Wcpt (world Confederation For Physical Therapy) Declarations Of Principle
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Declarations of Principle Declarations of principle record the Confederation’s agreed stance on issues affecting the practice of physical therapy internationally and have a two-thirds majority vote thereby becoming policy for all member organisations.
Mission Statement The World Confederation for Physical Therapy works to improve global health by: REPRESENTING the physical therapy profession internationally ENCOURAGING high standards of physical therapy research, education and practice SUPPORTING communication and exchange of information among Regions and Member Organisations of WCPT COLLABORATING with international and national organisations
CONTENTS
Autonomy ............................................................................................................................... 3 Education ............................................................................................................................... 4 Ethical Principles .................................................................................................................... 7 Appendix to WCPT Ethical Principles ................................................................................................................9
Evidence Based Practice ....................................................................................................... 13 Human Resource Planning .................................................................................................... 15 Informed Consent................................................................................................................... 16 Patients’/Clients’ Rights in Physical Therapy......................................................................... 18 Primary Health Care............................................................................................................... 22 Private Practice ...................................................................................................................... 24 Protection of Title ................................................................................................................... 25 Quality Services ..................................................................................................................... 26 Relationships with other Health Professionals....................................................................... 28 Research ................................................................................................................................ 30 Standards of PT Practice ....................................................................................................... 32 Torture.................................................................................................................................... 34
Autonomy The World Confederation for Physical Therapy (WCPT) believes it is fundamental to professional autonomy that individual physical therapists should have the freedom to exercise their professional judgement, whether they are working in heath promotion, prevention or in the management, treatment/intervention and rehabilitation of patients/clients – as long as it is within the physical therapist's knowledge and competence. The actions of individual physical therapists are their own responsibility. So it follows that their professional decisions cannot be controlled or compromised by employers, persons from other professions or others. Patients/clients should have direct access to physical therapist services. A corollary of the profession’s right of professional autonomy is that it has a continuing responsibility to self-regulate. The actions and conduct of physical therapists must always be within the bounds of the professional code of ethics governing physical therapists in each country. National associations must have a procedure for dealing with members who breach their code, and a procedure through which the public may recognise the authority of the profession to regulate itself.
Date adopted:
Originally adopted at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT, June 2007
Date for review:
2011 Declaration of Principle: Relationships with other health professionals
Related WCPT Policies: Position Statement: Regulation and reciprocity
Copyright © World Confederation for Physical Therapy 2007
Education Physical therapy education is a continuum of learning beginning with admission to an accredited physical therapy school and ending with retirement from active practice. The World Confederation for Physical Therapy (WCPT) recognises that there is considerable diversity in the social, economic and political environments in which physical therapy education is conducted throughout the world. WCPT will assist national physical therapy associations with the development of appropriate educational standards and with the development of accreditation processes. 1. The goal of physical therapy education is the continuing development of physical therapists who are entitled (as long as it is consistent with their education) to practise the profession without limitation within the scope of practice defined in individual countries. 2. WCPT recommends that education for entry-level physical therapists should be based on university or university-level studies of a minimum of four years, independently validated and accredited as being at a standard that affords graduates full statutory and professional recognition. WCPT acknowledges that there is variation in programme delivery and in entry-level qualifications, including Bachelors/Baccalaureate/Licensed or equivalent, Masters and Doctorate entry qualifications. It is expected that any programme, irrespective of its length and mode of delivery, should deliver a curriculum that will enable physical therapists to attain the knowledge, skills and attributes described in the guidelines for physical therapist professional entry-level education. 3. The curricula for physical therapy education should be relevant to the health and social needs of the particular nation. 4. The term “accredited” is used in relation to physical therapy education to describe a programme which is regularly evaluated according to established educational standards.
5. The first professional qualification should be completion of a curriculum that qualifies the physical therapist for practice as an independent autonomous professional. 6. An integral component of the curriculum for the first professional qualification is direct clinical experience under the supervision of appropriately qualified physical therapists or other relevant health professionals. As skills and experience increase, this clinical education will involve access to gradually increasing levels of responsibility. 7. The curriculum should equip physical therapists to practise in a variety of health care settings including, but not limited to, institutional, industrial, occupational and primary health care that encompass urban and rural communities. Consideration should also be given to preparing physical therapists to practise in environments that reflect the health care/service delivery models that operate in different countries. 8. The curriculum and continuing professional development (CPD) opportunities should prepare physical therapists with a knowledge of educational approaches which will help them supervise, educate and transfer skills to others. 9. Physical therapists should be equipped for evidence-based practice. 10. Research methodology should be included in entry-level programmes. 11. Professional physical therapy entry-level education should be conducted by physical therapists and other appropriately qualified educators. The educators should be able to transfer knowledge and skills about physical therapist examinations/assessment/ evaluations, and interventions/treatment and their outcomes, including the critical analysis of theories and methods of physical therapy. 12. Educators should have appropriate qualifications and/or experience in teaching and learning. They should also have an awareness and understanding of the culture in which they are teaching. 13. Educators should include a variety of approaches to student assessment (eg, formative and summative). 14. Individuals with appropriate education and/or credentials should teach basic and foundational sciences (e.g., anatomy, histology, physiology, imaging, pharmacology), behavioural and social sciences (e.g., psychology, ethics, sociology), movement sciences (e.g., kinesiology, biomechanics, exercise science) and research methodology. 15. The goals, content, format and evaluation of the education programmes provided for physical therapists are the responsibility of the faculty but should involve the active participation of the national physical therapy association. 16. Life-long learning and professional development is the hallmark of a competent physical therapist. It should be recognised that learning and development may take place in a variety of ways and is not limited to attendance at formal courses.
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17. Physical therapists should be encouraged to undertake post-graduate education in physical therapy or related fields which will advance their professional development.
Date adopted:
Originally adopted at the 13th General Meeting of WCPT June 1995 and revised at the 15th General Meeting of WCPT June 2003. Revised 2007 to incorporate the Position Statement: Education for entry-Level physical therapists (1995) and adopted at the 16th General Meeting of WCPT, June 2007.
Date for review:
2011
Related WCPT Policies:
WCPT Guidelines for physical therapist entry-level education Position Statement: Description of Physical Therapy
Copyright © World Confederation for Physical Therapy 2007
Page 6 of 35
Ethical Principles* The World Confederation for Physical Therapy (WCPT) expects physical therapists to: 1. Respect the rights and dignity of all individuals 2. Comply with the laws and regulations governing the practice of physical therapy in the country in which they practice 3. Accept responsibility for the exercise of sound judgement 4. Provide honest, competent and accountable professional services 5. Provide quality services 6. Be entitled to a just and fair level of remuneration for their services 7. Provide accurate information to patients/clients 1 , to other agencies and the community about physical therapy and the services physical therapists provide 8. Contribute to the planning and development of services which address the health needs of the community
*Appendix follows on page 3
1
The term patient/client is used in this document as a generic term to refer to individuals and groups of individuals who can benefit from physical therapy interventions/treatments.
Date adopted:
Originally adopted at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Patients’/clients' rights in physical therapy
Related WCPT Policies:
Endorsement: Rights of the child Endorsement: The United Nations Standard Rules on the equalisation of opportunities for persons with disabilities
Copyright © World Confederation for Physical Therapy 2007
Page 8 of 35
Appendix to: WCPT Declaration of Principle on Ethical Principles Responsibilities of WCPT and its Member Organisations Member organisations have a duty to publish, promote and circulate their code of ethics or code of conduct for the benefit of their members, the general public, employers, governments and government agencies. Member organisations have appropriate procedures for monitoring the practice of their members, disciplinary procedures and sanctions for members whose practice falls outside their code of ethics or code of conduct. The WCPT will assist national physical therapy organisations with the development of their own code of ethics or code of conduct.
Interpreting WCPT's Ethical Principles The following is intended to assist WCPT member organisations and individual physical therapists in interpreting WCPT's Ethical Principles. The information may be useful background for organisations developing their own codes of ethics or guides to ethical conduct which are consistent with WCPT's Ethical Principles and reflect national circumstances.
