Authorized Activities within Professional Practice: Updated January 16, 2023

PREFACE

Definition

A scope of practice highlights the professional activities permissible by respective legislation and/or education skills and training certifications. It provides an external boundary within which graduates of the profession work.

Introduction

This Scope of Practice document is developed for Manual Osteopathic Therapists with the core level of training and certification. It is to be used in conjunction with “The Standards of Practice for Manual Osteopathic Therapists” and “Code of Ethics for Massage and Manual Osteopathic Therapists” for quality assurance in Manual Osteopathic Therapists practice. The authors of this document recognize the overlapping roles between Manual Osteopathic Therapists and other Alternative Health Practitioners and therefore have included a list of activities restricted under the Alberta Health Professions Act (2000).

Purpose

As of 2022, Manual Osteopathic Therapy is not regulated in any province in Canada. Manual Osteopathic Therapists are self-governed under professional associations. The Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA) has thereby adopted this document as a guideline for all its members registered as Manual Osteopathic Therapists.

The World Health Organization Benchmark for Training in Osteopathy provides background for the development of this document and is referenced when applicable to Canadian jurisdictions.

The purpose of this Scope of Practice document is to:

Provide a summary of authorized professional activities for CMMOTA members and other Manual Osteopathic Therapists without governing bodies;

Provide new and prospective graduates of Manual Osteopathic Therapy entry-to-practice margins;

Provide existing Manual Osteopathic Therapists professional indicators to maintain;

Provide the general public a yard stick to measure their service;

Provide CMMOTA a parameter by which to initiate a complaints investigation process and implement a disciplinary action where applicable.

Acknowledgements

Special thanks to the World Health Organization for publication of their 2010 Benchmark for Training in Osteopathy that is referred to world-wide by professional organizations like ours.

Liability Statement

In addition to this document, Manual Osteopathic Therapists are accountable to all applicable pieces of federal, provincial, and municipal legislation, the Association’s Bylaws, Policies and Procedures, Standards of Practice for Manual Osteopathic Therapists and Code of Ethics for Massage & Manual Osteopathic Therapists documents.

GLOSSARY

Client: The person receiving a Manual Osteopathic Treatment from a qualified Manual Osteopathic Therapist.

Manual Osteopathic Therapist: Non-physician trained personnel that attended a licensed institution that meets the Type I or Type II Benchmark for Training in Manual Osteopathic Treatment. The Manual Osteopathic Therapist is also referred to as the Osteopathic Manual Therapist, Osteopathic Manual Practitioner and Manual Osteopathic Practitioner.

Manual Osteopathic Treatment: This is the therapeutic intervention provided by a qualified Manual Osteopathic Therapist or Student Manual Osteopathic Therapist.(see end note 1) Where the World Health Organization Benchmarks for training in Osteopathy refers to Osteopathic Manipulative Treatment, we have revised the wording to Manual Osteopathic Therapy or Treatment in order to comply with Canadian Legislation

Restricted Activity: An action that is legally impermissible and/or unethical and/or immoral for the Manual Osteopathic Therapist to perform on a client; and/or unauthorized due to inadequate training/skills/education and certification. (see end note 2)

Scope: Entry-level activity the Manual Osteopathic Therapist is trained and certified to competently perform. (see end note 3)

SCOPE OF PRACTICE

1. Client Interaction

Scope

The Manual Osteopathic Therapist:

• Communicates professionally with the client

• Applies principles of beneficence and non-maleficence when working with clients

• Respects the client’s right to refuse treatment

• Treats all clients fairly and impartially

• Maintains privacy and confidentiality of client information

• Provides the client with all the options pertaining to the treatment session, including the potential benefits and side effects

• Invites the client to attend treatment sessions

• Creates a safe environment for the client to fully disclose their health history

• Seeks informed consent from the client before performing any activity within this scope of practice document

• Seeks written informed consent for treatment of any sensitive areas (as defined in the CMMOTA Treatment of Sensitive Areas Policy) before performing any activity within this scope of practice document

• When required by law reports to relevant authority, or encourages reporting, when there is evidence and admission of abuse on a client

• Reasonably charges the client for services rendered

• Retains the right to refuse to provide treatment if safety of the client and/or the therapist is perceived to be compromised

• Discloses to the client their level of training/certification and licensure/registration

• Regarding Animals in Clinic Space – follows guidelines as set out by Alberta Health Services https://www.albertahealthservices.ca/assets/healthinfo/ipc/if-hp-ipc-animals-hcf.pdf

Restricted Activities

The Manual Osteopathic Therapist shall not:

1. Refer to themselves as a D.O, Doctor of Osteopathy, Osteopath, Manual Osteopath, Osteopath Practitioner or any other protected title under any Canadian Health Professions Act or other applicable Canadian Federal or Provincial Legislation;

2. Encourage, initiate or maintain a sexually intimate relationship with an existing client, except when legally married or in a common law relationship;

3. Encourage, initiate or maintain a sexually intimate relationship with a former client within a twelve (12) month period following the ending of the therapeutic relationship;

4. Encourage, initiate or maintain behavior of non-therapeutic nature;

5. Misrepresent their qualifications to members of the public.

2. Technical Skills

Scope

The Manual Osteopathic Therapist:

