Minggu, 1 Agustus 2010
Intervensi dan Modalitas Fisioterapi (Acuan WCPT)
1 Therapeutic exercise may include:
• Aerobic capacity/endurance conditioning or reconditioning
o aquatic programmes
o gait and locomotor training
o increased workload over time
o movement efficiency and energy conservation training
o walking and wheelchair propulsion programmes
• Balance, coordination, and agility training
o developmental activities training
o motor function (motor control and motor learning) training or retraining
o addressing required function
o neuromuscular education or re-education
o perceptual training
o posture awareness training
o sensory training or retraining
o standardised, programmatic, complementary exercise approaches
o task-specific performance training
o vestibular training
• Body mechanics and postural stabilisation
o body mechanics training
o postural control training
o postural stabilisation activities
o posture awareness training
• Flexibility exercises
o muscle lengthening
o range of motion
o stretching
• Gait and locomotion training
o developmental activities training
o gait training
o implement and device training
o perceptual training
o standardised, programmatic, complementary exercise approaches
o wheelchair training
• Neuromotor development training
o developmental activities training
o motor training
o movement pattern training
o neuromuscular education or re-education
• Relaxation
o breathing strategies
o movement strategies
o relaxation techniques
o standardised, programmatic, complementary exercise approaches
• Strength, power, and endurance training for head, neck, limb, pelvic-floor, trunk, and ventilatory muscles
o active assistive, active, and resistive exercises (including concentric,
o dynamic/isotonic, eccentric, isokinetic, isometric, and plyometric)
o aquatic programs
o standardised, programmatic, complementary exercise approaches
o task-specific performance training
2 Functional training in self-care and home management may include:
a) Activities of daily living [ADL] training
a) bathing
b) bed mobility and transfer training
c) developmental activities
d) dressing
e) eating
f) grooming
g) toileting
b) Barrier accommodations or modifications
c) Device and equipment use and training
a) assistive technologies and adaptive devices or equipment training during
b) activities of daily living [ADL] and instrumental activities of daily living [IADL]
c) orthotic, protective, or supportive device or equipment training during self care
d) and home management
e) prosthetic device or equipment training during ADL and IADL
d) Functional training programs
a) back schools
b) simulated environments and tasks
c) task adaptation
d) travel training
e) Instrumental activities of daily living [IADL] training
a) caring for dependents
b) home maintenance
c) household chores
d) shopping
e) structured play for infants and children
f) yard work
f) Injury prevention or reduction
a) injury prevention education during self-care and home management
b) injury prevention or reduction with use of devices and equipment
c) safety awareness training during self-care and home management
3 Functional training in work (job/school/play), community, and leisure integration or reintegration may include:
a) Barrier accommodations or modifications
b) Device and equipment use and training
c) assistive technologies and adaptive device or equipment training during IADL
d) orthotic, protective, or supportive device or equipment training during IADL
e) prosthetic device or equipment training during IADL
b) Functional training programmes
a) back schools
b) job coaching
c) simulated environments and tasks
d) task adaptation
e) task training
f) travel training
g) work conditioning
h) work hardening
c) Instrumental activities of daily living [IADL] training
a) community service training involving instruments
b) school and play activities training including tools and instruments
c) work training with tools
d) Injury prevention or reduction
a) injury prevention education during work (job/school/play), community, and leisure integration or reintegration
b) injury prevention education with use of devices and equipment
c) safety awareness training during work (job/school/play), community, and leisure integration or reintegration
e) Leisure and play activities and training
4 • Manual therapy techniques may include:
a) Acupressure
b) Manual lymphatic drainage
c) Manual traction
d) Massage
a) connective tissue massage
b) therapeutic massage
e) Mobilisation/manipulation
a) soft tissue (thrust and non-thrust)
b) spinal and peripheral joints (thrust and non-thrust)
f) Passive range of motion
5 Prescription, application, and, as appropriate, fabrication of devices and equipment may include:
a) Adaptive devices
a) environmental controls
b) hospital beds
c) raised toilet seats
d) seating systems
b) Assistive devices
a) canes
b) crutches
c) long-handled reachers
d) percussors and vibrators
e) power devices
f) static and dynamic splints
g) walkers
h) wheelchairs
c) Orthotic devices
a) braces
b) casts
c) shoe inserts
d) splints
d) Prosthetic devices (lower-extremity and upper-extremity)
e) Protective devices
a) braces
b) cushions
c) helmets
d) protective taping
f) Supportive devices
a) compression garments
b) corsets
c) elastic wraps
d) mechanical ventilators
e) neck collars
f) serial casts
g) slings
h) supplemental oxygen
i) supportive taping
6 Airway clearance techniques may include:
a) Breathing strategies
a) active cycle of breathing or forced expiratory techniques
b) assisted cough/huff techniques
c) autogenic drainage
d) paced breathing
e) pursed lip breathing
f) techniques to maximise ventilation (e.g., maximum inspiratory hold, stair case
g) breathing, manual hyperinflation)
b) Manual/mechanical techniques
a) assistive devices
b) chest percussion, vibration, and shaking
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Minggu, 1 Agustus 2010
Assessment/Examination (According WCPT)
• Examine patients/clients by obtaining a history from them and from other relevant sources
• Examine patients/clients by performing systems reviews that may include screens of the following [See Appendix A for further details]:
1. Cardiovascular/pulmonary systems
2. Musculoskeletal system
3. Neuromuscular system
4. Integumentary system
5. Communication, emotional state, cognition, language, and learning style
• Examine patients/clients by selecting and administering culturally appropriate and across the life span (neonate, paediatric, adolescent, adult, senescence) tests and measures.
