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Presidents Perspective

The Case for Evidence-Based Regulation: The Healthcare Regulatory Research Institute

Nancy R. Kirsch, PT, DPT, PhD, FAPTA


The professional community has long understood that the challenge to demonstrating the value of physical therapy clinical services is tied to producing the evidence to substantiate the claim that physical therapy interventions work. It is therefore no surprise that the regulatory community has embraced this same critical understanding. However, there is a paucity of work done in the area of regulatory research and when it has been done, it is often very isolated and therefore of less value to the global regulatory community than it could be. Regulators across disciplines have the common mission of public protection and an interest in ensuring that regulations are relevant, reflective of practice, and applicable to the challenges of the health care delivery system of the future. Until recently, research efforts in regulation were unfocused and unilateral and had limited impact. The nascent Healthcare Regulatory Research Institute (HRRI) is poised to change that going forward!

In a 2020 study by Benton et al., a scoping review of the literature in PT regulation determined that, to date, there had been no attempt to “determine or map the current state of physical therapy regulatory scholarship.” The article also noted there was very little work done in this area as it specifically relates to physical therapy, and the work that has been done has been limited to just a few countries with little collaboration. 1

Physical therapy in the United States is not alone as a field that has demonstrated little growth in the exploration of regulatory research. In 2016 the National Council of State Boards of Nursing (NCSBN) organized a summit to investigate the regulatory needs of the profession. International representatives and regulators from twenty US states and territories participated in an attempt to identify regulatory issues and determine their commonality and importance to regulation in the future. In March of 2021, a group of nursing regulators met again to identify the critical issues that will impact nursing regulation in the future. This group of leaders recognized that with the globalization of every aspect of life, nursing regulation also needs to take a broad and comprehensive international approach to examine the impact of regulation in the future. 2

The Board of Directors of the Federation of State Board of Physical Therapy also recognized the importance of demonstrating the value of regulation. It is critical to make sure that our member boards have the information necessary to support regulatory processes, including delivery and system designs that reflect the needs of the public. While we have always been aware that we must be proactive, not reactive, to achieve and maintain excellence in regulation, the pandemic has sharpened our focus in this area. We have to examine the data to manage what confronts us in the present and anticipate the challenges that lie ahead.

FSBPT established the Healthcare Regulatory Research Institute in 2017. Because regulatory research crosses discipline-specific boundaries, HRRI is not limited to just physical therapy regulatory research—however, all the research is of significant importance to physical therapy. Based on member input at Leadership Issues Forums (LIF), the FSBPT Board of Directors identified the following categories, in no particular order, as the priority areas of research to the regulatory community:

Category 1: Risks, Supports, Engagement, and Burnout
Category 2: Workforce, Mobility, and Access to Care
Category 3: Regulatory Interventions
Category 4: Standards of Care
Category 5: Board Effectiveness

The purpose of the Healthcare Regulatory Research Institute (HRRI) is to create a forum for the exchange of information and ideas and to pursue research and education to enhance regulation in support of public protection. The Healthcare Regulatory Research Institute engaged in the following research efforts in 2021.

As a follow-up to the Fisher Worklife Solutions literature review and manuscript on self-assessment in the continuing competence assessment process, completed in 2020, HRRI contracted with the company again to undertake the development of a Healthy Practice self-assessment tool to support the professional competency of physical therapists and physical therapist assistants

Additionally, in 2020 and 2021, HRRI contracted with David Zach Hambrick to serve as a consultant to guide the work of the Re-entry to Practice Task Force concerning the degradation of skills after a period of absence from the job. In May of 2021, Hambrick completed his Project Report, “Competence in Physical Therapy: A Framework for Understanding Effects of Disuse on Physical Therapy Performance .” HRRI also contracted with McKinley Advisors to begin background work to identify a sustainable path forward for HRRI. McKinley will lead HRRI through a strategic planning process early in 2022 to gather insights and prioritize the areas of focus to expand and advance the institute.

In addition to the McKinley strategic planning session, FSBPT’s membership identified research priorities during the 2018 Leadership Issues Forum that currently serve as priorities for considering future research opportunities for HRRI.

