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Feedback Requested: Draft Standards of Practice for Alberta Physiotherapists

Circulated on: January 3, 2023

Background

One of the core functions of the College of Physiotherapists of Alberta is to set and enforce practice and professional Standards. Standards of practice represent the minimum expectations for members of the profession. The Standards establish the minimum performance that every regulated member must achieve in their daily practice.

Standards of Practice are living documents. They change as trends in practice emerge and others wane. Over the course of 2022, the College of Physiotherapists of Alberta engaged in a process to review and revise the Standards of Practice to reflect changes in practice and data collected since the Standards were last revised in 2017.

In accordance with Section 133(2) of the Health Professions Act, the College of Physiotherapists of Alberta is circulating the draft Standards of Practice for Physiotherapists in Alberta for review and comment by regulated members of the College.

Note: Over the course of 2022, the College circulated two Standards of Practice - the Continuing Competence Standard and the Performance of Restricted Activities Standard in response to pending legislative changes. The comment phase for these Standards is now complete; therefore, they are not included in this feedback process.

Format of the Standards

As with previous iterations, the draft Standards of Practice for Physiotherapists in Alberta are organized alphabetically for ease of access. Each Standard includes a Standard statement, expected outcome, list of performance expectations, key definitions, and an identification of related Standards.

What has changed?

The following table is provided to highlight key changes to the Standards of Practice, comparing the draft Standards to the existing Standards of Practice for Alberta Physiotherapists.

Registrants can compare and contrast the two documents by reviewing the existing 2017 Standards, and comparing with the draft Standards.
Draft Standard Standard 2017 Status Comments

Advertising and Marketing

Advertising

Renamed

  • Altered framing of the Standard to reflect current practice realities and behaviour of registrants when promoting themselves and the services offered.
  • Added requirement to review and approve advertising, marketing and promotional activities prepared by a third party, reflecting recurring issues identified through data review.

Assessment, Diagnosis, Treatment

Client Assessment, Diagnosis, Interventions

Renamed

  • Addition of expectations related to Female Genital Mutilation in accordance with S133.2 of the Health Professions Act.

Boundary Violations

Professional Boundaries

Renamed

  • Delineation made between expectations in relation to patients and expectations in relation to others in the practice environment that the physiotherapist has authority over.
  • Addresses expectations in informal practice environments, reflecting trends related to locations where physiotherapists provide services.

N/A

Client-Centered Care

Retired

Many key concepts are addressed in Code of Ethical Conduct.

Primary use of this Standard over last 5 years related to discontinuing services when patients still require physiotherapy – now addressed in the Duty of Care Standard.

Communication

Communication

Retained

  • Added performance expectations specific to communication using social media.
  • Migrated most communication expectations found in other Standards into this Standard.

Concurrent Care

Collaborative Practice

Renamed

  • Concepts of collaboration are addressed in the Code of Ethical Conduct.
  • Primary use over the last 5 years has been in relation to concurrent care – performance expectations revised accordingly.

Conflict of Interest

Conflict of Interest

Retained

  • Minor wording changes to clarify College expectations.
  • Removed expectation to report conflict of interest to Registrar which may lead to an incorrect perception that Registrar “approved of” a conflict of interest.

Continuing Competence

Competence

Renamed

  • This Standard was circulated for registrant feedback in spring of 2022.
  • No further action required.

Documentation

Documentation and Record Keeping

Renamed

  • Changes address common issues of what constitutes a complete client record.
  • Content re: financial records placed in this Standard to reinforce that this information is part of a complete client record.
  • Additional content pertaining to requirements of electronic medical records (EMRs) reflect common issues brought to the College’s attention related to EMRs.

Dual Practice

Dual Registration

Renamed

  • Changes reflect increasing occurrence of physiotherapists providing both physiotherapy services and the services of a non-regulated provider (e.g., personal trainer).
  • Expectations related to representation/ misrepresentation of services and keeping services offered separate and distinct are retained.

Duty of Care

N/A

New

  • Content reflects frequently asked questions related to discontinuing care.
  • Reinforces the physiotherapist’s duties to their clients.
  • Reinforces client’s right to make informed decisions that the physiotherapist believes are dangerous or does not agree with.

Evidence-Informed Practice

Evidence-Informed Practice

Retained

  • Additions reflect the “Is It Physiotherapy Tool” used when considering emerging practices.
  • Changes reinforce the need to critically appraise evidence regarding emerging therapies and importance of clear communication when implementing emerging therapies in practice.

Funding, Fees and Billing

Fees and Billing

Renamed

  • Increased focus on communication re: fees and billing practices reflects data from the past 5 years.
  • Added concept of bundled physiotherapy services and related fraud prevention measures codify past messaging into the Standards.

Health Equity and Anti-Discrimination

N/A

New

See Note

  • Developed to address health-care harm occurring to individuals due to their identity, culture or individual characteristics.
  • Recognizes that, like Indigenous people, individuals from other identifiable groups experience health-care harm due to bias, discrimination, and oppression.

