Introduction: What to Expect on the NPTE: Content Outline, Examination, Administration, and Format

The National Physical Therapist Examination (NPTE) is a 225-question, 5-hour multiple-choice examination designed to equitably test all candidates for entry-level knowledge of content and safety aspects in physical therapy to ensure only individuals who have the requisite knowledge in physical therapy can earn licensure to practice physical therapy. The focus of the exam is on clinical application of knowledge, concepts, and principles necessary for the provision of safe and effective patient care. The examination is created and delivered through the Federation of State Boards of Physical Therapy (FSBPT). The NPTE is only one part of the evaluation process by licensing authorities. In some jurisdictions, the NPTE is supplemented by other means of accessing a candidate’s ability to practice physical therapy. For more information on each jurisdictional licensure requirements, see the FSBPT licensing authorities contact information at https://www.fsbpt.org/Free-Resources/Licensing-Authorities-Contact-Information. Additional information regarding the examination and registration can be found at the FSBPT website: www.fsbpt.org. Frequently asked questions about taking the exam can be found at https://www.fsbpt.org/Free-Resources/NPTE-Candidate-Handbook/Taking-the-Examination.

The examination is 5 hours in length and comprises the following:

• 225-multiple-choice question examination, over 5 hours provides you approximately 80 seconds (1.33 minutes) per question.

• The examination is split into five separate sections of 45 questions. Once a 45-question section is submitted, the candidate cannot return to those questions.

• 185 questions will be text, graphics, or video based. Forty questions will be scenario based.

• One hundred eighty items are scored, 45 are unscored pretest questions and will not be included in the final calculation of the score. Candidates will not know which questions are pretest questions, and they will be embedded throughout the examination.

• Scenario-based questions will have a standard set of headings for most questions including setting, sex, age, presenting problem/current condition, medical history, other information physical examination(s), and physical therapy plan of care.

• Video questions average around 9 seconds but can be longer and have no sound. The candidate can change the video so it will replay, loop, pause, step forward, or step backward. They can also alter the video speed. The candidate is encouraged to loop the video at the beginning of the question.

• Lab values will not have reference ranges alongside and will be focused on the impact on the physical therapy plan of care and patience response.

• Commonly used medications within questions will be referred to the generic or brand names of the medication. See Appendix D for a list of generic and brand names of commonly used medications in the United States.

• NEW Knowledge and Skills Required for 2024 NPTE! Regenerative medicine for musculoskeletal and neuromuscular conditions (eg, platelet-rich plasma, stem cell therapy) and the provision of Telehealth.

• NEW PT Work Activities for 2024 NPTE! Taping for edema management, interpretation of electrodiagnostic test results, gross motor development progression, telehealth, and negative pressure knowledge and skills have also been added.

• A “scheduled” 15-minute break is allowed after the second section of the exam. Candidates may also take unscheduled breaks following the other sections of the exam, but time taken for unscheduled breaks will be deducted from the overall exam time.

• Abbreviations that have been approved for use on the NPTE can be found at https://www.fsbpt.org/Free-Resources/NPTE-Candidate-Handbook/Abbreviations-and-Medical-Terminology. A thorough review is recommended.

• It is highly recommended that you complete the NPTE demonstration examination provided by the FSBPT, which is located on the FSBPT website at https://www.fsbpt.org/Secondary-Pages/Exam-Candidates/National-Exam-NPTE/Prepare-for-Exam/NPTE-Demo-Exam. This short exam demonstration includes a tutorial to navigate the system to provide candidates the look and feel of the exam administered at Prometric test centers.

The passing score is 600.

• All jurisdictions and state licensing agencies have adopted FSBPT’s criterion-referenced passing score.

• Questions are weighted, which means they do not equate to “one point per question,” but scores are based on difficulty levels of questions.

• The candidate’s scaled score reported by FSBPT ranges between 200 and 800, with a passing score of 600.

• Candidates requesting accommodations (ie, additional examination time, specialized testing environment) for individual circumstances should contact their state licensing board at least 4 months before the test date for information on options available.

The NPTE is only offered four times per year, and registration closes approximately 1 month before the examination date. The candidate’s academic institution must create an FSBPT profile, which provides the tester with instructions on creating an FSBPT ID and profile. Candidates must first register and be approved by the state licensing agency for where they plan to practice. Candidates can only apply to test and practice in one jurisdiction at a time. Each state has different criteria and requirements for application, and the candidate should contact their specific jurisdiction for more information. Following approval by the jurisdiction, the candidate can register for the NPTE at www.fsbpt.org.

Specific test dates can be found at FSBPT’s website www.fsbpt.org.

Candidates will take the NPTE at a Prometric Testing Center located throughout the United States. Once a notice of testing eligibility is received from FSBPT, the candidate is encouraged to reserve a testing seat at www.prometric.com to ensure a convenient testing site is available. Demand is high for testing dates and times with Prometric; however, many options are available throughout the week, and appointments can be made in the morning or afternoon.

Generally, FSBPT releases a candidate’s examination results 6 to 7 days after testing by logging in to your FSBPT account. Additional examination reports can be purchased through FSBPT. For specific examination result release dates, refer to FSBPT’s website www.fsbpt.org.

If you are unsuccessful at the NPTE, you can reregister to retake the examination on the following test date offered. You are allowed three consecutive attempts at taking the NPTE before skipping a test date in sequence. In most jurisdictions, there is a six-attempt lifetime limit taking the NPTE.

As you prepare for the NPTE, it is important to be efficient and effective with your study time. The FSBPT, which provides an outline and description of each content area tested on the NPTE, is available on the FSBPT website. This information is summarized in the following section. Pay close attention to which body systems and content areas make up the largest percentage of the examination. These areas are where you should spend most of your review to best prepare for success in this critical examination.

