Saturday, May 28, 2022

Responses to Physical Therapist’s Involvement

Robert Schiff

Hello Listserve,
Thanks for the responses…I will post any more that I receive at a = later date. The overwhelming majority was ABSOLUTELY NOT!!! I was glad = to see this. Thank you for your input. Here is a summary of the first = day’s responses. I will also repost the original inquiry.

Robert Schiff C.P.O., L.P.O.

Original Inquiry:
I would like to know other prosthetist’s opinions about physical = therapists making actual adjustments to prosthetic devices. In = particular, what would your feeling be if a therapist wanted to make an = actual adjustment to the prosthesis with allen wrenches (i.e. flexion, = extension, toe out, abduction, adduction), would you be comfortable with = this? To take in a little further, would you instruct the therapist on = how to make these adjustments if he or she needed to?

For those answering YES they would feel comfortable with this and=20 would instruct the therapist:

What are your feelings of liability with respect to a component = failing. Who is liable if the therapist adjusted something and did or = did not put loctite. Does=20
your relationship with the therapist have any bearing on = your decision or would you just instruct any therapist? Are you doing =
this to remain on good terms with that therapist?

For those answering NO they would not feel comfortable with this = and=20 would not instruct the therapist:
Why wouldn’t you? Is it a feeling of therapist infringment on = our scope of practice? Is it lack of trust? Or do you just feel that = it is just not their job. Would=20
you be more inclined to instruct a therapist that you have = known for 5 years how to make adjustments? 10 years? 20 years?

All input would be appreciated and confidentially posted on the = listserve.

Thanks

Responses:
More important….what if the patient lived 100 miles from the O&P shop = and=20 only 5 miles from the their PT

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I always like to make the adjustments myself and talk with the PT if needed.

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No. Good therapists will tell you that they are not trained for this = and smart ones will tell you they are not comfortable with it. I am = thankful for the pleasure of working with many talented therapists who = prefer to work as a team instead of stepping on each others toes or = undermining other professionals. As a side note, we aslo work in a = state where a jury awarded millions for a bad paint job on a car. CYA, = baby.

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NO.
At that point they are overstepping their scope of practice as defined = by their licensure.
I would very kindly, but very pointedly advise them that THEY will = assume PRODUCT LIABILITY from the point that THEY adjust that device and THEY = will absolve me of liability for it from that point forward. And if they persist.. Hand ’em the allen wrenches, bending irons and plumb = bobs…and the phone book to refer them an attorney.
Recently Al Pike made the observation that every prosthetist has = received basic training in amputee “gait training”. Where are we as prosthetists overstepping OUR bounds?

I recently had a patient transfer to our area – 61+ yo female 4yrs s/p = BKA PVD with established hip and knee flexion contracture (15%+) bilateral rotator cuff syndrome with corresponding stride length assymetry, trenedelenburg and LBP. Was I wrong in advising her to maintain a = stretching program? instructing her to prone? strengthen gluteals? and maintain = knee extension will seated to stretch hamstrings while watching TV? Am I, = since I am in a non licensed state subject to malpractice? I did refer her out = to PT…in a capitated environment… she was provided with….two visits = by her health plan – first as assessment, second to provide a home program = and self directed stretching. At the second visit she was provided with instruction sheets by a PT assistant. The visit lasted 35 minutes. The = PTA was unsure whether to do the exercise with or without the prosthesis. = She (the patient) called me to ask for guidance…

Never a dull moment.

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