Lots of questions here, let's see if I can answer them all . . .
SJ: That's an interesting point, and honestly I?ve never considered it from that perspective. I actually see the part-time work as CLOSER to a vision 2020 DPT position than my work at the hospital in some respects. Keep in mind that I work 40 hours in a hospital outpatient clinic, and an additional 6-8 one day per week the multidisciplinary clinic as a limited partner. I get my fill of manipulation (and "surgery" in the form of wound care) at my hospital job. In the multi-clinic, either I or the DC are usually the first points of contact for the patient in our practice, and seeing as how the use of differential diagnostic clinical tools becomes increasingly important in that kind of situation, I actually see it as a step toward direct-access portal-of-entry autonomy. I give a little with respect to manipulation at the multi-clinic (as the DC is the relative expert), I suppose, but there is, I believe, greater gain with respect to physical therapy as a portal-of-entry provider, as well as the DPT as the relative expert with respect to sleep positioning and movement pathology.
Greg: Rick is right. All of my evaluations are signed by a physician (either a referring MD . . . or if direct access, the pt's PCP --- most of whom I have an established relationship). Once signed, I can do anything within my practice act signed by the MD/DO. The only catch is that I can't do iontophoresis injection, phonophoresis injection, manipulation, or surgery (sharp wound debrietment), without MD PRE-authorization --- and some aren't all that quick about signing off. The association in NC is quite strong, especially near the state capital where the current and 2 former APTA presidents (and one former journal editor) live. The current legislative push, however, is to ?update? the practice act, keep the manipulation language, and remove the need for MD/DO authorization alltogether. Personally, I?m against that, but we can get into that discussion later.
Andrew M. Ball, PT, DPT, Ph.D. Orthopedic Physical Therapy Resident Carolinas Rehabilitation
Joined: July 6, 2005
"Could anyone provide me with a referrence that discusses which states do not permit PTs to perform spinal manipulation"
What is your definition of "Spinal Manipulation"? What makes you think that the term has the same meaning in all states, much less different practice acts? What is your definition of "Spinal Mobilization"?
From the office of the Assoc. Director for state governmental affairs for the APTA: The only two states to prohibit manipulation by PT's are Arkansas, and Washington.
Many other sets of language for groups of states. I'll try to synopsize.
Specific manual therapy as part of the practice of PT; AZ,KS,TN
Specific manipulation included as part of the practice of PT; ID,LA,ND
Specific mobilization as part of the practice of physical therapy; HI,MI,MA,MT,NE,NV,NJ,PA,SD,TX,WV.
Require a physician referal to utilize manipulation in PT practice; ME,NC
Silent PT practice act; manipulation is considered part of PT practice; AK,AL,DC,CA,CT,GA,IL,IN,KY,MD,MO,MS,NH,NM,NY,OH,OK,OR,RI,SC.
Prohibits "chiropractic" manipulation which is directed at the correction of subluxations of the spine; FL,IA,MN,WI.
Obvioulsy the language differs somewhat between many of the states, and the difinitions of manipulation and mobilization may varry as well. However it is very clear, with regards to only two states not allowing citizens of their states to have access to the highest standard of care for many of the most common conditions that we see as PT's.
Joined: July 6, 2005
"From the office of the Assoc. Director for state governmental affairs for the APTA: The only two states to prohibit manipulation by PT's are Arkansas, and Washington."
The Arkansas Physical Therapy practice act allows ALL Mobilizations including Spinal Mobilizations. Spinal Manipulations are prohibited as "spinal Manipulations" are defined in the chiropractic practice act.
Just curious; how do you practice knowing that the chiro board in your state has such power over you? Do you practice in fear of possibly being involved in a maneuver that creates a cavitation? I'm really not trying to be a smart a-- here; I just can't imagine it.
The other states that allow mobilization in their practice acts define mobilization and manipulation as synonymous, and applications supported by the guide to PT practice.
Joined: July 6, 2005
Thanks. We want other states to be aware of the ongoing situation here is Arkansas, so that they can prevent the same thing from happening to them. We have been told of other states attempting the same action or a simlar action on pts.
(c) Manual therapy techniques, including soft tissue massage, manual traction, connective tissue massage, therapeutic massage, and mobilization, i.e., passive movement accomplished within normal range of motion of the joint, but excluding spinal manipulation and adjustment; -Arkansas PT act.
I sympathize with you and your dilemna but I don't see how the act above allows "Mobilizations" since a mobilization is an adjustment, and because there is no clear way to distinguish between a "mobilization" and a "manipulation". Whether it is defined in the Chiropractic act or not doesn't seem really relevant since it is the PT practice act that is prohibitting it without reference to chiropractic.
I see exactly the same problem coming up in Florida if PT's continue to do spinal manipulations under their practice act, trying to make an argument about "specific" will not work, it is taking a clinical term and trying to equate it to a legal one, and convincing an unbiased jury that a spinal manipulation that looks, feels and is done exactly the same as a chiroporactic manipulation is actually a non-chiropractic manipulation is going to be difficult.
Physical therapy does not include the application of roentgen rays or radioactive materials, surgery, manipulation of the spine unless prescribed by a physician licensed to practice medicine in North Carolina, or medical diagnosis of disease.-NC Practice Act
This demonstrates the importance of comma placement. It doesn't read as if it allows surgery by a PT, but it almost does.
Joined: July 6, 2005
You see Randy this is where the problem with the definitions of the terms come into play. Manipulations and mobilizations in Arkansas are not defined the same way. According to the lawyers that are involved in this argument Physical Therapist in Arkansas are allowed to do all mobilizations even spinal mobilizations.
Even so the Chiropractic practice act in Arkansas states that "Nothing contained in this subsection shall be construed to limit or restrict the authority of a licensed Physical therapist to practice Physical Therapy as defined in 17-93-102(1)"
You would assume that if the Physical Therapy Board in Arkansas declared in a declaratory Order that a licensed Physical Therapist in Arkansas did not do anything outside the scope of Physical Therapy than it would not matter how the chiropractic practie act defined either of these terms.
Randy, what unbiased jury are you talking about anyway.
A manipulation is a manipulation. If done by a chiro it's a chiro manipulation. If done by a PT, it's a PT manipulation. That's the bottom line.
You people are unbelievable; you act as if you invented manipulation and put an exclusive pattent on it. And the thought of anyone wanting to practice chiro without, or even with a licence should be enough to dismiss any case.
The major problem in Arkansas is in whatever form they gave up oversight to this group of hacks on the chiro board.
Yes, good point about the comma; PT's would otherwise be in that liposuction market; it looks easy enough.
Student, the list I posted has not been published, as I said it was from the associate director office of state governmental affairs at the APTA
Joined: February 19, 2004
[QUOTE]A manipulation is a manipulation. If done by a chiro it's a chiro manipulation. If done by a PT, it's a PT manipulation.[/QUOTE]Whaaa? You say a manipulation is a manipulation, then contradict yourself by saying if it's done by a chiro it's a chiro manip and if done by a PT it's a PT manip.
I agree that a manip is a manip. In my notes I don't say 'I performed a chiropractic manipulation...'. I just say 'I performed a manipulation...'. It's the same principle with modalities. There is no such thing as 'PT ultrasound' or 'chiropractic interferential'. Good grief Tim, I'm not trying to start a battle with you, I just have to scratch my head and wonder why this issue is so complicated, because I have to say that these things are really made out to be much more complicated than they are.
The question before the Boards is 'Are PTs allowed to do manipulation?' If the answer's yes, good on ya. If the answer's no, you've got some work to do.