The COVID-19 pandemic has posed many challenges for physiotherapists, not least of which has been the challenge of remaining up to date with new developments and orders in effect, and their implications for practice. To simplify this process, Physiotherapy Alberta has updated our website to make it easier to find the most up to date information affecting physiotherapy practice.

Latest Update: November 4, 2021

COVID-19 Vaccine Booster Shots

On November 3, 2021, Premier Jason Kenney announced that beginning on November 8th, some Albertans will become eligible for COVID-19 Vaccine booster shots.

 Included among the eligible groups are health-care professionals who meet the following criteria:

  • Provide direct patient care.
  • Received their second dose of a COVID-19 vaccine less than eight (8) weeks after their first dose.

Health-care professionals who meet these criteria can book a booster shot 6 months after the date of their second dose.

Eligibility for COVID-19 vaccine booster shots was also extended to several other identifiable groups. For more information, visit the Government of Alberta’s COVID-19 Vaccine webpage.

Updated November 4, 2021

On November 3, 2021, Premier Jason Kenney announced that beginning on November 8th, some individuals will become eligible for COVID-19 Vaccine booster shots, including health-care professionals who:

  • Provide direct patient care.
  • Received their second dose of a COVID-19 vaccine less than eight (8) weeks after their first dose.

Health-care professionals who meet these criteria can book a booster shot six (6) months after the date of their second dose.

Eligibility for COVID-19 vaccine booster shots was also extended to several other identifiable groups. For more information, visit the Government of Alberta’s COVID-19 Vaccine webpage.

When making this announcement, Premier Kenney cited guidance from the National Advisory Committee on Immunization (NACI), issued on October 29, 2021, which included the following information:

  • “COVID-19 vaccines provide lasting protection against serious illness and death from COVID-19.
  • There is currently no evidence of widespread waning of protection against severe disease in the general Canadian population who have been vaccinated against COVID-19.
  • Emerging evidence suggests vaccine effectiveness against asymptomatic infection and mild COVID-19 disease may decrease over time.”

NACI recommended that a booster dose of an mRNA COVID-19 vaccine may be offered to "key populations who are essential for maintaining health system capacity, and who may be at increased risk of waning protection, and who could pose increased risk of transmission to vulnerable populations.”

Health-care professionals, including physiotherapists, who deliver in-person, direct patient care became eligible to begin booking their first COVID vaccinations on Monday, April 12, 2021, and became eligible to receive second doses beginning in June, depending on when their first does was received.

Vaccinating health professionals protects groups who are at high risk of experiencing severe outcomes from COVID-19, individuals who are severely immunocompromised or unable to receive a vaccine, and those Albertans who regularly come into contact with them. Physiotherapists eligible to access vaccination do so to reduce the risk of transmitting COVID-19 to vulnerable populations through the provision of in-person, direct care.

Employer-led Immunization Requirements for Employees

On August 31, 2021, Alberta Health Services announced that they are implementing a mandatory COVID-19 immunization policy for workers. AHS will require workers and staff of AHS, AHS subsidiaries, applicable contracted service providers and Covenant Health to be fully immunized for COVID-19. The deadline to be fully immunized was recently extended to November 30, 2021.

Additional information regarding this announcement can be found on AHS’ website. AHS has indicated that they will directly contact all contracted service providers to whom this requirement applies, providing them with additional details of compliance requirements.

Physiotherapists in community settings who have questions regarding whether the AHS policy applies to them are advised to direct their questions to AHS.

Physiotherapy Alberta reminds physiotherapists that employers may set expectations and employment requirements over and above the requirements and Standards established by Physiotherapy Alberta. Physiotherapists with questions regarding employer-led immunization requirements must direct their questions to their employer.

Alberta’s Restriction Exemption Program for Patients

The Restriction Exemption Program announced on September 15, 2021, only applies to discretionary services and businesses. Healthcare services, including physiotherapy, are not included in the category of discretionary services.

Furthermore, the Code of Ethical Conduct includes the expectation that physiotherapists

Act in a respectful manner and do not refuse care or treatment to any client on the prohibited grounds of discrimination as specified in the Canadian Human Rights Act* as well as on the grounds of social or health status.

Vaccine/immunization status is categorized as a “health status” therefore it is inconsistent with the expectations outlined in the Code of Ethical Conduct for physiotherapists to limit access to their practice locations on the basis of an individual’s vaccine/immunization status.

Physiotherapy service providers who are considering instituting immunization requirements for patients as a condition of service are reminded that declining to provide care is a serious matter. There are conflicting needs, values, and rights involved in such a decision. Physiotherapists and physiotherapy business owners should understand the many implications of refusing to provide care to a patient who declines to adhere to such requirements.

Additional vaccine information

Individuals with questions regarding the COVID-19 vaccines approved for use in Alberta are directed to the websites of the following organizations:

19 To Zero, in association with the University of Calgary Faculty of Nursing, held a webinar on April 8 to address common questions regarding COVID-19 vaccines. The recording of that webinar is available here.

