Open Book


2022 NPTE Updates: Research, Innovation, and Practice Analysis Updates

FSBPT is working on several NPTE initiatives. This article is based on a 2022 Annual Education Meeting presentation by Colleen Lettvin, Lorin Mueller, and Christine M. Sousa


Over the past year, FSBPT has been working diligently to continue to update and improve many aspects of the National Physical Therapy Examinations, from candidate registration to examination development and delivery. Some of these efforts have already been implemented while others will take effect in 2023 and 2024.

Exam Services

Each year FSBPT reviews feedback from candidates, schools, and jurisdictions to improve the process of taking the NPTE; the goal is to make the process efficient and smooth for the candidates while fulfilling our mission to protect the public through promoting safe and effective physical therapy practice. In the eleven years since we transitioned to fixed-date testing, we have continuously worked to make registration, eligibility, and scheduling easier. We have also worked diligently to maintain the security of the NPTE, which protects the public and the value of the credentials licensees hold. While there is always some tradeoff between examination security and candidate convenience, we are constantly using new technologies and strategies to reduce the extent to which they conflict.

In 2022, we committed to supporting two-day testing windows for all NPTE-PT and NPTE-PTA examinations. Two-day windows allow us to essentially double the number of scheduling slots we have available at Prometric while still limiting access to NPTE items. This system strikes a good balance between continuous testing, which some candidates used to attempt to harvest and share NPTE items, and one-day windows, which allowed us to deploy several new forms for each testing date and strictly control the window of time exam forms were available. We also continued to add jurisdictions to the Alternate Approval Pathway, which greatly speeds up the registration, eligibility, and scheduling process. Additionally, we continue to work with schools to help them better understand the nuances of the cohort creation and graduation validation processes. Schools can use this understanding to allow their students the opportunity to take the NPTE when the time is right for them.

Prometric has also introduced a new tool to aid candidate scheduling: ProScheduler. This tool allows candidates to see sites near their preferred location and what testing dates are available at those sites. Candidates now have more flexibility in selecting a testing location and a more efficient process for making that selection.

Early in 2022, we conducted a pilot study of a new exam delivery interface, ProDriver, along with a potential new design for the NPTE. The feedback we received on the interface was overwhelmingly positive, with participants reporting that the new interface was a little more user-friendly and visually appealing. We transitioned all law exams to ProDriver over the summer, and we transitioned the NPTE for many candidates in October.

NPTE Design Changes Coming in 2024

The other important piece of the pilot study that took place in 2022 was testing a proposed new design for the NPTE. This new design adds items with patient scenarios, which allows for testing more medically complex issues and better replicates how information would be presented in practice, as opposed to many stand-alone multiple-choice items. However, as scenario items will be more time-consuming than stand-alone items, we reduced the number of questions on the NPTE by 10% following the advice of our technical advisors. That recommendation was well-supported by the data from the pilot, and introducing scenarios at this test length did not result in the NPTE placing more of a time burden on candidates. The pilot collected data from seventy-eight PT candidates and sixty-four PTA candidates in March and April. Participants included candidates educated at CAPTE institutions as well as non-CAPTE candidates. (FSBPT provided candidates a free Performance Feedback Report based on their performance on the pilot test as a consideration for their participation.)

For the NPTE-PT, beginning in January 2024, forms will consist of 225 items: 180 items will be scored, and 45 items will be unscored. Up to 45 items will be scenario-based items, and the remaining (180 or more) items will be stand-alone multiple-choice items that might include graphics or videos. For the NPTE-PTA, 2024 forms will consist of 180 items: 140 of those items will be scored, and 40 items will be unscored. Up to 35 items will be scenario-based items, and the remaining (145 or more) items will be stand-alone multiple-choice items that might include graphics or videos.

There are a few important things to note about scenario items. First, the scenario information will be standardized to give information on patient characteristics, pertinent medical history, and current symptoms. Having standardized patient information improves the time-efficiency of the scenario for the examinees. Second, these items will still be independent of one another. In other words, if you miss the first question in a scenario set, you can still answer the other questions in the scenario set correctly. Test designs that have scenarios that “build on” previous questions in the set allow for testing more complex issues but create a lot of stress on the examinees and aren’t very time-efficient in relation to their contribution to test validity. Third, all the items that pertain to a scenario will be grouped together at the end of each section. That way, a candidate won’t have to re-read the scenario for each question it relates to.

In addition to assessing the timing impact of the introduction of scenarios, candidates were also asked to give their impressions of the scenario items and items with video (which were introduced in October 2022). Participants’ impressions were overall very positive, with over 95% reporting that they felt the new item types measured their knowledge and skills as well or better than stand-alone multiple-choice items.

2024 Content Outline Updates

January 2024 will also usher in updates to the NPTE Content Outlines. The content outlines specify the lists of topics that are considered to be important and relevant to entry-level practice and therefore eligible to be included on the NPTE. FSBPT collects data on what entry-level practitioners are doing in practice, as well as the knowledge and skills required to perform those tasks. Complete information on the data collection and processes we use to make these determinations can be found on the FSBPT website.

