Part 1 - An Overview of the Canadian Model of Physiotherapist Assistant Practice

The Canadian Physiotherapy Model

The model of physiotherapy practice is similar across Canada. However, the regulations and policies that govern physiotherapy may be slightly different in each Canadian province or territory.

In 2012, the Canadian Physiotherapy Association and the Canadian Alliance of Physiotherapy Regulators adopted the term of “Physiotherapist Assistant” to describe the support role within the practice of physiotherapy. However, provinces and territories continue to use different terms to describe this role. These include: Physiotherapist assistants, physiotherapy support personnel, physiotherapy support workers, physiotherapy aides, physiotherapy assistants, physiotherapist aides, rehabilitation assistants, and rehabilitation aides.

A review of the basic characteristics of this model may help you understand the responsibilities and daily work experiences of work as a physiotherapist assistant (PTA) in Canada. These include:

Scope of Practice
Within the scope of physiotherapy practice, a physiotherapist assistant must work under the supervision of a physiotherapist who is licensed to practice in Canada. The physiotherapist assistant performs tasks assigned to him/her by that licensed physiotherapist. The types of tasks that can be assigned to the physiotherapist assistant may vary, dependent upon the province’s or territory’s regulations and policies.

The goals of Canadian physiotherapy practice include the following:
  • promotion of physical activity and overall health and wellness
  • prevention of disease, injury, disability and mobility limitations
  • management of chronic conditions and activity limitations
  • restoration of function and rehabilitation of disease, injury or disability with therapeutic exercise programs and other interventions
  • counselling and planning of maintenance and support programs to prevent re-occurrence, re-injury or functional decline
Core areas of clinical physiotherapy practice in Canada focus on the neuromusculoskeletal, neurological and cardiopulmonary-vascular systems. The physiotherapist assistant’s practice includes but is not limited to: paediatrics, geriatrics, oncology, women’s health, pain, wound care, occupational health and sports medicine.

The physiotherapist must complete the initial assessment of the client to determine the physiotherapy plan of care. Once the assessment and plan of care is completed by the physiotherapist, the physiotherapist may assign components of the established physiotherapy care to the physiotherapist assistant. The type of care plan components that may be assigned are determined by the physiotherapist, the regulatory requirements of the province, as well as the following:
  • the education, training and competence of the physiotherapist assistant
  • the complexity and stability of individual client needs
  • the practice environment
While services are provided under the supervision and responsibility of a physiotherapist, physiotherapist assistants are accountable for their own individual performance.

Essential Competency Profile for Physiotherapist Assistants in Canada (April 2012)
Assignment of Tasks
Physiotherapist assistants receive the assignment of tasks from a supervisory, licensed physiotherapist. In Canada, physiotherapists must be licensed and/or registered in their province or territory in order to practice physiotherapy. However, physiotherapist assistants are not regulated at this time and do not require a license to practice in any of the provinces and territories in Canada. Physiotherapist assistants must work under the supervision of a licensed physiotherapist. Physiotherapist assistants should perform the task assigned to them in a competent manner. Competency must be established before the assignment of tasks. The physiotherapist must ensure that the assigned tasks are within the physiotherapist assistant’s capabilities. Initially, the physiotherapist may observe the delivery of service to a client to see that the assistant can complete the task successfully. The physiotherapist may review any new procedures with the assistant. The physiotherapist assistant must identify any new areas that they do not feel confident to complete to the physiotherapist. The assistant may need additional training and skill development.

According to the Essential Competency Profile for Physiotherapist Assistants in Canada (April 2012), the physiotherapist assistant practice setting assumptions are the following:
 
