Do Physical Therapist Assistants Add Quality?

When a physical therapist utilizes a physical therapist assistant is the physical therapist assistant really an extender of the physical therapist?  Probably not.  Then again, the response to the question does depend on quite a few factors.  Was a physical therapist assistant involved more than 50% of the treatment time?  Does the location of practice where services are provided have state regulations that require onsite supervision?  Does the location of practice have state regulations that dictate PT/PTA ratio?

In 2006 Linda Resnik, Zhanlian Feng and Dennis Hart addressed whether physical therapist state practice acts had an effect on services.  Specifically, what predicted high physical therapist assistant utilization?  Were the number of visits per episode of care affected by service delivery?  Was the patient's reported level of function at discharge affected by service delivery?

Focus on Therapeutic Outcomes Inc. (FOTO) provided data.  The data from 2000 and 2001 included 395 clinics from 38 states utilizing FOTO.  High utilization of a PTA occurred 7.7% of the time within a final sample of 63,900 patients.  High utilization was defined as services provided by a PTA more than 50% of the time.  60% of the patients within this data were treated in a hospital outpatient setting.

State practice acts did not have an association with high PTA utilization.  A high ratio of PTA to PT on staff was associated with high PTA utilization.

High PTA utilization was associated with 2.0 more visits per episode of care.  State practice acts that required onsite supervision of the PTA were associated with 3.1 more visits per episode of care.  If there was a state practice act that regulated PT/PTA ratio, this was associated with 1.1 fewer visits per episode of care.

High PTA utilization was associated with lower discharge scores.  State practice acts with unspecified PTA supervision was associated with lower discharge scores.  (In FOTO, greater the discharge score the better the functional level.)

My gut reaction is that physical therapist assistants might not be valuable in service delivery if the goal is efficient and effective care.  Although the evidence is devaluing services provided by physical therapist assistants, the actual process of how a physical therapist assistant is introduced into the service delivery model hasn't been analyzed.  Is there a competency issue with physical therapist assistants (education/training), is there a process issue (how and when a PTA is utilized) or is there a combination of both factors that create a less valuable product?

Even though we are a small slice of the pie in health care dollars, as various stakeholders are analyzing costs and determining the value of our services, what effect will a high utilization of PTAs (>50% of treatment time) have on our future?

Selena