Ethical Principle 1: Physical therapists respect the rights and dignity of all individuals All persons who seek the services of physical therapists have the right to service regardless of age, gender, race, nationality, religion, ethnic origin, creed, colour, sexual orientation, disability, health status or politics. Patients/clients have the right to: •
services of good quality
•
information
•
informed consent
•
confidentiality
•
access to data
•
health education
•
choose who, if anyone, should be informed on his/her behalf
Physical therapists have the absolute responsibility to ensure that their behaviour is at all times professional, ensuring that the potential for misconduct can not arise. Physical therapists have the right to expect co-operation from their colleagues. Physical therapists shall apply sound business principles when dealing with suppliers, manufacturers and other agents.
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Ethical Principle 2: Physical therapists comply with the laws and regulations governing the practice of physical therapy in the country in which they work Physical therapists will have a full understanding of the laws and regulations governing the practice of physical therapy. Physical therapists have the right to refuse to treat or otherwise intervene when in their opinion the service is not in the best interests of the patient/client.
Ethical Principle 3: Physical therapists accept responsibility for the exercise of sound judgement Physical therapists are professionally independent and autonomous practitioners. Physical therapists make independent judgements in the provision of services for which they have knowledge and skills and for which they can be held accountable. For each individual accepted for service, physical therapists undertake appropriate examination/evaluation to allow the development of a diagnosis. In light of the diagnosis and other relevant information about the patient/client, especially the patient’s/client's goals, physical therapists plan and implement the intervention. When the goals have been achieved or further benefits can no longer be obtained, the physical therapist shall inform and discharge the patient/client. When the diagnosis is not clear or the required intervention/treatment is beyond the capacity of the physical therapist, the physical therapist shall inform the patient/client and provide assistance to facilitate a referral to other qualified persons. Physical therapists shall not delegate any activity which requires the unique skill, knowledge and judgement of the physical therapist. The physical therapist will consult with the referring medical practitioner if the treatment programme or a continuation of the programme are not in accord with the judgement of the physical therapist.
Ethical Principle 4: Physical therapists provide an honest, competent and accountable professional service Physical therapists ensure patients/clients understand the nature of the service being provided, especially the anticipated costs, both time and financial. Physical therapists undertake a continuous, planned, personal development programme designed to maintain and enhance professional knowledge and skills. Physical therapists maintain adequate patient/client records to allow for the effective evaluation of the patient’s/client's care, as well as the evaluation of the physical therapist's practice.
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Physical therapists do not disclose any information about a patient/client to a third party without the patient’s/client's permission or prior knowledge, unless such disclosure is required by law. Physical therapists participate in peer review and other forms of practice evaluation, the results of which shall not be disclosed to another party without the permission of the physical therapist. Physical therapists shall maintain adequate data to facilitate service performance measurement and shall make that data available to other agents as required by mutual agreement. The ethical principles governing the practice of physical therapy shall take precedence over any business or employment practice, where such conflict arises the physical therapist shall attempt to rectify the matter, seeking the assistance of the national physical therapy association if required. Physical therapists shall not allow their services to be misused.
Ethical Principle 5: Physical therapists are committed to providing quality services Physical therapists shall be aware of the currently accepted standards of practice and undertake activities which measure their conformity. Physical therapists shall participate in ongoing education to enhance their basic knowledge and to provide new knowledge. Physical therapists shall support research that contributes to improved patient/client services. Physical therapists shall support quality education in academic and clinical settings. Physical therapists engaged in research shall abide by the current rules and policies applying to the conduct of research on human subjects shall ensure: •
the consent of subjects
•
subject confidentiality
•
safety and well-being of subjects
•
absence of fraud and plagiarism
•
full disclosure of support, and
•
appropriate acknowledgement of assistance
•
that any breaches of the rules are reported to appropriate authorities
Physical therapists shall share the results of their research freely, especially in journals and conference presentations. Physical therapists in the role of employer shall: •
ensure all employees are properly and duly qualified, ensuring compliance with statutory requirements
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•
apply current management principles and practices to the conduct of the service, with particular attention to appropriate standards of personnel management
•
ensure implementation and monitoring of appropriate policies and procedures
•
ensures appropriate evaluation and audit of clinical practice
•
provide adequate opportunities for staff education and personal development based on effective performance appraisal
Ethical Principle 6: Physical therapists are entitled to a just and fair level of remuneration for their services Physical therapists should ensure that their own fee schedules are based on reasonable considerations. Physical therapists should attempt to ensure that third-party fee schedules are based on reasonable considerations. Physical therapists shall not use undue influence for personal gain.
Ethical Principle 7: Physical therapists provide accurate information to patients/clients, other agencies and the community about physical therapy and about the services physical therapists provide Physical therapists shall participate in public education programmes, providing information about the profession. Physical therapists have a duty to inform the public and referring professionals truthfully about the nature of their service so individuals are more able to make a decision about the use of the service. Physical therapists may advertise their services;. Physical therapists shall not use false, fraudulent, misleading, deceptive, unfair or sensational statements or claims. Physical therapists shall claim only those titles which correctly describe their professional status.
Ethical Principle 8: Physical therapists contribute to the planning and development of services which address the health needs of the community Physical therapists have a duty and an obligation to participate in planning services designed to provide optimum community health services. Physical therapists are obliged to work toward achieving justice in the provision of health services for all people.
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Evidence Based Practice The World Confederation for Physical Therapy (WCPT) believes that physical therapists have a duty and responsibility to use evidence to inform practice and to ensure that the management of patients/clients, their carers and communities is based on the best available evidence. Evidence should be integrated with clinical experience, taking into consideration beliefs and values and the cultural context of the local environment. In addition, physical therapists have a duty and responsibility not to use techniques and technologies that have been shown to be ineffective or unsafe. Evidence based practice (EBP) is facilitated by environments that embrace and promote it. Managers and organisations should provide appropriate support structures, resources, facilities and learning opportunities to ensure the delivery of highest quality care. Physical therapists should be prepared to evaluate practice critically. In addition, they need to be able to identify questions arising in practice, access and critically appraise the best evidence, and implement and evaluate outcomes of their actions. Relevant life-long learning activities are fundamental to evidence based physical therapy and should be introduced in entry-level physical therapy programmes and extended through continuing professional development opportunities. Collaboration both within the profession and with other professions or disciplines is vital to the delivery of evidence based practice. This collaboration needs to take place at a local, national and international level, to facilitate information sharing and best practice, and to capitalise on opportunities for collaborative work that minimise duplication. WCPT encourages its Member Organisations to develop partnerships and collaborations on projects relevant to EBP. WCPT and its Member Organisations call on the national governments and non-governmental organisations to facilitate and promote evidence-based healthcare – for example, through providing appropriate resources such as computers, internet access, on-line databases, libraries, and training in EBP skills.
th
Date adopted:
Approved at the 15 General Meeting of WCPT, June 2003. Revised and reth approved at the 16 General Meeting of WCPT, June 2007.
Date for review:
2011 Declaration of Principle: Research
Related WCPT Policies:
Declaration of Principle: Standards of physical therapy practice Declaration of Principle: Education
Copyright © World Confederation of Physical Therapy 2007
Page 14 of 35
Human Resource Planning The World Confederation for Physical Therapy (WCPT) believes that physical therapists have the responsibility, through their national associations, to work with governments and other agencies, to contribute to national human resource (workforce) planning. Such planning should aim to ensure a balance between demand and supply for physical therapists and a balance between qualified physical therapists and support personnel, to facilitate the best possible level of quality service/care for the community.
th
Date adopted:
Approved at the 13 General Meeting of WCPT June 1995. Revised and reth approved at the 16 General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Ethical Principles
Related WCPT Policies: Position Statement: Support personnel for physical therapy practice
Copyright © World Confederation of Physical Therapy 2007
Informed Consent The World Confederation for Physical Therapy (WCPT) expects that physical therapists will ensure that appropriate consent has been given before any physical therapy is undertaken. 1. A competent adult should be provided with adequate, intelligible information about the proposed therapy: •
a description of the intervention/treatment to be provided
•
a clear explanation of the risks which may be associated with the therapy
•
expected benefits from the therapy
•
anticipated time frames
•
anticipated costs
•
reasonable alternatives to the recommended therapy
2. The physical therapist should ascertain the ability of the patient/client to understand the above before seeking consent. 3. When the adult is deemed not competent or when the patient/client is a minor, a legal guardian or advocate may act as a surrogate decision maker. 4. Physical therapists should record in writing in their documentation that informed consent has been obtained. Physical therapists functioning in team situations are responsible for ensuring that appropriate consent arrangements have been made prior to their commencing therapy. Such collective consent, however, does not negate the physical therapist's responsibility for ensuring that the patient/client is properly informed about the physical therapy.
