The Kentucky Board of Physical Therapy created the following Frequently Asked Questions (“FAQ’s”) to provide guidance to credential holders on issues of general concern. The FAQ’s address issues only as they relate to the requirements of KRS Chapter 327 and its associated regulations. They do not preclude individual credential holders, employers, or payors from establishing policies or guidelines that are more stringent than those required by KRS Chapter 327 and its associated regulations. The FAQ’s replace the Board’s Declaratory Opinions.
Question: Who can make changes to the PT Plan of Care (POC)?
Answer: Pursuant to 201 KAR 22:053 the POC and establishment of treatment plan is the role of the Physical Therapist.
The scope of the POC includes, but is not limited to, the treatment to be rendered, the frequency and duration of the treatment, the level of delegation to appropriate PTAs (the PTA must possess the appropriate training, education and expertise for that individual patient) and supportive personnel treating the patient, the frequency in which the PT treats the patient (between reassessments) and any other treatment or POC related decisions. It is the PT’s responsibility to ensure that they know and are confident in the care being provided by any PTA or supportive personnel who are treating the patient. The responsibility of the PT also includes patient transfers to other PTs for the same patient during the original POC, discharge planning and communication with the medical team.
Any PT who attempts to change an established POC or treatment who is not the PT of record and is not reassessing the patient or assuming the care of the patient may be violating 201 KAR 22:053 of the Practice Act and could be subject to disciplinary action. Any PTA who attempts to change a POC without discussing such change with the PT of record, may be in violation of the 201 KAR 22:053, as PTAs are not allowed to make any decision regarding the patient’s POC. Any unauthorized changes to the PT POC by individuals, including supervisors, who do not have the ability to change the POC* or decision regarding treatment may be a violation of unauthorized practice and can be referred to the Commonwealth Attorney’s Office under KRS 327.040 for possible criminal charges.
* Referring physician, NP, dentist, other legally authorized providers, may indeed make changes to the PT POC
Question: May a physical therapist assistant perform an assessment (to include interpreting data, performing re-assessment, or establishing or updating a plan of care) if a licensed physical therapist signs the required documentation?
Answer: No. Pursuant to 201 KAR 22:053 Section 3(5), a physical therapist assistant is required to refer to the physical therapist any inquiry that requires an interpretation of patient information related to rehabilitation potential. Similarly, pursuant to 201 KAR 22:053 Section 2(4) & (7), the physical therapist is responsible for providing the reassessment and developing a plan of care. Finally, it is the physical therapist who is tasked with performing these duties throughout the regulation; a physical therapist assistant is not authorized to perform these services.
Question: May a physical therapist assistant provide pro-bono work outside of a traditional clinical setting, absent the supervision of a licensed physical therapist?
Answer: No. This conduct is prohibited pursuant to 201 KAR 22:053. Section 1 of this regulation specifically provides that a physical therapist assistant may only provide services under the supervision and direction of a physical therapist. Additionally, Section 3 of this regulation provides that the physical therapist assistant may initiate treatment only after evaluation by the physical therapist. Both the pro-bono aspect of this question and the physical location where the services are to be provided are irrelevant in addressing the legality of the conduct.
Question: Is dry needling within the scope of practice of “physical therapy” as defined in KRS 327.010(1)?
Answer: Yes. KRS 327.010(1) defines “physical therapy,” in part, as “the use of selected knowledge and skills … invasive or noninvasive procedures with emphasis on the skeletal system, neuromuscular, and cardiopulmonary function.” There is nothing in KRS Chapter 327 to prohibit a credential holder from performing dry needling so long as he or she has the requisite training, expertise, and experience to perform this function.
Question: May physical therapist assistants perform Dry Needling in Kentucky?
Pursuant to 201 KAR 22:053 Section 3, physical therapist assistants in Kentucky can provide physical therapy services under the supervision and direction of a physical therapist who has the requisite education, training and experience relating to those services.
That stated, the Kentucky Board of Physical Therapy recognizes that both the American Physical Therapy Association and Federation of State Boards of Physical Therapy have cautioned physical therapist assistants from engaging in dry needling, as they are not trained in the same competencies that qualify physical therapists to perform these services. Prior to performing dry needling services, the Board recommends that the physical therapist assistant seek guidance on this issue by reviewing the Analysis of Competencies for Dry Needling by Physical Therapists Final Report located at: http://www.apta.org/StateIssues/DryNeedling
Question: Are electrophysiologic evaluations within the scope of practice of “physical therapy” as defined in KRS 327.010(1)?
Answer: Yes. Electrophysiologic evaluations are within the scope of physical therapy because they encompass “nerve and muscle function including subcutaneous bioelectrical potentials, motor development, [and] function capacity” as defined in KRS 327.010(1). There is nothing in KRS Chapter 327 to prohibit a credential holder from performing electrophysiologic evaluations so long as he or she has the requisite training, expertise, and experience to perform this function.
Question: Does a physical therapist need an order or referral to provide physical therapy services to a patient?
Answer: No. Physical therapists are authorized to provide direct treatment of physical therapy to their patients as long as the patient’s medical condition is within the scope of his or her practice.
Question: Is sharp wound debridement within the scope of practice of “physical therapy” as defined in KRS 327.010(1)?
Answer: Yes. Sharp wound debridement is within the scope of physical therapy because it includes “the use of selected knowledge and skills in planning, organizing, and directing programs for the care of individuals…encompassing…invasive or noninvasive procedures” as set forth in KRS 327.010(1). There is nothing in KRS Chapter 327 to prohibit a credential holder from performing sharp wound debridement so long as he or she has the requisite training, expertise, and experience to perform this function.
Question: Can a physical therapist assistant screen patients?
Answer: No. However, a physical therapist assistant may be directed by a physical therapist to gather relevant data as it relates to the screening process without formalizing an assessment.
Question: Can physical therapists utilize legend drugs in their practice?
Answer: Yes. Physical therapists can utilize legend drugs that are individually prescribed to the patient by a provider with prescriptive authority. However, under Kentucky pharmacy laws, physical therapists do not have prescriptive authority.
Question: Can a physical therapist or physical therapist assistant provide wellness or fitness services that are not part of an individualized physical therapy plan of care?
Answer: Yes. However, any individual engaging in such activities should not represent themselves as physical therapists or physical therapist assistants. Additionally, they should not represent these services as providing physical therapy.