ABSTRACT
Purpose: To gather the perspectives of physiotherapists and physiotherapist assistants on essential competencies for intraprofessional (physiotherapist–physiotherapist assistant) collaboration. Method: A survey was developed to gather physiotherapist and physiotherapist assistant perceptions of the essential elements of effective and efficient intraprofessional collaborative practice. Participants were asked to rate the importance of 36 elements in 6 different categories (communication, collaboration, consultation, assignment of tasks, conflict management, and roles/responsibilities) involved in intraprofessional practice. Results: A total of 1049 physiotherapists and 121 physiotherapist assistants responded to the survey. Analysis identified 10 competency elements perceived by participants as essential to effective and efficient intraprofessional collaboration. Comparisons using demographic variables consistently yielded the same top 10 elements. Conclusions: Our results indicated that physiotherapists and physiotherapist assistants working in private and public practice share very similar views on what is essential for effective intraprofessional practice. The consensus is that communication is key; open lines of communication help to determine responsibilities. Physiotherapy pre-licensure and continuing education programmes should include opportunities to work on communication, listening, and the skills needed to interact and collaborate effectively.
Key Words: competencies, collaboration, intraprofessional practice, physiotherapist assistant
RÉSUMÉ
Objectif : Recueillir les points de vue des physiothérapeutes et des assistants du physiothérapeute sur les compétences essentielles à la collaboration intraprofessionnelle (physiothérapeute—assistant du physiothérapeute). Méthode : Un sondage a été préparé afin de connaître la façon dont les physiothérapeutes et les assistants du physiothérapeute perçoivent les éléments essentiels d'une pratique collaborative intraprofessionnelle efficace et efficiente. On demandait aux participants d'évaluer l'importance de 36 éléments dans 6 catégories (communication, collaboration, consultation, attribution des tâches, gestion de conflits, rôles et responsabilités) qui regroupent les aspects de la pratique intraprofessionnelle. Résultats : Au total, 1 049 physiothérapeutes et 121 assistants du physiothérapeute ont répondu au sondage. L'analyse des réponses reçues a permis de cerner 10 éléments perçus par les participants comme étant essentiels à une pratique collaborative intraprofessionnelle efficace et efficiente. Les comparaisons en fonction de variables démographiques ont constamment permis d'en arriver avec les mêmes 10 éléments. Conclusions : Nos résultats indiquent que les physiothérapeutes et les assistants du physiothérapeute qui travaillent dans le secteur public ou en pratique privée ont en commun des points de vue très similaires sur ce qui demeure essentiel pour une pratique intraprofessionnelle efficace. Le consensus chez tous les répondants veut que la communication soit un élément crucial; des lignes de communication ouvertes aident à bien établir les responsabilités de chacun. La préautorisation d'exercice de la physiothérapie et les programmes de formation continue devraient inclure des possibilités de travailler sur la communication, l'écoute et les compétences nécessaires pour interagir et collaborer efficacement.
Mots clés : assistant du physiothérapeute, collaboration, compétences, physiothérapeute, pratique intraprofessionnelle
The increasing cost of health care services and shortages in health human resources are driving governments and employers to increase the use of support personnel in health care, including the delivery of physiotherapy (PT) services in all practice settings.1 As a result, the role of the physiotherapist assistant is evolving in Canada. This evolution is influenced by developments in educational programmes, government action on health services, changes in employment, and union initiatives.2
In Canada, physiotherapists and physiotherapist assistants have provincial and national guidelines on standards of ethical and legal practice.3,4 In addition, a physiotherapist assistant competency profile, developed in 2002, outlines five essential competencies: accountability, collection of client information, intervention, communication, and organization of the delivery of PT services.5 These documents were developed to define procedures, assist the physiotherapists' and physiotherapist assistants' understanding of the expectations when incorporating physiotherapist assistants into practice, and establish the roles and responsibilities of the physiotherapist assistant in patient care.
The Canadian Alliance of Physiotherapy Regulators' 2000 guidelines reflected the consensus view of provincial regulators that a positive working partnership between physiotherapists and physiotherapist assistants is in the best interests of patient care.4 Unfortunately, there has been very little research on what this positive partnership should look like.6 As educators from a college-based physiotherapist assistant programme and a master's-level PT programme, we have worked together to develop paired physiotherapist and physiotherapist assistant clinical placements and intraprofessional classroom activities.7 In the current research project, we wanted to determine from physiotherapists and physiotherapist assistants what they identified as the essential competencies for effective and efficient intraprofessional practice.
Methods
We developed a survey to elicit physiotherapists' and physiotherapist assistants' perceptions of which competencies are essential for effective and efficient intraprofessional practice. Respondents were given the following definitions:
Intraprofessional/intradisciplinary practice refers to practice between members of the same discipline or profession (e.g., nursing, PT) who may have different education and scopes of practice.