Physiotherapy Alberta strongly encourages all physiotherapists to be immunized. We remain grateful to all front-line health-care workers for their efforts during the pandemic, and to all those involved in the vaccine roll-out.

Updated: June 2, 2021

Physiotherapy Alberta supports vaccination as “one of the world's greatest public health achievements.”Vaccination saves lives and reduces the chances of debilitating long-term illness, including COVID-19. “For over 50 years, vaccines have helped prevent and control the spread of deadly diseases and saved the lives of millions of infants, children and adults.”1 Vaccines are rigorously researched and tested, and are evaluated for their safety, efficacy, and quality prior to being authorized for use by Health Canada.

Vaccination protects the health and wellbeing of physiotherapists and other health-care workers who are vital to the health system. Within the context of COVID-19, public health experts indicate that widespread vaccination is critical to bringing an end to the pandemic. Public health experts also indicate that vaccination is very likely to decrease the risk of a physiotherapist transmitting COVID-19 to their families and the patients they serve. Research is underway to determine the extent to which that risk is reduced.

Physiotherapy Alberta strongly encourages all physiotherapists to be vaccinated with the COVID-19 vaccination, and against all other communicable diseases, when they are eligible.

Vaccination of physiotherapists

We are heartened by the knowledge that all Alberta physiotherapists are eligible to receive a COVID-19 vaccination. We recognize that many people are anxious to be fully immunized and that the importance of vaccination cannot be overstated.

As difficult as it is to wait for vaccination when vaccine supplies are limited, as was the case in the spring of 2021, Physiotherapy Alberta strongly believes that vaccines must be provided based on available data regarding the groups most vulnerable to contracting the virus, developing severe illness, or experiencing adverse outcomes from COVID-19. We are grateful to the health ethicists and policy makers who have the difficult task of analyzing this data and developing just and equitable vaccine eligibility frameworks and criteria.

Patients and the COVID-19 vaccine

Although providing guidance or direction to patients regarding medications is not within the scope of practice for physiotherapists, as trusted health professionals physiotherapists can play a role in supporting public health initiatives such as mass immunization programs. Physiotherapists can do so through role modelling and by amplifying credible messages and information regarding vaccine development, efficacy and safety to their peers and patients.

Physiotherapists are encouraged to inform themselves about the vaccines approved for use in Canada, the process of their approval, and the risk profiles of the vaccines, seeking information from credible sources.

  • Physiotherapists are directed to Health Canada’s website for additional information about the vaccine approval process, and steps taken by Health Canada to “expedite the regulatory review of COVID-19 health products without compromising safety, efficacy and quality standards.2 
  • Alberta Health has provided a list of frequently asked questions and their answers, for use by regulated health professionals when speaking with their patients.
  • Finally, the 19 To Zero coalition of academics, public health experts, behavioural economists, and creative professionals has created a website with resources to support health professionals in their efforts to talk to people about vaccines and provides ideas for how to have informed conversations with people who are vaccine hesitant or COVID skeptical.

References

  1. Government of Canada. Regulating Vaccines for Human Use in Canada. Available at: https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/activities/fact-sheets/regulation-vaccines-human-canada.html Accessed February 1, 2021.
  2. Government of Canada. Drugs and Vaccines for COVID-19. Available at: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/about.html Accessed February 1, 2021.
As we continue to see COVID-19 case numbers rise across the province, physiotherapists need to remain vigilant in their use of measures to control the spread of the virus. This visual guide will help registrants to monitor their compliance with recommended measures on an ongoing basis. 
 

View the printable Visual Guide as a PDF.

 

Posted:July 29, 2020

Screening (updated September 10, 2021)

Physiotherapists working in community settings (e.g., private practice clinics, mobile practice settings), are required to engage in active screening of both patients and staff. Screening questions relate to signs and symptoms of infection, recent close contact with someone who has tested positive for COVID-19, and direction from a representative of Alberta Health Services or Canada Border Services to self-isolate or quarantine.

Individuals with even mild symptoms must not be in the practice setting, regardless of their vaccine status. As such, physiotherapists are advised to continue with screening of patients and others within the practice environment.

  • Patient screening is to occur at the time of booking the patient’s appointment and upon the patient’s arrival at the practice site (or the physiotherapist’s arrival in the case of a mobile practice).
  • Physiotherapists must engage in daily self screening.

Do not attend work if you have symptoms, have been instructed by Canada Border Services to quarantine, or have had close contact with someone who has tested positive for COVID-19 without the use of appropriate PPE during the contact.

In recent months Alberta Health has announced changes to  quarantine and self isolation rules. Physiotherapists should be aware of these changes, and their implications for the clinical practice setting. Physiotherapists are advised to ask the following questions of individuals at the time of booking and when they arrive for their appointments:

Have you been directed by Alberta Health Services to self-isolate? Have you been directed by Canada Border Services to quarantine?

Individuals answering yes to either question are not permitted in the practice setting.

Have you had recent, close contact with an individual who is required to self-isolate due to COVID-19?

