Practice Advice

All physiotherapists must comply with the Infection Control Standard. 

Hospitals and large organizations often have robust infection control measures led by an Infection Protection and Control (IPAC) team. However, it may be challenging for a solo practitioner to know what to consider.  

When providing care in a mobile physiotherapy model (such as in patients’ homes), you should create an infection control policy that applies to your situation.  

Here are some things to consider when creating your infection control policy in the context of a mobile service or when providing care in a private home: 

1. Perform a Point of Care Risk Assessment. Before each visit, evaluate potential risks by asking questions such as: 

• Does the patient (or anyone in the home) have symptoms of a respiratory virus? 

• Are there pets or other factors that could affect your infection control protocol? 

2. Prepare and use appropriate PPE. Bring necessary Personal Protective Equipment (PPE) such as masks, gloves, gown, and eye protection. 

3. Maintain hand hygiene. 

• Check if there is a sink with soap available at the site. If not, bring hand sanitizer containing at least 60% alcohol. 

• Wash or sanitize your hands before and after patient contact, and after removing PPE.  

4. Communicate your infection control procedures. Clearly explain to patients and their families the infection prevention steps you are taking to foster cooperation and understanding. 

5. Plan for safe disposal of waste. Carry an approved portable sharps disposal container for needles or other sharps. Dispose of gloves, masks, and other contaminated items safely after each visit. 

Physiotherapists who have more than one title (in healthcare or a non-healthcare field) are required to meet the requirements within the Dual Practice Standard.

This standard requires physiotherapists to clearly identify when they are providing physiotherapy care or non-physiotherapy care.

It should be clear to your patient when you are acting as their physiotherapist. Your two practices must be kept separate. This could affect a clinical day in the following ways:

1. Introductions: Be sure to introduce yourself as a physiotherapist when providing PT care. Be clear with your patient that today, they will be attending a physiotherapy appointment. Consider wearing a nametag with your protected title when providing PT care.
2. Scheduling: There must be a distinct appointment time for each service.
3. Record keeping: As a PT, you must meet the requirements of the Record Keeping Standard, as well as document chart entries using your protected title of PT or PT Resident. Record separate patient notes for each service, or separate entries in a shared patient record, that clearly identify which professional role/service was provided at each patient visit.
4. Billing: Any invoice provided to patients must clearly indicate that they received physiotherapy care when you were acting as their PT, and athletic therapy when you were providing care as an athletic therapist. The professional role/service provided should be clear on each invoice.
5. Communication: In your emails with patients, be clear about which service you are discussing in your responses to them. Use your protected title of PT when responding as a physiotherapist.
6. Conflict of Interest: If your clinical reasoning indicates that your patient would benefit from also seeing an athletic therapist, you must mitigate the potential conflict of interest by letting the patient know that they could be seen by any athletic therapist, and it would not negatively impact your patient/PT relationship. Patients should not feel that they were forced to see you as their athletic therapist. Remember, any service recommended must be clinically indicated.

Yes, a patient could continue to work with you as an out-patient in your clinic if you recognize the potential for a conflict of interest and disclose and mitigate these conflicts with your patient. 

It is your duty to act in their patient’s best interests. If a physiotherapist’s professional expertise or judgment could be affected or influenced by competing interests or relationships, they may be in a conflict of interest. Competing interests may be financial, non-financial or social in nature.  

In the recently adopted Conflict of Interest Standard, there is a performance expectation that a physiotherapist does not participate in any activity which could compromise professional judgment. An example given includes self-referring existing patients to their own services without ensuring transparent disclosure to the patient and offering alternative options. 

To avoid a conflict of interest, a physiotherapist must:  

• Disclose and discuss the situation with the patient before providing the list of services. 

• Make the patient aware of practical alternatives, if there are any. 

• Document the discussion in the patient’s record.  

The new Collaborative Care Standard lays out the requirements for physiotherapists when working collaboratively with other healthcare professionals. Make sure you read it in full.  

The key to a successful collaboration with a physiotherapist from outside your organization is communication. Engage your patient and their family in the plan. Help them to make an informed decision regarding combined care. Ensure you have their consent to communicate and share health information with the external PT. Check with your manager or privacy officer regarding your organization’s policies around accessing or sharing parts of the patient’s chart.