Collaborative practice occurs when health care workers from different professional backgrounds provide comprehensive services by working with patients, their families, and communities to deliver the highest-quality care across settings.
The survey asked respondents to rate six competency categories (communication, collaboration, consultation, assignment of tasks, conflict management, and roles and responsibilities) using a 5-point Likert-type scale. Respondents also rated the importance in effective and efficient intraprofessional collaborative practice of 36 competency elements within these 6 categories. Demographic information collected included profession, gender, age, years of experience, work setting, area of practice, and years of experience on an intraprofessional team. Ethics approval was obtained from the University of Ottawa Research Ethics Board. Written consent from respondents was not required, as returning the completed survey was considered to indicate the respondent's implied consent to participate.
During development of the survey, we piloted a paper-based survey instrument in English and French with a convenience sample of 30 health care providers working intraprofessionally in rehabilitation, pharmacy, and nursing, who provided feedback on clarity and reliability. Reliability within each competency category was examined using Cronbach's alpha. Strong reliability was found in four of the six competency categories: conflict management (α=0.750), roles and responsibilities (α=0.733), collaboration (α=0.720), and communication (α=0.704). No major changes were recommended by the respondents. Face validity of the survey content was also conducted at this time. We then made the survey available online through the University of Ottawa Web server and distributed a link by email, via the College of Physiotherapists of Ontario, to all registered physiotherapists in Ontario, who were asked to forward the survey link to physiotherapist assistant colleagues. Respondents remained anonymous; completed surveys included no identifiers apart from the general demographic information collected, which would not be sufficient to identify individual respondents.
Results
A total of 1,049 physiotherapists and 121 physiotherapist assistants responded to the survey; their responses were analyzed both together and separately. The majority of the sample was female (83.6%), responded in English (96.4%), worked in an urban area (71%), and was located in Ontario (96.5%). In terms of employment characteristics, 41.6% worked in private practice, 51.6% were employed in a publicly funded organization, and 6.8% did not specify. Mean length of experience reported was 18.0 (SD 10.6) years; mean time working as part of an intraprofessional team was 13.6 (SD 10.3) years.
By determining the mean scores for each element and competency category, we were able to identify the 10 competency elements rated the highest by the respondents as essential to effective and efficient intraprofessional collaborative practice (see Table 1). Comparing scores for these 10 elements by demographic variables (e.g., employment characteristics, physiotherapist vs. physiotherapist assistant, private vs. public setting, gender, language, years of experience) consistently yielded the same top items, with slight variations in the order in items 6–10.
Table 1.
Top 10 Highest-Scoring Competency Elements (1=not important, 5=very important)
| 10 Highest individual competency elements* | Competency category | Mean (SD) score |
|---|---|---|
| 1. Recognizes, responds, and communicates appropriately all significant changes in a patient's health. | Communication | 4.94 (0.25) |
| 2. Demonstrates active listening, using verbal and nonverbal communication. | Communication | 4.91 (0.30) |
| 3. Maintains confidentiality and respect for the integrity of the intraprofessional team. | Collaboration | 4.90 (0.32) |
| 4. Expresses ideas and viewpoints in a respectful, confident, and concise language. | Communication | 4.90 (0.31) |
| 5. Shares and exchanges information effectively. | Communication | 4.90 (0.31) |
| 6. Assigns or accepts duties that are within one's scope of practice and competencies. | Assignment of tasks | 4.89 (0.33) |
| 7. Knows when and how to seek out information and request support when required. | Consultation | 4.89 (0.33) |
| 8. Accepts accountability for one's own contributions. | Roles and responsibilities | 4.89 (0.34) |
| 9. Is cognizant of ethical standards, laws, and regulations governing professional practice. | Assignment of tasks | 4.87 (0.38) |
| 10. Has the ability to work independently and interdependently. | Roles and responsibilities | 4.87 (0.37) |
Respondents rated communication (“Conveys the information effectively in a responsive and responsible manner to coordinate services”) as the most important competency category. Collaboration (“Establishes and maintains effective working partnerships to achieve common goals”) was rated the second most important category by the majority of respondents. The category conflict management and resolution (“Works effectively to manage and resolve conflict in the provision of care”) was rated by the majority as the least important category. In the winter of 2011, we held two focus groups (one conducted in French, the other in English) to verify with regional physiotherapists and physiotherapist assistants the information gathered from the surveys. Focus group participants were in agreement with the results.
