PHYSIOTHERAPISTS IN PRIMARY

HEALTH CARE

Table of Contents
WHAT IS A PHYSIOTHERAPIST? ............................................................................................................ 2
PHYSIOTHERAPY SERVICES IN PRIMARY CARE ................................................................... 2
OTHER BENEFITS OF INTEGRATING PHYSIOTHERAPY SERVICES ................... 4
INTEGRATING PHYSIOTHERAPISTS INTO PRIMARY HEALTH CARE IN
ONTARIO ...................................................................................................................................................................... 5
HOW ARE PHYSIOTH ERAPISTS TRAINED ................................................................................... 7
LEARN MORE ABOUT HAVING A PHYSIOTHERAPIST ON YOUR TEAM ........ 7
EXAMPLES OF PHYSI OTHERAPISTS AND CHRONIC DISEASE
MANAGEMENT AND PREVENTION .................................................................................................... 8
DIABETES ................................................................................................................................................................ 8
ARTHRITIS .............................................................................................................................................................. 9
CHRONIC MUSCULOSKELETAL CONDITIONS ................................................................. 9
OBESITY ................................................................................................................................................................... 9
INCONTINENCE ............................................................................................................................................... 9
FALLS ........................................................................................................................................................................ 10
ADDITIONAL EXAMPLES AND RESOURCES ........................................................................... 10
EVIDENCE SUPPORTING THE ROLE OF P HYSIOTHERAPISTS I N PRIMARY
HEALTH CARE ...................................................................................................................................................... 11

1
WHAT IS A PHYSIOTHERAPIST?

Physiotherapists1 are highly skilled…health professionals who provide safe, quality client-centred
physiotherapy through a commitment to service availability, accessibility and excellence. The
profession is shaped by scientific evidence and the education and competencies of the
physiotherapists delivering the services. Physiotherapy is grounded in the belief that, to be
effective, its services must respond to the changing needs of populations and our health system 2

Only individuals registered with the College of Physiotherapists of Ontario can call
themselves physiotherapists or physical therapists3. Only physiotherapists complete
university degrees in physiotherapy as the entry level educational requirement for the
profession. Though others may suggest that they are providing physiotherapy services, this
is not the same as receiving physiotherapy from a registered physiotherapist. As partners,
registered physiotherapists and the College share the responsibility and accountability to
self-regulate, ensuring that patients and clients receive the highest standard of safe, quality
care from a qualified professional. Physiotherapists are accountable for meeting the legal,
regulatory and professional standards of practice requirements for their practice including
meeting standards for liability insurance coverage4. A registered physiotherapist may also
direct and supervise trained physiotherapist assistants or support personnel in providing
high-quality physiotherapy services.

A Physiotherapist (PT) supports individual and population wellness in their community by:

 Promoting physical activity and overall health;

 Preventing disease, injury, and disability;
 Managing acute and chronic conditions, activity limitations, and participation
restrictions;
 Improving and maintaining optimal functional independence and physical
performance;
 Rehabilitating injury and the effects of disease or disability with therapeutic
exercise programs and other interventions; and
 Educating and planning maintenance and support programs to prevent re-
occurrence, re-injury or functional decline.

PHYSIOTHERAPY SERVICES IN PRIMARY CARE

Physiotherapists have the skills and competencies to support individuals and populations
across the continuum of care, including health promotion and illness prevention, self-
management, treatment and rehabilitation. Physiotherapists can assess and treat
individuals across the life-span who have illness, injury or disability affecting the neuro-
musculoskeletal, cardiopulmonary, vascular, and neurological systems; they also promote

2
wellness and increased quality of life through education, specialized programming and a
holistic approach to care.

Evidence in support of the many roles and benefits of physiotherapists in primary

health care can be found at the end of this document.

