Physiotherapists working in community settings (e.g., private practice clinics, mobile practice settings), are required to engage in active screening of both patients and staff. Screening questions relate to signs and symptoms of infection, recent close contact with someone who has tested positive for COVID-19, and direction from a representative of Alberta Health Services or Canada Border Services to self-isolate or quarantine.
Individuals with even mild symptoms must not be in the practice setting, regardless of their vaccine status. As such, physiotherapists are advised to continue with screening of patients and others within the practice environment.
Patient screening is to occur at the time of booking the patient’s appointment and upon the patient’s arrival at the practice site (or the physiotherapist’s arrival in the case of a mobile practice).
Physiotherapists must engage in daily self screening and must isolate if sick with core symptoms of Covid-19 or are a confirmed case of COVID-19, in accordance with provincial requirements. Physiotherapists should not attend work if you have been instructed to quarantine by Canada Border Services or public health officials.
Physiotherapists should also be aware of any employer policies in place manage COVID-19 as a workplace hazard.
In recent months Alberta Health has announced changes to quarantine and self isolation rules. Physiotherapists should be aware of these changes, and their implications for the clinical practice setting. Physiotherapists are advised to ask the following questions of individuals at the time of booking and when they arrive for their appointments:
Have you been directed by Alberta Health Services to self-isolate? Have you been directed by Canada Border Services to quarantine?
Individuals answering yes to either question are not permitted in the practice setting.
Have you had recent, close contact with an individual who is required to self-isolate due to COVID-19?
The suspension of mandatory quarantine for close contacts of individuals who have tested positive for COVID-19 adds complexity to the screening process. However, although mandatory quarantine for close contacts of people diagnosed with COVID-19 has been discontinued, individuals who are not fully immunized and who have been exposed to COVID-19 have been advised by Alberta health to avoid high-risk locations and crowded indoor spaces.
Physiotherapists routinely work with patients with complex health needs or who are at risk of severe outcomes from COVID-19 and may not know a patient’s immunization status. As such, the College of Physiotherapists of Alberta recommends that patients who are close contacts of a case of COVID-19 be rebooked at a later date or offered telerehabilitation appointments rather than in-person services during the 10 days post-contact.
Physiotherapists are advised not to ask patients about their immunization status for the following reasons:
Privacy legislation includes the stipulation that health professionals only collect personal information “for purposes that are reasonable” and “only to the extent that is reasonable for meeting the purposes for which the information is collected.” (PIPA, Section 11) Immunization status is not information that would typically be collected by a physiotherapist and would not be needed in order to provide physiotherapy interventions.
There is also a risk that knowledge of immunization status may create a false sense of security for providers, leading them to decrease their vigilance in the use of PPE and infection prevention and control measures. Physiotherapists are reminded that current COVID-19 vaccinations are effective at preventing severe illness and death, but this does not mean that vaccinated individuals cannot become ill with or transmit COVID-19 to others.
While physiotherapists are advised not to ask patients about their immunization status, they are not prevented from documenting and using this information to inform the point of care risk assessment should a patient volunteer their immunization status.
Point of Care Risk Assessments must remain a mainstay of safe clinical practice
Complete a Point of Care Risk Assessment prior to every patient interaction, regardless of the practice setting in which you work.
Assess the task, the patient, and the environment to determine the risk of exposure to blood or body fluids and the 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 March 1, 2022, masks are no longer mandatory except in AHS operated and contracted facilities and continuing care settings.
The College of Physiotherapists of Alberta strongly recommends that physiotherapists continue to engage in continuous masking when in the workplace and providing direct patient care.
Ultimately, whether a person is required to isolate or not after a close contact and whether they can attend work depends on whether they develop symptoms, their vaccine status, and employer policies. However, mask use continues to be an important element in COVID-19 risk management and in discussions regarding close contacts.
The Alberta Public Health Disease Management Guidelines: Coronavirus – COVID-19 were updated on February 23, 2022. Changes are indicated in bold.
