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A P U B L I C AT I ON FO R THE P HYSIO T H ERAPY CO M M UN I T Y O F B C
The Value of Teamwork
in Healthcare
IN THIS ISSUE Autumn 2018
04 / Team-based Health Care in Action
08 / Patellofemoral Pain
bcphysio.org 14 / BC Physio Forum Call for Presentations
25 / Parkinson’s Disease and Physiotherapy
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AUTUMN 2018
WHAT’S INSIDE PRESIDENT’S MESSAGE
02 / CEO Message Professional Development Advisory Committee
03 / Knowledge Services Update PABC has transitioned to a new Education Manager
06 / PABC Education Updates and a new Knowledge Services Manager and we are
continuing to provide high quality continuing education
19 / Membership News to our membership, organized through our Professional
23 / Student Corner Development Advisory Committee. I am happy to welcome
Nathan Hers as our Education Manager and Terri McKellar
26 / UBC Update as our new Knowledge Services Manager. For those
interested in the types of courses that this committee helps
Patrick Jadan, facilitate, please check out the current PABC Sponsored
PABC President Course Listing on the bcphysio.org website.
ICBC Contract Negotiations
CONTRIBUTORS We continue to work closely with our provincial motor vehicle insurer, the Insurance
Patrick Jadan, Christine Bradstock,
Corporation of British Columbia (ICBC) as their model changes to be more care-
Jean-Francois Esculier, Kimberley based. I wish to extend my gratitude to Christine and our members that have
Payne, Stephanie Dutto, Kate Wale, volunteered to aid these discussions as part of our ICBC working groups. Some of
Taryn Walker, Sue Murphy, Karen their work has involved trying to define the different categories of injuries and the
Sauve, Michael Hunt, Anna Daburger, assessment and treatment plans for these injuries. More recently, they have been
Georg Reuter, Jason Giesbrecht, Terry working on the details of preapproved visits, compensation, and appointment
Fedorkiw, Jollean Willington, Scott length. Reaching a firm contract with ICBC will be a big step forwards for our
Okrainetz, Nathan Hers, Myriame profession in BC, as we have been without one for over a decade.
Lépine Lyons, Mary Charlton, Sandy Van
Kleeck, Laura Kean, Terri McKellar, Board Plans & Initiatives
Our board has voted in favour of creating an adhoc committee to examine scope
BOARD OF DIRECTORS of practice expansion. For the past 2-3 years we have been attempting to secure
Patrick Jadan President the ability to refer directly to MSK specialists, as a stepping stone to then be able
Dr. Alex Scott Greater Vancouver/ to refer directly for medical imaging. However, this initiative encountered some
Sunshine Coast Director resistance from the professional body representing general practice physicians in
Chiara Singh Greater Vancouver/ BC. So, we have decided to create this temporary committee to better coordinate
Sunshine Coast Director our efforts and to ensure that they are in line with our new strategic plan. We are
Joanna Sleik Kootenay Director happy to say that the response from members wishing to become involved in
Brad Jawl Vancouver Island this adhoc committee was overwhelming. I would like to formally recognize the
Director following members who will be on this committee: Kevin Bos, Maria Juricic, Tracy
Nikolina Nikolic Northern BC Barber, Darryl Caves, Viral Trivedi, Alison Greig, Della Gallagher, Kathy Davidson and
Director Christine Bradstock.
Kevin Bos Okanagan Director
Government Relations
Janet Lundie South Fraser Director
Christine, myself, and Dr. Alex Scott have a meeting pending with the Minister of
Cassandra Legault
Student Director, MPT1 Health. This meeting will be to follow up on the one we had with several senior civil
servants at the Ministry of Health in regards to workforce planning and recruitment.
Laura Kean
Student Director, MPT2 We will be addressing the need for an increased number of Master’s degree training
seats for physiotherapists in BC. We will express our intention to have this training
Dr. Tommy Gerschman
MD External Director occur in a more dispersed fashion, rather than only out of the UBC Vancouver.
Christine Bradstock CEO
Specifically, we will highlight the need for additional PTs to be trained in Northern BC.
Member of
Patrick co-owns Thrive Now Physiotherapy, with two locations in the Cowichan
Valley. Patrick has spent the past 8 years volunteering with PABC, and has
served on the Board of Directors since 2014.
PA BC D I RECT I O N S / 1
DIRECTIONS CEO AUTUMN 2018 MESSAGE
PABC has gone through Natalie Elster, Communications Coord / Admin Assistant:
some changes lately and our with only a few weeks here at PABC we have seen the
team has grown. In August, wonderful creative pieces that Natalie can produce. She is
before the students left, we also a website wizard, so expect to see some changes over
had a day of team building the next several months.
exercises. We have planned
another one for September Nathan Hers, Education Manager (contractor):
where we will be working providing thoughtful insight and ideas to our education
to better understand our programming, in May, Nathan hit the ground running.
individual strengths, how Working closely with the Professional Development
Christine Bradstock,
those strengths best fit into Committee, and Knowledge Services expect great things
PABC CEO
a stronger team and how as Nathan leads and grows this area.
this will all work to move the operational plan and
Jeremy McAllister, eHealth Manager (contractor): Jeremy
strategic plan forward. Below please find some
additional information about our team. has been working as our eHealth Manager for the last
couple of years. He has connected with many third-party
providers and increased opportunities for patients and
Staff and contractors at PABC:
physiotherapists. eHealth is a growing area and we are
Jollean Willington, Communications Manager: with a excited to have Jeremy leading us.
background in communications, public relations and
Alison Hoens, Knowledge Broker (contractor): Alison will be
publishing Jollean has already provided leadership
returning to us on January 1st 2019. We are all very grateful
and direction in her first 4 months. We look forward
to have her back and a part of our team! Her time at
to wonderful strides with our website, member and
Strategy for Patient-Oriented Research (SPOR) will add to
community outreach and government relations.
her already vast experience as our Knowledge Broker. Yeah!