The following examples are some of the roles and activities of physiotherapists in primary
health care:

 Assessment, diagnosis , treatment including individualized exercise programs, self-

management and education for patients with musculoskeletal complaints
 Assessment, diagnosis, treatment, education and management programs for
incontinence and pelvic pain
 Assessment and treatment for those with neurological conditions such as stroke and
Parkinson’s
 System navigation assistance for those who need to access physiotherapy and
other services in the community
 Mobility aides assessment and assistance in navigating funding options for devices
 Falls prevention programs including outreach programs in community
 Collaborative triaging for specialist care for musculoskeletal conditions
 Assessment and triaging for back pain including providing self-management
program and education, referral to community-based treatment programs
and identification of need for additional diagnostics, specialist referral
 Assessment, education, self-management programs and counseling for
increased activity for those with obesity, pre-diabetes, diabetes, arthritis and
other chronic diseases
 Facilitate linkages with community programs, assessment of appropriateness of
programs for those with chronic conditions including pain management,
providing counseling on safe participation for those with chronic conditions
 Pain management programs, counseling and education on self-management
techniques for those with chronic pain issues.
 Assessment, individualized self-management programs and treatment for those
with mobility and pain issues related to cancer including those in palliative phase
 Support and education for caregivers for assistance of those with chronic
diseases including prevention of injury programs for caregivers
 Return to work programs
 Individualized self-management and lung health programs which teach patients
skills to manage their acute periods and counseling for those with chronic
cardiorespiratory conditions such as asthma, COPD and deconditioning after
illness.
 Osteoporosis education and individualized self-management programs

3
Physiotherapists may also order certain diagnostics (e.g. x-rays, CAT scans, ultrasound,
MRI, specific laboratory tests) through delegation or medical directives, provided that
they are within the scope of practice of physiotherapy.

Physiotherapists with additional training may also perform the following authorized
activities:

 treating a wound below the dermis

 assessing or rehabilitating pelvic musculature for the treatment of incontinence or
pelvic pain
 administering a substance by inhalation
 acupuncture
 spinal manipulation
 tracheal suctioning

Physiotherapists who perform these authorized activities are rostered with the College of
Physiotherapists of Ontario.

OTHER BENEFITS OF INTEGRATING PHYSIOTHERAPY SERVICES

As members of an integrated primary health care team physiotherapists can make a

significant contribution to continuously improving the quality of the care experience,
improving health in populations, managing per capita costs and improving team function.
Recent research reports that many primary care providers support the integration of
physiotherapists into primary care settings.5

In their summary of current literature which mostly focused on the integration of

physiotherapy in primary health care setting, Cott et al., (July 2004) found that where
this integration had occurred the results included:

 Increased levels of satisfaction with service by both the patients and the physicians,
 Decreased wait times,
 Increased cost effectiveness when compared to institutional care,
 Reduced rates of referral to specialists, and
 Improved outcomes for patients including quality of life measures.6

There is compelling evidence supporting physiotherapy as a cost-effective solution for

addressing musculoskeletal conditions and chronic disease in primary health care. In North
America 27.8% of patients presenting to a primary care physician have a chief symptom that
is directly related to the musculoskeletal system.7 Given the extent of consultations of a
musculoskeletal nature in primary care in Ontario and the proven effectiveness of
physiotherapy interventions for acute and chronic physical conditions, physiotherapists are

4
well positioned to complement family physicians, nurse practitioners and their teams in
managing the health needs of patients with chronic pain, chronic disease, acute or chronic
musculoskeletal conditions and with community-based health and wellness promotion and
disease prevention activities.

INTEGRATING PHYSIOTHERAPISTS INTO PRIMARY HEALTH CARE

IN ONTARIO

In 2013 as part of the Ministry of Health and Long Term Care’s commitment to improve
access to community based, publicly funded physiotherapy services for Ontarians across
the province, policy barriers were removed to allow physiotherapists to be funded in
Family Health Teams (FHT), Aboriginal Heath Access Centres (AHAC), and Nurse
Practitioner-Led Clinics (NPLC) in Ontario. Interim funding was made available for these
primary health care teams to apply for a physiotherapist position to enhance their delivery
of specific programs to target populations, including lung health, cardiovascular health,
healthy aging and others. Prior to this change, a small number of physiotherapists were
already working in these settings under job titles such as health promotion educator. Due
to a different funding structure, physiotherapists have been embedded in several
Community Health Centres (CHC) for many years and as of 2012, there were 14
physiotherapists working in CHCs in Ontario.

