Practice Advice
PT Practice Advice
The College’s Practice Advisors are physiotherapists that anyone can contact for free and anonymous advice about matters relating to the practice of physiotherapy. Practice Advisors offer a safe space for physiotherapists, PT Residents, PT students, patients, caregivers and others to get answers to their questions.
Not sure what rule applies? Looking for something on the website and can’t find it? Dealing with a tough ethical dilemma and need to talk it through? The Practice Advisors are here to help. Call 1-800-583-5885 ext. 241 or email advice@collegept.org.
Si vous désirez communiquer avec une conseillère en français, veuillez appeler directement Mary-Catherine au 1-800-583-5885, poste 294.
Practice Advisors are an educational resource to support but not replace professional judgment. Physiotherapists are self-regulated professionals, responsible for their own decisions and actions. Practice Advisors may assist in identifying and evaluating the options and risks involved in taking various courses of action with the intention to support an individual’s reflection and decision-making process. Their guidance is grounded in the College’s standards and Code of Ethical Conduct.
In rare instances, the information presented may indicate that a person is at risk or fraudulent business practices are happening. In these cases, the Practice Advisor may share the information with others. The Practice Advisor will let you know that the information is being shared, why it is being shared, and any next steps.
On average, you can expect a response within one to two business days. This response time may vary depending on the nature of your inquiry.
If you have a complaint or concern about a particular physiotherapist’s practice, please contact investigations@collegept.org.
Featured Myth vs. Fact
FACT.
The patient’s healthcare needs and preferences are the guiding principles for creating a treatment plan, along with the findings of your physiotherapy assessment, and your clinical reasoning. Collaborating with your patients is the key to creating meaningful treatment goals, building trust, and improving your patient’s experience and outcome.
If you’re not confident in how to proceed when a patient does not agree with your recommendations, consider reviewing the Patient-Centred Communication Module. It has tips and techniques to help you better understand your patients and can empower you to make more collaborative decision-making in your physiotherapy care.
Featured Frequently Asked Questions
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.
| Considerations for Collaborative Care when merging external care with in-patient care* | In-patient physiotherapist | External physiotherapist |
| Consent | Must obtain patient (or substitute decision maker) consent to share personal health information with external PT | Must obtain patient (or substitute decision maker) consent to share personal health information with in-patient PT |
| Communication | Responsible for communicating with external PT | Responsible for communicating with in-patient PT |
| Use of hospital/facility equipment? | Yes | Unclear – must ask facility |
| Use of hospital auxiliary staff? Example: PTA | Yes | No |
| Permission to view patient’s in-patient chart? | Yes | No, unless they have permission from organization’s Privacy Officer |
| Goals of treatment | Developed with patient following assessment; revisit to ensure goals are compatible with patient, family and external PT | Developed with patient following assessment; ensure they are compatible with patient, family and in-patient PT |
| Treatment plan | Established with considerations of care provided by external PT | Established with consideration of care provided by in-patient PT |
*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 duplications of services, excessive fatigue to patient, contradictory treatment approaches or communication challenges
- How will we manage these risks?
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.
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.
Yes, a physiotherapist can reduce or waive the cost of an assessment or treatment for patients who are struggling financially. According to the Fees, Billing, and Accounts Standard, any changes to the regular fee schedule can only be made to lower the fees.
When offering discounts, physiotherapists should follow a professional and ethical approach. It’s recommended that physiotherapists document the reason for the fee reduction or waiver in the patient’s record and ensure that the amount charged is correctly reflected in any invoice given to the patient.
It’s important to remember that reducing or waiving fees should not result in a shorter or incomplete assessment. Any treatment plan should be based on what is clinically necessary, regardless of the fee charged or waived.