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Working with Physiotherapist Assistants

A physiotherapist assistant is anyone who provides care on behalf of, or as directed by, a physiotherapist. There is no specific educational requirement to work in this role, and PTAs are not regulated in Ontario.

The responsible physiotherapist must evaluate the competency of the physiotherapist assistant, must assign and supervise all care and is accountable for the care provided by the PTA.

Some physiotherapist assistants will have received a college level diploma; others may have training in kinesiology or athletic therapy. Some will be trained on the job and others may have a different background. Regardless of the training or background of the assistant, the Standard’s expectations apply.

The College has chosen, based on feedback from the profession, to use the term Physiotherapist Assistant (PTA) to apply to all health care workers who assist physiotherapists, no matter what their qualifications or training.

PTAs are not regulated and this job title is not protected. You are not required to use it in your practice. You can continue to use job titles such as rehab assistant, assistant or support personnel for example. So if you are including an assistant on your invoice, it would be acceptable to record something like, “Aabbcc Jones, R.Kin, physiotherapist assistant”.

Regardless of the job title you use in your practice, the Standard: Physiotherapists Working with Physiotherapist Assistants applies to any person to whom you assign patient care.

No, a physiotherapist is responsible for performing reassessments periodically. The frequency of the reassessments depends on a variety of factors including the acuity of a patient’s conditions and the rate of recovery.

The PT may use observations made by the physiotherapist assistant or use data that the assistant has collected as part of the reassessment, but this does not replace the physiotherapist’s professional obligation to perform ongoing reassessments.

Review the Supervision Requirements Summary Table for more information.

No, the physiotherapist is responsible for conducting the initial assessment (and all re-assessments) and for developing a plan of care. The PTA can, however, collect data and offer input on decisions.

Physiotherapists have unique knowledge, skills, and training and members of the public will seek out when they need help. As such, they should be responsible for doing the assessment and developing the plan of care.

Review the Supervision Requirements Summary Table for more information.

The written communication protocol is intended to ensure that anyone who is working as an assistant can easily and promptly contact the physiotherapist who is responsible for a patient’s care. A single protocol might be sufficient for your workplace if it meets these criteria.

No, the intent is to make sure the PTA knows who to contact and when to contact them. Assistants must be able to easily and promptly contact the PT who is responsible for patient care. It does not need to be kept in the patient chart.

The physiotherapist assistant should contact the physiotherapist if the patient becomes medically unstable, there is a change in their condition, if a patient or the physiotherapist assistant has a question about the treatment or if the patient appears to have plateaued and requires a re-assessment by a physiotherapist.

It should be easy for the physiotherapist assistant to contact the supervising physiotherapist―it is preferable that there be one contact method that the physiotherapist will check frequently.

If a PT assessed the patient, analyzed the findings and assigned physiotherapy treatment to a PTA then yes the PT is accountable and must be available to supervise.

A PTA can only function as a PTA when they are assisting a PT.If someone who has PTA training has been assigned to assist another health professional (say on the weekend) then the assistant is acting under the assignment and supervision of that health professional and the PT is not responsible.

No, it would not be appropriate to go on a vacation and leave your patients under the care of a physiotherapist assistant, as the assistant would not be supervised. Physiotherapists have a responsibility to ensure that they’re available and able to provide supervision when they work with PTAs.

If you know you will be going on vacation consider transferring some of your patients to another physiotherapist in the practice, or look into hiring a temporary physiotherapist to cover your time away. In some cases it may just be best to cancel your patients’ care until you return from your holiday.

Not necessarily. If you are off, but available to intervene on behalf of the patient, then you do not need to appoint an alternate supervisor.

However, if the physiotherapist assistant would not be able to reach you in a reasonable time if they have questions about treatment or if there is an emergency, you must appoint an alternate supervisor.

When contacted, the alternate supervisor becomes responsible for the patient’s treatment (the alternate steps in as the treating physiotherapist at that point). All of the usual supervisory responsibilities of a supervisor apply from that moment onward.

The answer will be different in each unique situation. The level of supervision required depends on the patients’ needs and the level of risk associated with their condition or setting.

The knowledge, skill and ability of the PTA and the supports available in the treatment environment also factor into a decision about the level of supervision that is required.

Each physiotherapist must use his or her own professional judgment, keeping in mind that you need to be able to intervene if necessary. The patient should always receive the same level of care that they would receive if the physiotherapist were providing the treatment directly.

No, entries in the patient’s health record by a physiotherapist assistant do not require a co-signature; however, physiotherapists need to monitor entries made in the patient’s record to ensure that record keeping standards are being met.

Review the Supervision Requirements Summary Table for more information.

The direct supervisor signs any notes made by a PTA student in a patient record. If a PTA directly supervises the PTA student, the PTA would co-sign the PTA student’s notes. The PT maintains overall accountability to ensure safe and effective care is delivered to the patient.