There are many benefits of embedding physiotherapists directly into the team as an
employee of the primary care organization, including: enhanced communication and a
more cohesive team, the ability of the physiotherapist to take on more diverse and
integrative roles, such as those necessary in the management of complex needs and
chronic diseases, and high job satisfaction.8

Physiotherapists are responsive to a changing health care system and dynamic

populations; they work collaboratively and interprofessionally to enhance efficiency and
effectiveness in addressing the needs of the populations they serve.

5
The following framework for integrating Physiotherapist services is adapted from the
model presented in Primary Health Care – A Resource Guide for Physical Therapists.9

Funding PT PT Role in the PHC

Service Team

Identifying
PT Case Management Opportunities
and Collaboration and Emerging
Roles

Funding PT services
 Physiotherapists are now included on the list of professions that may be funded
as employees in primary health care teams.

PT Role in Primary Health Care Teams

 Physiotherapists are generalists with specialist knowledge and skills in function
and mobility.
 The wide range of roles for physiotherapists in primary health care teams is
discussed in detail in earlier sections of this document. These roles include but
are not limited to: screening and early detection, management of acute and
chronic conditions, supporting patients in self-management, health promotion
and prevention of illness and injury.

PT Case Management and Collaboration

 The coordination of patient care through the role of a case manager should be
flexible and held by the team member who best fits the needs of the patient; a
physiotherapist is an appropriate choice as case manager for patients with needs
related to musculoskeletal complaints, function, and/or mobility.

6
Identifying Opportunities and Emerging Roles
 As primary health care models engage physiotherapists and aim to maximize the
benefit of their unique knowledge, skills and judgment, emerging opportunities
and areas of practice will be identified. It is important that team members
understand the scope and boundaries of emerging roles, ensuring all members
have access to all pertinent information, understanding of the intervention and
its goals for the patient, the practice, and the health system.

HOW ARE PHYSIOTHERAPISTS TRAINED

Physiotherapists’ unique contribution to health care stems from advanced

understanding of the body and its systems, what keeps it moving well, and how to
restore function and mobility. Physiotherapy interventions are founded upon and
integrate “the best current research evidence with clinical experience and patient
values.” Education of clients, caregivers, and other health professionals about injury
prevention, ergonomics, fitness, health and wellness is a large focus of the physiotherapy
profession.10

Physiotherapists have a Master’s level university-based education that provides a

foundation of modern science for the profession.

The entry-level educational curriculum includes, but is not limited to, the study of:
 biological sciences (e.g. human/functional anatomy, human physiology,
pathology, pathokinesiology, with specific and focused training on the
diagnosis of musculoskeletal conditions);
 applied sciences (e.g. human development, biomechanics and exercise physiology);
 clinical sciences (e.g. physical and functional pharmacology.);
 scientific inquiry (e.g. research, statistics, literature reviews) and professionalism
and ethics (e.g. health policy, legislation and regulation, interdisciplinary practice,
management);
 psychosocial sciences (e.g. psychology, sociology, cultural anthropology) are also
foundational to a physiotherapist’s education, and are often studied prior to or
concurrently with the entry-level physiotherapy program.

LEARN MORE ABOUT HAVING A PHYSIOTHERAPIST ON YOUR

TEAM

Contact the Ontario Physiotherapy Association

55 Eglinton Avenue East, Suite 210
Toronto, Ontario
M4P 1G8

7
Phone: (416) 322-6866
Toll free 1-800-672-9668
Fax: (416) 322-6705
Email: [email protected]

EXAMPLES OF PHYSIOTHERAPISTS AND CHRONIC DISEASE

MANAGEMENT AND PREVENTION

As the number of patients experiencing chronic and complex conditions increases, the role
for patients as self-managers and active participants in care is growing. Physiotherapists
are well positioned not only to facilitate and support patient self-management but to
engage in the interprofessional, comprehensive care that will support the needs of these
patients.