Additional information is available to the public, including an examination content outline can be found at https://www.fsbpt.org/Free-Resources/NPTE-Development/NPTE-Content.

Each major body system will be broken down into questions based on content areas. This section describes the different content areas, questions per section, and sample NPTE questions. First, review the type of information included in each content area. Then, pay attention to which content areas will constitute most questions within the body system to help streamline your studying.

Utilizing current best evidence, this section assesses the understanding and application of tests and measures, including outcome measures and their relevance to information collected from the history and systems review. Using information gathered within this category, questions will cover the appropriate and effective application of knowledge to patient/client management for rehabilitation, health promotion, and performance across the lifespan.

Data from Dutton M, Schneider M, Lwin J, et al. Physical Therapist Assistant Examination Review and Test-Taking Skills. New York, NY: McGraw Hill; 2022.

This section assesses the interpretation of knowledge about diseases/conditions according to current best evidence. Using information gathered within this category, questions will cover the appropriate and effective application of knowledge to patient/client management for rehabilitation, health promotion, and performance across the lifespan. This section will also include nonpharmacologic medical management (imaging, lab values, other medical tests, and surgical procedures), expected prognosis, interventions/contraindications within the context of physical therapy, differential diagnosis related to diseases/conditions and the impact of regenerative medicine (platelet-rich plasma, stem cells).

Data from Dutton M, Schneider M, Lwin J, et al. Physical Therapist Assistant Examination Review and Test-Taking Skills. New York, NY: McGraw Hill; 2022.

According to current best practice, this section assesses the understanding and impact of interventions (including types, applications, responses, and potential complications) for major body systems including the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and integumentary system. Using information gathered within this category, questions will cover the appropriate and effective application of knowledge to patient/client management for rehabilitation, health promotion, and performance across the lifespan.

Data from Dutton M, Schneider M, Lwin J, et al. Physical Therapist Assistant Examination Review and Test-Taking Skills. New York, NY: McGraw Hill; 2022.

EQUIPMENT, DEVICES, AND TECHNOLOGIES 5-6 QUESTIONS

According to current best practice, this section assesses the understanding and utilization of different equipment, devices, and technologies incorporating safety and contextual determinants for their application and use. Questions in this category cover the appropriate and effective application of knowledge to patient/client management through treatment and interventions while promoting health throughout the lifespan.

THERAPEUTIC MODALITIES 4-6 QUESTIONS

According to current best practice, this section assesses the understanding and utilization of different therapeutic modalities incorporating various safety and contextual determinants for their application and use. Questions in this category cover the appropriate and effective application of knowledge to patient/client management through treatment and interventions while promoting health throughout the lifespan.

The following information regarding the application, indications, contraindications, and precautions for the use of modalities that may appear on the NPTE was taken from the FSBPT PT Exam Content Outline:

• Biofeedback

• Iontophoresis

• Electrotherapy modalities, excluding iontophoresis (eg, neuromuscular electrical stimulation [NMES], transcutaneous electrical nerve stimulation [TENS], functional electrical stimulation [FES], interferential therapy, high-voltage pulsed current)

• Cryotherapy (eg, coldpack, ice massage, vapocoolant spray)

• Hydrotherapy (eg, aquatic exercise, underwater treadmill)

• Ultrasound procedures

• Hotpack thermotherapy

This section assesses the understanding of factors affecting patient/client protection and safety in addition to the role of the healthcare professional to ensure patient/client management and healthcare decision take place in a secure environment. The following information regarding safety and protection that may appear on the NPTE was taken from the FSBPT PT Exam Content Outline:

• Factors influencing safety and injury prevention (eg, safe patient handling, fall prevention, equipment maintenance, environmental safety)

• Function, implications, and related precautions of intravenous lines, tubes, catheters, monitoring devices, and mechanical ventilators/oxygen delivery devices

• Emergency preparedness (eg, cardiopulmonary resuscitation [CPR], first aid, disaster response)

• Infection control procedures (eg, standard/universal precautions, isolation techniques, sterile technique)

• Signs/symptoms of physical, sexual, and psychological abuse and neglect

This section assesses the knowledge and role of healthcare professionals to provide a trustworthy environment for clinical decision-making. The following information regarding professional responsibilities that may appear on the NPTE was taken from the FSBPT PT Exam Content Outline:

• Standards of documentation

• Patient–client rights (eg, ADA, IDEA, HIPAA, patient bill of rights)

• Human resource legal issues (eg, OSHA, sexual harassment)

• Roles and responsibilities of the physical therapist, physical therapist assistant, other healthcare professionals, and support staff

• Standards of professional ethics

• Standards of billing, coding, and reimbursement

• Obligations for reporting illegal, unethical, or unprofessional behaviors (eg, fraud, abuse, neglect)

• State and federal laws, rules, regulations, and industry standards set by state and accrediting bodies (eg, state licensing entities, Joint Commission, CARF, CMS)

• Risk management and quality assurance (eg, policies and procedures, incident reports, peer chart review)

• Cultural factors and/or characteristics that affect patient–client management (eg, language differences, disability, ethnicity, customs, demographics, religion)

• Socioeconomic factors that affect patient–client management

• Applications and utilization of health information technology (eg, electronic medical records, telemedicine)

• The provision and utilization of telehealth (ie, the use of telecommunication technologies to provide healthcare information and services)

This section assesses the knowledge and role of healthcare professionals’ ability to apply current measurement principles and research methods to make reasoned and appropriate assessment and to interpret the information sources and practice research to support patient–client management decisions.