Date adopted:
Originally approved at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Patients’/clients’ rights in physical therapy
Related WCPT Policies: Declaration of Principle: Ethical principles
Copyright © World Confederation for Physical Therapy 2007
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Patients’/Clients’ Rights in Physical Therapy The World Confederation for Physical Therapy (WCPT) promotes: •
the respect of the patients’/clients’ dignity, integrity and self-determination
•
the protection of the legal status of the patient/client in connection with the health system and the physical therapist in particular
•
a relationship of confidence and reliance between the patient/client and the physical therapist
This declaration must be interpreted within the context of national laws and regulations and professional standards of practice. Physical therapists should also be aware of relevant international declarations and national laws in areas such as human rights, equal opportunity, racial and gender discrimination, privacy, freedom of information, workplace accidents and injuries. This declaration represents some of the principal rights of patients/clients, which the profession of physical therapy endorses and promotes. Principles 1. Patients’/Clients’ Right to Physical Therapy Services of Good Quality 1.1. Every patient/client has the right to: •
appropriate physical therapy services without discrimination
•
the services of a physical therapist who is free to make clinical and ethical judgements without any outside interference
•
the services of a physical therapist who is free to exercise professional judgement according to his/her education and experience
•
ask for a second opinion of another physical therapist at any stage
•
the right to be treated in accordance with his/her best interests
•
choose freely and change his/her physical therapist or health service institution, regardless of whether they are based in the private or public sector
•
advocacy if he/she is unable to speak on his/her own behalf
2. Patients’/Clients’ Right to Information 2.1 Every patient/client has the right to: •
adequate information upon which to base the decision to consent or refuse examination/assessment and intervention/treatment
•
decline examination/assessment and intervention/treatment at any stage without it prejudicing future management
•
receive information about himself/herself recorded in his/her health records and about practice policies, charges for services, physical therapy goals, desired outcomes and procedures which are being rendered
•
choose who, if anyone, should be informed on his/her behalf
•
discuss the physical therapy intervention/treatment options, including information about significant benefits, risks and side effects
•
receive information in a way that is comprehensible and appropriate to the patient’s/client’s values and cultural and religious beliefs
•
receive information about complaints procedures
•
complain and to have the complaint managed sensitively
3. Patients’/Clients’ Right to Informed Consent 3.1 Every patient/client has the right to: •
provide or withhold informed consent for the type and nature of physical therapy to be provided
•
know o the purpose of any examination or intervention/treatment o any risk associated with the proposed intervention/treatment o the expected benefit of the intervention/treatment o reasonable alternatives to the proposed intervention/treatment o the implications of withholding consent
•
self-determination including participation in decisions about the physical therapy interventions
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•
make free decisions regarding himself/herself with knowledge of the consequences of his/her decisions
4. Patients’/Clients’ Right to Confidentiality 4.1 Every patient/client has the right to: •
confidentiality of any information (eg, health status, diagnosis, prognosis, interventions/treatment, any other personal information) obtained from him/her unless explicit consent is given or expressly provided for in law
5. Patients’/Clients’ Right to Access to Data 5.1 Every patient/client has the right to: •
have access to all information kept by the physical therapist relating to them
•
be notified when their physical therapy data are transmitted to a data bank
•
have incorrect data corrected or destroyed
6. Patients’/Clients’ Right to Health Education 6.1 Every patient/client has the right to: •
health education that will assist him/her in making informed choices about personal health and about the available health services
•
continuity of health services.
7. Patients’/Clients’ Right to Dignity 7.1 Every patient/client has the right to: •
be managed with dignity
•
be treated courteously
•
privacy that shall be respected at all times in all physical therapy services
•
have his/her culture, values and religious beliefs respected
•
die with dignity
•
humane terminal care
Acknowledgements: In developing this document, WCPT consulted various documents from other regional and international organisations in particular: World Medical Association Declaration on the Rights of the Patient [Adopted by the 34th World Medical Assembly, Lisbon, Portugal, September/October 1981, and amended by the 47th WMA General Assembly, Bali, Indonesia, September 1995, and editorially revised at the 171st Council Session, Santiago, Chile, October 2005 http://www.wma.net/e/policy/l4.htm]
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Date adopted:
Originally approved at the 15th General Meeting of WCPT, June 2003. Revised to incorporates the Declaration of Principle: Rights of the client (1995) and approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Ethical principles Declaration of Principle: Standards of physical therapy practice Declaration of Principle: Quality services
Related WCPT Policies:
Declaration of Principle: Informed consent Position Statement: Standards of practice Endorsement: Rights of the child Endorsement: The United Nations Standard Rules on the equalisation of opportunities for persons with disabilities
Copyright © World Confederation for Physical Therapy 2007
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Primary Health Care Access to primary health care services is key to ensuring that health care/services are responsive to the needs of individuals, their carers and communities. The World Confederation for Physical Therapy (WCPT) advocates for the provision of primary health care that is mindful of local cultural, socio-economic and political circumstances and provides equitable access for all to effective services. WCPT supports an approach that is flexible and innovative in providing models of service delivery that offer care/service developed in response to local needs. WCPT recognises that there are principles of best practice that should be evident in any model of health services delivery and that these include, but are not limited to: •
health services are equally accessible to all
•
local communities and individuals are partners involved in health care/service delivery, planning, operating and monitoring
•
the model is developed in response to an assessment of local needs, mindful of the ethical use of resources
•
services are developed taking account of local cultural and social norms
•
multi-professional, inter-agency and inter-sectoral collaboration at all levels is advocated
•
in acknowledging the roles that different health care/services personnel are able to contribute to service delivery, where appropriate, physical therapists should contribute to their education and ongoing development
•
where appropriate, communities and individuals are supported to be self-reliant
•
while rehabilitation may be the area of greatest need, health promotion and disease prevention should also be addressed and treatment/intervention provided as necessary
•
relevant research and evaluation findings are implemented ensuring best practice
•
monitoring and evaluation of services is in place with mechanisms for review and modification
Physical therapists have an important role to play in primary health care as: •
direct and indirect providers of services
•
members of multi-professional teams
•
consultants to Government, Non-Governmental Organisations (NGOs) and Disabled People’s Organisations (DPOs)
•
developers, implementers and managers of services
•
educators of other health personnel and support staff
Physical therapy entry level education and continuing professional development opportunities need to adequately prepare and equip physical therapists to work in a variety of settings able to deliver care/services in both urban and rural communities, acknowledging their roles as facilitators and educators of other health personnel, necessary for the attainment of physical therapy and patient/client goals. Physical therapists and national physical therapy associations are encouraged to work with Governments, NGOs and DPOs to promote and facilitate the development of primary health care and the contribution of physical therapists, encompassing the four core elements of promotion, prevention, treatment/intervention and rehabilitation.
Date adopted:
Approved at the 15th General Meeting of WCPT, June 2003. Revised and re-approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011
Related WCPT Policies:
Position Statement: Community Based Rehabilitation
Copyright © World Confederation for Physical Therapy 2007
Page 23 of 35
Private Practice Physical therapy is an autonomous and independent profession. The World Confederation for Physical Therapy (WCPT) therefore believes that there should be no impediment to physical therapists entering into private practice; in which physical therapists deliver services to patients/clients in accordance with government laws, rules and/or regulations and in accordance with WCPT declarations of principle and position statements. Physical therapists in private practice can expect to receive just and equitable remuneration for their services. WCPT Member Organisations may be involved in negotiations on behalf of privately practising physical therapists.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995. Revised and re-adopted at the 16th General Meeting of WCPT June 2007.
