What to Expect When Receiving Care from a Physiotherapist

Every patient-physiotherapist working relationship will start with the physiotherapist asking questions. Your physiotherapist will want to hear your story and to know about:

• The issue that led you to come for physiotherapy.
• How and when the issue started.
• How the issue effects your life and ability to do the things you want to do.

Your physiotherapist will ask questions about your life, including:

• Your work and household activities.
• Your recreation or sport activities.
• Your family situation (who you rely on for help, who relies on you).

Your physiotherapist will also want to know about your general health, including any other health concerns you have and any medications you are taking.

This will help them to understand who you are, what you are hoping to gain from physiotherapy, and the important background or context of your health and goals.

Sometimes, physiotherapists ask questions that may seem unrelated to the reason you came for physiotherapy. Often, these questions help the physiotherapist to rule out health concerns that are masquerading as something a physiotherapist can treat, but which require the help of another health professional. If you are uncomfortable with your physiotherapist’s questions, or do not understand why they want certain information, you can ask them to explain the reason for their question.

NOTE: It is your right to have the physiotherapist explain why they need the information they ask for.

Much of what physiotherapists do every day requires them to touch their patients to assess and treat movement and movement problems. This includes feeling for changes to body tissues or limitations in movement.

During the physical assessment part of your first appointment, your physiotherapist may:

• Look at your posture
• Watch as you do some general movements or activities such as walking or getting up from a chair
• Ask you to move different parts of your body so they can see how flexible you are, including both the area you are concerned about and other parts of your body
• Ask you to relax while they move the joints of your body into different positions
• Test how strong your muscles are
• Check for swelling or increased warmth of a joint or injured area
• Check how sensitive your skin is to touch

Your physiotherapist may also use their hands to assist with activities or exercises. It is common for the physical assessment to start with a general review of how your body moves and to become more specific and focused on the part of your body that is causing your concern or problem as it continues.

Sometimes, a physiotherapy assessment may occur over more than one appointment. This may happen if:

• You are in a lot of pain at the time of the assessment and can only tolerate part of an assessment
• Your condition is complex and requires a longer assessment
• You have a long health history to discuss or if other time constraints arise

Physiotherapists frequently work within what would be considered your personal space.

Your physiotherapist must confirm that they have your consent to do the assessment.

You can expect your physiotherapist will ask for your consent before they touch you (begin the assessment) and will check in with you to see how you are feeling as the assessment continues. They will explain what they are doing and why they are doing it. Often, they will do this as they work through the assessment. This can help you to feel more comfortable with your physiotherapist, may make the physiotherapist’s thought process clear, and helps to ensure that they have your continued consent. This may sound like a “running commentary.”

NOTE: You have the right to have the physiotherapist explain what they are doing and why during the assessment.

If at any time you are uncomfortable, you can tell the physiotherapist to stop what they are doing or withdraw your consent.

NOTE: You have the right to stop the assessment at any time and for any reason.

It is important for your physiotherapist to look directly at the part of your body that is causing your issue or concern.

• Your physiotherapist may ask you to change into a gown (like at a doctor’s office), or a pair of shorts or tank top before doing the physical assessment, so that they can directly see how your body moves and understand what is causing your issue.
• Your physiotherapist may ask you to move a piece of clothing or may ask your permission to move a piece of clothing so they can assess the part of your body where the issue is.
• Your physiotherapist may also use a towel or sheet to cover parts of your body while exposing the part of your body where the issue is.

NOTE: You have the right to refuse your physiotherapist’s request to change clothes or adjust your clothing.

This may affect the physiotherapy assessment or the treatment options available. If you are uncomfortable with changing or adjusting your clothes, talk to your physiotherapist about the situation and options available that will help you to feel comfortable and enable as complete an assessment as possible.

Once your physiotherapist has completed the assessment, they should have a good idea of what is happening to cause your issue. You can expect your physiotherapist to explain what their findings mean and provide you with information about the issue and its typical pattern of recovery.

At this point your physiotherapist will make recommendations and discuss options for how to treat the issue. You can expect to be an active participant in discussing the treatment options, the risks and benefits, and in deciding what will work best for you.

If you have had physiotherapy before and know the treatments that have worked for you in the past, it is always appropriate to discuss these with your physiotherapist.

Your physiotherapist will ask for your consent for the planned physiotherapy treatment at this point in the process.

Your treatment options and plan of care will depend on what the assessment findings are, your preferences and experience, and the experience, skills, and abilities of your physiotherapist. Although all physiotherapists enter practice with similar skills, they develop and refine those skills throughout the span of their careers. Not every treatment option is available from every physiotherapist. If your physiotherapist does not provide a specific treatment that you request or that they think would benefit you, they may refer you to another physiotherapist or other health-care provider for treatment.

Physiotherapists usually provide some education about your issue, advice for what you can do at home to help manage your issue between physiotherapy visits, and some treatment on the same day as your first assessment.