Physiotherapists are adaptable to the full range of healthcare delivery venues and have a
presence across the entire continuum of care. Physiotherapists also readily integrate into
interdisciplinary models of care and characteristically work closely with physicians and
increasingly with nurse practitioners.

In addition to their expertise in the treatment of acute musculoskeletal,

neurological, and cardiorespiratory conditions, physiotherapists has been noted as
having an important role in the management of many chronic diseases and
conditions and a role in the primary and secondary prevention of illness and
injuries. Some examples are highlighted below.

DIABETES

The Canadian Diabetes Association estimated that in 2013, there were 1,386,000
Ontarians living with Diabetes11. Physiotherapists educate patients on the benefits of
regular physical activity and have the knowledge and training to prescribe individualized
exercise plans that take into account any coexisting medical conditions such as heart
disease, high blood pressure or stroke.12 Physiotherapists also assist with management
of the vascular or peripheral neuropathy complications that arise from diabetes dealing
with foot disorders, balance difficulties and protective strategies to prevent further
damage.

Children and adolescents with Type 1 diabetes may develop complications such as limited
joint mobility and impaired growth in the late pubertal development.13 Physiotherapists
are educated on the special precautions that need to be taken for children with Type 1
diabetes when participating in certain sports, along with other exercise considerations for
healthy growth in children. Physiotherapists can also educate children and caregivers on
the monitoring of their blood glucose levels when participating in physical activity.14

8
ARTHRITIS

According to the 2011/2012 Canadian Community Health Survey of, 18% of Ontarians
reported having arthritis/rheumatism15. In the primary care pilot project called Getting a
Grip on Arthritis: A National Primary Health Care Community Initiative physiotherapists were
included in the provision of resources and development of tools for the education of
providers and their patients around the resources available, how to exercise, medication
and how to cope with arthritis and pain. The initiative had a significant impact on patient
with 83% reporting increased ability in self-management of these chronic conditions.16
Poor management of these conditions can contribute to the need for extensive surgical
interventions as the joints deteriorate as seen in the increasing numbers of hip and knee
replacements done in Ontario. In a report for ACREU, the analysis of the best practice
literature showed that; “There is conclusive evidence in the literature for the following
rehabilitation interventions for persons with RA and OA: client education, exercise
(aerobic and strengthening), joint protection instruction, and assistive devices.”17

CHRONIC MUSCULOSKELETAL CONDITIONS

In 2003 20.3% of the Ontario population reported having back problems (excluding
arthritis and fibromyalgia) and 11.3% of the Ontario population reported having
Repetitive Strain Injury.18 In industrial countries, musculoskeletal problems are the
most common cause of chronic disability.19 Physiotherapy interventions were found
to effectively reduce disability and pain for chronic musculoskeletal conditions such
as chronic low back pain, hip and knee osteoarthritis and rheumatoid arthritis.20

OBESI TY

A rising number of Ontarians have an unhealthy body weight. These individuals often
experience an increased risk for corresponding health concerns; some of which, such as
joint problems, may create further barriers to weight management activities.
Physiotherapists have a specialized knowledge of pathology and the body systems
impacted by obesity, making physiotherapists ideally suited to identify activity and
exercise strategies which are effective and safe for individuals and to coordinate
comprehensive weight management programs for individuals and in the community.21

INCONTINENCE

According to the Agency for Health Care Policy and Research in the United States, one in
four women between 30 and 59 years of age have experienced an episode of stress
urinary incontinence. They note that over 50% of elderly persons either at home or in long
term care have incontinence.22 Their evidence based guidelines for the treatment of these
conditions lists pelvic muscle rehabilitation as the first on the list of recommended
treatment approaches.23 Physiotherapists can apply their knowledge and skills in

9
musculoskeletal treatment techniques with additional specialized training to provide
pelvic floor rehabilitation and incontinence treatments.

