Do physical therapists (PTs) interpret electrocardiogram (ECG) findings?

ECG Interpretation by Physical Therapists

Physical therapists should not independently interpret ECG findings for diagnostic or clinical decision-making purposes, as ECG interpretation requires physician-level training and competency that is outside the scope of physical therapy practice.

Scope of Practice and Training Requirements

The available guidelines consistently specify that ECG interpretation is a physician responsibility requiring specialized training:

• Physician training standards recommend 500 ECG interpretations under supervision to attain initial competency, with ongoing maintenance requiring 100 ECGs yearly 1
• Residency training requirements emphasize that physicians must have knowledge of pathophysiology of electrocardiographic abnormalities, skills to recognize common patterns, and ability to apply this knowledge in bedside clinical decision making 1
• Computer interpretation alone is insufficient and must not replace qualified physician interpretation in making patient management decisions 1

Evidence on Non-Physician Interpretation

While some non-physician healthcare providers can identify specific ECG patterns in limited contexts, this is distinct from comprehensive interpretation:

• Paramedics and nurses can identify STEMI patterns for catheterization lab activation, but only with mandatory initial training and ongoing concurrent medical oversight of all ECG interpretations 1, 2
• False-positive rates for non-physician STEMI identification range from 8% to 40%, highlighting the need for physician verification 1
• Noncardiologists are more influenced by patient history when interpreting ECGs than cardiologists, making systematic physician-level training even more critical 2

Clinical Context and Patient Safety

The complexity of ECG interpretation and potential for adverse outcomes necessitates physician-level expertise:

• Major interpretation errors occur in 4% to 33% of cases, though adverse patient outcomes are rare (less than 1% of interpretations) 1
• Accuracy varies significantly by training level: medical students achieve 42.0% accuracy, residents 55.8%, practicing physicians 68.5%, and cardiologists 74.9% on standardized assessments 3
• ECG findings must be interpreted in clinical context, as the same pattern may have different implications depending on symptoms and clinical presentation 4, 2

Appropriate Role for Physical Therapists

Physical therapists working with cardiac patients should:

• Monitor for concerning symptoms during exercise or therapy sessions and recognize when to stop activity 5
• Understand basic rhythm monitoring to identify when immediate physician consultation is needed during supervised exercise
• Defer all diagnostic interpretation to qualified physicians, as even computer-generated interpretations require physician verification 1, 4, 2
• Communicate observations to the supervising physician rather than making independent diagnostic conclusions

Key Pitfalls to Avoid

• Never rely on pattern recognition alone without understanding underlying pathophysiology, which requires physician-level training 1
• Do not assume computer interpretations are accurate without physician verification, as errors remain common with false-negative rates of 22-42% for STEMI 1
• Avoid interpreting findings without clinical context, which may lead to inappropriate management decisions and adverse outcomes 4, 2