• Use hypothetico-deductive strategies to determine the specific selected tests and measures.
• Formulate a short list of potential diagnoses or actions from the earliest clues (history and systems review) about the patient/client.
• Perform specific tests and measures that reduce the selection of the tests and measures.
• Utilise reliable and valid tests and measures whenever possible and available.
• Tests and measures may include, but are not limited to,
1. Aerobic capacity/endurance
2. Anthropometric characteristics
3. Arousal, attention, and cognition
4. Assistive technology and adaptive devices
5. Circulation (arterial, venous, lymphatic)
6. Cranial and peripheral nerve integrity
7. Environmental, home, and work (job/school/play) access and barriers
8. Ergonomics and body mechanics
9. Gait, locomotion, and balance
10. Integumentary integrity
11. Joint integrity and mobility
12. Motor function (motor control and motor learning)
13. Muscle performance
14. Neuromotor development and sensory integration
15. Orthotic, protective, and assistive technologies, including Activities to Daily Living (ADL)
16. Pain
17. Posture
18. Prosthetic requirements
19. Range of motion
20. Reflex integrity
21. Self-care and home management
22. Sensory and proprioceptive integrity
23. Ventilation and respiration/gas exchange
24. Work (job/school/play), community, and leisure integration or reintegration
Evaluation
Evaluate findings from the assessment/examination (history, systems review, and tests and measures) to make clinical judgments regarding patients/clients.
Diagnosis
• Formulate a diagnosis utilising a process of clinical reasoning that results in the identification of existing or potential impairments, activity limitations, participation restrictions and environmental factors.
• Incorporate additional information from other professionals, as needed, in the diagnostic process.
• Know that the diagnosis may be expressed in terms of movement dysfunction or may encompass categories of impairments, activity limitations, participation restrictions and environmental factors.
• If the diagnostic process reveals findings that are not within the scope of the physical therapist’s knowledge, experience or expertise, refer the patient/client to another appropriate practitioner.
Prognosis
• Determine patient/client prognoses and identify the most appropriate intervention strategies for patient/client care/management.
Plan of Care/Intervention/Treatment
• Deliver and manage a plan of care/intervention/treatment that is consistent with legal, ethical, and professional obligations and administrative policies and procedures of the practice environment. This may include consent to plan of care/intervention/treatment.
• Collaborate with patients/clients, family members, payers (e.g., social system, insurance companies, patient self-pay), other professionals, and other individuals to determine a plan of care/intervention/treatment.
• Determine specific interventions with measurable outcome goals associated with the plan of care/intervention/treatment.
• Establish a physical therapy plan of care/intervention/treatment that is safe, effective, and patient/client-centred.
• Determine patient/client goals and outcomes within available resources and specify expected length of time to achieve the goals and outcomes.
• Monitor and adjust the plan of care/intervention/treatment in response to patient/client status.
• Refer to another agency/health practitioner cases, which are inappropriate for physical therapy.
Interventions/treatments
• Provide, whenever possible, evidence-based physical therapy interventions/treatments to achieve patient/client goals and outcomes.