FALLS

Falls are a major cause of injury and disability in older adults; just the fear of falling can
reduce activity levels and result in increased problems with weakness and balance leading
to more falls. According to a paper establishing evidence-based guidelines for falls
prevention, approximately one third of those over 65 will fall annually and half of those
will have repeat falls. The majority of accidental deaths in this age group are due to falls.24
Screening all for risk factors such as balance impairments and lower extremity strength
are important elements of a falls prevention program and a program of physiotherapy
including exercise for women over 80 regardless of risk factor status is supported by the
evidence.25

ADDITIONAL EXAMPLES AND RESOURCES

Ontario Physiotherapy Association series of briefing notes and infographics related to

frail elderly, stroke, CVD/CHF, COPD
Available at: http://www.opa.on.ca/about_phys_value.shtml. Accessed on 14/09/01

Soever, Leslie for the College of Physiotherapists of Alberta, Alberta Physiotherapy

Association and the Canadian Physiotherapy Association, Discussion Paper: Primary
Health Care and Physical Therapists - Moving the Profession’s Agenda Forward.
Available at:
http://www.internetgroup.ca/clientnet_new/docs/publications_primaryhealthcare.pdf.
Accessed on 14/09/01

College of Physiotherapists of Alberta, Alberta Physiotherapy Association and the

Canadian Physiotherapy Association: Primary Health Care – A Resource Guide for
Physical Therapists Available at:
http://www.physiotherapyalberta.ca/files/primary_health_care_1.pdf. Accessed on
14/09/01

Canadian Physiotherapy Association: The Value of Physiotherapy in Specific Patient

Populations (Information sheets that include Stroke, Cardiovascular, Low Back Pain,
Paediatric Care)
Available at: http://www.physiotherapy.ca/Advocacy/Legislation/The-Value-of-
Physiotherapy. Accessed on 14/09/01.

Canadian Physiotherapy Association Position Statement: Primary Health Care

Available at: http://www.physiotherapy.ca/getmedia/623371a0-4f99-4b25-bbc9-
2c58db9a6072/Primary-Health-Care_en.pdf.aspx. Accessed on 14/10/10

10
EVIDENCE SUPPORTING THE ROLE OF PHYSIOTHERAPISTS IN
PRIMARY HEALTH CARE

SUPPORT FOR THE ROLE OF PHYSIOTHERAPISTS IN PRIMARY

HEALTH CARE

OPPORTUNITY EVIDENCE

Strong evidence was found to support

physiotherapy at the PHC level for the
following conditions
System Effectiveness  Arthritis26 27 28 29
Research has shown that  Coronary Heart Disease30 31
physiotherapy diagnosis and  Chronic Lung Disease31 34
evidence-based treatments are  Incontinence31 34
effective and cost- efficient in  Diabetes31 34
treating a variety of physical health  Osteoporosis31 34
32
problems.  Fall prevention
 Low back pain31 34
 Total hip and knee replacements32
 Urinary incontinence32 31
 Mental health31
Other conditions  Physical inactivity (CPA, Physician Briefing)
where with supporting evidence for  Obesity in children and adults (CPA,
physiotherapy Physician Briefing)
 Case management/navigator role31
 Decreased wait times for surgery,
increased return to work, fewer
emergency room visits, fewer imaging
Effectiveness of
studies and increased patient
physiotherapy in primary health care
satisfaction32
settings
 Physiotherapist’s monitoring of patient
function through EMR in primary care can
increase activity levels33
 Strategies to manage childhood
Physiotherapists in Program design obesity; target family and child.
for Obesity Physiotherapists have skills to design
effective programs.34
 Rehabilitation services provided to 137
patients with chronic disease, who were
Reduced Use of Other Health
high users of the health-care system and
Services
had received at least four visits to their
family physician in the preceding year.

