Evidence-Based Scope of Practice Guideline

The Nova Scotia College of Physiotherapists (NSCP) regulates the practice of physiotherapy in NS in accordance with the legislation. The physiotherapy scope of practice is clearly detailed in the legislation.

This Guideline is to assist members in interpreting Core Practice Standards #1, 2, 10 and 13.

The legislation states that physiotherapy is the application of professional physiotherapy knowledge, skills and judgement by a physiotherapist with the object of obtaining, regaining or maintaining optimal health and functional performance within our scope of practice. It allows for assessment of neurological, musculoskeletal and cardiorespiratory systems for the purposes of a physiotherapy diagnosis.

Physiotherapy involves a detailed physiotherapy assessment, physiotherapy diagnosis and planned approach to dealing with functional performance. It does not cure diseases or syndromes, but rather treats the underlying physical dysfunction with the goal of maintaining or improving the overall health performance.

The Legislation 1998, C.22, S.2 defines the scope of physiotherapy practice in Nova Scotia as:

• (i) assessment of neuromusculoskeletal and cardiorespiratory systems and establishment of a physiotherapy diagnosis,
• (ii) development, progression, implementation and evaluation of therapeutic exercise programs,
• (iii) education of clients, caregivers, students and other health service providers,
• (iv) manual therapy treatment techniques including, but not limited to, massage, proprioceptive neu-romuscular facilitation and muscle energy techniques,
• (v) spinal and peripheral joint manipulation,
• (vi) spinal and peripheral joint mobilization,
• (vii) pain relief, including invasive acupuncture,
• (viii) administration of physical therapy related medications as prescribed by a physician,
• (ix) prescription, manufacture, modification and application of braces, splints, taping, mobility aids or seating equipment,
• (x) hydrotherapy, electrotherapy and the use of mechanical, radiant or thermal energy,
• (xi) ergonomic evaluation, modification, education and counselling,
• (xii) tracheal suctioning, and
• (xiii) such other aspects of physiotherapy as may be prescribed in regulations approved by the Gov-ernor in Council;

The NSCP follows the philosophy of client centered, evidenced-based* care in all aspects of Physiotherapy practice. Clients expect to receive appropriate and effective care, informed by best available evidence, combined with clinician’s skill and training and client preference.

An evidence-based approach to healthcare promotes an attitude of inquiry in health professionals. The NSCP expects physiotherapists to accurately incorporate evidenced-based knowledge by asking relevant questions, by accessing, appraising and interpreting the scientific research, and then reflect on their treatments and practices, by asking:

1. Why am I providing this service in this way?
2. Is there acceptable evidence that can guide me to a better patient outcome?

As the regulator for the physiotherapy profession, the NSCP expects that all NS physiotherapists consider three questions before making any claims about the benefits of treatments:

1. Do the claimed benefits related to care fall within the physiotherapists’ scope of practice?
2. Are such claims accurate, verifiable, truthful and not misleading?
3. Are such claims supported by acceptable evidence?

The onus is on the physiotherapist to be able to provide objective evidence and available research to substantiate all claims made and /or advertised pertaining to their physiotherapy services. A client must be well informed** as to their choices of treatment and the evidence behind it.

Treatment programs are determined based on the best available, peer reviewed and biologically plausible, evidence.

• Θ Nutritional and medication counselling (e.g. vaccination, vitamins, supplements)
• Θ Mental health, spiritual and psychological counselling
• Θ Acupuncture for conditions outside the neuromuscular and cardiorespiratory realm (e.g. weight loss, infertility and addictions such as smoking cessation)
• Θ Visceral manipulation
• Θ Craniosacral therapy
• Θ Complementary and Alternative*** Therapies (e.g. energy healing, self-affirmation, reflexology, holis-tic services)
• Θ Treatment of urogenital conditions that are not neuromusculoskeletal in nature
• Θ Curing diseases and syndromes (e.g. autism, verbal apraxia, attention deficit disorder, attention deficit hyperactivity disorder, asthma, infertility, Asperger syndrome)

• Client(s) – the recipient(s) of physiotherapy services and may be individuals, families, groups or populations. A client may also be referred to as a patient. In some cases, the client may be represented by their substitute decision-maker.
• *Evidence-based is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. Evidence-based research (EBR) aims at gen-erating a consensus statement that summarizes the outcome of a process of systematic evalua-tion of the literature. (https://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021)
• **Well informed means that the practitioner is aware of the risks and benefits associated with the practice and can clearly articulate them to the patient, along with the alternatives to that practice, so that the patient can make an informed decision
• ***Complementary and Alternative Health care (CAHC) … these are a broad range of healing philosophies, approaches, and therapies that conventional physiotherapy does not commonly use to promote well-being or treat health conditions. http://www.nccih.nih.gov. (NLM)

Dual Role Physiotherapists: The NSCP, in the interest of transparency and accountability to the public, has determined that a physiotherapist can only deliver services under one profes-sional role at a time. If you are treating a client as a physiotherapist and you believe that client would benefit from osteopathy or other services that are outside the scope of physiotherapy, you should refer that client to a colleague to provide the other services. If a treatment is not in the Scope of Physiotherapy it cannot be billed as, or called, physiotherapy.

Billing for Services: Billings must be specific and detailed. (e.g. Pelvic floor is an area treated, not a treatment). Physiotherapy treatment programs may include a variety of techniques. An individual technique should not be considered a complete service, but rather a part of a physio-therapy intervention program. (e.g. ‘Pilates’ exercises may be used as part of a client’s exercise program, but it is done as a physiotherapy exercise not as ‘Pilates’; an ‘osteopathic technique’ that falls within physiotherapy scope of practice is used as a physiotherapy intervention, it is not ‘osteopathy’).

Sale of Equipment: The legislation prohibits selling or supplying equipment or any appliance, splint or other assistive or supportive device to a patient for profit. (Sec 51 of Registration Regula-tions). This means that if you are selling equipment out of your clinic you can markup to cover your materials, time and handling costs, but you cannot make a profit on the equipment you are selling.

Physiotherapists must consider their responsibilities as a self-regulated professional and adhere to the Regulatory requirements. Our Code of Ethics requires licensed physiotherapists to report to the Nova Scotia College of Physiotherapists conduct of colleagues that is in contravention of The Code or Rules of Conduct of the NSCP. Failure to maintain the Standards or comply with the Act and Regulations is considered, at a minimum, Professional Misconduct.

It is considered an Offense under The Physiotherapy Act to practice in violation of any condition/limitation contained in your license 1998, c. 22, s.32 (1). The Registration Regulations indicate that practicing within “scope of practice” is a condition on a license. (s.23-24) pursuant to s.6 of the Act)

• Standard #1 Advertising
• Standard # 2 Client Assessment, Diagnosis, Interventions
• Standard # 10 Evidence Informed Practice
• Standard # 13 Legislative Responsibilities

NSCP Registration Regulations Section 41 of Schedule ’A’ Regulations respecting registration of physiotherapists pursuant to Section 6 (3) [i] Chapter 22 of the Acts of Nova Scotia 1998.

Core Standards of Practice for Physiotherapists in Canada 2016

http://www.nccih.nih.gov

This Evidence Based Scope of Practice Guideline is new and was approved by the NSCP Board September 18, 2019.