Case of the Month

Read real cases and their outcomes

Is what you’re doing REALLY physiotherapy? Or is it something else…

Sep 07, 2017

The Situation

Over the years, Ruth’s (not the PT’s real name) practice had evolved considerably from traditional physiotherapy toward more alternative therapies. Many of her patients came to her through word of mouth for things like anxiety, anger issues, headaches, treatment of concussions and chronic fatigue.

When Ruth was randomly selected for a College practice assessment for the first time in her long career, she was open, honest and passionate about providing her clients with care. But through the assessment process it came out that Ruth did not conduct traditional physiotherapy assessments. 

Ruth said that she “used her hands to listen to a patient’s body” to target an intervention. She didn’t always ask for a medical history and her records did not include notes about assessment, reassessment, the diagnosis and a treatment plan. When asked about what she did to continue to learn and grow as a physiotherapist, Ruth reported that she had taken a number of courses and ongoing education, but none of appeared to be strictly physiotherapy-related.

Her peer Practice Assessor was unsettled.   Her report to the College scored Ruth low in all areas, but more importantly, identified that the real problem lay in assessing the quality of the treatment, as the treatments being provided were completely different than anything taught in physiotherapy training programs and there are no physiotherapy practice standards or guidelines that applied.   The assessor could not determine whether the treatments provided were appropriate or adequate or properly performed because they seemed to be entirely outside the realm of physiotherapy.

Ruth provided a written submission to the College to address the areas of concern identified by the Assessor. She responded thoughtfully, acknowledging that she did not follow the standard model of care and provided additional information about her history as a physiotherapist and her current practices.  

What Happened

A College staff person called Ruth to discuss the results of her practice assessment.

Together, they discussed whether the types of treatments that Ruth was providing to her patients really fell within a reasonable description of the practice of physiotherapy.

Through the conversation, Ruth came to the conclusion that while her physiotherapy training provided important background for the area in which she was presently practicing, what she was doing had drifted far from the practice of physiotherapy.   This is not to say that there was anything inappropriate about what she was doing - she and her patients agreed that she was providing valuable services – it just wasn’t physio.

In the end, Ruth made the decision to resign from the College.  She wouldn’t be able to meet the practice requirements for physiotherapy, but that didn’t really matter to her.  After a wonderful 30 year career, she decided to continue her current practice, but no longer use the title physiotherapist or bill her services as physiotherapy. 

Have a Look at a Tool to Evaluate Emerging and Alternative Therapies

It's harder than you think to define “physiotherapy” and, depending on the context, you might get different answers.
If you are ever in a situation where you are not 100% certain if the modality you are using meets the definition of physiotherapy, contact the College’s Practice Advisor at or 647-484-8800 or 1-800-583-5885.

Or work through the series of questions laid out in the “Is It Physiotherapy? Tools” created by a national group of physiotherapy regulators.  

Is it Physiotherapy? Tool
Is it Physiotherapy Tool? (FRENCH)

Is it Physiotherapy? Decision Making Tree

Leave a comment
  1. H | Sep 27, 2017

    Interesting. It may not have been as much about the method and whether it helped people, but the fact that "she didn’t always ask for a medical history and her records did not include notes about assessment, reassessment, the diagnosis and a treatment plan."



  2. J | Sep 24, 2017
    I would be interested to know what method Ruth was using. According to the decision making tree "Is there evidence indicating that the skill or service is effective, safe and a benefit to patients?" There are many treatments such as acupuncture that in many studies seem to be comparable to placebo thus not showing they are very effective, on top of that sticking needles in people has it's risk. Yet it is regulated. If an intervention that does not show to be clearly better than placebo is regulated to the college then as long as Ruth was helping people feel better it should be allowed as well.

    Leave a comment

    Comment Form

    Practice Advice

    Free and anonymous advice for patients, physios, students and employers.
    Learn More