Issues in practice

ISSUES IN PRACTICE

Physiotherapists and the Assessment, Prescription and Dispensing of Orthotics

The use of orthotics is increasing (Canadian Physiotherapy Association)

The use of orthotics in the treatment of mobility and pain disorders has increased over the past several years. There are many valid reasons for this increased utilization:

Increased research and evidence in the use of orthotics in the treatment of soft tissue injuries
Increased public awareness of the importance of proper footwear;
Advances in orthotic devices and diagnostic equipment;
The aging of the Canadian population;
An increasing number of providers and dispensers.
The emergence of screening clinics identifying more disorders related to foot biomechanics.

Other reasons can contribute to increased utilization of orthotics, to varying degrees:

The proliferation of for-profit franchises dealing in orthotics;
Fraud or excessive utilization of orthotics that is unsupported by clinical reasoning and best practice;
Advances in prescription technology facilitating those with insufficient education and qualification to prescribe orthotics.

Some insurers say physiotherapists are not eligible to prescribe orthotics

Recently, extended health benefit insurers have sought ways to minimize cost increases in this area. One approach has been to limit those providers (regulated and unregulated) who can bill insurance plans for the assessment, prescription and dispensing of orthotics.

Physiotherapists in many provinces have received letters from a few extended health benefit insurers indicating that their profession is no longer eligible to bill for these services, which are provided within the normal course of treating of individuals insured by these plans, as deemed appropriate.

In most (if not all) provinces, the assessment, prescription and dispensing of orthotics are not controlled or protected acts within provincial health professional regulation. These activities are therefore in the public domain and not subject to restrictions related to scope of practice.

Physiotherapists are well-qualified to assess for, prescribe and dispense orthotics

It is the position of the Canadian Physiotherapy Association, supported by health professional legislation, that the assessment, prescription and dispensing of orthotics are activities within the scope of practice of a physiotherapist.

Physiotherapists graduate from university-based programs at a baccalaureate or professional master’s level.

They represent one of the few regulated health professions to be educated with the knowledge, skills and judgment to determine whether orthotics are required as part of a comprehensive treatment program, to assess their impact on function, and to evaluate outcomes.

Removing a highly qualified provider, such as a physiotherapist, from a list of providers allowed to bill for these services does not address the cost concerns of the insurance industry, but can result in limiting access to needed services by affected consumers.

CPA supports all stakeholders of the Canadian health system in their efforts to contain rising health care costs, but also believes it is equally important to ensure their clients have access to high quality care and services. We look forward to working with the Canadian Life and Health Insurance Association, its members and other extended health benefit insurers in the achievement of this goal.

Facts about Physiotherapists and Orthotics

The scope of practice of physiotherapists includes the assessment, prescription and dispensing of orthotics.

Physiotherapists are well qualified to assess dysfunction, injury or pain related to foot biomechanics and to assess for, prescribe and dispense orthotics in the treatment of dysfunction, injury or pain.

Scope of practice for regulated health professionals, such as physiotherapists, is set by provincial legislation in all provinces.

The scope of practice of physiotherapists includes assessment of physical dysfunction and the treatment, rehabilitation and prevention of this dysfunction, injury or pain. (Adapted from the Physiotherapy Act in Ontario, Physiotherapy Act 1991, c.37, s.3.)

In Description of Physiotherapy in Canada: 2000 and Beyond, assessment, diagnosis and interventions are listed as some of many primary functions of physiotherapists.

CPA includes the ‘prescription, fabrication and application of assistive, adaptive, supportive and protective devices and equipment’ as one grouping of interventions performed by physiotherapists.

Both scope and description include all activities related to the assessment, prescription and dispensing of orthotics.

Orthotics are only one component of the physiotherapist’s approach to the assessment, treatment and prevention of problems related to foot biomechanics.

Physiotherapists Entry-level curriculum includes, but is not limited to, the study of:

Biological studies including anatomy, physiology, pathology, pathokinesiology
Applied sciences including human development, biomechanics and exercise physiology
Clinical sciences including physical and functional pharmacology

In addition, the knowledge base of physiotherapists is solidified through over 1,000 hours, throughout the curriculum, learning within a clinical setting prior to graduation.

Physiotherapists pursue continuing education opportunities, further developing a knowledge base in their chosen area of practice such as neurology, orthopedics, and senior’s health.

Removing qualified, regulated health professionals, such as physiotherapists, from a list of qualified professionals seems in opposition to the best interest of the public.

Limiting competition between qualified regulated health professionals will not address cost concerns in this area

CPA believes that limiting the number of qualified regulated health professionals allowed to bill for the assessment, prescription and dispensing of orthotics will:

Reduce needed competition within this market. Cost savings are realized through competition. These savings are lost as the number of accessible qualified health professionals is reduced allowing the development of monopolies for services within some geographical areas;
Reduce access to needed services by the client where there are limited numbers of qualified health professionals, such as physiotherapists; and
Limit choice of health professional by the consumer for these services. This will likely result in an increased number of professionals involved in the care of one client, increased assessments and visits as clients attending physiotherapy must access orthotic services through another professional (regulated or unregulated).

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