According to the Guidelines, a health-care worker is not considered a close contact IF
- When treating patients who are asymptomatic and are not presumed, suspected or confirmed to have COVID-19, the physiotherapist was continuously wearing a well-fitting medical grade surgical or procedure mask or a well-fitting KN95 facemask, at all times, and in all areas of the workplace when providing direct patient care.
- When providing direct patient care to individuals with presumed, suspected or confirmed to have COVID-19, the physiotherapist was continuously masking using a well-fitted KN95 or N95 facemask, plus eye protection, gown and gloves.
According to the CMOH, individuals with symptoms consistent with COVID-19 should be presumed to have COVID-19.
Patient Use of Masks
Patients are required to wear masks when accessing health services in acute care and continuing care settings and should expect that they may be asked to wear a mask when accessing community-based health services.
Physiotherapists may ask patients to wear a mask during physiotherapy treatment. In instances where a patient declines to wear a mask, and the physiotherapist or physiotherapy business is considering requiring mask use as a condition of service, physiotherapists are reminded of the following:
- According to the Legislative Responsibilities Standard of Practice, 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.
- At the same time, the Code of Ethical Conduct states that 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.
- The physiotherapist’s duty to comply with legislation relevant to their practice.
- 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.
Providing In-Person Services to Unmasked Patients
If the physiotherapist opts to provide in-person services to an individual who declines to wear a mask, the physiotherapist must consider all the measures they can put in place to render the service safe for the patient and for other patients who may be present in the practice setting, 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.
- Scheduling the patient during a quiet time of day to limit exposure to patients and others in the practice environment.
- Designating times for high-risk patients (e.g., those known to have conditions that put them at additional risk of severe outcomes) and not booking the patient in question during these times.
- Enhancing other safety measures in use in the clinic before, during, and after the patient in question attends (e.g., increasing ventilation, treatment in a private room). Enhanced safety measures include use of:
- A fit tested N95 mask
- 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 appropriate based on the point of care risk assessment
Alberta Health recommends the use of eye protection as an additional layer of protection for all patient interactions within two metres, in areas where there are ongoing high levels of community transmission. Eye protection is a strategy to reduce the physiotherapist’s individual risk of becoming ill, as such, physiotherapists are advised to follow the recommendations of Alberta Health and implement eye protection as part of their routine point of care risk assessment and PPE use.
Eye protection is intended to protect the health care provider from potential COVID exposures arising from interactions with patients who had symptoms that were not recognized to be COVID-19 at the time of their appointment (e.g., due to patient confusion).
However, Alberta Health continues to indicate that continuous masking (with a well-fitting medical grade, surgical, procedure, or KN95 mask) and proper hand hygiene is considered to offer sufficient protection for HCWs who have cared for patients with presymptomatic/asymptomatic COVID-19 infection.
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.
For physiotherapists working with patients who are not symptomatic, eye protection may be worn continuously and changed when a mask is changed, or when the eye protection becomes wet or soiled.
Physiotherapists working with patients with known or presumed COVID-19 must follow the directions of Infection Prevention and Control officials regarding PPE use and when PPE must be changed or discarded.
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.
Current PPE recommendations when working with patients with known or suspected COVID-19, including those with respiratory symptoms are:
The College of Physiotherapists of Alberta’s direction to individuals working in private practice community settings is that they continue to defer in-person services for individuals with known or suspected COVID-19 until the patient’s symptoms have resolved and the patient has completed the mandatory isolation period. The above recommendations do not change this direction to private practice community sector providers.
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.
Changes to COVID-19 testing availability has affected contact tracing. 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 but access to these tests is variable.
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 all 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 directed to do so by local public health officials.
Individuals with COVID-19 symptoms and confirmed cases are still required to isolate.
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).
