Many physiotherapy practice settings employ physiotherapist support workers to assist in the delivery of physiotherapy services. This is true in both private and publicly funded settings, across various populations of patients. Physiotherapist support workers can be an integral part of a patient’s care. This article will help you recognize who the support workers are that you may be working with, the skill sets they have, and what services they can and cannot provide.
Get to Know Your Physiotherapist Support Worker
It is important to recognize that physiotherapist support workers are not regulated by the College of Physiotherapists of Alberta. These unregulated health providers have a range of education and training backgrounds. They may be trained on the job; however, it is increasingly common that physiotherapist support workers will have a degree in Kinesiology or a diploma as a therapy assistant from a post-secondary institution. Some support workers will have received training to work as a support worker with multiple health professions such as occupational therapy and speech-language pathologists. The names used to describe these healthcare providers can vary depending on the site. You may hear several of the terms listed below.
- Physiotherapist Assistant
- Physiotherapy Aide
- Therapy Assistant
- Kinesiologist
Regardless of their background, physiotherapist support workers work under the direction and supervision of a physiotherapist and are assigned tasks by your physiotherapist. Some examples could be:
Joris at the Local Private Practice Clinic
Joris graduated from the local high school and works summers at the clinic while studying for their kinesiology degree at university. Joris can do many administrative duties like booking patients and helping with billing as well helping with laundry and cleaning. With their schooling and on-the-job training, they also can assist the physiotherapist with the use of electrotherapy modalities like TENS or other treatments such as ultrasound. Joris has also completed some in-clinic training with the physiotherapy staff and has started to take patients through some basic exercises assigned by the physiotherapist.
Becky in Post-Surgical Care
Becky is a physiotherapist assistant who works in a hospital with people who have had total knee replacements. They do not have a diploma as a support worker, but they have been working for many years and have learned much of their job through their work with different physiotherapists. Becky often works with a physiotherapist when it's time for patients to get out of bed for the first time after surgery, and is involved in reviewing exercises, helping people learn how to climb stairs, and preparing them for their return home. When Becky sees that patients are almost ready to go home, they report back to the physiotherapist so that discharge plans can be finalized.
Vickie at the Hands Clinic
Vickie graduated from the Therapy Assistant program at Medicine Hat College to work with both physiotherapists and occupational therapists. They have been working for several years at the Hands Clinic and they can do many things as a support worker for both physiotherapy and occupational therapy. Depending on the tasks assigned she can be supervised by either the physiotherapist or the occupational therapist.
Arun at the Long-Term Care Facility
Arun graduated from a physiotherapy program in India and is currently working to become a physiotherapist here in Alberta. They have been working at the facility for several months and helps get patients out of bed and walking; they also help patients with their exercise programs. Arun documents their sessions with the patients and communicates regularly with the physiotherapist who works at the facility. If Arun notices anything has changed with a patient, they report it to the physiotherapist who then reassesses the patient.
What Can’t Physiotherapist Support Workers Do?
In Alberta, there are restricted activities that are listed in the Health Professions Act, which is legislation that regulates health professionals. These are tasks that are considered unsafe for the general public to do because of the higher risk or training needed. In the physiotherapy practice setting this would include procedures like:
- Performing wound debridement and care
- Suctioning a patient’s airways to clear mucous
- Using acupuncture needles
- Inserting or removing catheters
- Spinal manipulation or “cracking” of a spine
- Ordering diagnostic imaging
- Relocating a dislocated joint
- Performing internal pelvic examinations
Your support worker should never be performing any portion of these restricted activities. If you have concerns about any of these practices, you can ask our Practice Advisor for more information.
Physiotherapist support workers must be assigned tasks by the physiotherapist who supervises them. The tasks that the physiotherapist assign must be tasks that the physiotherapist is competent to perform themselves. If a physiotherapist is not competent to use a certain treatment technique, they cannot assign that task to a support worker. For example, if a physiotherapist starts at a private practice clinic where shockwave therapy treatments are used, but the physiotherapist has never used this before they cannot assign the support worker to use it, regardless of whether the support worker has been trained and educated to apply the shockwave to a patient. Physiotherapists can only assign tasks that they are competent to provide.