Date for review:
2011
Related WCPT Policies:
Declaration of Principle: Autonomy
Copyright © World Confederation for Physical Therapy 2007
Protection of Title The professional names of physical therapy or physiotherapy, the titles physical therapist or physiotherapist and appropriate abbreviations (for example PT, FT, physio) as such or in any translation, are the sole preserve of persons who hold qualifications approved by national professional associations. The World Confederation for Physical Therapy (WCPT) claims exclusivity to these titles. Members of the public wishing to access the services of a physical therapist are entitled to know that recognised qualifications are held and that professional behaviour is governed by ethical codes. WCPT calls on the governments of Member Organisations to enact legislation, where it does not already exist, to protect the public by limiting the use of these titles to appropriately qualified persons. Furthermore, WCPT calls on the governments of Member Organisations to refrain from developing generic classifications that deny the specificity of physical therapy by ensuring that qualified physical therapists always have the right to be employed as physical therapists.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995. Revised and readopted at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Position Statement: Description of physical therapy
Related WCPT Policies: Position Statement: Regulation and reciprocity
Copyright © World Confederation for Physical Therapy 2007
Quality Services The World Confederation for Physical Therapy (WCPT) recognises that patients/clients, governments and third-party funding agencies have a right to expect that the care/services provided by physical therapists will be consistent with prevailing national quality standards. Quality care/service is optimal care/service at a reasonable cost, balancing patient/client, organisational and professional considerations. Optimal care/service embraces concepts of: •
equity
•
efficiency
•
effectiveness
•
appropriateness
•
acceptability
•
accessibility
•
availability
•
safety
To obtain this level of optimal care/service there is a need for: •
research
•
development of tools to facilitate evidence-based practice
•
implementation of evidence and effective change management
•
evaluation of practice structures, processes and outcomes
•
monitoring of efficiency, effectiveness and safety
•
measurement of patient/client satisfaction
National physical therapy associations must demonstrate leadership in quality through the development of practice standards and monitoring procedures. They also have a role to play in contributing to the development of multi- and uni-professional tools, such as clinical guidelines, designed to facilitate evidence based practice. This should involve seeking opportunities for international collaboration where appropriate.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995 and revised at the 15th General Meeting of WCPT June 2003. Revised and re-approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Standards of physical therapy practice Declaration of Principle: Evidence Based Practice
Related WCPT Policies: Declaration of Principle: Patients' / Clients' Rights in Physical Therapy Position Statement: Standards of Practice
Copyright © World Confederation for Physical Therapy 2007
Page 27 of 35
Relationships with other Health Professionals Physical therapists are active members of multi-professional teams, working in partnership with other health professionals to provide patient/client management/services. The World Confederation for Physical Therapy (WCPT) expects physical therapists to have an adequate understanding of the role and function of the other professions, appreciating the core differences as well as the common features. It is the responsibility of the national physical therapy association, as well as individual physical therapists, to have strategies in place that explain the role and function of physical therapy, to demonstrate the efficacy of physical therapy, and to market physical therapy adequately and appropriately. In a growing number of countries, physical therapy has first contact status, a referral from a medical practitioner not being required, legally or ethically, before physical therapy services are provided. When a medical referral is legally or ethically required to initiate physical therapy services, the referral should contain essential medical information. Physical therapists are also able to take referrals from other health professionals. Whether a referral is required or not, physical therapists are qualified and professionally required to undertake a comprehensive examination/assessment of the patient/client, formulate a physical therapy diagnosis, plan and implement a therapeutic intervention/treatment programme where appropriate, evaluate the outcome of any intervention/treatment, and determine discharge arrangements. Physical therapists should have adequate policies and procedures in place for appropriate communication with the patient’s/client's medical practitioner and other relevant health professionals to ensure necessary consultation and to provide accurate documentation and reports.
Date adopted:
Approved at the 16th General Meeting of WCPT, June 2007. Replaces two previous Declarations of Principles on relationships with medical practitioners and relationships with other health professionals, both approved in June 1995 at the 13th General Meeting.
Date for review:
2011 Declaration of Principle: Primary Health Care
Related WCPT Policies:
Declaration of Principle: Autonomy Position Statement: Description of Physical Therapy
Copyright © World Confederation for Physical Therapy 2007
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Research The World Confederation for Physical Therapy (WCPT) sees the generation of evidence through research as essential to the development of evidence-based practice in physical therapy. Research in physical therapy should encompass all domains that impact on the practice of physical therapy and patient/client care. This includes, but is not limited to: basic science, diagnosis, specific interventions and technologies, 2 service delivery and organisation of care models/systems, economic analysis, development of outcome measures, educational approaches, social-anthropological studies, and health care policy. The most appropriate methods of enquiry should be used to address the topic for research. Research is required that demonstrates clinical and cost effectiveness. It may be necessary to develop and validate new methods of research. Collaboration is critical to the success of any research efforts, and the process should include all those who can make a valuable contribution with respect to the initial concept, design, planning, execution, analysis and dissemination. Collaboration is vital within the profession and with other professions or disciplines, as well as with consumers. It needs to take place at the local, national and international level. Physical therapists have a responsibility to promote research efforts and to share freely the results of such research through a range of dissemination routes including databases, publication in appropriate professional journals, conference presentations, electronic media and the national press.
2
Healthcare technology is defined by the International Network of Agencies for Health Technology Assessment (INAHTA) as “prevention and rehabilitation, vaccines, pharmaceuticals, and devices, medical and surgical procedures, and the systems within which health is protected and maintained.”
Date adopted:
Approved at the 15th General Meeting of WCPT, June 2003. Revised and reapproved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Evidence Based Practice
Related WCPT Policies: Declaration of Principle: Education
Copyright © World Confederation for Physical Therapy 2007
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Standards of Physical Therapy Practice The World Confederation for Physical Therapy (WCPT) recognises the absolute importance of the development and documentation of agreed standards for the practice of physical therapy. These standards are necessary to: •
demonstrate to the public that physical therapists are concerned with the quality of the services provided and are willing to implement self-regulatory programmes to maintain that quality
•
guide the development of professional education
•
guide practitioners in the conduct and evaluation of their practices
•
provide governments, regulatory bodies and other professional groups with background information about the professional nature of physical therapy
•
effectively communicate with members of the profession, employers, other health professions, governments and the public
WCPT recognises the diverse social, political and economic environments in which physical therapy is practised throughout the world. Thus, specific standards for physical therapy practice must be developed by each member organisation to suit prevailing circumstances. Where political environments dictate, national associations may unite to formulate agreed standards that may be applicable to that group. The following principles should be considered in the process of developing standards: 1. reflect the values, conditions and goals necessary for the continuing advancement of the profession 2. based on valid principles and be measurable to the extent possible 3. designed to assist the profession to meet the changing needs of the community 4. based upon clear definitions of the scope of practice and accountability
5. sufficiently broad and flexible to achieve their objectives and, at the same time, permit innovation, growth and change 6. subject to regular review with revision as required
National practice standards should be set in the following areas: •
administration and practice management
•
communication
•
community responsibility
•
documentation
•
education
•
ethical behaviour
•
informed consent
•
legal
•
patient/client management
•
personal/professional development
•
quality assurance
•
research
•
support personnel
Date adopted:
Approved at the 13th General Meeting of WCPT June 1995 and revised at the 15th General Meeting of WCPT June 2003. Revised and re-approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Quality Services
Related WCPT Policies: Position Statement: Standards of Practice
Copyright © World Confederation for Physical Therapy 2007
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Torture The World Confederation for Physical Therapy (WCPT) believes that: 1. Physical therapists shall not countenance, condone or participate in the practice of torture or cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife. 2. Physical therapists shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment. 3. Physical therapists shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment are used or threatened. 4. The physical therapist's fundamental role is alleviating distress of his or her fellow human beings, and no motive whether personal, collective or political shall prevail against this higher purpose. 5. The practising physical therapist should understand the general and specific neurological, musculoskeletal and psychological dysfunction which can be expected to appear as the effects of physical and psychological torture, as well as of appropriate functional assessment and treatment procedures for survivors of torture. 6. Education regarding the prevention and prohibition of torture as well as the assessment and treatment of torture victims should be included in the curriculum for entry level and continuing physical therapy education programmes. The World Confederation for Physical Therapy will support and encourage the international community, its member organisations and fellow physical therapists to support the physical therapist and physical therapist's family in the face of threats or reprisals resulting from a refusal to condone the use of torture or other forms of cruel, inhuman or degrading treatment.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Ethical principles
Related WCPT Policies: Declaration of Principle: Patients’/clients’ rights in physical therapy
Copyright © World Confederation for Physical Therapy 2007
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Mission Statement The World Confederation for Physical Therapy works to improve global health by: REPRESENTING the physical therapy profession internationally ENCOURAGING high standards of physical therapy research, education and practice SUPPORTING communication and exchange of information among Regions and Member Organisations of WCPT COLLABORATING with international and national organisations
CONTENTS
Autonomy ............................................................................................................................... 3 Education ............................................................................................................................... 4 Ethical Principles .................................................................................................................... 7 Appendix to WCPT Ethical Principles ................................................................................................................9
Evidence Based Practice ....................................................................................................... 13 Human Resource Planning .................................................................................................... 15 Informed Consent................................................................................................................... 16 Patients’/Clients’ Rights in Physical Therapy......................................................................... 18 Primary Health Care............................................................................................................... 22 Private Practice ...................................................................................................................... 24 Protection of Title ................................................................................................................... 25 Quality Services ..................................................................................................................... 26 Relationships with other Health Professionals....................................................................... 28 Research ................................................................................................................................ 30 Standards of PT Practice ....................................................................................................... 32 Torture.................................................................................................................................... 34
Autonomy The World Confederation for Physical Therapy (WCPT) believes it is fundamental to professional autonomy that individual physical therapists should have the freedom to exercise their professional judgement, whether they are working in heath promotion, prevention or in the management, treatment/intervention and rehabilitation of patients/clients – as long as it is within the physical therapist's knowledge and competence. The actions of individual physical therapists are their own responsibility. So it follows that their professional decisions cannot be controlled or compromised by employers, persons from other professions or others. Patients/clients should have direct access to physical therapist services. A corollary of the profession’s right of professional autonomy is that it has a continuing responsibility to self-regulate. The actions and conduct of physical therapists must always be within the bounds of the professional code of ethics governing physical therapists in each country. National associations must have a procedure for dealing with members who breach their code, and a procedure through which the public may recognise the authority of the profession to regulate itself.