Patient safety responsibilities will be shared between the two physiotherapists. You are expected to consult with the other physiotherapist once they are involved in the patient’s care. Each physiotherapist should ensure that their care is compatible, clinically indicated, and in the best interest of the patient. The collaboration should ensure that the plan of care addresses the needs and goals of the patient. Recognize that some of your goals may be shared, and others may be distinct depending on equipment, available resources, skill sets and other factors.

Establish an effective communication plan to ensure care remains compatible and complimentary with each other. Compatible care means « Methods and strategies that complement each other, work without conflict, and support the patient’s treatment goals rather than hindering them.” For example, an aspect of compatible care could be in the scheduling of treatments. Communicate with the external PT what your window of treatment time will be with the patient, and they should communicate their expected appointment times. Ensure these times allow the patient appropriate rest and recovery for their stage of rehab.

Both PTs must maintain documentation of physiotherapy care, and any communication regarding the clinical care.

Both PTs are responsible and accountable for managing the collaborative relationship including dealing with any conflicts that arise.

Should one of the physiotherapists choose to decline or discharge the patient, they must provide rationale for their decision to the patient and document the conversation in the patient’s record.

We have created a table to facilitate these considerations in your workplace.

*Refers to hospital, long-term care, rehab and other in-patient settings

Questions each PT should ask themselves: 

• Is my care compatible with the other PT? 
• Is my care clinically indicated? 
• Is my care in the patient’s best interest? 
• Is my care an appropriate use of human/financial resources?  
• Have I identified risks? For example, unneeded duplication of services, excessive fatigue to patient, contradictory treatment approaches or communication challenges that may interfere with safe, quality care.
• How will we manage these risks? For example, ensure discussions about conflicts and rationale for resolutions are documented.
• If I am considering discharge, can I meet the Duty of Care Standard?

A good place to begin your review of evidence-informed practice might be this summary article available on physio-pedia.com.  It includes some of the basic principles and the strengths and weaknesses of evidence-informed practice. It also includes further resources to deepen your understanding of how to critically assess the quality of the information that you are reading. You can learn about the levels and grades of evidence here. 

Remember that evidence-informed practice is not only the application of research evidence. It is a phenomenon that emerges from the interaction between research evidence, clinical experiences, and patient experience. Patient-centred communication and care should remain at the forefront of evidence-informed physiotherapy practice. 

Consider subscribing to a research summary service that will send relevant research information to your inbox to make it easier for you to stay up-to-date.  If you are a member of the Canadian Physiotherapy Association (CPA), you have access and can subscribe to research reviews such as PEDro and Ortho Evidence. 

As a PT resident with a provisional licence and a PhD in anatomy, your signature on patient charts and invoices should clearly reflect your physiotherapy qualifications. You should use the name listed on the Public Register followed by your PT protected title.

Here is an example of how to craft your signature using professional credentials in a patient-facing environment:

Smita Mehta, PT Resident

MScPT, PhD (anatomy)

Standardized measures refer to measurement tools that are designed for a specific purpose in each population. Information is provided regarding the administration, scoring, interpretation, and psychometric properties for each measure.

Using a goniometer to measure range of motion or a sit to stand test to measure functional movement are examples of standardized measures.

Standardized measures allow for greater consistency and reliability in physiotherapy assessments, by allowing PTs to evaluate outcomes in a reliable way. When a standardized tool is used, PTs can compare results against different patients, settings or points of time. 

Many aspects of physical therapy – such as strength, range of motion, balance, or endurance – can be difficult to quantify without clear, objective metrics. Standardized measures provide numeric scores or classifications that remove much of the subjectivity from the assessment process, allowing for more precise and reproducible re-assessments.  This can also assist in setting SMART goals with your patient. 

Standardized tools can facilitate collaborative care, by improving communication between healthcare providers. They also allow for comparison with population norms or other patients with similar conditions, aiding in decision-making and prognosis.

These measurement tools are often developed and validated through research, meaning they have evidence supporting their reliability and validity. By using these tools, physiotherapists ensure that their assessments are grounded in best practices, which increases the likelihood of effective treatment plans.

