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How HEALTH INSURANCE PROVIDERS are limiting how we can support you. Written passionately by Jodie Pulsifer and Adrienne Sim | Reviewed by the Whole FCP Crew This week, for the first time, Pacific Blue Cross has issued an article to educate its policy holders about the physiotherapy coverage you are entitled to and what they are not considering as a part of your health care plan. This was news to all of us and we are saddened by the impact and harms it may cause. In this article, Pacific Blue Cross has been very clear that Physiotherapy coverage is intended for the rehabilitation of an existing medical condition – like an illness or injury. The position that Pacific Blue Cross is taking is that Physiotherapy benefits are not intended to cover preventative, permanent or ongoing treatment. We are incredibly saddened to read this article as FCP providers strongly believe in the ability of all people to seek healthcare that keeps them well and that follows best practice standards in care that foster habit change and economics of healthcare. While we support PBC in their quest to ensure there are no fraudulent insurance claims, we do not believe this position article will do that and instead hinders the essential care that policy holders thought they could receive. FEMALE WORKERS IMPACTED MOST: As Pacific Blue Cross is the single largest insurance provider in BC this impact is going to be significant. This shift will disproportionally impact public health professionals in the education and health sectors who have policies with Pacific Blue Cross and whose demographic is made up in majority by female workers. While Pacific Blue Cross has articles and initiatives clearly stating that 1 in 3 Women are not having their health needs met and have voiced initiatives to help address these needs, we believe this position statement is in strong opposition to what continues to be ongoing emerging evidence to best practice healthcare for women and trans people who are most at risk of gender based health inequities. Women, birthers and people born with uteruses are not the people who are at greatest risk of acute injury and short term rehabilitation needs. They are the people who suffer most from gender based systemic health inequities and struggle most with non-acute, chronic and persistent health conditions and pain. FULL CIRCLE PHYSIOTHERAPY CARE MODEL: With this new information we want to let you know how we will continue to practice and what we will need to shift as we try to advocate for this to change. BIRTHERS: Out of the gates, Pelvic Health Physiotherapy services to support birthers through conception, pregnancy and post partum health challenges will continue to be one of the largest populations we support and will continue to do so. We have strong research for the work we do to help you get and stay active through direct 1:1 assessment and working on management of birth related pelvic health concerns. We will continue to support you with common pregnancy and postpartum related concerns including incontinence, pelvic girdle pain, birth injury and abdominal separation. PEOPLE IN PAIN: We will continue to work from a biopsychosocial and trauma informed lens that takes your whole health into consideration as we support you in learning about your pain, finding supportive strategies you can implement and giving you our 1:1 support as you need it to keep you able to engage in your life. THERAPEUTIC GROUP EXERCISE: We continue to have strong evidence that participating in group based care for pelvic health related concerns including incontinence and genitourinary symptoms of menopause is as effective as 1:1 care after you have had an individual appointment and your care is individualized to you. Not only is therapeutic group exercise as effective but it is MORE FUN and more economical making it a meaningful way to get your rehab built into your life. We have research to show that people in their 30s and 40s struggle most with self-directed exercise programs and may require more accountability to make progress. (To anybody in this stage, this feels like a no-brainer!). With a home exercise program alone, success for cure or significant improvement of urinary incontinence symptoms is 5-15% but in a supported environment success is upwards of 75%! Because of the evidence in for group based care and the way we have always practiced, we will continue to run these programs for those who are working 1:1 with us and as part of your ongoing treatment plan. As always we will remain transparent about our care, we will provide you with individualized assessment and support that fits for you. During group-based session as concerns arise, we will document your individualized modifications and continue to maintain our college standards for this service. Sadly, at this time to ensure no conflict with billings, we WILL NOT DIRECT BILL for these services. We will provide our regular physiotherapy receipts that you can maintain for tax purposes and consider inquiring about coverage directly with your provider. If you have any difficulties accessing the care you need, please speak directly to your physiotherapist so we can best support you and ensure your health needs are not missed and neglected. ADVOCATING FOR CHANGE: Outside of our practices, we are actively working to support you and are engaged in communication with our college, association and members of parliament. Wishing us all calm and steady days as we navigate these turbulent waters together. Yours in health, The Full Circle Physiotherapy Crew Non-linked References: 1. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017 Dec 22;12(12):CD007471. doi: 10.1002/14651858.CD007471.pub3. Update in: Cochrane Database Syst Rev. 2020 May 6;5:CD007471. PMID: 29271473; PMCID: PMC6486304. 2. Motolla. 