What Alternative Therapies Are within the Scope of Practice of Kinesiology?

The practice of kinesiology is growing as new treatments, complementary therapies, and alternative therapies are made available. The Canadian Kinesiology Alliance (CKA) and the provincial kinesiology associations (PKAs) wish to help Kinesiologists who are considering offering new treatments/therapies. This document provides information for Kinesiologists who want to recommend or provide complementary therapies or alternative therapies, in conjunction with their practice of conventional kinesiology, or who have clients seeking or receiving these therapies in addition to conventional kinesiology treatment.

Important: In this document, the words therapies and treatments are used in a broad, general way to mean modalities.

To determine whether an activity, or the use of a particular device, is within the scope of practice of kinesiology, a Kinesiologist should consider whether it

1. involves a controlled act or some other legally regulated activity and
2. falls within the defined scope of practice of kinesiology (i.e., assessment, rehabilitation, and management of human movement and performance).

Kinesiologists should also ask themselves whether they are competent to perform the activity or to employ the device in a safe and effective manner. Remember that Kinesiologists cannot prescribe medications or penetrate the skin (e.g., implant devices, perform diabetes testing). Even when treatment modalities overlap between professionals, each professional must stay within the parameters set by their field of practice.

Before using new treatments, complementary therapies, or alternative therapies, Kinesiologists should consider the following:

1. What is meant by conventional therapies, complementary therapies, and alternative therapies?
2. What are the expectations for practice?
3. What are the specific expectations when providing complementary therapies and alternative therapies?
4. What are the specific expectations of clients requesting or receiving complementary therapies and alternative therapies?
5. What else must be considered before providing some therapies (e.g., insurance, scope)?

Updated : 2020-05-12

Without prejudice

Disclosure: The practice of kinesiology varies from one province to another. The information in this document may differ and not correspond with the provincial legislation. The main purpose of this document is to present the current portrait of kinesiology (definitions, fields of practice, acts, etc.) across Canada, with information regarding resources in the various fields of kinesiology, practical tools, the extent of its scope of practice, and other potentially useful information. This document is in perpetual revision as per the evolution of the practice of kinesiology in Canada. The CKA / ACK will not be held responsible for any consequences or damages that may occur as a result of the use, misuse, misinterpretation, or abuse of the information found on its website. We emphasize that the aim of this document is to help guide you. Should anyone require guidance in interpreting any of the provided information, they should seek the advice of their provincial kinesiology association.

This document is based on a similar guideline from the College of Kinesiology of Ontario (CKO), which was based on a policy statement from the College of Physicians and Surgeons of Ontario. The CKA thanks and acknowledges the CKO for sharing information as a resource for the development of this guideline.

1. What is meant by conventional therapies, complementary therapies, and alternative therapies?

In kinesiology, conventional therapies are evidence-based therapeutic interventions, founded on a modern conceptualization of disease/dysfunction and rooted in the scientific principles (physiology, biomechanics, neurology, mobility, anatomy, psychology, sociology, posturology, anthropometry). These therapies, like exercise prescription and functional ability assessment, form the core of kinesiology practice.

Complementary therapies and alternative therapies fall within a broad group of therapeutic practices, services, remedies, or devices based on various theories or beliefs, which may or may not be grounded in evidence-based practice and scientific principles. Examples include herbal supplements and homeopathic remedies.

There may not always be a clear distinction between conventional therapies, complementary therapies, and alternative therapies. Moreover, some aspects of complementary therapies and alternative therapies may become incorporated into conventional kinesiology practice over time if scientific evidence, and support for the particular intervention, expands.

2. What are the expectations for practice?

The following general principles should guide a Kinesiologist when recommending, or directly providing, complementary therapies or alternative therapies, and when dealing with a client who requests or is receiving these therapies from another provider.

Act in the best interests of the client: As health care professionals, Kinesiologists must always act in the best interests of the client. A Kinesiologist’s recommendations and treatment must be focused on the needs, goals, and interests of the client, not on the interests of the Kinesiologist. Kinesiologists must refrain from the exploitation of clients for personal or professional gain.

Respect the autonomy of client choice: Clients are entitled to set goals and make decisions about their care, including goals and decisions with which the treating Kinesiologist may disagree. Kinesiologists should serve as a trusted resource for health care information by providing unbiased, accurate, and clinically appropriate recommendations for treatment to support informed client choice. Kinesiologists should acknowledge the diversity of cultures within a multicultural client population, including Indigenous/First Nations cultures, and respect how these differing cultural perspectives may inform client choice. Kinesiologists must always obtain a client’s informed consent prior to initiating treatment.

Avoid or appropriately manage conflicts of interest: Kinesiologists are expected to avoid or appropriately manage potential conflicts of interest. This is of particular importance when recommending or providing complementary therapies or alternative therapies in which the Kinesiologist may have a personal or financial interest.

Practice within the limits of personal skill, knowledge, and judgment: Kinesiologists are expected to limit their practice, whether conventional or complementary or alternative, to their individual sphere of competence. Kinesiologists must ensure that they possess adequate skills, knowledge, and judgment to recommend or provide any treatment modality, and should refer clients to other health care providers where the required, or requested, treatment would fall outside of this sphere.

