UPDATE: June 15
Effective June 14, 2022, at 11:59pm, Alberta moved into Step 3 of its 3-step plan to lift health restrictions put in place to manage the COVID-19 pandemic. This means that all remaining health restrictions were lifted.
- Isolation is recommended but is no longer mandatory for individuals with signs or symptoms of COVID-19 or with a positive test result.
- Masking in Alberta Health Services and contracted health facilities will be in accordance with AHS organizational policies.
What does this mean for physiotherapists?
Point of Care Risk Assessment
Point of care risk assessments remain a mainstay of safe clinical practice. Physiotherapists are advised to continue with this routine practice, conducting a risk assessment prior to every patient interaction.
When conducting an assessment to determine the risk of exposure to blood or body fluids and the PPE required to perform a patient care task, physiotherapists need to consider:
- The task,
- The patient, and
- The environment and context of practice.
Other relevant considerations include the physiotherapist’s own risk tolerance and health status.
Personal protective equipment including masks and eye protection remain appropriate measures to employ to control the risk of COVID-19, when indicated by the point of care risk assessment.
Consistent with Occupational Health and Safety legislation, business owners have a responsibility to implement measures necessary to control workplace hazards, and individuals within the workplace have a responsibility to adhere to the use of these measures. In the absence of requirements from the Government of Alberta, individuals should clarify the organizational policies that apply to their practice which may include the use of personal protective equipment, ongoing self-screening prior to attending work, or other measures deemed necessary by the business owner.
Standards of Practice and Code of Ethical Conduct
After more than two years of operating during a pandemic, physiotherapists are best positioned to assess risks within their practice and implement appropriate IPC measures. Once again, physiotherapists and physiotherapy business owners are transitioning to a period where they have increased autonomy and increased responsibility to monitor risks within their practice settings and implement the measures they deem necessary to control those risks. Point of care risk assessment is and will remain a mainstay of practice as physiotherapists make this transition.
Documents from the College of Physiotherapists of Alberta remain available to provide guidance for individuals and business owners who are uncertain of the actions or policies to consider. However, the change implemented by the Government of Alberta on June 14, 2022, means that none of the measures recommended in these documents are mandatory at this time.
As the College has previously stated, an end to mandatory restrictions does not mean a return to business as it was in 2019. Physiotherapists have been here before and must continue to meet the expectations for safe practice and infection prevention articulated in the Standards of Practice and Code of Ethical Conduct, as they have done throughout the pandemic.
On June 13, Alberta Health announced changes to self isolation rules that took effect June 14, 2022, at 11:59pm, meaning that although recommended, self-isolation is no longer mandatory. Physiotherapists should be aware of this change, and its implications for the clinical practice setting.
Due to the move to Step 3 of the easing of public health measures, physiotherapists working in community settings (e.g., private practice clinics, mobile practice settings), are no longer required to engage in active screening of either patients or staff.
However, physiotherapists routinely work with patients with complex health needs or who are at risk of severe outcomes from COVID-19. Physiotherapists have duties to patients and others within the practice environment established by the Standards of Practice, Code of Ethical Conduct, and Occupational Health and Safety legislation.
As such, physiotherapists are advised to employ point of care risk assessment, screening themselves and their patients for signs and symptoms of COVID-19, and may choose to defer in person services for individuals with signs and symptoms of COVID-19, consistent with infection prevention and control best practices.
Physiotherapists should also be aware of employer policies in place to manage COVID-19 as a workplace hazard.
Point of Care Risk Assessments must remain a mainstay of safe clinical practice
Physiotherapists are advised to complete a Point of Care Risk Assessment prior to every patient interaction, regardless of the practice setting in which they work.
Assess the task, the patient, and the environment to determine the risks posed by each patient interaction and determine the appropriate measures, including PPE, required to perform the patient care task.
Consider the physiotherapist’s own risk tolerance when determining whether to provide in-person physiotherapy services and the personal protective equipment to employ.