2019 Canadian guideline for physical activity throughout pregnancy Br J Sports Med 2018;52:1339–1346. 3. SOGC Guideline - No. 129-Exercise in Pregnancy and the Postpartum Period J Obstet Gynaecol Can 2018;40(2):e58–e65 4. NICE Guideline (NG210) Pelvic floor dysfunction: prevention and non-surgical management. Published Dec 2021. https://www.nice.org.uk/guidance/ng210 5. Cardoza, L, Rowner, E, Wagg, A, Wein, A, Abrams P. (Eds) Incontinence 7th Edition (2023). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0-9569607-4-0. 6. Dumoulin, C, Cacciary, LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment or inactive control treatments for urinary incontinence in women. Cochrane Database of Systematic Reviews (2018), Issue 10. Art. No.: CD005654. DOI:10.1002/12651858.CD005654.pub4. 7. Rygh, P, Asklund, I, Samuelsson, E. Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study. BMJ Open. 2021. Jan 4;11(1):e040819. DOI: 10.1136/bmjopen-2020-040819.

When to check in with a physiotherapist and how we can help. Written by Jodie Pulsifer We get this question A LOT! Currently the best answer is, it depends! When it comes to seeking out physiotherapy in pregnancy we have a dream world that takes down the barriers to accessing care and then we have the real world! In our dream world, we are a part of your healthcare team to support your obstetric care from pre-conception to long after delivery helping you to manage your health through lifestyle maintenance, practical adjustments for improving outcomes and preventative care to help reduce the risks associated with your long term health because of pregnancy and delivery injury. We don’t live in that perfect world… but strongly contemplating a PhD adventure to hope that someday we could live there. In the meantime, in this current world our recommendations for care can include reaching out for support early and helping you make a plan for moving through your pregnancy. We help to troubleshoot a number of lifestyle things: Pre-Conception: What is up with your period and what is this health optimization for conception all about?! We can support you in this phase to get a baseline understanding of your health by taking a look at sleep, nourishment, activity and lifestyle contributors to your entire neuroendocrine system. We can help consider habits and assess pelvic floor function and core function and strategies to help you feel strong, stable and resilient for conception that can carry you through pregnancy and beyond. First Trimester: This is a time where you are fully pregnant, even if you are not yet appearing it. Body changes begin immediately, including bowel changes, increased urinary frequency, fatigue +++ and insomnia, uncertainty about physical activity and possibly discovering you have loss of urine control with a sneeze or vomiting! We are here to help you make sense and manage any of these changes, get and stay physically active and think about strategies for support for the pregnancy ahead. Second Trimester: Often things smooth out here, you might have more energy to start getting back into your regular flow of life. We continue to support your activity strategies for the prevention of low back and pelvic girdle pain, gestational diabetes, preeclampsia. We can assess the pelvic floor internally to help you understand your anatomy, engagement patterns and support your body learning for prevention of stress incontinence. This is a great window of time to help you build stamina and strength for delivery. Third Trimester Early third trimester, we love to connect with you about your upcoming birth and birth choices. We can begin to discuss perineum protection strategies, including the role of perineum massage and stretching. We can discuss options and strategies for vaginal delivery, including birthing positions, pain management and things to discuss with your birth providers regarding strategies for reducing risk of severe tears. We also support questions around cesarian section delivery and recovery strategies following all forms of birth. We continue to help you stay active and comfortable right to the end of your pregnancy, including supports to manage low back and pelvic girdle pain if it arises. Other healthcare supports start to ramp up at the end of third trimester and a lot our work with you can begin to wind down. We are always happy to continue to support you right to the end if that feels right for you. Post Birth Virtual support is a great strategy to debrief birth and make a plan forwards that makes sense. If you sustain a severe tear, checking in at 2 weeks is recommended. Six weeks is not a magic window of time for recovery, you can reach us anytime you have questions or feel ready to connect and make a plan for you. We can help tailor your recovery to the experience of birth that you had and from there, decided together when seeing us in person might make sense, if a pelvic exam is beneficial for you, and support you with strategies for pain management and how to get moving again. We do this with you in a timeline and way that fits for your life and the things you are juggling. Anytime, our role is to help you look at bowel, bladder, sexual health, sleep hygiene, basic nourishment, activity demands, emotional wellbeing, life stressors and your life responsibilities. We help build strategies that make sense to you to help you feel well for where you are and as life shifts. Finally, since this isn't our dream world, we also want to note that we are always trying to consider how to give you the best support within the resources you have. We understand that jobs that allow you resources to access our services and extended health benefits are not something we can all are able to have. We try to work with you and the means you have (eg. geographical location, time, finances, life capacity) to make sure you can still get as much benefit as you can!

