According to the APTA Guide to Physical Therapist Practice,1 there are 25 categories of tests and measures in physical therapy (PT): aerobic capacity, anthropometric characteristics, arousal/attention and cognition, assistive and adaptive devices, circulation (arterial, venous, lymphatic), cranial and peripheral nerve integrity, environmental/home and work (job, school, play) barriers, ergonomics and body mechanics, gait/locomotion and balance, integument integrity, joint integrity and mobility, motor function (motor control and learning), muscle performance (strength, power, endurance), neuromotor development and sensory integration, orthotic/protective and supportive devices, pain, posture, prosthetic requirements, range of motion (including muscle length), reflex integrity, self-care and home management (activities of daily living [ADL] and instrumental activities of daily living [IADL]), sensory integrity, ventilation and respiration/gas exchange, and work (job/school/play), and community and leisure integration or reintegration.
The physical therapist selects those tests and measures within each category most appropriate to the patient/client's signs, symptoms, and concerns using the clinical decision-making model. Ultimately focusing on movement and function.
For Medicare purposes, standardized tests and measures should be focused on activities related to necessary function versus leisure, and those problems or impairments directly impacting necessary or essential function. In the outpatient setting, objective standardized tests and measures are required on initial examination. Essential function includes: adequate aerobic endurance to perform activities such as transitional movements and transfers, bed mobility, gait on a variety of surfaces or if non-ambulatory or limited in gait, other locomotion (i.e., wheelchair, power-operated vehicle, or power wheelchair), negotiating doorways and different surfaces, avoidance of objects, safety, balance in standing and movements related to effective ADL performance. In some instances, tests and measures include IADL and negotiating public transportation if a beneficiary is still working, or receiving treatment on an outpatient basis. Pain, in the absence of dysfunction, is not a qualifier for skilled physical therapy. However, if the patient/client is reporting pain and it affects functions not necessarily apparent or measurable in the clinic, close attention must be paid to patient/client monitoring of improvement external to the clinic as a measure of success. Examples of this are sleeping through the night or if driving is necessary (even if it is to and from medical appointments), the ability to safely turn the head, sit for a prescribed length of time, and operate a vehicle safely. Lack of sleep secondary to pain, can result in impairment in judgment and fatigue, endurance limitations, depression, and weakness. Specific cardiac rehabilitation is not considered a skilled reimbursable Medicare-approved PT procedure, although respiratory programs may be in certain circumstances. Individuals with cardiac problems qualify for skilled PT secondary to weakness, functional decline, gait abnormalities, aerobic capacity limiting function, etc.
In the non-Medicare adult context, the concept of function may be more generic in scope, encompassing leisure and lifestyle. However, as in Medicare, pain as a sole diagnosis, in the absence of functional limitation may likely not be reimbursable unless the patient/client has been specifically referred for pain management or a pain program, ...