Re: OT's and use of Modalities

[Guest guest]

In a message dated 7/16/02 3:15:34 PM Eastern Daylight Time,

rory8343@... writes:

> She

> was very evasive and finally said she was not a PT she

> was a PTA, I went on to ask her if she had gone to

> school in town at the local community college, she

> finally blurted out. " I didn't go to school, I'm

> technically an aide but I can do anything the PT can

> do. " (Read in a lot of defensiveness and hostility)

> Scary.

>

Not only scary, but illegal to represent oneself as a licensed professional.

I would encourage folks to report these individuals, and the therapists they

work for, to their state licensure boards. Therapists who practice outside

their scope of practice, or allow others to do so, are most likely in

violation of their state practice act. Report these " scoundrals " to initiate

an investigation and possible sanctions. If they are guilty, they will suffer

consequences. And if not a violation, they will be exonerated. They could

also be reported to Medicare or other insurers for possible billing fraud.

But as long as we look the other way and allow these practices to continue

without reporting them to the appropriate authorities, then we passively

condone their continued existence.

W. , PT, MS

Chair - Michigan Board of Physical Therapy

Therapeutics

2065 Van Antwerp Ave.

Grosse Pointe Woods, MI 48236

ph/fax

cell

dperrypt@...

[Guest guest]

Rick,

Great question. I would refer you to Dr. Rothstein's

recent editorial in PHYSICAL THERAPY in which he makes

the case that there is a difference between who we are

and what we do (e.g. The profession of Physical

Therapy versus physical therapy treatments/physical

therapy modalities).

As a turf battle brews between PT's and OT's (at least

in North Carolina) based upon the ridiculous notion of

the NC OT Association that PT's are not qualified or

trained to provide intervention with respect to fine

motor problems or activities of daily living (e.g.

non-gait related functional training), I believe that

we as physical therapists should not give anything

away. Even chiropractors respect physical therapy

modalities as & #34;physical therapy & #34; even if they

don't generally understand who we are a Physical

Therapists. As such, under current conditions, I

believe that it would be foolish to give up one of the

few things that the general public, as well as some of

our strongest opponents within the heatlhcare

marketplace, perceive as clearly & #34;physical

therapy, & #34; even if being a Physical Therapist

encompasses much more than that.

Given the unprovoked and organized attacks by state

and national occupational therapy associations upon

the scope of practice of physical therapists with

respect to fine motor problems and functional

activity, I belive that the offensive must be taken on

the issue of physical therapy modalities. Given the

close and traditionally cordial relationship between

PT's and OT's, it's unfortunate, but physical

therapists didn't draw the battle line in the sand ---

we just need to defend it.

M. Ball, PT, MS, MBA

=====

M. Ball, PT, MS, MBA, CITFS

Ph.D. Candidate (ABD), Healthcare Management

__________________________________________________

[Guest guest]

Dear Mr. Gawenda, I agree that a 2 day course is not sufficient to use

modalities. However please do not assume that OTs only take a 2 day course.

Modalities are not rocket science. I have taken many ceu courses, read many

books including all of Joe Kahn's (including studying in courses with him)

and discussed at length modalities. You would be surprised how many PTs use

" cook book " modalities. When discussing the subject they really don't know

much. On the other hand, I have learned techniques that no other American

PTs know from Saudi Arabian trained PTs. I do agree OTs should be trained as

part of their schooling . Should we be thinking about what is best for the

patient. I thought PT/OT turf wars went out in the 80's. Thnks for your

thoughts. Cenzoprano, OTR/L

[Guest guest]

It is very unfortunate that turf wars still continue. OTS and PTS should put

patient care first!!!!! I really don't care if PTS work on fine motor skills

if its part of an overall treatment plan to get the patient at the highest

level of function possible. Hey North Carolina OTS and PTS get over

yourselves and get the patients better!!

