participation in chosen life
situations.
 Definition: APTA

 Physical therapy scope of practice is

dynamic, evolving with evidence and
societal needs.
 Definition: APTA

 Some confusion as to definition in US

 Due to variety of legal definitions from state to
state
 Each state has their own ‘practice act’ for each
profession
 To limit this variety, APTA’s Board of
Directors created the ‘Physical Therapist
Scope of Practice’
 Originally titled ‘Model Definition of Physical
Therapy for State Practice Acts’
 Definition: APTA

 ‘Physical Therapist Scope of Practice’

 Identifies several activities inherent to PT
practice
 Uses language and terminology based on the
‘Guide to Physical Therapist Practice’
 AKA ‘the Guide’
 Fundamental Concepts:
 Five Elements of Patient/Client Management Model
 Other Important Activities in the Role of the PT
 Definition: APTA

 Five Elements of Patient/Client

Management Model
 Examination
 Evaluation
 Diagnosis
 Prognosis (including Plan of Care)
 Intervention
 Definition: APTA

 Other Important Activities in the Role of the

PT
 Consultation
 Education
 Research
 Definition: APTA

 The APTA definition also:

 Reflects the areas of:
1. Prevention
2. Health promotion, wellness and fitness
3. Consultation
 Differentiates:
 Patient
 Client
 States that physical therapy is:
 Provided by or under the direction and supervision
of a PT
 PT as a Profession

 APTA Position on Physical Therapy as a

Health Profession:
 Physical therapy is a health profession whose
primary purpose is the promotion of optimal health
and function. This purpose is accomplished through
the application of evidence-based principles to the
processes of examination, evaluation, diagnosis,
prognosis, and intervention to prevent or remediate
impairments in body structures and function,
activity limitations, participation restrictions or
environmental barriers as related to movement and
health.
 PT as a Profession
 Physical therapy encompasses areas of specialized
competence and includes the development of new
principles and applications to meet existing and
emerging health needs. Other professional activities
that serve the purpose of physical therapy are
research, education, consultation, and
administration.
 PT as a Profession

 Development of this APTA ‘Position’

 Swisher and Page
 Presented a comprehensive review of the variety of
descriptions of a profession
 Focused on 3 qualities commonly held in high regard
 Autonomy
 Ethical standards
 Accountability
 PT as a Profession

 Development of this APTA ‘Position’

 Moore
 ‘Hierarchy of Characteristics of a Profession’
 Historical Development

 Origins
 Worldwide Developments
 Local History
 Historical Development:
Origins
 Physical measures were already used in
ancient times
 Massage
 China in 3000BC
 Described by Hippocrates in 460BC
 Modified by the Romans
 Early 1800’s accepted as scientific procedure
 Developed into muscle reeducation techniques
 Historical Development:
Origins
 Hydrotherapy
 Practiced by ancient Greeks and Romans
 Electrotherapy
 1600’s when electricity and electrical devices were
introduced
 More modern techniques
 Developed in Europe (England and France)
 Historical Development:
Worldwide
 US
 World War I and Polio
 ‘Reconstruction Aides’-exclusively women
 ‘Vermont Polio Epidemic’-physiotherapists
(‘physicians’ assistants’)
 Post-World War I
 Shift from ‘preserving a fighting force’ to
‘maintaining a workforce’ and focus on ‘crippled
children’
 Historical Development:
Worldwide
 US
 Post-World War I
 1921-Founding of American Women’s Physical
Therapeutic Association
 Mary McMillan
 First Physical Therapist and President of AWPTA
 1922-Changed to American Physiotherapy
Association
 Men were now admitted in 1923
 Historical Development:
Worldwide
 US
 Post-World War I
 Two Main Issues during these times:
 Identity
 Physicians considered PTs as ‘technicians/aides’
 PTs didn’t think so
 Resolved in 1940’s when physical medicine was
established as a medical specialty (‘physiatrists’)
 Education requirements
 Previously no standardized educational program
 APA developed a suggested 9-month curriculum in
1928
 Historical Development:
Worldwide
 US
 World War II and Polio
 Due to WWII, 9-month curriculum was shortened to
6-month to meet demand for PTs during war
 Discontinued in 1946
 Polio still existed
 1938-National Foundation for Infantile Paralysis (‘the
Foundation’) was established for research, education, and
patient services (which included PTs)
 Use of moist heat to permit mobilization and prevent
contractures were applied during this time
 Historical Development:
Worldwide
 US
 Post-World War II
 US Army recognized need to retain PTs
 1947-Women’s Medical Specialist Corps
 PTs, OTs, dieticians
 Headed by Col. Emma Vogel, PT.
 1955-changed to Army Medical Specialist Corps
 Major breakthrough in polio treatment (vaccines)
 1951-PTs played prominent roles in field trials of the
vaccines
 Historical Development:
Worldwide
 US
 Post-World War II
 Name and role clarification continued to develop
 Physiatrist-physician who practices physical medicine
 Physical therapists (PTs)-practitioner of physical therapy
 1947-American Physical Therapy Association
 PTs no longer technicians
 PT education now at minimum of 12 months
 Historical Development:
Worldwide
 US
 1960’s to 1980’s
 Growth and recognition of PT in education,
practice, and research
 Focus now on aging population, health promotion,
and disease prevention
 Historical Development:
Worldwide
 US
 1990’s
 Cost-cutting by US private and government sectors
led to decline in delivery of health care services,
including PT
 Many PT educational programs closed because of
tight job market
 Hooked on Evidence program
 To substantiate PT services through ‘evidence-based
practice’
 Many revisions on PT program accreditation
initiated
 Historical Development:
Worldwide
 US
 2000’s
 2000-APTA Vision 2020
 Six Key Components (addressing practice, education, and
research):
 Autonomous practice
 Direct access
 Practitioner of choice
 Doctor of Physical Therapy (DPT)
 Evidence-based practice
 Professionalism
 Historical Development:
Worldwide
 US
 2000’s
 2003-Elements of Autonomous Practice
 Autonomous physical therapist practice is characterized
by independent, self-determined professional judgment
and action. Physical therapists have the capability, ability
and responsibility to exercise professional judgment
within their scope of practice, and to professionally act on
that judgment.
 Historical Development:
Worldwide
 US
 2000’s
 2003-Elements of Autonomous Practice
 Privileges
 Direct and unrestricted access
 Professional ability to refer to other health care
providers
 Professional ability to refer to other professionals
 Professional ability to refer for diagnostic tests
 Historical Development:
Worldwide
 US
 2000’s
 2003-Core Values:
 Accountability
 Altruism
 Compassion/caring
 Excellence
 Integrity
 Professional duty
 Social responsibility
 Historical Development:
Worldwide
 US
 2000’s
 2008 and onward
 Career outlook for PT and PTA changed for the better
 Historical Development:
Local
 1962 - University of the Philippines opened
first BSPT curriculum in Asia
 1964 – PPTA was founded
 1969 - creation of Republic Act 5680,
otherwise known as the 'Philippine Physical
Therapy and Occupational Therapy Law.‘
 June 1973 – first licensure examinations for
PT
Thank You