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What IS a mobilization
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What IS a mobilization - April 22, 2005 2:21:00 AM
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PTupdate.com
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Just recently, in my home state of Pennsylvania, the State Board of Physical Therapy passed the following new regulation:
"A physical therapist may not assign of delegate to physical therapy assistants or supportive personnel functions which require the formal education or training and the skill and knowledge of a licensed physical therapist, including the following functions.....mobilization. Mobilization is defined as a group of techniques comprising a continuum of skilled passive movements to the joints or related soft tissues, or both, throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation"
Others have asked for clarification, and are not getting it. So, what the heck IS a mobilization?
I can certainly see someone providing a Grade IV posterior glide of C7 on T1 as a mobilization, but what about passively stretching a hamstring? With the description above, even massage would be considered "mobilizing" the soft tissue.
I don't have a clue what I will be permitted to have a PTA perform, as the way things are written, it can all be left to ones interpretation.
I have always been the type to believe that it is not the actual technique or modality application that requires my skill (my 2 year old could perfomr an ultrasound), it is KNOWING WHEN to apply the technique/modality that requires the skill.
After all, do we not teach people how to perform their OWN mobilizations all the time? Patellar mobilization after surgery, Mulligan MWM to their own cervical spine, etc.
Anybody else living in a state where such a thing has been done? How are you dealing with it?
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
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Re: What IS a mobilization - April 22, 2005 2:43:00 AM
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Jon Newman
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Here's one answer that's bound to be unpopular. Don't use PTA's (or aides). Your worries will go away. Of course so will some of your profits. Which is more important?
jon
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Re: What IS a mobilization - April 22, 2005 2:48:00 AM
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PTupdate.com
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Wrong answer Jon. What is most important to me is getting my patients better, which I do quite well. I do not always need to be the one performing all the treatments to achieve that goal. I have far too many people seeking my services to perform it all by myself.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
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www.PTupdate.com
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Re: What IS a mobilization - April 22, 2005 2:59:00 AM
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SJBird55
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Well, it sounds like the PTA can do mobilization of anything in the abnormal physiological range of motion.
I believe your board just put a cabash on PTA having any role in any manual technique. Every manual technique is passive and it will be directed toward joints or soft tissues.
Ah.. but the glitch... "skilled" was dumped into that definition. Did anyone define "skilled." That's where the gray area would be. So, ask someone this... if you can distinctly explain what you want done and the person definitely understands what you tell them and that person can perform the activity to your specifications, then is the technique "skilled." Now, if you couldn't explain what your hands were doing and had no way of determining if your technique was being performed as you would do, then that might be "skilled."
I fullheartedly agree with your belief. A lot of the actual activities that we do as physical therapists isn't necessarily the "skilled" part - it's piecing together everything and coming up with a path and altering that path at a moment's notice that is where our skill comes into play. In other words, the critical thinking is what patients are really paying for. Well, and sometimes some of our manual skills too.
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Re: What IS a mobilization - April 22, 2005 3:00:00 AM
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Jon Newman
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Well perhaps if you saw less patients someone would open a private practice and see those who you couldn't. If that's your concern, I'm sure someone is willing to do that.
jon
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Re: What IS a mobilization - April 22, 2005 3:45:00 AM
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KAK
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John,
We do not have this in our practice act, but I believe that I read somewhere that it is the APTA’s stance- that only PTs provide joint mobilization. We may be seeing more of this.
I’m no lawyer, but it seems to me that the intent of the law is clear. It does not mean massage or stretching or it would be written as such. I think it means joint mobilization as we commonly know it. I would suggest writing your state board asking for clarification. I have done this with our board -providing specific examples to keep them from vague non-committal answers. There is normally a few weeks or more before you get a response because the board only meets so often, their response has to go through their attorney, etc.
I think only PTs should be performing joint mobilization. From my training (Maitland), it requires constant reassessment and judgment calls according to the patient’s response, not something you can write in a plan and delegate.
However, I do understand that something such as a patellar mob does not require the same skill.
Good luck.
Kathy
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Re: What IS a mobilization - April 22, 2005 3:48:00 AM
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JLS_PT_OCS
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Tough one there.
I liked it better when APTA had a nonbinding policy, and the state boards left it up to individual PTs.
How much more can we abuse the PTAs before they wither away? It seems they are always the redheaded stepchildren.
What your PT board did in PA, seems to be an open invitation to effectively require PTs to hire ATCs to assist with rehab instead of PTAs. Without making a judgement on whether that's bad or good, it sure seems to thumb it's nose at the PTA. I think we should have a better commitment to them than that.
But your excellent question remains. What can be defined as a mobilization? Is PROM now considered a skilled passive movement? Now they can't even do that? Very shaky. Aren't PTAs licensed in Penn? I went to school there, you'd think I would remember...
And I think every profession is like that, most of the daily routine is very mundane and requires little judgement, it's the few times you use it where you earn your money. That applies to electricians, molecular biologists, physicians, and engineers alike.
I find it hard to believe such a regulation went through without a more clear delineation.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What IS a mobilization - April 22, 2005 7:20:00 AM
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KAK
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“…not assign or delegate to physical therapy assistants or supportive personnel…”
Jason-
I think ATCs would be considered supportive personnel. I don’t see how this encourages a requirement to hire ATCs as they would be under the same restrictions. Maybe I missed your point?
