Case of the Month
The Case
The College became aware of a physiotherapist who was providing services outside the physiotherapy scope of practice, including giving diet advice and billing for supplements, and launched an investigation.
A review of patient files indicated the PT was telling patients that taking probiotics could help with weight loss, inflammation and gut health. The physiotherapist also sold probiotic capsules to the patient and included their name and registration number on the invoices.
Additionally, the PT provided patients with handouts recommending the use of the Calcarea Carbonica (weight loss supplement), Genacol (anti-inflammation supplement) and provided dietary advice on sugary or starchy foods and gluten.
The investigator noted the PT’s practice location was not listed on the Public Register. The physiotherapist updated the practice location after being informed of the investigation, but it appeared they had already been working at the clinic for approximately six years.
The physiotherapist maintained they had difficulty navigating the PT Portal and had tried unsuccessfully to change their practice location. However, they never followed up with the College to update the information. They also said they had taken courses on nutrition and supplements and noted they billed for supplements separately from physiotherapy services, putting each on separate invoices. The PT believed the services they provided were within the scope of practice for physiotherapists.
The Standards
The Physiotherapy Actdefines the practice of physiotherapy as the assessment of neuromuscular, musculoskeletal and cardiorespiratory systems, the diagnosis of diseases or disorders associated with physical dysfunction, injury or pain and the treatment, rehabilitation and prevention or relief of physical dysfunction, injury or pain to develop, maintain, rehabilitate or augment function and promote mobility.
Physiotherapists are advised to avoid providing recommendations about medications (including supplements) because of a lack of pharmaceutical knowledge, the risk of adverse events including side effects of the medication interacting with other medications, and the significance that such recommendations carry for patients.
Physiotherapists should direct patients to seek advice from a pharmacist, physician, or another health professional authorized to prescribe medications.
Physiotherapists can’t advise patients on specific diets. Physiotherapists don’t have the training or skills to diagnose deficiencies in things like minerals, vitamins, hormone levels, cholesterol levels or anything that would require blood analysis.
Patients should be able to trust regulated health professionals. For that reason, patients are likely to believe a healthcare provider’s advice – regardless of whether they’re qualified to give it.
The Fees, Billing and Accounts Standard requires physiotherapists ensure any fee, billing or account that uses their name and registration number is an accurate reflection of the services and/or products provided. Physiotherapists must never charge fees or create billings that are inaccurate, false or misleading. In this case, the physiotherapist was billing for products that are outside the scope of physiotherapy while including their PT registration number on the invoices. Doing so falsely creates the impression the services were part of physiotherapy treatment.
Additionally, physiotherapists are required to inform the College of any changes to their employment information within 30 days. While the PT updated their practice location after they were informed of the investigation, they should have done so earlier. If the physiotherapist had difficulty navigating the PT Portal, they should have contacted the College to troubleshoot the issue.
The Outcome
The physiotherapist received a caution and was required to complete a Specified Continuing Education or Remediation Program (SCERP) focused on scope of practice, fees and billing and regulatory obligations. The costs of the SCERP are paid by the PT. Notice of the SCERP and caution will appear on the Public Register.
I have a question. I practice pelvic health physiotherapy. One of the aspects of our care is constipation management. Key components to this education is good fluid intake, adding fibre to diet ( including keeping a fibre and fluid diary for a couple days), and suggesting supplements such as magnesium (OTC). Other key components are exercise, breathing, positioning, abdominal massage. Constipation management is essential to management of many conditions we treat.
when treating urge and frequency we recommend strategies around diet. Ex reducing coffee.
Are we working outside our scope of practice? How do we manage this if we are? Ive seen many women have success with the strategies we teach who’ve struggled for years.
please comment on above questions of a pelvic health PT
Thanks for your questions! As a physiotherapist, there are professional limits regarding dietary advice.
Specific diet counselling is not allowed. You cannot give personalized diet plans or detailed nutrition advice. For example, creating individualized meal plans or recommending specific nutrient amounts for individuals.
You can give general advice based on trusted sources like the Canada Food Guide. This includes suggesting a balanced diet with a variety of foods, encouraging eating fruits, vegetables, whole grains, and lean proteins, and advising to drink enough water and reduce processed foods and sugars.
PTs cannot prescribe supplements and must consider their training, knowledge, scope, and potential risks, including drug interactions. PTs should refer the patient to trained professionals such as pharmacists, MDs, NDs, etc.)
Feel free to contact advice@collegept.org if you have further questions
I sometimes recommend my patients to drink more water, I assume that is OK.
I also recommend my diabetic patients to properly control their sugar & insulin levels through diet before we participate in exercises; I assume that is also OK.
Evidence supports that systemic inflammation caused by an inflammatory diet can be a significant contributing factor to physical pain, are we as PTs allowed to at least give patients just a hand out on the topic (without selling anything)?
Are we not obligated to offer patients basic dietary information knowing that the evidence shows that an inflammatory diet may be a contributing factor to chronic pain and disability?
I certainly ask my patients to consult an MD or a dietician; though MDs rarely take the time to adequately address diet and most patents will never visit a registered dietician.
This is a rock & a hard place so I’d love the CPO feedback on this issue. Thank you
Has any one received feedback on the Pelvic Health Physiotherapy Constipation management question asked above?
I would like to know as well regarding the pelvic question above
I understand we are not giving diet plans, but as a healthcare professionals are you not giving them strategies and recommendations on diet depending on conditions because it has interaction with the outcome of physiotherapy?