Focus Physiotherapy office, in Toronto, on March 2. Backlogs for physiotherapy in the public system sees may turn to private clinics for help.Christopher Katsarov/The Globe and Mail
Amanda Hampton’s son was 18 months old when she and her partner were told he would need to see a physiotherapist.
“He wasn’t meeting his milestones,” said Ms. Hampton, who lives in Courtice, Ont. “He was crawling, but he wouldn’t stand independently or walk.”
The Hamptons were referred in April, 2022, to Grandview Kids, a pediatric rehabilitation centre in Oshawa, Ont. After waiting and being told the centre was still seeing referrals from the previous September, they decided to contact a private clinic.
Ms. Hampton said they were able to get him an assessment with a physiotherapist within a week. Sessions started the following week and now a year later he is standing, walking and running. Without going through private care: “We would be on the waiting list still.”
Ms. Hampton’s experience is not unique. Experts and people within the industry say growing waiting lists for physiotherapists and occupational therapists within the public-health care system have meant that many patients are waiting months or longer for treatment after injuries, surgery, or in the Hamptons’ case, developmental issues.
Like many areas of the health care system, physiotherapy and occupational therapy have suffered from staffing shortages that have constrained access to care. Without additional staff, experts say one potential solution is to use occupational and physiotherapy assistants, which they say could have a greater involvement in patient care and free up existing physiotherapists and occupational therapists to take on more cases.
“People don’t really know how well-trained assistants are, how robust their education is, and that they are competent health professionals,” said Laura Maybury, the program co-ordinator for the occupational therapy and physiotherapy assistant program at Durham College in Oshawa.
Occupational and physiotherapy assistants are dual-trained and graduate with skills in both occupational therapy and physiotherapy, meaning they can work with occupational therapists, physiotherapists, or both.
The occupational therapist or physiotherapist does the assessment and creates a program for a patient to follow but an assistant can then do the one-on-one training and implement that program, she said. Assistants can’t do assessments, progression or discharges, but can do activities of daily living, cognitive retraining and strengthening.
Ms. Maybury, a registered physiotherapist for 19 years who is also a liaison for the Canadian Physiotherapy Association and the Canadian Occupational Therapy Assistant/Physiotherapy Assistant Educators Council, said assistants have “tremendous potential” to fill that gap caused by a shortage of rehabilitation specialists.
“We know that the more services that clients get, the better the outcomes are,” Ms. Maybury said. “So, whether it’s in hospital, in-home home care, we know that more services result in better outcomes.”
Physiotherapy and occupational therapy are covered under Ontario’s public-health system for patients 65 years or older, 19 or younger, or any age after an overnight hospital stay for a condition requiring physiotherapy.
Ontario’s Ministry of Health said the department doesn’t maintain waiting lists for individual providers at publicly funded physiotherapy clinics. Those clinics are also expected to outline the options available to patients who face waiting lists.
The colleges that regulate physiotherapists and occupational therapists already have guidelines for the use of assistants. Under the colleges’ standards, the therapists remain responsible for all of a patient’s care. Assistants can administer the occupational or physiotherapy treatments assigned by the therapist. A physiotherapist who works with an assistant must be listed as doing so in a public register and abide by all restrictions in assigning and supervising care, noted under the college’s standards.
Ms. Maybury said those rules already allow assistants to be more involved in patient care and what she’s describing wouldn’t require any changes.
Occupational and physiotherapists “work as a team” with assistants, said Jean-Paul Hernandez, who represents occupational and physiotherapy assistants on the board of the Canadian Physiotherapist Association.
Mr. Hernandez compared assistants to nurses, who can be more hands-on with the patient while a doctor goes on to help the next person.
Mr. Hernandez said a barrier is that many physiotherapists and occupational therapists don’t realize that assistants could be doing more. He said the professional groups that represent those specialists, such as the Canadian Association of Occupational Therapists or the Canadian Physiotherapy Association, should be advocating for assistants more and educating their members.
“I feel that in my schooling we’ve been taught on the importance of collaboration and a circle of care team,” he said. “It’s a multidisciplinary group of people and assistants are on that too.”
Canadian Physiotherapy Association spokeswoman Caitlin Drake Smith said that physiotherapist assistants are integral members of the profession who support enhanced physiotherapy care in a wide variety of settings, including hospitals, home care, rehabilitation centres, retirement residences, in-patient acute/critical care, long-term care facilities, and private clinics.
“Optimizing the use of physiotherapy services and expertise, including the distinct skills of physiotherapist assistants, is one of the simplest, most expedient, and most beneficial actions we can take to improve health-care system capacity across Canada,” said the statement.
Golda Milo-Manson, developmental pediatrician and a vice-president at Holland Bloorview Kids Rehabilitation Hospital, said assistants are already a vital part of the facility’s medical teams.
Dr. Milo-Manson said the hospital currently has 45 occupational therapists, 25 physiotherapists and 18 occupational/physiotherapy assistants on staff. Dr. Milo-Manson says the waiting list at Holland Bloorview is currently between 100 and 140 days. That has come down since the height of the pandemic.
“It lets our occupational and physiotherapy colleagues, who bring the expertise, know how to partner best with families, with the kids, to enable them to achieve their goals as quickly as possible,” she says.