The suspension of mandatory quarantine for close contacts of individuals who have tested positive for COVID-19 adds complexity to the screening process. However, although mandatory quarantine for close contacts of people diagnosed with COVID-19 has been discontinued, individuals who are not fully immunized and who have been exposed to COVID-19 have been advised by Alberta health to avoid high-risk locations and crowded indoor spaces.

Physiotherapists routinely work with patients with complex health needs or who are at risk of severe outcomes from COVID-19 and may not know a patient’s immunization status. As such, Physiotherapy Alberta strongly recommends that patients who are close contacts of a case of COVID-19 be rebooked at a later date or offered telerehabilitation appointments rather than in-person services during the 14 days post-contact.

Physiotherapists are advised not to ask patients about their immunization status for the following reasons:

  • Privacy legislation includes the stipulation that health professionals only collect personal information “for purposes that are reasonable” and “only to the extent that is reasonable for meeting the purposes for which the information is collected.” (PIPA, Section 11) Immunization status is not information that would typically be collected by a physiotherapist and would not be needed in order to provide physiotherapy interventions.
  • There is also a risk that knowledge of immunization status may create a false sense of security for providers, leading them to decrease their vigilance in the use of PPE and infection prevention and control measures. Physiotherapists are reminded that current COVID-19 vaccinations are effective at preventing severe illness and death, but this does not mean that vaccinated individuals cannot become ill with or transmit COVID-19 to others.

While physiotherapists are advised not to ask patients about their immunization status, they are not prevented from documenting and using this information to inform the point of care risk assessment should a patient volunteer their immunization status.

Point of Care Risk Assessment (PoCRA) (Updated September 10, 2021)

Point of Care Risk Assessments must remain a mainstay of safe clinical practice 

  • Complete a Point of Care Risk Assessment prior to every patient interaction, regardless of the practice setting in which you work.
  • Assess the task, the patient, and the environment to determine the risk of exposure to blood or body fluids and the PPE required to perform the patient care task.
  • Consider the physiotherapist’s own risk tolerance when determining whether to provide in-person physiotherapy services and the personal protective equipment to employ.

PPE Use When Immunized (Updated September 10, 2021)

Alberta Health has stated that “At this time, immunized HCW [health care workers] should continue to use recommended PPE when caring for patients.” Given the current elevated daily case counts, physiotherapists are reminded that immunization is one of several layers of protection used to limit the risk of spread of COVID-19 within the practice setting and protect the health of everyone accessing the practice setting. Physiotherapists are directed to employ recommended PPE regardless of their immunization status or that of their patients.

Masks (updated September 10, 2021)

Effective September 4th, masks are required in all indoor public spaces and workplaces.

Physiotherapist Use of Masks

  • All physiotherapists are required to engage in continuous masking using medical grade surgical or procedure masks at all times, and in all areas of the workplace
    • All staff providing direct patient care must wear a medical grade surgical or procedure mask continuously, at all times and in all areas of the workplace if they are either providing direct patient care or cannot maintain two-meter distance from patients and co-workers.
    • Staff who do not work in patient care areas (e.g., administration staff) must also wear a medical grade surgical or procedure mask continuously if a physical barrier (e.g., plexiglass) or two-meter physical distancing cannot be maintained.
    • Physiotherapists working with patients known or suspected of having COVID-19 (e.g., in ICU or acute care environments) are to follow their employer’s directions regarding PPE use with this patient population and for the tasks performed.

Patient Use of Masks

Patients are also subject to the September 4th mask mandate.

As Physiotherapy Alberta has said since the beginning of the pandemic, physiotherapists and physiotherapy business owners should understand the many implications if they are considering refusing to provide care to a patient who declines to wear a mask in the practice setting.

  • According to the Legislative Responsibilities Standard of Practice, physiotherapists are required to be knowledgeable of and compliant with the legislation relevant to their practice. This includes having knowledge of CMOH Orders which require indoor mask use, and municipal bylaws regarding mask use that may remain in effect in their local municipality should the provincial order be rescinded.
  • At the same time, the Code of Ethical Conduct states that members of the physiotherapy profession have an ethical responsibility to “Act in a respectful manner and do not refuse care or treatment to any client on the prohibited grounds of discrimination as specified in the Canadian Human Rights Act as well as on the grounds of social or health status.”
  • Declining to provide care is a serious matter. There are conflicting needs, values and rights involved in such a decision, including:
    • The patient’s right to access to care and the requirement that access not be denied on the basis of a protected ground or health status, including health conditions that may preclude the use of a mask.
    • The physiotherapist’s duty to comply with legislation relevant to their practice.
    • Patients’ expectations that they will receive safe care, as stated in the Safety Standard of Practice.
    • The health and safety of everyone that enters the practice environment.

Eye Protection (Updated September 10, 2021)

Alberta Health recommends the use of eye protection as an additional layer of protection for all patient interactions within two metres, in areas where there are ongoing high levels of community transmission. Eye protection is a strategy to reduce the physiotherapist’s individual risk of becoming ill, as such, physiotherapists are advised to follow the recommendations of Alberta Health and implement eye protection as part of their routine PPE.

