Scope of Practice, Reserved Acts and Delegation (including member guidelines)

Released: October 2018, Replaces: September 2015

INTRODUCTION

The British Columbia Association of Kinesiologists (“BCAK”) is not a college recognized under the Health Professions Act (the “Act”), and it does not have the authority to govern the profession of kinesiology in B.C. However, it is positioning itself and its members for the time when B.C.’s kinesiologists are permitted to form a self-regulatory college. Part of the process is to establish a clear scope of practice, as discussed in this document.

A scope of practice must:

  • Protect the public interest.
  • Conform to the standards required by the Act, and any regulation under the Act defining the practice of kinesiology.
  • Be consistent with those of existing health care professions.
  • Clearly identify and address any areas where the practice of kinesiology “overlaps” with that of other professions.
  • Be consistent with the professional errors & omissions insurance policy that Prolink Insurance, or a kinesiologist’s independent insurer, provides.
  • Be a useful and readable tool to guide members in practice.

All assessments, treatments and interventions that BCAK members provide to patients/clients must fall within the scope of practice. At present, acting outside this scope of practice would result in not being covered by your Profession Insurance and is contrary to the BCAK code of ethics. If/when the BC Provincial Government regulates the profession of kinesiology under the Health Professions Act (HPA), it will become professional misconduct for a member to act outside the scope of practice.

It is expected that the scope of practice set out in this document will be substantially similar to any that a B.C. college of kinesiologists adopts if formed. It is based on:

  1. The scope of practice and guidelines adopted by the College of Kinesiologists of Ontario
  2. The scope of practice of other health care professions regulated under the Act.
  3. A draft scope of practice document from Canadian Kinesiology Alliance.


OBJECTIVE VERSUS SUBJECTIVE

The objective part of a scope of practice is, simply put, whether or not an assessment, treatment or intervention would fall within the scope of practice, as seen by an informed, objective outside observer.

The subjective part is whether you have the education, skills, training, experience and resources to safely and competently deliver the assessment, treatment or intervention.

You must judge whether an assessment, treatment or intervention is within your scope of practice, and the general BCAK scope of practice. It is always wise to seek another opinion if you are not sure, or to refer a patient/client to another practitioner, or another health care professional.

For example, a member who is practicing solely in an area such as ergonomics may not be able to safely offer nutritional or athletic therapy advice; this member needs to refer the patient/client to another practitioner who is better qualified to practice in that specific area.

Members must also only undertake performance of any modality or service after a full health history is taken from the patient/client and a thorough assessment has been conducted.

When deciding whether or not to deliver an assessment, treatment or intervention, you need to analyze your ability to deliver the service from both an objective and subjective perspective.

SCOPE OF PRACTICE

“Scope of practice statements are concise descriptions, in broad, non-exclusive terms, of each regulated profession's activities and areas of professional practice. These statements describe in general what each profession does and how it does it. They are not exhaustive lists of every service the profession may provide, nor do they exclude other regulated professions or unregulated persons from providing services that fall within a particular profession’s scope of practice.” See: BC Ministry of Health-Scope of practice reform for additional information.

Kinesiology has been broadly defined by the BCAK as:

Kinesiology is the scientific study of human movement, performance and function, and applies the sciences of anatomy, physiology, biomechanics, and motor learning (neuroscience). Kinesiologists utilize science-based approaches, research and assessment to aid in the enhancement of human performance and to assist in the prevention or rehabilitation of injury and other physiological conditions.

This definition allows for the diversity of settings in which members practice, and also reflects the practice of kinesiology not just as rehabilitative, but as a discipline aimed at improving health and general wellness. It is not restrictive; it allows for the use of a range of modalities that are flexible enough to be applicable to a broad spectrum of patients/clients, however, there are limits to what a member can and cannot do.

PERMITTED TREATMENTS

Subject to the foregoing, the following list, while not exhaustive, contains many of the modalities and services that members are permitted to utilize in their practice:

  1. Fitness & health evaluations and exercise prescription.
  2. Postural assessment and education.
  3. Athletic training, exercise therapy and interventions.
  4. Therapeutic application of heat and cold.
  5. General nutritional counselling.
  6. Ergonomics.
  7. Subject to the limitation in clause 2 of the “Restricted Activities” below, mobilization, manual therapy and manipulation.
  8. Completion of insurance assessment forms (subject to form specific limitations).
  9. Osteopathic manual techniques*.
  10. Electrical therapy techniques*, including:
  • Ultrasound.
  • Interferential Current Therapy (IFC).
  • Low Intensity Laser Therapy**.
  • Transcutaneous Electric Nerve Stimulation (TENS).
  • Muscle stimulation.
  • Pulsed high frequency electromagnetic stimulation (also known as therapeutic magnetic resonance).

Special Notes

  1. *In order for kinesiologists to consider themselves appropriately educated and trained to perform Osteopathic manual or Electrical therapy techniques they need to be able to show they have completed formal or non-formal training for delivery of these treatments. Informal training is not generally considered an acceptable form of training.
  2. *Kinesiologists are permitted to use osteopathic manual and electrical therapy techniques as part of a kinesiology treatment plan. However, if a kinesiologist is providing manual osteopathic and/or electrical therapy treatment solely, or is utilizing either of these techniques for treatment of a condition outside of the scope practice, the kinesiologist must consider the BCAK requirement of Dual Practice.
  3. **Kinesiologists are only permitted to perform low intensity (level) laser therapy (LLLT) and are not permitted to perform high intensity laser therapy (HILT) or utilize known forms of hazardous laser therapy regardless of the intensity.