It is also important to note that support workers cannot assess and make decisions regarding developing or changing patient care plans. Depending on the situation and setting where you are receiving physiotherapy, you may interact with the support worker more often and they may be the one to notice changes in your condition. However, due to their education, training, and experience, it is the physiotherapist’s responsibility to assess or alter your plan of care. The support worker may continue to be involved in your care and carry out the treatment plan, but they wouldn’t work with you to make decisions regarding your care.
Consenting to Services from a Physiotherapist Support Worker
Before a physiotherapist support worker is assigned to help with your physiotherapy services, the physiotherapist needs to discuss this plan with you and obtain your consent. Gaining your consent should occur before any tasks are assigned to the support worker and consent should be informed and ongoing. If something changes in your plan involving the physiotherapist support worker, you should be advised of the change and you need to consent to the change before it takes effect. Support workers are valuable members of the healthcare team and can be essential for you to receive the care you need, however, you as a patient still have the right to agree to or decline to have support workers as part of your care team.
A Patient’s Relationship with a Physiotherapist Support Worker
Physiotherapist support workers are assigned tasks by the physiotherapist and depending on the practice setting you may interact with the support worker for a considerable amount of time over the course of your treatment. It is important to recognize that building a positive therapeutic relationship with the support worker is a key part of your care and like any relationship, this takes time and is built on trust. The support worker should reflect the same professional characteristics as your physiotherapist. They should be:
- Respectful of you and your values.
- Open and honest when it comes to your care.
- Focused on your care when you interact.
- Able to listen attentively to your concerns and opinions regarding your care.
If you have concerns about your physiotherapist support worker, there are conflicts with how your care is being provided, or you are generally unsatisfied with your care, you can try these suggestions, which are provided in order of approach.
- You can discuss it with the supervising physiotherapist.
- You can bring it to the attention of the owner or manager in charge of the facility.
- You can bring concerns about your physiotherapy care and the physiotherapist’s supervision of that care to the College of Physiotherapists of Alberta.
Supervision is Mandatory
As mentioned earlier in this article, support workers are not regulated in Alberta. Physiotherapist support workers only provide physiotherapy services under the direction and supervision of a registered physiotherapist. The College of Physiotherapists of Alberta regulates the physiotherapist who supervises the support worker and there are Standards of Practice that govern that supervision.
The College requires the physiotherapist to have supervision strategies in place to maintain the safety of the patient and ensure that quality care is provided. Supervision can be either direct or indirect; meaning that the physiotherapist can be present next to the support worker while they work with you or they can have a treatment plan in place that is carried out by the support worker. If the treatment plan is carried out by the support worker without the physiotherapist present, the physiotherapist reviews your patient chart and discusses your progress when you are not present. The main components of appropriate supervision are:
- To determine the level of supervision required – certain situations may require the physiotherapist to be around more often due to the complexity of the patient and their injuries or condition, or the support worker’s competence and abilities. In other situations, the physiotherapist may be around less if the care provided is more routine and the support worker is more experienced. Regardless, the supervisor should have a plan in place to ensure that the patient is receiving quality, effective care and should follow up at intervals to make sure things are progressing as they should.
- To maintain accountability for the supervision provided – the physiotherapist evaluates the support worker’s abilities to carry out the tasks they assign and is responsible for ensuring the supervision they provide is sufficient to properly evaluate the work that is being performed. Seeing a physiotherapist once at the start for an assessment and then having no contact with them afterward is not acceptable practice.
- Take appropriate action when needed –if assigned tasks to the support worker are no longer working or appropriate or issues arise with the supervision, then the physiotherapist has the responsibility to act. This could be changing the plan of care if it is no longer appropriate, or pairing with a different support worker with the right skill sets to provide quality, effective patient care.
In Summary
- Support workers come from varied backgrounds and education but can be integral to your physiotherapy care.
- You should be aware of what a physiotherapist support worker can and can’t do regarding your care.
- It is important that you consent to having any portion of your care provided by a support worker.
- You should have a good working relationship with your physiotherapist support worker.
- Your physiotherapist is required to supervise the physiotherapist support worker and ensure that you receive quality, effective physiotherapy services.
- Any concerns you may have can be addressed by either the supervising physiotherapist, the facility in which your care is delivered, or by the College of Physiotherapists of Alberta when related to the supervision of the physiotherapy services and the supervising physiotherapist.
