“A profession’s scope of practice encompasses the services its practitioners are educated, competent, and authorized to provide. The overall scope of practice for the profession sets the outer limits of practice for all practitioners. The actual scope of practice of individual practitioners is influenced by their continuing professional education, the settings in which they practice, the requirements of the workplace, and the needs of their patients.” [1], [2]
[1] National Physiotherapy Advisory Group. (2009). Essential Competency Profile for Physiotherapists in Canada. Retrieved online http://npag.ca/PDFs/Joint%20Initiatives/PT%20profile%202009%20English.pdf
[2] Downie S, Walsh J, Kirk-Brown A, Haines TP. (2023) How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis. Int J Health Plann Mgmt. 2023; 38(5): 1184-1211. https://doi.org/10.1002/hpm.3678
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| LEGEND | |
|---|---|
| Within scope of practice and not a controlled or restricted act within the province/territory. | |
| * | Within scope of practice as a restricted or reserved or controlled act assigned to select regulated professions including physiotherapy through legislation in the public interest. Successful completion of an approved education program may be required to perform activity in some jurisdictions. |
| In process for implementation pending completion of regulatory changes. Will be reserved/restricted/controlled once completed (*). | |
| D | Only under delegation by another healthcare professional and/or medical directives in a health organization. |
| OTHER | Legislation, regulation or policies outside of the regulated health profession regulatory system is a barrier to practice. |
| Not implemented in jurisdiction | |
| APPENDIX B: PHYSIOTHERAPY SCOPE OF PRACTICE ACROSS CANADA - Summary of activities, interventions, and treatments | Jurisdiction comparison across Canada | ||||||||||||||
| The chart depicting physiotherapy scope of practice across Canada was informed by scans of current legislation including regulated health profession acts (RHPAs), provincial/territorial physiotherapy acts, and through consultation with regulators. The information is current as of April 2024. This information will be updated as new information is obtained and as standards of practice, legislation, regulation and policy evolves. | ||||||||||||||
| Category | Physiotherapy skill/activity | BC1 | AB | SK | MB | ON | QC | NB | NS | PEI | NL | YT | NU2 | NWT3 |
| Diagnosis | ||||||||||||||
| Communicating a diagnosis | Communicating a diagnosis, identifying a physical dysfunction, disease or disorder as the cause of a person’s symptoms. | * | * | * | * | |||||||||
| Ordering diagnostic tests, imaging and laboratory tests | ||||||||||||||
| Ordering diagnostic imaging | X-rays | * | D | D 4 | * | *5 | ||||||||
| Magnetic Resonance Imaging (MRI) | * | D 6 | * | |||||||||||
| Ultrasound | * | D | D 7 | |||||||||||
| Ordering laboratory tests | Collecting samples and/or ordering laboratory tests within scope including for inflammatory markers related to arthritis, nutritional markers for wound care and others. | D | D 8 | |||||||||||
| Ordering electrodiagnostic testing | Electromyography (EMG) and nerve conduction studies | D | ||||||||||||
| Treatment | ||||||||||||||
| Cardiorespiratory | Tracheal suctioning (endotracheal and nasopharyngeal) | * | * | * | * | * | * | * | ||||||
| Introduce an instrument past the pharynx or nasal passages | * | * | * | * | ||||||||||
| Administering a substance by inhalation, a drug or substance, including oxygen, as prescribed by an authorized health professional | * | 1 | * | * | * | D | * | |||||||
| Wound Care | Taking a swab of a wound below the dermis for testing | * | * | D | * | |||||||||
| Treating a wound below the dermis including modalities, cleansing, soaking, irrigating, probing, debriding, packing and dressing. | * | * | * | * | * | |||||||||
| Pelvic health | Inserting an instrument, hand or finger beyond the labia majora or anal verge for pelvic health assessment and treatment of pelvic pain, disorders and incontinence | * | * | * | * | * | * | * | * | |||||
| Administration of real-time imaging ultrasound for the assessment and treatment of incontinence | * | * | * | D | * | * | * | * | ||||||
| Needling | Acupuncture | * | * | * | * | * | * | * | * | * | * | |||
| Dry needling/Intramuscular stimulation | * | * | * | * | * | * | * | * | * | * | ||||
| Spinal Manipulation | Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust | * | * | * | * | * | * | * | * | |||||
| Manual therapy | Soft tissue and manual therapy techniques including massage and proprioceptive neuromuscular facilitation (PNF), mobilization of joints | * | ||||||||||||
| Exercise | Therapeutic exercise and exercise prescription | * | ||||||||||||
| Ergonomics | Ergonomic assessment, modifications, education | * | ||||||||||||
| Use of energy | Hydrotherapy, electrotherapy and use of mechanical, radiant and thermal energy | * | ||||||||||||
| Mobility aids and supports | Prescription, manufacture, modification and application of orthotics, pessaries, braces, splints, taping, mobility aids (such as walkers, crutches, canes, wheelchairs) and seating devices or equipment | 2 | 9 | * | * | |||||||||
| Casting | Setting or casting a fracture | * | * | D | ||||||||||
| Serial casting for range of motion | * | * | D | |||||||||||
| Reducing a dislocation of a joint | Reduction of a joint dislocation such as dislocations of the shoulder, kneecap or finger joints | * | * | D | ||||||||||
| Psychosocial and Lifestyle | Provide support for the psychosocial aspect of care and guidance on lifestyle choices impacting mobility and health | |||||||||||||
