A physical therapist treats a patient with a tibial plateau fracture that is currently partial weight bearing. During the treatment session, the physical therapist asks the physical therapist assistant to instruct the patient to ascend and descend stairs using bilateral canes. Assuming the patient falls during the training session, which individual would be MOST liable for the incident?

1. Physical therapist
2. Physical therapist assistant
3. Patient
4. Referring physician

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

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A physical therapist treats a patient with a tibial plateau fracture that is currently partial weight bearing. During the treatment session, the physical therapist asks the physical therapist assistant to instruct the patient to ascend and descend stairs using bilateral canes. Assuming the patient falls during the training session, which individual would be MOST liable for the incident?

1. Physical therapist
2. Physical therapist assistant
3. Patient
4. Referring physician

The first thing that I would like to determine in this scenario is – Did the physical therapist make an appropriate delegation to a qualified practitioner (i.e., physical therapist assistant).

There is no question that instructing a physical therapist assistant to train a patient to ascend and descend stairs using an assistive device is within the scope of practice of a physical therapist assistant.

However, we also need to dive a bit deeper to determine if a patient that is partial weight bearing is permitted to use bilateral canes. The answer to this question is absolutely no!

Why? Because bilateral canes are designed to promote balance and do not alter weight bearing status. An assistive device such as axillary crutches, Lofstrand crutches, or a walker would be appropriate for a patient that is partial weightbearing.

In my opinion, it seems like there is plenty of liability to go around. Our objective is to identify the individual who is most liable.

Let’s explore each of the options:

Option 1 - Physical therapist
The physical therapist would be liable for the incident since bilateral canes do not permit partial weight bearing and this action likely contributed to the adverse event during the training session.

Although the physical therapist was not directly involved at the time of the incident, the delegation of an inappropriate intervention results in the physical therapist assuming primary liability.

Option 2 - Physical therapist assistant
A physical therapist assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy services. Physical therapist assistants are able to instruct patients in ascending and descending stairs with an appropriate assistive device. However, based on the patient’s current weight bearing status the use of bilateral canes is inappropriate.

Although the physical therapist assistant will share in the liability, the physical therapist would remain the most liable based on the inappropriate delegation.

Option 3 - Patient
The patient would not be liable for the incident since it’s unreasonable to expect that a patient would possess the requisite knowledge to recognize that bilateral canes were an inappropriate assistive device for their prescribed weight bearing status. Simply not realistic.

Option 4 - Referring physician
There is no evidence to support the belief that the patient was inappropriately referred to physical therapy by the referring physician or that the patient’s weight bearing status was not clearly communicated in the referral.

The Code of Ethics for the Physical Therapist indicates that “Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient/client values.” The described scenario clearly indicates that the physical therapist did not demonstrate professional judgment by having a patient that is partial weight bearing use bilateral canes.

The correct answer is Option 1

Let’s explore the all student data:

70% of students selected Option 1, physical therapist - the correct response
26% of students selected Option 2, physical therapist assistant
2% of students selected Option 3, patient
2% of students selected Option 4, referring physician

System Classification
The question is a Non-Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is a Safety and Protection; Professional Responsibilities; Research and Evidence-based practice question which represents approximately 8% of all exam items.

Level Classification
This question is a Level 3 question since the question requires candidates to systematically analyze and often interpret information to determine an appropriate course of action. The questions tend to have some degree of subjectivity and candidates are required to assign varying degrees of importance to different variables. Remediation of Level 3 questions occurs by continuing to refine decision making processes when answering examination questions and differentiating between good, better, and best options.

Academic Focus Area
Looking to review related academic content? Pages 805-807 from our review book PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week.

Watch the video version of this Q&A episode on YouTube - https://youtu.be/YnGXE87dHGo.