The world of physical therapy is evolving, and statutory language must keep up. The Ethics and Legislation Committee regularly reviews and revises the Model Practice Act, and the seventh edition has been approved by the Board of Directors and published in January 2023. This article is based on a presentation at the 2022 Annual Education Meeting presented by Craig Miller and Sherise Smith.
The Model Practice Act (MPA) is a foundation for board members to use as a guide as they update their jurisdiction's practice acts. FSBPT launched a Model Practice Act Task Force in 1994, and that task force created the first edition of the MPA in 1997. Initially, it was intended as an à la carte document where jurisdictions could pick and choose which sections they wanted to use. However, over time and with experience, FSBPT has realized it is better to use it in its entirety, given the interconnected nature of the various sections. The American Physical Therapy Association (APTA) has also adopted the MPA as the gold standard in physical therapy regulation. The document is a tightly constructed and integrated model for regulating physical therapy. The component sections fit together well and complement other sections. Therefore, if jurisdictions change any aspect of the practice act, they should have their legal counsel review the document to ensure it is consistent.
The MPA is a dynamic document that continues to evolve with the evolving practice of physical therapy. Since 1997, FSBPT has revised the MPA about every five years. There was a minor revision in 2021 that was completed earlier to address some aspects of the PT Compact and telehealth. Beginning in 2021, the Ethics and Legislation Committee began creating the seventh edition. The committee gathered feedback from Leadership Issues Forum attendees, the Council of Board Administrators, the APTA, and additional stakeholders.
The input was extremely valuable and brought several significant topics to the forefront:
Other FSBPT members and committees have done great work on many of these issues, which the Ethics and Legislation Committee was able to use to inform changes and updates. For example, animal care has reached a critical mass, so it was appropriate to address this. Fortunately, FSBPT member and former Ethics and Legislation Committee Chair Kirk Peck has examined best practices and existing statutes related to animal care. Accordingly, the committee added this language:
4.03, G. Nothing in this [Act] shall prohibit a licensee [certificate holder] from providing physical therapy to animals for which the licensee [certificate holder] has completed the education and training as further established by rule.
Additionally, the committee added more careful consideration and wording around "informed consent," which they added as a term for the first time. The Boundary Violation Task Force in 2020 looked into important issues related to the practitioner-patient dynamic (as well as the educator-student dynamic) that may complicate informed consent. The task force was elevated to a Committee in 2022 by the Board of Directors (Sexual Misconduct and Boundaries Committee), and they continue to research the best guidelines to keep the public safe. For example, how is a patient-provider relationship defined, and when does that relationship end? How soon can a romantic relationship begin after the patient-provider relationship has ended? For now, the MPA language allows jurisdictions to make their own decisions on that timeframe, but the work of the Sexual Misconduct and Boundaries Committee should help inform jurisdictions in the near future.
Because of the work of the Sexual Misconduct and Boundaries Committee and additional input, current recommendations include additional language in the disciplinary section related to sexual boundaries: Section 4.04 Grounds for Denial of a License [and Certificate]; Disciplinary Action 12. Sexual contact between a physical therapist and patient/client after termination of the Physical Therapist-Patient/Client Relationship may still constitute sexual misconduct if the sexual contact is a result of the exploitation of trust, knowledge, or influence of emotions derived from that relationship. 13. Sexual contact between a physical therapist assistant and patient/client after termination of the Physical Therapist Assistant-Patient/Client Relationship may still constitute sexual misconduct if the sexual contact is a result of the exploitation of trust, knowledge, or influence of emotions derived from that relationship. 14. Abusing the physical therapist-patient/client relationship to exert undue influence or exploiting persons over whom the licensee has supervisory, evaluative, or other authority. 15. Abusing the physical therapist assistant-patient/client relationship to exert undue influence or exploiting persons over whom the licensee [certificate holder] has supervisory or other authority
Additionally, the Ethics and Legislation Committee worked on nexus to practice considerations, endorsement of non-CAPTE graduates, and the use of gender-neutral language, along with several other areas. The committee was careful not to be too prescriptive in the language, especially for emerging areas. In terms of detailed changes, the committee updated some definitions. For example, due to the changing nature of virtual care, Practice Acts should include "telehealth" in the definition of "physical therapy." In defining "physical therapist" the committee added "health care practitioner" and the common term "physio."
The committee also added several aspects of care to the scope of practice:
4. "Practice of physical therapy" means: b. Alleviating impairments, functional limitations and disabilities; promoting health; and preventing disease by designing, implementing and modifying treatment interventions that may include, but not limited to: therapeutic exercise; needle insertion; patient-related instruction; therapeutic massage; airway clearance techniques; integumentary protection and repair techniques; debridement and wound care; physical agents or modalities; mechanical and electrotherapeutic modalities; manual therapy including soft tissue and joint mobilization/manipulation; functional training in self-care and in home, community or work integration or reintegration; as well as prescription application and, as appropriate, fabrication of assistive, adaptive, orthotic, prosthetic, protective and supportive devices and equipment.
The committee also felt it was important to more specifically define "supervision:
Jurisdictions may find it a bit daunting to simply update their language accordinaly, especially if they do not understand the reason behind the changes. To help with their review, the MPA also has a useful commentary section. It notes specific interconnected sections, so if boards change one section, they know what other sections need close examination. The commentary section also adds additional context. For example, as noted, the committee added the term "informed consent," and the commentary section elaborates on what "informed consent" means. It also details how this term relates to different areas of practice, for example, dry needling. Another example is the addition of "physical therapy aide." The commentary section describes the position and how it relates to physical therapists and physical therapist assistants.
The Ethics and Legislation Committee has been meeting regularly for more than two years to finalize the updated MPA. FSBPT encourages every board to review the new edition of the practice act and compare it to their own act. This is a dynamic document that has evolved, and we hope it continues to be a valuable resource to all FSBPT jurisdictions.
Craig Miller received his BS in physical therapy from Wayne State University in 1994 and is currently pursuing his MPH at Eastern Washington University. He has worked across multiple settings, currently as the Director of Therapy for Home Care and Outpatient Services with Rivetus Rehabilitation. Craig has been on the Michigan Board of PT since 2018, and he is currently serving as Board Chair. He volunteered with APTA Michigan as the Legislative Director and Federal Affairs Liaison and has participated on several CMS Technical Expert Panels after being nominated by the APTA. Craig is married to his wife Sarah and has two children, Dane and Gwenyth, who are attending universities in Michigan. He has volunteered for many years coaching baseball and softball.
Sherise Smith, PT, MSPT, CBIS, is currently on the Ethics and Legislative Committee and the Boundary Violations Taskforce. Sherise was a member of the Nevada Physical Therapy Board from 2014 through 2020, including being the chair for the final two years of her term. She previously served on the FSBPT Foreign Educated Standards Committee from 2017 to 2018. She has also acted as the Nevada Board's legislative liaison and led the board's Advisory Committee on Dry Needling. Sherise received her undergraduate degree from the University of Nevada and her master's degree in physical therapy from Duke University. She has practiced in Nevada for thirty-one years, spending most of that time specializing in brain injury rehabilitation. She was the founding Chapter Director for ThinkFirst Northern Nevada. Sherise received the Physical Therapist of the Year Award from the Nevada Physical Therapy Association in 2018. She recently relocated to the Oregon Coast.