The following information regarding research and evidence-based practice that may appear on the NPTE was taken from the FSBPT PT Exam Content Outline:

• Research methodology and interpretation (eg, qualitative, quantitative, levels of evidence)

• Data collection techniques (eg, surveys, direct observation)

• Measurement science (eg, reliability, validity)

• Techniques for accessing evidence (eg, peer-reviewed publications, scientific proceedings, guidelines, clinical prediction rules)

• Statistics (t-test, chi-square, correlation coefficient, ANOVA, likelihood ratio, effect size, confidence interval)

FSBPT has determined several work activities that are deemed not critical for entry-level PTs to be tested on the NPTE. What follows is a list of those areas that will NOT be tested according to the FSBPT PT Exam Content Outline. Use this information to streamline your studying to include only pertinent information.

FSBPT has made the list of critical and noncritical PT work activities and rationales available to the public at https://www.fsbpt.org/Free-Resources/NPTE-Development/Ensuring-Validity.

PATIENT/CLIENT ASSSESSMENT

Tests and Measures

• Performance of the following tests and measures for Muscle Performance:

  • Electrophysiologic function using surface electrodes (eg, surface EMG)

  • Electrophysiologic function using needle insertion (eg, nerve conduction)

  • Muscle integrity using ultrasound imaging

• Performance of the following tests and measures for Neuromotor Development & Sensory Integration:

  • Oral motor function, phonation, and speech production

INTERVENTIONS

• Performance of the following Manual Therapy Technique:

  • Perform dry needling

• Performance and/or training patient/client/caregiver in the following Integumentary Repair & Protection Techniques:

  • Hyperbaric therapy

  • Hydrotherapy procedures using whirlpool tanks

• Performance and/or training of patient/client/caregiver in the following Therapeutic Modalities:

  • Phonophoresis

  • Hydrotherapy using contrast bath/pools

  • Phototherapy (laser light)

  • Monochromatic infrared agent procedures (eg, light emitting diodes [LEDs])

  • Ultraviolet light procedures

  • Diathermy

  • Dry heat thermotherapy (eg, fluidotherapy)

  • Paraffin bath thermotherapy

  • Shockwave therapy

  • Blood flow restriction training

  • Cupping

FSBPT has determined several work activities that are critical for entry-level PTs to be tested on the NPTE. What follows is a list of those areas that WILL be tested according to the FSBPT PT Exam Content Outline. Glean this information to identify any areas that you feel you have a limited understanding of and spend some time to review the content.

FSBPT has made the list of critical and noncritical PT work activities and rationales available to the public at https://www.fsbpt.org/Free-Resources/NPTE-Development/Ensuring-Validity.

PATIENT/CLIENT ASSSESSMENT

Information Gathering and Synthesis

Interview patients/clients, caregivers, and family to obtain patient/client history and current information (eg, medical, surgical, medications, social, cultural, language preference, economic) to:

• Establish prior and current level of function/activity

• Establish general health status

• Identify red flags (eg, unexplained weight change, fever, or malaise) and contraindications

• Identify risk factors and needs for preventative measures

• Identify patient/client’s, family/caregiver’s goals, values, and preferences

• Determine if patient/client is appropriate for PT

• Determine insurance, financial resources, and issues (eg, copays, deductibles, insurance limitations)

• Determine impact of medications on plan of care (eg, medication reconciliation, timing of intervention delivery, adherence)

  • Administer standardized questionnaires (eg, pain inventory, fall risk assessment)

  • Review medical records (eg, lab values, diagnostic tests, imaging, specialty reports, narrative, consults)

  • Gather information/discuss patient/client’s current health status with interprofessional/interdisciplinary team members

  • Identify signs/symptoms of change in patient/client’s health status that require intervention by interprofessional/interdisciplinary team members

Systems Review

Perform screen of the:

• Patient/client’s current affect, cognition, communication, and learning preferences (eg, ability to convey needs, consciousness, orientation, expected emotional/behavioral responses)

• Patient/client’s quality of speech, hearing, and vision (eg, dysarthria, pitch/tone, use of corrective lenses, use of hearing aids)

• Vestibular system (eg, dizziness, vertigo)

• Gastrointestinal system (eg, difficulty swallowing, nausea, change in appetite/diet, change in bowel function)

• Genitourinary system (eg, changes in bladder function, catheter complications)

• Reproductive system (eg, sexual dysfunction, menstrual dysfunction, menopause/andropause status)

• Cardiovascular/pulmonary system (eg, blood pressure, heart rate, respiration rate)

• Lymphatic system (eg, primary or secondary lymphedema)

• Integumentary system (eg, presence of scar formation, skin integrity, discoloration)

• Musculoskeletal system (eg, gross symmetry, strength, range of motion)

• Neuromuscular system (eg, gross coordination, motor function, balance, locomotion, gross sensory function)

Tests and Measures

Cardiovascular/Pulmonary

Select and perform tests and measures of:

• Cardiovascular function (eg, blood pressure, heart rate, heart sounds)

• Pulmonary function (eg, respiratory rate, breathing patterns, breath sounds, chest excursion)

• Perfusion and gas exchange (eg, oxygen saturation)

• Peripheral circulation (eg, capillary refill, blood pressure in upper versus lower extremities)

• Critical limb ischemia (eg, peripheral pulses, skin perfusion pressure)

• Physiological responses to position change (eg, orthostatic hypotension, skin color, blood pressure, heart rate)

• Aerobic capacity under maximal and submaximal conditions (eg, endurance, exercise tolerance, metabolic equivalents, perceived exertion)

Anthropometric

Select and perform tests and measures of:

• Body composition (eg, percent body fat, lean muscle mass, body mass index [BMI])

• Body dimensions (eg, height, weight, girth, limb length, head circumference/shape)

  • Quantify and qualify edema (eg, pitting, volume, circumference)

Arousal, Attention, and Cognition

Select and perform tests and measures of:

• Arousal and orientation (eg, level of consciousness, time, person, place, situation)

• Attention and cognition (eg, ability to process commands, delirium, confusion)

• Communication (eg, expressive and receptive skills, following instructions)

• Recall (including memory and retention)

Nerve Integrity

Select and perform tests and measures of:

• Cranial nerve integrity (eg, facial asymmetry, oculomotor function, hearing)

• Spinal nerve integrity (eg, dermatome, myotome)

• Peripheral nerve integrity (eg, sensation, strength)

• Neural provocation (eg, tapping, tension, stretch)

Environmental and Community Integration/Reintegration (Home, Work, Job, School, Play, and Leisure)

• Assess activities of daily living (ADL) (eg, bed mobility, transfers, household mobility, dressing, selfcare, toileting, sexual relations)

• Assess instrumental activities of daily living (IADL) (eg, household chores, hobbies)

• Assess ability to perform skills needed for integration or reintegration into the community, work, or school.

• Assess barriers (eg, social, economic, physical, psychological, environmental, work conditions and activities) to home, community, work, or school integration/reintegration

• Assess safety in home, community, work, or school environments

• Assess ability to participate in activities with or without the use of devices, equipment, or technologies

Ergonomics and Body Mechanics

Select and perform tests and measures of:

• Ergonomics and body mechanics during functional activities

• Postural alignment and position (static and dynamic)

• Specific work conditions or activities

• Tools, devices, equipment, and workstations related to work actions, tasks, or activities

Functional Mobility, Balance, and Vestibular

Select and perform tests and measures of:

• Balance (dynamic and static) with or without the use of specialized equipment

• Gait and locomotion (eg, ambulation, wheelchair mobility) with or without the use of specialized equipment

• Mobility during functional activities and transitional movements (eg, transfers, bed mobility)

• Vestibular function (eg, peripheral dysfunction, central dysfunction)

Integumentary Integrity

Assess skin characteristics (eg, continuity of skin color, sensation, temperature, texture, turgor)

• Assess wound characteristics (eg, tissue involvement, depth, tunneling, burn degree, ulcer/injury classification)

• Assess scar tissue characteristics (eg, banding, pliability, sensation, and texture)

• Assess activities, positioning, and postures that may produce or relieve trauma to the skin

• Assess devices and equipment that may produce or relieve trauma to the skin

Joint Integrity and Range of Motion

Select and perform tests and measures of:

• Spinal and peripheral joint stability (eg, ligamentous integrity, joint structure)

• Spinal and peripheral joint mobility (eg, glide, end feel)

• Range of motion (eg, passive, active, functional)

• Flexibility (eg, muscle length, soft tissue extensibility)

Motor Function

Select and perform tests and measures of:

• Muscle tone (eg, hypertonicity, hypotonicity, dystonia)

• Dexterity, coordination, and agility (eg, rapid alternating movement, finger to nose)

• Ability to initiate, modify and control movement patterns and postures (eg, catching a ball, gait)

• Ability to change movement performance with practice (eg, motor learning)

• Movement quality (eg, purpose, precision, efficiency, biomechanics, kinematics, compensatory strategies)

Muscle Performance

Select and perform tests and measures of:

• Muscle strength, power, and endurance without specialized equipment (eg, manual muscle test, functional strength testing)

• Muscle strength, power, and endurance with specialized equipment (eg, isokinetic testing, dynamometry)

Neuromotor Development and Sensory Integration

Select and perform tests and measures of:

• Acquisition and evolution of motor skills throughout the lifespan

• Sensorimotor integration

• Developmental reflexes and reactions (eg, asymmetrical tonic neck reflex, righting reactions)

Reflex Integrity

Select and perform tests and measures of

• Deep tendon/muscle stretch reflexes (eg, quadriceps, biceps)

• Upper motor neuron integrity (eg, Babinski reflex, Hoffman sign)

• Superficial reflexes and reactions (eg, plantar reflex, abdominal reflexes)

Pain and Sensory Integrity

Select and perform tests and measures of:

• Pain (eg, location, intensity, frequency, central, peripheral, psychogenic)

• Deep sensation (eg, proprioception, kinesthesia, pressure)

• Superficial sensation (eg, touch, temperature discrimination)

• Visceral organ sensitivity and integrity (eg, palpation, auscultation)

Evaluation and Diagnosis

Interpret each of the following types of data to determine the need for intervention or the response to intervention:

• Cardiovascular/pulmonary system

• Lymphatic system

• Arousal, attention, cognition, and communication

• Neuromuscular system

• Functional mobility, balance, and vestibular

• Musculoskeletal system

• Integumentary system

• Anthropometric

• Gastrointestinal system

• Genitourinary system

• Need for or use of assistive and adaptive devices/technologies

• Need for or use of orthotic, protective, and supportive devices/technologies

• Need for or use of prosthetic devices/technologies

• Barriers to home, community, work, or school integration/reintegration

• Ergonomics and body mechanics

• Pain and sensory integrity

• ADLs/IADLs and home management

• Imaging, lab values, and medications

• Electrodiagnostic test results (eg, electromyography, nerve conduction velocity)

  • Evaluate the patient/client’s ability to assume or resume home, community, work, school, and/or leisure activities

  • Develop physical therapy diagnosis by integrating system and non-system data

Development of Prognosis, Plan of Care, and Goals

• Establish PT prognosis based on information gathered during the examination process

