Complementary therapies

How the physiotherapy profession delivers care to meet patient and population need is driven by evidence-based practice (EBP), which strives to optimise safer, more consistent and cost-effective patient-centred care. The integration of patient values and preferences, clinical experience and application of scientific research within EBP is consistently recognised as important in shaping the physiotherapy profession. 

EBP is central to the four main pillars of physiotherapy practice, which following the 2020 CSP review are now interpreted as:    

• manual therapy and therapeutic handing
• exercise, movement and rehabilitation
• therapeutic and diagnostic technologies
• allied approaches 

While the allied approaches pillar allows room for the profession to evolve in the light of new practice developments, such advances must be based on scientific evidence. 

The CSP continually reviews areas of risk in respect of the practice of physiotherapy. These risks include consideration to the expectations, principles and reputation of physiotherapy as a healthcare profession. 

It is clear that some complementary, alternative and holistic (CAH) therapies do not have a robust current or emergent evidence base for effectiveness and as such will not be considered to be part of our professional scope. 

For example reflexology, aromatherapy, Reiki, cupping and energy medicine, to name but a few, are no longer within professional scope and hence no longer covered by our PLI scheme. It is therefore imperative that you seek alternative PLI provision for this element of your practice.

We absolutely recognise the effectiveness of acupuncture, exercise, massage and Pilates. 

These interventions, when used in the context of physiotherapy, remain integral to physiotherapy practice. 

Evidence-based 

In recent years we have ceased to recognise some formerly affiliated professional networks representing CAH therapies, as there has been no emergent evidence to support their use as part of healthcare practice. 

Two such examples would be the Association of Chartered Physiotherapists in Energy Medicine (ACPEM) and the Association of Chartered Physiotherapists in Reflex Therapy (ACPIRT).

We do not hold a monopoly on any single modality and/or intervention within any of the pillars of practice. This means other practitioners, not all of whom will be regulated healthcare professionals, may use some of them but in a different context. 

What distinguishes use in physiotherapy and healthcare practice is that modalities are selected based on autonomous practice, the exercise of professional judgment and the use of appropriate knowledge and skills to inform and maintain the quality of practice. 

We receive many enquiries from members to our Professional Advice Service asking whether they are covered for the delivery of modalities such as acupuncture or Pilates. In these scenarios the member can decide whether they are providing the intervention as a physiotherapist or in some other capacity for example as a Pilates instructor or an acupuncturist.

What all of this will mean in practice is where members choose, or a patient expects, a CAH therapy as a standalone offering, members must make it clear that that they are acting as a CAH practitioner and not working as a physiotherapist. 

If, following appropriate examination and clinical reasoning you choose to use an accepted CAH therapy as part of a physiotherapy programme then accurate record keeping will enable you to demonstrate, if challenged, that you were working as a physiotherapist and not as a complementary, alternative and holistic practitioner.  

Further information:

• A list of CAH therapies on the Federation for Holistic Therapies website
• CSP’s Pillar Review
• Scope pages
• Pilates / Yoga PLi page
• HCPC Standards of Conduct, Performance and Ethics

Sara Conroy and Jane Mitchell are CSP professional advisers