Expanding NPTE References: Balancing Validity, Accessibility, and Equity

Summary of the Recommendations of the 2025 Reference Expansion Task Force

For decades, the National Physical Therapy Examination (NPTE®) has relied on textbooks as the primary source for item references. Textbooks have long been considered authoritative and stable, making them ideal for supporting defensible exam content. However, physical therapy education is changing. Programs increasingly incorporate alternative resources—open educational resources (OERs), clinical practice guidelines (CPGs), and digital platforms—to reduce costs for students and to reflect current physical therapy practice. This evolution prompted a critical question: What, if any, additional educational resources should we consider as suitable references for NPTE items, and what criteria should we apply when considering allowing additional  resource types in the future? To explore these questions, FSBPT convened a fourteen-person Reference Expansion Task Force in October 2025. Their mission was clear: review feasibility, propose criteria, and recommend a path forward for incorporating non-textbook references while maintaining exam validity and fairness.

What We Learned from Programs

FSBPT regularly conducts a nationwide textbook survey, reaching out to PT and PTA educators to ensure the NPTE reference library stays aligned with textbooks currently adopted in classrooms. For example, in 2020, FSBPT gathered information from sixty PT and seventy PTA programs regarding the textbooks in use. While the survey offers valuable insight into prevailing trends, it focuses exclusively on textbooks and does not capture the growing use of alternative resources in physical therapy education. Early in 2025, FSBPT surveyed CAPTE-accredited PT and PTA programs to understand what non-textbook resources they use. The results were illuminating. A total of 121 programs responded—49 PT and 72 PTA—and 51 of those reported using non-textbook resources. These included CPGs, journal articles, OER textbooks, instructional videos, and publications from professional organizations. In all, programs submitted 681 resources, revealing a wide variation in quality and format.
This data confirmed that textbooks are no longer the sole instructional resource. Many programs supplement—or even replace—traditional texts with alternative references. These findings justified FSBPT’s directive to build a policy around best practices for establishing and maintaining criteria for non-textbook references that can be used in NPTE® item development to maintain a fair, valid, and defensible examination.

Setting the Stage

The task force began by reaffirming guiding principles that would shape every discussion.

• Fairness—ensuring all candidates encounter references that are equally fair and relatively familiar
• Opportunity to learn—resources should reflect what is widely accessible in PT and PTA education programs
• Financial burden—consider the impact of the resource’s purchase cost to candidates
• Relevance—inclusion of references must represent entry-level practice and link to the NPTE® Test Content Outline (TCO) in order to maintain exam validity

These principles served as a compass throughout deliberations, from analyzing survey data to debating individual resources.

Organizing the Discussion: The “Three Buckets”

To bring structure to the evaluation process, the task force adopted a “three-bucket” framework. Resources were sorted into green, yellow, or red categories. Green represented likely acceptable references—those that were relevant, current, authoritative, and widely accessible. Yellow represented resources that met some, but not all, acceptable criteria. Red represented unacceptable references, such as outdated, irrelevant, or unclearly attributed references.
This framework provided a practical lens for discussion and helped the group identify patterns and challenges across resource types.

Defining Acceptable References

Through iterative discussion, the task force refined important criteria for acceptable references.

• Relevance:
  • Ensure references align with entry-level PT/PTA practice and the TCO.
  • Consider scope differences: PT references may focus on differential diagnosis; PTA references should not focus on differential diagnosis.
  • Verify references reflect changes in current practice and evidence-based practice guidelines.
• Maintenance:
  • Verify references have clear evidence of currency and update cycles.
  • Resources older than five years require review, similar to the current textbook policy.
  • Prioritize sources with systematic revision plans (e.g., CPGs updated every four to five years).
• Authoritativeness:
  • Select professionally vetted, peer-reviewed, and supported by reputable organizations (e.g., APTA).
  • Avoid resources with unclear authorship or questionable credentials.
• Accessibility:
  • Use references that are widely available and ideally free or low-cost.
  • Minimize financial burden on candidates by choosing accessible resources.
• Persistence:
  • Choose references that are stable and reproducible—content should not change unpredictably.
  • Avoid ephemeral sources like blogs or social media posts.

Considerations and Challenges in Implementation

Several themes emerged during discussions about expanding resources as references for NPTE items. Transparency was a recurring concern. The task force stressed the need to communicate NPTE referencing policies clearly to relevant parties. Technology trends also loomed large. The group acknowledged the growing influence of AI-generated content and evolving OER platforms, noting that future policies must anticipate these shifts. Redundancy was another consideration; no single reference should be the sole source for a knowledge domain. The task force encouraged FSBPT to collaborate with APTA on the feasibility of making CPGs accessible without financial or membership constraints.

Final Recommendations

At the conclusion of the meeting, the task force proposed several concrete actions:

• Update the textbook survey to capture non-textbook resources more effectively.
• Engage experienced volunteers in resource review during 2026.
  • FSBPT is actively recruiting subject matter experts to participate in the 2026 Reference Expansion Review Task Force scheduled to meet in Fall 2026.
• Apply preliminary criteria for evaluating non-textbook references to the 2026 textbook survey results and further modify criteria as needed.

Looking Ahead

The inclusion of non-textbook references represents a significant evolution for the NPTE. This change acknowledges the realities of contemporary physical therapy education while safeguarding fairness and defensibility. As one task force member noted, “Our goal is not to prescribe teaching methods but to ensure that [the] NPTE reflects current practice and remains a valid measure of entry-level competence.”
Physical therapy educators, NPTE candidates, and NPTE volunteers can expect a wider range of reference materials in the future. To remain current, please consult updated surveys and communications outlining new criteria. For instance, subscribe to the Faculty Newsletter and review our website for details regarding the textbook survey and our processes to ensure validity. FSBPT remains dedicated to these enhancements, supporting the accessibility, fairness, and validity of the NPTE.