REP 28 - The grey areas of physiotherapy practice in health, wellness and prevention: the good, the bad and the “to be determined”
As a physiotherapist working in an extremely connected and evolving landscape, there are several challenges that come with navigating the world of health and wellness.
With the rise of social media, blogging and web presences, lines are starting to become blurred and different types of professionals are entering the rehabilitation space.
Personal trainers and fitness professionals are starting to market themselves as “rehabilitation specialists” or “Master’s fitness clinicians”. With large amounts of physiotherapists using modalities and manual therapy as their go-to forms of treatment, exercise professionals are beginning to fill the gaps.
My newsfeeds are inundated with comments from personal trainers about failed therapy stints for their clients, as well as the easing of musculoskeletal injury through proper exercise prescription practices.
“They don’t need a physiotherapist; they just need to be on a strengthening program.”
But as a physiotherapist in a rehabilitation space, I also ask myself “where does rehabilitation start and end?” Where do we fit into the health and prevention space?
This post shares some of the good, bad and grey areas of practice I have observed working in a gym setting. These practices range from fraud, to inappropriate use of support personnel, to proper integration into a lifelong exercise routine, and everything in between.
As I have attempted to navigate this space, I have come across some great practices and some not-so-great ones.
I began my physiotherapy career in a gym setting. I had the entire gym at my disposal to help clients with exercise-based rehabilitation. I used a combination of manual therapy, mobility work and exercise prescription to help my clients and I saw incredible results.
However, the more I worked in a gym environment, the more I discovered grey areas, or question marks that cause a clinician to stop and pause.
Here are a few of my observations.
As a physiotherapist in a gym setting, I witnessed an amazing opportunity for the continuation of exercise. Exercise became not a simple snapshot in time, but a lifelong endeavour.
By performing rehabilitation in a gym setting, clients who didn’t feel comfortable eased into their surroundings. As they worked with a physiotherapist in this athletic environment, clients who had never before set foot in a gym gained confidence.
The therapeutic exercise program given by the therapist creates a solid foundation for confidence with exercise and allows for a person to continue on in that setting, if they so choose. Clients learn equipment recognition and the skills to use them, which lowers the barrier for entry for practicing regular exercise.
As primary care providers, physiotherapists have an incredible opportunity to speak about healthy lifestyle practices with every person coming through their doors. Sleep, stress, nutrition and movement are all important aspects of the rehabilitation process not only for a patient’s current injury, but for future prevention.
Physiotherapists are in a wonderful position to start these types of conversations, not only with clients, but with other members of the healthcare team.
Physiotherapists have the opportunity to collaborate with other healthcare providers to provide a comprehensive health management team. More physiotherapists are now referring clients to dieticians, nutritionists, osteopaths and other health professionals and are working closely with physicians to provide clients with the best quality of care.
As in every profession, there are physiotherapists who try to take advantage of this new grey area.
While working at the gym, I was approached by a man who represented a “physiotherapy company” who asked if our staff would be willing to partner with them. Unaware that I was a physiotherapist, he proposed allowing clients to claim gym memberships through their physiotherapy benefits.
He explained that the company would provide the registration number of one of their staff, who would periodically come in to do “assessments.” Our staff would then use the physiotherapist’s registration number to bill gym member’s physiotherapy insurance.
I made the man aware that I was a physiotherapist and asked for the name of the physiotherapist who was willing to share their registration number, he promptly left.
While I felt upset by the interaction, I could understand how a gym owner who might not have knowledge of the rules and regulations for physiotherapist insurance claims might be tempted to participate in this blatant fraud.
I’ve heard of other healthcare professionals connecting with gyms to create similar “deals,” which usually benefit the healthcare professionals more than the clients.
They often go something like this:
“If you see me [the healthcare professional] x amount of times per month for treatment, then you can use the gym facility for free”.
In this example, clients are still monitored by a healthcare provider, but largely without specific goals for therapy. This “deal” also includes inflated costs of treatment to cover the membership of the gym. I have seen this practice often in gyms, and it is often taken advantage of by clients with unlimited physiotherapy coverage.
On numerous occasions, I have been asked to participate in this “deal” and have promptly educated my clients about the fraudulent nature of this arrangement.
Another “bad” I have observed is the inappropriate use of support personnel. Physiotherapists complete assessments, then delegate care to a personal trainer.
In this example, personal trainers are in charge of generating and executing exercise programs.
I have seen instances where physiotherapists do not conduct a re-assessment, and others where there is a periodic check in. These instances create opportunities for clients to get personal training covered under their insurance benefits.
This is also fraud and is not endorsed by the College of Physiotherapists in any province.
In these scenarios, physiotherapists place their licenses at risk and create doubt in the minds of the insurers who fund these programs.
As a profession, we need to hold ourselves accountable and ensure that we are practicing in a way that is ethically sound.
The to-be determined
I still have some questions about the prevention environment. From my experiences, there are a few “grey areas” that I would love clarification on how to navigate:
- Exercise for management chronic conditions. Physiotherapists have learned ways to help people begin exercising after heart attacks, strokes, lung diseases, cancers and a whole slew of chronic conditions. But when do these programs start and end? For example, cardiac rehabilitation takes three months in the public sector, but guidelines recommend one year. What is the best model for physiotherapists to adopt that help persons exercise when they have symptoms which may limit their capacity to do so?
- Private physiotherapy in small groups. This is prevalent in the public sector because it is both physically and cost effective, with a recent systematic review concluding that group physiotherapy may be more effective than one-on-one sessions). However, this type of physiotherapy is not covered in the private sector. Where does chronic disease management end and group fitness begin?
- Risk factors. We are in an era where hypertension, diabetes and chronic low back pain are sky rocketing. Physiotherapists have tools to help combat all of these things. But what is the best way for us to get involved?
Over to you
1. What thoughts can you share about the “to be determined” areas?
2. What are some of the other areas of practice that physiotherapists are interested in navigating but just aren’t sure how?
3. Wellness coaches are becoming increasingly prevalent, but isn’t that essentially what a physiotherapist is as well?
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