Froment FP1, Olson KA2, Hooper TL1, Schaffer SM3, Sizer PS1, Woodhouse LJ4, Brismée JM1
1Texas Tech University Health Sciences Center, Department of Rehabilitation Sciences, Lubbock, United States, 2Northern Rehab Physical Therapy Specialists, DeKalb, United States, 3High Point University, Congdon School of Health Sciences, High Point, United States, 4University of Alberta, Faculty of Rehabilitation Medicine, Alberta, Canada
Background: The World Confederation for Physical Therapy (WCPT) supports the right of member organizations (MOs) to develop national policies that encourage practice specialization by promoting high Physical Therapy (PT) standards. The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT), as sub-group of the WCPT, provides educational standards for musculoskeletal PT care. One potential PT profession development relates to advanced practice physiotherapy (APP) privileges. To date, no study has investigated in detail musculoskeletal APP privileges within countries that are WCPT MOs.
Purpose: To investigate the status of musculoskeletal APP privileges for physical therapists worldwide, and correlate education degrees, post professional educational training for countries that are and are not IFOMPT MOs.
Methods: An electronic survey was sent to WCPT and IFOMPT delegates. Descriptive statistics were used to assess variability of APP privileges prevalence between WCPT MOs. Inferential analyses using Pearson Chi-Square and Fisher's Exact tests, Spearman rank correlation coefficient, Point-biserial correlation coefficient, and Phi coefficient examined the strength of the relationships between the number and types of APP privileges and:
(1) country affiliation to IFOMPT;
(2) entry-level professional degree;
(3) post professional training.
The alpha level for significance was set at .05.
Results: The number of APP privileges allowed for each country was not correlated with the country affiliation to IFOMPT, with countries not affiliated with IFOMPT such as Bangladesh, Pakistan and Macau reporting 15 or more APP privileges allowed, while others affiliated with IFOMPT such as Austria, Japan and Germany reporting one or zero APP privilege allowed. The three most frequently allowed APP privileges among the 20 listed in the survey for all WCPT MOs were: (1) manipulation (85.0%), (2) perform dry needling (67.5%), and (3) direct access (55.0%). The five APP privileges that had statistically significant higher prevalence in countries that were IFOMPT MOs versus those that were not IFOMPT included: (1) direct access 72.7% versus 44.4% (p=.029), (2) perform dry needling 81.8% versus 55.6% (p=.035), and (3) Perform acupuncture 68.2% versus 40.0% (p=.03), (4) perform and interpret diagnostic ultrasound imaging 45.5% versus 20.0% (p=.03), and (5) perform injections of medications into joints, soft tissue 27.3% versus 6.7% (p=.02).
Only IFOMPT MOs displayed fair correlation (rs=.48, p .03) between entry level PT degrees and APP privileges number. Countries that were IFOMPT MOs were less likely to require post professional training to obtain the right to practice direct access and manipulation.
Conclusion(s): Only IFOMPT MOs showed a correlation between entry-level PT education program degree and the number of APP privileges suggesting that the number of APP privileges allowed for each country is a multifactorial process. The IFOMPT MOs were less likely to require post-professional training for direct access and manipulation APP privileges. We hypothesized that educational standards requirements to become IFOMPT MOs and the influence of the presence of musculoskeletal PT specialists in these countries may play a role in these findings.
Implications: Advanced scope of practice development is crucial for the expansion of PT profession autonomy. Our study serves as a foundation for future research aimed at evaluating the mechanisms regulating PT scope of practice.
Keywords: Scope of Practice, Advanced Practice Physiotherapy, Musculoskeletal
Funding acknowledgements: This study was unfunded.
Purpose: To investigate the status of musculoskeletal APP privileges for physical therapists worldwide, and correlate education degrees, post professional educational training for countries that are and are not IFOMPT MOs.
Methods: An electronic survey was sent to WCPT and IFOMPT delegates. Descriptive statistics were used to assess variability of APP privileges prevalence between WCPT MOs. Inferential analyses using Pearson Chi-Square and Fisher's Exact tests, Spearman rank correlation coefficient, Point-biserial correlation coefficient, and Phi coefficient examined the strength of the relationships between the number and types of APP privileges and:
(1) country affiliation to IFOMPT;
(2) entry-level professional degree;
(3) post professional training.
The alpha level for significance was set at .05.
Results: The number of APP privileges allowed for each country was not correlated with the country affiliation to IFOMPT, with countries not affiliated with IFOMPT such as Bangladesh, Pakistan and Macau reporting 15 or more APP privileges allowed, while others affiliated with IFOMPT such as Austria, Japan and Germany reporting one or zero APP privilege allowed. The three most frequently allowed APP privileges among the 20 listed in the survey for all WCPT MOs were: (1) manipulation (85.0%), (2) perform dry needling (67.5%), and (3) direct access (55.0%). The five APP privileges that had statistically significant higher prevalence in countries that were IFOMPT MOs versus those that were not IFOMPT included: (1) direct access 72.7% versus 44.4% (p=.029), (2) perform dry needling 81.8% versus 55.6% (p=.035), and (3) Perform acupuncture 68.2% versus 40.0% (p=.03), (4) perform and interpret diagnostic ultrasound imaging 45.5% versus 20.0% (p=.03), and (5) perform injections of medications into joints, soft tissue 27.3% versus 6.7% (p=.02).
Only IFOMPT MOs displayed fair correlation (rs=.48, p .03) between entry level PT degrees and APP privileges number. Countries that were IFOMPT MOs were less likely to require post professional training to obtain the right to practice direct access and manipulation.
Conclusion(s): Only IFOMPT MOs showed a correlation between entry-level PT education program degree and the number of APP privileges suggesting that the number of APP privileges allowed for each country is a multifactorial process. The IFOMPT MOs were less likely to require post-professional training for direct access and manipulation APP privileges. We hypothesized that educational standards requirements to become IFOMPT MOs and the influence of the presence of musculoskeletal PT specialists in these countries may play a role in these findings.
Implications: Advanced scope of practice development is crucial for the expansion of PT profession autonomy. Our study serves as a foundation for future research aimed at evaluating the mechanisms regulating PT scope of practice.
Keywords: Scope of Practice, Advanced Practice Physiotherapy, Musculoskeletal
Funding acknowledgements: This study was unfunded.
Topic: Education; Musculoskeletal; Education
Ethics approval required: No
Institution: Texas Tech University Health Sciences Center
Ethics committee: IRB
Reason not required: Exempted by TTUHSC IRB due to the topic (Scope of Practice)
All authors, affiliations and abstracts have been published as submitted.
