Good Practice: When it Comes to Scope of Practice Do You Know Your Limits?
By: Leanne Loranger, PT
Physiotherapists in Alberta are fortunate to have a broadly defined scope of practice statement and are authorized to perform a range of restricted activities. As self-regulated professionals, physiotherapists are also required to comply with the Continuing Competence Program and reflect on their practice. This includes conducting self assessments and the development of ongoing learning and evaluation plans.
All of this adds up to a practice environment where all physiotherapists are encouraged to work to the full scope of their practice and make use of all the skills and knowledge they possess. There’s a catch though. Sometimes when we are working to the limit of our scope, we forget where the limit is.
Scope of Practice Statement
The Health Professions Act sets out the scope of physiotherapy practice as follows:
In their practice, physical therapists do one or more of the following:
- assess physical function,
- diagnose and treat dysfunction caused by a pain, injury, disease or condition in order to develop, maintain and maximize independence and prevent dysfunction,
- teach, manage and conduct research in the science, techniques and practice of physical therapy, and
- provide restricted activities authorized by the regulations.
The regulations set out the restricted activities authorized to physiotherapists based on the list in the Government Organization Act. These are divided into basic and other authorized activities. Click here to review the complete list of restricted activities.
Restricted Activities and Supervision
Whether or not an activity is within the scope of physiotherapy practice, a physiotherapist must only perform those activities that they have competence to perform.
If you are on the General Register and have developed your skills and competence regarding a basic restricted activity, you may perform these activities independently. If you are on the Provisional Register you may learn and perform basic restricted activities, but you must be supervised at all times when performing these activities until you are admitted to the General Register.
In order to perform the advanced restricted activity of ordering diagnostic imaging, you are required to have five years of clinical experience in addition to completing a continuing education program on the subject. To qualify to perform other advanced restricted activities, you must complete a program of study that includes both supervised practice and a summative evaluation. Physiotherapists must be on the General Register in order to participate in supervised practice, including the practical or applied components of education programs. Once again, a supervising physiotherapist must be physically present and able to intervene if problems arise while you are learning these advanced restricted activities.
Some restricted activities listed in the Government Organization Act have not been identified as being within physiotherapy scope of practice; others are grey areas.
The pace of change within the pharmaceutical industry is rapid, with several new medications introduced each year. Maintaining competence regarding medications, their purposes and more importantly, their interactions and adverse reactions, is a full time pursuit; not something to be engaged in casually. As a clinician you may be well versed in common medications used to treat a specific patient population but that isn’t enough. The question isn’t how well you know the medications you commonly encounter, but rather how well you know the medications you uncommonly encounter, their actions, interactions, synergies and possible adverse effects.
We often are asked about recommending over the counter (OTC) medications. As a regulated health-care provider you are held to a high standard when making any recommendations about health care. As outlined in a guidance paper published by the Canadian Alliance of Physiotherapy Regulators “With OTCs, consumers are expected to make decisions about self care; and when they do so, they assume personal responsibility. When a health-care provider such as a physiotherapist makes a recommendation about an OTC, not only is greater credence given to the advice, but the PT as a regulated health professional, assumes responsibility and accountability for such recommendations."6
While OTCs (as well as vitamins or herbal supplements) may be unscheduled drugs, they are not without risk. Generally, our advice is to not make any recommendations about OTCs. In addition, prescribing medications/drug therapy is not authorized to physiotherapists. Physiotherapy Alberta does have a memorandum of agreement with the Alberta College of Pharmacists that allows physiotherapists to refer to pharmacists with prescribing authority for making decisions about appropriate drug therapy.
Click here for more information about OTC considerations in physical therapy practice.
Some physiotherapists are authorized to order diagnostic imaging, but what about applying ultrasound imaging, such as rehabilitative ultrasound imaging at the point-of-care?
While we and other regulators do not believe this is a high risk area of practice, our position is that the current legislation restricts the application of point-of-care ultrasound. Discussions are ongoing with Alberta Health in an effort to enable the application of ultrasound imaging at the point-of-care for physiotherapists.
In the interim, there is nothing to stop a physiotherapist from using ultrasound imaging under medical supervision.
Working Under Supervision in an Interdisciplinary Team
Some physiotherapists may work as a member of an interdisciplinary team performing tasks that would not be considered to be within the scope of physiotherapy practice. In this situation, the physiotherapist is working under the authority of another health-care provider (most commonly a physician) and it is the physician’s responsibility to supervise the physiotherapist, determine that the physiotherapist is competent to perform the task that they have assigned and it is the physician who is liable for that patient assignment. If you are working under medical supervision you are, as always, responsible to act within the limits of your competence and ability.
Examples of activities assigned to physiotherapists who work under supervision in Alberta include physiotherapists who perform trigger point injections or order lab tests as part of triage clinics in rheumatology.
While the physiotherapy scope of practice is broadly defined in Alberta, there are some areas that pose challenges. It is helpful to know where the limit of scope of practice is, both in terms of advocating for change and to ensure that your own practice fits within the limits of what is set out by our governing legislation. There may be exceptions in areas of practice where there is specific expertise or competence acquired over time.
Physiotherapists as competent health professionals need to be aware of both the limits to their scope of practice, and when these exceptions apply. If you are ever in doubt, you can always contact Physiotherapy Alberta to discuss the specifics of your situation.
- Province of Alberta. Health Professions Act. Edmonton: Alberta Queen’s Printer, 2013. Available at: http://www.qp.alberta.ca/documents/acts/h07.pdf
- Province of Alberta. Physical Therapists Profession Regulation. Edmonton: Alberta Queen’s Printer, 2011. Available at: http://www.qp.alberta.ca/documents/Regs/2011_064.pdf
- Province of Alberta. Government Organization Act. Edmonton: Alberta Queen’s Printer, 2013. Available at: http://www.qp.alberta.ca/documents/Acts/g10.pdf
- Physiotherapy Alberta. Restricted Activities. Available at: http://www.physiotherapyalberta.ca/physiotherapists/what_you_need_to_know_to_practice_in_alberta/restricted_activities. Accessed on December 10, 2014.
- Province of Alberta. Pharmacy and Drug Act. Edmonton: Alberta Queen’s Printer, 2013. Available at: http://www.qp.alberta.ca/documents/Acts/P13.pdf
- Canadian Alliance of Physiotherapy Regulators. Alliance Guidance Document on Over the Counter Drugs. Toronto. 2012. Available at: http://alliancept.org/pdfs/Alliance_Guidance_Document_on_Over_the_Counter_Drugs.pdf. Accessed on December 10, 2014.