Physiotherapy Scope

FAQs: Physiotherapy Scope of Practice

• Can I be asked to do activities that are not typically in the scope of physiotherapy practice?

  In a health emergency such as a pandemic, physiotherapists are valuable health team members who may be asked to participate in activities that are outside their normal duties.
  
  For example, PTs may be asked to assist with mask fit testing or screening procedures. Some of the activities that physiotherapists may be asked to perform are considered controlled acts and require delegation by a practitioner who is authorized to perform them.
  
  Recognizing these activities may not be common practice for PTs, they could only be done with adequate training on the procedures and if given the required personal protective equipment.
  
  With appropriate safeguards in place we would expect physiotherapists to be flexible during situations of health emergencies to assist the health care system manage increased demands. There may be exceptions to this and we encourage those PTs to have discussions with their organizations to address any concerns.

• What changes came into effect on September 1, 2011 as a result of amendments to the Physiotherapy Act?

  On September 1, 2011, several changes to the Physiotherapy Act came into effect. These amendments:

  - Updated the scope of practice of physiotherapy. The new statement adds the component of diagnosis of physical dysfunction and it is restructured to emphasize a systems approach, and

  - Added a number of new authorized acts to the ones that physiotherapists/physical therapists were already allowed to perform. 

  Physiotherapists should also note that the Controlled Acts and Restricted Activities Standard replaced the previous Standard of Professional Practice: Controlled Acts.

• What authorized activities were granted in the amendments to the Physiotherapy Act?

  As of February 2012, physiotherapists can perform the following activities:
  
   •  Spinal manipulation
   •  Tracheal suctioning
   •  Acupuncture
   •  Treating wounds below the dermis
   •  Assessing or rehabilitating pelvic musculature
   •  Administering a substance by inhalation (when the substance has been ordered by an authorized person)
  
  All of these activities require rostering. 
  
  The following three activities have not received government approval and cannot be independently performed by physiotherapists. PTs can only perform these activities when the authority to do so has been delegated to them by another healthcare provider.
  
  

   •  Ordering a prescribed form of energy (e.g. diagnostic ultrasound or MRI)
   •  Ordering diagnostics (e.g. x-rays or CAT scans)
   •  Ordering specified laboratory tests

   

• What is the difference between a controlled act and an authorized activity?

  Authorized activities include all legally restricted health care activities that may only be performed by people who have the appropriate legal authority.
  
  Controlled acts are a subset of authorized activities specific to the Regulated Health Professions Act (RHPA). Other authorized activities are restricted under different laws such as the Healing Arts Radiation Protection Act (HARP) and Laboratory and Specimen Collection Centre Licensing Act (LSCCLA) and their regulations.

• What is a roster and how and when do I get on the roster?

  A roster is a list of physiotherapists who are allowed to perform a specific authorized activity under their own independent authority. These lists are managed by the College of Physiotherapists of Ontario.
  
  Registrants are required to add their names to the roster (list) for each of the authorized activities they plan to perform. Some physiotherapists will choose not to perform authorized activities and will not need to add their names to any roster with the College.

  Part of the application process requires a signed legal declaration stating the individual is competent to perform the authorized activity. Information on the rosters is accessible on the Public Register. There are no fees for getting on a roster. Online rostering has been available since February 1, 2012.

• Can physiotherapists use ultrasound to treat a blocked duct in the breast of a lactating patient?

  While breast health does not fall within the scope of physiotherapy, and a blocked duct would not be a physiotherapy diagnosis, this may be an activity a physiotherapist could perform under the right circumstances. The physiotherapist would need to work with a regulated health care professional who has breast health within their scope (e.g. physician, midwife, nurse practitioner) who had assessed the patient, diagnosed the blocked duct, and determined whether therapeutic ultrasound would be an appropriate treatment. 

  Physiotherapists should only provide the care if they have the knowledge, skills, and judgement to do so safely and competently, and have information to support it as a safe and effective treatment. The PT should work collaboratively with the referring health care provider and consider how they will monitor for efficacy of treatment and progress. The PT should also have a conversation with the patient regarding the nature of the treatment, its benefits and risks, alternatives to treatment, and provide information that the PT is working collaboratively with another health care professional. See the Collaborative Care standard for more information. 

  Want to introduce something new to your practice? Not sure if something falls within physiotherapy scope? Have a look at the "Is It Physiotherapy" decision-making tool.

• What is the role of a physiotherapist in the assessment and management of concussions?

  Remember that a physiotherapist’s scope of practice is outlined in the Physiotherapy Act. According to the Canadian Alliance of Physiotherapy Regulators’ Position Statement on The Role of Physiotherapists in the Assessment and Management of Concussions:
  
  "A comprehensive, medical assessment is required to diagnose a concussion. Only medical doctors and nurse practitioners are qualified to provide a concussion diagnosis. 
  
  In conjunction with a concussion management team, physiotherapy diagnosis is appropriate in cases of symptoms and physical injuries or impairments that are associated with cervical spine, the sensorimotor and neuromotor control systems or the physical injuries, impairments or symptoms related to common concussion co-morbidities resulting from falls, whiplash, spinal cord injury or assault etc."
  
  View the complete position statement from CAPR.
  
  Physiotherapy Scope FAQs

• Can a physiotherapist recommend a patient take supplements, like vitamin C, as part of their treatment plan?

  No, physiotherapists are not allowed to prescribe or recommend medications, including over-the-counter drugs or supplements like vitamins, as part of a treatment plan. They also can’t suggest specific diets. However, physiotherapists can share general information if there’s evidence that supplements might help the patient reach their goals in physiotherapy. They should advise patients to talk to a healthcare provider (like a doctor, nurse practitioner, or pharmacist) who can answer questions about how supplements or medications might interact with any current medications and affect their health.
  
  Physiotherapists must be careful to stay within their training and scope of practice and think about any risks, like possible drug interactions, when talking about supplements with patients.