GUIDELINES

PHYSIOTHERAPY NZ GUIDELINES
For the use of physiotherapy assistants/support
workers
By Janet Copeland, Senior Research and Policy Advisor, September 2012
Contents

Background ......................................................................................................................... 3
Accountability ...................................................................................................................... 3
Responsibilities of the registered physiotherapist ............................................................... 4
Responsibilities of the employer .......................................................................................... 4
Responsibilities of the physiotherapy assistant/support worker .......................................... 5
Delegation ........................................................................................................................... 5
Supervision ......................................................................................................................... 6
Communication ................................................................................................................... 7
Specific Task Assignment ................................................................................................... 7
Tasks that must never be delegated .................................................................................. 8
Glossary of Terms .............................................................................................................. 9
References ....................................................................................................................... 10
Appendix 1 ......................................................................................................................... 10
Appendix 2 ........................................................................................................................ 10

2
Background

There are increasing and changing demands for services provided by physiotherapists due to demographic
changes in the population, altered patterns of health and disease (with an increased prevalence of chronic
diseases), improved technology and increased consumer expectations and resources.

A consequence of these pressures in our health system has been the increased utilisation of
assistant/support workers to augment the role of physiotherapists, and meet patient/client (and team)
outcomes by undertaking some of the duties that require less developed skills. Traditionally assistant/support
workers were employed in the hospital system but they are now widely used in residential care facilities and
as part of community teams. Assistant/support workers are not regulated and do not have standardised
educational preparation although workplace specific training is given. They are likely to have an increasing
role in the delivery of health services in the future and it is important guidelines are developed to ensure
consistency of practice and safety for the health consumer.

The assistant/support worker may be drawn from a range of workers. The roles and titles of these workers
will vary according to the environment in which they work. There is currently no national consensus on a
single name for this group of workers and their title may include but is not limited to:

• Physiotherapy assistant
• Allied health assistant
• Rehabilitation assistant
• Physiotherapy aide
• Health care assistant
• Mobility assistant

NB: The term physiotherapy assistant/support worker has been used throughout this document.

Accountability

Physiotherapy assistant/support workers are accountable for their actions and accountable to their employer.
They must therefore have the appropriate skills and knowledge to undertake activities that are delegated and
supervised by a registered physiotherapist. They are also accountable to the policies and procedures of the
organisation/practice where they are employed. Physiotherapy assistant/support workers must not lead
health consumers to believe they are a physiotherapist when undertaking aspects of physiotherapy care.
The patient should be informed of the boundaries and specificities of their role.

However it must be noted that the physiotherapist is always directly accountable for the physiotherapy care
the patient/client receives regardless of what the physiotherapy assistant/support worker does with the
patient. The physiotherapist is still directly accountable for ensuring that the physiotherapy assistant/support
worker has the necessary knowledge and skill level to perform the delegated task.

3
Responsibilities of the registered physiotherapist

(The scope of practice of physiotherapists can be found in Appendix 1.)

The patient/client must have a treatment plan developed by a registered physiotherapist who has undertaken
a comprehensive assessment before any physiotherapy treatment can be delegated.

The registered physiotherapist must determine the level of skill and knowledge required to ensure the safety,
comfort and security of the health consumer before delegating care. This must be based on the complexity of
the care required rather than the tasks (activities) to be performed.

The registered physiotherapist in conjunction with the other medical staff must provide ongoing monitoring of
the health status/needs of the patient/client for whom he/she is responsible. This must be planned along with
the necessary support and guidance that will be provided to the physiotherapy assistant/support worker
performing the delegated activity.

Responsibilities of the Employer

An organisation/practice is not legally able to employ a physiotherapy assistant/support worker to undertake

physiotherapy tasks without designating a supervising physiotherapist to assess the patient/client develop a
treatment plan and direct and supervise the physiotherapy assistant/support workers programmes. The
physiotherapist must be employed/contracted for sufficient hours to allow them to undertake the work to the
required standard.

The organisation/practice is responsible for ensuring the physiotherapy assistant/support worker:

Understands their boundaries and is not put in a position where they are expected to take on duties
that require a registered physiotherapist.
Meets the required ethical, professional, confidentiality standards and code of conduct of the
organisation.
Has an active working knowledge of cultural safety and the principles of cultural competence.
Is clearly identifiable as a physiotherapy assistant/support worker by patient/clients, their
family/whanau and other health professionals.
Is employed to a specific job description and holds a copy of it.
Has the necessary training to meet the identified and agreed competencies for the organisation and
designated role.
Is informed who their supervising physiotherapist is when they commence work.
Knows how to contact the registered physiotherapist at all times, and knows who to go to for help if the
physiotherapist is not available,

4
Responsibilities of the physiotherapy assistant/support worker

The physiotherapy assistant/support worker

• Informs the registered physiotherapist if they have not been trained to perform an activity.
• Does not accept any direction or delegation from another health professional for physiotherapy
related tasks.
• Informs the registered physiotherapist if the delegated task appears more complex or if they are
uncertain of the requirements or the health consumer’s response at any stage of the activity.
• Does not offer physiotherapy advice to patients/clients not allocated to their caseload.

