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BANGALORE PHYSIOTHERAPISTS NETWORK

Physiotherapy Scope of Practice: An Insight


"Transforming society by optimizing
The Quality of Life to improve the human experience

Released on 10th September 2017

Compiled by: Einstein Jerome

Contributors:
BPN Committee Members: Additional Contributors:
Aarti Prasad Ayyapan V
Asha Nayak Franklin
David Arunkumar J Gopakumar Panicker
Dhanajeyan Jayavel Karvannan
Kiran S Murthy Kethan Bhatikar
Kasiraj Kenneth G Hebick
Mohan Palanivel Rajan
Nandan Kumar Prem V
Naveen KS Ranganathan
Padmanaban Sekaran Roopa Lokesh
Partha Sarathi K Saikumar N
Parthipan Ramasamy Sai Mahendra
Pearlson K Sanjay Reddy
Pradnya Sanjeev Prabhu
Radhika Anand Senthikumar Thiagarajan
Suresh Babu Reddy Sowmiya V
Vijay Krishna Sunder Kumar
Vijeendran Veena Nambiar
Vinod Kumar Jain Vinod Babu K
CONTENTS:
Chapter I: Introduction
Chapter II: Operational Denitions
Chapter III: Physiotherapy- An Autonomous Profession
Chapter IV: Job Nature of Physiotherapist and Senior Physiotherapist
Chapter V: The Dr Prex
References
CHAPTER I
INTRODUCTION:
The history of Physiotherapy or Physical Therapy can be traced back to ancient Greece in the
era of Hippocrates. Considered one of the oldest methods to cure various physical ailments,
Physiotherapy has evolved from simple techniques to a complex assortment of therapies. Now, it
has multiple and specialized applications. Patients pursue Physiotherapy services so they may
benet from the highly individualized, "hands on" approach that characterizes Physiotherapy
care. Physiotherapy plays a key role in enabling people to improve their health, wellbeing and
quality of life.

Physiotherapy scope of practice is dynamic, evolving with changes in the evidence base, policy
and needs of the public2.

DEFINITION 1:
Physiotherapy means a system which includes comprehensive examination, treatment, advice
and instructions to any persons preparatory to or for the purpose of or in connection with
movement/functional dysfunction, bodily malfunction, physical disorder, disability, healing and
pain from trauma & disease, physical and mental conditions using physical agents, activities &
devices including exercise, mobilization, manipulations, electrical & thermal agents and other
electro therapeutics for prevention, screening, diagnosis, treatment, health promotion and
tness.

JOB NATURE 1:
Physiotherapists assess, plan and implement rehabilitative programs that improve or restore
human motor functions, maximize movement ability, relieve pain syndromes, and treat or
prevent physical challenges associated with injuries, diseases and other impairments. They apply
a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser
and other techniques. They may develop and implement programmes for screening and
prevention of common physical ailments and disorders1.

Physiotherapy is a dynamic profession with an established theoretical and scientic base and
widespread clinical applications in the restoration, maintenance, and promotion of optimal
physical function. Physiotherapists are health care professionals who help individuals maintain,
restore, and improve movement, activity, and functioning, thereby enabling optimal performance
and enhancing health, well-being, and quality of life. Their services prevent, minimize, or
eliminate impairments of body functions and structures, activity limitations, and participation
restrictions2.

Physiotherapy is provided for individuals of all ages who have or may develop impairments,
activity limitations, and participation restrictions related to (1) conditions of the
musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or
(2) the negative effects attributable to unique personal and environmental factors as they relate
to human performance2.

Physiotherapists play vital roles in today's health care environment and are recognized as
essential providers of rehabilitation and habilitation, performance enhancement, and prevention
and risk-reduction services. Physical therapists also play important roles both in developing
standards for physical therapist practice and in developing health care policy to ensure
availability, accessibility, and optimal provision of physical therapy2.
WORLD HEALTH ORGANIZATION (WHO)8:
Denition of Physiotherapist by World Health Organization emphasizes on assessment and
formulating a treatment plan independently by Physiotherapists.

