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: June 11, 2021
Open for Summer Plan – Stage 2: What Does it Mean for Physiotherapists?
Alberta entered Stage 2 of the Open for Summer Plan on June 10th. What does this mean for physiotherapists?
Not much.
Hospitalization numbers are down and have been below the Stage 2 target (500 people in hospital) for some time. More than 60% of eligible Albertans have now received at least one dose of a COVID-19 vaccine. In fact, on June 8th, Dr. Hinshaw reported that 67% of eligible Albertans have received one dose of the vaccine and 15% are now fully vaccinated. This is cause for celebration.
As a result of these accomplishments, many restrictions are easing, however the changes set to take place will have limited, if any effect on physiotherapists.
Services By Appointment Only
The requirement for one-on-one service provision by appointment only remains in place across the province for physiotherapists and other regulated health professionals.
Some physiotherapists have asked about the provision that allows personal and wellness services to resume walk-in services.
It is important to keep in mind that personal and wellness services are treated as distinct from health, social and professional services by the Government of Alberta and have been subject to different restrictions for the duration of the pandemic. Recent changes to the rules for personal and wellness services, do not affect health service provision and the rules that apply to physiotherapists or other regulated health professionals.
Group Classes
However, given the re-opening of gyms and fitness studios, physiotherapists may be able to resume group exercise-based physiotherapy interventions such as GLA:D programs, falls and balance classes, or Parkinson’s group classes, provided that they complete a point of care risk assessment and implement measures that mitigate the risks identified. Such measures include:
- Avoiding instructor close contact with participants and movement between participants.
- Limiting class sizes to the number of participants that will fit within the space available while maintaining 3-meter physical distancing from each other at all times.
- Not sharing equipment between participants.
- Not mixing class cohorts.
- Limiting participant socializing before and after class.
- Employing all other measures currently required for all in-person physiotherapy services (e.g., hand sanitizing, use of masks, patient screening).
Although Physiotherapy Alberta’s view is that group exercise interventions may be provided to these groups, where appropriate measures can be implemented, we also know that the populations served by these programs are different from that of the general population seen in the gym environment. As such a higher standard of care is required.
Providers who are unable to meet these expectations and mitigate relevant risks to providing group exercise-based interventions are directed to provide these interventions on a one-on-one basis.
Other Measures Continue
As Physiotherapy Alberta stated in the June 2nd update, the requirements to engage in continuous masking, patient screening, and use of infection prevention and control measures are unchanged as we enter Stage 2. Physiotherapists are reminded that vaccination in and of itself does not eliminate COVID-19 or the risk of exposure to the virus. While vaccines are highly effective at preventing severe illness and death, it is still possible to be exposed and to become ill from COVID-19. In some respects, the risk of exposure will increase in the coming weeks as restrictions are eased, even as vaccine uptake helps to prevent severe outcomes.
Maintaining the use of PPE, rigorous hand hygiene, physical distancing, patient and staff screening, and cleaning and disinfecting practices is essential.
Stage 3 Reopening
Physiotherapy Alberta has heard from some of our regulated members with questions about what to expect as we progress through the Open for Summer Plan and reach Stage 3 of reopening. We do not yet know when Stage 3 will occur. While we anticipate that many of the restrictions currently in place will be lifted in the coming weeks, Dr. Hinshaw has indicated that some protective measures may still be mandated after Stage 3 reopening, to mitigate the risk of virus spread particularly within health care settings and among vulnerable populations. These details have not yet been released.
Organizational leaders and private employers of physiotherapists are reminded that Occupational Health and Safety Legislation also establishes the requirement that employers implement appropriate measures to control the health and safety hazards workers are exposed to in the work environment. COVID-19 is categorized as a biological hazard. As such, employers will need to consider the ongoing use of Infection Prevention and Control measures and other measures to control this hazard, even as public health orders are lifted.
Taking Stock of What Was Learned
As Dr Hinshaw has noted, the measures in place to prevent the spread of COVID-19 also had the unanticipated effect of Alberta reporting no cases of the flu over the 2020-21 flu season. As we enter this next phase of the pandemic, it is a good time to take stock of what we have learned over the course of the last 15 months and what infection prevention and control practices we may choose to retain as we go forwards, regardless of the prevalence of COVID-19 in our communities or the public health orders in effect.
One thing that we are reasonably certain of: even as restrictions are eased and things return to more typical day-to-day operations, we are unlikely to return to a normal that resembles practice as it was in 2019.
