Dear Editor,

Are We Practicing What Has Been Determined by APTA HOD With Regard to Physical Therapists as Diagnosticians?

In 1985 APTA HOD passed that PTs may diagnose. In 1995, the HOD asserted that PTs MUST diagnose every patient they provide care for. Here it is 2006 and many physical therapists are about to become a "Doctor of Physical Therapy". But, are all of our patients receiving a diagnosis for physical therapy? This is not a trivial point. In fact, determining a movement impairment diagnosis is essential for best physical therapy care in all practice settings. For all practicing physical therapists to clinically reason using their unique body of knowledge to determine a movement impairment diagnosis, assures that physical therapy patients will receive interventions directed toward the underlying cause of their movement related problem. I believe that once physical therapists routinely determine diagnoses for physical therapy, they will begin to recognize patho-anatomic diagnoses and ICD-9 diagnoses as mere descriptors of symptoms which do little to direct physical therapy plans of care.

Our profession's evolving practice standards require us to employ new evidenced based, APTA Guide specific guidelines. For all physical therapists, our objective should be to practice using evidenced based methods, despite the fact it may appear to be different than established traditions. Likewise, sources of physical therapy referral have been shown to affect the clinical reasoning of physical therapists (1), and subsequently can hinder the application of contemporary practice guidelines, e.g. many PTs may be tempted to appease a referring physician by regurgitating the physician supplied patho-anatomic diagnosis, not stating the movement impairment diagnosis for physical therapy. The beneficiaries of new and applied knowledge and methods will be the patient-population served.

I have found that PTs practicing in acute care and or pediatric environments often feel exempt to APTA's directive that PTs should determine a PT diagnosis for all patients. Many rationalize their lack of diagnosing with a "focus on function" argument and often describe their practice setting as "unique" or "not applicable". I urge these practitioners to reconsider, believing that PTs who merely get their patients up to walk them without thoroughly examining, evaluating and determining a diagnose that identifies the underlying movement impairment, are not practicing at a professional level and are depriving patients best care. Patients with functional limitations have underlying movement impairments that cause their functional limitations. I would further argue that if a patient doesn't have a movement impairment, then they are not a candidate eligible for PT. Additionally, the use of the movement impairment diagnosis should not be restricted for use only in initial consultations and referrals, but should be a reverberating hypothesis that is supported or refuted in each progress note, especially under the "Assessment" portion of the progress and discharge notes.

What is at issue here is that the PT is the only practitioner who can label the cause of the dysfunction with a movement impairment diagnosis. Failure to identify the underlying cause of the dysfunction will result in a plan of care that is not specific to impact the causative variables. Hence, it is my belief that the differential diagnosis of movement impairments provides the single, most essential rationale for PTs to accountably justify their doctoral level, direct access, autonomous and preferred practitioner statuses. Are you providing a movement impairment diagnosis for all of your patients?

Robert E DuVall, PT, DHSc, MMSc, ATC, OCS, FAAOMPT, CSCS
Director of Orthopaedic Residency and Manual Therapy Fellowship Programs
SportsMedicine of Atlanta, Inc
2138 Scenic Highway
Snellville, GA 30078
Office: 770-979-1400
Fax: 770-978-3360
Website: www.SportsMedicineofAtlanta.com

(1) Dennis, JK. (1987). Decisions made by Physiotherapists: A study of private practitioners in Victoria. The Australian Journal of Physiotherapy, 33 (3), 181-191.