Indigenous Cultural Safety and Humility

N/A

New

See Note

Developed in response to Calls to Action of the Truth and Reconciliation Commission, findings of the In Plain Sight Report and other seminal documents.

Infection Control

Infection Control

Retained

Foregrounded requirements for use of infection prevention and control measures relevant to physiotherapy practice.

Informed Consent

Consent

Renamed

  • Name changed to reinforce importance of consent being informed.
  • Details added to support process of obtaining informed consent.
  • Added concept that risks related to proposed services inform type of consent and extent of consent discussion.

N/A

Legislative Responsibilities

Retired

  • Registrants are required to comply with the law. No need to codify compliance with legislation into the Standards.

Performance of Restricted Activities

Performance of Restricted Activities

Retained

  • This Standard was circulated for registrant feedback in fall of 2022.
  • No further action required.

Privacy and Record Retention

Privacy/ Confidentiality

Renamed

  • Changes made to align content with requirements of Health Information Act while continuing to address requirements of Personal Information Protection Act.
  • Provides increased direction in alignment with legislation rather than directing the registrant to multiple pieces of legislation.

N/A

Quality Improvement

Retired

  • Expectations regarding assessing effectiveness of services provided are now integrated into evidence-informed practice.
  • Other expectations from legacy Standard are addressed in the Code of Ethical Conduct or are beyond the College’s jurisdiction.

Risk Management and Safety

Risk Management

Safety

Renamed

  • Considerable overlap in constructs addressed in the legacy Standards.
  • Risk management and safety are interrelated and exist on a continuum therefore combined into single Standard.

Sexual Abuse and Sexual Misconduct

Sexual Abuse and Sexual Misconduct

Retained

  • This Standard is not included in this consultation process.
  • In accordance with Section 133.1 of the Health Professions Act, the feedback and approval process for this Standard differs from that of other Standards. This Standard will be circulated for registrant comment and feedback at a future date.

Supervision

Supervision

Retained

Standard reformatted to include separate sections for each category of supervisee to reinforce distinct expectations of each group and facilitate registrant understanding of requirements.

Title, Credentials and Specialty Designations

Use of Title

Renamed

  • Incorporated approved titles into Standard to increase clarity related to approved titles.
  • Expectations address ongoing issues with use of the term “specialist” and related terms, both in advertising and in relation to title use.

Virtual Care

N/A

New

  • Expectations focus on the provision of quality virtual services.
  • Limited reference to regulatory requirements for cross border services.

Note: As part of the Standard revision process, the College identified the need to develop new Standards of Practice pertaining to Indigenous Peoples and the provision of culturally-safe care, and to health equity and anti-discrimination more generally. The former is intended as part of the College’s response to the Truth and Reconciliation Commission Calls to Action and to address the distinct history and experience of anti-Indigenous discrimination and harm within the health system in Canada. The latter is intended to address the fact that many individuals have experienced health harm and unsafe care due to bias and discrimination by health professionals based on the individual’s identity, culture, or individual characteristics.

The College recognizes our duty to establish clear expectations for registered physiotherapists regarding the delivery of safe and equitable physiotherapy services. These draft Standards are intended to address this duty. They build upon the Code of Ethical Conduct and Standards currently in place that set expectations regarding client-centered care but differ by specifically naming discrimination and culturally unsafe care and the individuals and groups who have been harmed.

In developing these Standards, the College sought to engage with individuals with expertise or lived experience in anti-discrimination to inform and revise the Standards. Through this review and comment process, the College is seeking to further our understanding of how the language used in the Standards of Practice and the performance expectations identified affect distinct communities within the physiotherapy registrant population in different ways.

The College recognizes that our expertise is in regulation, not in the work of anti-discrimination. We are committed to hearing concerns with the content of these Standards that can further improve that which has been drafted.

Next steps

In 2022, physiotherapy regulators from across Canada also reviewed the Core Standards of Practice originally developed in 2016. The Core Standards of Practice serve as a foundational document upon which each physiotherapy regulator can develop the Standards to be implemented in their local jurisdiction.

The revised draft Core Standards of Practice inform the draft Standards of Practice for Physiotherapists in Alberta and are expected to undergo a review and validation process in 2023 separate from the review and feedback process of the Alberta Standards. The national validation process is an important step in the process of developing the Core Standards as it helps to build national consensus of what constitutes good physiotherapy practice. Registrants can expect to be contacted to be part of the validation of the revised draft Core Standards of Practice in the future.

The College of Physiotherapists of Alberta encourages all registrants to review the draft Standards of Practice for Physiotherapists in Alberta in full and to complete the feedback survey. The consultation period for review is now closed. Thank you for providing your feedback.

The consultation period for review of the draft Standards of Practice for Physiotherapists in Alberta will end on February 3, 2023.

Page updated: 06/02/2023