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Good Practice: Backstage Access to How 5 Standards of Practice were Altered

Physiotherapy practice evolves and changes with time, so the regulation of the profession must adapt to those changes to ensure the protection of the public interest. The College of Physiotherapists of Alberta spent the last twelve months working both within the organization and at a national level to update the Standards of Practice which govern physiotherapy practice. The process of change included collecting aggregate data from our records in Practice Advice and Conduct over the last five years as well as utilizing regulatory experience by those employed at the College and reviewing regulatory law cases. The data collected, as well as the discussions on a national and provincial level, led to the formation of new Standards, the retirement of some old Standards, and alteration of others.

The revised Standards of Practice are currently available for review and consultation. We are encouraging all Alberta physiotherapists to review the revised standards and provide feedback.

Data Collection and the Identification of Trends

Just like you, College staff keep notes and records. We document the types of questions we receive via email and phone calls, and the themes of complaints received. This results in a significant repository of information that we can draw on to monitor trends in practice and the types of issues physiotherapists are encountering. As the College initiated the review of the current Standards of Practice, the first step was to review all the data gathered relating to each specific Standard. Once we were able to look at all the different types of questions that came into practice advice and review the conduct and complaints data, we looked at what other regulators were doing and what information case law could provide. Discussions were initially held among College staff to identify Alberta-centric issues.

It is important to note that the data we collect is consistently reviewed to help the College make informed decisions on how to best uphold our mandate from the government. Just like the use of outcome measures in clinical practice, we use information collected to help give us an idea of where there are areas of concern. Historically, the data we collect drives the discussion around what topics we present to both the public and physiotherapists in the Good Practice and Blog articles as well as Podcasts and Webinars. The content we promote is based off identified trends in our data. We also consider the regulatory experience within the organization and look at judgements handed down in both the court system and at regulatory hearings.

For some indication of what the above actually looks like in practice, I put together an overview of several Standards and what types of discussions went into their recent changes.

5 Standards: Why and How They were Changed

Client Centered Care vs. Duty of Care

During the data review process of Client Centred Care, a significant overlap with the Code of Ethical Conduct was noticed. When we compared the two, we found almost all of the expectations in Client Centered Care Standard were already contained in the Code of Ethical Conduct.

When we examined the use of this standard in our registrant education, practice advice, and conduct reports it was primarily related to discontinuing services to a client who still needed physiotherapy services. So, from the Client Centered Care Standard the new Duty of Care Standard was formed. Many physiotherapists have had experiences where the therapeutic relationship is no longer positive and discharging the patient is the most reasonable option. The new Duty of Care standard reflects the most frequently asked questions regarding patient discharge and captures the physiotherapist’s duty to their client as they work through the discharge process. There are also new performance expectations that reinforce the client’s right to make informed decisions that the physiotherapist believes are risky or does not agree with.

Dual Registration transitioned into Dual Practice

There has been a significant trend for physiotherapists to offer services outside of the profession of physiotherapy. Initially, the Dual Registration Standard was written for individuals who were actively registered in two separate regulated health professions such as a physiotherapist and a chiropractor, or a physiotherapist and an acupuncturist. The registration data indicated that the number of those practitioners were very low, but the Practice Advice data indicated that there are far more physiotherapists participating in dual roles like physiotherapy and strength training or teaching yoga/Pilates. The main concerns in practice were physiotherapists misrepresenting their services or patients not understanding that the services they received were not physiotherapy services. The expectations in this Standard focus on keeping the two roles separate and distinct to more clearly indicate to the public when the physiotherapist is practicing as a physiotherapist or providing other, non-physiotherapy services.

Supervision sees a change in formatting

The bulk of questions regarding this standard came from physiotherapists who are supervising either physiotherapist assistants, physiotherapist interns, or students. There were also questions from physiotherapist interns trying to understand their responsibilities and achieve clarity on what they can and can’t do. From the physiotherapists, we saw questions on decision making around direct vs. indirect supervision as well as the responsibilities and liabilities of being a supervisor. Answers to most of the questions asked were contained in the Supervision Guide, which covers most of these concerns separately for each of these sub-populations of supervisees. Based on the data and the discussions it was agreed that the Standards of Practice should clearly address each of the supervisee groups separately.

Legislative Responsibilities was retired

Physiotherapists are expected to comply with legislation and to be law-abiding citizens. This standard, in essence, reiterated this expectation; however, given that laws exist and citizens are required to obey the law, having a standard that says that is unnecessary. Similar in a way to Client Centered Care, the Legislative Responsibilities Standard highlighted content that was in the Code of Ethical Conduct or was related to compliance to the legislation that governs physiotherapy practice and was removed.

Advertising was refocused

I hope you have noticed that there has been a significant effort on our part to educate physiotherapists regarding the expectations contained in the Advertising Standard. In the past year there have been several articles and podcasts discussing physiotherapists and advertising. Even this morning as I wrote this, I saw a physiotherapy clinic banner with “Best in Edmonton” tagged on. The changes to the Advertising Standard reflect a lot of the content contained in the educational material that has been published. The College wanted to make the performance expectations even more clear to registrants. As you review the changes you will note alterations in what physiotherapists can advertise for (only services they are competent to provide and not listing 37 areas they “specialize” in) as well as keeping the same focus that all advertisements must be truthful, accurate, and verifiable. The responsibility of the physiotherapist to ensure that any third party marketing or promotion is reviewed and approved and is in keeping with regulatory requirements is also clearly articulated. These changes were based on complaints and queries from both the public and physiotherapists.

The draft standards of practice will be available for review and comment until February 3, 2022. Please view the updated Standards in their entirety. We encourage all physiotherapists to provide feedback on the draft standards.

In addition to the review and feedback process pertaining to the Draft Standards of Practice for Physiotherapists in Alberta, registrants can expect that in the coming months they will be contacted to provide feedback on the revised Core Standards of Practice. The Core standards are a national project to develop a template that all physiotherapy regulators in Canada can draw upon when developing standards for their respective jurisdictions.

In 2022, Physiotherapy regulators from across the country were invited to participate in the development of these standards, which provide consistency to physiotherapy regulation across the country. The College of Physiotherapists of Alberta was a collaborator on the development of the Core Standards; however, there are differences between the Core Standards and the Alberta Standards, as is the case with all provinces and territories, Alberta has its own legislation and jurisdiction-specific requirements to address.

While registrants are encouraged to provide feedback on each set of Standards, it is the Standards of Practice for Physiotherapists in Alberta that govern physiotherapy practice within the province.

Page updated: 19/01/2023