Effective June 14, 2022, at 11:59pm, masks are no longer mandatory in any setting.
Masking in AHS and contracted health facilities will shift to organizational policy.
The College of Physiotherapists of Alberta advises physiotherapists to conduct a point of care risk assessment and to implement personal protective equipment appropriate to the risks identified when providing direct patient care. This includes the option to use of a well-fitting medical grade surgical or procedure mask or a well-fitting KN95 mask, depending on the risks identified through the point of care risk assessment.
Physiotherapists are advised to be aware of and follow organizational policies implemented by their employers.
Mask use continues to be an important element in COVID-19 risk management.
Physiotherapists are advised to consider all the measures they can put in place to render services safe for the patient and for other individuals who may be present in the practice setting in accordance with the findings of the point of care risk assessment, including, but not limited to:
- Use of telerehabilitation to deliver services (if appropriate for the patient’s care needs) to eliminate the risks of in-person care.
- Designating times for high-risk patients (e.g., those known to have conditions that put them at additional risk of severe outcomes) or scheduling these patients during a quiet time of day to limit exposure.
- Providing treatment in a private room,
- Employing physical distancing between treatment beds and other equipment,
- Using a fit tested N95 mask OR a seal-checked KN95 respirator (if a fit-tested N95 is not available or the physiotherapist has not been fit-tested)
- Wearing protective eyewear (goggles or face shield) and gown and gloves as appropriate based on the point of care risk assessment
- Physiotherapists may ask patients to wear a mask during physiotherapy treatment and patients will be subject to organizational policies regarding to masking when accessing care.
In instances where a patient declines to wear a mask, if a physiotherapist or physiotherapy business is considering requiring mask use as a condition of service, physiotherapists are reminded of the following:
- Physiotherapists are required to be knowledgeable of and compliant with the legislation relevant to their practice. This includes having knowledge of provincial legislation or mandates and municipal bylaws relevant to their community and practice setting.
- Physiotherapists are expected to promote and maintain a safe environment for clients, health-care providers, themselves, and others.
- Members of the physiotherapy profession have an ethical responsibility to “Act in a respectful manner and do not refuse care or treatment to any client on the prohibited grounds of discrimination as specified in the Canadian Human Rights Act as well as on the grounds of social or health status.”
Declining to provide care is a serious matter. There are conflicting needs, values and rights involved in such a decision, including:
- The patient’s right to access to care and the requirement that access not be denied on the basis of a protected ground or health status, including health conditions that may preclude the use of a mask.
- Patients’ expectations that they will receive safe care, as stated in the Safety Standard of Practice.
- The health and safety of everyone that enters the practice environment.
Physiotherapists and physiotherapy business owners should understand the many implications of refusing to provide care to a patient who declines to wear a mask in the practice setting.
Eye protection is used when high levels of community transmission are occurring, as an added layer of protection when interacting with patients within two meters.
Eye protection is a strategy to reduce the physiotherapist’s individual risk of becoming ill, as such, physiotherapists may consider using eye protection as part of their routine point of care risk assessment and PPE use.
Examples of appropriate eye protection include safety glasses, reusable goggles, face shields or face masks with built-in eye shields. Vision correcting eyeglasses are not classified as eye protection and do not address PPE recommendations.
Some eye protection is single use, while other products are reusable following cleaning and disinfection. Follow manufacturer instructions regarding whether eye protection is reusable and the approved cleaning and disinfecting products for the eye protection in use.
While other PPE may not be required to prevent the spread of COVID-19 when working with asymptomatic patients, physiotherapists should assess the tasks they are planning and continue to employ PPE typically used when performing the interventions planned (e.g., gloves when needling).
PPE Use When Working with Patients with COVID-19
Physiotherapists working with patients known or suspected of having COVID-19 in ICU, acute care, or continuing care environments, are to follow their employer’s directions regarding PPE use with this patient population and for the tasks performed.