In June 2022, the PT and PTA Practice Analysis Task Forces met to review the practice analysis data collected over a five-year span. Each task force consisted of a diverse panel of experts representing a broad range of practice settings, work experiences, and demographic characteristics. As they reviewed the practice analysis information, they shared their expertise on how clinical practice has evolved, and they made recommendations as to whether topics should be added or removed from the lists of topics covered by the NPTE. FSBPT’s Board of Directors accepted these recommendations, and they will be effective in January 2024, giving candidates and programs time to make any changes to their preparation that might be necessary.

In terms of the recommendations of the PT Task Force, the task force recommended a higher proportion of items be allocated to Neuromuscular and Nervous System items as well as Cardiovascular & Pulmonary items. They recommended relative decreases in Modalities and items relating to the Metabolic and Endocrine Systems. The PTA Task Force recommended relative increases in the following areas: Safety & Protection, Neuromuscular and Nervous System, Equipment, Devices & Technologies, and Cardiovascular & Pulmonary. They recommended decreases in Modalities and the Integumentary System. You can see the correspondence between the changes at both levels of the NPTE, which lends support to the validity of these recommendations. Note that because the number of questions on the NPTE is decreasing in 2024, as noted previously, the changes are relative to the percentages of items allocated in 2018–2023, rather than the absolute number of questions on a given topic.

Both task forces noted issues relating to the treatment of long-COVID and the importance in using evidence to support interventions related to the neuromuscular system as key factors in the increasing importance of topics relevant to those areas. They also noted the decreasing prevalence of various therapeutic modalities in current practice.

PT Exam



Knowledge and Skill Requirements

  • The impact of regenerative medicine on physical therapy prognosis and interventions related to the musculoskeletal system
  • The impact of regenerative medicine on physical therapy prognosis and interventions related to the neuromuscular and nervous system
  • Provision and utilization of telehealth


  • Phonophoresis


Work Activities

  • Taping for edema management
  • Electrodiagnostic test results
  • Gross motor development progression
  • Negative pressure wound therapy
  • Taping for lymphatic drainage
  • Phonophoresis



For the PTA exam, the task force did not add any knowledge and skill requirements, but they noted that the provision and utilization of telehealth is an important treatment context and should be monitored for future inclusion as source materials become available. The task force noted that much of the knowledge required of PTAs relating to telehealth was both state-specific and site-specific. As it stands, telehealth could be used as a treatment context in an NPTE item, but the question would not require any specific knowledge of the pros and cons of telehealth.

PTA Exam



Knowledge and Skill Requirements

  • NA
  • Impact of pharmacology used to treat the gastrointestinal system on physical therapy management
  • Applications, indications, contraindications, and precautions of phonophoresis

Work Activities

  • Gross motor development progression
  • Taping for neuromuscular reeducation
  • Taping for pain management
  • Nonselective debridement
  • Application of topical agents Iontophoresis
  • Phonophoresis
  • Intermittent pneumatic compression
  • Mechanical repositioning for vestibular dysfunction
  • Participation in professional organizations



Key Timeline Markers

The practice analysis reports, 2024 Content Outlines, and supporting documents should be posted in late 2022. FSBPT will issue additional communications aimed at educators and candidates throughout 2023. FSBPT expects to update PEAT in late 2023, in time for 2024 candidates to prepare for the new exam design and content. The new design and content outlines will first appear on NPTE test forms in January 2024, and all candidates will receive forms based on the new content outlines.

We are confident that these new changes and initiatives will better serve candidates while also advancing our mission of public protection.




Colleen Lettvin is the Assessment Content Manager at the Federation of State Boards of Physical Therapy. Colleen oversees the development of content for the National Physical Therapy Examination and other jurisprudence products such as Law examinations and Jurisprudence Assessment Modules. Colleen has been actively engaged in item and examination development as a long-term volunteer at FSBPT since 2005. Prior to joining FSBPT in 2016, Colleen was employed as a Senior Physical Therapist at Houston Methodist Hospital, where she played an integral role in developing the first American Physical Therapy Association (APTA)-accredited Critical Care Fellowship. Colleen has been a board-certified specialist in cardiovascular and pulmonary physical therapy by the American Board of Physical Therapy Specialties (ABPTS) of the APTA since 2010 and received her master of science in physical therapy from Texas Woman’s University.



Lorin Mueller, PhD, joined the Federation of State Boards of Physical Therapy (FSBPT) in 2011 as its Managing Director of Assessment. Prior to joining FSBPT, Lorin spent ten years as Principal Research Scientist at the American Institutes for Research in Washington, DC. Lorin received his PhD in industrial and organizational psychology with a specialization in statistics and measurement in 2002 from the University of Houston.




Christine Sousa is the Managing Director of Exam and Administrative Services with the Federation of State Boards of Physical Therapy (FSBPT). Christine has been with FSBPT since September 2006. She has more than twenty years of business and management experience, including the position of Director of Certification with the National Certification Commission of Acupuncture and Oriental Medicine. She received her bachelor of science in business administration in 1992 from George Mason University.