Hands Off Care Doesn’t Work

Posted: October 15, 2025

The College received a complaint from a patient who was unhappy with their physiotherapy care.

The patient started going to physiotherapy after an accident. They attended regular appointments for several months.

During that time, the patient said they rarely spoke with the physiotherapist, and most care was provided by a physiotherapist assistant. The patient was confused about what the treatment plan was and who was providing their treatment. When they raised concerns, they felt like they weren’t listened to.

In response, the physiotherapist described how they assessed the patient and developed the treatment plan. The physiotherapist said they conducted all reassessments for the patient and provided appropriate supervision to the physiotherapist assistant.

However, a review of the patient record raised concerns.

The Standards

Clear communication is an essential part of getting consent.

Before starting any treatment or assessment, physiotherapists need to ensure the patient understands what will happen during treatment, the expected benefits, and any risks or potential side effects. Physiotherapists also must explain alternative treatment options and what could happen if the patient chooses not to have treatment.

These conversations should be ongoing throughout treatment, so a patient shouldn’t be confused about what happens during their appointments.

In this case, although the patient had signed an initial consent form, there was no documentation of ongoing consent in the patient record. There was also no documentation of consent to involve a physiotherapist assistant.

According to the Working with Physiotherapists Assistants Standard, patients must give their consent to involve a physiotherapist assistant in their care.

In addition to lacking proper documentation about consent, the patient record was also missing details about which tasks were assigned to the physiotherapist assistant. In one case, the record appeared to show that the physiotherapist assistant performed a reassessment of the patient. As a reminder, all assessments and reassessments must be performed by the physiotherapist themselves and cannot be assigned to an assistant.

Finally, the physiotherapist failed to include information about treatment parameters in the patient record.

Parameters are specific, measurable elements set by the physiotherapist to guide and tailor treatments. These may include factors like treatment frequency, intensity, and duration, modality specifications, and progression criteria.

The Documentation Standard requires parameters be included in the treatment plan and patient record.

The Outcome

The physiotherapist was required to work with a practice enhancement coach at their own expense and review resources on documentation, working with physiotherapist assistants, and communication.

Details of this case have been changed to maintain anonymity.