DRAFT WCPT Policy Statement: Advanced Physical Therapy Practice

Policy type
Policy categories

This new draft policy is pending approval at the WCPT General Meeting in May 2019.

Advanced practice in physical therapy has become a more common feature of the profession in the past decade in a number of countries. The emergence of advanced practice opportunities reflects an area for significant development in the delivery of physical therapy to meet the needs of society and evolving service delivery models. 1-4

There is a growing body of evidence that suggests that advanced physical therapy practice (APP) is both clinically and economically effective. Further, that it delivers a desirable experience and improved outcomes for patients and clients. 1, 5, 6 While the development of APP is not yet widespread globally, it is considered beneficial and a desirable development by the majority of the World Confederation for Physical Therapy (WCPT) member organisations. 7

There have been a number of reasons for the development of APP that include the natural evolution of the profession.  Facilitators, those circumstances that have assisted the development of APP, are reported to be recognition of APP meeting the demands and service needs of the health system, 8 advocacy by the profession, support of medical professionals, political support and reimbursement models. 7

APP is well established in orthopaedic and musculoskeletal services in some countries. It has also been described in other areas of physical therapy practice including neurology, cardiorespiratory, paediatrics, physical therapy for older persons, women’s health and pelvic rehabilitation. It may also be limited to a specific area of practice within a health service. 7

There is a lack of a common understanding about what exactly advanced practice means for the profession and it is often conflated with specialisation. 7 Specialisation does not necessarily equate with APP. While physical therapists who are advanced practitioners are normally specialists, specialist physical therapists may not be advanced practitioners; they may not demonstrate or be required to provide the characteristics of advanced practice outlined below. For example, aspects of advanced practice may not be permitted within the legislative or regulatory frameworks informing the practice of physical therapy; however, specialisation, as defined in WCPT’s policy statement, can and does occur. 9

The practice context, including the maturity of the profession, the standard of physical therapist entry level education, professional autonomy and national regulation is important for advancing APP. Various member organisations of WCPT have described APP in a number of ways. 10, 11 While it is context specific, common themes emerge that lead to the following description:

Advanced physical therapy practice:

  • includes a higher level of practice, functions, responsibilities, activities and capabilities
  • may be associated with a particular occupational title[1]
  • requires a combination of advanced and distinctly increased clinical and analytical skills, knowledge, clinical reasoning, attitudes and experience
  • applies advanced level skills and knowledge to influence service improvement and achieve improved patient outcomes and experience, as well as the provision of clinical leadership
  • results in the responsibility for the delivery of care to patients/clients commonly with complex needs or problems safely and competently and to manage risk. 10, 11

Advanced practice is practised by a small, but growing, proportion of the profession who are recognised as being experts by members of the profession, patients and other healthcare professionals. The manner of that recognition varies across jurisdictions.

Certain components of advanced practice, for example the use of injection techniques, the ordering of imaging or the prescription of medicines, may have previously only been performed by other professions and to be adopted into the practice of physical therapists may require changes in regulation and/or legislation.

Advanced practice requires additional education and training, significant professional experience and competency development. It also involves collaborative work with other health professionals, research, knowledge translation and leadership in service delivery.

Currently, there is no globally defined educational pathway nor is there a globally agreed definition of advanced physical therapy practice competencies. WCPT wishes to harmonise and co-ordinate the development of advanced physical therapy practice through the development of consistent descriptions and guidelines regarding competencies, as well as the sharing of developments globally.

WCPT supports the right of member organisations to make national policies that permit advanced physical therapy practice, where such activity is considered by them to benefit the public, health care delivery and the profession by promoting high standards of physical therapy.

WCPT advocates that member organisations should encourage and support the following in their jurisdictions to further the development of advanced practice in the profession of physical therapy:

  • assessment of needs for the development of such roles to determine where they  may provide clinically and cost effective solutions to meet society and service needs
  • recognition that the role of advanced practice in the profession of physical therapy provides a positive contribution and a solution to contemporary health care challenges;
  • recognition that advanced practice is a unique and privileged position to hold within the health system and brings with it significant responsibilities, thus such competencies should be clearly defined by the profession;
  • provision of appropriate educational frameworks and opportunities;
  • description of appropriate career pathways;
  • advocacy to influence key stakeholders e.g. other health professionals, service providers.