Eye protection is intended to protect the health care provider from potential COVID exposures arising from interactions with patients who had symptoms that were not recognized to be COVID-19 at the time of their appointment (e.g., due to patient confusion).

However, Alberta Health continues to indicate that “continuous masking (medical/surgical masks) and proper hand hygiene is considered to offer sufficient protection for HCWs who have cared for patients with presymptomatic/asymptomatic COVID-19 infection.

Examples of appropriate eye protection include safety glasses, reusable goggles, face shields or face masks with built-in eye shields. Vision correcting eyeglasses are not classified as eye protection and do not address PPE recommendations.

Some eye protection is single use, while other products are reusable following cleaning and disinfection. Follow manufacturer instructions regarding whether eye protection is reusable and the approved cleaning and disinfecting products for the eye protection in use.

For physiotherapists working with patients who are not symptomatic, eye protection may be worn continuously and changed when a mask is changed, or when the eye protection becomes wet or soiled.

Physiotherapists working with patients with known or presumed COVID-19 must follow the directions of Infection Prevention and Control officials regarding PPE use and when PPE must be changed or discarded.

Other PPE

  • While other PPE may not be required to prevent the spread of COVID-19 when working with asymptomatic patients, physiotherapists should assess the tasks they are planning and continue to employ PPE typically used when performing the interventions planned (e.g., gloves when needling).

Hand Hygiene

  • Hand hygiene must be completed consistent with the WHO’s “5 Moments for Hand Hygiene”:
    • Before touching a patient
    • Before clean/aseptic procedures
    • After body fluid exposure or risk
    • After touching a patient
    • After touching patient surroundings
  • Complete hand hygiene using soap and water, or alcohol-based hand rub (minimum 60% alcohol).
  • Hands must be washed using soap and water if they are visibly soiled.
  • Patients must have access to hand hygiene facilities and should be encouraged to complete hand hygiene upon arrival, before and after use of shared equipment (including processing of payment) and prior to departure from the practice.  

Updated September 10, 2021

Effective July 29, 2021:

  • Contact tracers will not notify close contacts of positive cases. They will ask that individuals do so when informed of their positive result.
  • Close contacts of an individual with COVID-19 will no longer be legally required to quarantine, unless directed to do so by local public health officials.
  • Individuals with COVID-19 symptoms and confirmed cases will still be required to isolate.
  • Testing will continue to be available provincewide for individuals who are symptomatic. Asymptomatic COVID-19 testing will no longer be recommended.

Additional changes related to isolation of cases and testing, which had been scheduled to come into effect on August 16th and September 1st respectively have since been suspended due to increasing case numbers, hospitalizations, and ICU admissions.

When a Patient Tests Positive

Throughout the pandemic, physiotherapists have contacted Physiotherapy Alberta reporting that they have heard directly from patients who have tested positive for COVID-19 and seeking direction as to what actions the physiotherapist needs to take. With the changes to contact tracing announced at the end of July, this is likely to become the primary way that a physiotherapist will learn that they have been in contact with a case of COVID-19.

Physiotherapists are routinely within close contact (less than 2 meters away from) with individuals for longer than 15 minutes (continuously or cumulatively). However, Alberta Health has confirmed that the definition of close contact has not changed.

Specifically, this means that if a health professional was:

  • Wearing a medical grade surgical or procedure mask and
  • Practicing rigorous hand hygiene,

And the patient:

  • Was asymptomatic,

The health professional is not considered a close contact of a patient who develops symptoms of COVID-19 within 48 hours of their appointment and goes on to test positive for the virus.

Alberta Health has stated that a surgical/procedure mask and good hand hygiene is not sufficient PPE if a healthcare worker is in close contact with a symptomatic patient.

If a physiotherapist has been exposed to a patient who was found to have been symptomatic at the time of their appointment/treatment and the patient later tests positive for COVID-19, as of July 29th, the physiotherapist is no longer legally required to quarantine.

The Government of Alberta has stated that individuals who are not fully immunized are recommended to “avoid high-risk locations such as continuing care facilities and crowded indoor spaces. If you develop symptoms, you must isolate and should get tested.”

Given that physiotherapists are generally unable to maintain physical distancing while providing direct, in-person services and routinely encounter individuals at risk of severe outcomes from COVID-19, Physiotherapy Alberta reminds physiotherapists of their duties as described in the Code of Ethical Conduct and the expectations outlined in the Standards of Practice, including the expectations that

  • “Clients can expect to be safe in the care of the physiotherapist and in the practice environment.”
  • “The physiotherapist:
    • Promotes and maintains a safe environment for clients, health-care providers, her/himself, and others to support quality services.”
    • Adheres to best practices of infection prevention and control in physiotherapy practice according to applicable legislation, regulatory requirements, standards, and guidelines.”
    • “Uses routine practices (e.g., hand washing, point-of-care risk assessment, use of personal protective equipment) to minimize or prevent the spread of acquired infections in the health-care setting.”

Physiotherapy Alberta’s perspective is that if an unvaccinated or partially vaccinated physiotherapist is a close contact of a confirmed case of COVID-19, they have a responsibility to the public and their patients to discontinue direct, in-person services for 14-days from the day of contact with the confirmed case.  

