Consent is Key

Posted: February 18, 2025

The Case

The College received a complaint from a patient who was caught off guard by how their physiotherapist touched them during an appointment.

While performing a spinal manipulation, the physiotherapist put their hand up the patient’s shirt so they were touching their bare back. The patient said the physiotherapist hadn’t discussed this with them beforehand and the touch made them uncomfortable.

As the physiotherapist pushed against the patient with their chest and stomach to perform the manipulation, the patient felt even more unsafe.

The patient reported they left the appointment feeling violated.

The Standards

A patient should never be surprised about what happens during physiotherapy treatment.

Healthcare providers, including physiotherapists, are legally required to obtained patient’s informed consent to treatment. This requirement is also outlined in the Assessment, Diagnosis, Treatment Standard.

Informed consent is more than just having a patient sign their name on a form. Physiotherapists must ensure patients understand what they’re agreeing to.

Before starting treatment, a physiotherapist should have a thorough conversation with their patient that covers:

What will happen during the treatment

The expected benefits

Any risks or potential side effects

Alternative treatment options

What could happen if the patient chooses not to have the treatment

The physiotherapist must also answer any questions the patient has and let them know they can choose to stop the treatment or assessment at any time.

In this case, the physiotherapist said they had explained the treatment to the patient but acknowledged they did not provide enough detail.

Before starting the treatment, the physiotherapist should have explained exactly where they planned to place their hands. They also should have told the patient how hard they would press to perform the manipulation and with which parts of their body.

If this detailed conversation had happened, the patient might not have agreed to the spinal manipulation – or the physiotherapist could have modified the treatment to ensure the patient was comfortable.

When treatment involves touching potentially sensitive areas or being in close proximity to a patient (for example during a spinal manipulation) physiotherapists need to take extra care when getting informed consent.

Everyone has unique boundaries, which are based on a variety of factors, including their history of trauma. It’s a physiotherapist’s job to respect their patients’ boundaries.

The Result

After carefully reviewing the case, the committee decided to require the physiotherapist to work with a practice enhancement coach and review resources on professional boundaries, sensitive practice, consent, and patient communication.

Details of this case have been changed to maintain anonymity