11
 Cost savings from reduced hospitalization
were $490 per program graduate. Total
cost savings during the study were
$65,000.
 Ontario MOHLTC supported demonstration
project at Stonechurch Health Centre,
Hamilton, Ontario
 Stanford University which is renowned for
their Model for Chronic Disease
Reduced Use of Other Health
Management found rehab program
Services
resulted in reduced use of health services
saving $780/patient.35
 The costs of providing 30 to 60 minutes of
self-care education plus at least two follow-
up calls for people with knee OA were offset
within one-year by decreased frequency and
cost of physician primary care visits.36
 85% of UK general practitioners responding
Reduced Use of Other Health to a survey reported inappropriate
prescription of non-steroidal anti-
Services
inflammatory drugs would be reduced if
more resources were provided for
physiotherapy services.37
 Use of PT expertise in assessing MSK
pathology resulted in equal or better
patient outcomes and reduced use of other
more costly health resources38
 Cost-effective rehabilitation treatments
include self-care education, group exercise,
Cost Effective Methods of Delivery walking programs, strength training,
hydrotherapy, splinting, adaptive equipment,
postural training, and home adaptation. 39
 PTs assume many roles within primary
health teams that maintain an evidence
based approach to health care delivery and
collaborative interprofessional care.40
PT Roles and Models for integrating
 Imbedding PTs into a primary health care
PT into primary health care
teams is ideal. Considerations for the most
optimal health care delivery model for
different communities and populations
served is needed.41

12
1 Physiotherapist and related words are official marks used with permission by registered physiotherapists.
2 Canadian Physiotherapy Association. 2012 Description of Physiotherapy in Canada. Accessed 25/9/2014 at:

http://www.physiotherapy.ca/getmedia/e3f53048-d8e0-416b-9c9d-38277c0e6643/DoPEN(final).pdf.aspx
3 College of Physiotherapists of Ontario. Protecting the Public. Accessed 25/9/14 at:

http://www.collegept.org/Public/ProtectingthePublic
4 Ibid

5 Cott CA, Mandoda S, Landry MD. Models of integrating physiotherapists into family health teams in

Ontario, Canada: challenges and opportunities. Physiotherapy Can. 2011; 63(3):265-75.

6 Cott, C.A. et al, for ACREU, Adult Rehabilitation and Primary Health Care in Ontario, July 2004, p. 11.

7 Pinney S, Regan W. D. Educating Medical Students About Musculoskeletal Problems Are Community Needs

Reflected in the Curricula of Canadian Medical Schools? The Journal of Bone & Joint Surgery JBJS.ORG
Volume 83-A · Number 9 · September 2001 p1317-1320
8
Cott CA, Mandoda S, Landry MD. Models of integrating physiotherapists into family health teams in
Ontario, Canada: challenges and opportunities. Physiotherapy Can. 2011; 63(3):265-75.
9 College of Physiotherapists of Alberta, Alberta Physiotherapy Association and the Canadian Physiotherapy

Association: Primary Health Care – A Resource Guide for Physical Therapists Available at:
http://www.physiotherapyalberta.ca/files/primary_health_care_1.pdf. Accessed on 14/09/01
10 Accreditation Council for Canadian Academic Programs, Canadian Alliance of Physiotherapy

Regulators, Canadian Physiotherapy Association, Canadian Universities Physical Therapy

Academic Council. Essential Competency Profile for Physiotherapists in Canada, Toronto: Authors:
2004.
11 Canadian Diabetes Association. At the Tipping Point: Diabetes in Ontario. Accessed October 10, 2014 at:

http://archive.diabetes.ca/documents/get-involved/Diab_Prog_Report-ON_6.pdf
12 Australian Physiotherapy Association, Position Statement Physiotherapy and Diabetes, March 2006,

http://apa.advsol.com.au/independent/documents/position_statements/public/PhysiotherapyandDiabetes.
pdf
13 International Society for Pediatric and Adolescent Diabetes, Consensus Guidelines 2000,

http://www.diabetesguidelines.com/health/dwk/pro/guidelines/ispad/ispad.asp
14 Australian Physiotherapy Association, Positions Statement Physiotherapy and Diabetes, March 2006.
15 Statistics Canada. 2011/2012 Canadian Community Health Survey
16 Health Canada, Initiative Fact Sheet, Getting a Grip on Arthritis: A National Primary Health Care

Community Initiative, November 2006.