If a physiotherapist is contacted by an Alberta Health Contact Tracer or Zone Medical Officer of Health and advised that they need to quarantine, the physiotherapist will need to discuss the particulars of the patient interaction, PPE and other measures in use during that interaction, and the physiotherapist’s vaccine status with the public health official. Physiotherapists are to follow the directions of public health officials.

When a Physiotherapist Tests Positive for COVID-19

Physiotherapists who have even mild symptoms, have been directed by Canada Border Services to quarantine, or who have had close contact with a patient with known or suspected COVID-19 without the use of appropriate PPE must not be present in the practice setting.

  • Physiotherapists must adhere to the directions of public health officials or Canada Border Services officials if they are directed to self-isolate or quarantine.
  • Questions regarding the ability to return to work should be directed to public health officials.  

Physiotherapists should be aware that according to the Alberta Public Health Disease Management Guidelines – Coronavirus-COVID-19.

“If HCW becomes symptomatic, all the patients who they cared for (or co-workers) in the 48 hours prior to symptom onset in that HCW will NOT be considered close contacts if the HCW wore a surgical/procedure mask and practiced routine, frequent hand hygiene.”

As such, if a physiotherapist has adhered to the guidance provided by Physiotherapy Alberta and goes on to develop COVID-19 their patients would not be considered close contacts for the purpose of contact tracing.

If a physiotherapist tests positive for COVID-19, they may be identified as a priority for follow up by AHS Contact Tracers. If contacted, the physiotherapist will need to highlight the PPE and other measures in use at the time of patient contact and must comply with directions provided by the Contact Tracer. The physiotherapist will need to seek additional information regarding their specific case if they are provided with information that differs from the above.

Updated June 2, 2021

The ability to continue to offer physiotherapy services relies upon compliance with the Guidance for Resuming Physiotherapy Practice During a Pandemic issued by Physiotherapy Alberta, sector specific private business guidance issued by the Government of Alberta, and AHS operating procedures and measures in use in public health care facilities.

It is the adherence with all infection prevention and control measures that offers robust protection against virus spread within physiotherapy practice environments. No one measure alone will be enough to protect patients and staff and prevent a physiotherapy practice site from becoming a source of virus transmission.

The Infection Prevention and Control Visual Guide helps to summarize these measures into a brief checklist that can be used to review day-to-day operations and ensure that the measures put in place when in-person services were first allowed to resume are still being rigorously followed today.

Despite widespread vaccine uptake and use of infection prevention and control measures to limit the spread of COVID-19, no measure is perfect, and some risks remain when services are provided in-person. Every close contact that a physiotherapist has with another person is another opportunity for the physiotherapist to become exposed to COVID-19 and to subsequently become a vector for virus spread. In addition, every visit to the practice setting necessitates countless contacts with other members of the public as the patient travels to and from their appointment. The risks posed by in-person services increase when physiotherapists work with patients more likely to experience severe outcomes from COVID-19.

Although risks are mitigated by vaccine uptake and robust infection prevention and control measures, they are not completely eliminated. Physiotherapists are encouraged to employ a risk-based approach to determining when in-person services are indicated for a given patient and practice setting, and when the risk of in-person service outweighs the foreseeable benefits.

Telerehabilitation

Physiotherapists adopted telerehabilitation rapidly in response to the restrictions on in-person services that were in place in the spring of 2020. Physiotherapists should continue to employ telerehabilitation to the greatest extent practicable to achieve desired patient outcomes and protect patients, themselves and others in the practice environment from exposure to the virus.

Physiotherapists are encouraged to:

  • Complete a point of care risk assessment prior to any in-person service delivery.
  • Educate patients on the benefits of telerehabilitation services, including the reduced risk of contracting COVID-19, and positive patient outcomes that these services can provide.
  • Consider telerehabilitation as the sole means of service delivery when practicable and indicated by the patient’s condition and/or the risk assessment.
  • Adopt blended models of service delivery using telerehabilitation visits to augment judicious use of in-person care as appropriate, with the aim of achieving the best patient outcomes possible.
  • Recognize when physiotherapy assessments or treatments cannot reasonably be delivered via telerehabilitation. This format of service delivery may be appropriate for many patients however, it is unlikely to be appropriate for all patients seeking physiotherapy services.

Registration considerations

Telerehabilitation services are subject to the same Standards of Practice as any other physiotherapy service. All members of Physiotherapy Alberta are authorized to provide telerehabilitation services as part of their existing registration. No special registration is required, provided you are delivering services within Alberta.

If you are delivering services to patients visiting or residing in other jurisdictions, you need to contact the regulatory body in that jurisdiction to find out what rules apply to your practice. This is the case even if you are following your existing patients who have temporarily relocated to another jurisdiction.

To better understand the rules regarding Cross-Border service delivery, refer to the Canadian Alliance of Physiotherapy Regulators guidance documents regarding cross-border services.