Comply with governing laws, standards, and guidelines: Kinesiologists must comply with all governing laws, standards, and guidelines, both relating to their practice of kinesiology and any other complementary therapy or alternative therapy they may offer. This includes any licensing/registration requirements and professional standards related to other specifically regulated therapies (e.g., acupuncture). The Kinesiologist is responsible for knowing requirements relating to the Personal Information Protection and Electronic Documents Act (PIPEDA) as well as any other applicable legislation.

3. What are the specific expectations when providing complementary therapies and alternative therapies?

Conventional assessment first: Before recommending or providing a complementary therapy or alternative therapy to a client, a Kinesiologist must first have performed a conventional client assessment and formulated conventional treatment recommendations on the basis of that assessment. The Kinesiologist’s clinical assessment and judgment must be informed by evidence-based practice.

Criteria for complementary therapy and alternative therapy: Moreover, if a Kinesiologist plans to recommend, or provide, a complementary therapy or alternative therapy to a client, the recommended therapy must satisfy the following criteria:

• The therapy must be logically related to the client’s condition and treatment goals.
• The therapy must have a reasonable expectation of improving the client’s condition or of helping them achieve their treatment goals.
• The overall risks and costs of the therapy must not outweigh its potential benefits, in particular when compared with conventional therapies.

Client discussion: In discussing treatment options with a client, and when obtaining a client’s informed consent, the Kinesiologist must do the following:

• The Kinesiologist must provide information about all therapeutic options, including conventional therapies, and never overstate or exaggerate the benefits (or understate or minimize the risks) of a particular therapy.
• The Kinesiologist must never make a claim about a remedy, treatment, device, or procedure other than a claim that can be supported as a reasonable professional opinion.
• When recommending a complementary therapy or alternative therapy, the Kinesiologist must provide the client with the following information about the therapy:
  • The extent to which the therapy is supported by conventional kinesiology practice and scientific evidence
  • How the therapy would compare with conventional kinesiology therapies
  • A reasonable assessment of the expected clinical efficacy of the therapy

As noted above, a Kinesiologist who plans to recommend or provide complementary therapies or alternative therapies must ensure that any potential conflict of interest is avoided or appropriately managed and that they have the requisite skills, knowledge, and judgment to do so safely and effectively.

4. What are the specific expectations of clients requesting or receiving complementary therapies and alternative therapies?

Clients requesting therapies: Clients may sometimes request information about, or ask a Kinesiologist to provide, a particular complementary therapy or alternative therapy. Kinesiologists are not expected to be knowledgeable about every complementary therapy or alternative therapy that a client may ask about, nor are Kinesiologists expected to provide a particular therapy simply because it was requested by a client. Kinesiologists are expected to limit their practice to their sphere of competence and to recommend, and provide, treatment in accordance with their professional judgment and the client’s best interests. As much as possible, Kinesiologists should act as a resource for accurate and objective treatment information and should refer clients to another trusted source, such as another regulated health care provider, if the Kinesiologist is unable to answer particular questions.

Clients receiving therapies elsewhere: When completing clinical histories for clients, Kinesiologists should ask about other treatments they are receiving, including complementary therapies and alternative therapies. Kinesiologists should record the use of any complementary or alternative therapies in a client’s chart and be mindful of any possible interactions or contraindications that these therapies may create with the kinesiology plan of care. Kinesiologists should update a client’s clinical history at regular intervals.

5. What else must be considered before providing some therapies (e.g., insurance, scope)?

Let’s look at an example of a treatment modality you may consider using.

Sam is a Kinesiologist and she is interested in using high-intensity laser therapy in her clinic for non-invasive interventions. She must first decide if there is enough scientific evidence for this treatment modality. She must research credible sources and journals to reach a decision. She then must fully understand how to use this modality, which may include specific training or a course, to ensure she is competent in how to use the device, including all indications, contraindications, risks, benefits, and different uses of lasers. She would ensure this treatment falls within her scope of practice, and she would ensure her clients/patients are informed of all the risks, benefits, and alternative options before obtaining consent. She must also contact her insurance company to ensure there is adequate coverage for a Kinesiologist using a laser for therapeutic purposes.

From an insurance point of view, laser therapy is dealt with on a case by case basis. In order to provide laser therapy, Kinesiologists must get additional coverage from the CKA national insurance program through PROLINK. They must also get approval from the insurance provider to use a class 3 laser (cold laser). There is an additional premium associated with extending coverage to this type of service through CKA PROLINK insurance. Class 3 and class 4 lasers can cause eye and skin damage. Kinesiologists will need to prove they are fully trained/certified and are aware of the safety guidelines (in terms of preventing eye and skin damage) before they will be approved to extend their insurance coverage to this service.

Summary

When a Kinesiologist is interested in offering new treatments, complementary therapies, alternative therapies, or the use of a particular device, they must first consider

• whether it involves a controlled act or some other legally regulated activity;
• whether it falls within the defined scope of practice of kinesiology, is evidence based, and has gone through rigorous scientific studies;
• whether they hold the necessary competence to be able to perform the activity or to employ the device in a safe and effective manner; and
• whether they hold sufficient insurance coverage specifically for this therapy.

Alternative Therapies Reviewed by the CKA