If you’re unsure where to find examples of standardized measures, please reach out to our Practice Advice line for assistance.

A privacy breach occurs when personal health information is stolen, lost or used/disclosed without authority. Examples might include lost or stolen charts, or patient health information erroneously sent to people not involved in their care. 

When a privacy breach happens, whether intentional or not, physiotherapists should follow these steps – even if it’s just a single occurrence: 

1. Contain the breach and, if you are the agent of the health information custodian (HIC), notify your organization’s HIC and report the breach to them. 

2. Health Information Custodians must notify the affected person at the first reasonable opportunity and include mention that a complaint may be made to the Information and Privacy Commissioner of Ontario (IPC).

3. You (PT) and the HIC should determine whether your organization’s privacy policies and processes were followed.

4. Next, the HIC must determine:

• If this is a one-time occurrence or if it is part of a pattern of errors
• What the impact on the patient could be
• Whether the breach could happen again

Make note of the findings of the review.

5. The HIC must report the breach to the Information and Privacy Commissioner of Ontario (IPC) if it falls within one of the following seven categories. The categories are not mutually exclusive; more than one can apply to a single privacy breach. If at least one of the situations applies, you must report it. The following is a summary, for complete information see the regulation. 

1. Use or disclosure without authority
2. Stolen information
3. Further use or disclosure without authority after a breach
4. Pattern of similar breaches
5. Disciplinary action against a college member
6. Disciplinary action against a non-college member
7. Significant breach

Note: Not all privacy breaches need to be reported to IPC. For example, if a lost chart was a one-time occurrence, not intentional and not part of a pattern, the matter can be managed internally.

6. Debrief the issues with your team. Share the lessons learned so you can build a positive culture around privacy safeguards in your workplace.

No. You cannot use the title “Physiotherapist” or “Physiotherapy Resident” or bill for physiotherapy services using the title PT.  

The physiotherapist title is protected under the Regulated Health Professions Act to provide care to humans. The only way professionals can provide rehabilitation services to animals is under the direction and supervision of a veterinarian. 

When you’re leaving a practice and there’s no other PT available to take over your patients, it’s important to make sure they still have options for continuing their care. 

Talk to your employer about how you will let your patients know you’re leaving. Options may include providing your patients with a list of other physiotherapists in the area who can help them, or giving the patient an exercise plan to follow at home to keep up with their treatment.

Sometimes, your employment contract might have rules that stop you from telling patients where you are going next. If that’s the case, you can direct them to the College’s Public Register, where your new job will be listed. Make sure you update your information so patients can find you if they want to.

If a patient decides to keep seeing you at your new job, they can ask for a copy of their physiotherapy record from the Health Information Custodian at your previous clinic. This helps make sure you maintain the information you need to continue their care.

The Leaving a Practice Checklist outlines all of the things you’ll need to do before you leave.

The new Communication Standard guides physiotherapists to communicate professionally, clearly, effectively, and in a timely manner to support and promote quality physiotherapy services. One of the stated expectations is that the PT « documents all communications accurately, clearly, professionally, and in a timely manner. »

The College guidance regarding documenting communication has not changed. All forms of communication (for example, telephone, email or DM) that are relevant to the patient’s condition or the care provided are part of the clinical record. In the example above, a PT would not need to include a DM about what hours they are working.  However, the text message indicating a change in symptoms should be included in the patient’s record.

Yes! As a College-approved supervisor, you are an important and valued link for a PT resident to move towards their independent registration.  Not only do you act as a clinical mentor, but you also demonstrate for them how to behave as a regulated health professional.  

The College has a learning module called Supervising a Physiotherapy Resident: Everything You Need to Know as Their Supervisor. This module provides useful tips on how to manage your supervision, including keeping records of your meetings and tracking learning goals. It also introduces tools on the CPO website, such as the Identification of Learning Needs and Record Keeping Checklist.

Keeping records is key. For example:

• Track the dates and details of your check-in meetings.
• Monitor the progress of set learning goals.
• Document the results of any chart reviews.

If you have concerns about a resident’s practice or need advice on your supervision, please reach out to us at Practice Advice.