17 Cott, C. et al, for ACREU, A Client-Centred Health Service Model of Primary Health Care and Rehabilitation

for Arthritis, April 2005, p. 21.

18 Canadian Community Health Survey, cycle 2.1, 2003
19 Herbert, R.D. et al, British Medical Journal, Vol. 323, 6 October, 2001, p. 788.
20 Ibid
21 Canadian Physiotherapy Association, Physician Briefings for Physicians – Obesity, May 2008
22 Agency for Health Care Policy and Research, http://www.ahrq.gov/clinic/uiovervw.htm, September 2008
23 Ibid
24 Moreland et al, Evidence-Based Guidelines for the Secondary Prevention of Falls in Older Adults,

Gerontology, 2003:49:93-116.
25 Ibid.

26 Cott, C. et al, for ACREU, A Client-Centred Health Service Model of Primary Health Care and Rehabilitation

for Arthritis, April 2005.

27 Fricke, M., for Manitoba Branch of the Canadian Physiotherapy Association and the College of

Physiotherapist of Manitoba, Physiotherapy and Primary Health Care: Evolving Opportunities, 2005.
28 MacKay, C., Devitt, R., Soever, L. and Badley, E.M., for ACREU, An Exploration of Comprehensive

Interdisciplinary Models for Arthritis, 2005.

13
29 Roddy, E., Zhang, W., Doherty, M., Arden, N.K., Barlow, J., Birrell, F., et al, Evidence-based Recommendations

for the Role of Exercise in the Management of Osteoarthritis of the Hip or Knee – The Move Consensus,
Rheumatology, 2005, 44(1), 67-73.
30 Restall, G.,Leclair, L., Fricke, Moni. (2005). Integration of Occupational Therapy and Physiotherapy Services

in Primary Health Care in Winnipeg. School of Medical Rehabilitation, University of Manitoba. Accessed May
2013.
31Lacima, R.M., and Pera, M., Combined Fecal and Urinary Incontinence – An Update, Current Opinions in

Obstetric Gynecology; 2003, 15:405-10.

32 Richardson J, Letts L, Wishart L, Stewart DA, Law M, Wojkowski S. Rehabilitation in Primary Care: National

and International Examples and Training Requirements. Ontario, Canada; 2006

33 Richardson et al. BMC Family Practice 2013, 13:29 http://www.biomedcentral.com/1471-2296/13/29
34
Dr. Nick Kates, Provincial Lead, Quality Management Collaborative for Ontario’s Family Health Team
Accelerating Primary Care, 2008 Conference, Alberta
35 Stanford School of Medicine: Chronic Disease Self-Management Program. Information available at:

http://patienteducation.stanford.edu/programs/cdsmp.html. Accessed on 14/09/01.

36 Cott, C. et al, for ACREU, A Client-Centred Health Service Model of Primary Health Care and Rehabilitation

for Arthritis, April 2005 p. 20.

37 Roberts, C., Dolman, E.A., Adebajo, A.O., Underwood, M., A National Qualitative Survey of Community Based

Musculoskeletal Services in the U.K., Rheumatology, 2003, Sep:42(9):1074-8.

38 Moore, J. Goss, D. Baxter, R., Deberardino, T., Mansfield, L., Fellows, D., Taylor, D., Clinical Diagnostic

Accuracy and Magnetic Imaging of Patients Referred by Physical Therapists, Orthopaedic Surgeons and
Non-Orthopaedic Providers, Journal of Orthopaedic Sports Physical Therapy, 35-67-71, 2005.
39 Cott, C. et al, for ACREU, A Client-Centred Health Service Model of Primary Health Care and Rehabilitation

for Arthritis, April 2005 p. 20

40 Dufour SP, Lucy SD, Belle Brown J. Understanding Physiotherapists' Roles in Ontario Primary Health Care

Teams. Physiotherapy Can. 2014;66(3);234-242

41 Cott CA, Mandoda S, Landry MD. Models of integrating physiotherapists into family health teams in Ontario,

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