A short history of scope of practice changes in British Columbia, Canada

The Physiotherapy History of British Columbia Project group in Canada recently had a discussion about the changing scope of physiotherapy practice in BC. These notes were prepared by Nancy Cho and Patricia Grohne.

It would be interesting to see how these changes compare with what you have seen in your own practices. Perhaps add a comment below with your thoughts and observations.

Changes seen over time in B.C.: 

  • Entry level education. The Physiotherapy education change from Diploma to Bachelor and now Master’s entry level to practice in Canada. The addition of research master’s degree and the implementation of a clinical research scientist positions have raised the profile of physiotherapy
  • Advance Practice Physiotherapists – under the umbrella of primary care,
    • e.g. #1 at the Blusson Spine Cord Centre in Vancouver, PTs are assessing patients with low back pain referred by GPs and assessing before the surgeons; and triaging patients for surgical and non-surgical interventions
    • e.g. #2 PTs assessing clients diagnosed with osteoarthritis from GPs by providing client education and triaging to surgeons for surgical intervention or supporting non-surgical clients by sending for treatment and other community resources
  • Spinal cord injury management – changes in how patients are managed, previously  with long periods of bedrest to early surgical stabilizing spine to allow early mobilization of patients; in the past more complete spinal level injuries changing to more incomplete para/quads related to emergency/paramedic management of patients at point of injury, less trauma induced injuries to cancerous tumour related spine paralysis
  • Chronic disease management and self-care management focus of care – emphasis of education and teaching self management skills; moving client care into the community or home based care
  • Chronic pain management has grown into a specialty area using innovative team based care approaches.  PainBC is an organisation providing advocacy and education to health care clinicians, clients, and their families
  • Arthritis care changes from in-patient care to now mostly ambulatory care management with advance types of pharmaceuticals e.g. biologicals
  • Knowledge about brain plasticity (neuroplasticity) – the brain’s ability to adapt – to form new neurons, brain’s ability to change and reorganise throughout life – this has changed how we manage our patients/clients
  • Specialty areas of practice – e.g. pelvic floor PTs for bladder and bowel continence assessment retraining, pelvic pain, post op gender reassignment surgery management etc.
  • Solid organ transplants and bone marrow transplant patients where physiotherapy is involved in the pre-transplant intervention, patient/client education, and pre and post-operative care
  • Patients with neurological conditions such as muscular dystrophy, variants of ALS and Guillian Barre, are being offered mechanical ventilation to prolong their lives and are being accepted into long term care facilities
  • Many respiratory roles and function that physiotherapists did in the past are now being done by respiratory therapists
  • Management of ‘clearing copious chest secretions’ using manual skills, postural drainage techniques vs the advent of powerful antibiotics, autogenic breathing and active cycle breathing techniques
  • Exercises prescribed to an individual by physiotherapists vs. private or community based group exercise for disease specific participants e.g. post op joint replacement, post stroke; Together in Movement and Exercise (TIME), Fitness and Mobility Exercise Program (FAME), Good Living with OA Denmark (GLA:D) and alternative fitness practices including yoga, Tai Chi, or Pilates.
  • Portable oxygen tanks vs. piped in oxygen at the bedside in hospitals, or oxygen concentrators available for in-home use
  • Home made sandbags vs. off-the-shelf retail cuff weights and dumbbells
  • Stationary bicycles vs high tech computerised models
  • Electrotherapy treatment provided in rehabilitation departments vs. machines sold for home use and online
  • Ice pack made individually with plastic bags and crushed ice vs. freezer gel packs
  • Serial splinting for patients with spasticity vs. botulinum toxin

Posted by Dave Nicholls

Dr. Nicholls is an Associate Professor in the School of Public Health and Psychosocial Studies, AUT University, Auckland, New Zealand. He is a physiotherapist, lecturer, researcher and writer, with a passion for critical thinking in and around the physical therapies. David is the founder of the Critical Physiotherapy Network, an organisation that promotes the use of cultural studies, education, history, philosophy, sociology, and a range of other disciplines in the study of the profession’s past, present and future. David’s own research work focuses on the critical history of physiotherapy and considers how physiotherapy might need to adapt to the changing economy of health care in the 21st century. He has published 35 peer-reviewed articles and 17 book chapters, many as first author. He is also very active on social media, writing more than 500 blogposts for criticalphysio.net in the last three years. David has taught in physiotherapy programmes in the UK and New Zealand for over 25 years and has presented his work all around the world. The End of Physiotherapy – the first book-length critical history of physiotherapy, and written by David – was published by Routledge in mid-2017.

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