  • Determine the impact of regulatory board interventions, including remediation and sanctions, on changes in behavior and prevention of future harms. (Category 3)
  • Determine the current status of the physical therapy workforce and develop a projection model to identify future needs (geographic distribution and therapy deserts). (Category 2)
  • Define and identify the risks and harms to competence to the physical therapist and physical therapist assistant; Define and identify the supports to competence of the physical therapist and physical therapist assistant. (Category 3)
  • Determine if current licensure requirements adequately prepare practitioners for entry-to-practice. (Category 4)
  • Identify the harms and risks to the public that regulation of the profession prevents. (Category 5)
  • Determine if there is a link between past egregious behavior and future problems (e.g., performance in school, criminal records, etc.). (Category 3)
  • Determine the impact of new care delivery methods (digital physical therapy practice) on access to care and on quality of care. (Category 2)
  • Determine best practices in regulatory board effectiveness and efficiency; define regulatory board effectiveness. (Category 5)

HRRI is currently considering the following research projects for 2022:

  • Explore the scope and demographics of clinicians who leave and re-enter practice to further the work of the Re-Entry to Practice-Demographics Task Force.
  • Pilot and validate the Healthy Practice Self-Assessment Instrument to support the work of the Continuing Competence Committee.
  • Explore board write-ups of sexual boundary violations to identify how they were coded and to identify subcategories of sexual boundary violations (e.g., dating patients outside the clinic, sexual misconduct with patients during treatments, inappropriate jokes/language, sexual misconduct with students, etc.). This effort will support the work of the Sexual Misconduct and Boundaries Committee.
  • Identify regulatory issues in jurisdictions where CBD/marijuana is legal medically or recreationally. (What are the regulatory issues being faced by licensees and/or regulators? Are clinicians using products during [CBD] or after [marijuana)] work? What recommendations are clinicians providing to their clients?)
  • Work with Hannah Maxey and Veritas Health Solutions to facilitate a multi-disciplinary workforce data collection, emphasizing standardizing the collection of supplemental information from licensed health professionals during the state license renewal process.

We, the regulatory community, make a case for the importance of regulation. However, there is a strong movement in all sectors toward deregulation, and health care regulation is included in that trend. Empirical evidence is insufficient to substantiate how vital regulation is in protecting the public. The Board of Directors is very optimistic about the growth of HRRI and the development of a robust regulatory research entity that will direct and focus scholarship in the regulatory community. We can then begin the important task to disseminate valid evidence-based findings to support the work of member boards in their mission of public protection.



  1. Benton, A., Woolf, R., Kirsch, N., Benton, D., “The regulatory landscape in physical therapy: Identifying scholarship opportunities in INPTRA,” Physical Therapy Journal of Policy, Administration and Leadership 20, no.1 (February 2020), https://cdn.ymaws.com/www.aptahpa.org/resource/resmgr/communications/ptj-pal_february_2020_editio.pdf.
  2. Alexander, M., Martin, B., Kaminski-Ozturk, N., Zhong, E., Smiley, R., “Envisioning the Future of Nursing Regulation Through Research: A Global Agenda,” Journal of Nursing Regulation 12, no (October 2021). 3, https://www.sciencedirect.com/science/article/abs/pii/S2155825621001113.


Nancy R. Kirsch, PT, DPT, PhD, FAPTA received her PT degree from Temple University, her Master's in Health Education from Montclair University, Certificate in Health Administration from Seton Hall University, her PhD concentration in ethics from Rutgers University (formerly UMDNJ), and a Doctor of Physical Therapy from MGH Institute of Health Professions. She practiced in a variety of settings including in-patient rehabilitation, acute care, long-term care, and home care. She owned a private practice for twenty-five years and currently practices in a school-based setting. In addition, she is the Director of the Doctor of Physical Therapy Program, and Vice Chair of Rehab and Movement Sciences, at Rutgers, The State University of New Jersey.

Nancy has been a member of the New Jersey Board of Physical Therapy Examiners since 1990 and was chairperson of the board for twelve years. She served as an evaluator for FCCPT. Nancy has been involved with the Federation of State Boards of Physical Therapy in the following capacities: she served two terms on the Finance committee and also served on several task forces, in addition to the Board of Directors. Nancy has been active in the American Physical Therapy Association since she was a student. She served the New Jersey Chapter as Secretary and President, and as a delegate and chief delegate to the House of Delegates. She served the national association as a member of the ethics document revision task force. She also served a five-year term on the APTA Ethics and Judicial Committee and the APTA Reference Committee. She received the Lucy Blair Service Award and was elected a Catherine Worthingham Fellow from National APTA and received an Outstanding Service Award and the President's Award from the FSBPT.