As announced on February 3, 2023, the College of Physiotherapists of Alberta will be implementing a new tool later this spring to proactively monitor physiotherapy advertising. The tool will be used to screen websites and social media accounts where physiotherapy services are promoted. It will verify that the advertisements and promotional activities of physiotherapists are aligned with the performance expectations identified in the Advertising Standard of Practice, the Use of Title Standard of Practice, and governing legislation which requires that physiotherapists “not engage in advertising that is untruthful, inaccurate or otherwise capable of misleading or misinforming the public.”
This article will focus on some of the common issues identified in physiotherapy advertising, highlighting recent examples of advertisements that are not consistent with the Standards.
Comparative and Superlative
The Advertising Standard of Practice (2017) specifically requires that the physiotherapist “refrains from advertising that makes comparative or superlative statements about service quality, health providers, and products and/or endorses products for financial gain.” Two common questions that the College receives from registrants related to this performance expectation are:
- What does the College mean by the terms “comparative” and “superlative”?
- Where can I find a list of comparative and superlative terms that are prohibited?
The essence of the expectation is that physiotherapists do not use words to compare themselves with other physiotherapists, for the purpose of enhancing the perception of their own skills or the services they offer or to undermine the credibility of another physiotherapist in the eyes of the public.
Comparative Definition
- “perceptible by comparison; relative.” (Oxford Languages)
- “expressing a higher degree of a quality, but not the highest possible” (Oxford Languages)
- “of, or relating to, or constituting the degree of comparison in a language that denotes increase in the quality, quantity or relation expressed by an adjective or adverb.” (Merriam Webster)
Example: the comparative form of happy is happier. (Merriam Webster)
Superlative Definition
- “an exaggerated or hyperbolical expression of praise.” (Oxford Languages)
- “an admiring sometimes exaggerated expression especially of praise.” (Merriam Webster)
Example: the superlative form of happy is happiest.
Examples of terms and phrases used in advertising that are not consistent with the Standard include, but are not limited to:
- Expert Physiotherapist
- Extensive experience
- #1 NW Physiotherapy Clinic
- Best Physiotherapy Clinic in NE
- Specialist/Specialized
What’s wrong with using comparatives or superlatives?
The Standard of Practice requires that physiotherapists advertise in a manner that is truthful, accurate, and verifiable. Suggesting that a clinic or physiotherapist is the best in a given community or part of the province is not verifiable and raises a host of questions:
- On what measure are they the best?
- Who decided they were the best?
- How was the decision made?
- Could the clinic, physiotherapist, or the physiotherapist’s friends and family have unduly affected the decision through “voting” or other means?
Similar questions ought to be asked about claims of being an “expert” physiotherapist or having “extensive experience.” It may be true that a physiotherapist has three decades of clinical experience. Or that they have completed significant post-professional education to further develop their skills. If that is the case, the physiotherapist is expected to clearly, accurately, transparently communicate those facts. This is information that is verifiable. Claims of “expert” or “extensive experience” are not verifiable because they are not backed up by clear explanation of the basis of the statement.
If a member of the public were to read advertisements suggesting that a clinic is #1 in west Edmonton, they may or may not be unduly influenced to pursue care at that clinic. The same is true for claims that a physiotherapist is an expert. The outcome is exactly the opposite of the expected outcome articulated in the Standard.
A Special Word About Specialist/Specialty/Specialized
If one clinic or clinician is special, it automatically implies that other clinics are not. If treating one condition is a physiotherapist’s specialty, or stating they specialize in the care of a specific patient population, that automatically implies that other physiotherapists are less skilled or less able to provide care to that population.
These words are problematic as they compare one provider to another in a way that favors one individual over their competition and constitute exaggerated forms of praise of a clinician and that clinician’s skills. Using these terms in advertising will cause patients to believe that they can expect to receive a higher standard of care and achieve better outcomes.
If a physiotherapist has patient outcome data that demonstrates that they achieve better outcomes than those of their competitors, and that data is truthful, accurate and verifiable, they may share that information in a clear, objective, transparent and accurate manner. Otherwise, such claims are not permitted.
Beyond the issues with the comparative and superlative nature of these words, the use of the title “specialist” is reserved for those who have met the regulatory requirements and criteria established by Council. Only those who have received authorization from the Registrar may refer to themselves as a Clinical Specialist. Any other physiotherapist, using the term or otherwise implying that they are a specialist are in contravention of the Standards and the Physical Therapists Profession Regulation.