Terri McKellar, Knowledge Services Manager: with Terri
Christine Bradstock, CEO: Having a team of dedicated
guiding our knowledge services, drawing on her master’s
professionals makes my job easier. Thank you to the whole
degree in Library Information Technology and her 10
team of staff, contractors, the board and all volunteers!
years of experience as a nurse we look for some amazing
advances here. A true team player Terri will help to bring Our two summer students, Taryn and Kate, have left us
out the best in everyone. and headed back to university. They were a pleasure to
have in the office this last summer and we wish them all
Stephanie Dutto, Sales and Events Manager: in her 19th
the best as they move forward with university and in their
year here at PABC Steph brings a deep understanding of
careers. We will apply next year for student funding again;
the membership and the history of the organization. As she
the students provide great value to our organization.
plans the Forum and many other events we will see some
new and exciting opportunities for the PABC membership. Your PABC team is working hard for you, our members.
As we work toward the goals of our strategic plan we will
Kimberley Payne, Member Services and Office
draw on each others strengths and work collaboratively
Administrator: Kimberley is your go-to person on the
to move things forward. Please contact us if you have any
phone and email with respect to your member needs.
questions or suggestions!
Many of you know her well as she is in her 4th year here at
PABC. Kimberley has worked hard over the last couple of
years on community outreach and engagement. Look for
more of this in the future.
2 / Autum n 201 8
UPDATES FROM KNOWLEDGE
SERVICES MANAGER
Hello physiotherapists of BC! My name is Terri McKellar and I have recently joined
PABC as the new Knowledge Services Manager. Over the last few weeks I have
enjoyed learning about how the association supports physiotherapists in BC, and what
Knowledge Services does to strengthen that support. I have already spoken with a
number of you via email regarding reference/research questions and I look forward to
more of your interesting questions!
I have just finished my Master of Library and Information Studies (MLIS) at the University of British
Columbia. During my program I focused on health care related projects, working on systematic
reviews and scoping reviews, analyzing the collections of medical libraries, and examining the
Terri McKellar, data storage and sharing challenges of health-related research data.
MLIS, BN, BA Prior to obtaining my MLIS I was working in healthcare alongside some of you as a Registered
PABC Knowledge Nurse. Coming into this position I bring 10 years of nursing experience in a wide variety of
Services Manager settings. I started my career in Ontario working in cardiology. When I moved to BC I completed
the BCIT certification in Emergency Nursing and proceeded to work in emergency departments
across the lower mainland, from Royal Columbian to St. Paul’s and a few in between! Teamwork is
the key to a successful emergency department, and having a good team is what makes you go to
work everyday (or night).
To balance some of that acute experience, I worked on the Downtown Eastside in both
primary care and HIV supportive care, working with social workers, support workers, therapists,
pharmacists and physicians to provide full service interdisciplinary care to our clients. I also
worked at the BC Cancer Agency in the ambulatory clinics, connecting patients with both human
and digital resources to help them on their treatment journey.
Throughout all of my nursing experiences, I have endeavoured to promote strong teamwork and
collaboration among staff as well as with clients/patients. I believe effective teams are built out of
confidence in ones’ own ability as well as confidence in the rest of the team.
As your Knowledge Services Manager I want to help you be confident in the care you provide
to your clients by connecting you with the latest in physiotherapy research and treatment
modalities. I encourage you to reach out with your questions and feedback. I would love to hear
from you about how I can help you!
PA BC D I RECT I O N S / 3
F E ATURE EDI TO R IA L
Kamloops, BC
Team-based Health Care in Action
New Kamloops Urgent Primary Care Centre
These are exciting times for health care in British Columbia. With the provincial
Jollean Willington, government recently announcing plans to establish team-based, primary care
PABC Communications networks in 70 per cent of B.C. communities over the next three years, the
Manager landscape of health care is shifting how people receive care and how care is being
provided. Traditionally, health care has been funneled through a family doctor, but
many people have been struggling to find and access doctors. This has impacted our
health care system, increasing emergency room attendance across the province and
creating longer wait times for patients.
The provincial plan also outlines the opening of 10 urgent primary-care centres over the next
year with the aim of providing services to people who do not have a family doctor or access to
timely health care solutions. These centres will operate with extended hours 365 days a year
and will incorporate an interdisciplinary healthcare team, who will provide a range of services
on site to reflect the unique needs of each community.
“That team-based approach means we’re going to connect people to doctors, nurse
practitioners, pharmacists, psychologists, social workers, dietitians, physiotherapists and other
health care professionals that will meet their needs when they need it, where they need it,”
said premier John Horgan as part of the announcement.
4 / Autum n 201 8
Jason Giesbrecht, Executive Director for Primary and
Community Care Transformation for Interior Health in
Kamloops says, “The more traditional approach is to think
that physicians and nurse practitioners are the only primary
care providers. But in fact, physiotherapists are critical
and they deliver a significant amount of primary care in
the province. This shift toward a team-based approach is
a fantastic opportunity that physiotherapists across the
province need to seize.”
What will this shifting, decentralized approach look like in Ribbon Cutting with (l-r) Kamloops Urgent Primary Care Centre
Manager Kerry McLean-Small; Secwepemc Drummer Morgan
the care centres? At the recently opened Kamloops Urgent
Christopher; Secwepemc Elder Charlotte Manuel; Tk’emlúps
Primary Care Centre there will be a most responsible
te Secwepemc Band Councillor Rosanne Casimir; B.C. Minister
clinician, decided at upon admission, who may be the
of Health Adrian Dix; IH Board Director Dr. Selena Lawrie;
physio, physician, social worker, or an occupational Thompson Regional Hospital District Chair and Kamloops
therapist, depending on the person’s condition. That Mayor Ken Christian; and IH Executive Director of Primary and
most responsible clinician will lead the team in treament. Community Care Transformation Jason Giesbrecht.
This means moving away from the historical hierarchy in
a health care team. With patients often having multiple
conditions at the same time, Giesbrecht gives the example
of a patient who has diabetes and a sprained ankle or
has fallen and injured their hip. With the new structure,
that patient may see the nurse for their diabetes and a
physio for balance. “The idea is that these clinicians would
get together and build a shared care plan, recognizing challenge. The demand for physical therapy is growing
that this person is not a hip, or a sugar imbalance, but a significantly along with the role of physiotherapists
whole person. Therefore, the plan needs to be wholistic,” in primary care, but there is a real shortage of
Giesbrecht points out. physiotherapists in the province, and with more
This is a culture shift for therapists as well as other physiotherapists retiring, that shortage is even greater.
team members in these Centres, but he sees where “It’s going to be extremely difficult to maintain the
physiotherapists have an advantage. “PTs have a very presence of physiotherapists on these teams without
unique skill set that is not generally reproducible in there being some kind of action,” Giesbrecht states.