Physiotherapists are routinely within close contact (less than 2 meters away from) with individuals for longer than 15 minutes (continuously or cumulatively). However, Alberta Health has confirmed that if a health professional was:
And the patient:
The health professional is not considered a close contact of a patient who develops symptoms of COVID-19 within 48 hours of their appointment and goes on to test positive for the virus.
Alberta Health has stated that a well-fitting surgical/procedure mask or a well-fitting KN95 facemask and good hand hygiene is not sufficient PPE if a healthcare worker is in close contact with a symptomatic patient.
If a physiotherapist has been exposed to a patient who was found to have been symptomatic at the time of their appointment/treatment and the patient later tests positive for COVID-19, the physiotherapist is no longer legally required to quarantine.
However, the Government of Alberta has stated that individuals who are not fully immunized are recommended to “avoid high-risk locations such as continuing care facilities and crowded indoor spaces. If you develop symptoms, you must isolate and should get tested.”
Given that physiotherapists often work in high-risk locations, are generally unable to maintain physical distancing while providing direct, in-person services and routinely encounter individuals at risk of severe outcomes from COVID-19, the College of Physiotherapists of Alberta reminds physiotherapists of their duties as described in the Code of Ethical Conduct and the expectations outlined in the Standards of Practice, including the expectations that
- “Clients can expect to be safe in the care of the physiotherapist and in the practice environment.”
- “The physiotherapist:
- 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.”
If a physiotherapist is contacted by an Alberta Health Contact Tracer or Zone Medical Officer of Health and advised that they need to quarantine, the physiotherapist will need to discuss the particulars of the patient interaction, PPE and other measures in use during that interaction, and the physiotherapist’s vaccine status with the public health official. Physiotherapists are to follow the directions of public health officials.
** If a physiotherapist is advised that they are a close contact of a person who has tested positive for COVID-19, and that close contact occurred outside of clinical practice and when PPE was not in use, the physiotherapist must continue with routine screening and monitoring for signs or symptoms of COVID-19. The physiotherapist should have a high index of suspicion if they develop even mild signs or symptoms of COVID-19.
Physiotherapists who have even mild symptoms or who have been directed by Canada Border Services to quarantine, must not be present in the practice setting as per isolation orders. Physiotherapists should also be aware of any employer policies regarding attending work if they have been advised that they are a close contact of a person who has tested positive for COVID-19.
Physiotherapists must adhere to the directions of public health officials or Canada Border Services officials if they are directed to self-isolate or quarantine.
Questions regarding the ability to return to work should be directed to public health officials.
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.”
As such, if a physiotherapist has adhered to the guidance provided by the College of Physiotherapists of Alberta and goes on to develop COVID-19 their patients would not be considered close contacts for the purpose of contact tracing.
If a physiotherapist tests positive for COVID-19, they may be identified as a priority for follow up by AHS Contact Tracers. If contacted, the physiotherapist will need to highlight the PPE and other measures in use at the time of patient contact and must comply with directions provided by the Contact Tracer. The physiotherapist will need to seek additional information regarding their specific case if they are provided with information that differs from the above.
Throughout the COVID-19 pandemic, physiotherapists have been able to continue to safely offer physiotherapy services through their ongoing compliance with the Guidance for Resuming Physiotherapy Practice During a Pandemic, 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 all 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 and ensure that the measures put in place when in-person services were first allowed to resume are still being rigorously followed today.
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.
Effective July 1st, 2021, all public health restrictions pertaining to private physiotherapy clinics were lifted. However, practice has fundamentally changed due to the pandemic and many changes are expected to continue for the long-term. 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.
The College of Physiotherapists of Alberta recommends that physiotherapists “stay the course” with measures that have been in use for the duration of the pandemic:
- Provide services by appointment only.
- Follow the guidance in place from the College of Physiotherapists of Alberta related to provision of services during a pandemic.
- Ensure expectations for the quality and safety of services provided by physiotherapist support workers are met and that supervisees adhere to the expectations outlined in the College’s guidance documents.