Thankyou, Cenzoprano, OTR/L

[Guest guest]

Before we raise the battle cry between OT and PT and start driving our

horses into the spikes, lets look at the basic tenets. I could not

agree more that OT's without proper training should not be performing

physical agent modalities. For that matter, no clinician should be

performing any specific procedure that can cause a patient harm without

providing evidence of competence on an annual basis. As a program

director, I ensure that all PT's and OT's meet mutually established

criteria before performing any modalities. Prior to meeting these

criteria, I generally accept that the PT curriculum has provided

adequate coursework in the use of these agents. That being said, there

is a great deal of variation in the amount of time spent in modalities

in PT programs with some spending as little as a week. Any OT wishing

to incorporate PAMs into practice must submit to me adequate evidence of

substantial continuing education which I then determine to be adequate

for use of PAMs. Rather than drawing a line in the sand and dividing

the patient up into segments, we do the patient the greatest benefit by

treating them in a holistic fashion. Should a patient referred to an

occupational therapist for hand therapy be sent to the physical

therapist first for ultrasound and heat before the OT can start to work

on restoration of hand function? Should a patient referred to a

physical therapist for hand therapy be sent to an occupational therapist

for splinting if the PT has demonstrated competencies and training in

splinting? This is absurd and not in the interest of the patient. I

think it's in both of our professions best interest to take down the

volume on this one and talk about competencies rather than turf wars.

Kindest regards

Redge L MS OTR/L

Director of Rehabilitation Services

on Hospital

Bremerton, WA 98310

[Guest guest]

A most interesting topic and one I have had first hand involvement in both in

the clinic and in the regulatory arena.

My colleague, Dr. Rothstien makes terrific points as it relates to how every

profession should view itself and their relationship with other professions. A

position we should all aspire to.

My experience in the trenches though have fallen short of that ideal. The AOTA

position, though clear, does not take into consideration the responsibilities of

those of us who are in multidisciplinary settings as it relates to who is " best "

qualified to provide a treatment. In review of the OT and PT curriculum and

accreditation and licensure exam material it is clear that PT has the most

indepth study in their preparation for licensure as it relates to phyiscal

agents and modalities.

In the regulatory arena, we are reminded that the state's role is to define

scope and insure minimal competency. This creates difficulty in aligning scope

of practice definition legally and the use of continuing education with a

competency review at the facility/practice level. AS we all know, continuing ed

credits have not shown to be a valid competency measurement or qualifying tool,

therefore I struggle with my decision making as a department head as to whether

these procedures should be carried out by OT, and the potential increased

liability exposure it might create. For me as a PT to take a course in surgery

is one thing, to practice it is another.

I have also seen great issues arise in how the use of modalities by OTs relate

to the definition of " functional activities " . I have seen Ots use modalities as

a precurser to therapeutic exercise with no functional activity outcome in the

goals for that patient, yet claiming it is their " right " to perform it.

Their " right " is not the issue, it is the patient safety and outcome of care that

is the issue.

As in Jules editorial, PT does not " own " modalities, ther ex, mobs, etc but

does have a distinct decision making process for determining what will get us to

the outcomes we seek that include modality use. AS we discuss this issue that

has been around as long as I have been a PT, it comes down to knowledge of other

professions, clear understanding of how one's own professional role compliments

others for the better clinical outcome for our patients. Lets hope we all keep

these in mind as we determine what is best for the patient.

Jim Dunleavy PT,MS

Director of Rehabilitation Services

Christian Health Care Center

Wyckoff, NJ

[Guest guest]

,

Thanks you for the excerpts from the AOTA's position

paper. As I read it, with the exception of not being

considered entry-level skill as it is in physical

therapy, I fail to see how the use of physical

modalities in the name of function by the occupational

therapist differs from their use in physical therapy.

Not practicing in outpatient orthopedics, perhaps I'm

missing something.

Although I can appreciate the AOTA's desire to expand

traditional practice in the name of patient care,

personally, I'd have to disagree with the argument

that just because an occupational therapist may be

competent to use modalities, that it's appropriate to

do so on a regular basis --- although there should be

some degree of flexibility, in my opinion, built into

the system. I have similar reservations about PT's

using grade V mobilizations (a position that puts me

at odds with most other physical therapists in my

state), or chiropractors who prescribe therex for

patients with knee pain. It's not, in my opinion, an

issue of scope of practice and whether or not

treatment modalities and interventions cross

professions, but an issue of who is best qualified to

provide the ongoing service and respecting the unique

scope of expertise with respect to each profession.

Respect is something that, in my opinion, embodies

more than, " just getting along, " and cannot be

received without first being offered.

