Physical agent, mechanical, and instrument-assisted modalities in occupational therapy practice

This AOTA position statement explains how occupational therapists and occupational therapy assistants may use physical agent, mechanical and instrument-assisted modalities (PAMIMs). The Representative Assembly Coordinating Council adopted it in April 2024, and it replaces AOTA's 2018 statement on physical agents and mechanical modalities.

It defines the categories it covers: thermal agents such as hot packs, paraffin and therapeutic ultrasound; electromagnetic agents such as diathermy and low-level laser; electrotherapy such as NMES, FES, TENS and iontophoresis; mechanical devices such as traction and compression pumps; and instrument-assisted methods, including dry needling, scraping tools and cupping.

Its central position is that these modalities belong in occupational therapy only as part of a client-centered, occupation-based plan, and that using them on their own is not occupational therapy. It describes how the therapist and assistant share roles across evaluation, intervention and outcomes. Practitioners are responsible for keeping up their competence, for meeting any state requirements that go beyond entry-level training, and for checking payer coverage rules.