POLICY NUMBER: POL04-07

Chapter:
CLIENT SERVICES

Subject:
PHYSIOTHERAPY TREATMENT

Authorization:
Board of Directors’ Minute - November 15, 1994

Effective Date:
November 15, 1994

Last Update:
February 25, 2010

REFERENCE:

Workers Compensation Act R.S.P.E.I. 1988, Cap. W-7.1, Section 18.

Physiotherapy Act R.S.P.E.I. 1988, Cap. P-7.
Workers Compensation Board Policy, POL04-19, Health Care Providers.

DEFINITION:

In this policy

1. “Alternate care options” means programs recommended by health care providers such as
Home-based self care or referrals to other programs.

2. “Fitness for work” means an assessment that provides a comparison between a

worker’s demonstrated functional abilities and required job demands.

3. “Functional Capacity Evaluation” means a detailed examination and evaluation

that objectively measures the worker’s current level of function, primarily
within the context of the demands of competitive employment, activities of daily
living, or leisure activities.

4. “Functional Scan” means a functional scan that provides objective measurement of a

worker’s functional abilities.

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5. “Physiotherapy” means physical therapy practiced in a continuing way to remove,

alleviate or prevent movement dysfunction or pain, and includes diagnostic assessment,
design and conduct of treatment involving exercise massage, hydrotherapy, heat, sonic,
laser and electrical techniques, acupuncture, evaluation of progress, patient instruction,
research and educational or preventative measures. Physiotherapy concentrates on the
alleviation of pain, increase in strength, range of motion and endurance.

6. “Supportive care” means treatment that is therapeutically necessary for workers, who
have reached their maximum recovery from a work related injury, to maintain a
maximum level of recovery. Supportive care would only be considered after the
appropriate application of active and passive care either from health care providers or
through lifestyle modifications.

7. “Work conditioning” is an exercise based rehabilitation program designed specifically to

improve the capacity of a worker to return to work.

POLICY:

1. The Workers Compensation Board recognizes physiotherapy as an acceptable form of

medical aid when it is prescribed by a treating physician, and provided by a
physiotherapist licenced to practice in the province of Prince Edward Island. The
physiotherapy must be directed at the compensable condition and must focus on the
timely return to work.

Standard physiotherapy may include:

• An initial assessment of the worker’s physical condition which will include

Workers Compensation Board approval, preparation of a treatment plan with
timelines, a return to work plan, and a home based exercise program.

• Acute care therapy which will include treatments within a four week period.

2. Workers must be referred to a physiotherapist by their treating physician. The

physiotherapy may be provided in a hospital setting or in a private physiotherapy clinic.

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Supportive Care

3. Supportive care is appropriate when the worker requires treatment to maintain

functioning at the maximum level of recovery and when alternate care options have been
considered and attempted, but are not successful.

The Workers Compensation Board may pay for supportive care where a worker:

• has incurred a permanent impairment as a result of a work related injury;

• is a pre-1995 pensioner; or
• is on Extended Wage Loss benefits.

Supportive care, when approved by the Workers Compensation Board, may be provided
for up to twelve sessions per year provided a written request from a treating physician
has been made, outlining treatment goals.

Physiotherapy Extensions

4. The Workers Compensation Board may initially approve up to four consecutive weeks of
physiotherapy treatment per new injury or disease. Where the worker has returned to
work at full duties or on a return to work program within the first four weeks of
treatment, the physiotherapist may continue treatments for two additional weeks, if
required, without requesting an extension from the Workers Compensation Board. If the
physiotherapist believes treatment should continue beyond the six weeks, a request for an
extension must be made by the end of the fifth week of treatment.

5. Where the worker has not returned to work within the first four weeks of treatment and
the physiotherapist believes treatment should continue, a request for an extension must be
made by the end of the third week of treatment.

6. Extensions will be considered where there are specific medical conditions affecting the
worker. Extensions will normally be limited to a maximum of four weeks. Extensions
will not be approved where maximum function has been achieved and treatment goals are
solely for pain relief.

An extension of physiotherapy services will be considered for the following medical

conditions on a case by case basis:

• Systemic medical disorders (pre-existing or co-morbid) that compromise

functional recovery, documented by a medical physician;

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• The following complex musculoskeletal conditions treated non-surgically:

- Dislocation of complex joint;
- Adhesive capsulitis;
- All fractures;
- Grade 3 sprains.

• Traction/Compression Neuropathy – acute traumatic onset;

• Acute Traumatic peripheral neuropathy;

• Surgical repair of:

- Articular fractures (Open Reduction Internal Fixation/ Open
Reduction External Fixation);
- Capsulo-ligamentous injury;
- Articular derangement;
- Musculo-tendinous injury;
- Joint reconstruction.

