Chapter 4 Physical Therapist As Patient Client Manager (1) (1) - 1

The Five Roles of the
Physical Therapist
1. The Physical Therapist as Patient/Client Manager
2. The Physical Therapist as Consultant
3. The Physical Therapist as Critical Inquirer
4. The Physical Therapist as Educator
5. The Physical Therapist as Administrator
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The Physical Therapist
as
Patient/Client Manager
Chapter 4
24
Difference between manager
and administrator
 Management is all about plans and actions, but the
administration is concerned with framing policies and
setting objectives. ... The manager looks after the
management of the organization, whereas administrator
is responsible for the administration of the organization.
Management focuses on managing people and their work
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Elements of Patient Client
Manager
 The physical therapist integrates the five elements of
patient/client management—examination,evaluation,
diagnosis, prognosis, and intervention—in a manner
designed to optimize outcomes.
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PATIENT/CLIENT MANAGEMENT
 Best established and most recognizable role of the physical

therapist (PT)
 Patient/client management for the PT has changed over the years
in five areas:
1. Knowledge and skill used in the processes of evaluation and
diagnosis, prognosis, and discharge planning
2. Referral relationships with physicians
3. Technological advances in the tools available for examination
and intervention
4. Interpersonal relationships with patients and clients
5. Outcomes of care
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EVALUATION AND DIAGNOSIS
 Evaluation is the process of making clinical judgments,
based on examination data, to create a problem list for
each patient. Because this list may include problems that
require referral of the patient to other professionals . The
PT first must establish which problems fall within the scope
of practice of physical therapy, and for those, determine
whether the problems require the skilled services of a PT.
 This decision making process may also be considered clinical
problem solving, diagnosing, or clinical reasoning.
 The end product of evaluation is a diagnosis, which is the
term for problems that have been categorized into defined
clusters, syndromes, or categories.
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Physical Therapy Diagnosis
 Using the term is important to distinguish the PT’s
findings from, and to complement, diagnoses made by
other health care practitioners.
 Physical therapy diagnoses help identify the role of
physical therapy and its scope of practice
 In physical therapy, the term diagnosis as simply the
primary dysfunction toward which the PT directs
treatment and dispel the fears of the medical
community that PTs intend to diagnose disease, depend
on the practice of others, or perform clinical services
outside their scope of expertise
 By naming and classifying clusters of symptoms, signs,
and demographic data the clinician may obtain better
results.
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 The diagnoses PTs select also help them share their
results with other PTs.
 At the least, a diagnosis brings some psychological
comfort to the PT and the patient; labeling the problem
gives it a sense of reality and makes communication
easier.
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Physical Therapy Diagnosis
 For the profession as a whole, physical therapy

diagnosis achieves the following:
 It eliminates the search for a common
treatment for all patients, because
diagnosis decreases the generalization of
clinical problems.
 It provides an experiential basis, rather
than hypothetical mechanisms, in which to
ground physical therapy theory.
 It ensures the homogeneity of patients in
comparison groups for research.
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Diagnosis as Clinical
Decision Making
 Steiner et al suggested a patient-centered clinical
problem-solving process that incorporates the
International Classification of Functioning,
Disability, and Health (ICF) model devised by the
World Health Organization (WHO).
 Using the WHO model, which serves as the
common language for rehabilitation in almost 200
countries, Steiner et al created the rehabilitation
problem-solving form (RPS-Form).
 The form is helpful for discussing the process of
clinical decision making that is consistent with
other models
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 The Biopsychosocial Model of Steiner et al. addresses
health and disability at the biological (body function
and structure), individual (activities), and social
(participation) levels. These levels are the link between
the interaction of a person’s health condition (disease
or disorder) and the personal and environmental factors
that affect it.
 The RPS-Form allows the patient’s point of view to be
recorded, in his or her own words.
 Although designed for interdisciplinary rehabilitation,
the RPS-Form may also be useful for PTs who are not
part of such a team.
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PROGNOSIS
Prognosis is the determination of the predicted optimal

