Consent, delegation and scope of practice: worked physiotherapy scenarios

Work through three original physiotherapy scenarios about consent, delegation and competence, with reasoning grounded in Australian professional guidance.

Published 2026-10-10.

A clinically reasonable treatment can still be the wrong action if the patient has not agreed, the task has been delegated poorly or the practitioner cannot perform it safely. Professional reasoning starts by noticing those conditions before concentrating on the technique.

The three examples below are original educational scenarios, not official APC questions. They use Australian professional guidance to illustrate decisions. The Queensland assistant example is explicitly tied to its service setting; local procedures and applicable law still matter.

Scenario 1: the patient changes their mind

Maya, an adult who can make this decision, agreed to a shoulder assessment. When you explain a proposed hands-on component, she says she is uncomfortable and asks you not to continue. There is no emergency. Her partner says, “She signed the form already; just finish it.”

Pause before reading on. Would you continue briefly, ask the partner to approve it or stop the proposed component and discuss Maya’s concerns?

Stop that component and speak with Maya. Clarify what she does and does not want, explain any relevant alternatives and ask whether she wishes to continue with an acceptable part of the assessment. Keep the discussion free of pressure.

Consent is an ongoing decision, not permission that a signature makes permanent. A partner’s preference does not replace this adult patient’s decision. Record the discussion and what was agreed; do not describe declining one component as refusing all care.

If the facts changed—for example, uncertainty about decision-making capacity—the task would include appropriate support and assessment of that specific decision. Do not infer incapacity from disagreement, a diagnosis or the presence of a family member.

Scenario 2: the delegated session no longer matches the plan

In a Queensland Health rehabilitation service, an allied health assistant has demonstrated competence in supervising a prescribed walking programme. The written delegation gives assistance limits and says to stop and contact the physiotherapist if the patient develops new dizziness. Before today’s walk, the patient reports feeling dizzy on standing. The assistant asks whether to shorten the walk and continue.

The appropriate response is to stop the planned walk, help the patient remain safe and follow the escalation instructions. The physiotherapist should arrange assessment of the change and decide whether the programme needs revision. Further escalation depends on the findings and the service’s procedures.

Shortening the distance changes the dose but does not resolve the new safety concern. A completed session is not the goal if the conditions supporting the original delegation have changed.

A useful delegation specifies the task, limits, supervision, stop criteria and reporting arrangements. It does not ask the assistant to make an independent clinical decision beyond their competence. Qualifications alone do not establish competence for every task.

The physiotherapist retains responsibility for the delegation decision and overall patient management. The assistant remains accountable for their own actions. Avoid turning this into a blanket claim that one person is automatically legally responsible for everything another person does.

Scenario 3: the requested technique is beyond your competence

A physiotherapist covering a ward is asked to perform an unfamiliar specialised technique. The patient is stable, the task is not urgent and an appropriately skilled colleague can attend. The physiotherapist has watched the technique once but has not been trained or assessed as competent. A staff member says, “You are registered, so you can do it.”

Explain the limit, arrange the competent colleague and maintain appropriate care in the meantime. If future training is suitable, organise it through the service’s supervision and competency processes. Watching a demonstration does not establish readiness to perform the procedure independently.

The decisive fact is the mismatch between the requested task and this practitioner’s capability. It is not proof that the technique is permanently outside the whole profession’s scope. Additional training, supervision and any required authorisation must be considered in the relevant setting.

Nor should the response be to abandon the patient. A good answer includes a workable next step: who will help, what can safely continue and what information needs handing over. Patient agreement cannot, by itself, supply missing competence.

Compare the conditions that change the answer

These are conditional decisions. Remove or change a decisive detail and you must reconsider the options. That is why memorising “always refer” or “always proceed with consent” is less useful than explaining what the particular situation requires.

Use the examples for your next practice session

Try changing one feature of each example: the patient requests a different component, the assistant’s instructions are incomplete, or the qualified colleague is unavailable. Work out what additional information you would need rather than importing an automatic answer from the original scenario.

• State what the person is asking you to do and whether the patient has agreed.
• Identify the task, the practitioner or assistant’s capability, and the setting’s limits.
• Choose an action that addresses the immediate problem and provides a clear next step.
• Explain why the nearest alternative fails on the facts given.
• Say what new information would make you reconsider the plan.

Questions people ask

Does a signed consent form mean treatment must continue?

No. In this non-emergency example, the adult patient can decide and declines the proposed component. Stop that component, clarify their wishes and discuss acceptable alternatives. A signature does not override that decision.

Does delegation transfer all responsibility to the assistant?

No. The physiotherapist retains responsibility for the delegation decision and overall patient management; the assistant is accountable for their own actions. The task, competence, instructions, supervision and local framework all matter.

Is a task beyond my current competence automatically outside physiotherapy forever?

No. Personal competence and a profession’s scope are different questions. Do not perform an unfamiliar task independently merely because it is requested. Arrange appropriate care and consider training, supervision and any authorisation required in that setting.

Sources

• Ahpra — Shared Code of conduct (consent, competence and delegation)
• Australian Commission on Safety and Quality in Health Care — Informed consent
• Queensland Health — Allied Health Assistant Framework (Queensland service guidance)

Sources checked on 10 October 2026. These original examples have had an AI-assisted editorial source check; independent clinician review has not yet been recorded.