:confused:
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Re: What IS a mobilization - April 22, 2005 12:13:00 PM
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Randy Dixon
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I think Jason meant that ATC's practice under their own practice act and not adjunctively under a PT act.
I'm not a PT, but I have to agree with Jason, much of what PT's do is pretty routine, much of the "skilled' part requires sensitivity and experience, and a little training. The ability to do it well doesn't come with the degree and the lack of the degree doesn't prevent one from doing it well. Trying to control "manipulations" is ridiculous, I can do one on myself.
There I just did one, I think I hear the chiropractors' black helicopters coming!
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Re: What IS a mobilization - April 22, 2005 3:01:00 PM
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PTupdate.com
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Jon,
This summer, the 16th clinic within a 10 minute drive of my own clinic will be open for business, so there is hardly a need for more.
Is that you how choose to treat the people that come to you for help...just telling them to go down the road to the new private practice PT guy?
I am busy because of how I treat people, how I care, and the trust that people and their physicians have placed in me. I am not going to compromise that trust by sending them to some clod down the road.
If this is the avenue you choose to discuss more, start a separate thread. I opened this one to discuss another topic.
For those who mentioned asking for clarification...evidently this has been done, and nobody is getting an answer. It appears that the vagueness of the original definition put into place years ago is now haunting their desire to create a niche for PT's only. In the process, they are going to have a state full of paranoid PT's wondering if what they are delegating is legal or not.
Duffy
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: What IS a mobilization - April 22, 2005 3:32:00 PM
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Jon Newman
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Hi John,
I choose to treat the people who come to see me versus pass them on. It doesn't matter if the work I do is mundane.
As I said, it was bound to be an unpopular answer (versus the wrong answer) but it would get rid of those worries would it not?
To stay on topic, what were some of the other things that were excluded by the regulation? I'm assuming there were other things based on the .... in you quotations.
jon
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Re: What IS a mobilization - April 22, 2005 4:09:00 PM
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PTupdate.com
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The information in the "...." was the first six steps, which did not cover the mobilization. It covered the facts that PTA's cannot interpret referrals, perform evals/re-evals, determine or modify a plan of care, perform final DC assessment, provide therapeutic techniques beyond the skill of a PTA, etc.
It's a drastic thing to change in the profession, and I am very surprised they just threw it out in the newsletter, without indicating examples of permitted activities, answers to common questions, someone to call if not sure, etc.
Duffy
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John M. Duffy, PT
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www.PTupdate.com
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Re: What IS a mobilization - April 22, 2005 4:14:00 PM
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KAK
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John,
I feel your frustration. The vagueness of the definition was pitiful. We could speculate with all sorts of interpretations.
How and when did others ask for clarification?
I know I am repeating myself, but write a letter. If the board gets enough questions they will clarify. I have waited up to 8 weeks for an answer from our board. You can't just call and expect an answer over the phone; its government bureaucracy. They will have to discuss it. Ask them specifically if massage, PROM, or hamstring stretching is considered mobilization as defined by the statute. If you are concerned about practicing legally, that is the only sure way to know in this case. Living in a paranoid state is unhealthy!
Rick
ATC’s working in a PT clinic practicing Athletic Training and billing for Athletic Training- not PT. Correct?
If the ATC’s work is being billed as PT, they are not practicing under their act, but as supportive personnel under the PT’s act of practice.
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Re: What IS a mobilization - April 25, 2005 7:55:00 AM
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KAK
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I meant Randy
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Re: What IS a mobilization - April 27, 2005 1:00:00 AM
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JLS_PT_OCS
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The uncertainty of PT/ATC relations in the clinic was the type of thing I was alluding to.
If you clearly can't have PTAs doing some kinds of manual care, and ATCs can (regardless of licensure issues) then that certainly favors the ATCs from a hiring standpoint.
The issues about billing codes or regulations applicable is uncertain, and definitely a "plausible deniability" thing, it seems.
If you have X amount of work to do, and some portion of your employees can't do it anymore, you've got to hire someone to do it, right? And an ATC is much cheaper than a PT, so there you have it. You can even get the money for salary by firing some of your PTAs, seeing as how they cannot accomplish a big part of the workload now.
That's what I'm getting at.
Duff-
Is there a local chapter meeting you can attend to voice your concerns?
How about academic institutions in your area (there are a few pretty good ones, yes? :) ), what are they saying about it, from the PT and PTA side of the house?
Those may be good avenues to determine the impact and get some guidance.
Keep us posted!
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What IS a mobilization - April 27, 2005 1:18:00 AM
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Jon Newman
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In the enlightened state of WI, only PT's and PTA's can perform "physical therapy services". ATC's seeing a patient that is being billed "physical therapy" can only perform the work of an aide.
jon
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Re: What IS a mobilization - April 27, 2005 2:21:00 AM
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JLS_PT_OCS
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Jon, as it should be. Unfortunately, I think the profession has kind of left PTAs out to dry...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What IS a mobilization - April 28, 2005 5:29:00 AM
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NorthernPT
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In South Dakota, PTA's legally cannot perform spinal or peripheral joint mobilizations.
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