Canada is facing a major healthcare challenge – and it’s not just about hospital wait times or doctor shortages. According to the Public Health Agency of Canada, the economic burden of illness now sits at a staggering $236.3 billion annually.[i] One promising solution? Physiotherapy. Research continues to show that physiotherapy not only helps improve patient outcomes but also reduces overall health care costs.
Currently 15% of Canadians access physiotherapy services each year.[ii] As of 2023, there are 29,153 practicing physiotherapists in Canada[iii], yet with an aging population and rising demand, that number falls short. In fact, projections indicate we’ll need a 62% increase in physiotherapists just to meet the Organization for Economic Cooperation and Development (OECD) average and keep up with our populations needs.[iv]
This blog will explore how increased integration of Physiotherapy Assistants (PTAs) and Occupational Therapy Assistants (OTAs) can help bridge this growing gap – supporting physiotherapy services, improving access to care, and strengthening Canada’s health care system from the ground up.[v]
Table of Contents:
- The Rising Demand for Outpatient Therapy Services
- The Role of OTAs and PTAs
- Benefits of Integrating OTA/PTAs Into the Interprofessional Team
- The P.A.V.E Project: Physiotherapy At home with Virtual Engagement
- Addressing Concerns and Misconceptions Around OTAs and PTAs
- Conclusion
The Rising Demand for Outpatient Therapy Services
Canada’s demographic landscape is shifting notably, with seniors (aged 65 and older) now numbering over 7.8 million as of July 1, 2024.[vi] This group represents a significant portion of the population and is projected to grow, with estimates suggesting that by 2035, one in four Canadians will be over 65.[vii]
This aging trend is accompanied by a rise in chronic conditions; for instance, among Canadians aged 85 and older, 83.4% have hypertension, 54.0% suffer from osteoarthritis, and 42.0% live with ischemic heart disease.[viii][ix]
Despite the increasing demand for rehabilitation services, Canada is facing a shortage of physiotherapists. In fact, there would need to be a 62% increase in the number of physiotherapists in Canada to meet the average for the more than 100 OECD countries.[x]
This shortfall is particularly evident in outpatient settings, where wait times can be extensive – for example, median wait times for publicly funded outpatient physiotherapy services range from two days for urgent referrals to 20 months for low priority cases.[xi]
These delays are compounded by a national Health Human Resources (HHR) crisis, as outlined in Health Canada’s 2023 HHR Symposium Summary Report, which highlights widespread workforce strain and calls for immediate action to strengthen and support the health workforce.[xii] Addressing these workforce challenges is crucial to meet the growing needs of Canada’s aging population and to ensure timely access to essential rehabilitation services.
The Role of OTAs PTAs
Occupational Therapy Assistants (OTAs) and Physiotherapy Assistants (PTAs) play a vital role in supporting the delivery of rehabilitation services within Canada’s healthcare system.
Working under the supervision of licensed Occupational Therapists (OTs) and Physiotherapists (PTs), OTAs and PTAs help carry out treatment plans by guiding patients through therapeutic exercises, assisting with mobility training, and supporting activities of daily living.[xiii] While they do not assess, diagnose, or modify treatment plans, their scope of practice includes implementing care plans, documenting patient progress, and ensuring continuity of care.[xiv]
Their involvement not only enhances patient access and continuity of therapy, especially in high-demand settings like outpatient clinics and long-term care but also allows OTs and PTs to focus on more complex clinical decisions. By working collaboratively, these teams help maximize efficiency, reduce wait times, and ensure high-quality care across the rehabilitation continuum.
Benefits of Integrating OTA/PTAs Into the Interprofessional Team
Integrating OTAs and PTAs into the interprofessional healthcare team offers a range of benefits that directly enhance patient care and system efficiency. One of the most significant advantages is improved access to care – with OTA/PTAs supporting the delivery of routine treatments and follow-ups, clinics can reduce wait times and serve more patients without overburdening therapists.
This model also promotes the optimized use of therapist time, allowing OTs and PTs to concentrate on assessments, complex treatments, and discharge planning, while delegating routine interventions to trained support personnel. As a result, patients benefit from more consistent and frequent therapy sessions, which improves continuity of care and supports better outcomes.
OTAs and PTAs also play a key role in facilitating group programs, home exercise guidance, and functional training, enhancing patient engagement between formal therapy sessions. Moreover, OTAs and PTAs serve as valuable collaborators within the interprofessional team by coordinating care with case managers and other allied health professionals.
Their involvement supports a more streamlined and collaborative approach to patient care, ensuring that treatment plans are carried out consistently while aligning with the broader goals of the healthcare team.
The P.A.V.E Project: Physiotherapy At home with Virtual Engagement
In response to the current HHR crisis, I’ve had the privilege of contributing to an innovative research initiative aimed at optimizing the role of PTAs in community care. The project, titled P.A.V.E – Physiotherapy At home with Virtual Engagement – explores a hybrid care model that integrates in-person support with virtual clinical oversight.