other professions and beautifully situated to address and “In Kamloops, the data has shown that the predominant
provide care for the full continuum of the patient’s life. If patient will mostly be seen for orthopedic concerns.
you compliment the knowledge of the physiotherapist with We are requiring the applicants for two physiotherapy
the capability of the full team, the opportunities are really postings here at the Primary Care Centre to have level 3
quite significant,” states Giesbrecht. Orthopedic exams done or be committed to completing
Change brings challenge and Giesbrecht confirms the them within 2 years. That requirement for higher level
profession and work of physical therapy is greatly valued training is impacting our ability to recruit,” Giesbrecht
across disciplines. “As a physio myself, I didn’t always says with some concern.
understand or appreciate that. When I stepped out of Jason Giesbrecht believes that even though some
being in physiotherapy, it has become clear the work of physiotherapists have been providing primary care for years,
physiotherapists is highly regarded and respected. The this is just the beginning of a new chapter in health care.
challenge now for physiotherapists is in moving beyond “We as physiotherapists need to embrace this opportunity
that recognition of value, and becoming even more and continue to strive to top of scope and practice,
integral in the primary care sphere,” says Giesbrecht. continuing to grow with the technological advancements
While he makes a call for maintaining top of scope that are coming to physical therapy, including virtual
practice and continued training and education for applications. These opportunities are before us to take hold
physiotherapists, Giesbrecht also recognizes another and run with them,” Giesbrecht advises.
PA BC D I RECT I O N S / 5
UPDATES FROM PABC EDUCATION
Osteoarthritis: Not Just Wear and Tear?
Hello BC physiotherapists! I am your new PABC Education Manager.
This month I would like to explore a topic that many physiotherapists deal with routinely and
is an increasingly common issue in our society. Osteoarthritis. It is estimated that by 2040 25%
of adults in the US will have arthritis, and in Canada 35.1% of people over the age of 80 have a
diagnosis of arthritis. 1,2 With our aging population OA management will become an increasingly
important issue for health care providers to be knowledgeable about. There has been some recent
research on lower extremity osteoarthritis that has highlighted two realities that are relevant for our
profession: 1) that skilled exercise prescription is at the forefront of treatment of this condition and
Nathan Hers,
2) our current treatment paradigms are not in step with recent clinical recommendations.
PABC Education
Manager First, a story: you have a patient that has a traumatic knee or hip pain that is over 40 and they
can’t determine the cause. They shrug their shoulders, and state in a defeated tone, “its probably
just arthritis.” You can tell from their voice that they have accepted the inescapable force of time
on their joints - they played competitive sports as a child after all - there’s nothing to be done for
their pain or dysfunction. Or a well-meaning health provider has diagnosed this condition as well
and may have contributed to this feeling of helplessness. Does this sound familiar? It is likely a
common one and it is important to answer two questions: do we have a set of clinical criteria to
rule in or rule out osteoarthritis as the source of their symptoms, and is there anything to reduce or
improve their symptoms if OA is the cause.
The good news is that we have a set of clinical criteria that we can use to diagnose osteoarthritis
in the hip and knee. The Altman criteria from the American College of Rheumatology are still the
most commonly used diagnostic criteria, which can be used without imaging (though imaging can
increase our suspicion and accuracy of diagnosis if available).3
Altman Clinical Criteria for OA of the Knee Altman Clinical Criteria for OA of the Hip
PAIN IN THE KNEE PAIN IN THE HIP
And 3 of the following And all of the following
50+ Years of Age Internal Rotation of the Hip 15•
Pain associated with Internal Hip
Morning stiffness < 60 minutes
50+ Years of Age
6 / Autum n 201 8
There is also more recent criteria that are helpful in early OA.8 Like any tissue, our joint cartilage seems to respond
osteoarthritis, as missing this is one of the critiques of well to the right amount of force or load. Osteoarthritis
the ACR guidelines. In the knee these include having is now recognized as a disease with inflammatory and
multiple pain episodes that last more than 10 days in the metabolic components, and exercise has been shown to
last year. 4 This might be a helpful question in our clinical positively affect these areas.7 We don’t know for sure the
examination, specifically asking regarding the duration of exact mechanism of benefit from exercise, but a leading
pain in previous episodes. theory is that maintaining a healthy chemical environment
at the joint is part of the beneficial effect.9 Educating all
If OA is the suspected cause, there are three pillars
for treatment: exercise therapy, weight management, parties - both patients and health-care providers - will be
and education.5 I would like to focus on the two E’s: an important component of helping our aging population
live well with OA.
exercise and education. In terms of exercise therapy,
recent recommendations emphasize that an initial bout These treatment recommendations offer an opportunity
of supervised exercise therapy for a period of 6 to 8 for physiotherapists to lead the charge in educating the
weeks may be helpful for treatment, as well as booster rest of the health care team. OA is not just wear and tear.
sessions to assist with adherence for the longer-term Movement is not dangerous – and in fact will keep joints
management. This recent review emphasizes that a long- healthier and happier for longer. And in many cases,
term pattern of exercise is key to successful outcomes, physio can help.
and these booster sessions should focus on facilitating
this self-management strategy.
References:
The bottom line is that a number of different 1
Birtwhistle et al. (2015). Prevalence and management of
exercise programs have been shown to be helpful osteoarthritis in primary care: an epidemiologic cohort study from
for OA symptoms – aquatic, weightbearing, strength, the Canadian Primary Care Sentinel Surveillance Network. CMAJ
Open.
neuromuscular - and matching the intensity to the patient
2
Hootman et al. (2016). Updatd projected prevalence of self-
in front of you is key. Some interesting trends that help
reported doctor-diagnosed arthritis and arthritis-attributable
us target our exercise further – OA with a high degree activity limitation among US adults. Arthritis Rheumatology.
of knee varus seems to respond well to neuromuscular 3
American College of Rheumatology. ACR-Endorsed Criteria for
control exercises, and obese patients with knee OA seem Rheumatic Diseases. Retrieved from https://www.rheumatology.
to respond preferentially to quadriceps loading 6. There org/Practice-Quality/Clinical-Support/Criteria/ACR-Endorsed-
Criteria
are some good resources available from GLa:D as well
as http://nemex.trekeducation.org, which walks through
4
Luyten et al. (2012). Definition and classification of early
osteoarthritis of the knee. Knee Surgery, Sports Traumatology,
some progressions for neuromuscular exercise. Arthoscopy.