• Performs full body physical examinations, assessments and re-evaluations on clients as per the Standards of Practice for Manual Osteopathic Therapists document (see end note 4)

• Partners with the client to develop an appropriate Manual Osteopathic Therapy Treatment Plan

• Implements treatment techniques as outlined in the Standards of Practice for Manual Osteopathic Therapists Document (see end note 4) and the WHO Benchmark for Training in Osteopathy (see end note 1) and Appendix 34: Modalities for Manual Osteopathic Therapists

• Effectively manages time in the workplace

• Reads diagnostic reports

• Provides a progress report when requested

• Refers the client out to more experienced professionals when the complexity of the client care exceeds their expertise or when there is a high risk of a negative outcome in response to a therapeutic intervention or whenever is suitable (see end note 4)

Restricted Activities

The Manual Osteopathic Therapist shall not:

1. Perform any activity restricted in any Canadian Health Professions Act or other applicable Canadian Federal or Provincial legislation

2. Perform treatment on a client without seeking and obtaining informed consent

3. Perform treatment on a sensitive area on a client without seeking and obtaining informed written consent

4. Perform a therapeutic intervention to intentionally harm the client

5. Perform High Velocity Low Amplitude Thrusts on a client

6. Diagnose a condition presented by a client

7. Issue a requisition to a client for a diagnostic test

8. Perform a technique on a client without having the skill, education, training and certification

9. Puncture the dermis of the client in the course of treatment

10. Perform intra-anal, intra-penile and/or intra-vaginal treatments on a client

3. Research

Scope

The Manual Osteopathic Therapist:

• Performs research activities limited to the Standards of Practice for Manual Osteopathic Therapists, Code of Ethics for Massage & Manual Osteopathic Therapists and Scope of Practice for Manual Osteopathic Therapists Documents

• Employs ethical, morally sound and lawful methods of recruiting participants

• Seeks and obtains written informed consent from every participant in the study

• Accurately reports/documents the findings and any other data relevant to the research

• Avoids plagiarism

• Cites referenced sources accurately and comprehensively

Restricted Activities

The Manual Osteopathic Therapists shall not undertake any unethical and/or illegal research methods.

4. Teaching and Mentorship

Scope

The Manual Osteopathic Therapist:

• Educates when they show evidence of competence in Manual Osteopathic Therapy.

• As an Educator meets the Educator requirements as listed by the relevant employment organization and in absence of that, the Provincial Ministry of Private Vocational Training/ Advanced Education Department

• Mentor’s other manual osteopathic therapists within the boundaries of the Standards of Practice for Manual Osteopathic Therapists, Code of Ethics for Massage & Manual Osteopathic Therapists and Scope of Practice for Manual Osteopathic Therapists documents.

• Shall only teach modalities and techniques that are within scope for Manual Osteopathic Therapists, unless the Manual Osteopathic Therapist has adequate certification through an association that governs the out-of-scope modality that is being taught.

• Outside of those enrolled as students of manual osteopathic therapy or those who are already registered as a Manual Osteopathic Therapist, shall only teach manual osteopathic modalities and techniques that fall within the scope of practice for the professional designation of the trainee.

Restricted Activities

The Manual Osteopathic Therapist:

• Shall not teach and/or mentor student therapists in activities outside of their training, qualifications, skills, and certifications.

• Shall not teach modalities and techniques to Manual Osteopathic Therapists or those training to become Manual Osteopathic Therapists that are not within scope for the profession unless the course material content and course advertising clearly state that the modalities and techniques being taught are out of scope for Manual Osteopathic Therapists.

• Shall not teach manual osteopathic modalities and techniques to a trainee that fall outside of the scope of practice of a professional designation of the trainee unless such training is provided as part of a recognized manual osteopathic training program.

5. Leadership and Resource Management

Scope

The Manual Osteopathic Therapist:

• Performs cost-benefit analyses of their health care business and service to clients

• Applies quality assurance and quality control measures in the provision of services to the client including but not limited to therapeutic interventions and administrative tasks

• Monitors resource provision to clients

• Fairly allocates resources such as time, finances and intellectual wealth to clients and staff

• Prioritizes and budgets for task completion

Restricted Activities

The Manual Osteopathic Therapist shall not:

1. Fail to comply with any Provincial and Federal Government legislations, Human Rights Commissions and Labor laws in regards to health and safety and employment standards;

2. Fail to provide a workplace free of verbal or conduct harassment or discrimination due to disability, sexual orientation, gender, race, religion, country of origin, ethnic descent, family, appearance, color, age, criminal history, medical history, marital status etc.

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END NOTES

1. World Health Organization. 2010. Benchmark for Training in Osteopathy. Benchmark for Training in Traditional/Complementary and Alternative Medicine.

2. Alberta Queen’s Printer. 2000. Province of Alberta, Health Professions Act. Revised Statutes of Alberta (Chapter H-7).

3. College of Registered Nurses of Manitoba and College of Registered Psychiatric Nurses of Manitoba. 2010. Understanding Scope of Practice for Licensed Practical Nurses Registered Nurses Registered Psychiatric Nurses in the Province of Manitoba.

4. Canadian Massage and Manual Osteopathic Therapists Association. 2019. Standards of Practice for Manual Osteopathic Therapists, First Edition.

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