REP 7 - Advocating for the Role of Physiotherapists in Animal Rehabilitation
Sue Van Evra & Laurie Edge-Hughes, CPA Animal Rehab Division - Advocacy Committee
Perhaps you think that the role of a division is simply education and knowledge translation. While that is one ‘hat’ a division may wear, advocacy is another! The Animal Rehabilitation Division (ARD) advocates that physiotherapists are the professionals of choice to provide animal rehabilitation.
The vision of the ARD is to:
- Improve the neuromusculoskeletal health of animals
- Promote the advancement of clinical practice in animal rehabilitation
- Increase the awareness of and access to animal rehabilitation by physiotherapists
Currently, the practice of animal rehabilitation is unregulated in Canada. Canadian physiotherapy regulators do not recognize or regulate the practice of animal rehabilitation by physiotherapists. Physiotherapists who have completed educational training (i.e. the Diploma in Canine or Equine Rehabilitation through the ARD, a Certificate in Canine / Equine Rehabilitation at institutions in the United States, or Master Degrees in Animal / Veterinary Physiotherapy internationally) are therefore not authorized to use the protected terms and titles of ‘Physiotherapist’, ‘Physical Therapist’ or ‘Physiotherapy’ and ‘Physical Therapy’ when working with animals. As such the terms and titles ‘physio’ or ‘animal rehab therapy / therapist’ are often used by therapists engaged in animal rehabilitation practice.
The ARD has traditionally been a vocal and singular advocate for the role of ARD members in the care of animals in Canada, and it’s our honour to highlight some of the work we have been doing in this arena.
Collaborations in Ontario
The Animal Rehab Division has had a long-standing respectful relationship with the College of Veterinarians of Ontario (CVO) that dates to 2005. At that time, the Animal Rehab Division was asked to provide comment on the proposed changes to the CVO’s Draft Position Statement on Animal Rehabilitation in Veterinary Practice. We were then invited for comment on the 2009 proposed Position Statement on The Practice of Complementary and Alternative Veterinary Medicine. While our comments did not result in sweeping changes to the documents, they did result in smaller yet still meaningful changes. In fact, our response to the 2009 document was commended and we were asked if the CVO could publish it so that members of the public could read it. We believe that speaks volumes!
Our most recent discussions with the CVO began in 2017. This was brought about by the College of Veterinarians of Ontario proposing a ‘Modernization of the Veterinarians Act’ and a new Scope of Practice Model / Framework. With the proposed changes, and specifically the wording as it relates to ‘authorized activities’ (those activities that only a veterinarian is authorized to perform) there would be a deregulation of many aspects of animal healthcare – including many that are currently being provided by physios engaged in animal practice. However, other aspects of animal rehabilitation practice would be hampered if the language of the draft document was to be adopted exactly as created. As a result, and with the risk of other provincial veterinary colleges following suit, the ARD has directed a significant amount of time, energy and resources toward advocacy in Ontario.
Historically, the Ontario Veterinarians Act states that the practice of veterinary medicine “includes the practice of dentistry, obstetrics including ova and embryo transfer, and surgery, in relation to an animal other than a human being.” Additionally, veterinarians have also historically been granted exclusivity regarding the practice of healthcare on animals. However, the CVO has recognized that there was a “lack of efficiency and transparency of the complaints and discipline processes, a mismatch between the current exclusive scope of practice model and public expectation to have choices in selecting a provider for low risk animal health care activities, and a lack of focus on quality assurance mechanisms that manage risks in practice and support public protection.”
With the proposed new Veterinarians Act, the list of proposed ‘authorized activities’ includes:
- Making or communicating a diagnosis identifying a disease, disorder, dysfunction or condition as the cause of an animal’s signs and presentation
- Performing a medical assessment to determine the fitness for purpose or soundness of an animal, or group of animals, on which it is reasonably foreseeable that a person or organization will rely on the assessment.
- Ordering laboratory tests on an animal or on specimens taken from an animal.
- Prescribing, compounding, dispensing, or selling a drug
- Performing a procedure on tissue below the dermis
- Performing a procedure below the surface of a mucous membrane
- Performing a procedure on or below the surfaces of the teeth, including the scaling of teeth and occlusal equilibration
- Performing a procedure on or below the surface of the cornea
- Setting, immobilizing, or casting a fracture of a bone or a dislocation of a joint or a severed tendon
- Administering a substance by injection or inhalation, or monitoring of such
- Moving the joints of the spine beyond the animal’s usual physiological range of motion using a fast, low amplitude thrust
- Putting an instrument, arm, hand, or finger,
i. beyond the external ear canal,
ii. beyond the point in the nasal passages where they normally narrow,
iii. beyond the larynx,
iv. beyond the opening of the urethra,
v. beyond the labia majora,
vi. beyond the anus or cloaca, or
vii. into any other natural or artificial opening into the body
- Applying or ordering the application of a form of energy prescribed by the regulations under this Act
- Performing upon an animal any manual procedure for the diagnosis and/or treatment of pregnancy, sterility, or infertility
- Performing allergy testing
Where did the Animal Rehab Division jump in to advocate for our members?
As in the past, the ARD was included in the first round of consultation processes on the proposed ‘authorized activities’ list. We provided feedback and engaged in our second round of efforts by alerting the public to the proposed changes. The CVO had implemented a public consultation process, and the ARD was quick to let our members and subsequently their clients know about this process and to provide feedback using the CVO’s online survey.
We followed up by writing letters, asking for assistance and support from the College of Physiotherapists of Ontario, the Ontario Physiotherapy Association, and the Canadian Physiotherapy Association. We also contacted the Ministry of Agriculture in Ontario to highlight our concerns.
The results included the creation of a task group consisting of the CPA, OPA, and the ARD, with the goal of engaging the CVO to work with us collaboratively to address our remaining concerns. To this end, we have had three meetings with all parties and are pleased with the directions our talks have moved. We have been exceedingly grateful for being able to collaborate with the Ontario Physiotherapy Association and being able to lean on their political and regulatory savvy when it comes to discussions between different groups.
Some highlights of the progress made in our discussions
Some of the proposed ‘authorized activities’ will be ‘delegate-able’ by a veterinarian (i.e. acupuncture and/or manipulation). Additionally, further discussions have been had regarding the definitions of ‘Applying or ordering the application of a form of energy…’ As these specific activities are of interest to Animal Rehab Division members. The CVO was very open and interested in our input regarding modalities such as laser and shockwave. We are hopeful and optimistic that our voice(s) will be heard as the CVO progresses through the legislative and regulatory process.
All in all, the collaboration has left us feeling confident that the CVO values and wishes to encourage the Vet–Physio relationship.
Our Future Plans
The meetings in Ontario have brought forth the recognition of the need for some degree of regulation. While our educational programs are structured, have a competency component, and culminate in a Diploma, there is still a need for some form of regulation. However, since the Colleges of Physiotherapy / Physical Therapy across Canada are entrenched in the Health Professions Acts, we are likely to need to seek regulation external to the Physiotherapy Colleges. In the absence of authority, become the authority. As such, we are proposing a) to create a registry for non-veterinarian rehab practitioners inclusive of education and competence standards, and b) to have one active branch liaison per province within the next 2 years. It’s an exciting time but we have a LOT more work to do!
Please contact the ARD for more information!