The final piece of the puzzle in our treatment is the 5
Leech et al. (2018). Lower extremity osteoarthritis: optimising
chronically undervalued one; education. This is a vital musculoskeletal health is a growing global concern: a narrative
review. British Journal of Sports Medicine
component, as exercise as a primary method of treatment
is counterintuitive in light of our historical understanding
6
Bennell et al. (2015). Influence of biomechanical characteristics
on pain and function outcomes from exercise in medial knee
of OA. Often, we hear words like “wear and tear” or osteoarthritis and varus malalignment: exploratory analyses from
“bone on bone” in relationship to OA, which may lead a randomized controlled trial. Arthritis Care & Research
patients to assume that loading or exercising that joint 7
Mobasheri et al. (2016). An update on the pathophysiology of
would damage it further. Why would I add more wear and osteoarthritis. Annals of Physical and Rehabilitation Medicine.
tear to the joint? There is certainly a loading component 8
Alentorn-Geli et al. (2017). The association of recreational and
to OA - chronically overloading a joint via running or competitive running with hip and knee osteoarthritis: a systematic
review and meta-analysis. Journal of Orthopaedic and Sports
repetitive occupational tasks are risk factors for developing Physical Therapy.
OA.7 Counter to this wear and tear narrative is that 9
Leong et al. (2014). Osteoarthritis – why exercise? Journal of
recreational running has shown a protective effect for Exercise, Sports & Orthopaedics.
See our Education Calendar on page 12 and more at bcphysio.org.
PA BC D I RECT I O N S / 7
PATELLOFEMORAL PAIN ARE WE
OVERCOMPLICATING TREATMENT?
Most of the time, runners develop PFP simply because
Jean-Francois Esculier, they did too much, too soon. Not because they have flat
PT, PhD, Cert. Sport feet,1 higher than average Q-angle,2 weak gluteus medius3
Physiotherapy (SPC) or a so-called ‘tight IT-band’ causing patellar mal-tracking.
Considering that the average runner takes about 80 steps
per leg per minute, rapid increases in weekly mileage or speed can easily exceed the
patellofemoral joint’s capacity for adaptation, regardless of anatomical features.4,5
Keeping this in mind, an effective treatment plan should first and foremost include
appropriate education, to ensure patients understand their training errors and know
how to avoid them in the future.6
The latest treatment guidelines on PFP are clear: an active approach which empowers
the patient should be prioritized.7-9 Strengthening exercises for hip and thigh muscles are
highly effective, and are recommended for short, medium and long-term benefits on pain
and function. However, regardless of how brilliant the exercises may be, they will be totally
ineffective if the current running/activity program keeps overloading the patellofemoral joint.
According to a recent randomized clinical trial, education on appropriate management
of training loads according to symptoms is key for recovery of runners with PFP. Indeed,
prescribing exercises or gait modifications on top of education provided no additional
benefits compared with education alone.10 That doesn’t mean exercises or gait modifications
are useless – they can clearly help for PFP and other running-related injuries.11 These results
emphasize that physical therapists should first address the basics. Simply put, providing
advice on temporarily reducing running speed, running shorter distances more frequently and
implementing run/walk intervals while not exceeding pain levels of 2/10 should be prioritized.10
It must be noted that international consensus guidelines on PFP do NOT recommend passive
treatments such as manual therapy and electrophysical modalities, since they are not likely
to add any benefit to an active approach.9,12 Similarly, there is currently no scientific evidence
supporting any type of needling for PFP.
Instead, choose a personalized active approach that may include exercises, gait modifications
and footwear recommendations. And address the root cause of the problem using education
and symptom-based activity modifications!
Jean-Francois Esculier, PT, PhD, Cert. Sport Physiotherapy (SPC), is a physical therapist at
Allan McGavin Sports Medicine Clinic and postdoctoral fellow at the University of British
Columbia. He’s an active researcher on running-related knee pain and member of the
international Patellofemoral Research Network.
Want to learn more about causes and treatments of running injuries?
Take the course New Trends in the Prevention of Running Injuries
hosted by PABC in Victoria (January 19-20, 2019)!
8 / Autum n 201 8References:
1
Neal BS, Griffiths IB, Dowling GJ, et al. Foot posture as a risk 8
Barton CJ, Lack S, Hemmings S, et al. The ‘best practice
factor for lower limb overuse injury: A systematic review and meta- guide to conservative management of patellofemoral pain’:
analysis. J Foot Ankle Res 2014;7: 55. Incorporating level 1 evidence with expert clinical reasoning.
Br J Sports Med 2015;49: 923-34.
2
Pappas E, Wong-Tom WM. Prospective predictors of
patellofemoral pain syndrome: A systematic review with meta- 9
Collins NJ, Barton CJ, van Middelkoop M, et al. 2018 consensus
analysis. Sports Health 2012;4: 115-20. statement on exercise therapy and physical interventions
(orthoses, taping and manual therapy) to treat patellofemoral
3
Rathleff MS, Rathleff CR, Crossley KM, et al. Is hip strength a risk
pain: Recommendations from the 5th international patellofemoral
factor for patellofemoral pain? A systematic review and meta-
pain research retreat, gold coast, australia, 2017. Br J Sports Med
analysis. Br J Sports Med 2014;48: 1088.
2018;Epub ahead of print 2018 Jun 20.
4
Hreljac A. Impact and overuse injuries in runners. Med Sci Sports 10
Esculier JF, Dubois B, Bouyer LJ, et al. Is combining gait
Exerc 2004;36: 845-9.
retraining or an exercise program with education better than
5
Dye SF. The pathophysiology of patellofemoral pain: A tissue education alone in treating runners with patellofemoral pain?
homeostasis perspective. Clin Orthop Relat Res 2005;436: 100-10. A randomised clinical trial. Br J Sports Med 2018;52: 659-66.
6
Rathleff MS, Thomsen JL, Barton CJ. Patient education in 11
Barton CJ, Bonanno DR, Carr J, et al. Running retraining to treat
patellofemoral pain: Potentially potent and essential, but under- lower limb injuries: A mixed-methods study of current evidence
researched. Br J Sports Med 2018;52: 623-4. synthesised with expert opinion. Br J Sports Med 2016;50: 513-26.
