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Caught Up in the Cryo Hype

Jul 18, 2018

The Situation

It seems like the hype around cryotherapy has been all over the internet and media for the past few years, but as a health professional, where do you draw the line? In this case a physiotherapist owned a physiotherapy clinic that began offering full body cryotherapy to patients where they entered a cabin filled with nitrogen cooled air, reaching extremely low temperatures of approximately -166 degrees Celsius for two to three minutes. The clinic ran an ad in the local paper and distributed pamphlets to patients and the public to promote the new service. The materials indicated that cryotherapy is a recognized standard of care in Europe to treat a variety of conditions including rheumatoid arthritis, weight challenges and immunity deficiencies…even though no concrete, medical-based evidence was available to back up these claims. Furthermore, the materials included an array of alleged testimonials from celebrities and elite athletes.

Upon investigation, the College found that a number of patients visited the clinic for cryotherapy sessions but were never seen by a registered PT, given proper assessments or made aware of the risks of treatment. Additionally, the sessions were billed as physiotherapy even though the treatment wasn’t added to the plan of care by a registered physiotherapist, and no clinical basis or explanation for the treatment was made. 

The Standards 

The way in which the treatment was administered was problematic and goes against a number of College Standards.

  1. The PT never assessed the patient, so the patient didn’t actually receive physiotherapy care.
  2. Without being informed of the risks of treatment by a PT were the patients able to properly consent?
  3. Where the patient was assessed by the PT there was no clinical reasoning to support the use of cryotherapy.
  4. The FDA and Health Canada have issued warnings about the use of cryotherapy cabins.

The PT did not properly assess patients prior to treatment (if at all) nor supervise physiotherapy assistants who were administering the sessions. Finally, the PT wrongfully used their registration number to bill for treatments that did not qualify as physiotherapy, occasionally at the request of the patient. 
 
Additionally, the materials distributed by the physiotherapist to patients and the public were in violation of the College’s Advertising Standard for a variety of reasons. Not only did the advertising materials contain information that was misleading to the public and could not be classified as true, accurate or verifiable, they also implied treatment results that could not be guaranteed and contained endorsements and testimonials.

The Outcome 

A Committee at the College makes decisions about these cases. The Inquiries, Complaints and Reports Committee (made up of PTs and members of the public) will decide if the matter should be referred to the Discipline Committee for a public hearing or if some other action is reasonable.

Given the situation what do you think is a fair outcome? Comment with your recommendation from the options listed below.

a. The Committee should do nothing—there are no Standards that can be applied to this type of treatment. Cryotherapy is an evolving treatment, If patients are interested they should have the opportunity to experience it.

b. The PT should be forced to remove all the advertising related to the treatment – it is very misleading and the use of testimonials, endorsements and guarantees is not fair to other physiotherapists. 

c. The PT should be suspended for violating a number of College Standards, most importantly inappropriate billing practices and not meeting their professional duties while working with PTAs. 

d. This is serious and grounds for license revocation.
 
Leave a comment
  1. Karen Treleaven | Jul 30, 2018
    Because the PT clearly violated the above mentioned 4 standards, I believe C is clearly the appropriate response.
  2. MA | Jul 28, 2018

    It is hard to make a choice but to the committee to consider that license revocation means destroying PT's and his family's future. especially no harms reported to no any of his clients.

    I would go with B 

     
  3. BishH | Jul 26, 2018
    Quite clearly it is C. Is the poster "John" the actual Physiotherapist in this case ? Numerous Standards have been contravened in this case. I am glad our College takes these matters seriously, maybe the College of Nurses will smarten-up after the Wettlaufer hearings.
  4. John M | Jul 25, 2018

    On Behalf of the patient:

    Hello all, I have to go with option "A" - The Committee should do nothing. We live in a world of technology and ever-growing therapies for the human body. We see athletes and individuals who push their bodies to complete extremes on a regular day basis use these new technologies to rejuvenate their bodies and to help them recover. Why must regular individuals who visit their PT to help with aches, pains and soreness be limited to aged technology and aged procedures? Why must I only be allowed to visit a Chiropractor who will do nothing to my back and pains but am not allowed to be referred to a Cryotherapy chamber that I know has worked for me based on experience? These comments are based on actual experiences. Multiple visits to a Chiropractor left me never wanting to go again vs multiple Cryotherapy sessions that helped me feel more positive than ever. Multiple Cryotherapy sessions have without a doubt in my mind also trumped the pads that are placed on my body to send shock waves to my nerves. I find that people who get up and say Cryotherapy and or Cold Therapy is bad for you and should not be a means to help recover is absurd. What reasoning do they have, for all the doctors that throw these treatments under the rug, there are double the amount of individuals who can say that these treatments have helped them recover more than many of the treatments suggested to them in the past. It has been proven that Cryotherapy increases norepinephrine, activates cold shock proteins, decreases inflammation, improves immune function, increases metabolism, and increases antioxidant activity. This is not new science. It has been proven to help heal time and time again. These effects do come from multiple and consistent treatments rather than one off's here and there, but the fact of the matter is that if a PT decides to include it in his or her treatment session to their patient, why can't they? Why can't they do what is in the best interest of the patient? What is the fear of helping someone gain the best results while using the best treatments at their disposal? Why remain in pain if you can prevent it, that is where I get confused when reading all these articles. If you are able to help an individual feel better by using means that may help them on a regular basis, than that is what should be done 10 out of 10 times.  Having done these treatments on a regular basis, I can gladly and honestly stand by everything I have just mentioned in the most positive matter. Thank you for reading all that I had to say.

