Historical Perspectives of Autonomy Within the Medical Profession: Considerations for 21st Century Physical Therapy Practice

Johnson, Michael P.; Abrams, Sandra L

doi:10.2519/jospt.2005.35.10.628

Cited by 21 publications

(7 citation statements)

References 35 publications

(58 reference statements)

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“…Instead, the goal is interdependent practice and patient-centered care, as described by Johnson and Abrams-care marked by therapists working collaboratively with patients, other practitioners, and payers. 31 Therapists initiating a consultation for 30% of the patients during the pilot program provided good examples of the nature of collaborative practice afforded by the direct access model. The public marketing program allows us to not only promote the direct access model but also describe the variety of services physical therapists can provide.…”

Section: Discussionmentioning

confidence: 99%

Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report

2010

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Background and Purpose Despite legislative approval of direct access to physical therapy, other regulatory barriers and internal institutional policies often must be overcome before this practice model can be fully adopted. Few institutional initiatives have been published describing strategies designed to change policies restricting direct patient access. This case report describes steps and strategies associated with successful implementation of a direct access physical therapy model at a large academic medical center. Case Description The process of obtaining institutional medical board and hospital authority board approval and implementing a pilot program is described. Program details, including therapist qualifications and scope of practice, the required internal training program, and program outcome assessment, are provided. The therapist scope of practice includes the ability to refer patients directly to a radiologist for plain film radiography. Early pilot program findings, including challenges faced and subsequent actions, are described. Outcomes Reviewed patient care decisions by therapists participating in the pilot program were deemed appropriate 100% of the time by physician chart reviewers. Approximately 10% of the patients seen were referred to a radiologist for plain film imaging, and 4% and 16% of the patients were referred to physicians for pain medications or medical consultation, respectively. The pilot program's success led to institutional adoption of the direct access model in all physical therapy outpatient clinics. Discussion Autonomy is described, in part, as self-determined professional judgment and action. This case report describes such an effort at a large academic medical center. The interdependent, collaborative relationship among physical therapists, physicians, and hospital administrators has resulted in the implementation of a patient-centered practice model based on the premise of patient choice.

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Section: Discussionmentioning

confidence: 99%

Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report

2010

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“…Physiotherapists have a responsibility to base their clinical practice and decision making on research findings, one reason for this is to ensure patient safety. However, another aspect that makes evidence‐based working an important objective is that physiotherapists need to strive for autonomous practice, that is, to be given legitimacy within society, physiotherapists need to be able to act autonomously through high standards of practice and research [7]. According to Dannapfel et al .…”

Section: Introductionmentioning

confidence: 99%

The diverging perception among physiotherapists of how to work with the concept of evidence

Snöljung

Mattsson

Gustafsson

2014

Evaluation Clinical Practice

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“…W ith the advancement of physical therapists as directaccess providers of care, 24,33 it is important to be aware of unusual musculoskeletal conditions, contributing factors that may predispose patients to incur such injuries, the process of diagnosis, and the effective management of these injuries. Although there are numerous reports on lower extremity stress fractures, 2,3,6,21,28,29,52 reports on the clinical presentation of stress fractures about the knee joint are limited.…”

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confidence: 99%

Diagnosis of Medial Knee Pain: Atypical Stress Fracture About the Knee Joint

Rosenthal¹,

Moore²,

DeBerardino³

2006

J Orthop Sports Phys Ther

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Study Design: Resident's case problem. Background: A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient's past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament. Diagnosis: Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist's diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient's symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient's worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture. Discussion: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident's case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.

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Historical Perspectives of Autonomy Within the Medical Profession: Considerations for 21st Century Physical Therapy Practice

Cited by 21 publications

References 35 publications

Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report

Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report

The diverging perception among physiotherapists of how to work with the concept of evidence

Diagnosis of Medial Knee Pain: Atypical Stress Fracture About the Knee Joint

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