7
Crossley KM, Stefanik JJ, Selfe J, et al. 2016 patellofemoral pain 12
Barton C, Esculier JF. Letter to the editor-in-chief: No evidence
consensus statement from the 4th international patellofemoral pain exists to support manual therapy in physical therapy practice for
research retreat, manchester. Part 1 terminology, definitions, clinical patellofemoral pain. J Orthop Sports Phys Ther 2018;In press.
examination, natural history. Br J Sports Med 2016;50: 839-43.
COMMITTEE FOCUS
Professional Business Public Practice Forum
Development Affairs Advisory Planning
• Planning and coordinating • Developing initiatives • Recruitment to public • Advise on topics of interest
2019 courses to inform members & practice: Created a to pursue for Physio
develop resources for document showing the Forum presentations and
• Helping execute the new
physiotherapists working in wage difference between aid in selection of final
Post-Forum courses for
private practice. public & private practice presentation submissions
April 2019 Forum.
to use as a starting point • Advise on schedule and
• Gathered information on
• Evaluating new for a conversation with the
employment and self- format ideas for Physio
educational opportunities recruitment group from
employment contracts, Forum.
& proposals for BC HSA.
led to a presentation by a • Help on-site as room hosts
physiotherapists on an
lawyer at the PABC Forum • Insurance in public at Physio Forum 2019
ongoing basis
2018 practice, waiting for
information CPA & the
• Major focus for 2018 is
insurance provider are
a review of the private
gathering, then plan an
practice resources on
information session
PABC website to update
improve & make more • Pediatric survey: PABC &
accessible. BC Pediatric Physiotherapy
Council have joined to
review the impact of the
Ministry of Children and
Family Initiatives.
PA BC D I RECT I O N S / 9IT TAKES A TEAM TO BUILD A FUTURE!
Recently, I was awarded the Physiotherapy Educator role at the Royal Jubilee
Scott Okrainetz Hospital in Victoria, much in thanks to the PABC. The PABC asked my thoughts
about my growth through my early career and the only thing that comes to
mind is the word TEAM.
Team is such a powerful word. Its necessity is something Trust also builds stronger communication for a team, as it
that was born in each of us, even when we first started allows everyone to express their opinions safely to improve
our physiotherapy education. I still remember one of the efficiency without thought of repercussions. Mutual respect
first lectures of my Masters, the department head saying builds rapport, removes judgement, and tightens the
something to the effect of… `The competition is over, you bonds of a team. When an individual feels respected in a
are going to have to work together to get through this role, they often are willing to engage more for the benefit
program.` I owe thanks to so many of my classmates for of the team. When it comes down to it strengthening your
the team work and the support that they gave to help see team is necessary to strengthen the future of your career!
the program through. It was just the first stepping stone
that we set as a group to what will be some amazing
futures to watch!
As we all gained our identities in the profession, another
teammate emerged that always had our back, the
Physiotherapy Association of BC. Over the years I have
heard so many uplifting stories of my colleagues’ first
interaction with our PABC teammate. Mine was of meeting
one of the most uplifting and inspiring coaches in my life,
Rebecca Bing Tunnacliffe, also known as RBT. Under her
guidance in the committees I volunteered for or led with
the PABC, I gained new understandings of leadership,
commitment to the profession, and determination to see a
goal to the end. One lesson in particular she taught me is
that, in a team we work to help our other teammates reach
their potential. I have taken that with me though every twist
and turn my career has taken.
Day to day, no matter working in private or public practice,
your team helps you get the job done, to provide the best
care for each patient. Whether working with leaders, other
physios, OTs, front office staff, rehabilitation assistants,
nurses or doctors, it is important to maintain mutual trust
and respect. When a team trusts one another, you can have
faith everyone is going to work for the best possible result.
Scott Okrainetz is a grad of UBC 2011 MPT, the former PABC Public Practice Advisory Committee Chair and an overall
enthusiastic physiotherapist who is passionate about our epic profession!
10 / Autum n 20 1 8RURAL AND REMOTE TEAM-BASED PRIMARY CARE
Working in rural and northern school staff and other community leaders. Working with
communities speaks to the these groups to plan an extension program or clinic is
heart of what we do as physical especially rewarding. There is always an opportunity to
therapists. This includes speak with the local MLA regarding the value of physical
supporting our patients and and occupational therapists participating and investing in
clients from their initial intake local community resources and programs.
through to their immersion into
community activities.
Working in rural and northern
Mary Charlton communities speaks to the If there is a downside of rural based
heart of what we do as physical rehabilitation, it would be that our
therapists. This includes supporting our patients and clients
professionalism is 24/7. We are builders
from their initial intake through to their immersion into
community activities. and connectors of the community in
There are many positives to living and practising in remote which we live. We have access to private
areas of the province and people do it for various reasons. and confidential information which is
Many rural health care professionals have grown up in exactly that. Lines cannot be crossed. We
rural surroundings. Some professionals are lured to smaller
communities to raise their families and enjoy recreational
conduct ourselves by our code of ethics.
benefits that they would otherwise spend hours travelling
to enjoy occasionally. The combination of familiar faces
and pristine landscapes to explore draws many to the
It goes without saying that networking with other medical
countryside where both physical and mental health are at
professionals is essential in the health care delivery model
their best.
in northern and rural communities. Many divide their
Another benefit of practicing in smaller communities is time between a position with the Health Authority, local
the opportunity to build strong working relationships residential care facility public or privately funded, private
with other health care providers to provide integrated physiotherapy clinic or with Child Development centres.
team care. Working together and having consistent It can take some juggling of hours to add up to a full-time
communication with physicians, in-patient and community equivalent position, but most medical and community
nursing, occupational therapists, home support, families agencies are more than willing to adapt so they can
and visiting consultants, allows for a more holistic benefit from the expertise and experience that physical
treatment for the patient. therapists bring to their community. Multiple site work
Smaller communities often support rehab extension challenges and inspires us all.
programs such as Falls and Balance Programs, Post-op The team-based Primary Care model fits well with northern
Hip and Knee program and Osteoarthritis or Parkinson’s and rural community rehab positions where services are
Disease management. Therapists have an opportunity often housed in the same building or area of town. Getting
to meet and work with a wide rage of supporters such as to know your team members by their name, skills and
Indigenous health teams, the hospital auxiliary, palliative talents goes a long way to offering personalized rehab
care providers, local recreation centre staff, seniors groups, care for patients, community care and programs.
Mary Charlton has been a member of PABC since 1971 with a focus on Community Physiotherapy and Home Health.