My concern, therefore, is not one of scope of

practice, but rather respect for the scope of

expertise and scope of practice preferences between

healthcare professions.

With the " Collaboration to Controversy and Back Again "

(nods to Judy White, PT) that has characterized the

PT/OT relationship for the past few months, my

concerns are merely academic. I received word this

morning that the NCOTA and NCBTE " moved beyond

controversy and reached consensual agreement, "

returning PT's and OT's to the collaborative framework

that has characterized North Carolina for so many

years. I understand that Lynn Losada, President of

the NCOTA, deserves a hefty share of credit for the

successful and mutually beneficial resolution of the

crisis.

I do however think, that as physical therapy and (to a

more delayed extent) occupational therapy, progress

toward fully autonomous doctoring professions, that

the time is now to move beyond turf war level

discussions of what each profession CAN do in terms of

scope of practice, to higher-level and more mutually

beneficial discussions of scope of preference and

scope of expertise. I submit the evolution of the

bitter Optomotrist/Opthamologist scope of practice

discussions of 30 years ago, to the symbiotic

relationship that has emerged in more recent years by

moving toward a " hey, I respect that you as an MD can

do pre-op and post-op work, but wouldn't you rather be

freed up for surgery? " type of attitude. I believe

that although not completely analogous, PT and OT

could reach new heights given our cordial relationship

to date, if a similar scope of preference/scope of

expertise framework were applied to potentially

divisive topics such as gait training, physical

modalities, functional training/activities of daily

living, hand therapy, etc.

My statements were not intended as a divisive call to

arms . . . unless scope of physical therapy practice

needed to be defended from what initially appeared to

be a bona fide attack on the part of occupational

therapists (as opposed to a simple miscommunication

that spiraled out of control that it ended up actually

being). My call was, and continues to be as physical

therapy continues to evolve, for collaborative " scope

of preference/scope of expertise " discussions with not

only traditional allies such as occupational

therapists, but supervising allopathic disciplines,

and also traditional enemies of physical therapy as

well.

I apologize if my statements were misinterpreted, and

appreciate the opportunity to clarify my original

statements.

With Respect,

M. Ball, PT, MS, MBA

Ph.D. Candidate

=====

M. Ball, PT, MS, MBA, CITFS

Ph.D. Candidate (ABD), Healthcare Management

__________________________________________________

[Guest guest]

et al,

While passions run high on various topics, I would hate to allow

your inflammatory language to go without some perspective here.

Difficulties with a recent attempt to clarify NC PT Board rules

have not led to widespread picketing, paint ball marking, stink bomb

throwing, or even whoopie cushion infractions by various therapists.

Most therapists in the state had civil discussions on the topic, and

a large number did not even know of the conflict. The NCBPTE did

a great job in keeping PTs level headed, I only wish you could

all reference the recent PT Board letter we received this past week.

They usually are online, however I checked at www.ncptboard.org and

this newsletter has not been posted. Evidently there has been some

discussion between AOTA and APTA on these issues before, and

I am not one to represent any of the past or current history. My goal

is only to assure you that no one has " out grown " their britches, and

there has been minimal ugliness at a professional level. I hazard to

say I doubt any clients ever got wind of what remained a largely

high level regulatory/professional organization dialogue.

True collaboration works to minimize inflammation and understand

the perspective of others. Throwing NC into the fray as an illustration

of how things " should not be given up " did not serve anyone's interest.

Dee Daley, PT

ProActive Therapy

Fayetteville, NC

> As a turf battle brews between PT's and OT's (at least

> in North Carolina) based upon the ridiculous notion of

> the NC OT Association that PT's are not qualified or

> trained to provide intervention with respect to fine

> motor problems or activities of daily living (e.g.

> non-gait related functional training), I believe that

> we as physical therapists should not give anything

> away.

> Given the unprovoked and organized attacks by state

> and national occupational therapy associations upon

> the scope of practice of physical therapists with

> respect to fine motor problems and functional

> activity, I belive that the offensive must be taken on

> the issue of physical therapy modalities. Given the

> close and traditionally cordial relationship between

> PT's and OT's, it's unfortunate, but physical

> therapists didn't draw the battle line in the sand ---

> we just need to defend it.