Although isolation is no longer legally mandated, it is still recommended that individuals with COVID-19 symptoms or who have tested positive isolate.
The College of Physiotherapists of Alberta’s recommendation is that physiotherapists working in community-based environments conduct a point of care risk assessment and consider their responsibilities as articulated in the Code of Ethical Conduct, Standards of Practice, and Occupational Health and Safety legislation when deciding whether to provide in-person services to individuals with known or suspected COVID-19.
Current PPE recommendations when working with patients with known or suspected COVID-19, including those with respiratory symptoms are:
- A fit tested N95 or a seal-checked KN95 respirator (if a fit-tested N95 is not available or the individual has not been fit-tested)
- Protective eyewear (goggles or face shield)
- Gown and gloves as indicated by the point of care risk assessment
Hand hygiene must be completed consistent with the WHO’s “5 Moments for Hand Hygiene”:
Complete hand hygiene using soap and water, or alcohol-based hand rub (minimum 60% alcohol).
Hands must be washed using soap and water if they are visibly soiled.
Patients must have access to hand hygiene facilities and should be encouraged to complete hand hygiene upon arrival, before and after use of shared equipment (including processing of payment) and prior to departure from the practice.
PCR testing is currently available only for those who have clinical risk factors for severe outcomes and those who live or work in high-risk settings. Rapid antigen tests are available for at-home use.
Individuals who test positive on PCR testing continue to receive notifications. Contact tracers will not notify close contacts of positive cases. Individuals who test positive on PCR testing are asked to notify close contacts when informed of their positive PCR test result.
Individuals who test positive on a rapid antigen test and who are symptomatic are asked to notify close contacts from the previous 48 hours that they should monitor for symptoms and be cautious about going to high-risk settings like continuing care facilities or crowded indoor spaces.
Close contacts of an individual with COVID-19 are not legally required to quarantine, unless otherwise directed to do so by local public health officials.
Individuals with COVID-19 symptoms and confirmed cases are still recommended to isolate.
Physiotherapists are routinely within close contact (less than 2 meters away from) with individuals for longer than 15 minutes (continuously or cumulatively). Throughout the pandemic, physiotherapists have contacted the College of Physiotherapists of Alberta reporting that they have heard directly from patients who have tested positive for COVID-19 and seeking direction as to what actions the physiotherapist needs to take. The following advice applies to physiotherapists who are advised that a patient has tested positive, regardless of the test type (PCR or rapid antigen test).
According to the Alberta Public Health Disease Management Guidelines – Coronavirus, COVID-19, if a physiotherapist was wearing appropriate PPE for the patient’s presentation and practicing rigorous hand hygiene, they are not considered a close contact .
If a physiotherapist has not employed appropriate PPE and rigorous hand hygiene at the time of the interaction and is notified that they are a close contact, they are faced with an ethical conundrum. Although not legally required to quarantine, the physiotherapist must consider their duties to patients, as stated in the Standards of Practice and Code of Ethical Conduct, including the expectations that:
- Promotes and maintains a safe environment for clients, health-care providers, her/himself, and others to support quality services.”
- Adheres to best practices of infection prevention and control in physiotherapy practice according to applicable legislation, regulatory requirements, standards, and guidelines.”
- “Uses routine practices (e.g., hand washing, point-of-care risk assessment, use of personal protective equipment) to minimize or prevent the spread of acquired infections in the health-care setting.”
Physiotherapists who have symptoms of COVID-19 or who have tested positive are no longer legally required to isolate, however, isolation is recommended. Physiotherapists should also be aware of any organizational policies that apply to their practice setting and should consider their obligations to patients and others in the practice setting, established by the Standards of Practice, Code of Ethical Conduct, and Occupational Health and Safety legislation when deciding what to do.
Physiotherapists must adhere to the directions of public health officials if directed to isolate or quarantine for any reason.
Physiotherapists should be aware that according to the Alberta Public Health Disease Management Guidelines – Coronavirus-COVID-19.