Getting started

Business owners and clinicians alike are advised to take the time to set up their telerehabilitation services in a way that is consistent with the Standards of Practice.

Platform selection

While Physiotherapy Alberta cannot provide direction on telerehabilitation platforms that are or are not acceptable for use by physiotherapists, members are urged to consider the following when reviewing potential platforms:  

  • The relevant privacy legislation for private practice telerehabilitation services delivered within Alberta is PIPA, not PIPEDA or HIPPA.
    • Platforms often tout their compliance with PIPEDA or HIPPA, and there is some comfort in knowing a platform is compliant with this legislation, but it is not the legislation of note.
  • Determine if the platform can address privacy requirements established by PIPA.
    • Is the platform “end-to-end” encrypted during transmission of the information?
    • Is the information collected and stored through the platform password protected and encrypted?
  • It is essential to read the terms of service of the platform provider, ensure that patient information is securely stored and protected from access by third parties, and ensure you understand what information the platform collects regarding your use/access to the platform and how that information is used.
    • Platform providers should not access patient private information and should not share that information with other parties including external organizations and governments.
    • Platform providers may track data related to business use (e.g., your behaviour when using the platform).
  • Where is the data stored?
    • There is no rule that requires data be stored within Canada or within Alberta, however, if data is crossing international borders that needs to be communicated to patients.
  • What about patient records and video records of telehealth interactions?
    • Telerehabilitation visits are subject to the same Standard of Practice for Documentation and Record Keeping as other visits. Physiotherapists need to generate a record for each treatment or professional interaction completed. These records can be in paper or electronic format – consistent with the physiotherapy business’ usual practices.
    • Video recordings of telerehabilitation visits are not mandatory.
    • However, if the platform used generates a recording, that recording must be retained as part of the patient record. This has implications for ongoing record retention that physiotherapists and employers need to consider.

It is likely that physiotherapy businesses will be offered service contracts from platform providers on a “take it or leave it” basis but that’s not an excuse to use a platform that is not secure. Patient health information is a regular target for cyber attacks. With the significant influx of health information available online as a result of the pandemic, clinicians and business owners are advised to use caution to ensure that private information remains private.

Some parties have suggested that the adoption of platforms that are not secure may be justified due to the extraordinary circumstances of the pandemic. Physiotherapy Alberta does not share that perspective.

Remote working (updated June 10)

The adoption of telerehabilitation services may enable physiotherapists to work from home. Employers are advised to consider the privacy issues that can arise when staff work from home using their own computers, tablets or phones to connect with patients or to complete record keeping duties. The Office of the Information and Privacy Commissioner has an excellent resource on the security risks related to allowing employees to use their own devices for work purposes. Employers should also consider the risks involved in having employees store patient records in paper format within the home environment, and strategies to adopt to mitigate those risks.

Employers are advised to conduct a privacy threat assessment and employ policies and procedures to ensure the ongoing privacy of information that employees store within their homes or access from their own devices. This includes both the telerehabilitation visits and any recordings generated from them, and the patient records generated following a telerehabilitation visit.

Fees and billing

Physiotherapy Alberta’s perspective is that there is no reason that the fees for physiotherapy services should differ based on the method of delivery, provided that the time spent with the patient and the quality of the services are equivalent, albeit potentially different in terms of the interventions provided. As with all physiotherapy fees, members are advised to set fees in accordance with their business model, the costs of providing service, and market forces. Fees must be transparently communicated and justifiable.

Physiotherapy Alberta’s Telerehabilitation Guide provides additional information regarding telerehabilitation service delivery.

Private Clinics (updated September 10, 2021)

Effective July 1st, 2021, all public health restrictions pertaining to private physiotherapy clinics were lifted. However, the easing of restrictions as part of the Open for Summer Plan does not mean a return to business as it was in 2019. Practice has fundamentally changed due to the pandemic and many changes are expected to continue for the long-term. Some measures mandated to enable clinical practice during the pandemic are clinical best practices for infection prevention and control and were always expected of physiotherapists. Other measures are advisable given rising case numbers in the current context.

Physiotherapy Alberta strongly recommends that physiotherapists “stay the course” with measures that have been in use for the duration of the pandemic:

  • Provide services by appointment only.
  • Follow the guidance in place from Physiotherapy Alberta related to provision of services during a pandemic.
  • Ensure expectations for the quality and safety of services provided by physiotherapist support workers are met and that supervisees adhere to the expectations outlined in Physiotherapy Alberta’s guidance documents.
  • Ensure each physiotherapist or physiotherapist support worker is responsible for only one patient at any given time.*

*The notable exception is in the delivery of group exercise interventions.

  • If providing group exercise interventions (e.g., GLA:D programs, falls and balance classes, or Parkinson’s group classes):
  • Complete a risk assessment for the activity, identifying appropriate measures to mitigate the risks.
  • Consider the risk profile of individual participants and ensure that individual risk analysis supports their safe return to the exercise group.
  • Only provide group classes that are appointment-based and scheduled.
  • Screen attendees at the time of booking and upon arrival.
  • Employ measures such as continuous masking and routine, vigorous hand hygiene, as with all other in-person physiotherapy services.
  • Maintain 3-meter physical distancing between all participants
  • Limit class sizes to the number of participants that will fit within the space while maintaining 3-meter distancing between participants at all times.
  • Do not share equipment between participants.
  • Avoid instructor close contact with and movement between participants.
  • Do not mix class cohorts.  
  • Limit participant socializing before and after class.

