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Physical therapy in the United States evolved from its technical roots in the early 20th century to its current level of development, it is expected that a critical mass of practicing clinicians will have a Doctor of Physical Therapy degree by 2025 (APTA, 2014). The demands on the physical therapist to collaborate and practice as part of the inter-professional team continue to grow requiring further development and refinement of clinical skills. These clinical skills include the skills in ethical decision making that we will concentrate on in this text.

The roots of physical therapy go all the way back to 400 bc when Hippocrates and Galen advocated for treatment that included massage, manual therapy, and hydrotherapy. In the 18th century, orthopedists employed exercise as part of their treatment. In 1813, the Royal Central Institute of Gymnastics was founded in Sweden and therapeutic exercise became part of medical practice. In 1887, Sweden started registering practitioners of “physiotherapy.” In 1894, four nurses founded the Chartered Society of Physiotherapists. In 1913, the New Zealand School of Physiotherapy was founded, and in 1914, the first cohort of reconstruction aides the precursors to physical therapists graduated in Reed College in the United States. In 1921, the professional association was founded, which would become The American Physical Therapy Association.

Physical therapy grew rapidly as two world wars. Polio, a major pandemic, threatened the lives of many, yet those lives were spared with the help of major medical advancements, including the development of antibiotics, safer blood transfusions, improvements in infection control, and surgical innovations, which saved people on the battlefield, and at home, leaving them alive but with disabilities to conquer. Health care continued to develop through the 1950’s, though it was physician centric physical therapy continued to evolve. In the 1960s, the culture was to question and distrust authority, and medicine was not immune to that mentality resulting in further development of ancillary services and alternative healthcare treatments. People began to take more responsibility for their own healthcare needs.

The relationship of provider and patient/client continues to evolve as information available to individuals to manage their own healthcare continues to grow in quantity and availability.

The patient therapist trust relationship is based on three pillars. Trust is required of both the PT and the patient. The relationship is based on three, foundational concepts that are the bedrock that secures the trust the patient has in the therapist. The three pillars that uphold Trust are Transparency, legitimacy and effectiveness, Transparency insures the patient that the clinician is clear and honest in their motivations and actions. Legitimacy insures the public that the body of knowledge upon which PT is based is grounded in evidence and finally effectiveness requires that the PT demonstrates initial competence and consistently maintains the knowledge base necessary to be a safe and effective clinician throughout their professional career. See (Figure 2-1).


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