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

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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
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obtain better results.

 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
 Outcomes' is a jargonistic word in therapy and coaching,
and other professional services.
 An outcome refers to the end result of your therapeutic
process; the impact on your life and outlook.

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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
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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

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complexity 024
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
attentio
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