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Table 3 Ranking of mean frequency that ethical issues were experienced for total cohort and comparative rankings for WCPT regions (most frequent–least frequent)

From: Scarcity of resources and inequity in access are frequently reported ethical issues for physiotherapists internationally: an observational study

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
  1. *Scale A = Physical Therapist and Patient Interaction, B = Physical Therapist and other Health Professionals (including other Physical Therapists), C = Physical Therapist and the System, D = Professional and Economic Ethical Situations
  2. **Experienced daily = 1, weekly = 2, monthly = 3, yearly or less = 4, never = 5