Delegation

The process of delegation involves allocating work to a physiotherapy assistant/support worker who then has
responsibility for the completion of that task. In this situation the physiotherapy assistant/support worker is
responsible for completion of the task however the physiotherapist retains legal accountability for ensuring
the physiotherapy assistant/support worker has the necessary knowledge, skills and support to safely
undertake the delegated task.

The principles of delegation

1. The decision to delegate a component of the patient/client’s physiotherapy care is a professional
judgment made by a registered physiotherapist and should take into account the:
Health status of the patient/client;
Complexity of the delegated activity;
Context of care;
Level of knowledge, skill and experience of the assistant/support worker to perform the delegated
activity. Qualifications for physiotherapy assistant/support workers are being developed; attainment
of these will give a clearer indication of the individual’s knowledge and skills.

2. The decision to delegate must be consistent with the organisation/practice policies and service
specifications.

3. The registered physiotherapist must ensure that the physiotherapy assistant/support worker who has
been delegated the activity:
• Understands the delegated activity
• Has received clear direction, and indicated they have understood the delegated activity
• Knows who and under what circumstances they should ask for assistance
• Knows when and to whom they should report.

4. The registered physiotherapist is responsible for monitoring and evaluating the outcomes of delegated
physiotherapy care.

5. If the registered physiotherapist has made a professional judgment that delegation of treatment is
inappropriate, she or he must communicate (and document) this to the physiotherapy assistant/support
worker and the employer and propose a plan to ensure physiotherapy is provided to the client/resident.

5
Two essential components in the relationship between the physiotherapist and the physiotherapy
assistant/support worker to whom the task is assigned are supervision and communication.

Supervision

Please refer to the Appendix 1 for the definition of supervision as used in this document

A physiotherapist assigning tasks to a physiotherapy assistant/support worker is responsible for supervising

the individual performing the task. . It is essential that the supervising physiotherapist therefore be
responsible for setting, encouraging and evaluating the standard of work performed by the physiotherapy
assistant/support worker to ensure that the worker is able to safely, effectively, efficiently and competently
perform each task.

The nature of this supervisory relationship may be direct or indirect, or may be a combination of the two. In
determining the amount, form, quality and type of supervision required in performance of the task, the
physiotherapist must take into account several factors:
• Practice setting and type;
• Nature of the task;
• Acuity of the patient/client’s condition;
• Complexity of the patient/client’s needs;
• Degree of judgment/decision making required for modification of treatment based on the patient’s
response.

These factors must be considered in context with education, training, skills, job experience, personal
attributes, abilities and competence of the assistant/support worker.

It is expected that physiotherapists will not assign any task they have not previously observed (either
personally or by another physiotherapist) the physiotherapy assistant/support worker performing
competently.

In all cases, the physiotherapist must exercise his/her best clinical judgment to provide the physiotherapy
assistant/support worker with the appropriate mix of direct and indirect supervision as required.

In situations where indirect supervision is applied, it is reasonable and expected that the supervising
physiotherapist be readily available (by pager, telephone etc.) or in
the same physical area as the physiotherapy assistant/support worker for consultation, if the need
arises. The physiotherapy assistant/support worker knows who to go to for help if the physiotherapist
is not available.

supervision provided to the physiotherapy assistant/support worker.

6
Communication

Communication is an essential component in the relationship between the physiotherapist, the physiotherapy
assistant/support worker and the patient. Physiotherapists and physiotherapy assistant/support workers
need to communicate with each other, (at minimum), regarding the following:
• Relevant assessment findings, goals, interventions planned, acceptable range of treatments and the
expected response.
• Potential changes in the patient/client’s condition that are consistent with the normal course of
recovery.
• How to recognize, respond and report to the physiotherapist (or other appropriate individual) any
observed changes in the patient/client’s health status during or as a result of the physiotherapy
intervention.
• Any concerns the physiotherapy assistant/support worker may have regarding the patient/client or
delegated task.

It is important to ensure that the physiotherapy assistant/support worker understands the instructions and the
limitations/scope of his/her clinical practice as identified in their position description and competency
assessment. The physiotherapist must be accessible to the physiotherapy assistant/support worker should
questions or concerns arise.