Registered Physiotherapist, Clinical Practice Leader, Physiotherapy, Fraser Canyon Hospital, Primary & Community Care
PA BC D I RECT I O N S / 112018 EDUCATION CALENDAR EXCITING UPCOMING EDUCATIONAL OPPORTUNITIES PRODUCED BY PABC 1. MSK Assessment & Management of the Child with 3. Treatment of Temporomandibular Disorders and Cerebral Palsy with Stacey Miller and Maria Juricic on Sep Orofacial Pain with Maria Zerjav on November 3-4th, 29-30, 2018. “Hosted in Victoria with live video conference 2018. Hosted in Vancouver. to Prince George, Kelowna, Nelson and Vancouver. Course is full and waitlist is available. Learn from clinical leaders in the treatment of CP. 2. Enhancing Skills in Cardiorespiratory Physiotherapy 4. New Trends in the Prevention of Running Injuries with with Simone Gruenig on Oct 20- 21, 2018. Hosted in Jean-Francois (JF) Esculier on Jan 19-20 2019. Hosted in Nanaimo. This course provides invaluable information Victoria. An evidence-based update on the treatment on cardiorespiratory patient assessments, including a on runners. review of anatomy, posture and physiology. 12 / Autum n 20 1 8
PHYSIO FACES TERRY FEDORKIW:
PRACTISING IN THE SOUL OF CANADA
Terry Fedorkiw immigrated Currently, the Government of British Columbia, UBC
from Ireland to B.C in 1973 and the University of Northern British Columbia run a
and rather than settle in collaborative initiative called the Northern and Rural
Vancouver and take a position Cohort, sending 20 of the 80 MPT student cohort at
at GF Strong she had been UBC to complete four out of their six clinical placements
offered, Terry chose to move in northern and rural communities. Following Level 1
her physiotherapy practice to
placements, these students complete an academic block
northern B.C. in search of “the
at UNBC in Prince George using education technology.
real” Canada. She fell in love
with the landscape, lifestyle
Terry Fedorkiw
and people. 45 years later,
Terry says “I came up here
to get to the soul of Canada, with no intention of
Terry thinks that’s not enough, saying
staying, let me tell you. The rest is history,” from her “they come here for some rotations, but
private practice clinic in Prince George. then they go back to the lower mainland
Drawn by the north’s unique opportunities and challenges, to complete them and we lose them. The
Terry balances both with her connection to the community.
She has come to see the lasting impact of physical therapy
only way to address this is to really train
on the people living there, “Our skills are from the cradle to people here. People who train in the
the grave. From the baby born with torticollis to the woman north stay in the north.”
living in hospice. We help people have the best function
possible for their entire lives.” Being active is important
to her also, “We have access to an active lifestyle, skiing,
canoeing, and I also feel very valued and needed by the Newly retired at the beginning of June 2018, Terry wants
patients. It’s very rewarding to work here.” to remain in northern British Columbia, educating and
mentoring young physiotherapists and pushing for positive
change in the field of physiotherapy. “Physiotherapists are
Terry says the biggest challenge facing the catalysts for change in people, that’s what I love. It’s
been my life, and it’s been a very satisfying life.”
physiotherapists and those in need of care
in rural B.C is the shortage of physios.
“We’re really struggling up here to get
coverage and for patients to have access
to physio, it’s pretty sad,” she says.
A long-time advocate for change in the north, Terry has
been working with a goal for the University of Northern
BC (UNBC) to have its own physiotherapy program. “I’ve
been working at this for 15 years, and if we can situate the
program here, then people will embrace the north. The
lifestyle and challenge will entice physios. The challenge of
providing services to the communities, it makes us stronger
and more well-rounded.”
PA BC D I RECT I O N S / 13BC PHYSIO FORUM 2019 CALL FOR EDUCATION PRESENTATIONS Abstract submissions are being sought for education sessions at BC Physio Forum 2019, happening April 27, 2019 at the Westin Bayshore in Vancouver. BC Physio Forum is presented by the Physiotherapy Association of BC, the College of Physical Therapists of BC and the UBC Department of Physical Therapy. Session submissions should fit within one of the following areas: • Inspirational stories • Professional leadership • Case histories/clinical pearls • Best practices in education/mentorship • Clinical Research • eHealth • Innovation in physiotherapy • International practice • Business management • Physiotherapy special interest areas • Public practice physiotherapy • Quality improvement We are looking for 30 minute presentations (25 mins + questions),and 45 minute presentations (40 mins + questions). When you submit your session idea, please indicate which type of presentation you’d prefer. Abstracts will be evaluated by PABC’s Professional Development Advisory Committee through a blind review process. The abstracts will be reviewed for clarity and credibility, thoroughness of the submission, potential interest to participants, and relevance. All selections are final. Key dates: • November 1 at 9am – deadline for submissions • November 30 – presenters will be notified of the Committee’s decision • December 15 – presenters submit their final presentation description to PABC • January 15 – final schedule information will be sent to the presenter Contact for questions and submissions: Stephanie Dutto, PABC Events Manager - events@bcphysio.org 14 / Autum n 20 1 8
PHYSIO FORUM 2019 – BIGGER AND BETTER!
Save the Date! April 27 and 28, 2019
Westin Bayshore Hotel, Vancouver
Keynote Speaker: Dr. Tasha Stanton, Body in Mind Research Group
Join your physio colleagues for a day of professional development, networking, and fun! With
many educational sessions on a variety of topics, trade show, UBC buddy-up mentorship program,
prizes, and delicious food, there is something for everyone.
NEW THIS YEAR – POST FORUM COURSES ON APRIL 28
• Pain Neuroscience with Dr. Tasha Stanton from Body in Mind Research Group
• Clinical Management of the Fitness Athlete with Zach Long – The Barbell Physio
• Concussion Management with Shannon McGuire, PT
• Woundcare Management with Nancy Cho, PT
Save the date, and make your travel plans to come for the weekend!
Rural and Remote funding opportunities are available to attend the Physio Forum.
Visit bcphysio.org/awards-bursaries for details and application.
Are you interested in presenting at Forum? Call for Education Presentations deadline
is November 1, 2018. See bcphysio.org/bc-physio-forum-2018/call for details.