Free Services
The Advertising Standard (2017) states that the physiotherapist:
- Refrains from using advertising that offers free services.
The Standard does enable a physiotherapist to provide general health promotion and education to the public, as in the case of a public presentation. Physiotherapists are also permitted to:
- Tell people about the services they offer (for example, that they provide pelvic health or pediatric physiotherapy services at their practice location).
- Tell members of the public about the appropriateness of physiotherapy to address the needs of an individual patient (for example, that pelvic health physiotherapy services are first line care for individuals experiencing urinary incontinence, or that physiotherapy can help people experiencing symptoms related to Parkinson’s disease).
However, in light of language that prohibits advertisement of free services, the following examples of advertisements are not consistent with the Standard:
- “We are giving away 50 vouchers for a FREE assessment, plus a $50 gift card towards your first shockwave therapy”
- “Drop by our grand opening. We’ll be offering free physiotherapy…”
- “Opening Promotional Offer. Free first assessment & treatment. Completely free when you book with us.”
- “Free 15 minute Physio Consult”
- “7th Treatment Free”
- “Free in-person or phone consult, $100 value”
Evidently, there is some confusion, or perhaps a lack of awareness about what is, or is not permitted by the Standards. To address this issue, the College has refined the language regarding free services in the draft Standards circulated to registrants for consultation in January 2023. In the draft Standard, the performance expectation states that the physiotherapist:
- Does not advertise free physiotherapy services. This includes offers of free consultations, screening appointments, assessments, or free trials of physiotherapy treatments.
What’s Wrong with Free Services?
The bottom line is that advertisements of this nature incentivize specific actions that may or may not be in the patient’s interest. For example, if the patient has a gift card for shockwave therapy, they can reasonably be expected to seek out that service, regardless of its clinical appropriateness. Others may see an advertisement for a free knee pain assessment and be motivated to attend for that service instead of continuing with an existing therapeutic relationship, or may be motivated to seek unnecessary treatment. Finally, offering a seventh treatment free may reasonably be expected to result in patients continuing treatment for at least seven visits for the purpose of collecting that incentive, whether they actually require seven visits in order to address their condition, are improving, or not.
Discounts
During the January 2023 consultation regarding the draft Standards of Practice, the College received a few questions about discounts. As with past iterations of the Standards, the requirement is that if a physiotherapist is offering a discount for a defined patient population, they must clearly identify the discount on their fee schedule. Physiotherapists are also prohibited from using time limited pricing or discounts.
Examples of advertisements that are not consistent with the Standard include:
- January special - 15% off all physiotherapy services.
- Facebook special – 10% off your physiotherapy assessment if you bring in a screen shot of this advertisement.
- 15% off for members of XYZ gym (discount posted in the gym, but not in the physiotherapy practice location)
If a physiotherapist wants to offer a discount, for seniors, university students, or any other identifiable group, the discount must be clearly stated on the practice setting’s fee schedule for all patients to see. Every patient should be able to identify if they qualify for a discount and to advocate for comparable discounts for other, similar groups.
Do Not Provide Guarantees of Successful Outcomes
Life is uncertain and within physiotherapy practice there are no guarantees. A physiotherapist can use all of their skills and treat a patient according to best practices and still be unable to achieve positive outcomes. Patients can similarly follow all of the instructions given by their physiotherapist and do all of their home exercises and self-management activities and still not achieve their desired outcomes. Advertisements that guarantee success are misleading to the public.
Examples of advertisements that are not consistent with the Standard include:
- Chronic pain ends here.
- Get ready for a pain-free winter…
What CAN I Say in Advertisements?
The following are suggestions for how to advertise in a manner consistent with the Standards:
- Focus on your skills, your additional training, your years of experience. Provide clear, tangible, accurate and verifiable information such as: how long you’ve been in practice, which courses you have completed, and if your practice is focused on a specific patient population, how long you have spent working with that population.
- If offering discounts – make sure that the discount is found in your fee schedule and is not time limited.
- Provide guarantees for the things you can control: that you will be attentive to the patient’s needs, that you will work with them to address their goals and concerns and that you will bring your best to the patient-physiotherapist interaction.