Jodie's Story of How We Came to Be HERE Written by Jodie Pulsifer Full Circle Physiotherapy has become much more than just a clinical practice. It has been an evolution of all of the people who have crossed paths with it, have asked what could it be and let it continue to adapt to what might be possible. One of the things I am most proud about in my own life is the self identity I have been forging, sometimes with great difficulty, is that I am allowed to grow and change and that I can give that same grace and permission to those around me. As I give myself permission to change, I have tried to build relationships and frameworks around myself that embody and support that ever evolving process. This is the story of Full Circle Physiotherapy from how my memories have been shaped and evolved over time and from own vantage point today: Full Circle Physiotherapy was the name given to my own sole proprietorship when I started out in pelvic health at Pomegranate Community Midwives in 2016. I was young, a new mom, new in my pelvic health career and excited and simultaneously entirely unsure about what life in solo private practice could be. The one thing I knew was that I wanted to be identified not by my own name but by something that could be more expansive. I wanted something that could shift with me if I took another maternity leave and to have the space for others within. I had no idea what it would become but I knew that I thrive in community and needed something that might leave room for the expansiveness of my own curiosities. MEETING MY COMMUNITY As I set down my roots in my solo pelvic health practice, I also took a job at Treloar Physiotherapy where I had the opportunity to work with other pelvic health providers. That’s where I met Jen LaRoy and learned about her work in pelvic health and the way she pushed for acceptance of pelvic health as an area and expertise in practice that was paralleled to our orthopedic colleagues in training and compensation. Treloar accepted and encouraged her to build the program there and it has expanded and had so many of us walk through and work in their space. I am eternally grateful for the connections that space allowed me to make. When I took a second surprisingly early mat leave in 2017, Jen covered part of it at Pomegranate and the expansiveness of Full Circle Physiotherapy began! As I eased back into daytime work in 2018, Jen stayed on to work a few hours in the evenings to give more options for appointments for clients. When Jen made the move back to her hometown of Chilliwack in 2019, Full Circle was able to have the framework for her to provide home visits and still care for some of her Vancouver based clients when she was in town or virtually. SHARED VISIONS COLLIDING AND EXPANDING At some point in this adventure I met Adrienne Sim and my own life and professional development expanded exponentially. Adrienne, having trained at Curtin University with a Certificate in Women’s Health, could quote research in ways I am still trying to catch up to and she inspired me to dive deeper and get smarter! In 2019, when Adrienne started thinking about working in her home community of Langley, she asked me what solo practice was like. I told her about how much I loved my own agency for my schedule, my time and for feeling like I knew where the resources were being spent and distributed. I suggested to her that I had the digital infrastructure already in place and would be more than happy to share and rebrand. Adrienne was planning on returning from her own maternity leave in 2020 to her position at Fortius where she had found her dream connection of bringing pelvic health to the sports world and then run a small solo practice from her home office in Langley. Unfortunately, Fortius was put in a really challenging position during the Covid-19 pandemic and was forced to permanently close. Adrienne found herself having to pivot what was going to be just a side hustle solo practice into her full time job and that was when Full Circle Physiotherapy needed to grow some wings. It was from there that we truly became a framework for us, as independent providers, to be networked together as a community of providers with shared vision and shared resources. LEARNING OUR OWN RESILIENCY AND ADAPTABILITY What we learned in the pandemic was that we had resiliency. We pivoted immediately as we weren’t tied to large overheads in real estate and the digital infrastructure allowed us to continue to reach our clients virtually and we could stay connected as a community over larger geographical landscapes. We’ve learned that we could support each other in our personal and professional growth and have room for others too. We’ve sat together and had hard conversations around legal contracts to keep each other safe in business and give value to each others’ time. We’ve committed to sharing in tasks and projects, to sharing costs transparently, to being open and honest with each other, to work together and to have boundaries to turn off too! We’ve provided mentorship to newer physiotherapists