PA BC D I RECT I O N S / 15At PABC office August 2018 (l-r): Kate Wale, Minister
of Justice Jody Wilson-Raybould, Taryn Walker
KATE WALE
Hi! I was your Communications, Sales and Events Coordinator this summer. I’m a third-year
Communications student at Thompson Rivers University in Kamloops. I initially went into
this area because I’m a people person and love hearing about their unique perspectives.
My position at PABC was my first work experience in an office and my first time living in
Vancouver, away from my family.
Contributing to the PABC team this summer has given me the opportunity to learn more about
physiotherapy and has also helped define goals for my future. One of my favorite projects has been
reaching out and interviewing members for our new Physio Faces profile. It gave me the chance to talk to
PABC members from a wide variety of backgrounds across the province. Through these interviews, I have
become a lot more confident in myself and my abilities in the interviewing, writing and editing processes.
Working on Physio Faces has shown me the truly broad scope of physiotherapy and introduced me to the
community of incredible physiotherapists that call B.C. home.
My experiences at PABC have also made me think more about my professional aims. Before this summer
I was considering corporate and internal communications. The opportunity to work with PABC has made
me want to explore public relations or advocacy work instead. I would love to work for another non-profit
or non-government organization that has a mission and purpose I could feel good about being a part
of and would allow me to use my skills to make a positive impact. This change is partly inspired by the
physiotherapists I interviewed, who are very driven to help their patients and are constantly striving to
improve their individual practices and the profession as a whole. I hope I can apply that same passion and
drive in my career!
Thank you to Canada Summer Jobs for making this learning opportunity possible! I would also like to thank
the incredible staff at PABC. You taught me so much and made me feel like a valued part of the team, and
I’m so grateful for my time here. Finally, I would like to say thank you to our members for showing me a
new side of physiotherapy. I am inspired and British Columbia is lucky to have you!
16 / Autum n 20 1 8TARYN WALKER
I was your Knowledge and Membership Services Coordinator at PABC for the summer.
Growing up as an athlete I had plenty of first-hand prevention and rehab experiences
with physiotherapy. So coming into this summer job I thought I knew all about what a
physiotherapist could do. My time at PABC has given me the chance to learn a lot about
physiotherapy and the really cool things physiotherapists do everyday to improve our
healthcare system.
My position at PABC has given me incredible experiences and opportunities to learn about some PABC
members advocating for more Master of Physical Therapy training seats. Some physiotherapists are
supporting telehealth consultation while others are adding mindfulness into their practice, inventing new
equipment, and volunteering to keep young girls in sports and physically active. These physios showed
they are driven by helping people, and that the health care system always has room for improvement.
As the Knowledge Coordinator, I have worked on education projects offered by PABC and have seen
how important “evidence-based practice” and research is. One of my hopes is to have a career where I
can use research supported approaches to work with ongoing issues in Canadian health care right now.
I also got some great news while working at PABC. Having applied to the Bachelors + Masters of
Management dual-degree program at UBC, where I am entering the third year of my kinesiology
undergraduate degree, I found out I was accepted to the program! Starting in September I will be taking
business classes in addition to my kinesiology studies.
I am so thankful to UBC, the Canada Summer Jobs program, and PABC for the opportunities I have had
this summer. I look forward to going back to school and pursuing a career where I can combine business
skills, healthcare knowledge and bring my heightened appreciation for the opinions of professionals
actually in the field. I’m so excited to someday work alongside a broad variety of healthcare providers
and start making a difference in the Canadian healthcare profession. Thank you!
What’s Changing?
We’re making changes to increase care for
your patients injured in a crash.
This means:
• double the money for care and recovery
• more money per treatment
• more types of treatments covered
• reduced user fees.
Find out more at: icbc.com/change
PA BC D I RECT I O N S / 17MEMBER SERVICES SNAPSHOT
Hello PABC members, I hope you had a fantastic summer full of fun and adventure. The first half
of 2018 was a busy one for membership services. In keeping with our 2018 – 2023 Strategic Plan
outreach initiative, I was fortunate to be invited to four public practice events so far this year - the
Step Up event at VGH, PARADE in Langley and the Community Rehab Forum in Burnaby as well as
the annual Health Sciences Association Convention. Thank you to all the members who stopped by
the booths to say hello!
We also had the opportunity to promote awareness and the value of physiotherapy to the public
and other professional groups by attending the RCMP Health Fair in Surrey, the Family Health Expo
in Vancouver, the Pharmasave annual convention and the Arthritis Walk, both in Vancouver.
Kimberley Payne,
PABC Member We know that MPT students are the profession’s and indeed the Association’s future! PABC happily
Services & Office supported and attended the successful UBC Rehab Job Fair in June and the 1st Annual UBC
Administrator Physiotherapy Tennis Open in July. PABC is looking forward to coming back to these excellent
events next year!
Coming up, PABC will be attending the Rehab Equipment Expo at the Richmond Oval on Tuesday,
September 11th and the 2nd annual BC Congress of Sports Medicine Conference on Saturday,
November 17th, 2018.
If you know of any events or professional meetings you think PABC should attend, please let
me know!
Have you changed workplaces or gained a new accreditation?
If so, please log in to your PABC website account to update your Find a Physio profile. If your clinic
has moved or the PT list on your Find a Clinic workplace page is not up to date, please submit your
updates to me at office@bcphysio.org. Most importantly, you need to have at least one workplace
filled out in the workplace field on your profile to be searchable in the Find a Physio directory!
Between January 1st to June 30th this year, 918 people emailed or called for Membership Services
and General Information. Some of the main inquires were for Find a Physio services from the public
and business-related questions from our members. We are just a call or click away and always look
forward to assisting you.