"Physiotherapists assess, plan and implement rehabilitative programs that improve or restore
human motor functions, maximize movement ability, relieve pain syndromes, and treat or
prevent physical challenges associated with injuries, diseases and other impairments. They apply
a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser
and other techniques. They may develop and implement programmes for screening and
prevention of common physical ailments and disorders"

INTERNATIONAL CLASSIFICATION8:
International Standard Classication of Occupations (ISCO) is a tool for organizing jobs into a
clearly dened set of groups according to the tasks and duties undertaken in the job.

The World Health Organization (WHO) has classied physiotherapists in professional group
(ISCO Code 2264) and paramedical professionals have been classied in a separate entity (
ISCO code 2240).
CHAPTER II
OPERATIONAL DEFINITIONS 3:
Scope of Practice is a statement describing Physiotherapy within the context of the
regulatory environment and evidence base for practice within a jurisdiction. Scopes of practice
are dynamic, evolving with changes in the evidence base, policy and needs of service users.

Direct Access the patient/client directly asks the Physiotherapist to provide services (the
patient refers themselves) and the Physiotherapist freely decides his conduct and takes full
responsibility for it. Also, the Physiotherapist has direct access to patients/clients and determines
which need Physiotherapy assessment/intervention without referral from a third party.

Self-Referral Patients are able to refer themselves to a Physiotherapist without having to see
anyone else rst, or without being told to refer themselves by a health professional.

The terms direct access and patient self-referral refer to the circumstances where Physiotherapy
services are available to patients/clients without the requirement of a referral. In many health
service delivery systems throughout the world, the users of Physiotherapy services do not
require such a referral. In these instances, direct access to Physiotherapy services is supported
by national/provincial/regional/state legislative frameworks and by the standards of professional
practice of Physiotherapists. A growing body of research evidence supports the clinical and cost
effectiveness of such services and their acceptability among service users3.

Components of Scope of Practice 2:


The Scope of practice for Physiotherapists is dynamic, evolving with evidence, education, and
societal needs, and has 3 components:

1. Professional
2. Jurisdictional, and
3. Personal

Professional Scope of Physical Therapist Practice 2:


The professional scope of practice for Physiotherapists is ever evolving. It is based on the
profession's unique body of knowledge, supported educational preparation, a body of evidence,
and existing or emerging practice frameworks..

Personal Scope of Physiotherapy Practice 2:


Physiotherapists are responsible for practicing within the scope of their own personal
knowledge, skills, and abilities. Physiotherapists (PT) should not provide services that they do
not personally have the knowledge, skills, and abilities to perform, even if the state law
generally allows a PT to provide the service. If a Physiotherapist practices outside of their own
personal competencies they could potentially be in violation of their license, as well as in
violation of professional standards of conduct.

Jurisdictional (Legal) Scope of Physiotherapy Practice:


Physiotherapists in India are regulated by the Ministry of Health and Family Welfare, Govt. of
India and by the existing respective State Councils such as:
1. The Delhi Council for Physiotherapy and Occupational Therapy (http://www.dcptot.com/)
2. Maharashtra State Council For Occupational Therapy and Physiotherapy
(http://www.msotptcouncil.com/)
3. Gujarat State Council for Physiotherapy (http://www.gscpt.in/)

Delhi Council for Physiotherapy & Occupational Therapy Act 1997: Physiotherapy means
physiotherapeutic system of medicine which includes examination, treatment, advice and
instructions to any persons preparatory to or for the purpose of or in connection with movement
dysfunction, bodily malfunction, physical disorder, disability, healing and pain from trauma and
disease, physical and mental conditions using physical agents including exercise, mobilization,
manipulation, mechanical and electrotherapy, activity and devices or diagnosis, treatment and
prevention.
(Reference: http://delhiassembly.nic.in/asple/billspassed/141997.htm)

