Physical Therapy & Clinical Pilates

CPTBC’s Practice Advisors recently answered questions related to the use of clinical Pilates as part of the intervention provided to a patient. These questions usually present in one of three scenarios:

  1. I am a certified Pilates instructor. Can I provide Pilates-based physical therapy sessions to my patients and issue a receipt for physical therapy services?
  2. I am looking at providing group Pilates classes for some patients who attend our clinic who would benefit from this intervention. Is this OK?
  3. Our physical therapist assistant is a certified Pilates instructor. Can I assign the task of specific Pilates exercises for one of my patients who would benefit from incorporating Pilates exercises into their physical therapy treatment program?

The answer to all three is: It depends. Consider the following for each of these scenarios:

A physical therapist issuing physical therapy receipts must provide physical therapy services to their patients. Physical therapy services must meet what is described in the College Bylaws in Section 56: Minimal Treatment Standards.

These standards include steps such as gathering information, completing an assessment, ensuring consent for treatment, determining goals and a treatment/discharge plan and documentation of the details in accordance with Practice Standard 1: Clinical Records.

This applies to individual sessions with patients and group sessions with patients. If a physical therapist is not following these steps with a patient, then they must not use “physical therapy” to describe what they are providing – in communications with the patient, or on the receipt issued. Let’s look at each scenario in more detail.

The Answer to Scenario 1: It Depends.

This situation was described in the Fall 2016 newsletter on page nine. Pilates exercises can be integrated into an individualized physical therapy treatment plan, with a view to achieving the physical therapy goals set with the patient. Other exercises and interventions would likely also be part of the treatment plan.

What is provided to the patient would be considered “physical therapy services.” The clinical record should document the physical therapy assessment and treatment plan, the details of the intervention provided, the reassessments and treatment progression and other pertinent aspects of the service that the physical therapist provided, as described in Practice Standard 1.

If all these pieces are in place, then a physical therapy receipt can be issued. BUT if the sessions provided to the patient were not in accordance with Minimal Practice Standards and/or were generic Pilates sessions not connected to assessment findings, then what was provided was Pilates, not physical therapy services, and a physical therapy receipt must not be issued.

The Answer to Scenario 2: It Depends.

Group Pilates can certainly be offered. As described above, what must be determined is whether the service being provided is physical therapy services or Pilates sessions. Again, physical therapy services must meet the Minimal Treatment Standards as outlined in the CPTBC Bylaws, and the clinical record must support that physical therapy services were delivered at each session. If the group sessions are not individualized to each patient’s needs in accordance with physical therapy assessment findings and designed to target the individual patient’s physical therapy goals (and documented as such), then the Minimal Treatment Standards have not been met, and the patient has not received physical therapy services.

The Answer to Scenario 3: It Depends.

This situation was described in the Summer 2012 Newsletter. Practice Standard 3: Assignment of Task to a Physical Therapist Support Worker (PTSW) requires that a physical therapist only assign tasks within their own level of competence. It also requires that the physical therapist assesses the competence of the PTSW to ensure they can safely deliver the intervention. The physical therapist must not assign the task of “Pilates sessions” to a PTSW, but can assign the task of assisting the patient with patient specific poses or exercises that are part of the physical therapy treatment plan. The PTSW always works under the direction and supervision of the physical therapist, and the physical therapist conducts regular reassessments and progresses exercises based on the changes identified.

If the physical therapist feels that the patient would benefit from Pilates instruction that is not patient specific and is taught by a certified instructor, then the patient could be referred to a Pilates studio for a program that is not part of physical therapy services, but beneficial nonetheless.

The bottom line is that physical therapists need to consider what service their patient needs – physical therapy services, individualized and progressed to meet physical therapy goals, and/or Pilates classes that could replace or complement physical therapy services.

Receipts can only be issued for physical therapy services. Tasks can only be assigned under the direction and supervision of the physical therapist as part of the individualized physical therapy treatment plan.

Questions?

If you have questions about these or any other practice questions, don’t hesitate to call the Practice Advisors at 604-730-9193/1-877-576-6744, or email us at practicequestions@cptbc.org.