Good Practice: Non-Traditional Practice

A common question that the College of Physiotherapists of Alberta’s Registration Department fields, especially around renewal season is “do my hours count?”

What counts as physiotherapy practice in Alberta is broadly defined, making it (relatively) easy for members who are working in a variety of roles to meet their practice hour requirement and remain registered. Nonetheless, when faced with the question of whether a person’s hours count, we are really faced with the essential question of what is and what is not physiotherapy.

One of the wonderful things about physiotherapy practice is that it encompasses everything from direct patient care, to research, teaching, administration, advocacy and more. While many physiotherapists spend their days treating patients in traditional settings, others are engaged in health promotion roles or business management activities. So how do you know what you are doing is physiotherapy? It comes down to the legislative definition of practice for the profession, the Standards of Practice and Code of Ethics, and how your work exemplifies and embodies the principles and expectations that they include.

“My practice includes both animal and human patients. Which hours can I count?”

The Health Professions Act (HPA) regulates the provision of health services to humans. Although individuals with a physiotherapy background may pursue training to provide animal rehabilitation, the services provided by physiotherapists under the HPA relate exclusively to health services provided to people. The College of Physiotherapists of Alberta does not have jurisdiction to regulate treatment of animals, as this falls under the Veterinary Profession Act. The protected titles physiotherapist, physical therapist or PT cannot be used by individuals who are delivering animal rehabilitation. The hours spent providing treatment for animals do not qualify as physiotherapy practice hours for the purpose of registration, as they do not fall within the defined terms of physiotherapy practice in the province of Alberta and within the College of Physiotherapists of Alberta’s jurisdiction.¹

“I’m in an administrative health care role and do not treat patients. Does this count?”

The HPA defines physiotherapy practice, stating that physiotherapists do one or more of the following:

1. Assess physical function,
2. Diagnose and treat dysfunction caused by a pain, injury, disease or condition in order to develop, maintain and maximize independence and prevent dysfunction,
3. Engage in research, education and administration with respect to health services delivery and the science, techniques and practice of physiotherapy, and
4. Provide restricted activities authorized by the regulations.^2,3

As I’ve already said, that is a broad definition that allows many people to fit within physiotherapy’s defined scope of practice. For example, a person who works in an administrative health-care role can still be seen to be working within the scope of practice and can count their work hours towards meeting their registration requirements. A key consideration is whether the person’s physiotherapy education or identity as a physiotherapist is considered to be an asset or a requirement for the position they hold.

Of course a great many individuals who are not trained as physiotherapists could argue that they too assess physical function and diagnose and treat that dysfunction. Does that mean that they can also count their work hours as physiotherapy? Of course not!

“I teach Pilates at my community league. Is this physiotherapy?”

To claim that your work should count towards the practice hours requirement you need to be registered at the time when you were accruing hours. This means that you need to meet the requirements for registration and comply with the Standards of Practice or other professional obligations. The Standards require certain actions be undertaken as part of the process of providing care, such as the completion and documentation of an assessment of the client’s condition, the development of a treatment plan and goals that address the client’s needs, documentation of the treatment provided including the education offered to the client, and measurement and monitoring of the outcomes of treatment.⁴

To claim these work hours as physiotherapy practice hours, the person would need to:

1. Complete appropriate assessments for every individual attending the class (i.e., assessments appropriate for the conditions they are attempting to treat).
2. Determine which individuals meet the criteria to attend the class, (i.e., that the treatment offered was safe for the patient’s condition and would address their needs and goals).
3. Plan and modify the treatment (the exercises completed) based on the client’s capabilities and response.
4. Document the treatment intervention in sufficient detail that another similarly trained physiotherapist would be able to replicate the treatment.
5. Maintain and store records according to the standards of practice requirements.⁴

In other words, if the physiotherapist was attempting to treat a group of low back pain patients using Pilates as a treatment technique and had completed assessments to determine what the patients’ needs were, ensured that they were appropriate for the class, and documented the treatment and response to treatment, then the argument could be made that this is physiotherapy. On the other hand, if the class is composed of people in the community who self-select to attend the class without any formal pre-assessment, intervention tailoring or documentation, this does not meet the Standards and should not be considered physiotherapy practice.

“I volunteer with a non-profit society, providing group exercise training and education to a group of people with a specific condition. Is this physiotherapy?”

Volunteer hours count; however, the Standards still need to be met, as already described. In this scenario, the requirement to document treatment seems to pose a challenge. It’s worth noting that while you must document your treatment, in cases where a standard program is delivered, physiotherapists only need to retain a copy of the standard program (or protocol) and briefly document patient participation with the program. For example, using check-box charting mechanisms to track activities completed and narrative notes for exceptions or changes to the protocol.

“I’ve spent the last three years caring for my parent who had a stroke, providing both personal care and therapy. Can I count these hours?”

When it comes to the scenario where a physiotherapist has taken time off to provide care for a loved one, we’ve now moved beyond what would be accepted as physiotherapy clinical practice. Indeed, the Conflict of Interest Standard of Practice states that physiotherapists are expected to refrain from providing care to a person with whom them have a close personal relationship except in extenuating circumstances.⁵ Furthermore, a physiotherapist providing care to their loved one would certainly be challenged to maintain an appropriate therapeutic relationship and professional boundaries, and avoid having their professional judgment influenced by their personal relationship. These hours would not be considered physiotherapy practice hours because it is unlikely that the physiotherapist will have been providing care consistent with the Standards of Practice.

The College of Physiotherapists of Alberta supports the broad range of physiotherapy practice and physiotherapists’ efforts to assume non-traditional roles. Yet we still must provide the necessary oversight to ensure that our mandate of public protection is met. In the end, when it comes time to add up your practice hours, ask yourself “does my work fit within the scope of physiotherapy practice?” and “does my behavior meet the Standards of Practice, Code of Ethics or other professional obligations for the profession?” If so, we would consider that you are practicing physiotherapy, even if your work is non-traditional.

Page updated: 20/04/2022