- If providing group exercise interventions (e.g., GLA:D programs, falls and balance classes, or Parkinson’s group classes):
- Complete a risk assessment for the activity, identifying appropriate measures to mitigate the risks.
- Consider the risk profile of individual participants and ensure that individual risk analysis supports the participants’ safe return to the exercise group.
- Only provide group classes that are appointment-based and scheduled.
- Screen attendees at the time of booking and upon arrival.
- Employ measures such as continuous masking and routine, vigorous hand hygiene, as with all other in-person physiotherapy services.
- Maintain 3-meter physical distancing between all participants
- Limit class sizes to the number of participants that will fit within the space while maintaining 3-meter distancing between participants at all times.
- Do not share equipment between participants.
- Avoid instructor close contact with and movement between participants.
- Do not mix class cohorts.
- Limit participant socializing before and after class.
Providers who are unable to meet these expectations and mitigate relevant risks of providing group exercise-based interventions are encouraged to continue providing these interventions on a one-on-one basis.
Public health experts have clearly identified that COVID-19 poses a serious threat to people residing in communal living settings. Seniors and especially those with comorbidities, the very seniors who are commonly residents of long-term care and continuing care facilities, are at greater risk of severe disease and death from COVID-19.
However, many, if not most residents of these settings have now received at least two, if not three doses of a COVID-19 vaccine, and most are eligible for fourth doses. The Government has eased restrictions in place in long-term care and continuing care facilities in the province, provided the facility is not part of an outbreak.
Group activities are currently permitted in continuing care environments for residents who are not isolated or quarantined due to COVID-19, provided the facility operator has public health measures in place to mitigate relevant risks and has not been directed by a local Medical Officer of Health to take other action (e.g., due to a site outbreak).
Physiotherapists working in long-term or continuing care environments are directed to conduct a point of care risk assessment related to the group interventions they provide, and to implement appropriate measures to mitigate the risks identified (e.g., physical distancing of participants, limiting class sizes based on physical space available). Physiotherapists working in this sector may 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 to residents who are not symptomatic, isolated, or quarantined, are also permitted, provided the physiotherapist adheres to workplace and sector specific requirements, public health orders applicable to the setting, 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 that are arranged by the patient or family. Where possible and appropriate, telerehabilitation services should be considered.
Private providers delivering mobile services in continuing care settings may pose more risk to residents if they provide care at multiple sites, serving as a potential source of transmission between facilities. They are therefore encouraged to avoid movement between sites on the same day, where feasible.
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.
The College of Physiotherapists of Alberta is aware that many physiotherapists provide private mobile practice services. These health services may be provided as long as public health orders and sector guidance is followed. Appointments should be limited to one-on-one services.
Mobile and home-based businesses providing physiotherapy services can continue to operate, following the recommendations and guidance established for physiotherapy community services (private practice).
The provision of mobile health services in continuing care environments to residents who are not symptomatic, isolated, or quarantined, is subject to workplace and sector specific requirements, public health orders 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 that are arranged by the patient or family. Where possible and appropriate, telerehabilitation services should be considered.
Private providers delivering mobile services may pose more risk to residents if they provide care at multiple sites, serving as a potential source of transmission between facilities. They are therefore encouraged to avoid movement between sites on the same day, where feasible.
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.
Physiotherapists working in the school sector are encouraged to employ telerehabilitation, if appropriate for their patient’s condition.
Physiotherapists providing in-person services are:
- Required to adhere to the same measures to prevent the spread of COVID-19 as other regulated members of the College of Physiotherapists of Alberta, as identified in the Guidance for Resuming Physiotherapy Practice During a Pandemic. This includes the continuous use of medical grade masks, physical distancing, rigorous hand hygiene using soap and water or alcohol-based hand rub and point of care risk assessment.
- Advised to provide interventions to their patients on a one-on-one basis when practicable.
- Advised to complete a point of care risk assessment to determine the appropriateness of concurrent treatment with a subset of students from the same classroom cohort.
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 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.