Date adopted:
Originally adopted at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT, June 2007
Date for review:
2011 Declaration of Principle: Relationships with other health professionals
Related WCPT Policies: Position Statement: Regulation and reciprocity
Copyright © World Confederation for Physical Therapy 2007
Education Physical therapy education is a continuum of learning beginning with admission to an accredited physical therapy school and ending with retirement from active practice. The World Confederation for Physical Therapy (WCPT) recognises that there is considerable diversity in the social, economic and political environments in which physical therapy education is conducted throughout the world. WCPT will assist national physical therapy associations with the development of appropriate educational standards and with the development of accreditation processes. 1. The goal of physical therapy education is the continuing development of physical therapists who are entitled (as long as it is consistent with their education) to practise the profession without limitation within the scope of practice defined in individual countries. 2. WCPT recommends that education for entry-level physical therapists should be based on university or university-level studies of a minimum of four years, independently validated and accredited as being at a standard that affords graduates full statutory and professional recognition. WCPT acknowledges that there is variation in programme delivery and in entry-level qualifications, including Bachelors/Baccalaureate/Licensed or equivalent, Masters and Doctorate entry qualifications. It is expected that any programme, irrespective of its length and mode of delivery, should deliver a curriculum that will enable physical therapists to attain the knowledge, skills and attributes described in the guidelines for physical therapist professional entry-level education. 3. The curricula for physical therapy education should be relevant to the health and social needs of the particular nation. 4. The term “accredited” is used in relation to physical therapy education to describe a programme which is regularly evaluated according to established educational standards.
5. The first professional qualification should be completion of a curriculum that qualifies the physical therapist for practice as an independent autonomous professional. 6. An integral component of the curriculum for the first professional qualification is direct clinical experience under the supervision of appropriately qualified physical therapists or other relevant health professionals. As skills and experience increase, this clinical education will involve access to gradually increasing levels of responsibility. 7. The curriculum should equip physical therapists to practise in a variety of health care settings including, but not limited to, institutional, industrial, occupational and primary health care that encompass urban and rural communities. Consideration should also be given to preparing physical therapists to practise in environments that reflect the health care/service delivery models that operate in different countries. 8. The curriculum and continuing professional development (CPD) opportunities should prepare physical therapists with a knowledge of educational approaches which will help them supervise, educate and transfer skills to others. 9. Physical therapists should be equipped for evidence-based practice. 10. Research methodology should be included in entry-level programmes. 11. Professional physical therapy entry-level education should be conducted by physical therapists and other appropriately qualified educators. The educators should be able to transfer knowledge and skills about physical therapist examinations/assessment/ evaluations, and interventions/treatment and their outcomes, including the critical analysis of theories and methods of physical therapy. 12. Educators should have appropriate qualifications and/or experience in teaching and learning. They should also have an awareness and understanding of the culture in which they are teaching. 13. Educators should include a variety of approaches to student assessment (eg, formative and summative). 14. Individuals with appropriate education and/or credentials should teach basic and foundational sciences (e.g., anatomy, histology, physiology, imaging, pharmacology), behavioural and social sciences (e.g., psychology, ethics, sociology), movement sciences (e.g., kinesiology, biomechanics, exercise science) and research methodology. 15. The goals, content, format and evaluation of the education programmes provided for physical therapists are the responsibility of the faculty but should involve the active participation of the national physical therapy association. 16. Life-long learning and professional development is the hallmark of a competent physical therapist. It should be recognised that learning and development may take place in a variety of ways and is not limited to attendance at formal courses.
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17. Physical therapists should be encouraged to undertake post-graduate education in physical therapy or related fields which will advance their professional development.
Date adopted:
Originally adopted at the 13th General Meeting of WCPT June 1995 and revised at the 15th General Meeting of WCPT June 2003. Revised 2007 to incorporate the Position Statement: Education for entry-Level physical therapists (1995) and adopted at the 16th General Meeting of WCPT, June 2007.
Date for review:
2011
Related WCPT Policies:
WCPT Guidelines for physical therapist entry-level education Position Statement: Description of Physical Therapy
Copyright © World Confederation for Physical Therapy 2007
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Ethical Principles* The World Confederation for Physical Therapy (WCPT) expects physical therapists to: 1. Respect the rights and dignity of all individuals 2. Comply with the laws and regulations governing the practice of physical therapy in the country in which they practice 3. Accept responsibility for the exercise of sound judgement 4. Provide honest, competent and accountable professional services 5. Provide quality services 6. Be entitled to a just and fair level of remuneration for their services 7. Provide accurate information to patients/clients 1 , to other agencies and the community about physical therapy and the services physical therapists provide 8. Contribute to the planning and development of services which address the health needs of the community
*Appendix follows on page 3
1
The term patient/client is used in this document as a generic term to refer to individuals and groups of individuals who can benefit from physical therapy interventions/treatments.
Date adopted:
Originally adopted at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Patients’/clients' rights in physical therapy
Related WCPT Policies:
Endorsement: Rights of the child Endorsement: The United Nations Standard Rules on the equalisation of opportunities for persons with disabilities
Copyright © World Confederation for Physical Therapy 2007
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Appendix to: WCPT Declaration of Principle on Ethical Principles Responsibilities of WCPT and its Member Organisations Member organisations have a duty to publish, promote and circulate their code of ethics or code of conduct for the benefit of their members, the general public, employers, governments and government agencies. Member organisations have appropriate procedures for monitoring the practice of their members, disciplinary procedures and sanctions for members whose practice falls outside their code of ethics or code of conduct. The WCPT will assist national physical therapy organisations with the development of their own code of ethics or code of conduct.
Interpreting WCPT's Ethical Principles The following is intended to assist WCPT member organisations and individual physical therapists in interpreting WCPT's Ethical Principles. The information may be useful background for organisations developing their own codes of ethics or guides to ethical conduct which are consistent with WCPT's Ethical Principles and reflect national circumstances.
Ethical Principle 1: Physical therapists respect the rights and dignity of all individuals All persons who seek the services of physical therapists have the right to service regardless of age, gender, race, nationality, religion, ethnic origin, creed, colour, sexual orientation, disability, health status or politics. Patients/clients have the right to: •
services of good quality
•
information
•
informed consent
•
confidentiality
•
access to data
•
health education
•
choose who, if anyone, should be informed on his/her behalf
Physical therapists have the absolute responsibility to ensure that their behaviour is at all times professional, ensuring that the potential for misconduct can not arise. Physical therapists have the right to expect co-operation from their colleagues. Physical therapists shall apply sound business principles when dealing with suppliers, manufacturers and other agents.