level of improvement in function, the time needed to reach
that level, and the levels of improvement that may be
reached at various intervals during the course of physical
therapy.The prognosis is documented in the physical therapy
plan of care, which includes the following:
 Specific short- and long-term goals for identified
problems
 The duration and frequency of specific interventions
selected to meet goals
 The expected outcome
 The optimal level of improvement expected
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Discharge
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Discontinuation
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OUTCOMES
 PTs ask themselves early in the patient/client management process,
“What outcome is likely, given the diagnosis?”
 After listing the likely outcomes for each diagnosis, PTs may
reexamine the actual outcomes to determine whether the predicted
outcomes are reasonable and then modify them as necessary.
 At the end of an episode of care, the PT informally reflects on, or
formally analyzes through organizational review processes, the
overall impact of the interventions on the patient’s disorders,
impairments, functional limitations, disabilities, health status, and
satisfaction with care, as well as risk prevention, in terms of each
likely outcome.
 The more PTs assume responsibility for practicing without referrals,
the more accountable they will become for the outcomes of the care
they provide.
 PTs who provide care as members of interdisciplinary teams face the
challenge of determining the contribution 24of the physical therapy
component to the outcome of the team effort.
CLINICAL DECISION MAKING
 May’s model is useful for considering decisions in every

component of patient/client management because
 May’s presents a model for this process that categorizes decisions
along two continuums: from familiar to unfamiliar and from
standardized to open
 May’s model is useful for considering decisions in every
component of patient/client management because, in the course
of a day, all four types of decisions could be made in patient care
 Pediatric PT attends DMS
 Pediatric PT attends case of Torticollis
 Pediatric PT attends DMS with visual and hearing problems
 Pediatric PT attends DMS but parents want aramotherapy
incorporated
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May’s Model of Decision Classification
Familiar Unfamiliar
Standard PT is familiar with the task and
there are well understood
The PT is un familiar with the
task, although there are well
procedures for the management understood procedures for
of individuals with this problem the management of
individuals with this kind of
problem
Open The PT has worked with tasks

with many of the same features
PT is unfamiliar with the task,
which may be very complex,
(perhaps psycho-social issues, and there are no well
perhaps complex multisystem understood procedures for
pathology), so there is basis on the management of
which to begin evaluation and individuals with this particular
treatment set of problems
Denoting increasing task

complexity 24
REFERRAL RELATIONSHIPS
 1960 and before; referral with detail prescription
 Then referral to PT from Physician as “Evaluate and treat”
 From technical role of implementing plans of care as
instructed by prescription to total responsibility for the
patient/client management process, from examination to
outcomes.
 Now after direct access; referral from PT to physician
 Marketing
 Physician choices
 Patient choices
 The issue of physician owned physical therapy services
(POPTS)
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physician owned physical
therapy services (POPTS)
 a cohesive, team approach to care, which translates to
accessible, high-quality treatment centered around the
needs and best interests of the patient.
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INTERPERSONAL RELATIONSHIPS
 In the 1977 Mary McMillan Lecture, Mary Clyde

Singleton reminded the physical therapy
profession of the importance of its human side,
seen in PTs’ devotion to human welfare and in
the need for PTs to be compassionate, loving,
understanding, and conversant with the
humanistic attributes of self and the
relationship with others.
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 Art of physical therapy, which is the profession’s
commitment to humane service, has not changed,
but the challenges to the therapeutic relationship in
which it must be achieved have. Some of these
challenges,
 The need to address a broader range of cultural
issues
 Compliance with an ever-increasing number of
laws, regulations, and ethical principles that
guide physical therapy practice
 Third-party interpretation of regulations
governing payment for services
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 Increased access to information for both the PT and the
patient
 Increased accountability and responsibility for care
provided
 Less delegation of care to support personnel
 Employer productivity and caseload expectations
 Professional development of the PT
 Quality of evidence supporting PTs’ decisions
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Thanks
for your
attention!
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Chapter 4 Physical Therapist As Patient Client Manager (1) (1) - 1

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The Five Roles of the

 Best established and most recognizable role of the physical

 For the profession as a whole, physical therapy

Prognosis is the determination of the predicted optimal

 May’s model is useful for considering decisions in every

Open The PT has worked with tasks

Denoting increasing task

 In the 1977 Mary McMillan Lecture, Mary Clyde

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