• Interventions/treatments may include
1. Co-ordination, communication, and documentation
2. Patient/client-related instruction
3. Therapeutic exercise
4. Functional training in self-care and home management
5. Functional training in work (job/school/play), community, and leisure integration or reintegration
6. Manual therapy techniques
7. Prescription, application, and, as appropriate, fabrication of devices and equipment
8. Airway clearance techniques
9. Integumentary repair and protection techniques
10. Electrotherapeutic modalities
11. Physical agents and mechanical modalities
• Provide physical therapy interventions/treatments aimed at prevention of impairments, activity limitations, participation restrictions, and injury including the promotion and maintenance of health, quality of life, and fitness in all ages and populations.
• Determine those components of interventions that may be directed to support personnel.
• Respond effectively to patient/client and environmental emergencies in one’s practice setting.
Re-examination/Determination of Outcomes
• Re-examine patient/client throughout the episode of care/intervention to evaluate the effectiveness of interventions/treatments and outcomes.
• Adjust plan of care/intervention/treatment in response to findings.
• Use valid and reliable outcome measures instruments, where available.
• Evaluate and record outcomes at the end of an episode of care/intervention/treatment.
Prevention, Health Promotion, Fitness, and Wellness
• Provide physical therapy services for prevention, health promotion, fitness, and wellness to individuals, groups, and communities.
• Promote health, quality of life, independent living and workability by providing information on health promotion, fitness, wellness, disease, impairment, activity limitations, participation restrictions, and healthrisks related to age, gender, culture, and lifestyle within the scope of physical therapist practice.
Evidence-Based Practice
• Use evidence to inform practice and to ensure that the services rendered and the care/intervention /treatment provided to patients/clients, their carers, and communities is based on the best available evidence, taking into consideration be liefs and values and the cultural context of the local environment.
• Use information technology to access sources of information to support clinical decisions and not use techniques and technologies that have been shown to be ineffective or unsafe.
• Critically evaluate sources of information related to physical therapist
• practice, research, and education and apply knowledge from these sources in a scientific manner and to appropriate populations.
• Consistently integrate the best evidence for practice from sources of information with clinical judgment and patient/client values to determine the best care/intervention/treatment for a patient/client.
• Be prepared to contribute to the evidence for practice.
Management of Care/Intervention/Treatment Delivery
• Provide first-contact care/intervention/treatment through direct access to patients/clients, who have been determined through the examination and assessment processes to need physical therapy care/intervention/treatment.
• Provide services to patient/client referred by other practitioners to ensure that service is continuous.
• Assess potential risks for the patient/client and the physical therapist in the practice environment.
• Manage support staff effectively and efficiently.
• Understand the changing and diverse context within which physical therapy services are delivered.
• Know quality assurance frameworks and how they are utilised/applied.
• Understand performance indicators and outcome measures derived from a range of scientific and measurement approaches.
• Understand the social and economic factors that impact on health and the delivery of health services.
Communication
• Expressively and receptively communicate in a culturally competent manner with patients/clients, family members, caregivers, practitioners, interdisciplinary team members, consumers, payers, and policymakers.
• Communicate with others using written, verbal, and non-verbal modes.
• Recognise the barriers to effective communication and strategies for overcoming these.
• Provide mentorship for students and colleagues utilising a range of communication skills.
• Communicate in a way that maintains the patient’s/client’s confidentiality.
• Document practice using, where possible, internationally accepted data standards such that data is useful not only for clinical care but also research, administration and statistics.
Consultation/Screening
• Provide consultation within boundaries of expertise to businesses, schools, government agencies, other organisations, or individuals.
• Determine when patients/clients need further examination or consultation by a physical therapist or referral to another health care professional.
Critical Analysis/Clinical Reasoning/Clinical Decision Making
• Use clinical judgment and reflection to identify, monitor, and enhance clinical reasoning to minimise errors and enhance patient/client outcomes.
• Consistently apply current knowledge, theory, and professional judgment while considering the patient/client perspective in patient/client care/management.
Education
• Effectively educate individuals and groups.
• Provide mentorship for students and colleagues utilising a range of teaching skills.
• Engage in appropriate self-directed learning.
Management/Administration/Supervision
• Direct and supervise human resources to meet patient’s/client’s goals and expected outcomes.
• Participate in management of a physical therapist practice.
• Participate in establishing a practice business plan.
• Participate in activities related to resource management, marketing, and public relations.
• Manage practice in accordance with regulatory and legal requirements.