Maharashtra State OTPT Council Act 2004: "Physiotherapy" means a branch of modern
medical science which includes examination, assessment, interpretation, physical diagnosis,
planning and execution of treatment and advice to any person for the purpose of preventing,
correcting, alleviating and limiting dysfunction, acute and chronic bodily malfunction including
life saving measures via chest physiotherapy in the intensive care units, curing physical
disorders or disability, promoting physical tness, facilitating healing and pain relief and
treatment of physical and psychosomatic disorders through modulating physiological and
physical response using physical agents, activities and devices including exercise, mobilization,
manipulations, therapeutic ultrasound, electrical and thermal agents and electrotherapy for
diagnosis , treatment and prevention.
(Reference: http://www.msotptcouncil.com/OTPTActs.aspx )
CHAPTER III
PHYSIOTHERAPY AN AUTONOMOUS PROFESSION
Physiotherapy professional entry-level education prepares Physiotherapists to be rst contact
autonomous practitioners, able to assess/examine, evaluate, diagnose, treat/intervene, evaluate
outcomes and discharge patients/clients without referral from another health professional (eg
medical practitioner) or other third party3.

Physiotherapists plan and administer physiotherapy/ rehabilitation treatments independently and


also being a part of the multidisciplinary team1.

Physiotherapy is an essential part of the health and community/welfare services delivery system.
Physiotherapists practice independently of other health care/service providers and also within
multidisciplinary rehabilitation/habilitation programmes to prevent, gain, maintain or restore
optimal function and quality of life in individuals with loss and disorders of movement1.

Primary care refers to the work of health professionals who act as a rst point of consultation for
all patients within the health care system. Such a professional would usually be a primary care
physician, such as a general practitioner or family physician, a licensed independent practitioner
such as a Physiotherapist1.

They combine their in-depth knowledge of the body and how it works with specialized hands-on
clinical skills to assess, diagnose and treat symptoms of illness, injury or disability1.

Physiotherapists may also contribute to the development of local, national and international
health policies and public health strategies1.

PATIENT REFERRAL:

Ministry of Social Justice Referral Notication: Ministry of Social Justice & Empowerment's
letter No. 9-3/CCD/2007 dated 15/05/2008

Subject: Handling of Children with disabilities and referral which states that Most of the
doctors are not trained for rehabilitation of Persons with disabilities, they often try to treat their
disabilities even when medical or surgical interventions are not required. In the process, most
critical period of six years of life is lost which is most important period to train & rehabilitate
the child with disability to utilize the residual capacity of the impaired organs. Consequently, it
is too late for such children to respond to the rehabilitation therapies even by most qualied &
skilled rehabilitation professionals like Physiotherapists etc.

Chief Commissioner has taken notice of the complaints from parents, Rehabilitation
professionals, NGO's etc. and has directed that appropriate instructions may be issued by
Medical Council of India and Indian Medical Association through print and electronic media to
the effect that the doctors not trained on rehabilitation should restrict their treatment of children
with disabilities to their medical illness/disease or else action be initiated against such practices
under relevant section of MCI. They should refer such children to the qualied rehabilitation
Professionals to ensure that they get appropriate rehabilitation/therapeutic assistance well in
time. The court of the Chief Commissioner for persons with disabilities shall be constrained to
initiate action under Section 59 of the Persons with Disabilities Act, 1995 against the Doctors
who may persist with such practices.
PRIME MINISTER'S OFFICE (PMO) NOTE:

As per the Note received by DGHS by Prime Minister Ofce (Dated 17.04.2008) It is felt that
the profession of Physiotherapy is strongly required for the society in contest of the trend of
their involvement in the Health Care Delivery. These professionals are qualied enough to
undertake the protocols of their system i.e. Physiotherapeutic system of medicine there by
conserve as an independent practitioner within their ambit

PLANNING COMMISSION OF INDIA (2007-2012):

As per the ndings of the Planning Commission of India (2007-2012), separate status for
Physiotherapists and Occupational Therapists needs to be provided.