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Ethical Principle 2: Physical therapists comply with the laws and regulations governing the practice of physical therapy in the country in which they work Physical therapists will have a full understanding of the laws and regulations governing the practice of physical therapy. Physical therapists have the right to refuse to treat or otherwise intervene when in their opinion the service is not in the best interests of the patient/client.
Ethical Principle 3: Physical therapists accept responsibility for the exercise of sound judgement Physical therapists are professionally independent and autonomous practitioners. Physical therapists make independent judgements in the provision of services for which they have knowledge and skills and for which they can be held accountable. For each individual accepted for service, physical therapists undertake appropriate examination/evaluation to allow the development of a diagnosis. In light of the diagnosis and other relevant information about the patient/client, especially the patient’s/client's goals, physical therapists plan and implement the intervention. When the goals have been achieved or further benefits can no longer be obtained, the physical therapist shall inform and discharge the patient/client. When the diagnosis is not clear or the required intervention/treatment is beyond the capacity of the physical therapist, the physical therapist shall inform the patient/client and provide assistance to facilitate a referral to other qualified persons. Physical therapists shall not delegate any activity which requires the unique skill, knowledge and judgement of the physical therapist. The physical therapist will consult with the referring medical practitioner if the treatment programme or a continuation of the programme are not in accord with the judgement of the physical therapist.
Ethical Principle 4: Physical therapists provide an honest, competent and accountable professional service Physical therapists ensure patients/clients understand the nature of the service being provided, especially the anticipated costs, both time and financial. Physical therapists undertake a continuous, planned, personal development programme designed to maintain and enhance professional knowledge and skills. Physical therapists maintain adequate patient/client records to allow for the effective evaluation of the patient’s/client's care, as well as the evaluation of the physical therapist's practice.
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Physical therapists do not disclose any information about a patient/client to a third party without the patient’s/client's permission or prior knowledge, unless such disclosure is required by law. Physical therapists participate in peer review and other forms of practice evaluation, the results of which shall not be disclosed to another party without the permission of the physical therapist. Physical therapists shall maintain adequate data to facilitate service performance measurement and shall make that data available to other agents as required by mutual agreement. The ethical principles governing the practice of physical therapy shall take precedence over any business or employment practice, where such conflict arises the physical therapist shall attempt to rectify the matter, seeking the assistance of the national physical therapy association if required. Physical therapists shall not allow their services to be misused.
Ethical Principle 5: Physical therapists are committed to providing quality services Physical therapists shall be aware of the currently accepted standards of practice and undertake activities which measure their conformity. Physical therapists shall participate in ongoing education to enhance their basic knowledge and to provide new knowledge. Physical therapists shall support research that contributes to improved patient/client services. Physical therapists shall support quality education in academic and clinical settings. Physical therapists engaged in research shall abide by the current rules and policies applying to the conduct of research on human subjects shall ensure: •
the consent of subjects
•
subject confidentiality
•
safety and well-being of subjects
•
absence of fraud and plagiarism
•
full disclosure of support, and
•
appropriate acknowledgement of assistance
•
that any breaches of the rules are reported to appropriate authorities
Physical therapists shall share the results of their research freely, especially in journals and conference presentations. Physical therapists in the role of employer shall: •
ensure all employees are properly and duly qualified, ensuring compliance with statutory requirements
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•
apply current management principles and practices to the conduct of the service, with particular attention to appropriate standards of personnel management
•
ensure implementation and monitoring of appropriate policies and procedures
•
ensures appropriate evaluation and audit of clinical practice
•
provide adequate opportunities for staff education and personal development based on effective performance appraisal
Ethical Principle 6: Physical therapists are entitled to a just and fair level of remuneration for their services Physical therapists should ensure that their own fee schedules are based on reasonable considerations. Physical therapists should attempt to ensure that third-party fee schedules are based on reasonable considerations. Physical therapists shall not use undue influence for personal gain.
Ethical Principle 7: Physical therapists provide accurate information to patients/clients, other agencies and the community about physical therapy and about the services physical therapists provide Physical therapists shall participate in public education programmes, providing information about the profession. Physical therapists have a duty to inform the public and referring professionals truthfully about the nature of their service so individuals are more able to make a decision about the use of the service. Physical therapists may advertise their services;. Physical therapists shall not use false, fraudulent, misleading, deceptive, unfair or sensational statements or claims. Physical therapists shall claim only those titles which correctly describe their professional status.
Ethical Principle 8: Physical therapists contribute to the planning and development of services which address the health needs of the community Physical therapists have a duty and an obligation to participate in planning services designed to provide optimum community health services. Physical therapists are obliged to work toward achieving justice in the provision of health services for all people.
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Evidence Based Practice The World Confederation for Physical Therapy (WCPT) believes that physical therapists have a duty and responsibility to use evidence to inform practice and to ensure that the management of patients/clients, their carers and communities is based on the best available evidence. Evidence should be integrated with clinical experience, taking into consideration beliefs and values and the cultural context of the local environment. In addition, physical therapists have a duty and responsibility not to use techniques and technologies that have been shown to be ineffective or unsafe. Evidence based practice (EBP) is facilitated by environments that embrace and promote it. Managers and organisations should provide appropriate support structures, resources, facilities and learning opportunities to ensure the delivery of highest quality care. Physical therapists should be prepared to evaluate practice critically. In addition, they need to be able to identify questions arising in practice, access and critically appraise the best evidence, and implement and evaluate outcomes of their actions. Relevant life-long learning activities are fundamental to evidence based physical therapy and should be introduced in entry-level physical therapy programmes and extended through continuing professional development opportunities. Collaboration both within the profession and with other professions or disciplines is vital to the delivery of evidence based practice. This collaboration needs to take place at a local, national and international level, to facilitate information sharing and best practice, and to capitalise on opportunities for collaborative work that minimise duplication. WCPT encourages its Member Organisations to develop partnerships and collaborations on projects relevant to EBP. WCPT and its Member Organisations call on the national governments and non-governmental organisations to facilitate and promote evidence-based healthcare – for example, through providing appropriate resources such as computers, internet access, on-line databases, libraries, and training in EBP skills.
th
Date adopted:
Approved at the 15 General Meeting of WCPT, June 2003. Revised and reth approved at the 16 General Meeting of WCPT, June 2007.
Date for review:
2011 Declaration of Principle: Research
Related WCPT Policies:
Declaration of Principle: Standards of physical therapy practice Declaration of Principle: Education
Copyright © World Confederation of Physical Therapy 2007
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Human Resource Planning The World Confederation for Physical Therapy (WCPT) believes that physical therapists have the responsibility, through their national associations, to work with governments and other agencies, to contribute to national human resource (workforce) planning. Such planning should aim to ensure a balance between demand and supply for physical therapists and a balance between qualified physical therapists and support personnel, to facilitate the best possible level of quality service/care for the community.
th
Date adopted:
Approved at the 13 General Meeting of WCPT June 1995. Revised and reth approved at the 16 General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Ethical Principles
Related WCPT Policies: Position Statement: Support personnel for physical therapy practice
Copyright © World Confederation of Physical Therapy 2007
Informed Consent The World Confederation for Physical Therapy (WCPT) expects that physical therapists will ensure that appropriate consent has been given before any physical therapy is undertaken. 1. A competent adult should be provided with adequate, intelligible information about the proposed therapy: •
a description of the intervention/treatment to be provided
•
a clear explanation of the risks which may be associated with the therapy
•
expected benefits from the therapy
•
anticipated time frames
•
anticipated costs
•
reasonable alternatives to the recommended therapy
2. The physical therapist should ascertain the ability of the patient/client to understand the above before seeking consent. 3. When the adult is deemed not competent or when the patient/client is a minor, a legal guardian or advocate may act as a surrogate decision maker. 4. Physical therapists should record in writing in their documentation that informed consent has been obtained. Physical therapists functioning in team situations are responsible for ensuring that appropriate consent arrangements have been made prior to their commencing therapy. Such collective consent, however, does not negate the physical therapist's responsibility for ensuring that the patient/client is properly informed about the physical therapy.
