Physiotherapists may be asked about medication by their patients or by members of the public. This includes medication they have been prescribed by a registered prescriber and medication they have purchased ‘over the counter’ (OTC) from the pharmacy or supermarket. Physiotherapists also are often asked about nutritional and dietary supplements.
Physiotherapists who give advice about medication or medicines must ensure they have the knowledge and skills to do so. The underlying principle is ensuring the health and safety of the public.
New Zealand Law
The Health Practitioners Competence Assurance Act 2003 (HPCAA) is relevant. Physiotherapists, working in accordance with their scope of practice under the HPCAA, need to ensure their patients receive safe and appropriate evidence-informed advice.
1. Prescription medications
1.1. A record of the patient’s medications must always be included in a physiotherapy assessment to ensure there are no contraindications or a need for caution in their physiotherapy management (see Physiotherapy health records standard).
This record should include:
- the medication name and dosage
- whether symptoms are being controlled by the medication
- whether the medication is being taken as prescribed.
1.2. Physiotherapists must not alter the medication prescription given by a registered prescriber without first contacting that prescriber.
1.3. Physiotherapists must not give advice if they are unsure of the potential risks related to the medication or possible drug interaction with other medications the patient is currently taking. These patients must be referred to a pharmacist or a registered prescriber for advice.
1.4. If a patient has an action plan that has been issued by a registered prescriber, a physiotherapist can support that patient in monitoring their symptoms and initiating the prescribed medication change, i.e. a Chronic obstructive pulmonary disease or Asthma action plan (see Physiotherapists administering prescription medicines standard). Any discussion or changes initiated must be documented in the patient’s records.
1.5. Physiotherapists should maintain a good relationship with referring health practitioners in order to be able to quickly consult about a patient’s medication requirements if needed.
1.6. Physiotherapists can administer medicine via standing orders. This regulation has inherent legal obligations (see Physiotherapists administering prescription medicines standard).
2. Over the counter medications
Physiotherapists may offer advice about OTC medication including alternative and complementary ‘medicines’ being aware of ‘evidenced-informed practice’. They must keep in mind the key principle for physiotherapists under the HPCAA is to ensure the health and safety of the public.
In some situations, physiotherapists may suggest a patient obtains particular OTC medication.
It is important for physiotherapists to:
- realise that advice given in the role of a physiotherapist may be seen as ‘expert’ advice by the public
- ensure they have the appropriate knowledge and training to give advice on the OTC medication
- acknowledge their limitations and refer the patient to a pharmacist or doctor if not completely sure of the advice to be given
- whenever possible go through the instructions given for OTC medications with the patient to ensure the patient understands the correct dosage and any risks involved
- ensure that any advice given is evidence-based
- only promote or sell products that are evidence-informed
- record any advice given in the patient’s records.
3. Nutritional and Dietary Supplements
Ingredients in nutritional supplements may be incorrectly labelled, and the product may inadvertently contain a banned substance. Nutritional supplements can also react adversely with some prescription drugs. Particular care is needed, especially in relation to children, pregnant or lactating women, sports people, and older adults.
3.1. Advice should not be given on nutritional and dietary supplements unless the physiotherapist has appropriate, relevant, recognised education and training in this area. (See New Zealand registered physiotherapists practising in a defined field Position Statement)
3.2. Physiotherapists must not create a perception of nutritional and dietary supplements being part of mainstream physiotherapy training and practice.
3.3. Physiotherapists must provide truthful, accurate and relevant information in regard to any supplements. (Aotearoa New Zealand Code of Ethics and Professional Conduct, 6.1)
3.4. Physiotherapists must fully disclose any interests, including financial interests, held in products and services recommended to their patients. (Aotearoa New Zealand Code of Ethics and Professional Conduct, 6.2)
- Physiotherapists must consider the likelihood that their professional judgement might be influenced by a financial advantage within the secondary business (Aotearoa New Zealand Code of Ethics and Professional Conduct, 6.5)
3.5. It is imperative that in all decisions made by the physiotherapist, the underlying principle of ensuring the health and safety of the public is taken into account.
Braund, R., & Abbott, J. H. (2011). Nonsteroidal antiinflammatory drugs (NSAIDs) and paracetamol for acute musculoskeletal injuries: physiotherapists’ understanding of which is safer, more effective, and when to initiate treatment. Physiotherapy theory and practice, 27(7), 482-491.
Braund, R., & Abbott, J. H. (2011). Recommending NSAIDs and paracetamol: A survey of New Zealand physiotherapists’ knowledge and behaviours. Physiotherapy Research International, 16(1), 43-49.
Derry, S., Moore, R. A., & Rabbie, R. (2012). Topical NSAIDs for chronic musculoskeletal pain in adults. The Cochrane database of systematic reviews, 9, CD007400.
Morris JH, Grimmer K. Non-medical prescribing by physiotherapists: issues reported in the current evidence. Man Ther, 2014; 19(1):82-86.
Aotearoa New Zealand Code of Ethics and Professional Conduct 2018. Principle 6.1, 6.2, 6.5
Physiotherapists administering prescription medicines standard
Physiotherapy health records standard
Physiotherapy practice thresholds in Australia & Aotearoa New Zealand (2015) Key competencies 2.1, 3.2
MedSafe: The New Zealand Medicines and Medical Devices Safety Authority
Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription
Complementary and alternative medicines (CAM) are medical products that are not seen as part of standard care by registered health professionals
Nutritional/dietary supplements include vitamins, minerals, herbs, meal supplements, sports nutrition products, natural food supplements, and other related products used to boost the nutritional content of the diet.