(Reference: Page 84 and 85 Eleventh Five year Plan (2007-2012)_ Vol 2 Social Sector
Eleventh Five Year Plan(20072012)Social Sector Volume II-Planning Commission of India)

RCI:

During the year 1998/99 Physiotherapy was notied vide Govt. Of India Notication No. 674
dated 13.10.98 for inclusion under the Rehabilitation Council of India (RCI ) & subsequently
same were withdrawn (through their Notication dated the 25th June, 1999) from the purview of
the RCI Council as Ministry of Health was planning to have a separate Council for
Physiotherapists.

DOCUMENTATION ABOUT PHYSIOTHERAPY IN THE THIRTY-FIRST REPORT


ON PARAMEDICAL AND PHYSIOTHERAPY CENTRAL COUNCILS BILL-2007
(PRESENTED TO THE RAJYA SABHA ON 21ST OCTOBER,2008 AND LAID ON THE
TABLE OF LOK SABHA ON 21STOCTOBER,2008)5:

Clause 8.2 Physiotherapy being considered a discipline distinct from paramedical disciplines
nds a specic mention in the title (Paramedical and Physiotherapy Central Councils Act,
2007)

Clause 9.36 Committee's attention was also drawn to the parallel position of Naturopathy and
Yoga when compared with physiotherapy as both were based on physical and psycho-somatic
methods of diagnosis and treatment, with both claiming benet to the patients in a drugless
manner. It was argued that both Naturopathy and Yoga are granted equal status along with
Ayurveda under AYUSH. Thus, physiotherapy also deserved to be granted an independent
status.

Clause 9.46 The fact that physiotherapy education over the years has made signicant
advancements and has evolved as a distinct profession seems to be well established. This is
strengthened by the considered opinion of Ministry of Law that physiotherapy profession should
not be equated with the paramedical professions

Clause 9.47 The Committee also takes note of the fact as mentioned by the representative of
the Ministry that in USA, physiotherapy profession has reached a stage where these
professionals can practise independently. Not only this, in some of the international Acts, it has
been specically provided that physiotherapists having the required experience can give
physiotherapy treatment without a referral. These Acts also confer upon a physiotherapist the
right to practise with or without referral governed by the circumstances of the case.

Clause 25.5 During the course of interactions, the Committee observed that there was a lot of
dissatisfaction among the allied health professionals particularly physiotherapists and
occupational therapists with regard to their pay scales. It was brought to the notice of the
Committee that their entry into Government service after completion of four and a half years
degree course in the respective profession was not being addressed properly. The Committee
was given to understand that their recurrent demands for bringing parity in the pay scales have
yielded no results so far. General perception was that discriminatory treatment was being meted
out to them as their pay scales did not commensurate with their status and responsibility.

Clause 25.6 The Committee feels that all the allied health professionals including
physiotherapists and occupational therapists play a crucial role in the eld of medicine and
physical rehabilitation. The Committee, therefore, strongly recommends that their legitimate
interests should be taken care of and their existing pay structure may be revised according to
their qualications and duration of the course they have to put in before entering into a Govt.
job.

The ndings and documentation of this committee are in favour strong of an independent status
and council for Physiotherapists.

