CAPP Courses are Now Open to Physical Therapist Assistants!

Recognizing the Critical Role of PTAs In Pelvic Health Rehabilitation

The Board of Directors of the Section on Women’s Health has been evaluating the role of the physical therapist assistant (PTA) in pelvic health practice. Historically, SOWH pelvic health courses have been open only to physical therapists due to the ongoing evaluation and assessment involved in internal pelvic examinations.

However, the board now recognizes that PTAs both have an important role to play and a benefit to receive from the education their PT colleagues receive. During APTA’s 2016 Combined Sections Meeting, we voted unanimously to accept a new PTA Education Statement recognizing and inviting PTAs to participate in Section courses as a vital part of the PT/PTA pelvic health rehabilitation team.

We hope PTAs will attend any of our 24 courses in 2016—including all CAPP-Pelvic and CAPP-OB courses–for education and training that prepares them for this role. Access to the Section’s Collaborative Courses (those unrelated to the CAPP courses) will be determined on an individual basis and in conjunction with the particular instructor and owner of that material.

PTs and PTAs who comprise a pelvic health team are trusted with following their own state practice act and licensing regulations in regards to scope of practice. However, we have developed guidelines regarding the role of the PTA in pelvic health rehabilitation to assist teams who want SOWH help in defining roles. The entire PTA Education Statement is listed below.

The Section on Women’s Health (SoWH) Physical Therapist Assistant (PTA) Education Statement

The Section on Women’s Health (SoWH) invites Physical Therapist Assistants (PTA) to participate in the continuing education courses in the pelvic and pregnancy series (CAPP or Certificate of Achievement in Pelvic/Pregnancy). Participation for PTAs will include successful completion of lab skills testing and written examinations.

Currently, the “CAPP” designation may be achieved by PTs. While PTAs are encouraged to attend CAPP courses, the CAPP designation remains for the practitioners (PTs) who will perform evaluative activities with patients/clients.

The intent of the CAPP courses is to provide a greater knowledge base for the PTA who is working in pelvic health. While the courses include a significant portion of evaluation content, the Section believes that the PTA working in this field benefits from understanding the evaluative components provided by the PT.

In opening courses to our PTA colleagues, SOWH understands that PT/PTA pelvic health teams would desire guidance on appropriate PTA utilization. Thus, the Section is providing the following six statements regarding PTA practice in pelvic health:

1. Internal pelvic intervention often requires continuous evaluation and assessment. Thus, some patients may not be appropriate candidates for a PTA due to the need for ongoing assessment during interventions.

2. It is the responsibility of the PT to recognize patients/clients with conditions that require ongoing assessment and evaluation. In these cases, the PT should abstain from delegating these patients/clients to a PTA.

3. Patients/clients with pelvic health (obstetric, gynecologic, urologic, and gastrointestinal) conditions may have sensitive diagnoses and/or psychosocial considerations that would benefit best from care from a consistent health care provider. Thus, delegation to PTAs for some of these patient/clients should be avoided or managed in such a way to promote patient trust, satisfaction, and adherence.

4. It is the responsibility of the PT to exercise judgment as to whether a patient/client’s condition or psychosocial health requires an elevated level of sensitivity that may preclude or limit delegation to a PTA.

5. The SOWH trusts the PT and PTA to know, understand, and adhere to state practice acts and any rules/regulations that govern that PT and PTA’s professional license in relation to working with patients/clients with pelvic health conditions.

The SOWH also acknowledges that many PT/PTA teams would like guidance and examples on appropriate PTA utilization. Thus, the SoWH is providing the following suggestions on interventions that may be appropriately delegated. This is NOT intended to supersede PTA licensure rules and regulations, nor is this intended to be an inclusive list. However, consider this list as a resource for developing PT/PTA pelvic health team collaboration.

With appropriate delegation, PTAs would likely provide the following within the PT’s plan of care:

• Biofeedback intervention and progression
• Electrical stimulation intervention for the pelvic floor
• Internal pelvic floor muscle techniques that do not require ongoing assessment/evaluation
• External pelvic floor muscle exercise
• Education of pelvic floor muscle home exercise program
• Intervention with vaginal weights
• Intervention with vaginal dilators
• Behavioral intervention for bowel and bladder
• Internal pelvic floor tests and measures

SOWH has developed the above statements and guidelines in correlation with the American Physical Therapy Association (APTA) statement on PTA practice.

The APTA states the following:

“Physical therapist assistants (PTAs) are educated and licensed clinicians that work under the direction and supervision of a physical therapist to improve your mobility and help you move forward.

PTAs must complete rigorous academic and clinical education associate degree programs; pass a national licensure examination; and be licensed or certified by the states in which they work (the exception is Hawaii, where there is no licensure/certification for PTAs).

Working closely with the physical therapist, they may provide components of your care such as therapeutic exercise, functional training, deep soft tissue massage, and physical modalities such as electrotherapy and ultrasound. PTAs may also provide instruction in exercise, proper body mechanics, and other injury prevention and wellness topics.

PTAs work with physical therapists to treat patients of all ages who have medical problems or other conditions that limit their abilities to move and perform functional activities in their daily lives. They work in all settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes.”

(Reference:  http://www.moveforwardpt.com/aboutptsptas/default.aspx#.VnRi3bSZ6fQ accessed 12-18-15)

An additional resource regarding appropriate PTA practice: http://www.apta.org/PTA/PatientCare/

Author: Lora Ann Mize, PT, DPT, WCS is a board-certified specialist in women’s health and pelvic floor physical therapy. Mize has worked as a clinician in the profession 10 years and is an SOWH instructor in the area of pelvic health, as well as director of education for SOWH. An assistant professor at Lynchburg College Doctorate of Physical Therapy Program.