In this model, the PTA conducts home visits while the physiotherapist joins remotely via secure video conferencing. Together, we assess the patient’s functional abilities using standardized outcome measures and collaboratively develop an individualized treatment plan.
Over a six-week period, the PTA delivers the prescribed interventions independently, with the discharge session following the same hybrid format. This approach not only enhances access to care for patients with mobility or transportation barriers but also allows physiotherapists to dedicate their time to higher-complexity cases – offering a scalable, patient-centered solution to address growing service demands in outpatient and home-based settings.
Addressing Concerns and Misconceptions Around OTAs and PTAs
Despite the growing recognition of OTAs and PTAs, some misconceptions still persist – particularly the concern that these roles may replace therapists. In reality, OTAs and PTAs are not a substitute for OTs or PTs, but rather a way to extend the reach and impact of therapists in busy clinical environments.
These support personnel undergo formal education and competency-based training to safely and effectively assist in delivering therapy services. Their responsibilities are clearly defined and operate strictly under the supervision and delegation of a licensed therapist, who remains fully responsible for assessing patients, developing care plans, and making clinical decisions. By clarifying roles and promoting collaborative practice, OTAs and PTAs help ensure more patients receive timely, high-quality care without compromising clinical oversight or standards.
Conclusion
As Canada’s population continues to age and the demand for outpatient rehabilitation services rises, innovative solutions are needed to meet the growing care needs without overburdening an already stretched healthcare system. OTAs and PTAs offer a practical, efficient way to enhance service delivery while maintaining high standards of care.
By supporting therapists, improving patient access, and contributing to interdisciplinary collaboration, OTA/PTAs play a vital role in strengthening outpatient therapy services. Their structured training, defined scope of practice, and close supervision by licensed therapists ensure that care remains safe, effective, and patient-centered.
Addressing misconceptions is key – these professionals don’t replace therapists; they extend their reach. Embracing the integration of OTAs and PTAs not only improves patient outcomes but also helps build a more resilient and responsive rehabilitation system for the future.
References
[i] Economic Impact of Physiotherapy in Canada Prepared for Canadian Physiotherapy Association.; 2023. https://physiotherapy.ca/app/uploads/2024/04/Deloitte-report_EN.pdf
[ii] Economic Impact of Physiotherapy in Canada Prepared for Canadian Physiotherapy Association.; 2023. https://physiotherapy.ca/app/uploads/2024/04/Deloitte-report_EN.pdf
[iii] Physiotherapists | CIHI. Cihi.ca. Published 2024. Accessed April 29, 2025. https://www.cihi.ca/en/physiotherapists
[iv] Singh S, Goodwin S, Zhong S, et al. Inequalities in health-related quality of life and functional health of an aging population: A Canadian community perspective. Samaranayaka A, ed. PLOS ONE. 2024;19(7):e0304457. doi:https://doi.org/10.1371/journal.pone.0304457
[v] Economic Impact of Physiotherapy in Canada Prepared for Canadian Physiotherapy Association.; 2023. https://physiotherapy.ca/app/uploads/2024/04/Deloitte-report_EN.pdf
[vi] Public. Aging and chronic diseases: A profile of Canadian seniors – Canada.ca. Canada.ca. Published 2020. Accessed April 29, 2025. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/aging-chronic-diseases-profile-canadian-seniors-report.html
[vii] Passalent LA, Landry MD, Cott CA. Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada. Physiotherapy Canada. 2009;61(1):5-14. doi:https://doi.org/10.3138/physio.61.1.5
[viii] Public. Aging and chronic diseases: A profile of Canadian seniors – Canada.ca. Canada.ca. Published 2020. Accessed April 29, 2025. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/aging-chronic-diseases-profile-canadian-seniors-report.html
[ix] Singh S, Goodwin S, Zhong S, et al. Inequalities in health-related quality of life and functional health of an aging population: A Canadian community perspective. Samaranayaka A, ed. PLOS ONE. 2024;19(7):e0304457. doi:https://doi.org/10.1371/journal.pone.0304457
[x] Economic Impact of Physiotherapy in Canada Prepared for Canadian Physiotherapy Association.; 2023. https://physiotherapy.ca/app/uploads/2024/04/Deloitte-report_EN.pdf
[xi] Passalent LA, Landry MD, Cott CA. Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada. Physiotherapy Canada. 2009;61(1):5-14. doi:https://doi.org/10.3138/physio.61.1.5
[xii] Canada H. Summary Report of the Health Human Resources Symposium – Canada.ca. Canada.ca. Published 2022. Accessed April 29, 2025. https://www.canada.ca/en/health-canada/services/health-care-system/health-human-resources/summary-report-symposium.html
[xiii] Essential Competency Profile for Physiotherapist Assistants in Canada.; 2012. https://npag.ca/PDFs/Joint%20Initiatives/PTA%20profile%202012%20English.pdf
[xiv] Canada H. Summary Report of the Health Human Resources Symposium – Canada.ca. Canada.ca. Published 2022. Accessed April 29, 2025. https://www.canada.ca/en/health-canada/services/health-care-system/health-human-resources/summary-report-symposium.html
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