Virtual Practice

This page provides an overview of the expectations related to virtual practice (tele-rehabilitation), based on existing College standards and rules.

What is Virtual Practice?

Virtual practice, also known as tele-rehabilitation, is the delivery of physiotherapy services at a distance, using telecommunications technology as the service delivery medium.

Virtual practice relates to all aspects of patient care, including the patient interview, physical assessment and diagnosis, treatment, maintenance activities, consultation, education, and training. It can include the use of media such as videoconferencing, email, apps, web-based communication, and wearable technology. Physiotherapist assistants may or may not be present with the patient.

Virtual practice is an alternate mode of service delivery for traditional rehabilitation services and as such, the practice of virtual care does not remove or alter any existing responsibilities for the provider.

Providers must adhere to all existing practice requirements, including the scope of practice of the profession, the standards of professional practice, the Code of Ethical Conduct, as well as any provincial and federal laws that guide practice.

Registration Requirements

• Physiotherapists must be registered to practice in Ontario to provide virtual care to patients in Ontario.
• Physiotherapists assessing or treating patients residing in another jurisdiction must be registered to practice in that jurisdiction.

Competence

• Physiotherapists who provide virtual care must ensure they have the knowledge, skills, abilities and judgement to safely and effectively provide care remotely.

Standards and Expectations

All relevant standards, rules and legislation apply to the practice of virtual care by physiotherapists:

This means:

• The College’s Standards of Practice apply to virtual care.
• The College’s Code of Ethical Conduct applies to virtual care.
• All relevant legislation applies to virtual care.
• Physiotherapists must use their professional judgement to determine:
  • Whether virtual practice is the most appropriate method to deliver services considering the circumstances.
  • Whether a direct physical examination is required to complete the assessment and determine a physiotherapy diagnosis and treatment plan.
  • Whether they have the ability to deliver substantively similar care as physiotherapy delivered face-to-face.
  • Whether patient factors such as physical, sensory, or cognitive deficits may impact the ability to deliver appropriate care through virtual practice.
• Physiotherapists must ensure virtual practice does not expose the patient to greater risk than other possible service delivery methods.
• Record keeping must indicate if the physiotherapy session was provided through virtual practice.
• Physiotherapists must be aware of, and comply with, the privacy legislation relevant to virtual practice, including the Personal Health Information Protection Act.
• Physiotherapists are accountable for the privacy and security of patients’ health information that is transmitted for the purpose of virtual practice.
• Physiotherapists must obtain informed consent for virtual practice.
• The consent conversation must include all elements of consent according to the Health Care Consent Act.
• Physiotherapists must ensure clear communication during virtual practice.
• Physiotherapists must manage the additional technology considerations associated with virtual practice, such as security, data storage and technical troubleshooting.
• When selecting and using a technology platform, physiotherapists must take reasonable steps to ensure personal health information is protected and the patient provides informed consent before proceeding with care.
• Physiotherapists must have an adverse event plan in place should a patient experience an emergency during a virtual physiotherapy session.

Liability Insurance

• Liability insurance requirements apply in virtual practice.
• Physiotherapists should check with their insurance providers if treating patients out of province to ensure coverage.

Fees and Billing

• Physiotherapists who provide virtual care should ensure that their invoices are clear:
  • that the care being billed for was provided through virtual practice
  • who provided the care.
• Physiotherapists should discuss fees and payment options with the patient.
• Physiotherapists should advise their patients to confirm with their insurer whether virtual physiotherapy sessions are covered. 

Ontario Health Checklists

This checklist for clinicians from Ontario Health can help physiotherapists plan, assess and deliver virtual care.

Ontario Health also has checklists that physiotherapists can use to help patients asses which virtual care options are best suited to their needs:

• Standardized Checklist for Use of Virtual Care for Patients
• Checklist for Use of Virtual Care for Patients – Customizable Version

Learn More