| Pharmaceuticals/Medication | ||||||||||||||
| Administering of medication as prescribed by a physician or other authorized profession or as prescribed by a physiotherapist | Oral and injection | * | * | D | *10 | |||||||||
| Topical medications | * | * | D | * | * | *11 | ||||||||
| Cortisone/steroid and intramuscular injections | * | * | D | *12 | ||||||||||
| Prescribing medication | Prescribing over the counter and limited prescription medications related to a physiotherapy treatment plan | D | D | |||||||||||
| System Navigation | ||||||||||||||
| Referring | Referring to other health professionals including referring to physician specialists | OTHER | OTHER | OTHER | OTHER | OTHER | ||||||||
© 2024 Canadian Physiotherapy Association
| Footnotes: | ||||
1. Per the College of Physical Therapists of British Columbia, 16 February 2024: Professional regulation is undergoing significant change both in terms of the introduction of the new Health Professions and Occupations Act (“HPOA”), which is not yet in force, and the scheduled amalgamation of several of the colleges under the Health Professions Act in June 2024. https://cptbc.org/2024/02/16/faqs-on-proposed-physical-therapists-regulation-amendments/ The College of Physical Therapists of BC will amalgamate with the other six colleges to form the College of Health and Care Professionals of BC on June 28, 2024. Until then, the College of Physical Therapists of BC and the other six colleges will continue to regulate health professionals. https://cptbc.org/2024/02/29/ministry-of-health-confirms-name-of-new-multi-profession-college/ | ||||
2. Jurisdiction does not have a defined or described scope of practice for physiotherapy. Physiotherapists working in this jurisdiction are required hold an active licence from another jurisdiction. Individual physiotherapist scope of practice may vary depending upon respective legislations. | ||||
| 3. Jurisdiction does not have a defined or described scope of practice for physiotherapy. Physiotherapists working in this jurisdiction are required hold an active licence from another jurisdiction. Individual physiotherapist scope of practice may vary depending upon respective legislations. | ||||
| 4. All legislation has passed, all proclaimed, all pending a change to a regulation for implementation. in interim can perform through delegation or standing order. The regulation change needed is an amendment to the Exemptions Section of Regulation 107/93 under the RHPA (MRI and Ultrasound for diagnostic purposes are referenced in the Regulation as per the Interpretation Section) via the addition of “a member of the College of Physiotherapists of Ontario” for purposes of MRIs and diagnostic ultrasound. | ||||
| 5. Physiotherapists employed by Nova Scotia Health or IWK Health can already request X-rays, but starting in early spring (2024), physiotherapists working in private practice will also be able to request X-rays. They must be in good standing with the Nova Scotia College of Physiotherapists to request an X-ray. | ||||
| 6. All legislation has passed, all proclaimed, all pending a change to a regulation for implementation. in interim can perform through delegation or standing order. The regulation change needed is an amendment to the Exemptions Section of Regulation 107/93 under the RHPA (MRI and Ultrasound for diagnostic purposes are referenced in the Regulation as per the Interpretation Section) via the addition of “a member of the College of Physiotherapists of Ontario” for purposes of MRIs and diagnostic ultrasound. | ||||
| 7. All legislation has passed, all proclaimed, all pending a change to a regulation for implementation. in interim can perform through delegation or standing order. The regulation change needed is an amendment to the Exemptions Section of Regulation 107/93 under the RHPA (MRI and Ultrasound for diagnostic purposes are referenced in the Regulation as per the Interpretation Section) via the addition of “a member of the College of Physiotherapists of Ontario” for purposes of MRIs and diagnostic ultrasound. | ||||
| 8. No laws require amendment. All that remains are changes to two regulations: the first under the Laboratory and Specimen Collection Centre Licensing Act amendments are required to sections 17 and 18 of Regulation 45/27 (that replaced Regulation 682) under that Act to enable “a member of the College of Physiotherapists of Ontario” to collect specimens for and requisition laboratory tests. Second an amendment is required to section 12 of Regulation 207/94 under the Medical Laboratory Technology Act to include “a member of the College of Physiotherapists of Ontario” as a “prescribed person” in order to satisfy the requirements of subsection 5. (1) of the Act. interim can be performed through delegation or standing order | ||||
| 9. Recommendation and application only | ||||
| 10. Practice of Physiotherapy includes (j) administration of physical therapy-related medications as prescribed by a physician or a nurse licensed to practice as a nurse practitioner in the jurisdiction where the nurse practices nursing, | ||||
| 11. Practice of Physiotherapy includes (j) administration of physical therapy-related medications as prescribed by a physician or a nurse licensed to practice as a nurse practitioner in the jurisdiction where the nurse practices nursing, | ||||
| 12. Practice of Physiotherapy includes (j) administration of physical therapy-related medications as prescribed by a physician or a nurse licensed to practice as a nurse practitioner in the jurisdiction where the nurse practices nursing, |
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