Providers who are unable to meet these expectations and mitigate relevant risks of providing group exercise-based interventions are advised to continue providing these interventions on a one-on-one basis.

Long Term Care (updated September 10, 2021)

Public health experts have clearly identified that COVID-19 poses a serious threat to people residing in communal living settings. Seniors and especially those with comorbidities, the very seniors who are commonly residents of long-term care and continuing care facilities, are at greater risk of severe disease and death from COVID-19.

However, many, if not most residents of these settings have now received both doses of the COVID-19 vaccine and effective May 10, 2021, the Government eased restrictions in place in long-term care and continuing care facilities in the province to allow small indoor gatherings and larger outdoor gatherings.

Group activities are currently permitted in continuing care environments for residents who are not isolated or quarantined due to COVID-19, provided the facility operator has public health measures in place to mitigate relevant risks and has not been directed by a local Medical Officer of Health to take other action (e.g., due to a site outbreak).

Physiotherapists working in long-term or continuing care environments are directed to conduct a point of care risk assessment related to the group interventions they provide, and to implement appropriate measures to mitigate the risks identified (e.g., physical distancing of participants, limiting class sizes based on physical space available).

Mobile health services in continuing care environments to residents who are not symptomatic, isolated, or quarantined, are also permitted, provided the physiotherapist adheres to workplace and sector specific requirements, CMOH Order 37-2021 and the regulatory requirements established by Physiotherapy Alberta. Physiotherapists will need to work with continuing care operators to address questions regarding access to the site and the ability to provide in-person services that are arranged by the patient or family. Where possible and appropriate, telerehabilitation services should be provided.

Private providers delivering mobile services in continuing care settings may pose more risk to residents if they provide care at multiple sites, serving as a potential source of transmission between facilities. They are therefore expected to avoid movement between sites on the same day, where feasible.   

Mobile practice (AHS and Private Businesses) (Updated September 10, 2021)

Physiotherapists working for Alberta Health Services and Covenant Health in home care environments are subject to the operational procedures their employers have in place and will be directed by infection prevention and control experts on staff.

Physiotherapy Alberta is aware that many physiotherapists provide private mobile practice services. These health services may be provided as long as public health orders and sector guidance is followed. Appointments should be limited to one-on-one services.  

Mobile and home-based businesses providing physiotherapy services can continue to operate, following the recommendations and guidance established for physiotherapy community services (private practice).

The provision of mobile health services in continuing care environments to residents who are not symptomatic, isolated, or quarantined, is subject to workplace and sector specific requirements, CMOH Order 37-2021 and the regulatory requirements established by Physiotherapy Alberta.

Physiotherapists offering private mobile services in continuing care environments will need to work with continuing care operators to address questions regarding access to the site and the ability to provide in-person services that are arranged by the patient or family. Where possible and appropriate, telerehabilitation services should be provided.

Private providers delivering mobile services may pose more risk to residents if they provide care at multiple sites, serving as a potential source of transmission between facilities. They are therefore expected to avoid movement between sites on the same day, where feasible.    

Schools and Early Learning Centres (Updated September 10, 2021)

Physiotherapists working in schools and early learning centres are reminded that the principles related to limiting the spread of COVID-19 are unchanged as is the duty to implement measures to limit the spread of COVID-19.

Physiotherapists working in the school sector are encouraged to employ telerehabilitation, if appropriate for their patient’s condition, to address ongoing physiotherapy care needs of students who are engaged in online learning.

Physiotherapists providing in-person services are:

  • Required to adhere to the same measures to prevent the spread of COVID-19 as other regulated members of Physiotherapy Alberta, as identified in the Guidance for Resuming Physiotherapy Practice During a Pandemic. This includes the continuous use of medical grade masks, physical distancing, rigorous hand hygiene using soap and water or alcohol-based hand rub and point of care risk assessment.
  • Advised to provide interventions to their patients on a one-on-one basis when practicable.
  • Advised to complete a point of care risk assessment to determine the appropriateness of concurrent treatment with a subset of students from the same classroom cohort.

Hospitals (Updated September 10, 2021)

Over the past 18 months, most of the direction provided by Physiotherapy Alberta has been directed to regulated members employed in the private sector, such as private clinics and other physiotherapy businesses. This is due to the fact that physiotherapists in the private sector have faced restrictions on their ability to operate their businesses and have limited access to infection prevention and control experts to direct their practice.

Physiotherapists working for Alberta Health Services and Covenant Health are subject to the operational procedures their employers have in place and will be directed by infection prevention and control experts on staff.