  1. Client safety is the most important element.
  2. Physiotherapists are responsible for the overall physiotherapy services provided. Physiotherapist assistants (PTAs) are responsible for providing care, as assigned by physiotherapists, and within the limits of their knowledge and skills and within the applicable regulations.
  3. PTAs work under the supervision of a registered/licensed physiotherapist who maintains accountability for client care.
  4. Physiotherapists consider the education, training and competencies of PTAs. As well the physiotherapist must consider the complexity of individual client needs and of the environment when he/she assigns tasks to the PTA.
  5. Physiotherapists are responsible for client assessment, interpretation of findings, determination and initiation of interventions, progression of interventions, re-evaluation, and discharge planning.
  6. PTAs work collaboratively in teams within the health care system.
  7. PTAs practice client-centred care and act only with the client’s informed consent . Consent is informed if, before giving it, the client received information that a reasonable person in the same circumstances would require in order to make a decision about the treatment, as well as responses to requests for additional information. The client must have been given an adequate explanation about the nature of the proposed treatment and its anticipated outcome as well as the significant risks involved and alternatives available (adapted from College of Physiotherapists of Ontario, 1996).
  8. Physiotherapy practice is evidence-informed. Because the PTA’s practice is an integral component of physiotherapy practice, PTA practice is also evidence-informed.
  9. PTAs work within applicable legislation and regulations, as well as within established work setting protocols.
Physiotherapist assistants are not permitted to change the treatment plan but can modify the treatment within the established guidelines set by the physiotherapist.
Physiotherapy Tasks NOT Within The Scope of a Physiotherapist Assistant
It is important to understand what the physiotherapist cannot assign to a physiotherapist assistant. There are some differences across the country, but the following tasks cannot be assigned to a physiotherapist assistant and are the responsibility of the physiotherapist to complete:
 
  • client assessment,
  • interpretation of findings,
  • determination and initiation of interventions,
  • progression of interventions,
  • re-evaluation, and
  • discharge planning.
Physiotherapy-Specific Education and Training
You must have the appropriate education and workplace training to work successfully as a physiotherapist assistant in Canada. Many of the Canadian physiotherapist assistant training programs are presently going through a national accreditation process. A list of physiotherapist assistant training programs that are involved in the Canadian accreditation process can be found at the Physiotherapy Education Accreditation Canada website at: www.otapta.ca.
Continuity of Care
There are many different practice settings for physiotherapist assistants. You may be employed in a hospital emergency department, inpatient acute or critical care, rehabilitation centre, or out-patient department. Your practice may be a community based practice in a nursing home, or with home care services. You may work in private practice. Physiotherapist assistants work with clients who range in age from infants to elderly populations. Physiotherapy service is offered across Canada 7 days of the week with extended hours into the evening. Service hours are determined by the setting and needs of the client population being served.
Relationship with Occupational Therapy Discipline
Often an employer will recruit for a position that has a combined role of a physiotherapist assistant and an occupational therapist assistant. Titles for these positions vary but may include rehabilitation assistant, rehabilitation aide, OTA and PTA. The successful candidate has training and work experience in both the occupational therapy and physiotherapy fields. Many Canadian educational programs for assistants provide both occupational therapy and physiotherapy training. The graduate of the program can work as an occupational therapist assistant and/or physiotherapist assistant. This allows one individual to provide different aspects of care to the client in a more coordinated and client-centered way. This could result in more streamlined care to the client. The assistant is supervised and receives assigned tasks from two different discipline groups, physiotherapists and occupational therapists. Information on occupational therapist assistants can be found at the Canadian Association of Occupational Therapists at www.caot.ca.
Informed Consent
Physiotherapist assistants in Canada support the client’s and family’s right to make choices about their care. The physiotherapist must obtain consent for the overall plan of physiotherapy care from either the client or the client’s substitute decision maker. That consent includes the role and parts of the care plan that will be assigned to the physiotherapist assistant.

Physiotherapist assistants must obtain consent from the client for each treatment interaction. As a physiotherapist assistant, you must:
  1. Introduce yourself by name and designation (i.e. physiotherapist assistant)
  2. Inform the client what you are going to do and why
  3. Obtain permission from the client to implement treatment

Physiotherapy Work and Lifestyle

Work in the Canadian physiotherapy model is very rewarding and enjoyable. It also has its challenges and demands. It is very important to consider the following questions:

1. Do you have good communication skills?
Excellent communication skills are essential to work as a physiotherapist assistant. You must be able to communicate well with the physiotherapist and your clients. The physiotherapist assistant and physiotherapist must communicate:
  • relevant assessment findings, goals, planned interventions, acceptable range of treatments and the expected response.
  • potential changes in the client’s condition that are consistent with the normal course of recovery.
     