When you return for follow-up appointments, you can expect that your physiotherapist will ask a few questions about how you felt after the assessment, explain their plan for the current treatment session, answer any questions you have, and confirm that they have consent to proceed with the planned treatment. They may repeat some of the same tests they completed during the assessment to establish if there has been a change since they last saw you.

• To receive clear and understandable information about what the physiotherapist has found, what their findings mean, and what the physiotherapist proposes as a plan to address their findings
• To ask questions and receive answers to your questions about the physiotherapist’s actions, assessment findings, and treatment recommendations
• To provide your voluntary, informed consent before your physiotherapist begins the assessment and before they provide any treatment
• To say no to any proposed assessments or treatments or to tell the physiotherapist to stop what they are doing and to be heard

Physiotherapists build effective working relationships with their patients (called the therapeutic relationship) over the course of the physiotherapy assessment and follow-up visits. Research has shown that effective therapeutic relationships help to improve patient outcomes.

To develop the therapeutic relationship, your physiotherapist will take the time to learn about you and what is important to you. They may also tell you a bit about themselves. However, physiotherapists are required to establish and maintain appropriate professional boundaries with patients and limit the personal information they share to maintain professional boundaries. Appropriate professional boundaries help to make sure that the relationship remains therapeutic in nature and does not become a personal relationship.

Physiotherapists know that there is an inherent power imbalance between patients and their physiotherapists. This power imbalance is due to the physiotherapist’s knowledge and skills, their role as your health-care provider, their access to your private information, and your reliance on them for care. Physiotherapists try to equalize the balance of power in the therapeutic relationship; however, due to their role and access to your information, this is never fully achieved.

Physiotherapists are required to avoid using this power inappropriately.

By paying attention to the power imbalance and establishing appropriate boundaries the physiotherapist can create an effective therapeutic relationship and provide quality physiotherapy care.

NOTE: Due to the risks of combining personal and professional relationships, physiotherapists must avoid personal relationships with their patients and are expected to avoid treating people with whom they have a close personal relationship.

From time to time, the College receives questions and concerns about an interaction that happened between a patient and their physiotherapist. Sometimes these questions relate to touch, what constitutes appropriate touch, or what the patient perceived was inappropriate touch in physiotherapy practice.

Appropriate touch:

• The purpose has been explained.
• The purpose is consistent with the reason you came to see the physiotherapist.
• You granted permission.
• The touch lasted for the duration necessary for the stated purpose and no longer.
• The touch ended if or when you said stop.

Inappropriate touch:

• The purpose was not explained.
• The purpose is not consistent with the reason you came to see the physiotherapist.
• You did not grant permission.
• The touch continued longer than necessary.
• The touch did not stop when you said stop.

The College also receives questions and concerns about interactions between a patient and their physiotherapist which were sexual in nature. Under the rules established by the Health Professions Act and the College of Physiotherapists of Alberta’s Standards of Practice, physiotherapists must avoid conduct that constitutes sexual abuse or sexual misconduct between the physiotherapist and their patient.

A person is considered a physiotherapist’s patient for 365 days from the last date of physiotherapy services.

Sexual abuse is defined in the legislation and includes any form of sexual contact with a patient. The definition of sexual abuse also includes any form of touching of a “sexual nature” unless that touching is appropriate for the clinical interaction (e.g. touching of a patient’s genitals for the purpose of assessing the pelvic floor muscles).

Sexual misconduct is defined in the legislation and includes behaviours or comments that are sexual in nature that the physiotherapist knows or ought to know will cause offence or humiliation to the patient or negatively affect the patient’s health and well-being.

You can read the complete definitions of sexual abuse and sexual misconduct in the Health Professions Act Section 1(1)(nn.1 to nn.3). You can read further information about the definition of a patient for the purpose of physiotherapy services in Alberta in the The College of Physiotherapists of Alberta Sexual Abuse and Sexual Misconduct Standard of Practice.

According to the rules established in the Health Professions Act and the Standards of Practice, physiotherapists must not engage in sexual relationships with patients, this includes any person who has received physiotherapy care from the physiotherapist within the last 365 days (one year).

It does not matter if the patient is the one making sexual advances, or if both patient and physiotherapist are adults and agree to the relationship. The legislation is clear - if the physiotherapist engages in a sexual relationship with a patient, they are breaking the rules set out in legislation and the Standards and could permanently lose their license to practice.

The College of Physiotherapists of Alberta’s job is to make sure that Albertans receive safe and effective physiotherapy care from competent and ethical physiotherapists.

We encourage you to call the College if:

• You have a concern about a physiotherapist’s actions, or the services received from a physiotherapist
• Think a physiotherapist has engaged in inappropriate behaviour
• Or are unsure if what your physiotherapist did or said was appropriate

Should you have questions or concerns about the care you received from a physiotherapist, we encourage you to contact the College of Physiotherapists of Alberta.