which turned into a model shift for our own self development. We’ve rumbled with how to add more members to our group and deepened our own understanding of who we are and the commitments we make to each other. We strive to say yes to each other’s changing lives as much as we can and we shift our framework to adapt and meet those needs but also allow for those needs to be met beyond what we can support. WHAT WE HAVE BECOME As I write this, I reflect back to my own opening paragraph about what change can be possible. Full Circle Physiotherapy has become a framework around all of us that embodies and supports us in our ever evolving lives. We have permission to stay, we have permission to grow, we have permission pause, we have permission to go. Full Circle Physiotherapy has become more than just a clinical practice. We are an evolving group of humans that try to welcome the possibility of our own growth and adaptation as healthcare changes, as new knowledge arises and as culture and society shift in our changing world. As frightening as it can be to look ahead to the unknown, I’m so honoured to have this community along for this part of the ride!

The Path To Care Is Winding Written by Jodie Pulsifer | Reviewed by Adrienne Sim The therapeutic relationship is a very important part of successful treatment. You need to feel safe in care and trust in your provider to help you in your health journey. We know that your physiotherapy care starts long before your appointment starts. It may begin when your healthcare provider recommending getting care or a friend tells you they have an awesome provider they trust. You might read our bios that we’ve made to try and reflect our personalities and style of practice so that you can get a sense of who we are and if we might be the right fit for you. You might think about care but decide it’s not the right time. You might look at our schedules and locations and it’s not the right fit. There might be finances or childcare logistics that feel challenging to overcome. We know this all too well because we experience this too. As healthcare professionals, we know all too well how difficult it is to try and reach out to get help for our own health! “BOOK” If you make it through all of those navigations and click to book an appointment with one of us. You can book a virtual or in person initial assessment depending on your location and preference. People often assume that physiotherapists have to see you and put our hands on you to understand what is happening in your body. The reality is, we are the most effective with understanding your body when we take the time to throw the net wide and capture the fuller story of your health. “INTAKE FORM” When you book an appointment, our booking system will send you an intake form to fill out. This will include detailed questions about your health history, including your social connections, life obligations, relationships, habits and patterns can help us put a number of puzzle pieces together with more clarity. It will also include an opportunity to add your insurance information if you want us to direct bill for your physiotherapy services. are. As you answer this form, we know it is long and we truly value the time you take to complete it. We have carefully put those questions together with the diversity of training that we have because it helps us get a fuller picture of your health. We also know that sometimes it feels impossible to answer more questions about your health and we can work with you wherever you are and with whatever you feel you can fill out. “APPOINTMENT” When we arrive together to your appointment, virtually or in person, we will take the time to ask you what you hope to get from your visit with us. We can briefly review your intake form and then take time to ask more probing questions and begin to dialogue about your health. We will give you space to ask questions, we can provide education and strategies for your health and discuss what options we might be able to provide to support you, including a physical assessment and treatment strategies. Together we can decide what might be the most meaningful next step in your care. If we have more time in an appointment, virtually we could watch your movement patterns and provide you movement support. In person we can put our hands on externally to assess patterns of movement and provide input to your body. If you have pelvic health concerns, we could perform a pelvic floor exam to provide feedback to your movement patterns and education about your body. “TREATMENT PLAN” As the appointment unfolds, we will check back in to make sure we are working to meet the needs and expectations that you had when you came into care. We can adjust the appointment to make sure it continues to support your needs while working with the skills of each provider. The best plan forward is one that is adaptable, where you feel safe to ask questions, where you feel you can return to care in a timeline that is appropriate for you and that your provider is adaptable to your needs.