  • the client’s actual response and any observed changes in the client’s health status that occur during or as a result of the physiotherapy intervention.
You must be able to identify when a change has occurred with a client and report that change to the physiotherapist. This is a critical element in the delivery of safe and effective physiotherapy care.
2. Do you understand your professional responsibility to maintain client confidentiality?
Often, physiotherapist assistants will learn personal information about a client and/or their families during treatment. The physiotherapist assistant must keep that information secure and private. You may share the information as needed only. For example, you may discuss information learned about a client with a colleague who is a health professional working with that client. However, you CANNOT share information about a client with your family and friends.
3. Can you manage a 7-day work model which may include some evenings?
Physiotherapy practice in many Canadian hospital settings is a 7-day practice model. Saturday and Sundays are regular work days with other days of the week taken off as ’rest’ days. Both private and public health care settings offer physiotherapy services during evening hours. Expect busy practices both in public and private settings.
4. Are you able to manage your time well and prioritize tasks?
The workload is often very busy in both in the public and private health sectors. Physiotherapist assistants in Canada face the daily challenge of an increased demand on their limited resources. You must manage a number of tasks at the same time and be able to prioritize those tasks. The most important ones must be completed while others may not be completed by the end of the day. You must decide what activity in your workday needs to be done today and what can wait until tomorrow. These decisions are often made with the physiotherapist. You will be asked to explain to colleagues and team members why you gave priority to certain tasks. This requires strong communication skills.
5. Are you able to develop collaborative working relationships with health care colleagues?
Physiotherapy is a well-established profession in Canada. Collaborative work or teamwork is very common. Physiotherapist assistants work closely with other professions in almost all practice settings. However, you may work in an interprofessional environment where your colleagues do not understand your role as well as you might have expected they would. Heavy workload demands may create stress and conflict. Professional interactions are challenging and you must use diplomacy and respectful communication skills in collaborative team relationships. You must understand and respect each other’s role and scope of practice in order to serve the genuine interest in the client. You must put your own pride aside for the sake of the client’s wellbeing.
6. Are you able to contribute to the development of the physiotherapist assistant profession?
Many physiotherapist assistants in Canada help to build their profession in addition to their clinical practice. For example, physiotherapist assistants may teach or mentor physiotherapist assistant students. They may serve on hospital and community committees. You will be expected to take part in some of these tasks.
7. Do you understand the provincial policies, procedures or statements that the physiotherapist regulatory bodies and associations have developed for physiotherapist assistants?
Physiotherapist assistants are not regulated in any of the Canadian provinces and territories. Therefore a provincial or territorial regulatory body and/or professional association for physiotherapists often create documents to help guide or legislate the physiotherapy tasks that physiotherapists may assign to physiotherapist assistants in that particular province or territory. This has resulted in differences in the role of physiotherapist assistants from one jurisdiction or area to another across Canada.

Self-Reflection

As you work through the self-assessment tool, it is important to consider your  professional and personal ability to:

  • Work in partnership with the client. This is called client centred practice.
  • Apply current research evidence to your practice so that your client receives the most appropriate care. This is called evidence based practice.
  • Balance your work schedule with other life responsibilities such as family, work, leisure, etc.
  • Be able to set priorities for your professional duties.
  • Consider all aspects of a client including their physical, cognitive and affective wellbeing.
  • Provide culturally sensitive care. Clients will not always share your religious, political and personal values.
  • Communicate effectively with clients. Be sure that your language, vocabulary, non-verbal cues, tone and volume are correct for your particular client. Accommodate different language abilities, hearing or vision difficulties as well as any cognitive impairment.
  • Communicate effectively with the physiotherapist who supervises your work. Clear communication between the physiotherapist and you will help ensure safe and efficient physiotherapy care delivery.
  • Work collaboratively with other members of the health care team.
  • Be confident and assertive with other health care providers.
  • Evaluate your own practice for its strengths and weaknesses. Participate in professional development to improve your practice.
  • Document your interactions with clients. Include subjective and objective client information and describe how the client tolerated the intervention.
  • Make sure that you obtain client consent at every step in the rehabilitation process.
  • Provide responsible decision making, sound clinical reasoning and judgment.
  • Use professional language, not jargon or slang.
  • Understand the Canadian health care system and how it will affect your practice.
  • Understand the regulations, standards, policies and ethical frameworks which control physiotherapy practice.
  • Make sure your practice is ethical. Respond appropriately to ethical situations in practice, protect client confidentiality and privacy, and maintain appropriate client boundaries.
  • Understand the legal aspects which govern physiotherapy practice such as the need to obtain consent, provide informed choice, ensure confidentiality, and maintain records etc.
  • Understand and apply infection control procedures such as hand washing. These are known as universal precautions.

If or when you apply for physiotherapy licensure in Canada, you must take part in a formal assessment to make sure that your knowledge and skills meet Canadian licensing standards. This process includes language tests, written and oral or clinical examinations.

To learn more about becoming a physiotherapist in Canada, please refer to the Canadian Information Centre for International Credentials: http://www.cicic.ca or the Canadian Alliance of Physiotherapist Regulators website: http://www.alliancept.org.