Controlled Acts and Restricted Activities Standard

1.  Authority and Responsibility

Physiotherapists must have the authority to perform a controlled or legally restricted act. They get this authority from legislation, delegation, or a transfer of authority. 

• Every controlled act* performed by a physiotherapist must be within the scope of practice of physiotherapy.

• Physiotherapists are responsible both for deciding to offer a controlled act and for performing it.

• Physiotherapists who are asked by the College must be able to show that they meet the requirements in this standard.

2.  Education and Training

Physiotherapists must be able to prove that they have successfully completed training for the controlled acts they perform. This can be formal education or training delivered on the job. During the training, the physiotherapist must:

• Learn the indications, contraindications, adverse outcomes, and risks associated with performing the controlled act.

• Practise the controlled act under the supervision of a person who is authorized to perform it.

• Be evaluated on the knowledge, judgement, and practical skills needed to perform the controlled act.

• Show that they are able to safely and competently perform the controlled act.

3.  Managing Adverse Outcomes

Physiotherapists must know what to do if performing a controlled act results in an adverse outcome. Physiotherapists must have written instructions that tell them how to manage adverse outcomes that can be reasonably foreseen.

4.  Communication with Other Health Care Providers

Physiotherapists may perform controlled acts that affect the care their patients receive from other health professionals. They must communicate with these professionals in a timely way. 

5.  Rosters for Controlled Acts

The College keeps rosters listing the physiotherapists who are permitted to perform each controlled act. To perform the act, the physiotherapist must be listed on the roster.

There are two exceptions:

• Giving the patient a diagnosis

• Performing a controlled act delegated by another health professional. In this case, they can agree to perform it only under the conditions listed in #6 below.

6.  Delegation: When Another Health Professional Delegates a Controlled Act to a Physiotherapist

Physiotherapists must agree to perform controlled acts only under these conditions:

• The controlled act falls within the scope of practice of physiotherapy.

• The physiotherapist believes that the delegating health professional can perform the controlled act safely, competently, and ethically, and has the legal authority to delegate it.

• The physiotherapist has given the delegating health professional all the information he or she needs to support the delegation.

• The physiotherapist believes that the delegating professional has met his or her own profession’s standards for delegating controlled acts.

• The delegating professional has explained the circumstances in which the physiotherapist can perform the controlled act. This includes the patient (or class of patients) the physiotherapist can treat and any other limitations.

The physiotherapist must explain to patients who gave them the authority to perform the controlled act. The physiotherapist must not delegate the controlled act to anyone else.

7.  Delegation: When a Physiotherapist Delegates a Controlled Act to Another Health Professional

Physiotherapists may delegate the controlled acts they are authorized to perform except for:

• Acupuncture

• Communicating a diagnosis

• Spinal manipulation

• Internal assessment or internal rehabilitation of pelvic musculature

Physiotherapists who delegate a controlled act must have the knowledge, skills, and judgment to perform it safely, competently, and ethically.

Physiotherapists are responsible for deciding to delegate the act and must document that they have:

• Ensured the person who will be performing the act has the knowledge, skills, and judgment to do so safely, competently, and ethically.

• Explained the circumstances in which the person can perform the controlled act. This includes the patient (or class of patients) the person can treat and any other limitations.

• Ensured that the person knows how to deal with any adverse outcome that can reasonably be foreseen and has a written protocol for doing this.

• Confirmed that the person knows they must not delegate the act to anyone else.

Glossary 

Physiotherapists who perform controlled acts under their own authority must roster for each of these activities with the College. These include:

• tracheal suctioning 
• spinal manipulation 
• acupuncture (including dry needling)
• treating a wound below the dermis 
• pelvic internal exams (this includes putting an instrument, hand or finger, beyond the labia majora, or beyond the anal verge)
• administering a substance by inhalation