Good Practice: Back to the Basics

The College of Physiotherapists of Alberta hears from physiotherapists on a regular basis who have found themselves in tricky situations. The role of the Practice Advisor is to help physiotherapists to understand the expectations outlined in the Standards of Practice and avoid crossing the line and breaching the Standards. Among other expectations, physiotherapists are required to manage challenging patient care situations and avoid or manage any real, potential or perceived conflicts of interest that may arise within in their practice.¹ Unfortunately, the current practice environment confronts physiotherapists with the potential for conflict and conflict of interest situations daily. Consider these scenarios:

• Pressure from managers, patients or others to continue treatment even when the assessment or reassessment findings demonstrate that it is not clinically indicated or is not leading to the improvements and functional gains desired.
• Individuals seeking specific treatment modalities or interventions, contrary to the assessment findings and physiotherapist’s recommendations.
• Waitlists and pressures to move patients through the system or to see more patients in a day, affecting decisions about physiotherapy treatment.
• Payment systems, from fee for service care to third-party contracts, which put pressure on physiotherapists, effecting treatment decisions.

Any time a physiotherapist’s judgment is or could be influenced by factors other than objectively demonstrable need for treatment, a potential conflict of interest exists. How the physiotherapist manages or responds to such situations is important.

The Client Assessment, Diagnosis, Interventions Standard of Practice and Client-Centered Care³ Standard, set the bar for physiotherapist with regards to delivering services that are centered on the client’s needs and goals and that are clinically indicated based on appropriate assessment and evidence-informed clinical decision making. Through this standard, the College of Physiotherapists of Alberta has directly addressed the mechanism by which physiotherapists can navigate the difficult situations described above.

The performance expectations outlined in the Standard are not new to physiotherapists who are taught from the first day of their physiotherapy education the skills and importance of appropriately assessing, planning, and delivering interventions that address the patient’s needs and goals. Developing client-centered treatment plans for patients based on comprehensive assessments, and using relevant assessment methods, standardized measures and our best clinical, evidence-informed decision-making skills is what we are trained to do. Throughout the Standards of Practice, the responsibility to only deliver services that are clinically indicated and to not promote or provide unnecessary services is clearly identified. The need to base treatment decisions on the individual patient presentation and strong clinical evidence remains key to our practice as professionals.

Several expectations identified in the Client Assessment, Diagnosis and Intervention Standard² speak directly to this responsibility by requiring that the physiotherapist:

• Applies appropriate assessment procedures to evaluate clients’ health status using standardized measures as available.
• Uses critical thinking and professional judgment to interpret the assessment findings and determine a physiotherapy diagnosis.
• Re-evaluates and monitors clients’ responses throughout the course of interventions, making adjustments and discontinuing services that are no longer required or effective.
• Delivers only services that are clinically indicated for clients.

The Client-Centered Care Standard³ ensures that the client has a voice in these treatment decisions, by requiring that the physiotherapist:

• Communicates with clients to facilitate their understanding of the care plan and how it addresses their goals, outlines the risks and benefits of services and obtains informed consent.

By having these expectations clearly defined, physiotherapists have a clear structure by which they can reflect upon their practice and treatment decisions, most especially when faced with challenging situations or potential conflicts of interest.

By continuing to apply these “basic” practices that are so inherent to what we do as professionals on a daily basis, physiotherapists can navigate challenging situations with confidence, knowing that their treatment decisions are evidence-informed, based on objectively demonstrated need for service, and that patients’ voices are included in these important discussions.

Page updated: 03/01/2024