“If HCW becomes symptomatic, all the patients who they cared for (or co-workers) in the 48 hours prior to symptom onset in that HCW will NOT be considered close contacts if the HCW wore a well fitting surgical/procedure mask or well-fitting KN95 mask and practiced routine, frequent hand hygiene.”
Throughout the COVID-19 pandemic, physiotherapists have been able to continue to safely offer physiotherapy services through their ongoing compliance with the guidance provided by the College of Physiotherapists of Alberta, public health orders, sector specific private business guidance issued by the Government of Alberta, and AHS operating procedures and measures in use in public health care facilities.
It is the adherence with infection prevention and control measures that offers robust protection against the spread of communicable diseases within physiotherapy practice environments. No one measure alone will be enough to protect patients and staff and prevent a physiotherapy practice site from becoming a source of virus transmission.
The Infection Prevention and Control Visual Guide helps to summarize these measures into a brief checklist that can be used to review day-to-day operations.
Despite widespread vaccine uptake and use of infection prevention and control measures to limit the spread of COVID-19, no measure is perfect, and some risks remain when services are provided in-person. Every close contact that a physiotherapist has with another person is another opportunity for the physiotherapist to become exposed to COVID-19 and to subsequently become a vector for virus spread. In addition, every visit to the practice setting necessitates countless contacts with other members of the public as the patient travels to and from their appointment. The risks posed by in-person services increase when physiotherapists work with patients more likely to experience severe outcomes from COVID-19.
Although risks are mitigated by vaccine uptake and robust infection prevention and control measures, they are not completely eliminated.
Physiotherapists are encouraged to employ a risk-based approach to determining when in-person services are indicated for a given patient and practice setting, and when the risk of in-person service outweighs the foreseeable benefits.
Physiotherapists adopted telerehabilitation rapidly in response to the restrictions on in-person services that were in place in the spring of 2020. Physiotherapists should continue to employ telerehabilitation to the extent practicable to achieve desired patient outcomes and protect patients, themselves and others in the practice environment from exposure to the virus.
Physiotherapists are encouraged to:
- Complete a point of care risk assessment prior to any in-person service delivery.
- Educate patients on the benefits and limitations of telerehabilitation services, including the reduced risk of contracting COVID-19.
- Consider telerehabilitation as the sole means of service delivery when practicable and indicated by the patient’s condition and/or the risk assessment.
- Adopt blended models of service delivery using telerehabilitation visits in addition to in-person care as appropriate, with the aim of achieving the best patient outcomes possible.
- Recognize when physiotherapy assessments or treatments cannot reasonably be delivered via telerehabilitation. This format of service delivery may be appropriate for many patients however, it is unlikely to be appropriate for all patients seeking physiotherapy services.
Telerehabilitation services are subject to the same Standards of Practice as any other physiotherapy service. All members of the College of Physiotherapists of Alberta are authorized to provide telerehabilitation services as part of their existing registration. No special registration is required, provided you are delivering services within Alberta.
If you are delivering services to patients visiting or residing in other jurisdictions, you need to contact the regulatory body in that jurisdiction to find out what rules apply to your practice. This is the case even if you are following your existing patients who have temporarily relocated to another jurisdiction.
Business owners and clinicians alike are advised to take the time to set up their telerehabilitation services in a way that is consistent with the Standards of Practice.
The College of Physiotherapists of Alberta cannot provide direction on telerehabilitation platforms that are or are not acceptable for use by physiotherapists. Physiotherapists are urged to consider the following when reviewing potential platforms:
Platforms often tout their compliance with PIPEDA or HIPPA, and there is some comfort in knowing a platform is compliant with this legislation, but it is not the legislation of note. The relevant privacy legislation for private practice telerehabilitation services delivered within Alberta is PIPA.
Determine if the platform can address privacy requirements established by PIPA.
Is the platform “end-to-end” encrypted during transmission of the information?