• Develop plan of care based on data gathered during the examination process, incorporating information from the patient/client, caregiver, family members, and other professionals

• Revise treatment intervention plan based on treatment outcomes, change in patient/client’s health status, and ongoing evaluation

• Develop objective and measurable goals based on information gathered during the examination process, in collaboration with the patient/client, caregiver, family members, and/or other professionals

• Select interventions based on information gathered during the examination process, incorporating information from the patient/client, caregiver, family members, and other professionals

• Modify plan of care based on patient/client’s resources (eg, financial, transportation, time, insurance benefits, available technologies)

Procedural Interventions

Therapeutic Exercise/Therapeutic Activities

Perform and/or train patient/client/caregiver in:

• Aerobic capacity/endurance conditioning

• Balance, coordination, and agility activities

• Body mechanics and postural stabilization techniques

• Flexibility techniques

• Neuromotor techniques (eg, movement pattern training, neuromuscular education or reeducation)

• Relaxation techniques

• Strength, power, and endurance exercises

• Genitourinary management (eg, pelvic floor exercises, bladder strategies)

• Gastrointestinal management (eg, bowel strategies, positioning to avoid reflux)

• Manual/mechanical airway clearance techniques (eg, assistive devices, assistive cough, incentive spirometer, flutter valve, percussion, vibration)

• Techniques to maximize ventilation and perfusion (eg, positioning, active cycle breathing, autogenic drainage, paced breathing, pursed lip breathing)

• Mechanical repositioning for vestibular dysfunction

• Habituation/adaptation exercises for vestibular dysfunction

• Postural drainage

Functional Training

• Recommend barrier accommodations or modifications (eg, ramps, grab bars, raised toilet, environmental control units)

Perform and/or train patient/client in:

• The use of environmental modifications (eg, ramps, grab bars, raised toilet, environmental control units)

• Activities of daily living (ADL) (eg, bed mobility, transfers, household mobility, dressing, selfcare, toileting, sexual relations)

• Community and leisure integration or reintegration (eg, work/school/play)

• Instrumental activities of daily living (IADL) (eg, household chores, hobbies)

• Mobility techniques

• Gross motor developmental progression

• Fall prevention and fall recovery strategies

• Behavior modification and strategies that enhance functioning (eg, energy conservation, pacing, preactivity planning, reminder schedules)

Manual Therapy Techniques

• Perform manual lymphatic drainage

• Perform spinal and peripheral manual traction

• Perform and/or train patient/client/caregiver in soft tissue mobilization (eg, connective tissue massage, therapeutic massage, foam rolling)

• Perform instrument-assisted soft tissue mobilization

• Perform peripheral joint range of motion

• Perform peripheral mobilization/manipulation (thrust)

• Perform peripheral mobilization/manipulation (nonthrust)

• Perform spinal mobilization/manipulation (nonthrust)

• Perform cervical spinal mobilization/manipulation (thrust)

• Perform thoracic and lumbar spinal mobilization/manipulation (thrust)

Apply taping for:

• Neuromuscular reeducation

• Edema management

• Pain management

Equipment and Devices

Fabricate, apply, and/or adjust:

• Adaptive devices (eg, utensils, seating and positioning devices, steering wheel devices)

• Protective devices (eg, braces, cushions, helmets, protective taping)

• Supportive devices (eg, compression garments, corsets, elastic wraps, neck collars, serial casts, short-stretch bandages)

• Orthotic devices (eg, braces, shoe inserts, splints)

Apply and/or adjust:

• Assistive devices/technologies (eg, canes, crutches, walkers, wheelchairs, tilt tables, standing frames)

• Prosthetic devices/technologies (eg, lower extremity and upper-extremity protheses, microprocessor-controlled prosthetic devices)

• Mechanical neuromuscular reeducation devices/technologies (eg, weighted vests, therapeutic suits, body weight–supported treadmill)

• Prescribed oxygen during interventions

Train patient/client/caregiver in the use of:

• Adaptive devices (eg, seating and positioning devices, steering wheel devices)

• Assistive devices/technologies (eg, canes, crutches, walkers, wheelchairs, tilt tables, standing frames)

• Orthotic devices (eg, braces, shoe inserts, splints)

• Prosthetic devices/technologies (eg, lower extremity and upper-extremity prostheses, microprocessor-controlled prosthetic devices)

• Protective devices (eg, braces, cushions, helmets, protective taping)

• Supportive devices (eg, compression garments, corsets, elastic wraps, neck collars, serial casts, short-stretch bandages)

• Mechanical neuromuscular reeducation devices/technologies (eg, weighted vests, therapeutic suits, body weight–supported treadmill)

Integumentary Repair and Protection Techniques

Perform and/or train patient/client/caregiver in:

• Nonselective debridement (eg, removal of nonselective areas of devitalized tissue)

• Selective enzymatic or autolytic debridement (eg, removal of specific areas of devitalized tissue)

• Negative pressure wound therapy (eg, vacuum-assisted wound closure)

• Application of topical agents (eg, cleansers, creams, moisturizers, ointments, sealants) and dressings (eg, hydrogels, wound coverings)

• Desensitization techniques (eg, brushing, tapping, use of textures)

  • Perform sharp debridement (eg, removal of specific areas of devitalized tissue)

  • Recommend topical agents (eg, pharmacological to physician, over-the-counter to patient) and advanced wound dressings (eg, negative pressure wound therapy, wound coverings)

Therapeutic Modalities

Perform and/or train patient/client/caregiver in:

• Biofeedback therapy (eg, relaxation techniques, muscle reeducation, EMG)