1st annual UBC Physiotherapy Tennis Open
18 / Autum n 20 1 8MEMBERSHIP NEWS
The BC Section held it’s Spring Social including and Kevin Valcke. A great big thanks to all who helped
presentation of the 2018 Sport Physiotherapy Canada them along the way – It takes a village! We are excited to
BC Section Student Merit Award. It was a very successful watch their further development and successes in Sports
evening, with a great time had by all! Thanks to the five Physiotherapy.
applicants for the 2018 Student Merit Award – Tom Michie,
Congratulations to Sheana Lehigh who gave birth to
Tina Lin, Samantha Smith, Lisa Ruggles, and Ryan Maron.
beautiful Audrey Eliana Branden on June 18, 2018 @
It was a very strong field with all applicants receiving at
3:07pm. At 8 pounds 2 ounces, she is a healthy, happy,
least one nod for the award. A wide range of sports were
precious little girl and loved immensely.
covered from cross country running and figure skating
to rugby and wheelchair tennis. Congratulations to Lisa Big news for Kids Physio Group! They will be expanding
Ruggles as this year’s award recipient. Best of luck to all their 3 current locations with a brand-new clinic opening
embarking on the path of a sports physiotherapist! in early 2019 in City Square Mall on Cambie street and
12th avenue. This is a joint venture with Jump Gymnastics
The BC Division of Sports Physiotherapy Canada would like
led by Kids Physio’s Silvana Echeverri. Through pediatric
to congratulate Jenny Dea on the successful completion of
physiotherapy and non-competitive developmental
her Diploma in Sports Physiotherapy!
gymnastics, their bright new clinic will host babies, children
Also, congratulations on the successful achievement of and youth in a space designed just for them where they
their Certificate in Sports Physiotherapy to Emily Grainger will reach their goals while having FUN.
MEMBERSHIP RENEWAL
Thank you to all of our members for being a part of PABC this year. PABC is looking forward to another exciting year as we
continue our committment to professionally supporting all of our members and upholding the highest standard of practice.
Please continue to reach out to PABC anytime should you need any assistance as we are here to help support you.
As the year comes to an end, we would like to remind you that it’s time to renew your membership to continue receiving
your benefits and assist in supporting your profession.
PA BC D I RECT I O N S / 19PABC’S RECENT GRAD
RURAL AND REMOTE BURSARY AT WORK!
I am writing to express my sincere gratitude for creating the Rural and Remote
Sandy VanKleeck Recent Graduate Bursary. I was thrilled to be the recipient of this bursary and I am
MScPT, BKin. PABC deeply appreciative of the support.
member since 2014. Graduating from the University of Alberta Masters of Physiotherapy program in April 2015,
I have been working at the Prince George Child Development Centre. I currently work with
children from birth to 18 years old in both the Early Intervention Therapy and School Aged
Therapy programs. Our centre serves children and families in Prince George and the outlying
communities of Mackenzie, McBride, and Valemount, as well as all the small communities in
between such as Salmon Valley, Bear Lake, Dunster, and Tete Jaune Cache. We also service
small communities far north of Mackenzie such as Kwadacha Nation and Tsay Keh Dene
Nation. I have also provided service to the communities of Vanderhoof, Fort St. James, Fraser
Lake, and Quesnel when their CDCs were short staffed. All of these communities have a large
indigenous population and many of them are quite isolated. If you’re curious enough, you
should google map these locations - they are far apart and remote!
The funding from the Rural and Remote Recent Graduate Bursary was used to attend the
Paediatric Vestibular Rehabilitation course that was hosted by the Canadian Physiotherapy
Association Paediatric Division in June. I am the first physiotherapist at our centre to receive
vestibular training.
I work with children who struggle with balance and clumsiness, have traumatic brain injuries,
vertigo and dizziness, gravitational insecurities, vestibular disorders, poor optokinetics,
nystagmus, hypoplasia of cranial nerves 3, 4 and 6, cochlear damage, hearing impairments,
progressive neurological diseases, and post concussion syndrome. This course has provided
me with the knowledge and skills to better assess and treat these children.
Thank you again for your generosity and support. I will be sharing what I gained through this
course with an in-service to my coworkers, as well through mentorship to future students.LEGAL WORD THE IMPORTANCE OF
CONTRACT RENEWAL
The B.C. government has recently 2001 that “there is no one conclusive test” to determine
announced its new focus on who is an employee vs. an independent contractor.
“team-based” health care. Instead the Court decided that the central question is
As a result, we expect that more whether the worker is “performing services as a person
BC physiotherapists may be in business on his own account”. In other words, “whose
working in community health business is it”? In answering this question, it is then
centres, including the new essential to look at the degree of “control” over the
Primary Care Centres that are to person performing the services.
be opened in the coming year.
In practice, the decision makers (such as the courts, CRA,
Georg Reuter These changes could result in
Employment Standards and Human Rights Tribunals and
Partner, Richards physiotherapists being required
Buell Sutton WorkSafe BC) typically look at some or all of the following
to sign new contracts governing
factors:
their working relationship. This
article will go through some of the issues that should be • Level of control over worker’s activities?
considered in drafting and reviewing such contracts. • Whether worker provides his or her own tools?
• Can the worker sub-contract?
Employee vs. Independent Contractor • Does the worker have financial risk, opportunity to
Probably the first issue to consider is whether a new profit?
contract should be structured as an employment • Does employer provide work premises?
relationship or as an “independent contractor” agreement.
• Does worker provide services to others? Is this
There are both pros and cons to each approach. permitted?
For physiotherapists working as employees the “pros” are • Method of remuneration?
generally greater job security, entitlement to employee
• Whether there is a written agreement?
benefits (e.g. paid vacation, health and dental benefits,
etc.) and protection under employment legislation such
as the BC Employment Standards Act (or under a union Drafting Employment and Independent Contractor
Agreements:
collective agreement). The downside of working as an
employee are higher deductions (for taxes, Employment From my perspective both employment and independent
Insurance (EI), Canada Pension Plan (CPP)), etc.) and less contractor agreements should be short and written in easy
flexibility in terms of hours, scheduling patients or the to understand language.
clinics the physiotherapist is working at. For employment agreements it is important to keep in
For clinics and health centers hiring physiotherapists there mind that physiotherapists in BC, unlike certain other
are also pros and cons to both approaches. Generally health professionals such as physicians and dentists, are not
when hiring, the “pros” of engaging a physiotherapist as exempt or excluded from the Employment Standards Act.
an employee are greater control over working hours and All employment agreements must therefore be reviewed
lower liability for source deductions such as income tax, carefully to ensure that they do comply with the minimum
EI and CPP. The advantages of engaging physiotherapists legal requirements in the Employment Standards Act.
as independent contractors are usually lower payroll and Furthermore, employment agreements for newly hired
administration costs. employees must be signed before the employee’s
The legal distinction between employment and anticipated start date. If signed after the start date (e.g.
independent contractor status can however be difficult new employment agreement for existing employees)
to define. The Supreme Court of Canada in a leading then the employer must provide some new “legal
decision known as 67112 Ontario Ltd. v. Sagaz ruled in consideration” to make the agreement binding.
PA BC D I RECT I O N S / 21You can also read
