Dear Academy of Pelvic Health Physical Therapy Members,
Since the recent publication of the Position Statement on the Use of Chaperones, the Academy has received a number of concerns, questions, and editorial suggestions from members from across different practice settings. The Academy is providing the following information in a question-and-answer format to provide clarity on the position statement development process, address legal and financial concerns, and provide the future outlook for position statement development.
Chaperone Position Statement Membership Q & A
Q. What is a Position Statement?
The American Physical Therapy Association (APTA) defines position statements as documents intended to communicate best practices for physical therapist practice and are not intended to limit the development of innovative approaches to physical therapist practice in the evolving health care system. A Position Statement does not carry the force and effect of law but is adopted as a means of providing direction on issues of the profession typically initiated by members. They are used to help guide the profession and are often relevant to public protection.
The Academy, a component of the APTA, publishes Position Statements as a service to its Academy members. The information contained in any Academy Position Statement is neither exhaustive nor exclusive to all circumstances or individuals. Position Statements are not peer-reviewed, nor submitted to the Academy membership for approval. Position Statements do not define or establish a community standard. They are not intended to, nor should they be used to support a cause of action, create a presumption of a breach of legal duty, or form a basis for civil liability. Position Statements are often mistakenly referred to as Clinical Practice Guidelines (CPG) however they are not synonymous with one another and do not carry the same rigor as CPGs.
Q. Who is involved in developing a Position Statement?
The member-elected Academy Board which represents members across various practice settings approves position statements. The Board may charge the Position Statement Representative of the Practice Committee to develop a position statement or may establish a task force if needed to investigate, conduct research, and develop a position statement. As elected members of the organization, the Academy Board provides direction, input, and final approval on position statements.
Q. Was there a prior Position Statement on the Use of Chaperones?
The Academy did not have a formal position statement on the use of chaperones previously, but there was an informal document titled “Second Person in the Room” that was written over 10 years ago in response to questions from members at the time. Over the last few years, Academy members requested more robust guidance on the use of chaperones, thus identifying a need for the Academy to develop an official position statement.
Q. What processes were involved in the development of the Position Statement?
The Academy has an appointed Practice Committee which includes a Position Statement Representative who began the process of developing a new position statement on the use of chaperones at the request of the Director of Practice. The process involved gathering information on best practices concerning the use of chaperones. An extensive article review on the use of chaperones was performed based on information from other medical professional groups that have led on this issue. There was no literature referencing chaperones in pelvic floor physical therapy (PFPT), similar to how there was no position statement prior to APHPT’s statement regarding internal exams performed by PFPTs. Once the draft statement was developed, it was reviewed by the Academy’s Board of Directors over several months for additional edits and feedback followed by consultation with the APTA Practice department which also provided input before the position statement was finalized and unanimously approved by the Academy’s Board for dissemination to members. The Academy’s Board is composed of member-elected clinicians from a variety of practice settings including but not limited to private practice, hospital, and DPT program settings. Academy Board members serve as elected representatives of the membership and also as appointed liaisons to the Academy’s committees and volunteer groups across research, education, community, operations, and practice sectors.
Q. Is the Position Statement a legal mandate?
The position statement is not a legal mandate, the position statement is a best practice guideline for members. Physical therapy professionals can choose whether or not to adopt the guidelines to their specific practice setting and size. The purpose of the position statement was to reference best practices from other professional organizations and detail three options to address the use of chaperones, how to document practice choice, and how to handle patient requests to have a family member present in lieu of a chaperone. The guidelines are provided to help the clinician in decision-making using best practices of other health professional organizations such as the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) which perform internal exams. The position statement addresses trauma-informed care and includes guidelines if the patient declines a chaperone or chooses a family member.
Q. Is the position statement legally admissible in a court of law?
It is true that codes and standards of professional societies can be admissible as evidence of a standard of care. They do not establish a standard of care, however, and they can be rebutted, such as by expert testimony. However, not every pronouncement by a professional society is even admissible as evidence. A court may weigh the extent to which the statement is sufficiently authoritative, such as by virtue of being the result of a consensus process or based on analysis and consideration of actual evidence. Disclaimers of an intent to establish a standard of care or for the statement to be used in litigation can also be effective.
The Academy does not provide legal advice on clinical issues and refers members to their attorney, institutional risk department, or specific state Practice Act. Legal risk has always been present for our members that perform sensitive examinations, including internal pelvic exams. This document does not change that risk. It is the Academy’s role to provide guidance in practice in order to allow our members to determine what should be implemented in their practice and seek appropriate legal, institutional, or state Practice Act counsel as they feel necessary.
Q. What is the financial implication of this Position Statement?
It is the clinic’s choice whether or not to provide a staff member as a chaperone, and just like any staff duties, the guidelines recommend that training is documented. We should be documenting the competencies of all our staff, and this should be no different. The Academy does not provide financial advice, including the cost of training staff for duties that a clinic chooses to provide.
Q. What is next for the Use of Chaperones Position Statement?
Since publishing the position statement, the Academy Board has received extensive feedback from members and has decided to conduct a subsequent editorial review of the position statement. Over the course of the next few weeks, editorial changes to the position statement will be made; while maintaining the position that offering the option of having a chaperone to our patients, whether the chaperone is a staff member or a family member or friend, is recognized as best practice. This and all Academy position statements will also include legal disclaimers. In addition, resources and references may be created and added based on the collective feedback the Academy has received from members and committees.
Q. What will the future process of Position Statement development look like?
A clear definition of what a position statement is will be listed on the website and a consistent legally-vetted disclaimer will be added to all Academy position statements to help address legal concerns from members. The Academy Board is already developing a process for the development of future position statements that will include a 30-day comment period modeled after the Academy’s Clinical Practice Guidelines comment process as we recognize the importance of member feedback when developing such statements. Once the process is finalized and adopted, the written details of the process will be shared with members on the Academy website after CSM to set a new precedent for the development and dissemination of future position statements. These processes will be vital to the foundational infrastructure and growth of the Academy’s newly added Practice & Advocacy pillar and the development of future position statements.
We appreciate our members for sharing feedback, concerns, and questions with the Academy Board. We hope we were able to provide clarification regarding the position statement process and our next steps. If you have additional input you would like to share, we invite you to submit your additional comments and questions using our dedicated form below.
Board of Directors
APTA Pelvic Health