The following is a summary of current NC PT Board position statements regarding clinical matters. The complete position statements can be found at https://www.ncptboard.org/app/LandingPages/ScopeOfPracticeHome.php
Is dry needling connective tissue within the scope of PT practice?
Dry needling techniques that use PT procedures with assistive devices for the purpose of correcting or alleviating myofascial pain are within the scope of PT practice in North Carolina. The PT Board has noted that dry needling is an advanced skill for which training beyond entry level education is required. It is incumbent upon the licensee to obtain the appropriate training and be competent to perform dry needling.
Therapists need to assess their own competence after obtaining advanced training prior to performing dry needling on patients. Certification is not currently required by the Board. If a licensee has not obtained advanced training, he or she would not be considered to meet the requirements noted above.
Dry needling courses are currently approved per the continuing competence rules.
Is blood flow restriction training part of the scope of practice of PT in North Carolina? How does this ruling apply to a PTA?
Blood flow restriction training is within the scope of PT practice in North Carolina because it is an advanced skill being taught in entry level PT education, taught routinely in continuing educational programs and routinely performed nationally in PT practice. It is incumbent upon the licensee to obtain the appropriate training and education to be competent to perform this technique in a manner that is considered safe and effective for the patient.
If the technique does not require an evaluation, it may be delegated to a PTA who has the education/training and competence to perform the technique. It is incumbent upon the PT to assure that the PTA always works under the supervision of a PT, the PT delegates only portions of the plan of care that are safe and effective for the patient and the PTA is trained to perform.
Is musculoskeletal ultrasound within the scope of PT Practice in NC? Can musculoskeletal ultrasound be used to guide needle placement when performing dry needling?
No. The standard for making this determination is contained in Board Rule 48C.0101(a). The Board determined that the standards of Board Rule 48C.0101(a) are not met at this time. Therefore, the use of musculoskeletal ultrasound for diagnostic purposes or guiding needle placement during dry needling and PT documentation requirements is not currently within the scope of PT practice in North Carolina. Further, clients receiving this technique should not be advised or led to believe they are receiving PT.
If new or additional information is provided to the Board regarding where this is taught in entry-level or continuing education and is routinely practiced by physical therapists, it will review the new information and make a determination.
Is Radial Pressure Wave treatment in the PT scope of practice in North Carolina?
No. The standard against which the question must be analyzed is contained in Board Rule 48C.0101(a) (see footnote 1). At this time, the Board was unable to determine that Radial Pressure Wave treatment satisfies the standards of 48C.0101(a) based on the information reviewed. If new or additional information is provided to the Board regarding where this is taught in entry-level or continuing education and is routinely practiced by physical therapists, it will review the new information and make a determination.
Are PTs allowed to cast patients with rigid cast material?
No. The standard against which the question must be analyzed is contained in Board Rule 48C.0101(a) (see footnote 1). At this time, the Board was unable to determine that PTs casting patients with the use of rigid cast material satisfies the standards of 48C.0101(a). If new or additional information is provided to the Board regarding where this is taught in entry-level or continuing education and is routinely practiced by physical therapists, it will review the new information and make a determination.
Can PTAs perform manual lumbar spine traction using a mobilization belt as part of their scope of practice?
No. The standard for making this determination is contained in Board Rule 48C .0101(a) (see footnote 1). After review of the information available on this topic and discussion by the Board, the Board determined that that the standards of 48C.0101(a) are not met at this time. Therefore, the use of manual lumbar traction is not currently within the scope of practice for a PTA in North Carolina.
Is it legal for a PTA to perform gait training if the PT did not assess it, but it is listed in the plan of care, there are gait training goals, and it was delegated to the PTA to perform?
The NC Board of PT Examiners noted that a patient’s ambulatory status is usually included as part of a PT evaluation if the patient is physically and mentally able to participate. If the physical therapist has performed an evaluation and created the plan of care and goals, delegation of a portion of that plan to the PTA is allowed. In some cases, a PTA progressing a patient to ambulation may be considered a major modification. However, there may be other cases that it would not. For example, there may be times that a physical therapist could evaluate a patient who is not quite ready to ambulate (such as a patient with ankle surgery who is still a little groggy from anesthesia), so the therapist cannot perform a “gait evaluation”; however, due to the patient’s prior functional status, diagnosis, physical condition, setting, experience of PTA, and the working relationship between the PT and the PTA, the PT feels comfortable having the PTA progress the patient to gait training without performing an “official gait evaluation” (based on the patient’s age, strength, sitting balance, etc.). Ultimately, the decision and responsibility to make this determination is up to the judgment of the physical therapist who performed the evaluation, which should always include patient safety at the forefront of the treatment goals and plan of care. If the PT feels that a gait evaluation needs to be performed before the PTA initiates gait training, then the PTA should follow the direction of the PT.
For a PTA, failure to follow the direction of the PT may be considered practicing beyond the scope of practice and could be a violation of the Practice Act and Board Rules. If the PTA has received direction to begin ambulation with a patient yet believes that upon seeing the patient it would not be safe or effective for that patient, the PTA should not begin the intervention. The PTA is responsible for communicating the status of the patient to the PT if the PTA believes there may be an adverse event and may make minor modifications to the treatment plan consistent with the plan of care. Whether the PT sees the patient for reassessment is up to the PT. Although the PTA is trained to assist the PT and generally does what the PT delegates, the PTA must still rely on his/her own judgment and training regarding safety and standards of care. If the patient is injured, the PTA’s license might be in jeopardy similar to the PT’s. PTAs should document communications with the PT regarding recommended actions and notate “per the PT.”
1 Physical therapy is presumed to include any acts, tests, procedures, modalities, treatments, or interventions that are routinely taught in educational programs or in continuing education programs for physical therapists and are routinely performed in practice settings. 21 NCAC 48C.0101(a).
