AN EXPLORATORY STUDY OF PHYSICAL THERAPISTS FROM HIGH-INCOME COUNTRIES PRACTICING OUTSIDE OF THEIR SCOPE IN LOW AND MIDDLE-INCOME COUNTRIES

J. Hartman¹, K. Dholakia²

¹University of Wisconsin, Madison, Family Medicine and Community Health, Doctor of Physical Therapy Program, Madison, WI, United States, ²Widener University, Institute for Physical Therapy Education, Chester, PA, United States

Background: Medical volunteers from high-income countries (HIC) traveling to low- and middle-income countries (LMIC) have become a significant part of the multi-billion-dollar volunteer industry that exists worldwide. Fueled by altruism, opportunism, and capitalism, millions of students and professionals are travelling to all corners of the world. The Physical therapy profession is no exception. Physical therapy students and professionals from HIC are traveling to LMIC more than ever. Often working in low-resourced settings, they can find themselves in challenging situations.

Purpose: This study aims to quantify how often physical therapists in these situations are practicing outside their scope of practice, in what circumstances, and their likelihood of doing so in the future.

Methods: The study was designed as anexploratory descriptive study. A36-item survey was used and consisted of both qualitative and quantitative questions investigating participant demographics and background, prevalence of practicing outside of one’s professional scope, the types of activities conducted, and reflections and attitudes about the experience.

Results: 126 licensed physical therapists from around the world participated. The typical duration of visits was less than a month (73.8%). 67.5% of respondents believed that physical therapists practice outside of their scope and 31.7% reported doing so. Top reasons were the belief that something is better than nothing (47.5%), there was a mismatch between the physical therapist and host community’s expectations (40.0%), and to preserve the relationship with the host (25.0%). 64.5% reported they deemed it appropriate to practice outside of their scope in some situations and 53.8% reported they would perform the same clinical activity if given the chance. Half of the respondents reported their first experience occurred while in physical therapy school or within the first ten years of their career.

Conclusions: For many reasons, physical therapists, often early in their career, go on short-term experiences to LMIC. They can find themselves in difficult predicaments which cause some to practice outside their scope. A keen understanding of the risks and challenges associated with short-term experiences in global health and a skill set that enables best practice is imperative.

Implications: This study is the first to explore the prevalence of physical therapists from HIC who practice outside of their scope of practice in LMIC. Given the risks associated with these types of activities, these findings create an urgent need for more discussion and research investigating best practices, training, and accountability for physical therapists from HIC who practice in LMIC.

Funding acknowledgements: No funding to acknowledge

Keywords:
Ethics
Volunteerism
Altruism

Topics:
Professional issues
Professionalism & ethics
Professional practice: other

Did this work require ethics approval? Yes

Institution: University of Wisconsin, Madison

Committee: Health Sciences Institutional Review Board (IRB)

Ethics number: ID #2020-1579