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Scope of Practice

Introduction
This document has been written by ACPAT taking into consideration the current legislation and guidelines of: The Veterinary Surgeons Act 1966, The Veterinary Surgeon Exemptions Order (1962) and The Chartered Society of Physiotherapy (CSP).
The scope of practice of animal physiotherapy is derived from The Scope of Practice of Physiotherapy PA44 (CSP, June 2005).
The aim of the document is to make sure that ACPAT members are working within their individual scope of practice and within the overall scope of the physiotherapy profession and that their practice adheres strictly to the CSP Rules of Professional Conduct and Quality Assurance Standards.

"Chartered Physiotherapists shall only practice to the extent that they have established, maintained and developed their ability to work safely and competently and shall ensure that they have appropriate professional liability cover for that practice"

(Rule 1, Rules of Professional Conduct, CSP 2002)

It is recommended that all animal physiotherapists make themselves aware of the relevant sections of the Veterinary Surgeons Act 1966 and the Veterinary Surgery (exemptions) Order 1962 that relate to the provision of physiotherapy.

The 1966 Act provides that (with certain specific exceptions) only Veterinary Surgeons may carry out acts of veterinary surgery upon animals. 'Veterinary surgery' is so defined by that act as to include the making of a diagnosis and the carrying out of tests for diagnostic purposes.

Of the exemptions created by the Veterinary Surgery (exemptions) Order 1962, one permits the treatment of an animal by physiotherapy, but this would not, for example, include acupuncture, homeopathy or aromatherapy.

The scope of practice of the profession of animal physiotherapy is a dynamic and constantly developing process, based on research and evidence and has the best interest of the animal / client at the heart


Scope of Practice of the Animal Profession

Physiotherapy is an applied science which possesses its own knowledge base, its own education methods and practical application based on that knowledge. Physiotherapy is supported by the best available evidence of effectiveness and research within this field linking theory and developing practice.

The practice of animal physiotherapy requires specialised skills and training, such as animal handling, anatomy, physiology, pathology. Animal Physiotherapists must always gain consent from the client prior to commencing physiotherapy.

However the scope of practice will still adhere to the overall scope of the profession of physiotherapy and retain its links to the three core skills:

  • Manual therapy (e.g. massage, mobilisation and manipulation)
  • Electrotherapy (e.g. ultrasound, laser and neuromuscular stimulation)
  • Exercise and movement (e.g. hydrotherapy and gait re-education)

Development of Physiotherapy
Several key factors have led to the development of the physiotherapy profession from its origins:

  • The choice, range and application of different treatment techniques and modalities – themselves brought about by changing and improving technology, research and development.
  • Practitioner innovation – leading to the development of new approaches, their rigorous testing and subsequent adoption by the profession at large
  • The evolution of services for new client groups and more generally the increasing expectations of clients.

Animal physiotherapists are required to demonstrate key professional attributes such as clinical reasoning and decision making – attributes which define the core competence of the profession; such professional expertise is further refined through post qualifying practice and continued professional development (CPD).

A profession's scope of practice encompasses the services its members are educated, competent and insured to provide. The overall scope of the physiotherapy profession encompasses all individual physiotherapists’ scopes and sets the limits of practice for all physiotherapy practitioners.

Chartered Animal Physiotherapists can ensure they are working within the scope of the profession of physiotherapy if they can either:

  • Identify how their practice is related to one of the core skills of physiotherapy and/or
  • Identify a 'responsible body of opinion' within the profession asserting that a modality they choose to practice safely and effectively is also used by other Chartered Physiotherapists. This could be expressed either through views of a recognised clinical interest group, other groups with substantial membership amongst other physiotherapists or a selection of members with a recognised expertise the field. It is however expected that the practice has been evaluated or that there is research to show benefit to patients.

Scope of the Individual
Contrasting clinical profiles for generalist and specialist practitioners helps to further develop an understanding of scope of practice:

  • A generalist develops a broad base of skills, knowledge and experience in a range of areas, enabling them to deal with most patients (presenting with straightforward to moderately complex needs). Professional strength lies in the breadth of their understanding and approach underpinned by clinical reasoning and decision making.
  • A specialist by contrast has developed finely honed skills via training and experience in a very specific area of practice, arising from a detailed and particular knowledge base. Professional strength lies in the depth of their understanding and approach underpinned by clinical reasoning and decision making.

However, while this basic division helps to clarify what is meant by scope of practice, it is not readily applicable to most physiotherapists as many practitioners move between the two categories throughout their career, with much depending on client group, team roles and environment. Such a changing role is certainly supported through general literature on professional practice:

"Throughout a professional career, professionals will be changing the scope of their own competence, through becoming more specialist, through moving into newly developing areas of professional work or through taking on managerial / educational roles and they will also be continuously developing the quality of their work in a number of areas beyond the level of competency to one of proficiency / expertise"

( Eurat 1994)

Scope of practice in practical terms encompasses all elements that form a clinical intervention, including assessment, risk assessment, evaluation of the animal and treatment goals, treatment given, together with advice and training, following owner assessment. As such, all elements within the scope of practice of physiotherapy are covered by Professional Liability Insurance.


Defining Individual Scope
Within the overall scope of animal physiotherapy, individual physiotherapists practice within their own individual scope. This may be described, in general terms by some or all of the following:

  • Occupational role (e.g. clinician, educator, researcher)
  • Sector ( e.g. private practice, higher education)
  • Environment ( e.g. community, veterinary practices)
  • Client group
    • Animals (e.g. equine, canine)
    • Owners, handlers, riders
  • Speciality ( e.g. musculoskeletal, neurological, orthopaedic)
  • Assessment ( e.g. communication with owner/vet, physical, observational)
  • Treatment techniques and modalities ( e.g. manual therapy, electrotherapy, rehabilitation)
  • Advice ( e.g. management, training)
  • Appropriate referral to other professionals and practitioners ( e.g. veterinary surgeons, saddlers, canine hydrotherapy)

More specifically, members need to consider their individual scope of practice in relation to individual animals and circumstances. When presented with a client's animal, the physiotherapist undertakes a personal risk assessment - as part of the overall assessment - asking themselves the following key questions before proceeding:

  • Is the animal safe?
  • Is the handler / rider safe?
  • Am I safe?
  • Are the environmental conditions satisfactory?
  • Can I justify the decisions I have made during the assessment? E.g. has the research and experiential evidence been considered?
  • Can I identify the most appropriate approach for the client's animal?
  • Do I have the correct balance of skills, knowledge and experience to be competent in my chosen approach?

By answering the above questions, the physiotherapist:

  • Identifies and determines the limits of their own competence*
  • Demonstrates an understanding of the scope of the profession of physiotherapy.
  • Illustrates an awareness of other professional’s expertise / other approaches which may be of more benefit to the patient.
  • Ensures every interaction is a learning experience, which will not only inform, but may change and develop that individual's own scope of practice.

* An information paper 'Interim Guidance on Competence' has been produced by the Learning and Development Function and can be accessed either via the CSP website or in hard copy from:
The CSP's Enquiry Handling Unit 020 7306 6666 or enquiryhandlingunit@csp.org.uk

Individual physiotherapists, in accordance with the CSP's professional standards, must ensure the effectiveness of their practice.


Seeking Advice re Scope of Practice

Most animal physiotherapists practice within the known and understood scope of the profession. However, on occasions the practitioner may have doubts as to whether their practice lies within or outside the scope. Members are advised to look to the CSP's Rules of Professional Conduct. They should consider the following:

  • Is this practice related to the core skills of physiotherapy?
  • Is there a responsible body of opinion within the animal physiotherapy profession which asserts the modality in question is used safely and effectively by other chartered animal physiotherapists?

Members should then seek further advice as required from the ACPAT committee (a recognised Professional Networks (PN) of the CSP).


Exploring New Developments

In exploring new developments, the following guidance is given:

  • The new modality, technique or philosophy should be clearly based upon the core of physiotherapy
  • Evaluation and/or research is being or has been undertaken into the innovative practice and it has been shown to be beneficial
  • Education and training relevant to the practice should be undertaken by the physiotherapist(s) using it
  • Members exploring new ideas should seek out other members and other professionals who are involved in exploring the same or similar ideas. They should discuss with them the effects of the new approach, the theoretical underpinning, the uses and contraindications, the educational training and professional issues relating to the areas being investigated and published research that has been carried out
  • Members should at all times recognise the responsibilities of their professional practice, i.e. they should always aim to benefit the patient through the exercise of their professional knowledge and skills acquired through training and experience.

Professional Liability Insurance (PLI)
Professional and Public Liability Insurance is required for the practice of animal physiotherapy.


Conclusion

It is important to emphasise effectiveness within an individual's scope of practice, as well as safety and risk limitation. Ultimately physiotherapy practice must be in the best interests of the animal's care. Inevitably, development in one area of practice such as specialisation will be balanced by the dilution of skills in another area of professional work. But by considering the questions set out above and acting on the responses they generate, an individual is able to appreciate the limits of her / his own current scope and the wider scope of the profession. Therefore the individual should understand the need for updating skills as required.


Reference

  • Eraut M (1194) Developing professional knowledge and competence. The Falmer Press.
  • Rules of Professional Conduct (2002) CSP
  • The Curriculum Framework (2002) CSP
  • The Scope of Practice of Physiotherapy PA44 (2005) CSP
  • Physiotherapy and Complementary Medicine PA48 (2001) CSP
  • Veterinary Surgeons Act (1966) RCVS
  • The Veterinary Surgeon Exemptions Order (1962) RCVS

Complaints Procedure

Complaints Procedure