Specific Task Assignment

With respect to specific task assignment:

• Physiotherapists are always responsible for completing an initial assessment and preparing a
physiotherapy care plan.
• Physiotherapy assistant/support workers, with the patient’s consent, may carry out portions of this
physiotherapy care plan for medically stable patients/clients.
• Physiotherapists must engage in a documented process to ensure that the physiotherapy
assistant/support workers are competent to carry out the tasks prior to assigning them.
• The nature of tasks that can be appropriately delegated to physiotherapy assistant/support workers
(i.e. shared responsibilities), should be of a more ongoing, observational and assistive nature rather
than of an independent or evaluative nature and may include:
o Implementing therapeutic interventions as assigned by the physiotherapist and may include
thermal (e.g. hot and cold packs), electrical gym equipment e.g. treadmills and mechanical
modalities, or providing physical assistance
o (supporting or enhancing in nature) to patients/clients including providing instructions in
using equipment (e.g. crutches);
o Reinforcing the physiotherapist’s explanation and providing verbal instructions to the
patient/client regarding the intervention plan;
o Providing the physiotherapist with feedback on the specific interventions in relation to
identified patient/client outcomes;
o Participating in the collection of qualitative and quantitative client data related to the
patient/clients physical status and functional ability as assigned by the physiotherapist;
o Performing selected objective measures/tests/procedures as assigned by the
physiotherapist within established guidelines and limits and which supplement the

7
 o patient/client history and systems review performed by the physiotherapist in concordance
with the overall (re)assessment plan;
o Documenting their intervention within the established guidelines, policies and procedure of
the practice setting and collecting relevant statistics whilst complying with applicable
legislation and regulations. ;
o Performing any task that contributes to a safe and effective practice environment that
supports a patient/client-centred delivery of physiotherapy services

It is important to emphasise that the delegation of duties and transfer of care from physiotherapists
to physiotherapy assistant/support workers must be within that individual physiotherapy
assistant/support worker’s level of competence and take into account the factors mentioned earlier.

Tasks that must never be delegated

The types of tasks that must not be delegated are considered to be of an evaluative nature and/or require
ongoing clinical judgement and include:
• Interpretation of referrals, diagnosis or prognosis;
• Assessment of the patient/client;
• Interpretation of assessment findings, treatment procedures and goals of treatment;
• Planning, initiation or modification of treatment program beyond established limits;
• Discussion of treatment rationale, clinical findings and prognosis with the client/family;
• Documentation that should appropriately be completed by a physiotherapist, however in some
settings the physiotherapy assistant/support worker is expected to document in the patient’s records
they have carried out the delegated task;
• Discharge planning – however the physiotherapy assistant/support worker could be responsible for
instructing the patient/client on the use of a walking aid (having previously demonstrated their
competency for the task). The patient/client could then be discharged;
• Any task or procedure that requires continuous clinical judgement e.g. any intervention that has an
evaluative component that immediately influences the treatment programme;
• Therapeutic modalities e.g. ultra sound that require clinical judgement with dosage.

8
Glossary of Terms

Accountability
Being answerable for your decisions and actions.

Assessment
A systematic procedure for collecting qualitative and quantitative data to describe progress and ascertain
deviations from expected outcomes and achievements.

Competence
The combination of skills, knowledge, attitudes, values and abilities that underpin effective performance as a
physiotherapist.

Delegation
The transfer of responsibility for the performance of an activity from one person to another with the former
retaining accountability for the outcome.

Patient/Client
This term includes health consumer and people living in residential care facilities and/or their
families/whanau/representatives or significant others

Physiotherapy assistant/support worker

A person employed within a health care, residential or community context who undertakes a component of
physiotherapy care and is not regulated in law by a regulatory authority.

Health practitioner
Health practitioner or practitioner means a person who is, or is deemed to be, registered with an authority as
a practitioner of a particular health profession

Supervision
In the context of this document supervision is the direct or indirect oversight of a physiotherapy
assistant/support worker by a physiotherapist and involves regular meetings and ongoing monitoring.

9
References

Australian Physiotherapy Association (2008) Working with a Physiotherapy Assistant or Other Support
Worker

Canadian Alliance of Physiotherapy Regulators (2000) National Guidelines for Support Workers in
Physiotherapy Practice in Canada

Nursing Council of New Zealand (2011) Guideline: delegation of care by a registered nurse to a health
care assistant

Physiotherapy New Zealand (2005) Roles and Responsibilities of: The Physiotherapy Assistant, the
Supervising Physiotherapist, and the Employer

Appendix 1

General Scope of Practice: Physiotherapy

Physiotherapy provides services to individuals and populations to develop, maintain, restore and optimise
health and function throughout the lifespan. This includes providing services to people compromised by
ageing, injury, disease or environmental factors. Physiotherapy identifies and maximises quality of life and
movement potential by using the principles of promotion, prevention, treatment/intervention, habilitation and
rehabilitation. This encompasses physical, psychological, emotional, and social well being.

Physiotherapy involves the interaction between physiotherapists, patients/clients, other health professionals,
families/whanau, care givers, and communities. This is a people-centred process where needs are assessed
and goals are agreed using the knowledge and skills of physiotherapists.

Physiotherapists are registered health practitioners who are educated to practise autonomously by applying
scientific knowledge and clinical reasoning to assess, diagnose and manage human function.

The practice of physiotherapy is not confined to clinical practice, and encompasses all roles that a
physiotherapist may assume such as patient/client care, health management, research, policy making,
educating and consulting, wherever there may be an issue of public health and safety.

Appendix 2
Training programmes

Career force offer:

Foundation Skills Level 2
Core Competencies Level 3 and the
Allied Health Assistant will be available soon.
http://www.careerforce.org.nz

10