Table 3 Ranking of mean frequency that ethical issues were experienced for total cohort and comparative rankings for WCPT regions (most frequent–least frequent)
Item | Scale* | N | Mean** (SD) | Total cohort ranking | Africa region ranking | Asia Western Pacific region ranking | Europe region ranking | North America Caribbean region ranking | South America region ranking |
|---|---|---|---|---|---|---|---|---|---|
45. Scarce resources and time affecting quality of physical therapy treatment | C | 857 | 2.39 (1.3) | 1 | 1.5 | 2 | 1 | 2 | 1 |
56. Physical therapy not accessible to all people in society who need it, e.g. due to cost, lack of services in regions, or discrimination by health care system | D | 847 | 2.64 (1.4) | 2 | 1.5 | 1 | 2 | 1 | 5 |
40. Respecting the patient's therapeutic relationship with other health professionals, when the physical therapist disagrees with the other health professional's opinion | B | 855 | 2.95 (1.2) | 3 | 4 | 3 | 3 | 3.5 | 19.5 |
36. Miscommunication, or lack of communication, between physical therapists and other health professionals causing errors and affecting quality in patient care | B | 855 | 3.10 (1.2) | 4.5 | 7 | 4.5 | 4 | 7.5 | 8 |
39. Referrals, or absence of referrals, from other health professionals that constrain the quality of physical therapy services | B | 855 | 3.10 (1.2) | 4.5 | 3 | 4.5 | 5.5 | 7.5 | 10 |
52. Lack of evidence available to support effectiveness and safety of physical therapy practices | D | 847 | 3.19 (1.3) | 6 | 5 | 7 | 5.5 | 11 | 8 |
41. Conflict with another health professional about patient’s management | B | 855 | 3.26 (1.1) | 7 | 10 | 6 | 9 | 11 | 6 |
43. Physical therapist required by an organisation or system to discharge patient from treatment based on reasons other than patient’s clinical need, e.g. insurance limits, health care system policy | C | 857 | 3.27 (1.3) | 8 | 16 | 10 | 10 | 3.5 | 4 |
44. Physical therapist prevented by an organisation or system from treating patient based on clinical need, e.g. health insurance will not cover condition, health care system policy does not allow | C | 857 | 3.29 (1.4) | 9 | 13 | 8 | 11 | 5.5 | 11 |
17. Mismatch/discrepancy between patient’s or family/caregivers’ wishes and physical therapist’s professional judgement | A | 844 | 3.31 (1.1) | 10 | 11 | 11 | 7 | 9 | 16 |
24. A purposeful absence of truth-telling by patient during treatment | A | 844 | 3.33 (1.1) | 11 | 6 | 9 | 12 | 11 | 23 |
16. Mismatch/discrepancy between the patient’s expectations and the physical therapist’s expectations of the therapeutic relationship | A | 844 | 3.37 (1.1) | 12 | 15 | 13 | 8 | 14 | 23 |
57. Conflict in duties toward employer, third-party payer, and the patient | D | 847 | 3.47 (1.2) | 13 | 18 | 14 | 18 | 5.5 | 13.5 |
31. Continuing physical therapy treatment for patient’s psychological/psychosocial support after treatment goals have been reached | A | 844 | 3.51 (1.1) | 14 | 19 | 15 | 23 | 18 | 12 |
58. A lack of advocacy for patient’s interests, needs or supports when they are unable to advocate for themselves | D | 847 | 3.55 (1.2) | 15 | 12 | 12 | 24.5 | 13 | 13.5 |
47. Withholding or limiting physical therapy services to improve work conditions of the physical therapy provider or for the convenience of the physical therapist, e.g. time, location | C | 856 | 3.57 (1.3) | 16 | 20 | 16 | 14 | 21 | 8 |
37. Physical therapist aware of misconduct by other health professionals, e.g. incompetency, violating laws and professional obligations | B | 855 | 3.58 (1.2) | 17 | 8 | 19 | 16 | 24 | 27.5 |
38. Prescription and ongoing provision of analgesics and/or sedatives to patients without appropriate review over time | B | 854 | 3.59 (1.3) | 18 | 14 | 28 | 15 | 15 | 19.5 |
46. Physical therapist pressured by organisation or system to return patient to sport or work commitments too early | C | 857 | 3.68 (1.2) | 19 | 29.5 | 26 | 19 | 16 | 2 |
51. Inadequate/unlawful record keeping by physical therapist | D | 847 | 3.69 (1.3) | 21.5 | 9 | 29.5 | 21 | 17 | 17.5 |