Is the information collected and stored through the platform password protected and encrypted?
Read the terms of service of the platform provider and ensure that patient information is securely stored and protected from access by third parties, and that you understand what information the platform collects regarding your use/access to the platform and how that information is used.
Platform providers should not access patient private information and should not share that information with other parties including external organizations and governments.
Platform providers may track data related to business use (e.g., your behaviour when using the platform).
Where is the data stored?
There is no rule that requires data be stored within Canada or within Alberta, however, if data is crossing international borders that needs to be communicated to patients.
What about patient records and video records of telehealth interactions?
Telerehabilitation visits are subject to the same Standard of Practice for Documentation and Record Keeping as other visits. Physiotherapists need to generate a record for each treatment or professional interaction completed. These records can be in paper or electronic format – consistent with the physiotherapy business’ usual practices.
Video recordings of telerehabilitation visits are not mandatory.
However, if the platform used generates a recording, that recording must be retained as part of the patient record. This has implications for ongoing record retention that physiotherapists and employers need to consider.
It is likely that physiotherapy businesses will be offered service contracts from platform providers on a “take it or leave it” basis but that’s not an excuse to use a platform that is not secure. Patient health information is a regular target for cyber attacks. With the significant influx of health information available online as a result of the pandemic, clinicians and business owners are advised to use caution to ensure that private information remains private.
Some parties have suggested that the adoption of platforms that are not secure may be justified due to the extraordinary circumstances of the pandemic. The College of Physiotherapists of Alberta does not share that perspective.
The adoption of telerehabilitation services may enable physiotherapists to work from home. Employers are encouraged to consider the privacy issues that can arise when staff work from home using their own computers, tablets or phones to connect with patients or to complete record keeping duties. The Office of the Information and Privacy Commissioner has an excellent resource on the security risks related to allowing employees to use their own devices for work purposes. Employers should also consider the risks involved in having employees store patient records in paper format within the home environment, and strategies to adopt to mitigate those risks.
Employers are encouraged to conduct a privacy threat assessment and employ policies and procedures to ensure the ongoing privacy of information that employees store within their homes or access from their own devices. This includes both the telerehabilitation visits and any recordings generated from them, and the patient records generated following a telerehabilitation visit.
Fees and billing
As with all physiotherapy fees, members are advised to set fees in accordance with their business model, the costs of providing service, and market forces. Fees must be transparently communicated and justifiable.
The College of Physiotherapists of Alberta’s Telerehabilitation Guide provides additional information regarding telerehabilitation service delivery.
Although Alberta has now moved to step 3 of easing public health measures, practice has fundamentally changed due to the pandemic and many changes are expected to continue for the long-term.
The easing of restrictions on June 14 does not mean a return to business as it was in 2019.
Some measures mandated to enable clinical practice during the pandemic are clinical best practices for infection prevention and control and were always expected of physiotherapists. Other measures are advisable given the current context.
Physiotherapists have become adept at implementing infection prevention and control measures over the past 2 years. As they enter this new phase, they have increased autonomy to identify the measures needed to deliver safe physiotherapy services within their practice context.
Point of care risk assessment, cleaning and disinfecting high touch surfaces and equipment between patients, and routine, effective hand hygiene are mainstays of practice.
Other ongoing IPC measures will need to be tailored to the practice setting, population served, and services offered. Physiotherapists will need to consider their responsibilities and obligations established in the Standards of Practice, Code of Ethical Conduct and Occupational Health and Safety legislation when determining which measures to keep and which to discontinue.
On June 22, 2022, Minister Copping and CMOH Dr. Hinshaw announced that effective June 30, 2022, CMOH Orders pertaining to continuing care will be rescinded.
When making this announcement, Minister Copping noted that individuals residing in continuing care settings remain among the most vulnerable and highlighted that although the CMOH Orders pertaining to continuing care will be rescinded on June 30, 2022, protective policies will remain in place through operating standards to safeguard residents.
