Case of the Month
The Case
The College received a complaint from a patient who attended physiotherapy for approximately three months following a motor vehicle accident. The patient had two physiotherapy sessions per week, but they were not satisfied with their progress or the care they received.
The patient noted that they had casts on both arms for the first month of treatment. The patient said their physiotherapy treatment consisted only of moving their foot back and forth during this time.
When the casts were removed the PT started treating their arms, wrists and fingers. The patient said the physiotherapist applied biofreeze and treated their fingers by cracking them inward which caused the patient intense pain.
The patient also noted that they mentioned shoulder pain to the physiotherapist on a few occasions, but the PT never addressed their concerns.
The physiotherapist disputed the patient’s claim that treatment during the first month consisted solely of moving their foot back and forth and said they also treated the cervical spine and associated musculature symptoms and worked on active shoulder range of motion exercises.
The physiotherapist confirmed that they used biofreeze on the patient’s arms and fingers with their consent. They further noted that they discussed with the patient the importance of stopping treatment if they experienced pain, but the patient tolerated treatment well.
The PT said that the patient did not mention shoulder pain during the initial assessment, but they did talk about it in other sessions. The physiotherapist was planning to conduct a full reassessment, but the patient cancelled the rest of their appointments instead.
The Standards
As outlined in the Essential Competency Profile for Physiotherapists in Canada, physiotherapists are required to conduct a comprehensive assessment to gather both objective and subjective information. This information is collected by selecting and performing the appropriate tests and then interpreting these assessment findings to confirm a diagnosis, establish treatment goals (using outcome measures) and develop a treatment plan.
In this case, the Committee found that the treatment provided lacked clinical justification. Without a comprehensive assessment, there were no treatment goals to guide the treatment and evaluate effectiveness over time.
In reviewing the patient record, the physiotherapist did note occasions where the patient mentioned shoulder pain, however the notes did not include a discussion about how the pain would be addressed. Physiotherapists must ensure that patient concerns are addressed and factored into the treatment plan in a timely way.
The Outcome
The Committee determined that the lack of evidence used to inform clinical decision-making and the repeated use of treatment without guidance from objective outcome measures was significant enough to require the physiotherapist to participate in a Specified Continuing Education or Remediation Program (SCERP).
The PT will review College resources and work with a practice enhancement coach. All costs associated with the SCERP will be paid by the physiotherapist.
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