Good Practice: When it Comes to Scope of Practice Do You Know Your Limits?
January 8, 2015
Leanne Loranger, PT
Updated April 2021
Physiotherapists in Alberta are fortunate to have a broadly defined scope of practice statement and to be enabled to perform a range of restricted activities as part of their physiotherapy practice. However, as self-regulated professionals, physiotherapists are required to comply with Physiotherapy Alberta’s Continuing Competence Program and to reflect on their practice and individual knowledge and skills. This includes developing ongoing learning plans to advance those skills.
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 is a catch though. Sometimes when we are working to the limit of our scope, we forget where the limit is.
Physiotherapists’ Scope of Practice
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 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.1
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 are competent to perform. In addition to being competent in their performance, some restricted activities may only be completed after the physiotherapist has received authorization from Physiotherapy Alberta.
Activities that do not require additional authorization:
If you are on the General Register and have developed your skills and competence, you may perform the following activities without additional authorization.
Inserting and removing catheters
Reducing a dislocation of a joint
Suctioning or instillation
Wound debridement and care
If you are on the Provisional Register you may only learn or perform these activities under supervision of a member on the General Register who is competent in the performance of the activity.
The supervision requirements for restricted activities are outlined in Section 16 of the Physical Therapists Profession Regulation.2 The supervision requirements for restricted activities differ from Physiotherapy Alberta's expectations for appropriate supervision in other situations in that there is no flexibility or discretion regarding in person direct supervision:
The supervising physiotherapist must be present in the treatment cubicle or room.
The supervising physiotherapist must be able to observe and promptly intervene (i.e., stop or change actions) if required.
Activities requiring additional authorization from Physiotherapy Alberta include:
Ordering diagnostic imaging
Pelvic Health (Internal Examinations)
Performing spinal manipulation
Using needles in practice
To apply for authorization to perform these activities, you must first complete a program of study that meets the requirements established by the Council of Physiotherapy Alberta. In order to perform the restricted activity of ordering diagnostic imaging, you are also required to have five years of clinical experience in Canada.
Pelvic health internal examinations are distinct from the other activities in this category in that physiotherapists on the Provisional Register may learn and apply for authorization to perform internal examinations. However, a physiotherapist intern’s practice of this activity must always be directly supervised, including after authorization has been granted by Physiotherapy Alberta.
Physiotherapists must be on the General Register to participate in supervised practice (including continuing education courses) or seek authorization to order diagnostic imaging, perform spinal manipulation or use needles. Once again, the supervising physiotherapist must be physically present and able to intervene if problems arise while you are learning these activities.
Medication Advising and Assistance
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.
Physiotherapy Alberta is often asked about physiotherapists 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."3
As a clinician you may be well versed in common medications used to treat a specific patient population but that is not enough. The question is not 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.
Physiotherapy Alberta’s Medications Guide provides further guidance regarding the role of physiotherapists in medication advising, medication assistance, and medication reconciliation.4 Physiotherapists should also be aware that Physiotherapy Alberta has 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.
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 perspective 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 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 and determine that the physiotherapist is competent to perform the task that they have assigned. It is the physician who is responsible and accountable for that patient assignment. If you are working under medical supervision you are, as always, responsible to act within the limits of your individual competence and skills.
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.
As competent health professionals, physiotherapists 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
Canadian Alliance of Physiotherapy Regulators. Alliance Guidance Document on Over the Counter Drugs. Toronto. 2012. Available at: https://www.alliancept.org/publications/. Accessed on March 15, 2021.