This includes the continuation of mask use, in accordance with operational policies.
Physiotherapists working in continuing care settings need be aware of and comply with operating policies relevant to the sector and practice setting.
Point of care risk assessment, cleaning and disinfecting high touch surfaces and equipment between patients, and routine, effective hand hygiene are mainstays of practice. Physiotherapists must also implement other measures indicated by the point of care risk assessment to render their services safe.
Physiotherapists working in this sector may also need to provide services to individuals with suspected, presumed or confirmed COVID-19. When doing so, they must adhere to employer guidance regarding PPE use and current PPE recommendations for working with COVID-19 patients.
Mobile health services in continuing care environments are also permitted, provided the physiotherapist adheres to workplace and sector specific requirements, operating policies, and the regulatory requirements established by the College of Physiotherapists of Alberta. Physiotherapists will need to work with continuing care operators to address questions regarding access to the site and the ability to provide in-person services. Where possible and appropriate, telerehabilitation services should be considered.
Private providers delivering mobile services in continuing care settings may pose a risk to residents if they provide care at multiple sites on the same day. As such, they are encouraged to conduct point of care risk assessments and consider the measures they can put in place to control the risk of becoming a source of transmission between facilities.
Physiotherapists working for Alberta Health Services and Covenant Health in home care environments are subject to the operational procedures their employers have in place and will be directed by infection prevention and control experts on staff.
Mobile and home-based businesses providing physiotherapy services can continue to operate, employing point of care risk assessment to determine infection prevention and control measures necessary to enable safe practice and following the recommendations and guidance established for physiotherapy community services (private practice).
The provision of mobile health services in continuing care environments is subject to workplace and sector specific requirements, operating policies, and the regulatory requirements established by the College of Physiotherapists of Alberta.
Physiotherapists offering private mobile services in continuing care environments will need to work with continuing care operators to address questions regarding access to the site and the ability to provide in-person services. Where possible and appropriate, telerehabilitation services should be considered.
Private providers delivering mobile services in continuing care settings may pose a risk to residents if they provide care at multiple sites on the same day. As such, they are encouraged to conduct point of care risk assessments and consider the measures they can put in place to control the risk of becoming a source of transmission between facilities.
Physiotherapists working in schools and early learning centres are reminded that the principles related to limiting the spread of COVID-19 are unchanged as is the duty to implement measures to limit the spread of COVID-19.
Like other regulated members of the College of Physiotherapists of Alberta, physiotherapists providing in-person services in schools and early learning centres are required to deliver services in accordance with the expectations identified in the Standards of Practice and Code of Ethical Conduct, and in a manner consistent with point of care risk assessments.
Over the past two years, most of the direction provided by the College of Physiotherapists of Alberta has been directed to regulated members employed in the private sector, such as private clinics and other physiotherapy businesses. This is because physiotherapists in the private sector have limited access to infection prevention and control experts to direct their practice.
Physiotherapists working for Alberta Health Services and Covenant Health are subject to the operational procedures their employers have in place and will be directed by infection prevention and control experts on staff.
Personal protective equipment use in AHS/Covenant settings is based on the point of care risk assessment conducted by the physiotherapist and the organization’s guidance re: PPE use when working with patients with known or suspected COVID-19, in accordance with the interventions planned and the risks inherent with those interventions. When questions or conflicts arise regarding the appropriate PPE to use for a specific intervention within this practice setting, physiotherapists are directed to discuss their concerns or questions with infection prevention and control experts on staff.
Similarly, operational decisions and actions to limit the spread of COVID-19 between patients within the acute care environment, such as limiting staff movement between units and scheduling patients in a manner that limits the risk of virus transmission, are best made at the facility level. Questions regarding operational matters should be directed to facility and AHS leadership.