• Iontophoresis

• Electrotherapy modalities, excluding iontophoresis (eg, neuromuscular electrical stimulation [NMES], transcutaneous electrical nerve stimulation [TENS], functional electrical stimulation [FES], interferential therapy, high-voltage pulsed current)

• Cryotherapy (eg, cold pack, ice massage, vapocoolant spray)

• Hydrotherapy (eg, aquatic exercise, underwater treadmill)

• Ultrasound procedures

• Hot pack thermotherapy

Mechanical Modalities

Apply and/or train patient/client/caregiver in:

• Intermittent pneumatic compression

• Assisted movement devices (eg, continuous passive motion devices, dynamic splint)

• Mechanical spinal traction

Nonprocedural Interventions

Communication

Discuss physical therapy evaluation findings, interventions, goals, prognosis, discharge planning, and plan of care with:

• Physical therapists, physical therapist assistants, and/or support staff

• Interprofessional/interdisciplinary team members

• Patient/client and caregiver provide written, oral, and electronic information to the patient/client and/or caregiver

Documentation

Document:

• Examination results

• Evaluation to include diagnosis, goals, and prognosis

• Intervention(s) and patient/client response(s) to intervention

• Patient/client/caregiver education

• Outcomes (eg, discharge summary, reassessments)

• Communication with the interdisciplinary/interprofessional team related to the patient/client’s care

• Rationale for billing and reimbursement

• Disclosure and consent (eg, disclosure of medical information, consent for treatment)

• Letter of medical necessity (eg, wheelchair, assistive equipment, disability parking placard)

• Intervention/plan of care for specialized services and settings (eg, individual education plan, individual family service plan, vocational transition plan)

  • Assign billing codes for physical therapy evaluation and treatment provided

Education

Educate patient/client and/or caregiver about:

• Patient/client’s current condition and health status (eg, nature of the condition, prognosis, potential benefits of physical therapy interventions, potential treatment outcomes)

• Role of the physical therapist and/or physical therapist assistant in patient/client management

• Lifestyle and behavioral changes to promote wellness (eg, nutrition, physical activity, tobacco cessation)

• The role of physical therapy in transitional planning (eg, hospice, palliative care, setting changes)

Educate the healthcare team about:

• The role of the physical therapist and/or physical therapist assistant in patient/client management

• Safe patient handling (eg, injury prevention, ergonomics, use of equipment)

  • Educate community groups on lifestyle and behavioral changes to promote wellness (eg, nutrition, physical activity, tobacco cessation)

  • Participate in the clinical education of students

Patient/Client and Staff Safety

Emergency Procedures

• Implement emergency procedures (eg, CPR, AED, calling a code)

• Perform first aid

• Implement disaster response procedures

Environmental Safety

• Perform risk assessment of the physical environment (eg, barrier-free environment, outlets, windows, floors, lighting)

• Prepare and maintain a safe working environment for performing interventions (eg, unobstructed walkways, equipment availability)

• Perform regular equipment inspections and/or maintenance (eg, modalities, assistive devices)

Infection Control

• Perform and/or train patient/client and/or caregiver on appropriate infection control practices (eg, universal precautions, hand hygiene, isolation, airborne precautions, equipment cleaning)

Research and Evidence-Based Practice

• Search the literature for current best evidence

• Evaluate the quality of published data

• Integrate current best evidence, clinical experience, and patient values in clinical practice (eg, clinical prediction rules, patient preference, clinical practice guidelines)

• Design, direct, and/or participate in research activities

• Compare intervention outcomes with normative data

Professional Responsibilities

• Supervise physical therapist assistant(s) and support personnel (licensed/unlicensed)

• Assign tasks to other personnel (licensed/unlicensed) to assist with patient/client care

• Discuss ongoing patient care with the interprofessional/interdisciplinary team members

• Refer patient/client to specialists or other healthcare providers when necessary

• Disclose financial interest in recommended products or services to the patient/client

• Provide notice and information about alternative care when the physical therapist terminates provider relationship with the patient/client

• Document transfer of patient/client care to another physical therapist (therapist of record)

• Report healthcare providers that are suspected to not perform their professional responsibilities with reasonable skill and safety to the appropriate authorities

• Report suspected cases of abuse to the appropriate authority

• Report suspected illegal or unethical acts performed by health- care professionals to the relevant authority

• Advocate for public access to physical therapy and other healthcare services

• Determine own need for professional development

• Participate in learning and/or development activities (eg, journal clubs, self-directed reading, continuing competence activities) to maintain the currency of knowledge, skills, and abilities

• Practice within the federal and jurisdiction regulations and professional standards

• Participate in professional organizations

• Perform community-based screenings (eg, fall risk, posture, musculoskeletal, flexibility, sports specific)

• Participate in performance improvement and quality reporting activities (eg, Physician Quality Reporting System, standardized outcomes measurement, application of health informatics)

The National Physical Therapist Examination (NPTE) is a high stake, comprehensive test of entry-level knowledge for licensure in physical therapy practice. The 225-question examination includes content from every major system of the body requiring the candidate to focus for 5 hours to complete the exam.

Due to the nature of the NPTE, many candidates have difficulty determining learning strategies for preparation and long-term retention of information for clinical practice. It is key that candidates for the licensure exam recognize opportunities to use exam preparation guidelines to not only prepare for the NPTE but to better prepare for clinical practice. The following guidelines were developed by Sein et al 2021:

• Meet with your advisor to assist you in developing a learning plan.

• Take an initial NPTE practice exam to identify gaps in knowledge.

• Create a study schedule that addresses knowledge gaps and that includes time for exercise, days off, breaks and limited study hours to avoid burnout and maximize outcomes.

