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What Patients Need to Know about Restricted Activities

What exactly is a restricted activity?

In Alberta, health professionals such as physiotherapists, doctors, nurses, among many others, are regulated under the Health Professions Act and other pieces of legislation designed to ensure the quality and safety of health services provided to Albertans. Included in some of this legislation is a list of activities designated as restricted activities. Restricted activities are things that should only be performed by authorized individuals, as there are risks these activities pose if performed incorrectly or on the wrong person.

Think about someone working at the hardware store prescribing medication or performing surgery behind the tool counter. There is a reason why the government steps in to provide rules and laws to protect the public.

What is a restricted activity for physiotherapists?

Physiotherapists are regulated by the College of Physiotherapists of Alberta. Physiotherapists aren’t authorized by legislation to prescribe medication or perform surgery; however, there are a few things physiotherapists can do that fall under the title of restricted activities.

We can break this down into two groups of activities. First, there are restricted activities that are authorized to all physiotherapists in Alberta. These are either taught in accredited university physiotherapy education or in clinical training. The physiotherapist MUST be competent in the performance of the activity and is expected to determine when the activity is appropriate for a given patient and scenario. These are all activities that require the development and ongoing practice of a skill. They are restricted under existing legislation because they pose risks if done improperly. If a physiotherapist does not have the knowledge and skills to know when and how to perform the activity, or if they don’t work in settings or with patients where the use of the skill is appropriate, the physiotherapist has a professional responsibility to not engage in the activity.

The second group requires further proof of competence and formal, individualized authorization. The College of Physiotherapists of Alberta fulfills our mandate of public protection by ensuring that only those with appropriate evidence of competence development become authorized to perform these activities. Each activity requires further education (outside of a physiotherapy degree) and a formal submission of evidence that the physiotherapist has achieved competence before they are authorized.

Restricted activities authorized to all physiotherapists include:
  • Reducing a dislocation of a joint: Dislocations of shoulders are probably the most common one people think of but other joints like kneecaps or fingers can dislocate as well. We all have that one friend who pops their shoulder out every month at hockey and puts it back in themselves but usually joints don’t slide back in that easily and there can be risks to relocating a joint as well. Physiotherapists who are trained and competent may be able to relocate a dislocated joint and often work in sport environments where this can occur.
  • Suctioning or instillation: Suctioning is often performed when a person has an artificial airway in place. People who are unable to clear out their airway on their own can develop secretions that need to be removed by suctioning them out. Suctioning can cause breathing symptoms to worsen, changes to the heart rate or blood pressure, or physical damage to the airway. Suctioning may be performed by competent and duly trained physiotherapists, often in hospitals or health facilities, and occasionally in community settings.
  • Inserting and removing catheters: Catheters are thin flexible tubes that are inserted into the urethra and up to the bladder to assist the flow of urine. Due to risk of infections and discomfort for the person being catheterized this is a restricted activity. Physiotherapists who are duly trained and competent can perform this activity when it is appropriate for the person’s health needs.
  • Wound debridement and care: People can develop chronic or complex wounds due to diabetes, a serious burn, frostbite or for other reasons. When this happens, the wound may require debridement and care. A duly trained and competent physiotherapist can assist with removal of dead tissue to help the wound heal better and faster. As they clean and remove tissue there are risks with causing bleeding, pain, infections, or delays in the healing process.
Restricted activities that require further authorization:
  • Ordering diagnostic imaging: Ordering x-rays, diagnostic ultrasounds and MRIs are all within the capacity of physiotherapists. Recently, the government has opted not to use public funds to cover imaging ordered by qualified physiotherapists, but physiotherapists can still be authorized to order diagnostic images through private imaging clinics by completing additional training and fulfilling other requirements.
  • Performing spinal manipulation: Yes, physiotherapists who have gone through the appropriate training can “crack” your back. There is risk associated with spinal manipulation and the potential to worsen a person’s symptoms, so this is a skill set for which the College of Physiotherapists of Alberta requires proof that the physiotherapist has completed additional training and fulfilled other requirements before the physiotherapist can become authorized.
  • Internal exams during pelvic health visits: The act of inserting devices or fingers beyond the anal verge or labia majora poses a risk of infection or skin irritation as well as potential pain or discomfort. There are also risks related to the sensitive nature of the treatment, especially for people who may have suffered sexual trauma in the past. That is why the physiotherapist is required to demonstrate that they have completed additional training in the performance of the activity and fulfilled other requirements before they can be authorized.
  • Using needles in practice: Acupuncture, IMS, dry needling, etc. are all treatment interventions that can be provided by authorized physiotherapists. Similar to spinal manipulation, physiotherapists authorized to perform dry needling must have successfully completed additional training and fulfilled other requirements before becoming authorized.