The College of Physiotherapists of Alberta is aware that some programs and services have experienced significant operational disruptions and that some physiotherapists have experienced redeployment over the course of the pandemic. Registered physiotherapists have a professional obligation to decline work they are not competent to perform; however, they also have a professional responsibility to consider the public interest and undertake all reasonable steps to become competent before making a conscientious decision to decline the task, when faced with redeployment.
Although nasopharyngeal swabbing is not part of a physiotherapist’s typical range of practice activities, during early waves of the pandemic, physiotherapists’ performance of this activity was motivated by the exceptional need for competent practitioners to undertake this activity.
Performing a nasopharyngeal swab is a restricted activity in accordance with the Government Organization Act and is therefore regulated under the Health Professions Act and the Physical Therapy Profession Regulations.
As per Schedule 7.1 of the Government Organization Act, it is a restricted activity to "insert or remove instruments, devices, fingers or hands
(ii) beyond the point in the nasal passages where they normally narrow,
(iii) beyond the pharynx
According to Section 13 of the Physical Therapists Profession Regulation any regulated member of the College of Physiotherapists of Alberta is authorized to perform the activity provided they are competent to do so. Regulated members who are on the Provisional Register must be directly supervised by a regulated member on the General Register when they perform the activity.
Advice to employers
Employers should be aware that nasopharyngeal swabbing is not an activity that is taught in entry to practice physiotherapy education. Physiotherapists must only perform those activities that they are competent in. As such, a physiotherapist would require additional training and assessment of their competence to perform a nasopharyngeal swab before being deployed to do so.
As highly educated and conscientious health professionals, physiotherapists are likely well suited to undertake this activity once sufficiently trained.
Advice to physiotherapists
Although performing a nasopharyngeal swab is a new activity for most physiotherapists, during the pandemic, all health professionals have been called upon to serve the greater good and to contribute, as they are able to the pandemic response.
Registered physiotherapists have a professional obligation to decline work they are not competent to perform; however, they also have a professional responsibility to consider the public interest and undertake all reasonable steps to become competent before making a conscientious decision to decline the task.
Duly trained physiotherapists can also fulfill the role of contact tracer, leveraging their communication, patient management and critical thinking skills to do so.
Although these roles differ from more “traditional” physiotherapy, they fit within the definition of what constitutes physiotherapy as they draw upon several of the Essential Competencies of Physiotherapists.
For those seeking work, the College of Physiotherapists of Alberta encourages you to consider these work opportunities.
Acute and continuing care facilities have faced staffing and workload challenges throughout successive waves of the pandemic. Meanwhile, patients still require basic care. Basic care activities are not typically performed by physiotherapists however employers may reassign physiotherapists to other duties to ensure patients’ basic needs are met.
Registered physiotherapists have a professional obligation to decline work they are not competent to perform; however, they also have a professional responsibility to use the skills they possess for the betterment of society and the benefit of those they serve. During a public health crisis, physiotherapists can be redeployed to assist with basic care activities and can apply their patient handling skills to do so. When doing so, appropriate precautions and facility protocols must be followed.
Health-care professionals, including physiotherapists, who deliver in-person, direct patient care became eligible to begin booking their first COVID vaccinations on Monday, April 12, 2021, became eligible to receive second doses beginning in June 2021, and are currently eligible to receive a booster (3rd dose) 5 months after their second dose.
Seniors and individuals who are immunocompromised are currently eligible to receive a fourth dose of a COVID vaccine 5 months after receiving their third dose.
Vaccinating health professionals protects groups who are at high risk of experiencing severe outcomes from COVID-19, individuals who are severely immunocompromised or unable to receive a vaccine, and those Albertans who regularly come into contact with them. Physiotherapists eligible to access vaccination do so to reduce the risk of transmitting COVID-19 to vulnerable populations through the provision of in-person, direct care.
Employer-led Immunization Requirements for Employees
The College of Physiotherapists of Alberta reminds physiotherapists that employers may set expectations and employment requirements over and above the requirements and Standards established by the College. Physiotherapists with questions regarding employer-led immunization requirements must direct their questions to their employer.