Updated June 2, 2021
Health-care professionals, including physiotherapists, who deliver in-person, direct patient care became eligible to begin booking their first COVID vaccinations as part of Phase 2C of the vaccine roll out plan on Monday, April 12, 2021.
If you have not yet received your first dose of a COVID-19 vaccine, you are encouraged to book a vaccination at your earliest opportunity.
On June 1, 2021, Premier Jason Kenney announced Alberta’s plan to distribute second doses of COVID-19 vaccines. Eligibility to book a second dose of the vaccine will be based on the date that you received your first dose and the vaccine you received.
If you received an mRNA vaccine (Moderna or Pfizer):
- First dose in March or earlier – book second dose starting now
- First dose in April – book second dose starting June 14
- First dose in May – book second dose starting June 28
If you received an AstraZeneca vaccine as your first dose, you have the option to receive either a second dose of AstraZeneca or an mRNA vaccine. Additional information when to book a second vaccine dose following a first dose of AstraZeneca, how to book a second dose of AstraZeneca, and the safety and effectiveness of different vaccine options for individuals who received AstraZeneca as their first vaccine dose can be found on the Government of Alberta website.
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.
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.
Continue public health measures
Vaccination of health-care workers does not mean that the pandemic is over, or that public health measures can be relaxed. For now, we all must continue to follow public health guidelines, including physical distancing, practicing good hand hygiene, masking when in public, and staying home when sick.
- Although Stage 3 of Alberta’s Open for Summer Plan includes the lifting of all restrictions, it remains to be seen if health care settings, including community and continuing health care settings will be subject to ongoing protective measures, and what those measures may be.
- Stages 1 and 2 of the Open for Summer Plan include the requirement to continue physical distancing and masking.
Even after being fully immunized, physiotherapists are expected to continue to employ all the currently recommended infection prevention and control measures identified by Alberta Health and Physiotherapy Alberta in the Guidance for Resuming Physiotherapy Practice During a Pandemic in their practice settings, bearing in mind:
- Not all individuals who are eligible for vaccination can receive a vaccine due to other health conditions.
- Vaccination is known to be highly effective at preventing severe illness and death from COVID-19, however:
- There is a proportion of the population for which the vaccine is not effective.
- Data is currently lacking regarding whether vaccination prevents a vaccinated individual from transmitting the virus. Vaccinated individuals may still be able to spread the virus even if they do not become ill.
- A proportion of the general population whom physiotherapists treat will not be fully vaccinated for several months.
Information regarding Alberta’s COVID-19 vaccine program is updated frequently. Physiotherapists are encouraged to stay up-to-date on the vaccine roll out by monitoring the Government of Alberta COVID-19 Vaccination website.
Physiotherapy Alberta strongly encourages all physiotherapists to be vaccinated as soon as they are eligible. We continue to be 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.”1 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
- 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.
- 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.
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"
View the printable Visual Guide as a PDF.
Posted:July 29, 2020
Screening (updated June 2, 2021)
Physiotherapists working in private health care environments (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 travel, and recent close contact with someone who has tested positive for COVID-19.
Physiotherapy Alberta is aware of recent changes to quarantine rules for individuals who are fully vaccinated. Physiotherapists who fall within this category should be aware of these changes.
Physiotherapy Alberta has also received calls from physiotherapists wanting to know if they should be asking patients about their vaccine status. Physiotherapists are advised not to ask patients about their vaccine 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) Vaccine status is not information that would typically be collected by a physiotherapist and would not be needed in order to provide physiotherapy interventions.
- Physiotherapists who collect this information may be tempted to try to interpret quarantine requirements on their own. To do so is beyond the scope of physiotherapy practice.
The physiotherapist’s limited data collection may lead them to make incorrect interpretations regarding quarantine requirements for themselves or their patients. Physiotherapists must adhere to the directions of public health officials and should recognize their expertise in this area.
- There is also a risk that knowledge of vaccination 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 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.
The change in direction regarding quarantine requirements for fully or partially vaccinated individuals adds a layer of complexity to the screening process. Physiotherapists are advised to avoid attempting to determine if quarantine is necessary, but rather to adhere to the directions of public health officials. As such, physiotherapists are advised to add the following question to their current screening process:
Have you been directed by Alberta Health Services to quarantine?
Individuals with risk factors for COVID-19 or even mild symptoms must not be in the practice setting, regardless of their vaccine status.
- Patient screening in these settings 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).