The College of Physiotherapists of Alberta recently published an article that went into much greater detail on dry needling that you can read for more information.

What is my role in all of this?

It’s important to remember that each physiotherapist must evaluate each patient to determine if a restricted activity is appropriate for that patient and their health needs and goals. The physiotherapist must also take into consideration the potential side effects or negative outcomes that may result from the performance of the restricted activity. A person’s medical history among other things would help dictate the appropriateness of a restricted activity. The physiotherapist must also evaluate whether they are the right person to provide the treatment and whether they have developed the specific skills required by that specific patient.

When it comes to restricted activities it is important to remember:

  1. Share your past medical history. There may be items in there that might help your physiotherapist decide if you are a good candidate to receive a restricted activity.
  2. It’s ok to ask questions of your physiotherapist. You should feel comfortable with what is happening. Having a thorough explanation of the treatment or assessment is important. You should feel that you are able to ask questions and get clarification of what’s involved. Knowing why the physiotherapist is suggesting a treatment goes a long way to putting you at ease as to why its recommended. You can inquire as to other potential options that don’t involve the restricted activity if you are hesitant or you don’t feel it will be beneficial to you.
  3. Informed consent is important. Click here to read more about consent. The main points with consent are that it should be informed, ongoing, and you can withdraw consent at anytime (meaning you can say “no” to any treatment your physiotherapist suggests, including restricted activities).

You may have seen the new advertisements coming from the Health Quality Council of Alberta encouraging patients to become advocates for their own health. The campaign is attempting to get patients to voice their questions and concerns, become more engaged in their health, and think of themselves as part of the health-care team. There is a wide range of videos, tips, and resources designed to get patients to advocate on their own behalf or on behalf of a loved one. You can click here to read more.

How do I know if a physiotherapist can perform these activities?

If you are considering receiving one of these treatments from a physiotherapist, we suggest you check that they are authorized first. The role of the College is to regulate the profession and ensure the public is being protected. For a physiotherapist to perform dry needling, spinal manipulation, internal pelvic exams, or order diagnostic imaging they MUST gain authorization from the College. You can use Verify a Physiotherapist to check whether or not they have been authorized or if they have any conditions on their practice permit or conduct findings on their record.

What about the other people involved in my care?

Each profession has their own scope of practice and set of restricted activities and there is some overlap. You may have a nurse or occupational therapist providing wound care, for example, or see a chiropractor for spinal manipulation. The College of Physiotherapists of Alberta only physiotherapists.

You might at times be wondering why your physiotherapist has someone else with them while they are providing care to you or a loved one. This can happen for a few reasons but mostly it is for training purposes and/or to ensure safe quality care is being provided.

For example, physiotherapy interns (regulated members who are in the process of completing their final entry to practice requirements) are capable of performing any of the basic restricted activities as long as the intern is deemed competent by their supervisor. Interns are unable to perform any of the authorized restricted activities except pelvic health exams. While performing any restricted activity, interns MUST have DIRECT supervision by a registered physiotherapist competent in that activity. It is important to remember that you should be notified of who is in the room with your physiotherapist and the reasons as to why they are there.

Page updated: 09/06/2022