When a physio is not a physio

Deciding whether to use the services of a physiotherapist or a physical therapist has patients confused, writes FIONA REDDAN

WHAT’S IN A name? Well, according to the Irish Society of Chartered Physiotherapists (ISCP), if you’re looking for the services of a physiotherapist, quite a lot.

Unlike other medical professionals such as doctors and midwives, there is no protection in Irish legislation for the title of physiotherapist or physical therapist in Ireland. This means that in effect, anyone can not only assume such a title, but also practice under it.

The confusion arises because in many other countries, such as the UK and the US, the titles “physiotherapist” and “physical therapist” are protected, and may be adopted only by people with the adequate qualifications such as four-year full-time degrees.

In Ireland, however, physical therapists or sports therapists typically do not have the same qualifications as a physiotherapist, and often earn their qualifications through part-time programmes.

While a framework has been in place since 2005 to protect these titles, there is currently no registration board in place.

“Without these boards it’s not functioning in the way the legislation intended,” says Dr Emma Stokes, a researcher and teacher at Trinity College Dublin, who is a member of the ISCP, and is also vice-president of the World Confederation for Physical Therapy. “In my view, if you don’t protect both titles, you don’t protect the public,” she adds.

So what are the differences?

According to the ISCP, which accredits physios in Ireland, to be a member of the society, candidates must have completed a three- or four-year degree programme, typically in one of four Irish universities, as well as undertaking continuous professional development. This training includes three core areas of muscular skeletal, neurology and cardiorespiratory.

A physical therapist, on the other hand, can complete a course on a part-time basis, from 15 months to a three- year term, so the levels of experience and qualifications do differ. Moreover, training is typically focused on muscular-skeletal areas.

According to Anne Mangan, director of the Institute of Physical Therapy (IPT), which is based in Stillorgan, Co Dublin, and is currently training 160 students, physical therapists specialise in treating soft tissue problems, noting that they are “muscular skeletal practitioners first and foremost”.

However, while the work undertaken by a physical therapist may be legitimate, the ISCP argues that it is essential that the patient should understand exactly what experience and training the person treating them has obtained.

While only chartered physiotherapists are entitled to work in the public sector, it is in the private arena that confusion arises.

“It creates a huge challenge for members of the public who want to go to physiotherapists who are educated to international standard in programmes recognised by a professional organisation in Ireland,” says Stokes.

According to the ISCP, this grey area is leading to many problems, and it has a “large file” with complaints from members of the public who thought they were seeing a trained physiotherapist.

“One of the key challenges facing users of physiotherapy is that many vulnerable individuals and groups are seeking to augment – or indeed simply obtain access to – physiotherapy services, and we have numerous examples where these parents or carers think they are getting an appropriately qualified physiotherapist and employ a physical therapist,” says Stokes.

Complaints vary from a child with cerebral palsy being incorrectly treated to a medical consultant who sought physiotherapy for his father who is in a private nursing home. He only discovered that the person carrying out the therapy was not a fully qualified physiotherapist after having paid for the treatment.

“I would like to think that my background would have made me less vulnerable to such an error. I can’t imagine how members of the general public are supposed to be able to make an informed choice when the current situation here in Ireland remains so confusing,” he said of his experience.

However, Mangan asserts that physical therapists are very aware that they must communicate this to patients. “The key thing all physical therapists do is explain the differences,” she says. Moreover, she adds that she would not be in favour of the title “physical therapist” being protected and allowable for use only by chartered physiotherapists.

“Titles don’t really carry from one country to another,” she says, pointing out that osteopaths in the US are medical doctors, unlike in the UK or Ireland.

For Stokes, another issue is that there is little perceived comeback when it comes to physical therapists. If a chartered physio behaves in an inappropriate manner or offers inappropriate treatment for example, a complaint can be made to the society.

Another perceived anomaly is the fact that private health insurers offer no distinction between chartered physios and physical therapists. Moreover, physical therapists typically charge similar fees, about €40-€50, as chartered physios.

So, if you’re looking for physical therapy services, what can you do? The first point is to be clear about what you need – if a physical therapist will fulfil this, then you may be happy to employ their services. The Irish Association of Physical Therapists (IAPT) has a list of therapists on its website, iapt.ie

If, on the other hand, you wish to see a fully qualified chartered physiotherapist, then Stokes recommends you first ask whether or not they are a member of the society.

You can also check out the society’s website, iscp.ie, to search for its members in your area.