Date adopted:
Originally approved at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Patients’/clients’ rights in physical therapy
Related WCPT Policies: Declaration of Principle: Ethical principles
Copyright © World Confederation for Physical Therapy 2007
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Patients’/Clients’ Rights in Physical Therapy The World Confederation for Physical Therapy (WCPT) promotes: •
the respect of the patients’/clients’ dignity, integrity and self-determination
•
the protection of the legal status of the patient/client in connection with the health system and the physical therapist in particular
•
a relationship of confidence and reliance between the patient/client and the physical therapist
This declaration must be interpreted within the context of national laws and regulations and professional standards of practice. Physical therapists should also be aware of relevant international declarations and national laws in areas such as human rights, equal opportunity, racial and gender discrimination, privacy, freedom of information, workplace accidents and injuries. This declaration represents some of the principal rights of patients/clients, which the profession of physical therapy endorses and promotes. Principles 1. Patients’/Clients’ Right to Physical Therapy Services of Good Quality 1.1. Every patient/client has the right to: •
appropriate physical therapy services without discrimination
•
the services of a physical therapist who is free to make clinical and ethical judgements without any outside interference
•
the services of a physical therapist who is free to exercise professional judgement according to his/her education and experience
•
ask for a second opinion of another physical therapist at any stage
•
the right to be treated in accordance with his/her best interests
•
choose freely and change his/her physical therapist or health service institution, regardless of whether they are based in the private or public sector
•
advocacy if he/she is unable to speak on his/her own behalf
2. Patients’/Clients’ Right to Information 2.1 Every patient/client has the right to: •
adequate information upon which to base the decision to consent or refuse examination/assessment and intervention/treatment
•
decline examination/assessment and intervention/treatment at any stage without it prejudicing future management
•
receive information about himself/herself recorded in his/her health records and about practice policies, charges for services, physical therapy goals, desired outcomes and procedures which are being rendered
•
choose who, if anyone, should be informed on his/her behalf
•
discuss the physical therapy intervention/treatment options, including information about significant benefits, risks and side effects
•
receive information in a way that is comprehensible and appropriate to the patient’s/client’s values and cultural and religious beliefs
•
receive information about complaints procedures
•
complain and to have the complaint managed sensitively
3. Patients’/Clients’ Right to Informed Consent 3.1 Every patient/client has the right to: •
provide or withhold informed consent for the type and nature of physical therapy to be provided
•
know o the purpose of any examination or intervention/treatment o any risk associated with the proposed intervention/treatment o the expected benefit of the intervention/treatment o reasonable alternatives to the proposed intervention/treatment o the implications of withholding consent
•
self-determination including participation in decisions about the physical therapy interventions
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•
make free decisions regarding himself/herself with knowledge of the consequences of his/her decisions
4. Patients’/Clients’ Right to Confidentiality 4.1 Every patient/client has the right to: •
confidentiality of any information (eg, health status, diagnosis, prognosis, interventions/treatment, any other personal information) obtained from him/her unless explicit consent is given or expressly provided for in law
5. Patients’/Clients’ Right to Access to Data 5.1 Every patient/client has the right to: •
have access to all information kept by the physical therapist relating to them
•
be notified when their physical therapy data are transmitted to a data bank
•
have incorrect data corrected or destroyed
6. Patients’/Clients’ Right to Health Education 6.1 Every patient/client has the right to: •
health education that will assist him/her in making informed choices about personal health and about the available health services
•
continuity of health services.
7. Patients’/Clients’ Right to Dignity 7.1 Every patient/client has the right to: •
be managed with dignity
•
be treated courteously
•
privacy that shall be respected at all times in all physical therapy services
•
have his/her culture, values and religious beliefs respected
•
die with dignity
•
humane terminal care
Acknowledgements: In developing this document, WCPT consulted various documents from other regional and international organisations in particular: World Medical Association Declaration on the Rights of the Patient [Adopted by the 34th World Medical Assembly, Lisbon, Portugal, September/October 1981, and amended by the 47th WMA General Assembly, Bali, Indonesia, September 1995, and editorially revised at the 171st Council Session, Santiago, Chile, October 2005 http://www.wma.net/e/policy/l4.htm]
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Date adopted:
Originally approved at the 15th General Meeting of WCPT, June 2003. Revised to incorporates the Declaration of Principle: Rights of the client (1995) and approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Ethical principles Declaration of Principle: Standards of physical therapy practice Declaration of Principle: Quality services
Related WCPT Policies:
Declaration of Principle: Informed consent Position Statement: Standards of practice Endorsement: Rights of the child Endorsement: The United Nations Standard Rules on the equalisation of opportunities for persons with disabilities
Copyright © World Confederation for Physical Therapy 2007
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Primary Health Care Access to primary health care services is key to ensuring that health care/services are responsive to the needs of individuals, their carers and communities. The World Confederation for Physical Therapy (WCPT) advocates for the provision of primary health care that is mindful of local cultural, socio-economic and political circumstances and provides equitable access for all to effective services. WCPT supports an approach that is flexible and innovative in providing models of service delivery that offer care/service developed in response to local needs. WCPT recognises that there are principles of best practice that should be evident in any model of health services delivery and that these include, but are not limited to: •
health services are equally accessible to all
•
local communities and individuals are partners involved in health care/service delivery, planning, operating and monitoring
•
the model is developed in response to an assessment of local needs, mindful of the ethical use of resources
•
services are developed taking account of local cultural and social norms
•
multi-professional, inter-agency and inter-sectoral collaboration at all levels is advocated
•
in acknowledging the roles that different health care/services personnel are able to contribute to service delivery, where appropriate, physical therapists should contribute to their education and ongoing development
•
where appropriate, communities and individuals are supported to be self-reliant
•
while rehabilitation may be the area of greatest need, health promotion and disease prevention should also be addressed and treatment/intervention provided as necessary
•
relevant research and evaluation findings are implemented ensuring best practice
•
monitoring and evaluation of services is in place with mechanisms for review and modification
Physical therapists have an important role to play in primary health care as: •
direct and indirect providers of services
•
members of multi-professional teams
•
consultants to Government, Non-Governmental Organisations (NGOs) and Disabled People’s Organisations (DPOs)
•
developers, implementers and managers of services
•
educators of other health personnel and support staff
Physical therapy entry level education and continuing professional development opportunities need to adequately prepare and equip physical therapists to work in a variety of settings able to deliver care/services in both urban and rural communities, acknowledging their roles as facilitators and educators of other health personnel, necessary for the attainment of physical therapy and patient/client goals. Physical therapists and national physical therapy associations are encouraged to work with Governments, NGOs and DPOs to promote and facilitate the development of primary health care and the contribution of physical therapists, encompassing the four core elements of promotion, prevention, treatment/intervention and rehabilitation.
Date adopted:
Approved at the 15th General Meeting of WCPT, June 2003. Revised and re-approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011
Related WCPT Policies:
Position Statement: Community Based Rehabilitation
Copyright © World Confederation for Physical Therapy 2007
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Private Practice Physical therapy is an autonomous and independent profession. The World Confederation for Physical Therapy (WCPT) therefore believes that there should be no impediment to physical therapists entering into private practice; in which physical therapists deliver services to patients/clients in accordance with government laws, rules and/or regulations and in accordance with WCPT declarations of principle and position statements. Physical therapists in private practice can expect to receive just and equitable remuneration for their services. WCPT Member Organisations may be involved in negotiations on behalf of privately practising physical therapists.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995. Revised and re-adopted at the 16th General Meeting of WCPT June 2007.