• Focus on being an informed effective clinician not just on exam performance. Identify and prioritize learning information that relates to the most common or clinically relevant material based on the FSBPT NPTE outline.

• Apply for necessary learning accommodations as soon as possible.

• Organize a small group of people to engage in “parallel study” (study in the same place or location but not study together).

• Use test preparation resources to guide studying and learning. The FSBPT offers student and academic versions of Practice Exam and Assessment Tool (PEAT) that are retired NPTE exams. These resources interspersed with “Accessphysiotherapy,” and other resources will identify gaps, offer opportunities for question reviews, and desensitize exam taking.

• Practice recalling and summarizing using metacognitive techniques:

  • Distributed practice (practice overtime as opposed to mass practice, coming back to the material repeatedly with cognitive breaks in learning sessions).

  • Retrieval practice (recall previously studied information, elaboration on more detail on the topic and thinking back to the initial learning episode). Activities such as quizzing oneself, creation of mind maps and learning from feedback on practice tests will assist long-term memory.

  • Interleaving (when studying a particular subject in a single session, move back and forth between different areas or between different principles or concerns and procedures). This is mixing-related but distinct material such as cardiac anatomy, cardiac conduction, and cardiac conditions.

• Use test-enhanced learning practices that measure your learning progress (at least a baseline test, midpoint test, and pre-licensure exam) to evaluate and monitor the effectiveness of your study interventions.

• Embrace learning from errors through metacognitive processes (focus on questions answered incorrectly or you were unsure of and try to generate the correct answer). Attempt to explain why the right answer is correct to uncover errors in knowledge. Track errors using an error analysis table or spreadsheet to keep a record of questions missed and why. This will provide an opportunity to work in areas of knowledge gaps.

• Prioritize learning from questions over time rather than doing simulated exam close to the test date.

• Practice common test-taking tips (discussed below) and practice strategies to mitigate exam anxiety (breathing, positive mindset) and maximize test day performance.

• Post exam NPTE reflection and continued learning will assist you in future study to fill in knowledge gaps to improve future learning and patient care.

High stakes exams can heighten anxiety during the examination, affecting ability to work through the questions successfully. An effective method to combat test anxiety (in addition to proficient content knowledge and preparation) is understanding strategies to work through questions to arrive at the most logical answer. This section will provide testing strategies and tips to help you navigate the NPTE.

EXAMINATION QUESTION BASICS

While solid content knowledge is crucial to success in the NPTE, careful understanding of the format of NPTE questions and strategies to eliminate wrong answers to arrive at the best choice is a key component to successful test-taking. These are some facts about the NPTE to bear in mind:

• With only 5 hours to complete 225 questions, the candidate has approximately 80 seconds per question.

• The NPTE will not only have multiple-choice questions but also scenario-based questions that may include the therapeutic setting, sex, age, medical history, presenting problems/current condition, other information such as medication, living situation, examination data, interventions, and plan of care. Images and videos are also included.

• The questions do not test memorization skills but rather the application and clinical understanding of concepts. For example, a typical question will not ask, “What is the action of the iliopsoas muscle” but instead, “Which muscle might be affected if a patient has difficulty during the terminal swing phase of gait?”

• There is only ONE right answer. However, every other choice will seem attractive and reasonable.

• The NPTE will take time and effort. To prepare best for the examination, study in large blocks of time to mentally train the brain to replicate the examination duration. No extra points are awarded for finishing quickly; therefore, take your time.

DETERMINING THE BEST CHOICE

1. Read each question slowly or out loud in your head.

2. Pick out keywords in the question stem to help understand the question.

3. Rephrase the question into your own words.

4. Formulate an answer before looking at the choices.

5. Read each answer choice slowly, carefully, and twice.

6. Do NOT read into the question or add details that are not already in the stem.

7. Eliminate the wrong answer choices one by one.

8. Eliminate similar answer choices since there can only be ONE best answer.

9. Refer back to your stem when in doubt or to confirm your answer selection.

10. Do not spend too much time deliberating on one question.

11. Do NOT leave any questions blank.

12. Do NOT change your answers.

1. READ EACH QUESTION SLOWLY OR OUT LOUD IN YOUR HEAD

Candidates often read questions too quickly and miss pertinent information that changes the meaning of the question. Remember reading slow is smooth; and smooth reading is fast. For example, missing “keywords” in the statement or seeing “anterior” versus “posterior” when reading too fast. There is plenty of time to read each question and answer twice, and there will be some questions that you can answer quickly, leaving more time for the difficult questions. Pace yourself.

2. PICK OUT KEYWORDS AND WORD ASSOCIATIONS IN THE QUESTION STEM TO HELP UNDERSTAND THE QUESTION

Keywords can help clarify what the question asks and eliminate irrelevant information that may distract from the correct answer. For example, the bold words in the sample question below would be keywords to clarify the question.

During gait observation, the PT notices a lack of heel strike at initial contact. Which of the following muscles should the PT strengthen to improve this gait deviation?

While the other words are helpful, the bold words are keywords that differentiate what the candidate should be thinking to answer the question.

“Lack of heel strike at initial contact” defines at what point during gait the candidate should be concerned.

“Strengthen to improve” lets the candidate know the goal is to increase heel strike, and the focus should be on what muscle improves this motion.

Words can also be associated or linked to other words based on prior learning. Associated words can assist in determination of the answer by providing a connection such as function of muscles. Examples may be related to function with such as “anterior tibialis and dorsiflexion” and “iliopsoas and hip flexion.”

3. REPHRASE THE QUESTION INTO YOUR OWN WORDS

Before looking at the answer choices, rephrase the question into your words to clarify and simplify in your mind what the question is asking.

