Physiotherapy Scope of Practice

When considering whether to implement a new treatment technique, it is important to consider whether it falls under the scope of practice as a physiotherapist and PTs must ensure that they have the required knowledge, skills and training to provide safe and effective care.  

As a reminder, physiotherapists are expected to apply an evidence-informed approach in their assessment and treatment techniques. If there was an issue or incident where a patient was harmed during the use of a treatment or device, the PT would need to be able to demonstrate the steps they took to ensure the tool/technique was safe to use within the context of the physiotherapy appointment. 

Some questions the physiotherapist should consider include:

• What are the risks associated with the application and use of the device? Can I manage any adverse event (reasonably) predicted as an outcome of treatment? 
• Has it been approved by Health Canada for use on a patient? 
• Is it in the patient’s best interest to use the device? 
• What is the quality of the evidence?  Has it been researched and supported by independent bodies or has the only supporting research been performed by people associated with the company? 
• Am I the most appropriate health care professional to provide this treatment? Does it require the knowledge and expertise of a physiotherapist, or could the patient be self-administering this treatment?   

Finally, a physiotherapist is encouraged to verify with their liability insurer if an emerging technology or assessment approach would be included in their coverage.

In summary, physiotherapists must assess the level of risk involved in using the technique/equipment, ensure they can manage the risks to avert adverse outcomes, have a plan to address any potential adverse outcomes, and have the patient’s informed consent to proceed.

It is not within a physiotherapist’s scope to prescribe medications, or to recommend specific over the counter (OTC) medications/drugs such as vitamins or supplements as part of a treatment plan, or to follow a specific diet. 

Physiotherapists can, however, let patients know if they are aware of evidence supporting supplementation as it relates to physiotherapy treatment, provide general information, and advise patients who wish to use supplements or OTC medications to follow up with a health care provider that can answer any questions about how it may relate to their health or other medications/supplements they may be taking (e.g. pharmacist, MD, NP, etc.).

When discussing supplements and medications with patients, physiotherapists need to consider their own training, knowledge, scope, and any potential risks to the patient, including possible drug interactions and effects on systems outside the scope of PT.

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.

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.

If you are running a class as a “general exercise class,” i.e., the participants have not been individually assessed, then it is not considered physiotherapy care even if it will be delivered by a physiotherapist, and it would be important to ensure the participants understand this. You would not be required to follow the expectations for record keeping, etc. You may deliver this “exercise class” at any suitable location. Billing and any records from this class should be kept separate from your physiotherapy records. 

As a reminder, participation in group exercise classes may be billed as physiotherapy if the following conditions are met:

• The patient has had an individual physiotherapy assessment 
• There is a physiotherapy diagnosis with related patient-specific goals 
• The group exercise program is part of an individualized treatment plan to address patient-specific goals 
• The class is run by a PT or PT Resident, or assigned to a PTA who has the knowledge, skills and judgment to do so, and is appropriately supervised by the PT/Resident in a manner which meets the Working With PTAs standard 
• The patient is reassessed as appropriate for their condition/situation, and the treatment plan is modified as required 
• A discharge assessment is completed 

In this example, the patients would have to require physiotherapy care. This means the patient is presenting with specific complaints or concerns within PT scope (e.g. pain, decreased function, etc.) and requiring PT knowledge and skills to assess and treat. Billing a fitness or generalized exercise program as physiotherapy without an actual need for physiotherapy intervention could be considered as fraud. Physiotherapists must ensure that 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 or accounts that are inaccurate, false or misleading. 

You should use your clinical reasoning skills to determine if a participant to your class requires clearance from their family physician, and what type of medical information you would need from the participants before they could successfully participate in your class.

Physiotherapists should be aware that some extended health insurers do not pay for group physiotherapy sessions and should consider advising patients to verify with their insurers that the group physiotherapy sessions will be covered prior to beginning their sessions.

Physiotherapists should verify with their liability insurance policy to see if you would be covered to provide group exercise classes in the community.