As some of you may know, I am a lawyer. But that doesn’t mean I am practicing law when I am acting as the College Registrar. I am not, although I believe my legal training helps me to perform well.
When our Practice Advisor, Shelley Martin, is talking to you on the phone, she isn’t providing you with physiotherapy even though her expertise as a PT is critical to her role.
How about you? If you are a physiotherapist, does that mean you are delivering physiotherapy whenever you deliver any sort of care or service?
At the College, we’ve recently been asked whether physiotherapists can assign Zerona® therapy to physiotherapy assistants. Have you heard of this therapy? It is a cold laser fat reduction therapy that was featured on the Dr. Oz television show. The question assumes that Zerona® therapy is physiotherapy, but I’d like to explore that a little more.
The scope of practice in the Physiotherapy Act refers to “the assessment of neuromuscular, musculoskeletal and cardio respiratory systems, the diagnosis of diseases or disorders associated with physical dysfunction, injury or pain and the treatment, rehabilitation and prevention or relief of physical dysfunction, injury or pain to develop, maintain, rehabilitate or augment function and promote mobility.”
If someone seeks out Zerona® to treat their back pain or improve their ability to walk, is it physiotherapy? If a person wants the therapy to look better in a bikini would you still call this physiotherapy? (I know that someone who wants it for cosmetic purposes might benefit from a mobility perspective, but is it really right to use this as a justification for calling it physiotherapy?)
It’s hard to define physiotherapy because practice constantly evolves and because, as in the Zerona® example above, the same activity may sometimes be physiotherapy and sometimes not.
The Canadian Physiotherapy Association has a Description of Physiotherapy in Canada which provides lots of examples of activities that may be included as part of physiotherapy. It also says, “Physiotherapy services are ‘those that are performed by a physiotherapist and any other trained individual working under a physiotherapist’s supervision and direction’”. I think this is incomplete because it doesn’t say what services are not included.
Here are some other examples of treatments we have recently had questions about. What do you think?
- supervision of an exercise program for weight loss
- acupuncture for plantar warts or fertility or smoking cessation
- desensitization techniques for children with autism
Which of these things is physiotherapy? What happens when they are performed by personal trainers, kinesiologists, traditional Chinese medicine practitioners or psychologists? Are they still physiotherapy?
As a health care provider and a caring professional, the services you provide may be no less valuable whether they are technically ‘physiotherapy’ or not. Many things that are not physiotherapy may be included in your practice because they are for the benefit of your patients. Maybe we could say that if quality performance of the activity does not rely on the knowledge, skills or judgement that come from physiotherapy training, it’s not physiotherapy.
This isn’t just a question of semantics. Patients are entitled to rely on the title “physiotherapist” as a guarantee that you will deliver safe and effective physiotherapy, but not that you will be good at other things, like cold laser fat removal or psychotherapy. It is important your patients understand that when you deliver a service that is not part of the knowledge, skills and judgement you have acquired as a physiotherapist, they are assuming a different kind of risk.
There is another group that is entitled to rely on your invoices as affirmation that the services provided were physiotherapy and not something else. They are the payors who have entered into agreements to pay for certain therapeutic treatments, but not, for instance, for cosmetic interventions.
All the same, if you happen to have tried this Zerona® therapy, let me know if it worked!
Shenda’s Blog 
I don’t think that the laser therapy is Physiotherapy unless it can be linked back to a plan of care. The plan of care should always be within the scope of practice of our profession. Any other methods or therapies should be explicitly explained as not being physio…
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As a combined grad P&OT ’67 ( I know – a dinasoar) I have always taken a broad perspective when consulting and treating patients and look at the big picture as well as treating on a micro level. Even though I am not licenced to practice OT, I often get a better insight into people’s ills because I have a broader perspective than most.
I think, that due to the many professions that are elbowing in on our professions, think, athletic therapists, respiratory therapists, massage therapists (yes I was trained to do massage back in the day) lyphatic drainage therapists, kinesiologists, personal trainers, that it is wise that we keep our options open in defining ourselves. If those of us who trained in acupuncture did not challenge the right to treat “below the dermis”, the opportunity to practice acupuncture would have been denied.us by the College; indeed, the College had to redefine our Scope of Practice, because of it. Treating below the dermis has allowed a whole new field of pelvic care Physios in whic to specialize, a field that wasn’t there just a few short years ago.
Yes, these options are a litt e “far out”, but, the worst thing we could do is to not grow and be pidgeon holed into a narrow Scope of Practice that would limit, in the long run, our options in the future. Indeed, it is getting harder and harder to define exactly who and what we are and do when there are so many other professions close to ours int he health Sciences.
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I Think that our profession concerned with promotion of health, with prevention of physical disabilities, with evaluation and rehabilitation of persons disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical. But doesn’t mean we close our scope of practice and limit our vision to other domain of sciences.
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I am a firm believer that physiotherapy is a health care service that SHOULD only be provided by physiotherapists. However, given the fact that our title “PT” is regulated title by our college and the practice of providing physiotherapy is not, it leads to many people being able to say they can provide physiotherapy including chiropractors, natural practicioners, even kinesiologists and personal trainers.
Is this fair? Is this right? Is this ethical? Luckily the CPA/OPA has launched an extensive campaign to educate the public of this fact: if you are seeing a health care professional who claims they are providing physiotherapy, then check they are actually a Registered PT. I have seen so many chiropractic clinics which have the word “physiotherapy” in their clinic name, and when I walk in and ask who the PT is, I am told that although a PT is not on staff that physiotherapy services can be provided by another health professional. This just makes my blood boil! Even when you look at the biggest chain of chiro clinics called “PhysioMed Rehab” a consumer would think this means there are indeed physiotherapists there, which they do but this is misleading because it is a chiro owned clinic; the owner of the chain state at a recent OPA conference that did he conveniently named his chain as such because because to him Physio is synonymous with Physiology.
Bottom line, I think we need to stand up for ourselves, our roles, our profession and take ownership because other health care professionals are misleading the public, providing unregulated PT services, and making alot of money on our good name and reputation. I might be a new grad (2010), but I am fiercly passionate about this because I know how much work I put into not only getting into PT school (where there was 1200 applicants for 66 spots), how hard I worked to pass and receive my degree, and how much effort I put into delivering safe and effective patient care.
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I think Physiotherapy is treatment which improve capabilities of our body by using natural techniques. Exercise is also a technique which use as physiotherapy.
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In my terms physiotherapy treatment includes therapeutic exercises, manual therapy, acupuncture, electrical modalities such as TENS or ultrasound, and work hardening.
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I am a Physiotherapist who has enjoyed decades of practice and service to our College. I wish to slow down ( decrease my annual hours substantially) but do not want to completely retire. Many of my peers are in a similar situation. I work now on contract so when a LTC subcontractor may need relief for PT short term illness or leave of absence I would like to fill that role . I love the stimulation but may not be needed some months and that is ok for me but can the College consider this semi-retired group when calculating minimum number of hours annually. Currently I can see a year when I might not meet them but I do not want to give up my license even if it is required more occasionally and I don’t want to pay the large sums anymore but prorated doesn’t work because I never know when I will be needed. If some clever colleague can come up with a solution, what a relief that would be! Can you jog my memory as to what currently are the minimal practice hours over what defined period of time.
LOVING MY CAREER JUST WANTING TO PRACTICE LESS !
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The current requirement for practice hours is 1200 hours in the previous five years, which is a little less than one day per week over five years.
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