Expert Opinion: Committee also took note of the views expressed by Dr. M.K. Bhan, Professor
of Pediatrics, AIIMS and presently on deputation as Secretary, Department of Biotechnology
who pointed out that currently, access to high quality rehabilitation was very limited in our
country and physiotherapy deserved to be supported and promoted in a decisive manner, in
terms of education and training. While accepting the fact that in planning physical rehabilitation,
assessment by medical and surgical disciplines was important, it was also mentioned that only a
small number of physicians had a reasonable understanding of physical rehabilitation. In general
it has been seen that the medical profession does not always enable thriving of the support
services and generally reluctant to grant them proper professional status. This indirectly leads to
much needed professions such as physiotherapy becoming unattractive and in the process
keeping good quality students away. It was, accordingly, emphasized that adequate recognition
should be granted to physiotherapy through legislation and for ensuring adequate access to
physiotherapy services in the country, physiotherapists be allowed to open independent service
centres. The education of physiotherapists should in itself provide ample understanding of when
physical therapy is required

( Reference: Clause 9.39Thirty-First report on Paramedical and Physiotherapy Central Councils


Bill-2007)
CHAPTER IV
JOB NATURE OF PHYSIOTHERAPIST AND SENIOR PHYSIOTHERAPIST AS PER
DR. RAM MANOHAR LOHIA HOSPITAL (UNDER MINISTRY OF HEALTH AND
FAMILY WELFARE, GOVT. OF INDIA)6
CHAPTER V
THE DR PREFIX:
1. As per Maharashtra OTPT Council (The certicate is issued to "Registered PT/OT Practitioner"
which mentions "Dr" before name of Registered practitioner as per provision of the act Rule 83 (1)
of Act II of 2004. The format of certicate is published in Government Gazette. I.e.("PART 4 B -
269" published in Maharashtra government Gazette on Friday, 14 September 2007).
2. The Gujarat State Council for Physiotherapy also provides Dr Prex with PT Sufx for its
Registered Members.

3. PTs in India use the title 'Doctor' and prex it before their name with a sufx P.T.

(Physiotherapist) so as to make their stand clear they are not medicine doctors. However, the use
of the title 'Dr' according to the IAP (Indian Association of Physiotherapist

http://www.physiotherapyindia.org/) is by tradition and convention and is used in the same


manner as it is used by the MBBS/MS/BDS/MDS/BHMS/BAMS/BNYS/BUMS degree holders.
PTs argue that they are not breaching any law prevailing in India as legally only one who has
earned a degree in MD/DM or Phd is justied to use and prex the 'Doctor' title4.
THE NATIONAL KNOWLEDGE COMMISSION (NKC):
"8.3 Allied Specialties: Allied Specialties as different from Para-medicals and nursing are
Physiotherapy and Dental Professions. These need to be studied and discussed separately5
(Page 62 of The National Knowledge Commission (NKC) , Established by the Honl. Prime
Minister of India in 2005)"

REFERENCES:
1. Ministry of Health and Family welfare, Government of India. Curriculum handbook of
Physiotherapy [Internet]. Delhi: 2015 [cited 2015 March 17]; Available from:
http://www.mohfw.nic.in/WriteReadData/l892s/5632211456985633.pdf

2. APTA Website: Available from: http://www.apta.org/ScopeOfPractice/ (Accessed 05


September 2017)

3. World Confederation for Physiotherapy (WCPT) Website: Available from:


http://www.wcpt.org/node/29535 (Accessed 05 September 2017)

4. Wikipedia: Available from: https://en.wikipedia.org/wiki/Physical_therapy_education


(Accessed 05 September 2017)

5. The National Knowledge Commission (NKC) , Established by the Honl. Prime Minster of
India in 2005

6. PRS Legislative Research: Available from: http://www.prsindia.org/billtrack/the-


paramedical-and-physiotherapy-central-councils-bill-2007-141/ (Accessed 05 September 2017)

7. Dr.Ram Manohar Lohia Hospital: Duties & Responsibilities of Physiotherapist and Senior
Physiotherapist, Available from:
http://rmlh.nic.in/index1.aspx?lsid=51&lev=2&lid=64&langid=1
(Accessed 05 September 2017)

8. ILO: Mapping occupations to the international standard classication : Available from:


http://www.who.int/hrh/statistics/Health_workers_classication.pdf (Accessed 05 September
2017)

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