Glossary

Advanced scope of practice: in physical therapy includes:

  • a higher level of practice, functions, responsibilities, activities and capabilities
  • may be, but is not necessarily, associated with a particular occupational title e.g. ‘consultant physiotherapist’, ‘advanced physiotherapy practitioner’, ‘advanced practice physiotherapist’ ‘extended scope practitioner’[2]
  • requires a combination of advanced and distinctly increased clinical and analytical skills, knowledge, clinical reasoning, attitudes and experience
  • results in the responsibility for the delivery of care to patients/clients more commonly with complex needs or problems safely and competently and to manage risk 10, 11

Scope of practice: is a statement describing physical therapy within the context of the regulatory environment and evidence base for practice within a jurisdiction. Scopes of practice are dynamic, evolving with changes in the evidence base, policy and needs of service users. WCPT sets out the internationally agreed scope of practice and member organisations set out the scope of practice agreed in their countries. 12

Specialisation: physical therapist specialisation is the result of in-depth knowledge, skills and competence attained by a physical therapist qualified in a specific area, within the scope of practice recognised as physical therapy. This usually results from defined training and educational pathways, associated with a formal process for testing and recognising the higher level acquired, but it may also be demonstrated as a result of informal learning and experience. 9


References

  1. Desmeules F, Roy JS, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord. 2012;13:107.
  2. E. K, Sheppard L. The 'lone ranger': A descriptive study of physiotherapy practice in Australian emergency departments. Physiotherapy. 2010;96(3):248-56.
  3. Kersten P, McPherson K, Lattimer V, Geirge S, Breton A, Ellis B. Physiotherapy extended scope of practice – who is doing what and why? Physiotherapy. 2007;93(4):235-42.
  4. McPherson K, Kersten P, George S, Lattimer V, Breton A, Ellis B, et al. A systematic review of evidence about extended roles for allied health professionals. Journal of health services research & policy. 2006;11(4):240-7.
  5. Fennelly O, Blake C, Fitzgerald O, Breen R, Ashton J, Brennan A, et al. Advanced Practice Physiotherapy Progressing Integrated Care of Musculoskeletal Disorders in Ireland: a National Evaluation. International Journal of Integrated Care. 2017;17(5):A119.
  6. Warmington K, Kennedy CA, Lundon K, Soever LJ, Brooks SC, Passalent LA, et al. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians. Open access rheumatology : research and reviews. 2015;7:45-53.
  7. World Confederation for Physical Therapy. Advanced practice: Results of survey of WCPT member organisaitons. London, UK: WCPT; 2018. 
  8. Gamlin J, Raymer ME, J L. Advanced Roles in Musculoskeletal Physiotherapy. In: Jull, et al, editors. Grieves’ Modern Musculoskeletal Physiotherapy. 4th ed. In: Jull G, Moore A, Falla D, Lewis J, McCarthy C, Sterling M, editors. Grieves’ Modern Musculoskeletal Physiotherapy 4th Edition. London, UK: Elsevier; 2015.
  9. World Confederation for Physical Therapy. Policy statement: Specialisation. London, UK: WCPT; 2017. http://www.wcpt.org/policy/ps-specialisation (Access date 10th March 2017)
  10. Chartered Society of Physiotherapy. Advanced practice in physiotherapy. Understanding the contribution of advanced practice in physiotherapy to transforming lives, maximising independence and empowering populations. London, UK: CSP; 2016. https://www.csp.org.uk/system/files/csp_advanced_practice_physiotherapy_2016_2.pdf (Access date 1st October 2018)
  11. Australian Physiotherapy Association. APA Position Statement Scope of practice. Hawthorn, Australia: APA; 2016. https://www.physiotherapy.asn.au/DocumentsFolder/APAWCM/Advocacy/Scope%20of%20Practice_with%20on%20brand%20diagrams.pdf (Access date 2nd July 2018)
  12. World Confederation for Physical Therapy. Policy statement: Description of physical therapy. London, UK: WCPT; 2015. www.wcpt.org/policy/ps-descriptionPT (Access date 28th September 2016)
     

    [1] These titles are defined by various countries and where such titles exist may not mean the same thing across jurisdictions eg ‘consultant physiotherapist’, ‘advanced physiotherapy practitioner’, ‘advanced practice physiotherapist’, ‘extended scope practitioner’

    [2] These titles are defined by various countries e.g. ‘consultant physiotherapist’, ‘advanced physiotherapy practitioner’, ‘advanced practice physiotherapist’ ‘extended scope practitioner’