Personal protective equipment use in AHS/Covenant settings is based on the point of care risk assessment conducted by the physiotherapist and the organization’s guidance re: PPE when working with patients with known or suspected COVID-19, in accordance with the interventions planned and the risks inherent with those interventions. When questions or conflicts arise regarding the appropriate PPE to use for a specific intervention within this practice setting, physiotherapists are directed to discuss their concerns or questions with infection prevention and control experts on staff.

Similarly, operational decisions and actions to limit the spread of COVID-19 between patients within the acute care environment, such as limiting staff movement between units and scheduling patients in a manner that limits the risk of virus transmission, are best made at the facility level. Questions regarding operational matters should be directed to facility and AHS leadership. 

Physiotherapy Alberta is aware that some programs and services have experienced significant operational disruptions and that some physiotherapists have experienced redeployment over the course of the pandemic. Registered physiotherapists have a professional obligation to decline work they are not competent to perform; however, they also have a professional responsibility to consider the public interest and undertake all reasonable steps to become competent before making a conscientious decision to decline the task, when faced with redeployment.

Nasopharyngeal Swabbing

Although nasopharyngeal swabbing is not part of a physiotherapist’s typical range of practice activities, their performance of this activity is motivated by the exceptional need for competent practitioners who can undertake this activity during the COVID-19 pandemic.

Regulatory considerations

Performing a nasopharyngeal swab is a restricted activity in accordance with the Government Organization Act and is therefore regulated under the Health Professions Act and the Physical Therapy Profession Regulations. 

As per Schedule 7.1 of the Government Organization Act, it is a restricted activity to "insert or remove instruments, devices, fingers or hands 

(ii) beyond the point in the nasal passages where they normally narrow, 

(iii) beyond the pharynx

These activities are identified as basic restricted activities in Section 13 of the Physical Therapists Profession Regulation. Any regulated member of Physiotherapy Alberta is authorized to perform the activity provided they are competent to do so. Regulated members who are on the Provisional Register must be directly supervised by a regulated member on the General Register when they perform the activity. 

Advice to employers

Employers should be aware that nasopharyngeal swabbing is not an activity that is taught in entry to practice physiotherapy education. Physiotherapists must only perform those activities that they are competent in. As such, a physiotherapist would require additional training and assessment of their competence to perform a nasopharyngeal swab before being deployed to do so.

As highly educated and conscientious health professionals, physiotherapists are likely well suited to undertake this activity once sufficiently trained.

Advice to physiotherapists

Although performing a nasopharyngeal swab is a new activity for most physiotherapists, this is an unprecedented situation in which the greater good calls all health professionals to contribute, as they are able in order to manage and hopefully stop the spread of COVID-19.

Registered physiotherapists have a professional obligation to decline work they are not competent to perform; however, they also have a professional responsibility to consider the public interest and undertake all reasonable steps to become competent before making a conscientious decision to decline the task.

Contact Tracing

Duly trained physiotherapists can also fulfill the role or contact tracer, leveraging their communication, patient management and critical thinking skills to do so.

Although these roles differ from more “traditional” physiotherapy, they fit within the definition of what constitutes physiotherapy as they draw upon several of the Essential Competencies of Physiotherapists.

For those seeking work, Physiotherapy Alberta encourages you to consider these work opportunities.

Helping with Nursing Care

We know that acute and continuing care facilities continue to face staffing and workload challenges. Meanwhile, patients still require basic care. These are not typically activities performed by physiotherapists however employers may reassign physiotherapists to other duties to ensure patients’ basic needs are met.

Registered physiotherapists have a professional obligation to decline work they are not competent to perform; however, they also have a professional responsibility to use the skills they possess for the betterment of society and the benefit of those they serve. During a public health crisis, physiotherapists can be redeployed to assist with basic care activities and can apply their patient handling skills to do so. When doing so, appropriate precautions and facility protocols must be followed.

The COVID-19 pandemic represents an unprecedented challenge to health-care providers and society at large. Physiotherapy Alberta recognizes the critical role that physiotherapists play in the health and wellbeing of Albertans. Whether working in a private practice clinic, a hospital, or any other setting where direct patient care is provided, we applaud the efforts that physiotherapists are making to serve patients and adhere to the instructions of public health experts.

We recognize that the situation is changing rapidly, which leads to uncertainty and anxiety, and sometimes makes it difficult to know what to do. Physiotherapy Alberta is committed to providing guidance to help physiotherapists address this challenge.

This document constitutes the requirements for Physiotherapy Alberta registrants to resume non-essential services while complying with the Chief Medical Officer of Health (CMOH) Orders and amalgamates directions previously provided to physiotherapists regarding re-opening in one document. The information provided in this document is informed by the directives of the CMOH and the CMOH Orders currently in effect, the Code of Ethical Conduct, and the Standards of Practice.

Note to readers: This document is current as of the date of publication and reflects the rules and requirements for Alberta physiotherapists. In the event of a discrepancy between this information and the directives of provincial public health authorities, the directions of provincial public health authorities prevail. Additional information will be provided to registrants and directives or CMOH Orders change or as new information becomes available.

Click here to read "Guidance for Resuming Physiotherapy Practice During a Pandemic"