During gait observation, the PT notices a lack of heel strike at initial contact. Which of the following muscles should the PT strengthen to improve this gait deviation?

Rephrased question: Which muscle increases heel strike at initial contact?

4. FORMULATE AN ANSWER BEFORE LOOKING AT THE CHOICES

Think about the possible answer choices before looking at the options. This approach can also clarify the direction the candidate should be thinking before getting confused by multiple options.

During gait observation, the PT notices a lack of heel strike at initial contact. Which of the following muscles should the PT strengthen to improve this gait deviation?

Formulating an answer: Heel strike at initial contact requires dorsiflexion of the foot. Dorsiflexion is the result of anterior tibialis muscle contraction.

5. READ EACH ANSWER CHOICE SLOWLY, CAREFULLY, AND TWICE

Beware of similar choices that could be incorrect if read too quickly. For example, “anterior tibialis” and “posterior tibialis” can be erroneously mixed up if read too quickly.

During gait observation, the PT notices a lack of heel strike at initial contact. Which of the following muscles should the PT strengthen to improve this gait deviation?

1. Gastrocnemius

2. Anterior tibialis

3. Quadriceps

4. Posterior tibialis

6. DO NOT READ INTO THE QUESTION OR ADD DETAILS THAT ARE NOT ALREADY IN THE STEM

Avoid adding your own words to the question stem. For example, in the previous question, the following thoughts would be erroneous in concluding as to why there is a lack of heel strike at initial contact:

• If the patient has a SACH foot, dorsiflexion could be limited by a stiff heel cushion, therefore strengthening the quadriceps could be reasonable to increase knee extension and possibly stride length before the heel touches the ground. There is no mention of the patient having a SACH foot.

• Lack of heel strike might be because the person has a shortened stride length due to tight hamstrings, therefore, strengthening the quadriceps could be the right answer as the person tries to overcome lack of hip flexion and knee extension from a decreased length in the hamstrings. There is no mention of tight hamstrings in the question.

7. ELIMINATE WRONG ANSWER CHOICES

Remember, all the answer choices in the NPTE will be reasonable, so there will not be an absurd answer completely out of place, but usually there are one or two choices that do not fit the question.

During gait observation, the PT notices a lack of heel strike at initial contact. Which of the following muscles should the PT strengthen to improve this gait deviation?

1. Gastrocnemius

2. Anterior tibialis

3. Quadriceps

4. Posterior tibialis

Using the assumption that one or two choices do not fit the question, the answer choice should immediately be centered around a muscle that performs dorsiflexion, which must also act on the ankle. Since choice “c,” the quadriceps, does not act on the ankle, this choice can be eliminated with confidence.

At this point, the critical thinker would also have deduced that a correct heel strike requires dorsiflexion and that the gastrocnemius and posterior tibialis do not perform dorsiflexion (they are plantarflexors), allowing these options to be eliminated.

There is now only one option after eliminating the other three choices using the process of elimination, which is “b,” anterior tibialis.

8. ELIMINATE SIMILAR ANSWER CHOICES—THERE IS ONLY ONE BEST ANSWER

Even if a candidate is not certain of the correct answer, eliminating incorrect answers can narrow down options for a better chance at determining the right answer. At times, the candidate may even be able to eliminate all other options, leaving only the correct answer.

• With a knowledge of muscles and actions, the tester should recognize the gastrocnemius and posterior tibialis both perform plantarflexion. Since there can only be ONE best answer, these choices can be eliminated since they perform the same motion.

• Even if a candidate is not certain of the correct answer, eliminating incorrect answers can narrow down options for a better chance at determining the right answer. At times, the candidate may even be able to eliminate all other options, leaving only the correct answer.

9. REFER BACK TO YOUR STEM WHEN IN DOUBT OR TO CONFIRM YOUR ANSWER SELECTION

Once an answer has been chosen, reread the question to confirm it is the best choice.

10. DO NOT SPEND TOO MUCH TIME DELIBERATING ON ONE QUESTION

If the above strategies do not produce a definitive answer, the most logical answer should be selected based on deductive reasoning. If necessary, the candidate can mark the question to return later for review but should not spend too much time on a difficult question to avoid running out of time.

11. DO NOT LEAVE ANY QUESTION BLANK

The tester is not penalized for wrong answers; therefore, a “best guess” should be taken for every question.

12. DO NOT CHANGE YOUR ANSWERS

Not changing your answers may be the most critical testing strategy! Many candidates second-guess their answer selections (especially when reviewing) and ultimately change answers from “correct” to “incorrect.” This costly error can be the difference between passing and not passing the examination. DO NOT change an answer unless you are absolutely certain that the new answer is correct.

PRACTICE YOUR TEST-TAKING STRATEGIES

ADDITIONAL TESTING STRATEGIES

Besides proficient content knowledge and utilizing these testing strategies to think through answer choices carefully, some intangible factors can greatly influence success in the NPTE. For example, stress and anxiety while studying and during the NPTE can often sabotage success as candidates become occupied with negative thoughts. The following shifts in mindset and activities can help the candidate better prepare and perform during the NPTE.

• Developing a positive mental attitude toward the NPTE can change a negative mindset into a positive one and help the candidate become more confident and motivated in their review process.

Change the mindset from “I can’t possibly learn all this information” to “I will spend the time studying to understand the material.”

• Physical activity can decrease stress and anxiety as well as improve intellectual acuity

  • Even short bouts of exercise can re-focus the mind for more effective studying

• Proper nutrition can also support a positive mindset and mental sharpness

  • Foods high in trans-fats or sugar can have a negative effect of brain health