14. Absence of shared decision-making between patient and physical therapist, e.g. paternalism, not culturally wanted or accepted | A | 843 | 3.69 (1.1) | 21.5 | 32 | 27 | 17 | 19 | 23 |
29. Physical therapist prioritising patients for treatment based on reasons other than patient’s clinical need, e.g. cherry picking of easier patients, likelihood of improvement, economic potential | A | 843 | 3.72 (1.2) | 23.5 | 26 | 24 | 22 | 22.5 | 30.5 |
53. Physical therapist practicing outside of personal scope of knowledge and skills | D | 847 | 3.72 (1.2) | 23.5 | 23 | 20 | 20 | 39 | 39.5 |
54. Physical therapist overtreating patients for own economic gain | D | 847 | 3.73 (1.3) | 24 | 24 | 25 | 24.5 | 26 | 30.5 |
34. Bullying or harassment of physical therapist by other health professional(s) | B | 855 | 3.79 (1.2) | 25 | 22 | 18 | 31 | 27.5 | 19.5 |
55. Conflict between physical therapist’s professional obligations (as per code of ethics) and cultural or personal values | D | 847 | 3.80 (1.2) | 26.5 | 21 | 18 | 30 | 27.5 | 34 |
18. Patient’s privacy and/or dignity not respected during physical therapy treatment, e.g. not draping appropriately, gossiping about patients | A | 843 | 3.80 (1.1) | 26.5 | 28 | 33 | 23 | 22.5 | 30.5 |
28. Stopping treatment of a patient when they did not comply with physical therapist’s instruction or advice | A | 844 | 3.83 (1.0) | 28.5 | 35 | 32 | 26.5 | 20 | 16 |
30. Concerns of the physical therapist regarding treatment of terminally ill patients, e.g. deciding benefit or harm to the patient, futility of treatment, lack of resources | A | 844 | 3.83 (1.2) | 28.5 | 27 | 22 | 28 | 34.5 | 25.5 |
15. Failure to gain informed consent, e.g. cultural differences, cognitive impairment, not attempted | A | 844 | 3.84 (1.1) | 30 | 25 | 17 | 26.5 | 37.5 | 39.5 |
59. Physical therapist recommending and selling products for own economic gain | D | 847 | 3.90 (1.2) | 31 | 17 | 29.5 | 36 | 37.5 | 16 |
48. Breach of patient confidentiality by physical therapist | D | 847 | 3.94 (1.1) | 32 | 33 | 31 | 34 | 29.5 | 43 |
26. An absence of purposeful truthtelling by therapist during treatment | A | 843 | 3.97 (1.1) | 33.5 | 34 | 34 | 29 | 34.5 | 34 |
42. Inappropriate, insulting or offending behavior among colleagues on social media | B | 855 | 3.97 (1.2) | 33.5 | 31 | 36 | 35 | 25 | 19.5 |
33. Other health professionals seeking financial or other benefit from referring patients to physical therapists | B | 855 | 4.02 (1.3) | 35 | 38 | 23 | 41 | 31 | 27.5 |
50. Overcharging patients for physical therapy services | D | 847 | 4.06 (1.2) | 36 | 29.5 | 37 | 39 | 29.5 | 3 |
25. Violence or threatening behaviour by patient towards physical therapist | A | 844 | 4.07 (1.0) | 37 | 39 | 35 | 37 | 36 | 25.5 |
22. Discrimination by physical therapist towards patient on basis of age, gender, appearance, culture or religion, e.g. refusal to treat, lack of respect for cultural beliefs, poor quality treatment | A | 844 | 4.23 (1.0) | 38 | 40 | 41 | 38 | 40 | 43 |
49. Fraudulent billing for physical therapy services | C | 847 | 4.24 (1.1) | 39 | 37 | 38.5 | 43 | 33 | 41 |
23. Physical therapist accepting inappropriate gifts or gratuities | A | 844 | 4.27 (1.0) | 40 | 36 | 38.5 | 42 | 42 | 30.5 |
21. Inappropriate relationship between patient and physical therapist during treatment, e.g. intimate friendship, business partnership | A | 844 | 4.28 (1.0) | 41 | 41.5 | 40 | 40 | 43 | 34 |
19. Sexual harassment by patient during treatment | A | 844 | 4.32 (0.8) | 42 | 44 | 43.5 | 32 | 32 | 43 |
32. Physical therapist abusing their status/power to influence patient’s behavior for their own interest | A | 844 | 4.38 (1.0) | 43 | 43 | 43.5 | 44 | 41 | 37.5 |
35. Violence or threatening behaviour against patients by other health professionals | B | 855 | 4.39 (0.9) | 44 | 41.5 | 42 | 45 | 44 | 36 |
27. Violence or threatening behaviour by physical therapist towards patient | A | 844 | 4.72 (0.7) | 45 | 45 | 45 | 33 | 46 | 45.5 |
20. Sexual harassment by physical therapist during treatment | A | 844 | 4.81 (0.5) | 46 | 46 | 46 | 46 | 45 | 45.5 |