• Any condition that is approved by the Workers Compensation Board.

Work Conditioning

7. Work conditioning therapy includes treatment over a four week period and will work in
conjunction with the Ease Back Program. Requests for work conditioning therapy can be
considered only when a report is submitted by the treating physiotherapist indicating the
medical need for such conditioning. The Workers Compensation Board may request a
medical examination from a treating physician to support this request.

Functional Scan

8. A Functional Scan is a short functional assessment that provides objective

measurement of functioning for clients who have experienced a musculoskeletal injury
and are in the acute or sub-acute phase of recovery. The Functional Scan objectively
measures the client’s ability to lift in 3 different positions, push/pull and to carry. One or
two additional functional tolerances, as related to the client’s essential job requirements,
may be performed on a case-by-case basis. Tolerances for sitting, standing, and walking
are subjectively measured. The functional scan is typically performed when a client is
considered medically stable or within a maximum of 5 days from starting physiotherapy

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treatment.

A Functional Scan must be pre-approved and may be utilized by the Workers

Compensation Board to develop or adjust a return to work plan.

A Functional Scan is conducted by a physiotherapist, licensed in the province of Prince

Edward Island, who is able to demonstrate evidence of education, training, and
competencies specific to the delivery of a Functional Capacity Evaluation.

Fitness for Work

9. The Fitness for Work Assessment is typically administered in the sub-acute phase of the
recovery process. This assessment consists of a comprehensive musculoskeletal
assessment (performed by a Physiotherapist, not performed by the same treating
physiotherapist if being treated at the same clinic) and functional scan (including
objective testing of sitting, standing, and walking tolerances). Two or three key positional
tolerances may also be tested depending on essential job demands and nature of injury.
Job demands are obtained through a job analysis, the Workers Compensation Board, or
the worker as confirmed by the employer. In addition, screening tools for psychological
issues and self-perception are also administered. The report provides a comparison
between demonstrated abilities and required job demands and makes specific
recommendations for return to work that can be utilized by the Workers Compensation
Board when designing easebacks.

A Fitness For Work Assessment must be pre- approved and is conducted by a

physiotherapist licensed in the province of Prince Edward Island, who is able to
demonstrate evidence of education, training, and competencies specific to the delivery of
a Functional Capacity Evaluation.

Functional Capacity Evaluation (FCE)

10. A Functional Capacity Evaluation is a detailed examination and evaluation that

objectively measures the worker’s current level of function, primarily within the context
of the demands of competitive employment, activities of daily living, or leisure activities.
Measurements of function from a Functional Capacity Evaluation are used to make return
to work/activity decisions, disability determinations, or to design rehabilitation plans. A
Functional Capacity Evaluation measures the ability of an individual to perform
functional or work-related tasks and predicts the potential to sustain these tasks over a
defined timeframe.

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The Functional Capacity Evaluation quantifies safe functional abilities and is a pivotal
resource for return to work and job placement decisions and disability evaluation.

A Functional Capacity Evaluation must be pre-approved by the Workers

Compensation Board and requires medical approval from the worker’s treating physician. A
Functional Capacity Evaluation must be conducted by a physiotherapist licensed in the
province of Prince Edward Island, who is able to demonstrate evidence of education,
training, and competencies specific to the delivery of a Functional Capacity Evaluation.

Where the Workers Compensation Board requests a functional capacity evaluation, the
Treating Clinic shall conduct the assessment in a timely fashion and shall provide a report to
the Workers Compensation Board generally at a case conference within two weeks of the
completion of the assessment.

Recurrences

11. Where a worker files a claim for a recurrence, the physiotherapist shall complete an
initial assessment with recommendations for treatment. Approval for treatment will not
be granted beyond the initial assessment until the claim has been adjudicated by the
Workers Compensation Board.

Agreement with Physiotherapists

12. The Workers Compensation Board will establish an agreement to provide service
standard expectations and fee schedules with private practice physiotherapists.

The Workers Compensation Board will only pay for modalities of care approved and
recognized by the Canadian Physiotherapy Association and accepted by the Workers
Compensation Board.

HISTORY:

February 25, 2010 - Amended to include sections on “Functional Scan”, “Functional Capacity
Evaluation”, and a “Fitness For Work Assessment”.

April 24, 2008 - Amended #6 to clarify the criteria for approving extensions of physiotherapy
treatments.

October 25, 2007 - Amended “Phase 1” in #1 of the policy and also added a definition of “work

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conditioning”.

February 28, 2005 - Amended to ensure the policy is clear with respect to approval of extensions
of physiotherapy treatments and recurrences.

October 24, 2002 - Modified to include a provision for supportive care.

May 30, 2002 - Replaces Policy and Practice Physiotherapy Treatments dated November 15,
1994.

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