RESTRICTED ACTIVITIES (ACTS) (Formerly called “Reserved Acts”)

The Health Professions Council of BC currently states that the following can only be undertaken by a member of a profession recognized under the Act, often only by members of a specified profession. The current restricted activities - 2002 modified form list is provided below, while the proposed 2010 draft of restricted activities currently not yet in force can be found here. If an activity is on the “Restricted Activities” list, kinesiologists cannot undertake the activity even if it falls within the “Permitted Activities” unless they have been properly delegated to do so (See: RESTRICTED ACTIVITIES (ACTS) – DELEGATION).

1 . Making a diagnosis identifying a disease, disorder or condition as the cause of signs or symptoms of the individual.

2 . Performing the following physically invasive or physically manipulative acts:

a. procedures on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, in or below the surfaces of the teeth, including the scaling of teeth;

b.setting or casting a fracture of a bone or reducing a dislocation of a joint;

c. movement of the joints of the spine beyond the limits the body can voluntarily achieve but within the anatomical range of motion using a high velocity, low amplitude thrust;

d. administering a substance, including substances other than a drug,

e. putting an instrument, hand or finger(s),

3 . Managing labour or delivery of a baby.

4 . Applying or ordering the application of a hazardous form of energy including diagnostic ultrasound, electricity, magnetic resonance imaging, lithotripsy, laser and X-ray, or as prescribed by regulation.

5 . Prescribing, compounding, dispensing or administering by any means a drug listed in Schedule I or II of the Pharmacists, Pharmacy Operations and Drug Scheduling Act.

For the purposes of this reserved act, the following definitions shall apply:

  • "prescribing": the ordering of a drug.
  • "compounding": mixing ingredients, at least one of which is a drug.
  • "dispensing": preparing or filling a prescription for drugs.

a. Designing, compounding or dispensing therapeutic diets where nutrition is administered through enteral or parenteral means.

For the purposes of this reserved act, the following definitions shall apply: "designing": the selection of appropriate ingredients for enteral or parenteral nutrition.

  • "compounding": mixing ingredients, for enteral or parenteral nutrition
  • "dispensing": filling a prescription for enteral or parenteral nutrition.

6 . Prescribing appliances or devices for vision, hearing or dental conditions; dispensing such prescribed appliances or devices for dental conditions; fitting such appliances or devices for dental conditions, or fitting contact lenses.

For the purposes of this reserved act, the following definitions shall apply:

  • "prescribing": ordering the fabrication or alteration of appliances or devices for vision, hearing, or dental conditions.
  • "dispensing": filling a prescription by fabricating or altering a dental appliance or device.

7 . Testing or treatment for specified conditions as identified below:

a. Allergy challenge testing or allergy desensitizing treatment involving injection, scratch tests or inhalation, and allergy challenge testing
by any means with respect to a patient who has had a previous anaphylactic reaction;

b. Cardiac stress testing conducted for medical diagnosis and treatment planning.

(For additional Information, see also: Health Professions Council - Shared Scope of Practice Model Working Paper)

Many of the restricted activities are treatments, services and assessments that a kinesiologist would appear unlikely to ever consider doing. Nonetheless, it is important that all kinesiologists know the restricted activities. If/when kinesiologists are granted the right to form a college, the accompanying definition of kinesiology may permit kinesiologists to undertake activities on the restricted list, either of their own volition, or under supervision of another health care professional, e.g. a physician.

RESTRICTED ACTIVITIES (ACTS) – DELEGATION

The Act permits health care professionals who are permitted to undertake restricted acts to in turn delegate the performance of those acts, subject to their supervising the person doing so.

To sum up:

  • Members of the BCAK, and kinesiologists in B.C. generally, must not carry on any action that falls within the list of restricted acts. If the action is something that only a practitioner of a regulated health care profession is permitted to carry on, no one else can do so.
  • A member may carry on a restricted act only if:

a) Under the supervision of a member of one of the 26 recognized health care professions, and

b) Members of that health care profession are legally permitted to undertake the restricted act.

It is up to you to ensure that the person who is delegating performance of a restricted act to you is a member of a recognized health care profession, and that “they” have the legal right to perform that act.

INSURANCE POLICY (COVERAGE)

Most professional or “Practicing” members of the BCAK hold professional liability insurance through the group insurance broker, Prolink Insurance Ltd. The Prolink Insurance website states as follows:

Definition of Kinesiologist

Kinesiologists are human movement specialists offering a wide variety of assessments and services to the public to assist with both injury/illness prevention and injury management. Their practice is based on the core sciences of anatomy, physiology, biomechanics and psychomotor behavior. Kinesiologists work in the fitness, clinical, and industrial environments.

Scope of Practice for a Kinesiologist

Kinesiologists utilize the science of human movement to provide services that deliver quality solutions through prevention, objective assessment, and evidence-based intervention

Ultimately though, the insurer permits and relies on the BCAK to define the scope of practice of its member kinesiologists in B.C.

The policy covers errors, omissions and negligence of insured persons acting within the BCAK scope of practice. It does not cover any other action, treatment, or therapy. If you are not sure whether you are covered, contact the BCAK office and/or LMS Prolink for clarification.

If you have questions regarding scope of practice or the wording or terms in this document, please contact the BCAK office. This is important if you’re considering the addition of new treatments or therapies to your practice, which are not, or may not be covered by the scope of practice and professional liability insurance.