• Assure safety in practice environment, including risk assessment.
• Understand the impact of health and social care policies on professional practice.
• Use Information Communication Technology (ICT) and information management systems to maintain patient/client records.
• Understand the roles of the other health practitioners and concepts of multiprofessional practice.
• Identify, justify and negotiate to secure additional resources as required to deliver comprehensive services necessary to meet the needs of patients/clients, their families and carers or populations.
Research
• Have knowledge of the varied research methodologies.
• Identify questions arising from practice that may serve as stimuli for future research.
• Be an informed consumer of the research literature.
• Contribute to professional practice through research (e.g., present a single case study, literature review, poster presentation).
5.2 Practice Settings
• Understand the role of physical therapists and the scope of physical therapy practice in multiple practice settings.
• Appendix B provides further details.
5.3 Professional Behaviours
5.3.1 Accountability
• dhere to legal practice standards, including all statutory authorities (e.g., federal, state, local, regional, provincial and institutional regulations) related to patient/client care and fiscal management.
• Be aware of the cost burden of physical therapy services.
• Practice in a manner consistent with Ethical Standards established by WCPT or by the Member Organisation.
• Encourage membership in the national physical therapy organisation.
• Participate in organisations and efforts that support the role of the physical therapist in furthering the health and wellness of the public.
• Make clinical and billing decisions based on the best interests of thepatient/client and not the payer.
5.3.2 Altruism
• Place patient’s/client’s needs above the physical therapist’s needs.
• Incorporate free/voluntary/pro bono services (e.g., voluntary service overseas, riding programmes for those with disabilities, free services to the homeless) into practice.
5.3.3 Compassion/Caring
• Exhibit caring, compassion, and empathy in providing services to patients/clients.
• Promote active involvement of the patient/client in his or her care/intervention/treatment.
• Respect the patient’s/client’s right to refuse physical therapy care/intervention/treatment.
5.3.4 Cultural Competence
• Identify, respect, and act with consideration for patients’/clients’ differences, values, preferences, beliefs, and expressed needs in all professional activities.
• Manage patients/clients and interact with colleagues in a manner that is nondiscriminatory and non-oppressive.
• Understand the impact of health and social care policies on professional practice.
5.3.5 Ethical Behaviour
• Understand the ethical issues that inform and shape physical therapy practice.
• Know the professional, statutory, and regulatory codes of practice.
• Abide by the professional code of conduct, values, and beliefs.
• Maintain the principles and practice of patient/client confidentiality.
5.3.6 Integrity
• Demonstrate integrity in all interactions with patients/clients, family members, caregivers, other health care providers, students, other consumers, and payers (e.g., social system, insurance companies, patient self-pay).
• Adhere to codes of professional conduct.
5.3.7 Personal/Professional Development
• Manage uncertainty, change, and stress.
• Implement effective time-management and workload planning.
• Identify individual learning needs.
• Construct and implement a personal development plan.
• Reflect and modify behaviour in the light of experience and advice.
• Set realistic goals related to personal development.
• Recognise the significance of continuing professional development.
5.3.8 Professional Duty
• Demonstrate professional behaviour in all interactions with patients/clients, family members, caregivers, other providers, students, other consumers, and payers.
• Participate in self-assessment to improve the effectiveness of care/intervention/ treatment.
• Participate in peer assessment activities.
• Participate in activities that support the development of the profession and patient/client services.
• Participate in professional organisations (e.g., national physical therapy organisation, WCPT).
• Understanding of the roles of other professions pertinent to physical therapist practice.
• Acknowledge cross-professional boundaries and employ appropriate referral procedures.
5.3.9 Social Responsibility and Advocacy
• Advocate for the health and wellness needs of society.
• Advocate for the professional competence of physical therapists in a changing health delivery environment.
• Participate and show leadership in community organisations and volunteer service.
• Advocate for the profession through decision-makers and key stakeholders (e.g., to include, but not be limited to, legislative, regulatory, political, payer).
• Understand the sequelae of humanitarian situations, including torture and natural, technological or pandemic disasters, and intervene when and as appropriate.
• Understand the sequelae of civil or criminal violence (including domestic violence) and intervene when and as appropriate.
5.3.10 Teamwork
• Understand the roles of different health and social care professionals involved in the management of patients/clients.
• Work with other professionals to ensure patient/client-centred services and the provision of seamless services.
• Refer to other professionals as indicated by patient/client needs.
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