Physiotherapy in NZ

[emad]

In New Zealand There is an Act will come into force in spet .18,2004 which is called The Health Practitioners Competence Assurance Act (HPCA)


Physiotherapists will be identified as :

Physiotherapists

The Practice of Physiotherapy

The practice of physiotherapy is described as including:

assessing, diagnosing, treating, reporting or giving advice in the capacity of a physiotherapist, using the knowledge, skills, attitudes and competence initially attained for registration as a physiotherapist in New Zealand and built upon in postgraduate and continuing physiotherapy education and wherever there could be an issue of public safety;
advertising, holding out to the public, or representing in any manner that one is authorised to practice physiotherapy in New Zealand.
“Practice” in this context goes wider than clinical medicine to include teaching, research, medical or health management, in hospitals, clinics, general practices and community and institutional contexts, whether paid or voluntary, given that such roles influence clinical practice and public safety.

General Scope of Physiotherapy

“Physiotherapists are registered healthcare practitioners educated to apply scientific knowledge and clinical reasoning to assess, diagnose and manage human function. They promote mobility, health and independence; rehabilitate; and maximize potential for activity.”



This act will come with new thing called scope of practice , which means every profession will choose on activity ,technique.......which not allowed to other professions to practise .

this is good for phystherapists , which type of physio . do you think must be performed by physios only ?

And what is your view regarding the physio defination in NZ .


cheers
emad

[Anonymous]

Hi Emad,
In the US our scope of practice has significant legal importance. It is used to limit non PTs from claiming that they provide PT. Examples are chiros and even some gyms that do not have a PT on their staff. It is also used to hold us accountable to some degree, so that we don't go claiming to provide chiropractic or whatever. Useful as a legal tool, not as a clinical one.

Cory

[emad]

Hi Cory:

Your view so is that scope of practice is useful as legal tool ,not as clinical tool.

It seems that the health care gives more importance to legal issues more that clinical aspects , this is so clear in dealing with insurance companies.


Cory ,what type of physio chiros can not perform their in USA ,i mean which techniques ?

cheers
emad

[BB]

Hi Emad,

I don't think it actually limits the chiros from doing any techniques, they just can't call it physical therapy. On the other hand, in my state of washington, I cannot legally perform manipulation (I don't think that I would anyway).

X-rays and ordering imaging is out of our scope. Prescribing medication is out of both the chiros and our scope. And so on.

I know of a therapist who caught a local gym advertising that they offerred work hardening (a program to get injured workers back in shape for their jobs). He called them on it because this is something that is considered physical therapy and they did not have a PT. This may be out of the chiro scope, but I'm not sure. I've never heard of one doing it or doing the tests such as FCEs and so on.

Cory

[nari]

In Australia, chiros can perform all electrotherapy, exercises,mobilisations and manips performed by physios, but they cannot call it 'physiotherapy' or "physical therapy" - although the latter name is being used by all sorts of exercise-prescribing people including masseurs and also trainers and vets.
What we may be moving towards is prescription of NSAIDS, but we can easily order XRs through the GP, and that is quite easy to do.

I really cannot think of anything that is, or should be exclusively 'ours', but we are better at doing some things than other professionals are, because we have more relevant knowledge behind us.. -eg sport stuff.

The legal issues behind chiros practising 'physiotherapy' should be clearer if they are specifically taught in undergrad (or postgrad) to perform techniques we call 'ours', we then cannot really claim them to be ours alone. Nor can we stop (can we?)chiro and osteo colleges throughout the world from teaching PT techniques.

Nari

[nari]

Bernard

All techniques, be they traction, or muscle energy, or just exercises, or (dare I say) electrotherapy or passive mobilisation, will benefit some people in some way.

I have known physios who do nothing much else than traction, and it works well for some.

I think we need to move into a clinical situation where we place much more emphasis on people doing their own "physiotherapy", with guidance and strategies from us. If we can grasp more and more of the concept of where pain is coming from, and how it is modulated and where, this is a positive step forwards. I do think this is what NOI is trying to do, but we just do not know enough yet.

If someone recovers rapidly with exercises and facilitation of natural movements and functional movements, that is good. It tends not to change the status of people locked in fear of movement and pain - these are the ones which NOI is trying to address.

Only a few ideas.

Nari

[bernard]

Hello Nari,

If someone recovers rapidly with exercises and facilitation of natural movements and functional movements, that is good. It tends not to change the status of people locked in fear of movement and pain - these are the ones which NOI is trying to address.

Are you trying to fool me? :wink:
Graded exposure and movements made without fear and pain are the basis of natural movements.

We are, on Somasimple, trained with the same concepts but we aren't directed in only one direction. :roll:

[emad]

Hi Bernard:

I choosed to read every post and reply , this for your first post .

I agree abslouetly with you , we should keep up to date with all concepts ,skills ,tecniques :arrow: evidence ,reasoning ,research.

Then apply those concepts to practice and assess ,evalute ,monitor ,audit ,review to ssure the outcomes :arrow: If working ,that is okay :!: However ,i think ,and convinced we have to apply personally ,individualised approaches :arrow: this is why this technique work with patient number 1 ,but not working with patient number 2 .


Indepandncy

Any thing ,concept ,appraoch that do NOT endorse /encourge/promote independant consumer is not working ethically /working on subconscious level/has defects /like to make the consumer unaware .

This a process of Learning , learning both of the patient and therapist .

Noi does not promote indepandcy , may be a true problem/crisis if they intend to do this /insist to make of therapists dependant on them ....

cheers

emad

[emad]

Hi Nari:

Nari wrote

a clinical situation where we place much more emphasis on people doing their own "physiotherapy", with guidance and strategies from us

This is fine what i do those days , however reacging this manner is so difficult, and this why some physiotherapy schools changed to be schools of physical education.

But i would ask you the most important thing is doing ,encourging while on the conscious level,awarness , may NOI promote what you mentioned but not on the conscious level of therapists thinking /percepation/awarness .


cheers
emad

[emad]

Hi Bernard & Nari :

There is difference .

On NOI they encourge natural motions as part of Neurodynamics ( neural mobilis ) Only .

But , as part of considering fear of motion and reflexes i do noy think so .


cheers
emad

[fapt]

Well, Physiotherapy in Taiwan is different in the word
The practice of physiotherapy is described as including:

assessing, diagnosing, treating, reporting or giving advice in the capacity of a physiotherapist, using the knowledge, skills, attitudes and competence initially attained for registration as a physiotherapist


In our medical system, Physical therapy is Not independent in Taiwan, and they need to obey Dr order, and our insurance should pay the money if you have Dr diagnosis. And the Physical therapy private clinic, people can't go there without Dr order. :x I think these limit PT to growth-up yet. We always do Not assessment patient and set a goal because we should obey the orders... :cry:

We can do manipulation, traction, mobilization, and ES for patient. But most of them like to go to traditional chinese medicine to manipulation there spine problem, and these bone-setter arenot illegal and there are no raws can astrict. If they do not cue the pain, they will go to see PT. By the way, In taiwan, there are no chiros and osteo.

Because these factors, for a long time, many staffs in clinic are burn-out and look it down these professional. :cry: