Scope of Practice

An un deniable fact that all health care professions evolve as the  evidence base expands and as demographics and technologies change this leverages the scope of practice for a qualified Physiotherapist. A conventional practice of future was once and exprimental practice in the past. As this journey of evolution continues, the public’s safety must be protected, physiotherapy practice must continue to be evidence informed and regulation should support, not hinder, these goals.

Working withing the scope of practice is the profesionalism adopted by and qualitfied physiotherapist. A physiotherapist must not only work within the boundaries of scope of practice, but also within the scope of the profession that defines Physiotherapy and its specialities. A physiotherapist can always expand their skill set and scope of practice by getting trained and certified by various treatment specific training programs that are offered by recognied intitures of Physiotherapies. The competancy level of the Physiotherapist are enhanced by various training, resulting in broader scope of work.

The Scope of practice of a Physiotherapisy revolves around 4 pillars of practice. These are:

1. Massage
2. Exercise and movement
3. Electrotherapy
4. Kindred methods of treatment

PRESCRIBING

Prescribing may appear a strange addition to a physiotherapist’s toolkit and outside the remit of the profession. This means that before prescribing can be deemed a suitable addition to a physiotherapist’s skill set, they must already be an expert in the field they wish to apply it. As a consequence, although the scope of prescribing within physiotherapy is very wide, it is limited to only an individual's clinical speciality. This is a major difference from medical prescribing who may prescribe for any condition. Once a physiotherapist decides that prescribing would be of benefit to their practice there are two types of prescriber they can become, based on their level of training supplementary prescribes or independent subscribers.

Evidence Base For Prescribing Within Physiotherapy.

Physiotherapy lacks the overall high-quality evidence for the effectiveness of prescribing, even then there are numerous endorsed benefits . Accurate Diagnosis has a direct impact on effective prescribing of the prescriber. Physiotherapists in a range of MSK advanced scope roles have be shown through randomised controlled trials and systematic reviews to have equal diagnostic skill to orthopaedic surgeons and to be more accurate than other healthcare professionals, including non-orthopaedic physicians.

The following pre-requisites are necessary so safely undertake the role of prescribing:

1. Understand the legal context relevant to prescribing
2. Understand pharmacodynamics, pharmacokinetics, pharmacology and therapeutics relevant to prescribing
3. Understand different prescribing mechanisms
4. Able to make prescribing decisions based on relevant physical examination assessment and history taking
5. Able to communicate information about medicines and prescriptions clearly
6. Able to monitor response to medications and modify or cease treatment as appropriate within scope of practice
7. Able to undertake medication calculations
8. Able to identify adverse medication reactions, interactions and take appropriate action
9. Able to recognise medication error and respond appropriately

LEGISLATIVE & REGULATORY CONSIDERATIONS

1. Does anything in the jurisdiction’s practice act/regulations prohibit the activity or mention anything to support the activity?
2. Consider the purpose of the activity/service. How does the definition of physiotherapy in your jurisdiction speak to this?
3. Is this a restricted, controlled or authorized act?