     

     

  5. Jon M. | Jul 25, 2018

    Hello all, 

    I have to go with disciplinary action being taken by the board if referring to anything related to misinformation and especially towards not monitoring the treatments. That is simply a lack of care and professionalism as monitoring the sessions and informing the patients of clear, honest and truthful information is what matters most.

    But if we are referring to the actual use and referral of Cryotherapy as part of PT Treatment sessions, I have to go with option "A" - The Committee should do nothing.

    We live in a world of technology and ever growing therapies for the human body. We see athletes and individuals who push their bodies to complete extremes on a regular day basis use these new technologies to rejuvenate their bodies and to help them recover.

    Why must regular individuals who visit their PT to help with aches, pains and soreness be limited to aged technology and aged procedures? Why must I only be allowed to visit a Chiropractor who will do nothing to my back and pains but am not allowed to be referred to a Cryotherapy chamber that I know has worked for me based on experience? These comments are based on actual experiences. Multiple visits to a Chiropractor left me never wanting to go again vs multiple Cryotherapy sessions that helped me feel more positive than ever. Multiple Cryotherapy sessions have without a doubt in my mind also trumped the pads that are placed on my body to send shock waves to my nerves. 

    I find that people who get up and say Cryotherapy and or Cold Therapy is bad for you and should not be a means to help recover is absurd. What reasoning do they have, for all the doctors that throw these treatments under the rug, there are double the amount of individuals who can say that these treatments have helped them recover more than many of the treatments suggested to them in the past.

    It has been proven that Cryotherapy increases norepinephrine, activates cold shock proteins, decreases inflammation, improves immune function, increases metabolism, and increases antioxidant activity. This is not new science. It has been proven to help heal time and time again. These effects do come from multiple and consistent treatments rather than one off's here and there.

    The fact of the matter is that if a PT decides to include it in his or her treatment session to their patient, why can't they? Why can't they do what is in the best interest of the patient? What is the fear of helping someone gain the best results while using the best treatments at their disposal? Why remain in pain if you can prevent it, that is where I get confused when reading all these articles. 

    If you are able to help an individual feel better by using means that may help them on a regular basis, than that is what should be done 10 out of 10 times. 

    Having done these treatments on a regular basis, I can gladly and honestly stand by everything I have just mentioned in the most positive matter. Thank you for reading all that I had to say.  

  6. John H Wright | Jul 25, 2018

    In this case the use of Cryotherapy is not the principle concern. The lack of evidence of effectiveness is not a barrier to inclusion in a treatment plan. One could argue that use of modalities like ultrasound and laser, very common in clinical practice, would be examples which very few practitioners would consider ‘malpractice’, but lack clear evidence of efficacy  

    The advertising standard is clear and evidence suggests that it was violated  

    Of most concern to me is the lack of PT assessment and plan, billing for services not provided and assignment to R.A. without appropriate supervision.I refer the reader to case 2015 - 0113 that in my opinion is similar. The findings and sanctions in this example were reasonable, refecting a balance between punishment (suspention and fine) and remediation (education and supervision). Except in very extreme cases I believe there should always be a path to redemption as the above sanctions offer, hence I would not support outright revocation. 

  7. Marilyn Holmes | Jul 25, 2018
    C, however pending results of a discipline or other hearing, possibly D. 
  8. David Graham | Jul 25, 2018

    The CPO has no problem with a physiotherapist using an "alternative" treatment provided the physio first did a traditional physio-therapeutic assessment, then offered the patient a traditional treatment before offering the "alternative" treatment, explaining to the patient the reasons for the "alternative" treatment and getting consent etc. 

    The patient has the right to choose treatments, even ones that are ineffective or even if those treatments cause harm. 

    This allows a physio to offer a questionable treatment like cryotherapy, or Matrix Repatterning which involves the magical entrainment of the therapist's and patient's energy fields, or the waiving of a dead chicken over a patient.

    Physiotherapists should not be allowed to offer their patients quackery.

     

     

     

     

  9. Tim Childs | Jul 20, 2018

    C: If contextual factors are in play (ie the PT was a new grad and the power imbalance lead them to go along with this, or the physio can legitimately demonstrate they were unaware of improper billing practices) I believe sanctioning is appropriate below the threshold of licence revocation. Unfortunately, it does not seem like that was the case in this scenario

    However, in general I feel our regulatory body is too hesitant to revoke the licence of members who practice unethically. The best case scenario is that the person was unaware of existing standards - I do not want a person that ignorant of their obligations carrying the same designation as myself. Worst case, it was deliberate and malicious. A simple ethics webinar will not cut it. People do not commit ethical infractions because they don't know it's unethical. They do it because they do not care or figure they will not get caught. Examples need to be made. If other professions choose to operate that way, that is their business. I hold PTs to a higher standard.

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