Texas Board of PT Examiners Response
From: Karen Gordon
To: Luke Haynes
Subject: Dry Needling
Date: Wednesday, August 1, 2018 10:06:36 AM
The Texas PT Practice Act/rules do not prohibit a PTA from performing dry needling. The supervising PT holds the primary responsible for all physical therapy care rendered under his/her supervision, and is responsible for assuring that a PTA has the competencies required to perform any technique or procedure, including dry needling. Consideration should be given to the PTA’s level of skill/training and experience/advanced competency, the practice setting in which the procedure is performed, the type of monitoring that might be needed, and the acuity and complexity of the patient’s condition.
It would be a violation of the PT Practice Act/Rules for a PT to delegate a technique or procedure to a PTA who is not competent to perform it, and it would be a violation of the PT Practice Act/Rules for a PTA to perform or attempt to perform techniques or procedures for which they are not competent.
It is recommended that you review the rules and regulations of payer sources, i.e. Medicare/Medicaid or private insurance, to determine if dry needling is reimbursable if performed by a PTA as they can differ from the licensure rules/regs. If you have any further questions, please feel free to contact me.
Karen Gordon, PT
PT Board Coordinator
Texas Board of PT Examiners
Executive Council of PT & OT Examiners
333 Guadalupe, Suite 2-510
Austin, Texas 78701
Position statement concerning PT supervision of PTA
Haynes PT Institute
Haynes Method of Neuromuscular Dry Needling®
Required Supervision by PT
The practice of physical therapy often involves a multi-staff approach to treatment that may involve more than 1 PT or may involve a PTA (or more than one). In a perfect scenario it is ideal for the same clinician to remain the only clinician treating that patient throughout the patient’s course of treatment. That scenario is not always possible or even practical; clinicians call in sick or go on vacation or move on to other opportunities. The patient still needs to be treated and their care managed in a consistent manner. That is just as much the case when dry needling is included in the treatment plan.
It is incumbent upon each Physical Therapist to gain proper training and competence in dry needling before practicing the technique on patients. It is even more incumbent on the examining or supervising Physical Therapist to ensure clinical competence of the subordinate treating clinicians that they 1) have the clinical competence to performed dry needling in a safe and effective method and, 2) that the subordinate treating clinician has the training in the approach that the supervising clinician has prescribed in their treatment plan for that patient.
Specifically, the supervising clinician should establish specific treatment parameters based on defined protocols that both clinicians have demonstrated competency. The subordinate clinician will have the ability to withhold treatment but not modify or add to the established treatment protocol based on the patient’s condition. If there were adverse events that took place in one of the needling locations such as bruising, increased soreness etc, then it would be permissible for the clinician to modify or delete that treatment point. Communication between the patient and the treating clinician, and the treating and supervising clinician is of the utmost importance in the PT/PTA treatment relationship when utilizing dry needling as a treatment modality.
It would not be appropriate for a supervising PT to allow a PTA to alter the treatment protocol (except for withholding certain treatment locations due to adverse events) without discussing the case with the supervising PT first and only then with approval of the supervising PT. If the treating PT is onsite it would be ideal to discuss the adverse event with the PT prior to treatment to discuss other options. At a minimum the PTA should discuss the adverse event with the supervising PT before the patient return for follow up treatment. The PT/PTA treatment team is responsible first to ensure no harm to the patient and second to utilize the dry needling protocols taught to the most effective benefit of the patient. From a legal standpoint inadequate supervision on the part of the PT would make the PT liable for any adverse event that occurred due to negligent acts on the part of the PTA. Negligent acts would include ignoring established danger zones and contraindications established as part of training as well as altering the established treatment protocol without documented consultation with the PT.
The Haynes Method of Neuromuscular Dry Needling® is structured to teach its students the safety aspect of dry needling but to also to teach specific treatment protocols that establishes the structure necessary within the PT/PTA for the supervising clinician to establish the treatment protocol or protocols to be implemented and the assurance that, upon completion of the certification process, the PTA would be clinically competent to carry out the dry needling protocols that are part of the plan of treatment and would further ensure the communication between the two clinicians that is vital to proper execution of the dry needling protocols.