Review the Supervision Requirements Summary Table for more information.

Support personnel/PTAs are not regulated in Ontario. Essentially anyone can work as a PTA but the PT must ensure that the PTA can carry out the assigned treatment competently. It is up to the PT to decide the appropriate supervision. The number of years of experience of the PTA may be one of several factors the PT would consider when deciding on the amount/type of supervision.

No, if someone other than the PT has done the assessment and developed the plan of care it would be misleading to bill the care as if it was carried out by the physiotherapist.

For example, if an RMT (or Chiropractor, Athletic Therapist, OT, etc.) conducted an assessment and developed a treatment plan this would not be billed as a PT assessment.

Not always. If the physiotherapist is required to complete a form to process payment by a third party and if that form was created by the third party and has no place for the physiotherapist to record information about assistants, we do not require it.

In these situations however, the College would expect that the names and job titles of any assistants who were involved in the appointment be readily available to the patient, the payor or the College, upon request.

All statements or invoices that go to the patient must include the name and job title of everyone who provided treatment.

Review the Supervision Requirements Summary Table for more information.

The Standard states that “a physiotherapist assistant’s name and job title should appear on invoices whenever they have provided all or part of the treatment.”

If someone other than the physiotherapist provides treatment to a patient, that person’s name and job title should be included on the statement that the patient receives.

This includes situations where the physiotherapist assistant provides all of the treatment (without a physiotherapist present), and in situations where the physiotherapist assistant provides some of the treatment (perhaps in conjunction with the physiotherapist).

To determine whether the activity performed by the physiotherapist assistant was treatment, ask yourself if the activity was part of the physiotherapist’s treatment plan, for example applying modalities, exercises, gait training, etc.

Things such as tidying the treatment area, removing an ice pack or escorting patients to and from the treatment area would likely not be classified as treatment.

This expectation exists within the Standard because patients should always know the name and role of everyone involved in their treatment.

Review the Supervision Requirements Summary Table for more information.

Yes. The physiotherapist is obligated to be able to provide information about which physiotherapist assistant(s) provided care. In rare circumstances where identifying the specific physiotherapist assistant is not possible, the physiotherapist can meet this obligation by providing a list of physiotherapist assistants who could have been involved in the patient’s care on the day of the patient’s visit. Since the intention of this expectation is that the patient should be able to know who provided their care on a given day, it would not be acceptable to provide an overly long list of names that would make it impossible for the patient to do so.

Yes, you can delegate 02 titration to a PTA. Physiotherapists can delegate to anyone who has the knowledge, skills and judgment to safely and competently perform the activity – this includes assistants and any other health care professional the PT believes is competent.

The acts that can be delegated are:

• Administering O2
• Suctioning
• Wound care

The acts that cannot be delegated are:

• Acupuncture (dry needling) and this includes all parts, even removing needles
• Spinal manipulation
• Communicating a diagnosis
• Internal assessment and treatment of pelvic musculature

Remember, when delegating a controlled act to another person, the physiotherapist must:

• Make sure the person performing the act has the knowledge, skills, and judgment to do so safely, competently and ethically.
• Explain the circumstances in which the person can perform the controlled act, including the patient (or class of patients) the person can treat and any other limitations.
• Ensure that the assistant knows how to deal with possible adverse outcomes and has a written plan.
• Confirm that the person they are delegating to understands that they cannot delegate this act to anyone else.

Please consider using the Physiotherapist Competency Checklist when assessing competency and considering delegating any activity.

Yes, the rostered PT (administrator of the oxygen) is required to delegate the controlled act of O2 administration to the PTA. The controlled act given to physiotherapists is “administering a substance by inhalation” and is not limited to adjusting O2 levels. This activity could be a risk to patients and therefore requires delegation.

Physiotherapists must ensure the PTA has the Knowledge and skill. If the PTA is changing the delivery of oxygen from the wall to a portable tank, they will need to set up the portable O2 system which is administering O2 and delegation is required. This activity involves risk and the PTA will require special knowledge.

For example, the PTA will need to make sure the tank is turned on and has enough oxygen in it. They will need to be certain that they reconnect the hose to the oxygen and not to the air valve. They must know that three litres by face mask delivers a different FiO2 than three litres by nasal prongs. They need to know when humidification is needed, and they likely need to monitor SpO2 during the activity, meaning they may need to increase the flow rate if the patient desaturates.

You are rightly concerned and need to act. You may not have directly witnessed the behavior, but you believe the patient. Discuss with the patient possible options including speaking with the support worker’s employer about her concerns and how the organization has to deal with the issue.

Get consent from the patient to act, but even if the patient does not provide consent and you are concerned for the safety and well being of the patient it might be ok to proceed to relay the concerns.