physiotherapy alberta newsletter 2012 issue 3 · magee. the bylaws were amended to reﬂ ect this...

PTIssue 3, 2012 | www

A.ph

lysio

betherapyalbert

rta.ca

a

In this Issue:

Health Workforce Planning

Good Practice: Embracing Diff erent Cultures and Generations in the Workplace

Why workforce planning is an important issue that eff ects you: Member Spotlight

Research in Focus: General vs. Specifi c: Exercises for Chronic Low Back Pain

Member Survey Highlights

PT Alberta | Issue 3, 2012 | www.physiotherapyalberta.cap. 1

PT Alberta is published three times a year by Physiotherapy Alberta* to communicate policies, standards and other important matters to members. All members are expected to read and understand the regulatory items and material within that apply to them. If you have any questions, please contact us.

Staff

Registrar: Dianne MilletteProfessional Practice: Iain MuirCorporate Services: Joyce VogelgesangCompetence/Practice Advice: Audrey LoweComplaints + Conduct: Nancy ChisholmCommunications: Alison BairdRegistration: Erin HowesAccounting/Hearings Director: Jane McKenzieAdministration Support: Haylee O’Reilly

Council 2012/2013

President: Greg CutforthPresident-elect: Grant IrwinMember-at-large: Tress GibsonMember-at-large: Gwen HarrisMember-at-large: Nancy LittkeMember-at-large: Candis WhittallPublic Member: Ron CrossleyStudent Representative: Travis Jones

Physiotherapy Alberta - College +

Association

Suite 300, 10357 - 109 StreetEdmonton, Alberta T5J 1N3

T: 780.438.0338 | 1.800.291.2782F: 780.436.1908info@physiotherapyalberta.cawww.physiotherapyalberta.ca

Leadership + Regulation

2 President + Registrars’ Message3 Council News4 Publication of Conduct Matters9 Membership Update11 Membership Survey Highlights

Professional Practice + Development

15 Good Practice - Embracing Diff erent Cultures and Generations in the Workplace

19 Professional Development20 Webinar Series21 Research in Focus - General vs. Specifi c: Exercises

for Chronic Low Back Pain24 Evidence + Outcomes Conference Overview25 Finding Balance Sponsorship

Communication + Marketing

26 Marketing26 Media Sightings27 Member Spotlight

University News

29 Department of Physical Therapy, U of A

*The College of Physical Therapists of Alberta operates as Physiotherapy Alberta - College + Association.

PT Alberta | Issue 3, 2012 | www.physiotherapyalberta.ca p. 2

Leadership + R

egulation

Dianne Millette, PT

Registrar

Greg Cutforth, PT

Council President

President + Registrars’ Message

We welcome your input and recognize that there is always room for growth, so we will be using the results of our recently completed member survey for our own quality improvement purposes.

The purpose of the survey was to benchmark member understanding of the role and purpose of Physiotherapy Alberta, program awareness, services and resources, and to see if there is alignment of member and Council priorities. The survey also asked about member attitudes and perceptions of the organization’s performance in areas such as registration, conduct, continuing competence, member resources (e.g., newsletter, website), responsiveness of staff , use of social media, and opportunities for involvement with Physiotherapy Alberta.

The results show members have a good understanding about the regulatory and member service roles. Governing the profession, licensing members and setting standards of practice and protecting the public were all noted as core roles. Professional development and communication about the profession is also well understood.

Not surprisingly, there were a few areas where our role is not well known or understood. For example, there is lack of awareness about the practice advisory service. While the majority of respondents did not know about the service, our call volume has grown exponentially. Call volume is up 43% over last year, proving this is an important service that we will to continue to operate.

In terms of important activities, the majority of respondents reported involvement in professional practice issues, promoting leadership in the health system, and clarifying the role of physiotherapists as being important activities. Fewer respondents consider involvement in workforce and health human resources planning to be important. This is one area we wish to address.

We believe that health human resource management and workforce planning is an important regulatory and professional issue. Regulators have a direct role in contributing to the labour market economy by controlling who gets to practice a profession. There is pointed messaging from the federal and provincial governments aimed at regulators to collaborate as key contributors while Canada re-designs it’s immigration system to be faster, targeted and effi cient with fair distribution of immigrants. Economic immigration is the focus of the future and physiotherapists are part of that wave.

In addition to ensuring that our policy related to licensure is fair and evidence based, we are involved in a number of initiatives related to workforce planning and health human resources. We hear quite regularly from members who are concerned about workforce issues such as unfi lled positions and the impact on existing staff , physiotherapists leaving the profession, and the challenges that internationally educated physiotherapists face when trying to become credentialed and licensed to practice.

As a member of the Canadian Alliance of Physiotherapy Regulators, we are currently involved in supporting eff orts to modernize the credentialing system. By way of contributing to policy decisions based on evidence, we look for ways to improve policy and processes to ensure that qualifi ed individuals have the opportunity to demonstrate that they have the competencies to practice physiotherapy in Canada.

Physiotherapy Alberta was the recipient of a Health Canada grant to develop a bridging program for internationally educated physiotherapists. The program intends to support the successful integration of internationally educated physiotherapists in Alberta. While the focus of this program is on the internationally educated, it may be relevant to those interested in returning to the workforce after a period of absence.

Physiotherapy regulators across Canada contribute to the Canadian Institute for Health Information health human resource data collection. This provides standardized data collection about the supply of physiotherapists in Canada. The reports can be found at www.cihi.ca.

Council believes that involvement in health human resource initiatives are an important function of a regulator. Included in this edition are other thoughts on workforce planning and health human resource planning.

As always, we welcome your comments and thoughts.


Lead

ersh

ip +

Reg

ulat

ion Council News

Key highlights, discussions and decisions from Council’s October 19 meeting

Annual report Case 2011-11 and Case 2011-03: there were fi ndings and Council agreed to publish for education purposes only Council approved the 2011 Annual Report for submission with no personal or identifying information released. See to government. The Health Professions Act (HPA) requires pages 4-8.the College to submit an annual report of its activities

to the Minister of Health and Wellness to ensure the Committees

requirements of the HPA are being met. The annual Terms of reference for the Registration and Competence report is also posted on Physiotherapy Alberta’s website Committees were approved. for members’ review.

Carol Puri was appointed Chair of the Registration Council positions Committee.

No nominations for the position of President-elect were Council recommended to the Ministry of Finance and received during the 2012 recruitment process earlier this Enterprise that Melissa Merritt join the Diagnostic year. This lead Council to revisit the process of members and Treatment Protocol Working Group. The focus electing the President. Council decided to return to the of work to date is to review the protocols and make process of members electing Council members-at-large recommendations for amendments to the Minister. Other with Council electing the positions of President and College representatives are Simon Cooke and Dr. David Vice-President from among the members of Council. Magee.The bylaws were amended to refl ect this change and are posted on Physiotherapy Alberta’s website for members’ Marketing program

review.Council approved the 2012/2013 marketing program. The marketing plan for 2012-2013 builds on work of the

Employee compensation

previous two years and continues many of the same Council approved a compensation system for College activities with an addition of some new initiatives. See employees which include: compensation philosophy and page 26 for details.strategies important to the organization.

Social media guidelinesFinancial matters

Council approved social media guidelines. Physiotherapists Council reviewed the 2012/2013 proposed budget and must consider the inherent risks associated with social reserve allocation. media and other on-line activities including the potential

Council amended the 2012/2013 Fee Schedule to exempt for professional discipline when there is unprofessional

individuals from having to pay the application fee if content and/or breeches of privacy. The guidelines were

they (1) request to cancel their registration and (2) apply developed to minimize member’s risks when using social

for reinstatement within the same membership year media and are posted on Physiotherapy Alberta’s website.

following the cancellation date of their registration.

Publication of discipline decisions

Two cases conducted under the Physical Therapy Profession Act were reviewed. Under this legislation, publication decisions are made by Council. One case was reviewed under the Health Professions Act (HPA). Under the HPA decisions are made by a tribunal.

Case 2010-24: there were no fi ndings and Council agreed not to publish any details.


Leadership + R

egulation

Publication of Conduct Matters

Decisions of the Discipline Committee (under Physical Therapy Profession Act) or Hearing Tribunal (under Health Profession Act) are published to educate members about unprofessional behaviour. The publication presents the key analysis & fi ndings and sanctions ordered from the full decision.

Case 2011-11 registration form. The letter stated the College’s concern that the physiotherapist had included Conducted under the Physical Therapy Profession Act. practice hours for 2008, when she held an inactive

Background membership. She denied receiving this letter.

The physiotherapist engaged in professional misconduct • November 24, 2010: The College sent a letter advising

or unskilled practice by engaging in the practice of the physiotherapist that she did not have an active

physiotherapy from about May 1, 2010 to May 4, 2011 while license. The physiotherapist signed that she had

her practice permit and/or registration with the College of received the letter; however, in her testimony stated

Physical Therapists of Alberta(CPTA) was cancelled. that she did not recall receiving the letter.

The Discipline Committee had the opportunity to hear • February 16, 2011: The College sent another letter

the evidence provided by the College and the Member, as after not receiving a response to previous letters.

well as the opportunity to review the materials in CPTA • March 30, 2011: The College received a response from documents and consider the submissions of both parties. the physiotherapist when she submitted a revised

The Committee was presented with evidence to support registration form, after a phone conversation with

the fact that the physiotherapist did not have a license to the Registrar. In this package, the physiotherapist

practice physical therapy for the 2010 year. submitted her application form, with a correction to hours, along with letters she thought she had sent to

• January 6, 2010: The College sent the physiotherapist the College on October 13, 2010 and February 25, 2011.

a letter advising that she did not have a practice These letters did not reach the College offi ce as they

permit. Both parties provided testimony that this appeared to have been faxed to an incorrect number.

letter was not received by the physiotherapist. As well, the College provided the Committee with As the physiotherapist responded to the College

evidence the letter was returned to the College offi ce. on October 13, 2010 and on February 25, 2011, the

The Committee is of the opinion that although this Committee agrees with the College’s submission that the

indicated the physiotherapist may not have been physiotherapist did not have an active permit, and that

aware of this letter, the Committee did not support she was aware at several points in time over the year that

the physiotherapist’s view that she continued to hold she did not have an active permit.

a valid practice permit. The College received an email from Insurance Company

• May 1, 2010: Council minutes show the X requesting verifi cation that the physiotherapist

physiotherapist’s license was cancelled. had an active permit, as she had billed her Insurance approximately $8,000 in physiotherapy services from July

• September 30, 2010: College receives the 8, 2010 until March 23, 2011. The College also received

physiotherapist’s application for a practice permit. an email from Y Insurance Company requesting practice

The Member had initially testifi ed that in May 2010 permit verifi cation from the physiotherapist as they had

she became aware that her College dues had not received an invoice from the physiotherapist for treatment

been paid. In later testimony under cross examination dates of April 1, 5, and 11, 2011.

the physiotherapist stated she was not sure when she became aware that she did not have an active As the fact that the physiotherapist did not have a practice

permit. In any event, it appears that she was aware permit from May 1, 2010 until May 4, 2011 has been

in September 2010 that she did not have a permit, as established, and there were reports that she had billed

she was submitting an application for registration. for physiotherapy services during that time, this evidence indicates that she, in fact, did practice physiotherapy

• October 6, 2010: The College sent a letter to the without a practice permit.

physiotherapist to the address provided on the


Lead

ersh

ip +

Reg

ulat

ion

Registration is a fundamental part of the practice The physiotherapist’s role in acknowledging what she has

of physiotherapy and each physiotherapist has a done was also considered. Although the physiotherapist

positive obligation to ensure that they hold a valid was forthright in her evidence, the Committee is

practice permit. The Committee has considered the not convinced that she was taking an active role in

physiotherapist’s evidence that she was unaware of accepting her responsibility in ensuring not only that

the fact that she did not have a valid practice permit. she had a permit to practice, but that it was solely her

The Committee does not accept this evidence and responsibility to notify the College of any changes to

has referred above to the evidence that establishes her contact information, as well as her responsibility to

that at various times during the relevant period the complete the registration form.

physiotherapist was aware that she had not received The Committee does feel that these factors must also a practice permit. In any event, in the opinion of the be weighed against the fact that the physiotherapist Committee, the physiotherapist had a positive obligation was an experienced therapist who had no previous to ensure that she did have a valid practice permit but complaints brought against her. The Committee also gave she did not meet this professional obligation. consideration to the mitigating factors presented by both

On this issue of whether the proven conduct of the physiotherapist and the College.

practicing without a valid permit constitutes professional Discipline Committee decisionmisconduct or unskilled practice, the Committee

fi nds that the College has established on a balance The Discipline Committee of the College of Physical of probabilities that this proven conduct constituted Therapists of Alberta has had the opportunity to review professional misconduct. the allegation in the Notice of Hearing, hear the evidence

provided by the College and the physiotherapist, review Considerations of the Discipline Committee the material in the Documents of the CPTA, and hear

The Committee agrees with the College’s statement submissions from both parties and have determined that

that practicing without a practice permit is a the allegation as laid out in the Notice of Hearing is well

serious allegation. Failure to consider the signifi cant founded and does constitute professional misconduct.

consequences of this action signifi cantly undermines the The Discipline Committee of the College of Physical integrity of the profession and has a signifi cant negative Therapists of Alberta hereby orders that the eff ect on the public’s confi dence in the profession. physiotherapist’s penalty for her actions be as follows:

The Committee agrees that it was solely the 1. A reprimand.physiotherapist’s responsibility to ensure that she had a

2. Pay a fi ne to College of Physical Therapists of practice permit. At the very least, the Committee would Alberta in the amount of $750. This may be paid in have expected increased diligence on her part when she installments as agreed upon by both parties to lessen became aware in May 2010 and September 2010 that she the fi nancial burden.did not have a permit.

3. Conditions placed on the physiotherapist’s ability to The Committee was concerned that the physiotherapist re-apply for registration in that:continued to practice at various points in time

throughout 2010 and 2011 even though she had received a. she successfully complete the jurisprudence communication that she did not have a permit. Although module, andthe physiotherapist made eff orts to attempt to obtain

b. she successfully complete a practice review.a practice permit, there was no evidence that led to indicate that she discontinued her practice until March 4. An order for publication of the decision to be

2011. determined by the College Council.


Leadership + R

egulation

Case 2011-03

Conducted under the Health Professions Act.

factors, including the physiotherapist’s early guilty Background

plea and restitution to X Insurance Company, as well On or about November 5, 2009, the physiotherapist as some fi nancial pressures the physiotherapist was submitted her registration renewal application to the under, the Court imposed a conditional discharge. College of Physical Therapists of Alberta, at which time The conditions that the physiotherapist had to she falsely declared the following: meet were to confi rm her restitution to X Insurance

“I have not pleaded guilty or been found guilty Company and to complete 50 hours of community

of a criminal off ence in Canada or an off ence of service. The Court ordered that the physiotherapist

a similar nature in a jurisdiction outside Canada had one year in which to fulfi ll the conditions

for which I have not been pardoned and have not imposed by the Court in order for her to receive

reported to the College of Physical Therapists of an absolute discharge and be left with no criminal

Alberta previously.” record. The conditional discharge became an absolute discharge eff ective June 11, 2010.

The Tribunal found that the admission put forward by the physiotherapist was supported by the evidence. The • On November 5, 2009, the physiotherapist submitted

Tribunal made the following fi ndings: her registration renewal to the College for the 2010 year. Despite having pleaded guilty to the charges

• The physiotherapist became a regulated member only three months earlier, the physiotherapist, in

of the College on or around July 25, 2007 and has her registration renewal, checked a box and declared

been continuously registered with the College since “I have not plead guilty or been found guilty of a

that time. The physiotherapist graduated from X criminal off ence in Canada or an off ence of a similar

University in 1991 and immigrated to Canada in nature in a jurisdiction outside Canada for which I

1999. After she passed the Physical Therapy National have not been pardoned and have not reported to the

Examination, she practiced in X Province for a College of Physical Therapists of Alberta previously.”

number of years prior to moving to Alberta in 2007. In May 2011, the physiotherapist opened her own • In December 2010, the College was advised by

physiotherapy clinic where she currently practices. an employee with the Investigative Division of X Insurance Company, that the physiotherapist, a

• In August 2008, the physiotherapist became aware registered member of the College, had been charged

of the criminal charges that were to be laid against with several criminal off ences, including fraud.

her. The physiotherapist was charged with one count of fraud over $5,000.00, contrary to Section 380(1) • In a letter dated January 25, 2011, the College

(a) of the Criminal Code, and 7 counts of forgery, advised the physiotherapist that the College had

contrary to Section 368(1) (a) of the Criminal Code. received information indicating she had been charged

According to these charges, between 2004 and and/or convicted of a criminal off ence, and sought

2006, the physiotherapist made seven false claims the details of any criminal off ences with which the

for physiotherapy, massage therapy, orthotics, physiotherapist had been charged or convicted.

and support stockings under her personal health • In a letter dated February 2, 2011, the physiotherapist insurance plan, which she received through X advised the College that she had pleaded guilty Insurance Company. X Insurance Company paid the to criminal charges arising from fraudulent physiotherapist a total of $6,856.00 of the false remuneration claims for personal health benefi ts claims. from X Insurance Company. The physiotherapist

• On July 15, 2009, the physiotherapist pleaded guilty stated in her letter to the College that she met the

to the charges. After considering several mitigating terms of her conditional discharge by completing her community service in December 2009.


Lead

ersh

ip +

Reg

ulat

ion

• In a letter dated June 2, 2011, the College advised the must show that they are of good character and reputation. physiotherapist that, pursuant to Section 56 of the Section 25 of the PTPR indicates that a regulated member HPA, the Complaints Director had initiated a complaint applying for renewal of a practice permit must, to the regarding the physiotherapist’s false declarations to satisfaction of the Registrar, confi rm that the member the College about past criminal conduct. continues to meet the requirements set out in Section

9. The implication of these Sections is that the member • The College advised the physiotherapist on April 24, applying for a practice permit must be honest and 2012 that, pursuant to Section 66(3) of the HPA, the forthright.matter was being referred to the Hearings Director

for a hearing. The Notice of Hearing was sent to the The Government of Alberta has granted physiotherapists physiotherapist on July 5, 2012. the honour and responsibility of self-governance. The

public has placed trust in the profession to hold its • In a signed declaration dated July 19, 2012, the members to expected professional standards. This trust physiotherapist acknowledged that on or about relies upon every member being honest and forthright November 5, 2009, she submitted her registration in his/her dealings with the Registrar of the College. The renewal application to the College at which time she physiotherapist’s conduct was a breach of that trust and made the false declaration that “She had not plead as such is a very serious conduct deserving of a serious guilty or been found guilty of a criminal off ence sanction.in Canada or an off ence of a similar nature in a

jurisdiction outside Canada for which [she has] not The Tribunal had the opportunity to review the sanctions been pardoned and [has] not reported to the College of as laid out in the Joint Submission of Sanction. The Tribunal Physical Therapists of Alberta previously.” agrees with the submissions, in that not being truthful

in one’s declarations for obtaining a practice permit is a There was no evidence that would indicate to the signifi cant allegation. Not only does the College rely on Tribunal that the allegation has not been proven. The the honesty of its members, but the public is also relying physiotherapist, by her own admission, stated that she had on the honesty and integrity of physiotherapists in the made a false declaration. The Tribunal is also in agreement provision of physiotherapy services as well as ethical with both parties that this does constitute unprofessional business practices. Providing an ethical framework for conduct.decision making is a cornerstone of physiotherapy practice.

The College relies on the truthful submissions of its Not adhering to this Practice Standard can carry signifi cant members. The College does not request any criminal implications.records checks, or any other searches on physiotherapists

The Tribunal agrees that having the physiotherapist applying for license renewal. The protection of the public complete Philosophy 333 from Athabasca University is can best be accomplished by therapists being truthful in appropriate. It may serve as a tool to assist and develop the their declarations. This is a fundamental part of being a physiotherapist’s decision making abilities in the future. physiotherapist, and failure to be honest does contravene These types of sanctions can serve the public interests by the Standards of Practice, particularly Standard 2(1); to potentially improving the knowledge base and decision-“apply an ethical framework for decision making.”making skills of the College’s members.

The Tribunal reconvened and advised the parties that the Although the original criminal charges related to actions admission was accepted and that the Member was guilty the physiotherapist took on her own personal health of unprofessional conduct. The Tribunal then invited Y to insurance plan as opposed to fraudulently billing in her proceed with submissions on sanction.own practice, she used her knowledge as a physiotherapist

Considerations of the Tribunal in order to create the false submissions. These types of allegations may harm the standing of the profession. The

Section 9 of the Physical Therapists Professional Tribunal feels it is in the public’s best interest to monitor

Regulations (PTPR) (in place at the time of her registration) the physiotherapist’s billing practices for a period of time.

indicates that therapists applying for a practice permit


Leadership + R

egulation

The cost of the Hearing was estimated to be 4. A condition will be placed on the physiotherapist’s

around $10,000 to $12,000. The Joint Submission is practice permit requiring her to undergo periodic

recommending that the physiotherapist pay for slightly inspections by a Practice Reviewer appointed by

less than half the cost of the Hearing. The Tribunal has the Complaints Director. The Practice Reviewer

considered this, along with the fact that there has been will conduct periodic inspections of the Member’s

no fi ne recommended against the physiotherapist and patient charts and billing records subject to the

feel that the amount proposed is just. following conditions:

The evidence demonstrated that the physiotherapist • The Practice Reviewer will attend at the

knew she was not answering the renewal application physiotherapist’s clinic or place of employment

question honestly and thereby deceiving the Registrar on two (2) occasions in the twelve-month period

into renewing her practice permit without question following the end of the suspension of her

or conditions. Had the physiotherapist been honest in practice permit;

her renewal application, the Registrar could very well • On each occasion that the Practice Reviewer have rejected her application or alternatively imposed attends for the purposes of the inspection, conditions on the renewal of the practice permit the physiotherapist will provide the Practice similar or identical to the requirements of this Order Reviewer with a random sample of 20 patient to undertake the Philosophy 333 course and undergo a charts including billing records;practice review.

• The Practice Reviewer will review the charts Lastly, the Tribunal agrees that a summary of this and billing records to determine whether there decision should be published without name or identifying are any fi nancial irregularities or billing issues;information to provide education and to serve as

• Upon conclusion of the each inspection, the deterrence to members. Practice Reviewer will provide a written report

Tribunal decision to the Complaints Director summarizing the Reviewer’s fi ndings; andThe Hearing Tribunal has had the opportunity to review

the material provided In the Agreed Statement of Facts • If the written report indicates that there are

and Acknowledgement of Unprofessional Conduct and concerns regarding the physiotherapist’s

agree that the allegation has been well founded and does practices it relates to the matters in issue

constitute unprofessional conduct. The Tribunal has also in this hearing, the Complaints Director may

had the opportunity to review the Joint Submission on refer the matter back to a Hearing Tribunal for

Sanction and considered the submissions of both parties further consideration; and

and will accept the sanctions as follows: • The costs of the practice review will be borne by

1. The physiotherapist shall receive a reprimand. the physiotherapist.

2. The physiotherapist will be suspended for a period of 5. The physiotherapist shall be required to pay a

14 days, with the period of suspension to commence portion of the costs of the hearing in the amount of

on September 8, 2012. $5,000.00 to be payable on or before December 31, 2012, or in accordance within a payment schedule 3. The physiotherapist shall be required to provide agreeable to the Complaints Director, andproof to the Complaints Director, on or before

December 31, 2012, that she has successfully 6. Should the physiotherapist fail to comply with the

completed Philosophy 333 from Athabasca University, orders as set out above, or should any disagreement

or an equivalent course as approved in advance by between the parties regarding sanction arise, the

the Complaints Director. The assignments must all be matter may be remitted to a Hearing Tribunal for

completed and the course cannot be challenged for further consideration.

credit.


Lead

ersh

ip +

Reg

ulat

ion Membership Update

July 1 to October 31, 2012

General register Vicki Kerr-Wilson Kurt ShanskiCeilidh-Anne Kinlin Sarita SriramIzak AckermannAlison Kramer Ozge SuleymanJeny AlexAngie Krasnay Andrew ThomasJennifer AndrewsRumi Krzywicki Kerri WagarAislin BeaulieuCarson Lai Keltie WildLisa BerndtssonChristina Le Fang YangErin BrantonJoel Luk Man Keen YeungChristopher BurnieHeidi Mason Lina ZuluagaLindsey CorriganThomas MathewDaniel CrumbackMeena MeleppuramErin Daling Provisional register

Anna MigorskaNikki Desaulniers Abdihakim AbdihalimAlyson MooreDouglas Dirk Rhoda AgbabiakaHeather NowatzkiLara Fowler Krista AndermattOluseyi OlubowaleRoisin Gibb Krista AnnicchiaricoKamalanathan PonnusamyKimberly Gibbs Nathan BernesManikandan RamakrishnanAmy Guidinger Amanda BoppMargret ReichelPaula Haugen Alison BowieSamir SahdevSamuel Hebblewhite Dan BradleyJeff rey ScottSheila Heltke Ainsley Brouillard Carmen Hon

Kaeleigh Brown Leonie Hum

Michelle Byrne Rachel Humphrey

Alec Chisholm Jessica Hung

Karen Chouinard-Stewart Devan Husar

Laura Corbeil Selenia Iacchelli

Ashley Corrick Lindsey Janot

Natalie Cuglietta Melissa Johnson

Terrilyn Dallyn Jolene LaBerge

Ashley Dalton Juliet Le

Jennifer Duke Dominique LeBlanc

Moustafa Elsayed Carrie Lewis

Jordana Ferguson Laura Loturco

Brittany Francis Abdulrashid Macabanding

Dustin Fraser Shannon MacLeod

Stacy Gagnon Tracy Mandeville

Forrest Gainer Erin McDiarmid

Vania Gamache Melissa McMahon

Tyler Gamblin Lindsay Milne

Daniel Gillespie Sarah Mitchell

Anthony Giorgianni Alisha Mohamed

Amy Goldstrom Amanda Moores

Kat Grant Leah Moroz

Himani Gupta Muniswamy Munieaswara Moorthy

Ashley Hancock Nicole Neigel

Candra SextonNavdeep Kaur

General register: member

meets all registration

requirements, may use

title physiotherapist and,

if authorized, perform a

restricted activity.

Provisional register:

member may practice

only under supervision

and must use title

physiotherapist intern.

Cancelled member: no

longer practicing in

Alberta.


Leadership + R

egulation

Jordan Perchard Steven Cindric Ian King

Justin Pickerell Vanessa Colden Andrea Kosa

Venkata Naga Mahesh Pothula Barbara Colter Renee Kuip

Shari Quinn Abbie Connick Kara Lamb

Julie Rabnett Susan Corscadden Janine Lange

Revija Raveendran Nair Alana Crowley Gaetane Leclerc

Kristen Redhead Sarah Cushing Odette Lemay

Lisa Romaniuk Carole Damnjanovic Kristy Lerch

John Scaplen Kelly Debouter Jill Lidstone

Ashlin Schoepp Barbara Delarue Roselyn Longares

Matt Scott Graeme Donald Wanda Lopeter

Samantha Scott Shawnda Eatmon-Powell Lisa Lydiatt

Simone Semotiuk Roxanne Elenko Nicola MacDougall

Krista Shore Candace Emerson Lindsay MacKeen

Breanne Smith Brenda Erichsen Melanie MacPherson

Raphael Soares Jeshua Evans Heather Major

Michael Stewart Trish Falk Susan Mann

Jeanine Stott Jane Ferguson Marietta Martens

Jenna Truelove Sara Fisher Kelli McIntyre

Tashina Van Vlack Lucy Forster Jackie Millington

Cherylyn Vande Glind Nadawn Fraser Patricia Monette

Jason Waddell Tanya Frizzell Wayne Morrison

Rhea Wade Mary Ghoroghi Mamatha Namboory

Lynne Wong Ineke Gibson Hayley Ng

Ilona Glass Edmund Ngo

Cancelled Sherry Grant Kerry O’Connor

Bilikis Adelaja Shirley Green Charlene Olm

Christopher Applewhaite Robin Greenslade Alicia Olsen

Megan Archibald Shaheeza Haji Linda Olson

Terri Baldwin Jody Heggie Hannah Pickard

Timothy Baron Christopher Hetke Michelle Pieke

Anita Bealer Robynn Hoetmer Erin Pinder

Melanie Beaulieu Rebecca Holeczi Katarzyna Ploch

Heather Bell Audrey Holliday Michael Potkonyak

Jan Beran Barbara Hughes Shawna Lee Pound

Stacey Blackmore Patricia Hunt-Sidnell Kyle Powell

Jamie Boelman Christina Huynh Jane Proudlove

Todd Bottenfi eld Jill Jeske Rana Quan

France Bouchard-Gill Catherine Johnson Heather Rieck

Yoko Bourne Amanda Johnston Valerie Rodriguez

Janice Boyd Deana Karner Audrey Rose

Mary Brassil Megan Kavanaugh Debra Ross

Kimberley Burkett Ann Kendall Kenda Salmon

Barbara Byrne Corina Kerrison Laura Schaefer

Suzanne Chebib Lisa Kibria Dana Schepp

In MemoriamShawna Pynten

Calgary AB1974-2012

David van DriesumEdmonton AB

1961-2012

Kirsten ShrawderGina SilvestriLeanne SimmsMikki SparksJames SquireKerry St. GeorgeAnne TomsZuzana TriskaAngela TutonCarol Van KoughnettNizar WaljiMarina WallinGlen WarrenTeresa WaserBrittany WeaverAnthony WillmotJanine WiltonDianne ZackowskiAndrea ZelibkaDavid Zelibka


Lead

ersh

ip +

Reg

ulat

ion Membership Survey Highlights

In June 2012, 549 members responded to the online Physiotherapy Alberta member survey. The survey instrument was

written by NRG Research Group in collaboration with Physiotherapy Alberta. The key objective of the Survey was to

benchmark member’s understanding of the role and purpose of Physiotherapy Alberta, programs, services and resources,

and how member interests and priorities align with those of Physiotherapy Alberta.

Survey results are used to inform Council as they undertake strategic planning for 2013-2016.

The following are a few abridged highlights from the survey results.

Data analysis

Throughout the questionnaire, seven-point scales were used for respondents to rate their opinions. The top-box rating of

6 & 7 (i.e., Important, Agree, Likely, Satisfi ed, and Easy) was typically used as the measure for discussion in this report.

The role of Physiotherapy Alberta

• More than one-half of members surveyed indicated that Physiotherapy Alberta’s roles and responsibilities include governing/licensing/ regulating Alberta physiotherapists.

Importance of Physiotherapy Alberta involvement in issues of interest

• Members are most likely to consider it important for Physiotherapy Alberta to be involved in professional practice issues, followed by promoting physiotherapy leadership in the health system, clarifying roles between physiotherapy and other health professions, and promoting self-regulation. Just over one-half consider health human resource planning important.


Leadership + R

egulation

Importance of member services off ered

• Research and the latest evidence is considered important by 78% of respondents. Other services considered important are resources such as guides related to practice, e-learning opportunities, and information on liability coverage programs.

• When asked what other member services they would like to see, 76% of respondents had no additional comments.

Likelihood to engage in social media activities

• Few members are likely to engage in any social media activities if off ered by Physiotherapy Alberta.

• Members in their 20s and 30s are more likely than older members to engage via Facebook.

Importance of Physiotherapy Alberta hosting events

• 81% of members consider it important for Physiotherapy Alberta to host professional development events such as webinars. Over one-half also consider an annual educational conference to be important.

• Town halls to discuss specifi c issues, an annual business meeting, and social events are considered less important events for Physiotherapy Alberta to host.


Lead

ersh

ip +

Reg

ulat

ion Physiotherapy Alberta website visits

• Nine in ten members have visited the Physiotherapy Alberta website at least once in the past six months, with a mean of 6.9 visits in that time period.

Satisfaction with Physiotherapy Alberta’s website

• Among those who have visited the Physiotherapy Alberta website at least once within the past six months, four in ten are satisfi ed with the website. Another one-half give a neutral rating while 8% give an unsatisfi ed rating.

Suggestions for Physiotherapy Alberta website improvements

• Of those members who are not satisfi ed with the Physiotherapy Alberta’s website, the most common suggestion is to make the website experience more convenient.


Leadership + R

egulation

Comments/Questions?

If you have any comments or questions regarding these or any other results from the member survey, or if you would like a complete copy of the results, please email us at [email protected] or call 780.438.0338.

Please note that some values have been rounded up.

Awareness and feelings toward advertising

• Almost one-half of members have personally seen advertising that Physiotherapy Alberta sponsored in magazines, local community arenas, grocery stores, or in newspapers. Nearly one-half of members say there is not enough advertising sponsored by Physiotherapy Alberta, while 17% say the volume of advertising is just right and 2% say there is too much advertising. Notably, 35% don’t know whether the volume of advertising is too much, not enough, or just right.

• Six in ten respondents are unwilling to personally contribute more fi nancially to help pay for more profession-specifi c advertising; 18% would be willing to contribute more, while 21% don’t know.

Thank you to the 549

members who completed the

survey.


Pro

fess

ional

Pra

ctic

e +

Dev

elop

men

t

Embracing Diff erent Cultures and Generations in

the Workplace

Diff erences in Culture

In North America we say “the squeaky wheel gets the oil” but a Chinese children’s parable says “the loudest duck is the one that gets shot.” These simple phrases illustrate two diff erent cultural norms around voicing one’s opinion. In the Canadian workplace it is understood that in order to get ahead one should voice their opinion, however, in China there are rules that voicing one’s opinion has drastic consequences.

An individual’s behaviour is heavily infl uenced by their childhood cultural norms. Cultural norms are the shared beliefs and values of the society in which we were raised and encompass what we are taught to think, feel, and do in any given situation. It is the way we refl exively behave when nobody tells us what to do. What is diffi cult to appreciate is simply how diff erent the culture and unwritten rules of the Canadian workplace may seem to someone from another country

Canada’s workforce is becoming increasingly diverse. Now more than ever there are greater age gaps between co-workers and an increased number of workers immigrating to Canada. Workers trained outside of Canada will have a diff erent set of cultural norms, values and assumptions from their Canadian-trained counterparts. Add to this mix multiple generations with extremely diff erent approaches to work processes, workplace learning and problem solving.

The physiotherapy profession mirrors the diverse demographics of Canada’s workforce. Approximately 9% of physiotherapists in Alberta received their entry-level training in countries where the predominant spoken language is not English. In addition to French or English, Alberta’s physiotherapists speak 42 other languages ranging from Chinese and Hindi to Tagalog and Twi. Twelve percent of the members are aged 20-29 and seven percent are aged 60 or over. As such, there may be workplaces where the ages of the physiotherapist workforce spans three generations.

The increasing heterogeneous workforce has the potential for confl ict, yet with skilful management, can provide tremendous opportunity to capitalize on diff erences and ensure productive engaged workers who provide high-quality physiotherapy services. When discussing workforce issues arising from diff ering age and cultures, two themes emerge:

1. Generalizations about groups are useful when they help provide insight into people’s behaviours; however, they are not helpful if one assumes that generalizations apply to every individual from that group.

2. The golden rule of “do to others what you would have them do to you” may not apply. In some cases, actions you consider acceptable may be off ensive to others. In order to treat people respectfully understand what behaviours, actions or words imply respect to them. Ask if you are unsure and bring what you learn into your interactions with co-workers.

Good Practice

Helping members apply legislation, standards and policies to real-life practice.


Profession

al Practice + D

evelopmen

t

how to manage a situation. In turn, their Canadian educated supervisor may think that the IEPT lacks initiative or the skills to work independently. On the other hand, a Canadian worker whose supervisor is internationally educated in Asia may resent their supervisor if they use a management style involving close monitoring of staff and continually provide specifi c directions for routine tasks.

When it comes to illustrating workplace rules an iceberg analogy is often used. Let’s say 10% of the iceberg is visible, that is to say there are written rules that are apparent to all -- these may cover dress code, work hours, and organizational structure. But 90% of the iceberg which covers unwritten rules is below the surface and not apparent. These unwritten rules (i.e., soft skills) are culturally specifi c and encompass values and patterns a culture has created over time. Soft skills are the set of personality traits, communication style, language, social graces, personal habits and friendliness that characterize relationships. In Canada, soft and technical skills are seen as relatively equal in importance while many internationally educated professionals come from cultures where technical skills are viewed as more important than soft skills. Often it is the unwritten rules that present challenges to those who are internationally trained.

This is why much of the training of the Alberta Internationally Educated Physiotherapist Bridging Program (AIEBP) focuses on developing soft skills (see page 18). Despite training, it may take years for an internationally educated physiotherapist (IEPT) to develop what is judged by others to be an eff ective communication style. Even with extensive training, in times of stress an IEPT may default to their dominant pattern of communication from their country of origin which may be perceived as being stiff or unfriendly.

A signifi cant number of IEPTs come from countries where the professional culture is predominantly hierarchial and expert-driven, while in contrast, Canada is relatively egalitarian. This diff erence aff ects the perceptions about technical and soft skills, titles and protocols, decision making, social order and class, therapeutic relationships, workplace structure and how qualifi cations are presented. An IEPT who relies on strategies which were successful in a hierarchical setting may be perceived in the Canadian workplace to be lacking collaboration and critical thinking skills. Patients may perceive them as condescending. Teams may perceive them as poor communicators and poor team players.

Example of cultural diff erences:

In Canada, workers tend to prefer managers who provide them with freedom and space, while in India and China, workers’ preferences are weighted towards managers who provide specifi c direction. An IEPT from Asia may expect supervisors to provide specifi c instructions on

How to integrate an IEPT into a workplace that

embraces diversity:

• For managers and supervisors, identify and address subtle actions that may seem prejudiced (e.g., not pronouncing foreign names correctly). Establish practices that not only make majority but also non-majority individuals feel valued.

• When it comes to promotions make sure there is a level playing fi eld between IEPT and Canadian trained workers.

• Train staff members on how to separate cultural diff erences from professional profi ciency.

• Establish a mentoring program where mentors can help the IEPT develop soft skills.

• Provide language support and further soft skills training.

• Make sure your communications are being perceived in the way you intended them to be. Don’t hesitate to ask “What are you taking away from this conversation”

• When you react negatively to some aspect of an IEPT’s behaviour try to give them the benefi t of the doubt.

• Stop and clarify. If you think the impact you are having is not the impact you want to have (i.e., the IEPT is upset or withdrawn) stop and ask what is triggering this reaction in them.

• Patience is a virtue when working with others, it will allow you to develop rapport and gain a better understanding of our co-workers actions.


Pro

fess

ional

Pra

ctic

e +

Dev

elop

men

t

Multigenerational Workforce

Every generation has its own unique characteristics impacted largely by current events and the technologies available during formative years of learning. Think about the technology available to diff erent generations as youngsters. The diff erences in exposure to technology dramatically impact how readily one adapts to, uses and interacts with technology and uses it for solving everyday work problems. Generally, the following characteristics apply to diff erent generations in the workforce.

Baby Boomers (year of birth approximately between

1946-1963)

Baby Boomers grew up when there were plenty of people and relatively few classrooms, facilities, jobs, etc. Consequently, they are characterized as being hard working, work-focused and competitive. They are used to working with hierarchy and rank but also are extremely team oriented. Relationships and getting along is valued. They are optimistic, future focused and like being involved in matters. Boomers are willing to challenge the status quo, after all it was the boomers who achieved reforms to civil and human rights.

They were the fi rst to experience boom and bust economies, and survive the restructuring workplace changes of the 80s and 90s. Some boomers may fi nd it challenging to work somewhere where hierarchy isn’t as important as competence. As well, growing up with only television as the main communication technology, they may have diffi culty adapting to newer technologies. With the economic meltdown of 2008, many boomers have delayed retirement.

Generation X (1964-1980)

Gen Xers are characterized as preferring to work independently at a fairly rapid pace. They have little patience with rules that don’t make sense to them and are willing to challenge bureaucracy. This generation brought around a relaxation of workplace rules in terms of dress code, work hours and work-life balance. Gen Xers value competence and think if they have the skills to do the job, they should get the promotion rather than wait around to pay their dues. For this generation, it is product rather than process that is valued.

Gen Xer don’t have automatic loyalty to employers. They are cynical when confronted about talk of company loyalty and team spirit. This generation has learned to expect to work for more than one company and stays

with an organization until they have learned all they can. Job hopping is seen as a workplace survival skill and key to success. A Gen X would quit their job if off ered increased stimulation elsewhere.

Generation Y (1981-1995)

Like Boomers, Gen Yers are extremely social, but because of new technology they connect diff erently by using social networks such as Facebook and Twitter. Unlike boomers, Gen Yers exhibit a willingness to trust their managers but expect openness and fairness. They are highly socially responsible and concerned about environmental issues. Gen Yer’s fi nd a structured 8-5 job confi ning and tedious. They don’t mind accountability for their work but want freedom to come and go and complete it on their own terms. Employers have introduced fun, motivating processes and services to attract and keep Gen Yers such as mentorship programs, virtual work environments, onsite snacks, games tables, lunch time massage and yoga, and shorter work weeks.

Gen Yers are technologically savvy having grown up with computers and advanced gaming platforms, yet in other matters may not be interested in taking on the responsibility to resolve diffi cult issues because they are used to others in authority taking on this role in their lives. What may be obvious problem solving steps to independent Gen Xers and Boomers may not be so obvious to Gen Yers.


Profession

al Practice + D

evelopmen

t

To work with multi-generations in the workforce,

realize one size doesn’t fi t all.

Baby Boomers:

• Acknowledge their value and respect their experience.

• Involve them in mentoring for Gen Yers and specifi c team based projects.

• Capture and log their historical knowledge before they retire.

Generation X:

• Provide them with a variety of experiences that are challenging and present opportunities for growth.

• Understand that if you don’t meet their needs they will leave for their next job.

• Let them work with independent competent team members who demonstrate mutual respect. In addition to team recognition, ensure their individual contributions are acknowledged.

• Workplace policies and benefi ts should make sense and be structured to appeal to their sense of independence and balance between home and work.

Generation Y:

• Help them integrate into the workplace without turning them off .

• Providing a repertoire of foundational experiences from which to launch their careers and opportunities for bonding with mentors and peers.

• Be open to fl exible schedules and virtual work environments.

• Be specifi c in what you want them to do and give them support and constructive feedback to ensure it is done correctly.

References

Liswood, Laura. The Loudest Duck, moving beyond diversity while

embracing diff erences to achieve success at work John Wiley &

Sons, Hoboken, New Jersey 2012

Laroche, Lionel. Don Rutherford. Recruiting, retaining, and

promoting culturally diff erent employees, Butterworth-Heinmann,

Burlington, MA 2007

Laroche, Lionel. “Integrating Foreign Trained Professionals.”

ISAP Conference 2008 – Building Canada’s Future: The Role of the

Settlement Sector in Ontario. 2011 November 30. http://www.

settlementatwork.org/_news_/94010

Meagan Johnson, Larry Johnson, Generations Inc, AMACOM New

York, NY. 2010

Guide for employers of Internationally educated nurses http://ien.

oha.com/Pages/IENMain.aspx

IESE (2011, November 9) Boomers, Gen X and Gen Y:

Multigenerational Workforce retrieved 2012 October from http://

www.youtube.com/watch?v=RGNiXMlLzO8

qxy333 (2011, July 9) Gen Y Gen X Gen Z retrieved 2012 October

from http://www.youtube.com/watch?v=h6Zby_7ncK8&NR=1&feat

ure=endscreen

Physiotherapy Alberta, in partnership with Alberta Health and Wellness and the Department of Physical Therapy, University of Alberta, has received a Health Canada grant to develop a bridging program for internationally educated physiotherapists (IEPT) in Alberta.

The purpose of the Alberta Internationally Educated Physiotherapists Bridging Program (AIEPB) is to provide education, clinical experience and support for IEPTs who are pursuing registration in Alberta. This type of program is critical to maximize the potential of all interested IEPT’s and support integration into the workforce in Alberta. IEPTs are key to ensuring that Alberta continues to have an adequate supply of physiotherapists in the future.

The program will be housed within the Department of Physical Therapy, University of Alberta.

For more information visit the AIEPB’s website at www.physio-bridging.ualberta.ca/.


Pro

fess

ional

Pra

ctic

e +

Dev

elop

men

t

Online learning, or e-learning, is education designed specifi cally for distance learning done over the internet. It is becoming more and more common to access courses, classes and even entire university programs online.

Online learning is a hot commodity. These days, most educational institutions are off ering e-learning courses and businesses are using online learning for staff training and development. The physiotherapy world is no diff erent - several websites are now off ering e-learning courses tailored to the needs of physiotherapists.

Aside from the obvious benefi ts of convenience and less expense, e-learning has a number of other benefi ts:

• Self-paced: Students can work through course materials at their own pace by allowing materials to be absorbed in smaller chunks. Online learning gives the participant more control.

• Accessible anytime from anywhere: Learners can work through materials when they want, from where they want. E-learning gives the learners more fl exibility to set their own schedule.

• Worldwide: Learners can access courses from instructors all around the world, exposing them to a variety of ideas and perspectives that may not be possible in locally-delivered classroom settings. Online learning gives students greater variety.

• Increases retention: Evidence suggests that well-designed e-learning courses improve retention since learners have the ability to revisit and replay course sections. Also, many courses elements are combined to reinforce the message (e.g., audiovisual, virtual lectures, quizzes and discussion forums).

Here are a few websites off ering physiotherapy-specifi c online learning courses:

Physiotherapy Alberta’s eLearning Center

elearning.physiotherapyalberta.ca

In our eLearning Center you’ll fi nd a variety of short courses and virtual communities of practice where you can share ideas, pose questions and interact with other physiotherapists. The Physiotherapy Alberta eLearning Center is off ered at no charge to members. As member participation increases, so will the diversity of course topics.

Professional Development

MedBridge Education

www.medbridgeeducation.com

MedBridge Education provides video-based online education taught by industry experts in a convenient, easy-to-use format. Courses are designed to improve clinical reasoning, skill-sets and patient outcomes. Each course is video-based with 3D models, demonstrations and interactive learning assessments.

Educata

www.educata.com

Educata off ers a broad spectrum of courses covering areas as diverse as orthopaedics, cardiovascular/pulmonary, geriatrics and oncology. The courses are taught by top-ranked educators and experienced clinicians and combine visuals and interactive technology to provide a rich learning environment.

Great Seminars Online

www.greatseminarsonline.com

Great Seminars Online (GSO) brings the latest research and evidence-based treatment information to clinicians around the world. GSO’s online continuing education off ers a wide variety of courses from seating and mobility to vestibular rehabilitation. Courses include real patients and the latest research in rehabilitation. You will not just watch talking slides but see expert clinicians grapple with diffi cult patients and concepts.

Online Learning Opportunities


Profession

al Practice + D

evelopmen

t

Webinar Series

Clinical Decision Support Tools in the Management of Work-Related Musculoskeletal Disorders

January 24, 2013

An Introduction to Addressing Chronic Headaches in your Physiotherapy Practice

February 21, 2013

Electrical Stimulation for Wounds: Review of Research Evidence and Clinical Techniques

March 21, 2013

Screening for Musculoskeletal Red Flags: The Physiotherapist’s Role in Primary Care

April 18, 2013

To register for upcoming webinars, visit: www.physiotherapyalberta.ca/physiotherapists/professional_development/upcoming_webinars.

Recently, Physiopedia published a toolkit on using manual

therapy and exercise for the treatment of neck pain. The

toolkit was written by Jordan Miller, Anita Gross, Tim Rogers

and Jessica Willemse from McMaster University. The purpose

of the toolkit is to provide busy physiotherapists with an easy-

to-use resource for on the best available evidence of manual

therapy and exercise in the treatment of neck pain.

The evidence for the toolkit was drawn from three of

McMaster’s Cervical Overview Group’s (COG) systematic

reviews. This evidence was evaluated by the International

Collaboration on Neck Pain (ICON), who rated the three

reviews included in the toolkit at 8-9/12 using the ‘Assessment

of Multiple Systematic Reviews’ (AMSTAR) methodological

rating tool. Although the Toolkit has yet to be formally

rated, it does appear to be based upon credible evidence.

The toolkit is divided into fi ve sections including:

1. Identifying your patient

2. Determining the evidence

3. Informing your technique

4. Appropriate dosage

5. Individualizing treatment

Particularly appealing is the use of tables, photos and

symbols to highlight the positive and negative evidence

for a specifi c technique, exercise, dosage or outcome. All

manual therapy techniques and exercises included in the

toolkit are illustrated with

photographs.

Overall, the toolkit appears

to be a useful resource for

busy clinicians interested in

evidence-based information

for the treatment of neck

pain. So why not check this

out today by visiting Manual

Therapy and Exercise for

Neck Pain: Clinical Treatment

Toolkit: www.physio-pedia.

com/Manual_Therapy_and_

Exercise_for_Neck_Pain:_

Clinical_Treatment_Tool-kit

Manual Therapy and Exercise for Neck Pain: Clinical Treatment Toolkit


Pro

fess

ional

Pra

ctic

e +

Dev

elop

men

t Research in Focus

General vs. Specifi c: Exercises for Chronic Low

Back PainLuciana Gazzi Macedo, BScPT, MSCPT (Thesis), PhD

from systematic reviews and randomized controlled trials suggesting that exercise is eff ective in improving outcomes for those with chronic non-specifi c low back pain, but the type of exercise is irrelevant.5-7

On the other hand, systematic reviews and randomized controlled trials of acute non-specifi c low back pain often state this patient population should stay active and that exercise therapies are not recommended.7-9 This is probably due to the fact that patients with acute low back pain have a rather good prognosis and

Low back pain is extremely costly and causes great economic burden for health-care systems as

well as considerable suffering for the individual. The point prevalence of low back pain has been reported to be between 12-33% and the estimates of a one year prevalence range from 22% to 65%.1 Around 11-84% of the population will at some time exhibit low back pain1 and of these 70 -80% will have at least one recurrence.2

Supervised exercise therapies are one of the most commonly advocated treatments for non-specifi c low back pain.3,4 Despite the growing number of studies evaluating the eff ectiveness of exercise intervention, there is still considerable debate over which is the most appropriate type of exercise. Between the wide varieties of exercise therapies available, specifi c exercises (e.g., motor control, graded activity) compared to general exercises (e.g., aerobic exercises, endurance training) have gained increased attention within the clinical and research communities.

Specifi c exercises have gained special attention as they are often based on specifi c rationales for their mechanism of action. Basic science and case-control studies have demonstrated that individuals with low back pain have impaired control of the trunk muscles and a signifi cantly worse psychological profi le (e.g., self-effi cacy, kinesiophobia) as compared to those with no back pain. However, despite the strong rationale for the mechanisms of action of these interventions, high-quality clinical trials are needed to confi rm its eff ectiveness and the possible superiority of one type of exercise over the other. However, in clinical practice, both types of exercise therapies are used and deemed superior before studies supporting these clinical decisions are conducted.

One of the issues in physiotherapy is that a wide range of possible exercise therapies are available to treat patients with low back pain when there is little to no evidence to support the use of one treatment over the other. In fact, most evidence-based clinical guidelines summarizing the evidence for exercise therapies state that generally, for those with chronic non-specifi c low back pain, it does not matter which exercise is provided.4 There is actually strong evidence


Profession

al Practice + D

evelopmen

t

the addition of exercises does not provide signifi cant benefi ts above the natural progression of the condition.

Still, supporters of specifi c exercise techniques for patients with chronic low back pain argue that these types of exercises should not be prescribed for all patients and researchers should focus on identifying subgroups of patients that would respond better to each type of exercise. The justifi cation behind this idea is that all patients are diff erent and exercise therapies should focus on the particulars of each specifi c case. Furthermore, randomized controlled trials that evaluate the eff ects of exercise therapies often demonstrate small eff ects with a wide variation of response between participants. Thus, it is likely that targeting the intervention to those that respond to the treatment would signifi cantly increase treatment eff ects.

However, the literature supporting subgroups is very limited and to date, the great majority of clinical prediction rules are of weak methodological quality and lack validation. Although clinicians often believe that is possible for them to identify patients that should receive specifi c treatments, this is not easily translated into research and most researchers today suggest that a classifi cation system is as eff ective as no classifi cation system.10

In the midst of this scenario where many research groups are trying to identify subgroups of patients

with low back pain, The STarT Back Tool (www.keele.ac.uk/sbst/) has demonstrated promising ability to improve patient outcomes. This tool was used to allocate patients to diff erent treatments based on their prognosis (low, medium or high risk of poor prognosis).11

• Low-risk patients received only an initial physiotherapy session (advice on pain management and advice to stay active with information about local exercise facilities).

• Medium-risk patients were referred to standardized physiotherapy for six weeks (assessment, diff erential diagnosis and targeting of modifi able prognostic factors).

• High-risk patients were referred for psychologically informed physiotherapy.

The STarT Back Tool contains nine questions related to low back pain prognosis such as pain location, presence of pain in other areas of the body, walking capacity, speed of activities in daily living, negative beliefs, etc. Although the tool is not a clinical prediction rule, it is probably the fi rst step in helping clinicians select the group of patients that should receive more focused attention in clinical practice.

Despite the recent focus on specifi c exercises and the identifi cation of subgroups that would benefi t from


Pro

fess

ional

Pra

ctic

e +

Dev

elop

men

t diff erent interventions, the evidence suggests that exercise therapies for patients with chronic low back pain are moderately eff ective in reducing pain, disability and increasing quality of life in both the short and long term. However, the type of exercise does not seem to matter and the current message seems to be that patients should keep active and perform exercises even

after treatment has been completed. In fact, a recently

published Cochrane Review has shown evidence that post

treatment exercises can signifi cantly decrease the number of

recurrences in the long term.12

Luciana Gazzi

Macedo is originally

from Brazil where

she completed her

Physical Therapy

degree at the

Federal University

of Minas Gerais.

Following her

degree she moved

to Canada where

she completed a

Master of Science

in Physical Therapy

(thesis) from

the University

of Alberta. With

growing interest

in common spinal disorders, specifi cally prognosis and

treatment, she completed a PhD program in 2010 at the

George Institute for Global Health and The University of

Sydney, Australia. She is currently a post-doctoral fellow at

the Common Spinal Disorders Research Group, Department

of Physical Therapy, University of Alberta. Dr Macedo holds

a prestigious Canadian Institutes of Health Research (CIHR)

postodoctoral fellowship and an Alberta Innovates Health

Solutions (AIHS) postdoctoral incentive award.

References

1. Walker BF. The prevalence of low back pain: a systematic

review of the literature from 1966 to 1998. J Spinal Disord

2000;13:205-17.

2. Goldby LJ, Moore AP, Doust J, et al. A randomized controlled

trial investigating the effi ciency of musculoskeletal

physiotherapy on chronic low back disorder. Spine

2006;31:1083-93.

3. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European

guidelines for the management of chronic nonspecifi c low

back pain. Eur Spine J 2006;Suppl 2:S192-300.

4. Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley

J, Maher C. An updated overview of clinical guidelines for

management of non-specifi c low back pain in primary care.

Eur Spine J 2010;19:2075-94.

5. Macedo LG, Maher CG, Latimer J, McAuley J. Motor control

exercise for persistent non-specifi c low back pain: a

systematic review. Phys Ther 2009;89:9-25.

6. Macedo LG, Smeets RJEM, Maher CG, Latimer J, McAuley J.

Graded activity and graded exposure for persistent non-

specifi c low back pain: a systematic review. Phys Ther

2010;90:860-79.

7. Keller A, Hayden J, Bombardier C, van Tulder M. Eff ect sizes

of non-surgical treatments of non-specifi c low-back pain. Eur

Spine J 2007;16:1776-88.

8. Machado LAC, Maher CG, Herbert RD, Clare H, McAuley JH.

The eff ectiveness of the McKenzie method in addition to fi rst-

line care for acute low back pain: a randomized controlled

trial. BMC Med 2010;8:10.

9. Hancock MJ, Maher CG, Latimer J, et al. Assessment of

diclofenac or spinal manipulative therapy, or both, in addition

to recommended fi rst-line treatment for acute low back pain:

a randomised controlled trial. Lancet 2007;370:1638-43.

10. Apeldoorn AT, Ostelo RW, van Helvoirt H, et al. A randomized

controlled trial on the eff ectiveness of a classifi cation

-based system for subacute and chornic low back pain. Spine

2012;37:1347-56.

11. Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of

stratfi ed primary care management for low back pain with

current best practice (STarT Back): a randomised controlled

trial. The Lancet 2011;378:1560-71.

12. Choi BKL, Verbeek JH, Tam WWS, Jiang JY. Exercises for

prevention of recurrences of low back pain. Cochrane

Database Syst Rev 2011.


Profession

al Practice + D

evelopmen

t

The Evidence + Outcomes Physiotherapy Alberta Conference held in Calgary this October was a success! Over 120 physiotherapists and physiotherapy students came out for this professional development opportunity. Attendees gained insight and knowledge from both the plenary speakers and breakout workshops. Overall feedback from the event was highly positive, 93% said the conference exceeded or met their expectations and many attendees commented on attending another Physiotherapy Alberta event in the future.

If you were able to join us in Calgary for the Evidence + Outcomes

conference, thank you for making it such a success!

Top: Dr. Laugh

Middle (left to

right): Dr. Brian

Goldman, Victoria

Feige

Bottom (left to

right): President

Greg Cutforth, Dr.

Cy Frank


Com

mun

icat

ion +

Mar

keti

ng

Finding Balance Sponsorship

This year’s Finding Balance Campaign kicked off in Edmonton on November 1 at Greenfi eld Elementary School. Health Minister Fred Horne was in attendance to discuss the importance of falls prevention.

“Falling can be very serious, but serious falls are also preventable,” said Fred Horne, Minister of Health. “We want to keep Albertans living as independently as they can, for as long as possible. If we take care of ourselves with healthy eating, staying active, and learning about the eff ects of medication, we can reduce hospital visits and prevent falling injuries.”

Multiple stations were set up, each with a diff erent message about preventing falls. The students learnt about proper footwear, removing hazards that could cause falls, how to get up after a fall and, at the Physiotherapy Alberta station, exercises that help with balance by providing strength. Students brought in their grandparents to teach them strategies for falls prevention.

The event also garnered news coverage on CTV news, Global Morning News, and CTV Morning News Live in Edmonton. For more on media coverage, visit: www.physiotherapyalberta.ca/public_and_patients/physical_health_and_movement_tips/fi nding_balance_falls_prevention

Raise awareness and preventing falls among Alberta seniors


Com

mun

ication + M

arketing

Marketing Media Sightings

• Wall and Rinkboard ads: Look out for our wall and rinkboard advertisements in minor hockey rinks across the province. Our rinkboard ads will run until November 2013. There are 12 placements in Calgary, 18 in Edmonton and 4 in other various cities across the province.

• Ad bars: The next time you’re at a grocery store this holiday season, you may fi nd a Physiotherapy Alberta advertisement on the conveyor belt divider at the checkout counter. These ad bars can be seen in Safeway, Sobeys and Co-Op stores across the province for the month of December.

• News coverage: A media release plan was recently implemented to help generate positive publicity and help physiotherapists be seen as a knowledgeable and integral part of a health-care team. Keep your eyes open for more physiotherapy related news items in the future.

• Twitter: Physiotherapy Alberta continues to make headway with the @PTAlberta twitter account. We now have over 215 followers. Follow us for the latest news and research on physiotherapy and active living.

• Impact Magazine: Another advertorial was printed in Impact Magazine’s winter issue. In this issue, Laurie Plouff e, a physiotherapist in Edmonton, provided information on preventing running injuries.

• Member marketing materials: A new “Treat Your Body Well” poster was created to encourage the public to visit a physiotherapist. The new poster is ideal for waiting rooms and physician offi ces.

Did you know you can order

marketing materials to help

promote physiotherapy? Some can even be customized with your clinic information. Visit /www.physiotherapyalberta.ca/physiotherapists/promoting_physiotherapy to order yours!

Physiotherapy + physiotherapists in the media

Back-to-School Backpack Safety Tips

In late August, two physiotherapists were featured on seperate news programs to discuss backpack safety intime for the back-to-school season.

Julia Books from the Alberta Children’s Hospital discussed backpack safety on Global Morning News in Calgary and Elizabeth Zahary from Summerside Children’s and Sports Physical Therapy gave grade 3-7 students tips on adjusting their backpacks for CTV News in Edmonton.

A special thanks to Julia and Elizabeth for being great representatives for the profession and for volunteering to go on camera.

For information on backpack safety and to view the video, visit the Physiotherapy Alberta website at: www.physiotherapyalberta.ca/public_and_patients/physical_health_and_movement_tips/backpack_safety

Preventing ACL Injuries

The October 16, 2012 edition of the Edmonton Journal ran a story featuring Sherwood Park physiotherapist Doug Gilroy discussing the importance of using a neuromuscular warm-up to prevent ACL injuries among youth female soccer players. The video of the warm-up can be viewed here: www.edmontonjournal.com/life/moves+female+athletes+aimed+preventing+injuries+says+Sherwood/7383223/story.html


Com

mun

icat

ion +

Mar

keti

ng Member Spotlight

Marg Mooney has worked clinically in rural and

urban centres in acute care, home care, private

practice, long term care, a tertiary rehabilitation

centre, and mental health. She has held various rehabilitation administrative positions. In her current role as Senior Practice Lead for Physiotherapy for AHS, Marg is responsible for provincial PT practice leadership, creates practice support resources, consults on professional practice questions from AHS clinicians and leadership, and leads the AHS Provincial Physiotherapy Professional Practice Council.

Why is workforce planning an important issue for the

profession?

Workforce planning is essential if the population’s health and wellbeing is going to continue to benefi t from physiotherapy’s contributions and if physiotherapists are going to continue to be recognized as important members of the interdisciplinary health-care team. With our profession being a hard-to-recruit discipline for the last several years, we are now seeing the eff ects of too few PTs available for all the roles that our education, skillsand attributes make us suitable to fi ll within the health system.

Because we share many aspects of our work with other disciplines (both regulated and unregulated), there are others who are given a job when PTs are not able to be recruited. Without adequate access to physiotherapy,

Positioning physiotherapy + raising its profi le

“Workforce planning is about our continued ability to help

our clients and our future as a profession. Physiotherapists who

believe they are valuable and indispensable members of the

health-care industry and believe their clients benefi t from their assistance should care about

workforce planning.”

those with health needs do not benefi t from physiotherapy’s unique approach to injury prevention and movement optimization, maintenance and restoration.

Workforce planning is about our continued ability to help our clients and our future as a profession. Physiotherapists who believe they are valuable and indispensible members of the health-care industry and believe their clients benefi t from their assistance should care about workforce planning. As PTs we have potential to fi ll many non-traditional and emerging roles such as case manager, triage clinician, clinical specialist, educator, administrator, chronic disease manager, health prevention and promotion clinician, etc. When there are not enough PTs to meet even the basic physiotherapy needs of clients, these important opportunities often go to others. This can impact physiotherapists’ job satisfaction and undermine opportunities for us to be recognized as contenders for these roles in the future.

What do you see as the opportunities and challenges of

meeting future workforce demands?

One of the biggest challenges of meeting future demands is quantifying what the actual demand for physiotherapy is now and what it will be in the future. We have incomplete utilization data, which tells us only what is currently done by PTs who are paid by the health system in only a few sectors of care, and not what is done by PTs regardless of where they work or who funds them, what is required to meet the actual demand, or what physiotherapists should do.

When there are workforce shortages, less gets done. In times like this, there is the potential that the refl ected


Com

mun

ication + M

arketing

statistics will get used as benchmarks that might lead authorities to make decisions that further erode the ability of physiotherapists to be active in the health-care system. If we physiotherapists can’t retain jobs due to insuffi cient supply, slowly our profi le in the industry is reduced to the point of permanent lost opportunities.

When budget effi ciencies need to be found and a position is vacant for a long period of time, the position is often seen as expendable. Eliminating them does not have a direct human resource implication, so there is often signifi cant pressure for managers to sacrifi ce vacant positions.

It is diffi cult for PTs to work in an understaff ed situation. Over an extended period, individual clinicians are aff ected by overwork and the stress of constantly prioritizing what they can do and for whom. Mandated practice standards may at times be a challenge. There is always the potential that PTs will leave the profession because of these stresses, thus further compounding the issue for their colleagues. The quality of our work life depends on adequately staff ed workplaces.

There are also opportunities for the profession to contribute to solutions to these problems. The profession must continuously redefi ne itself by focusing on the future needs of the individuals, populations and communities we serve. Physiotherapists can be actively engaged in initiatives that focus on:

• Workforce planning

• Optimizing our role and that of therapist assistants and other interdisciplinary team members

• Creating practice support tools that lead to effi ciencies or assist with explaining PT roles

• Data collection and utilization

What can a front line physiotherapist do to impact

workforce planning?

Individual physiotherapists can help in planning for the future and carving out the new workplace by:

• Taking some time to understand the issue.

• Implementing a process to facilitate a focus on PT recruitment at their work site or program.

• Educating colleagues about PT workforce issues and the scope of practice and roles of physiotherapists.

• Becoming leaders in interdisciplinary collaborative practice. This is done by understanding what PTs bring to interdisciplinary care, understanding the roles of others, communicating eff ectively, being good at confl ict resolution and generally being good team players.

• Promoting effi ciencies by focusing on what they are uniquely skilled in while helping with tasks that PTs may have been solely responsible for in the past.

• Becoming a clinical preceptor/supervisor to multiple students.

• Helping internationally-educated physiotherapists transition to the Alberta workplace.

• Applying for leadership positions.

• Volunteering for Physiotherapy Alberta or employer initiatives that focus on improving recruitment, retention or practice support.

How do you see the role of front line clinicians in the

public sector changing over the next 10 years?

• Front line PTs will continue to occupy key roles on interdisciplinary teams in all parts of the health system. They will be practicing collaboratively with many others by collectively deciding work fl ows and considering context-specifi c factors related to the workplace, service and population served.

• There will be greater merging of public and private providers to deliver services.

• Therapists will work with multiple therapist assistants both in person and across distance to deliver care.

• Physiotherapist roles will span the health continuum from promotion to prevention to acute care to traditional rehabilitation and to supportive living.

• There will be advance practice roles that require a broad set of skills and clinical specialist knowledge.

• Clinicians will take up the professional challenge to supervise students and mentor colleagues to prepare a future ready workforce.

There is active participation of physiotherapists preparing for this future now, and there are many emerging opportunities for more involvement.


Department of Physical Therapy

MScPT Class of 2012

The University of Alberta (UofA) Department of Physical Therapy is proud to present the latest cohort to complete the MScPT Program. A few of the 78 students are still working on fi nal clinical placements but the majority has completed the National Physiotherapy Competence Exam – Written Component andare eligible to apply for a practice permit. They are keenly looking for their fi rst PT position!

This Class includes the fi rst 10 students to complete the MScPT Program at the UofA Augustana Campus in Camrose. Unique in Canada, the UofA MScPT satellite campus experience is proving to be very positive for students, instructors and for the local university and professional community. Thanks to all those who have contributed to this inaugural adventure!

Lindsay Akins Stacy Gagnon Shannon MacLeod Jason WaddellJason Allen Forrest Gainer Tracy Mandeville Rhea WadeApril Andrews Vania Gamache Andrea McCaff rey Lynne WongKrista Annicchiarico Tyler Gamblin Christopher McKanna Kimberly Archibald Daniel Gillespie Alisha MohamedJenna Armstrong Amy Goldstrom Amanda MooresMichelle Axelson Samantha Hammond Leah MorozJulie Banack Kimberly Hillier Nicole NeigelNathan Bernes Carmen Hon Vi NgoAnna-Lise Binotto Jessica Hung Vivi NguyenAmanda Bopp Devan Husar Trisha NovakKaitlan Braden Selenia Iacchelli Christelle PicheDaniel Bradley Noel Ives Julia RabnettAinsley Brouillard Lindsey Janot Kristen RedheadKaeleigh Brown Melissa Johnson Alaina RisiAlec Chisholm Tarah Katerenchuk Lisa RomaniukAmber Clarke Kathleen Kenyon Ashlin SchoeppHeather Cody Janelle Khan Matthew ScottLaura Corbeil Justin Koch Samantha ScottNatalie Cuglietta Murray Kowalczyk Simone SemotiukNicole Eyolfson Allison Kraby Jerri SeungJordana Ferguson Jolene LaBerge Breanne SmithRaquel Foth Carrie Lewis Jenna TrueloveBrittany Francis Amber Long Jessica Van SoestDustin Fraser Crystal MacLellan Cherylyn Vande Glind


University N

ewsKicking the Hornet’s Nest: Symposium

Honours Dr. Tapio Videman

by Keri Scobie

More than 100 academics, students, researchers and clinicians attended the September 21, 2012, back pain research symposium organized to celebrate the career and achievements of long-time faculty member Dr. Tapio Videman. The session featured provocative talks from leading minds in the fi eld of back pain and medical research, which sparked lively discussion and debate among attendees throughout the day.

Dr. Nortin Hadler (University of North Carolina) discussed the personal, social and policy ramifi cations of back pain and argued that we should not regard back ache as an ‘injury’ any more than we consider head ache a head ‘injury.’

Dr. Michele Crites Battié (University of Alberta) provided a further example of policies based on an outdated injury model of exposure to driving and whole-body vibration. She asked the question: How do we move beyond prior beliefs and related policies when current knowledge no longer supports their foundation?

Dr. Olli Miettinen (McGill University) shared his opinions on how back pain research has been “wrong headed” in considering the majority of cases as non-specifi c. He argued that expert knowledge of experienced clinicians should be harvested to produce probability functions for diagnosis.

Dr. Yue Wang (University of Alberta) presented highlights of his doctoral research done under the supervision of Dr. Tapio Videman and Dr. Michele Crites Battié. This research won the 2012 ISSLS Award for Clinical Science, which is arguably the most prestigious international award in back pain research. Findings indicate that the intervertebral

disc endplates might be a substantial contributor to the experience of back pain.

Scholarships for Graduate Studies

Just a reminder that there is funding for physical therapy clinicians who would like to complete a research Masters or Doctorate (Rehabilitation Science). To qualify for the scholarship, you must have a BScPT, MScPT or DPT degree and you must be entering a fulltime MSc or PhD program or a Post-Doctoral training program to work with a member in the Department. The award is adjudicated based on academic achievement. A licensed PT in Canada will be funded at the top level while a PT without a Canadian license can also be supported, but at a reduced level. For more information, please contact Jaynie Yang: [email protected]

Submitted byBernadette Martin, Associate Chair

Canadian publications mail#40063092

Return undeliverable

Canadian addresses to:

Physiotherapy AlbertaSuite 300, 10357 - 109 Street Edmonton, AB T5J 1N3

The Movement Specialists.