- In some instances, physiotherapists have been identified as close contacts of a person with COVID-19 because the patient was found to have had symptoms at the time of the physiotherapy appointment.
- Physiotherapists must engage in daily self screening.
- Do not attend work if you have symptoms, have recently travelled internationally, or have had close contact with someone who has tested positive for COVID-19 without the use of appropriate PPE during the contact.
Point of Care Risk Assessment (PoCRA)
- 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.
Masks (updated June 2, 2021)
Stages 1 and 2 of the Alberta Open for Summer Plan include the stipulation that physical distancing and mask requirements remain in effect. This is pertinent to both physiotherapists and their patients.
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 surgical/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 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 (Updated June 11)
- Effective December 8th, the provincial government made it mandatory for masks to be worn in all indoor public spaces and workspaces. This order remains in effect as Alberta enters Stage 2 of the Open for Summer Plan. Effective May 4, 2021, failure to comply with the Government of Alberta order carries the risk of a $2000 fine, and prosecution for up to $100,000 for a first offense.
- 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 when the provincial order is 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.
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Physiotherapists and physiotherapy business owners should understand the many implications of refusing to provide care to a patient who declines to wear a mask in the practice setting.
Eye Protection (Updated January 25, 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 June 2, 2021
When a Patient Tests Positive
Physiotherapy Alberta has heard from some regulated members who have reported that they have received notification that they were considered a close contact despite adhering to guidance from Physiotherapy Alberta regarding continuous masking using medical grade surgical or procedure masks, hand hygiene and proper screening of patients.
Alberta Health has confirmed that the definition of close contact has not changed and that if a health professional was:
- Wearing a medical grade surgical or procedure mask and
- Practicing rigorous hand hygiene,
And the patient:
- Was asymptomatic,
- Was not themselves a close contact of someone with COVID-19 and
- Had not recently traveled outside of Canada at the time of the treatment visit. *
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.
If a physiotherapist has been exposed to a patient who was found to have been symptomatic at the time of their appointment/treatment, public health officials will determine whether the physiotherapist is a close contact and must quarantine. This will depend on:
- Whether the PT was wearing a surgical/procedure mask, eye protection and was practicing good hand hygiene at the time of the interaction and
- Whether they had brief/transient contact with the patient. *
*It is not yet clear how the parameters of brief/transient contact will be defined.
If a physiotherapist is contacted and advised that they are a close contact to a patient who has tested positive, they 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 and seek additional information regarding their specific case to understand why they are being considered a close contact. Physiotherapists are to follow the directions of public health officials if directed to quarantine.
When a Physiotherapist Tests Positive for COVID-19
Physiotherapists who have even mild symptoms, have recently travelled outside of Canada, 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 if they are directed to self-isolate or quarantine.
- Physiotherapists who are fully vaccinated may not be required to quarantine following unprotected close contact with an individual who has COVID-19. Physiotherapists who are partially vaccinated may be subject to a shortened quarantine period.
- The requirement to quarantine is dependent on the number of vaccine doses, timing of vaccinations, and symptoms exhibited by the physiotherapist.
- Questions regarding the ability to return to work should be directed to public health officials.
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 are anticipated to be identified as a priority for follow up by AHS Contact Tracers. 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. With individuals returning to their home provinces to weather the pandemic this is relevant, even if you are following your existing patients.
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 June 11, 2021)
Effective November 27th, health services provided by regulated health professionals “can remain open by appointment only as long as public health orders and sector guidance is followed. Appointments should be limited to one-on-one services.”
It is important to keep in mind that personal and wellness services are distinct from health, social and professional services, and have been for the duration of the pandemic. Recent changes to the rules for personal and wellness services, which take effect with Stage 2 of the Open for Summer Plan, do not affect health service provision and the rules that apply to physiotherapists. The requirement for one-on-one service provision remains in place across the province for physiotherapists and other regulated health professionals.
Some regulated members have asked how this rule effects the provision of physiotherapy services by physiotherapist support workers. Physiotherapy Alberta’s perspective is that when support workers provide physiotherapy services, they are doing so under the supervision and direction of a regulated physiotherapist and in accordance with the standards and requirements established for the provision of physiotherapy services during the pandemic. The support worker is acting as an extension of the physiotherapist and is able to provide physiotherapy services due to the active supervision provided by the physiotherapist.
The physiotherapist remains accountable for the services assigned, the appropriateness of that assignment, and the quality and safety of the services provided.
If a physiotherapist employs support workers, regardless of the education or credentials of the support worker, Physiotherapy Alberta expects that:
- All expectations outlined in the Standard of Practice – Supervision are met, including:
- services are assigned by the physiotherapist,
- the patient understands the roles of the physiotherapist and support worker respectively,
- the patient consents to the support worker’s involvement,
- the physiotherapist provides ongoing monitoring and re-assessment of the patient’s status and progress,
- supervision strategies are in use to ensure quality and effective services are provided by the support worker.
- The booking record clearly identifies that the patient is booked with the physiotherapist.
- The patient reports seeing the physiotherapist for a component of the treatment session and understands and can describe the supervisory relationship between the physiotherapist and the support worker.
Neither the physiotherapist or the physiotherapist support worker may be responsible for the care and treatment of more than one patient at any time.
The notable exception is in the delivery of group exercise interventions. The updated rules allowing gyms to open as part of Stage 2 of the Open for Summer Plan may be relevant to physiotherapists who offer group exercise-based physiotherapy interventions such as GLA:D programs, falls and balance classes, or Parkinson’s group classes.
Although Physiotherapy Alberta’s view is that group exercise interventions may be provided to these groups, where appropriate measures can be implemented, we also know that the populations served by these programs are different from that of the general population seen in the gym environment. As such a higher standard of care is required.
Physiotherapists who offer these interventions may be able to transition back to offering group classes, however it is important that those who do so continue to follow the health sector specific guidance provided by Physiotherapy Alberta regarding the provision of services:
- The physiotherapist completes a risk assessment of the activity and identifies appropriate measures to mitigate the risks.
- The risk profile of individual participants supports their safe return to the exercise group.
- Group classes are appointment-based and scheduled.
- Attendees are screened at the time of booking and upon arrival.
- Measures such as continuous masking and routine, vigorous hand hygiene are employed, as with all other in-person physiotherapy services.
- 3-meter physical distancing is maintained between all participants and class sizes are limited to the number of participants that will fit within the space while maintaining 3-meter distancing from each other at all times.
- Equipment is not shared between participants.
- Instructor close contact with participants and movement between participants is avoided.
- Class cohorts are not mixed, and
- Limiting participant socializing before and after class.
Providers who are unable to meet these expectations and mitigate relevant risks to providing group exercise-based interventions are directed to continue providing these interventions on a one-on-one basis.
Long Term Care (updated June 11, 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, in accordance with CMOH Order 16-2021.
CMOH Order 23-2021 explicitly enables the return to group activities 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).
Order 23-2021 also enables the provision of mobile health services in continuing care environments to residents who are not symptomatic, isolated, or quarantined, provided the physiotherapist adheres to workplace and sector specific requirements, CMOH Orders 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 June 11, 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. As stated on the Government of Alberta website, health services provided by regulated health professionals “can remain open by appointment only as long as public health orders and sector guidance is followed. Appointments should be limited to one-on-one services.”
Home-based businesses providing regulated health services can also continue to operate and “should follow the restrictions in place based on the type of service they provide.” In other words, the restrictions and practices established for physiotherapy community services (private practice) apply to physiotherapy home-based or mobile services.
The provision of mobile health services in continuing care environments to residents who are not symptomatic, isolated, or quarantined, is enabled through CMOH Order 23-2021, provided the physiotherapist adheres to workplace and sector specific requirements, CMOH Orders 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 June 2, 2021)
With the return to in-person learning on May, 25th, 2021, physiotherapists 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.
In instances where students are engaged in in-person learning, physiotherapists working in the school sector 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 May 5)
Over the past 14 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.
While physiotherapists working in acute care environments will not have experienced business closures in the same way as private physiotherapy business owners, Physiotherapy Alberta is aware that some programs and services have experienced significant operational disruptions and many physiotherapists in these environments have experienced redeployment as a consequence.
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 challenges due to illness, self-isolation and quarantine requirements. 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.
This is an unprecedented situation in which the greater good calls all health professionals to contribute, as they are able.
Update: March 16 - Physiotherapists Included in Phase 2C Vaccination Plan
Vaccination of Physiotherapists Against COVID-19
Guidance for Resuming Physiotherapy Practice During a Pandemic
Mandatory Masking in Public Spaces: Considerations for PTs
What does Stage 2 of Alberta's Reopening Mean for Physiotherapists?
Urgent Care and Telerehabilitiation: Information for Patients
Direction to Physiotherapists Working in Long-Term and Continuing Care Environments