Discussion
Positive working relationships are essential in any professional field. Our results indicated that physiotherapists and physiotherapist assistants working in private and public practice share very similar perceptions of what is essential for effective intraprofessional practice: elements of communication and collaboration. These findings are similar to recommendations concerning ideal intraprofessional collaboration in nursing.8 The finding that communication is a key element of intraprofessional practice is also consistent with past research on the physiotherapist–physiotherapist assistant relationship6 and the regulator's perspective.4 Some of the difficulty in determining physiotherapist assistants' scope of practice stems from the variation in education, credentials on graduation,2 and provincial practice standards across Canada. Open lines of communication between physiotherapists and physiotherapist assistants help to determine roles and responsibilities for clinical situations and encourage optimal functioning of the intraprofessional team.7,9 The report on a recent Alberta survey suggested communication and listening skills courses for intraprofessional teams.10
The idea that collaboration is essential was previously raised by physiotherapists interviewed for a 2010 Canadian Physiotherapy Association environmental scan on the status of support personnel in Canada.1 Our respondents rated collaboration the second most essential category; within that category, maintaining confidentiality and respect for the integrity of the intraprofessional team was rated highest.
Limitations
Our study has several limitations. First, we were not able to collect information from all Ontario physiotherapists and physiotherapist assistants; despite our large sample size, therefore, it is not possible to know how the responses from our sample would differ from those of the entire population. Second, the lower physiotherapist assistant response rate may have affected our results; future research should attempt to increase input from physiotherapist assistants. It should also be noted that there was bias in the selection of participating physiotherapist assistants, as the physiotherapist assistant sample was determined by the physiotherapists who chose to forward the email invitation to their physiotherapist assistant colleagues.
Finally, during the paper-based pretesting of the survey, only face validity was tested; more rigorous content validity testing would have added to the credibility of the survey results.
Conclusions
Our findings offer valuable insight into what physiotherapists and physiotherapist assistants perceive as essential elements for a positive physiotherapist–physiotherapist assistant working partnership. The fact that the two groups share a very similar vision of essential competencies for effective and efficient intraprofessional practice is also important to note. PT pre-licensure and continuing education programmes should include opportunities for physiotherapists, physiotherapist assistants, and students to work on communication, listening, and other skills needed for effective interaction and collaboration.
Key Messages
Physiotherapists and physiotherapist assistants working in private and public practice share very similar views on what is essential for effective and efficient intraprofessional practice. The consensus was that communication is key.
What is already known on this topic
It is agreed that positive working partnership between physiotherapists and physiotherapist assistants is in the best interests of patient care.
What this study adds
While physiotherapist and physiotherapist assistants have their own individual competency profiles, this study aimed to identify the essential competencies for effective and efficient intraprofessional collaboration between these two groups.
Physiotherapy Canada 2013; 65(2);148–151; doi:10.3138/ptc.2012-02
References
- 1.Colbran-Smith M. White paper: physiotherapist support personnel study. Canadian Physiotherapy Association; 2010. [cited 2011 Sep 21]. Available from: http://www.physiotherapy.ca/getmedia/322dbde4-702b-459a-bf53-02c4214fb9df/White-Paper-Physiotherapist-Support-Personnel-Study.pdf.aspx. [Google Scholar]
- 2.Canadian Physiotherapy Association. The evolution of the physiotherapist assistant. Physiother Pract. 2011;1(1):20–2. [Google Scholar]
- 3.College of Physiotherapists of Ontario. Physiotherapists working with physiotherapist support personnel: guide to the standards for professional practice. 2009. [cited 2011 Aug 12]. Available from: http://www.collegept.org/Resources#SupportPersonnel.
- 4.Canadian Alliance of Physiotherapy Regulators. National guidelines for support workers in physiotherapy practice in Canada. The Alliance; 2000. [cited 2011 Sep 21]. Available from: http://www.alliancept.org/pdfs/alliance_resources_newsroom_guide_sup_workers_eng.pdf. [Google Scholar]
- 5.Canadian Alliance of Physiotherapy Regulators. Competency profile: essential competencies of physiotherapist support workers in Canada. Toronto: The Alliance; 2002. [Google Scholar]
- 6.Plack M, Williams S, Miller D, et al. Collaboration between physical therapists and physical therapist assistants: fostering the development of the preferred relationship within a classroom setting. J Phys Ther Educ. 2006;20:3–13. [Google Scholar]
- 7.Jelley W, Larocque N, Patterson S. Intradisciplinary clinical education for physiotherapists and physiotherapist assistants: a pilot study. Physiother Can. 2010;62(1):75–80. doi: 10.3138/physio.62.1.75. http://dx.doi.org/10.3138/physio.62.1.75. Medline:21197181. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.McNamara S, Lepage K, Boileau J. Bridging the gap: interprofessional collaboration between nurse practitioner and clinical nurse specialist. Clin Nurse Spec. 2011;25(1):33–40. doi: 10.1097/NUR.0b013e318202104d. http://dx.doi.org/10.1097/NUR.0b013e318202104d. Medline:21139465. [DOI] [PubMed] [Google Scholar]
- 9.Goude J. Bridging the great divide: improving the relationship of PTs and PTAs through communication works. Adv Phys Ther Rehab Med. 2001;12(23):29. [Google Scholar]
- 10.Alberta Health Services. Report on the essential competencies validation survey for therapist assistants. Alberta Health Services; 2010. [Google Scholar]