Date for review:
2011
Related WCPT Policies:
Declaration of Principle: Autonomy
Copyright © World Confederation for Physical Therapy 2007
Protection of Title The professional names of physical therapy or physiotherapy, the titles physical therapist or physiotherapist and appropriate abbreviations (for example PT, FT, physio) as such or in any translation, are the sole preserve of persons who hold qualifications approved by national professional associations. The World Confederation for Physical Therapy (WCPT) claims exclusivity to these titles. Members of the public wishing to access the services of a physical therapist are entitled to know that recognised qualifications are held and that professional behaviour is governed by ethical codes. WCPT calls on the governments of Member Organisations to enact legislation, where it does not already exist, to protect the public by limiting the use of these titles to appropriately qualified persons. Furthermore, WCPT calls on the governments of Member Organisations to refrain from developing generic classifications that deny the specificity of physical therapy by ensuring that qualified physical therapists always have the right to be employed as physical therapists.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995. Revised and readopted at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Position Statement: Description of physical therapy
Related WCPT Policies: Position Statement: Regulation and reciprocity
Copyright © World Confederation for Physical Therapy 2007
Quality Services The World Confederation for Physical Therapy (WCPT) recognises that patients/clients, governments and third-party funding agencies have a right to expect that the care/services provided by physical therapists will be consistent with prevailing national quality standards. Quality care/service is optimal care/service at a reasonable cost, balancing patient/client, organisational and professional considerations. Optimal care/service embraces concepts of: •
equity
•
efficiency
•
effectiveness
•
appropriateness
•
acceptability
•
accessibility
•
availability
•
safety
To obtain this level of optimal care/service there is a need for: •
research
•
development of tools to facilitate evidence-based practice
•
implementation of evidence and effective change management
•
evaluation of practice structures, processes and outcomes
•
monitoring of efficiency, effectiveness and safety
•
measurement of patient/client satisfaction
National physical therapy associations must demonstrate leadership in quality through the development of practice standards and monitoring procedures. They also have a role to play in contributing to the development of multi- and uni-professional tools, such as clinical guidelines, designed to facilitate evidence based practice. This should involve seeking opportunities for international collaboration where appropriate.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995 and revised at the 15th General Meeting of WCPT June 2003. Revised and re-approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Standards of physical therapy practice Declaration of Principle: Evidence Based Practice
Related WCPT Policies: Declaration of Principle: Patients' / Clients' Rights in Physical Therapy Position Statement: Standards of Practice
Copyright © World Confederation for Physical Therapy 2007
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Relationships with other Health Professionals Physical therapists are active members of multi-professional teams, working in partnership with other health professionals to provide patient/client management/services. The World Confederation for Physical Therapy (WCPT) expects physical therapists to have an adequate understanding of the role and function of the other professions, appreciating the core differences as well as the common features. It is the responsibility of the national physical therapy association, as well as individual physical therapists, to have strategies in place that explain the role and function of physical therapy, to demonstrate the efficacy of physical therapy, and to market physical therapy adequately and appropriately. In a growing number of countries, physical therapy has first contact status, a referral from a medical practitioner not being required, legally or ethically, before physical therapy services are provided. When a medical referral is legally or ethically required to initiate physical therapy services, the referral should contain essential medical information. Physical therapists are also able to take referrals from other health professionals. Whether a referral is required or not, physical therapists are qualified and professionally required to undertake a comprehensive examination/assessment of the patient/client, formulate a physical therapy diagnosis, plan and implement a therapeutic intervention/treatment programme where appropriate, evaluate the outcome of any intervention/treatment, and determine discharge arrangements. Physical therapists should have adequate policies and procedures in place for appropriate communication with the patient’s/client's medical practitioner and other relevant health professionals to ensure necessary consultation and to provide accurate documentation and reports.
Date adopted:
Approved at the 16th General Meeting of WCPT, June 2007. Replaces two previous Declarations of Principles on relationships with medical practitioners and relationships with other health professionals, both approved in June 1995 at the 13th General Meeting.
Date for review:
2011 Declaration of Principle: Primary Health Care
Related WCPT Policies:
Declaration of Principle: Autonomy Position Statement: Description of Physical Therapy
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Research The World Confederation for Physical Therapy (WCPT) sees the generation of evidence through research as essential to the development of evidence-based practice in physical therapy. Research in physical therapy should encompass all domains that impact on the practice of physical therapy and patient/client care. This includes, but is not limited to: basic science, diagnosis, specific interventions and technologies, 2 service delivery and organisation of care models/systems, economic analysis, development of outcome measures, educational approaches, social-anthropological studies, and health care policy. The most appropriate methods of enquiry should be used to address the topic for research. Research is required that demonstrates clinical and cost effectiveness. It may be necessary to develop and validate new methods of research. Collaboration is critical to the success of any research efforts, and the process should include all those who can make a valuable contribution with respect to the initial concept, design, planning, execution, analysis and dissemination. Collaboration is vital within the profession and with other professions or disciplines, as well as with consumers. It needs to take place at the local, national and international level. Physical therapists have a responsibility to promote research efforts and to share freely the results of such research through a range of dissemination routes including databases, publication in appropriate professional journals, conference presentations, electronic media and the national press.
2
Healthcare technology is defined by the International Network of Agencies for Health Technology Assessment (INAHTA) as “prevention and rehabilitation, vaccines, pharmaceuticals, and devices, medical and surgical procedures, and the systems within which health is protected and maintained.”
Date adopted:
Approved at the 15th General Meeting of WCPT, June 2003. Revised and reapproved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Evidence Based Practice
Related WCPT Policies: Declaration of Principle: Education
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Standards of Physical Therapy Practice The World Confederation for Physical Therapy (WCPT) recognises the absolute importance of the development and documentation of agreed standards for the practice of physical therapy. These standards are necessary to: •
demonstrate to the public that physical therapists are concerned with the quality of the services provided and are willing to implement self-regulatory programmes to maintain that quality
•
guide the development of professional education
•
guide practitioners in the conduct and evaluation of their practices
•
provide governments, regulatory bodies and other professional groups with background information about the professional nature of physical therapy
•
effectively communicate with members of the profession, employers, other health professions, governments and the public
WCPT recognises the diverse social, political and economic environments in which physical therapy is practised throughout the world. Thus, specific standards for physical therapy practice must be developed by each member organisation to suit prevailing circumstances. Where political environments dictate, national associations may unite to formulate agreed standards that may be applicable to that group. The following principles should be considered in the process of developing standards: 1. reflect the values, conditions and goals necessary for the continuing advancement of the profession 2. based on valid principles and be measurable to the extent possible 3. designed to assist the profession to meet the changing needs of the community 4. based upon clear definitions of the scope of practice and accountability
5. sufficiently broad and flexible to achieve their objectives and, at the same time, permit innovation, growth and change 6. subject to regular review with revision as required
National practice standards should be set in the following areas: •
administration and practice management
•
communication
•
community responsibility
•
documentation
•
education
•
ethical behaviour
•
informed consent
•
legal
•
patient/client management
•
personal/professional development
•
quality assurance
•
research
•
support personnel
Date adopted:
Approved at the 13th General Meeting of WCPT June 1995 and revised at the 15th General Meeting of WCPT June 2003. Revised and re-approved at the 16th General Meeting of WCPT June 2007.
Date for review:
2011 Declaration of Principle: Quality Services
Related WCPT Policies: Position Statement: Standards of Practice
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Torture The World Confederation for Physical Therapy (WCPT) believes that: 1. Physical therapists shall not countenance, condone or participate in the practice of torture or cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife. 2. Physical therapists shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment. 3. Physical therapists shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment are used or threatened. 4. The physical therapist's fundamental role is alleviating distress of his or her fellow human beings, and no motive whether personal, collective or political shall prevail against this higher purpose. 5. The practising physical therapist should understand the general and specific neurological, musculoskeletal and psychological dysfunction which can be expected to appear as the effects of physical and psychological torture, as well as of appropriate functional assessment and treatment procedures for survivors of torture. 6. Education regarding the prevention and prohibition of torture as well as the assessment and treatment of torture victims should be included in the curriculum for entry level and continuing physical therapy education programmes. The World Confederation for Physical Therapy will support and encourage the international community, its member organisations and fellow physical therapists to support the physical therapist and physical therapist's family in the face of threats or reprisals resulting from a refusal to condone the use of torture or other forms of cruel, inhuman or degrading treatment.
Date adopted:
First adopted at the 13th General Meeting of WCPT June 1995. Revised and re-approved at the 16th General Meeting of WCPT June 2007
Date for review:
2011 Declaration of Principle: Ethical principles
Related WCPT Policies: Declaration of Principle: Patients’/clients’ rights in physical therapy
Copyright © World Confederation for Physical Therapy 2007
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