The Code of Ethical Conduct includes the expectation that physiotherapists
Act in a respectful manner and do not refuse care or treatment to any client on the prohibited grounds of discrimination as specified in the Canadian Human Rights Act* as well as on the grounds of social or health status.
Vaccine/immunization status is categorized as a “health status” therefore it is inconsistent with the expectations outlined in the Code of Ethical Conduct for physiotherapists to limit access to their practice locations on the basis of an individual’s vaccine/immunization status.
Employers who are considering instituting immunization requirements for patients as a condition of service are reminded that declining to provide care is a serious matter. There are conflicting needs, values, and rights involved in such a decision. Physiotherapists and physiotherapy business owners should understand the many implications of refusing to provide care to a patient who declines to adhere to such requirements.
Additional vaccine information
Individuals with questions regarding the COVID-19 vaccines approved for use in Alberta are directed to the websites of the following organizations:
The College of Physiotherapists of Alberta strongly encourages all physiotherapists to be immunized. We remain grateful to all front-line health-care workers for their efforts during the pandemic, and to all those involved in the vaccine roll-out.
The College of Physiotherapists of Alberta supports vaccination as “one of the world's greatest public health achievements.”1 Vaccination saves lives and reduces the chances of debilitating long-term illness, including COVID-19. “For over 50 years, vaccines have helped prevent and control the spread of deadly diseases and saved the lives of millions of infants, children and adults.”1 Vaccines are rigorously researched and tested, and are evaluated for their safety, efficacy, and quality prior to being authorized for use by Health Canada.
Vaccination protects the health and wellbeing of physiotherapists and other health-care workers who are vital to the health system. Within the context of COVID-19, public health experts indicate that widespread vaccination is critical to bringing an end to the pandemic. Public health experts also indicate that vaccination is very likely to decrease the risk of a physiotherapist transmitting COVID-19 to their families and the patients they serve. Research is underway to determine the extent to which that risk is reduced.
The College of Physiotherapists of Alberta strongly encourages all physiotherapists to be vaccinated with the COVID-19 vaccination, and against all other communicable diseases, when they are eligible.
Vaccination of physiotherapists
The College of Physiotherapists of Alberta also believes that vaccines must be provided based on available data regarding the groups most vulnerable to contracting the virus, developing severe illness, or experiencing adverse outcomes from COVID-19. We are grateful to the health ethicists and policy makers who have the difficult task of analyzing this data and developing just and equitable vaccine eligibility frameworks and criteria.
Patients and the COVID-19 vaccine
Although providing guidance or direction to patients regarding medications is not within the scope of practice for physiotherapists, as trusted health professionals physiotherapists can play a role in supporting public health initiatives such as mass immunization programs. Physiotherapists can do so through role modelling and by amplifying credible messages and information regarding vaccine development, efficacy and safety to their peers and patients.
Physiotherapists are encouraged to inform themselves about the vaccines approved for use in Canada, the process of their approval, and the risk profiles of the vaccines, seeking information from credible sources.
Physiotherapists are directed to Health Canada’s website for additional information about the vaccine approval process, and steps taken by Health Canada to “expedite the regulatory review of COVID-19 health products without compromising safety, efficacy and quality standards.”2
Alberta Health has provided a list of frequently asked questions and their answers, for use by regulated health professionals when speaking with their patients.
Finally, the 19 To Zero coalition of academics, public health experts, behavioural economists, and creative professionals has created a website with resources to support health professionals in their efforts to talk to people about vaccines and provides ideas for how to have informed conversations with people who are vaccine hesitant or COVID skeptical.
Government of Canada. Regulating Vaccines for Human Use in Canada. Available at: https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/activities/fact-sheets/regulation-vaccines-human-canada.html Accessed February 1, 2021.
Government of Canada. Drugs and Vaccines for COVID-19. Available at: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/about.html Accessed February 1, 2021.