NZ Physio Registration cheat sheet

HPCA Act 2003: registration is via the Physiotherapy Board of New Zealand; practising certificates are annual and require a current APC before practising, with competence, conduct and health as the three notification pathways.

Health and Disability Commissioner Code of Rights (1996): Right 4 (services of an appropriate standard), Right 6 (full information), Right 7 (informed choice and consent), Right 10 (complaints) are the most frequently tested rights.

Privacy Act 2020: 13 information privacy principles; health information is 'sensitive', so disclosure requires the individual's authorisation or a permitted exception (serious threat, court order, statutory duty).

ACC accident vs treatment injury: a treatment injury claim requires the injury be caused by treatment, not an ordinary consequence of the underlying health condition, and not solely a failure to obtain consent.

Informed consent requires capacity, adequate information (nature, risks, benefits, alternatives), and freedom from coercion; written consent is evidence, not a legal substitute for the process.

Mandatory reporting under the Children's Act 2014 (Oranga Tamariki Act) applies to any person who believes a child or young person is being harmed; professionals are protected from civil liability for good-faith reports.

Fitness to practise: the Board may impose conditions, suspend, or cancel registration; interim suspension can occur pending a hearing where risk to the public exists.

Documentation standard: contemporaneous, dated, signed, legible, and factual; corrections are made by strikethrough with initials and date, never by erasure or overwriting.

Te Tiriti o Waitangi articles: kāwanatanga (governance), tino rangatiratanga (Māori self-determination over taonga including health), ōritetanga (equity), and wairuatanga/ritenga (spiritual and customary practices) under the fourth article tradition.

Cultural safety (Nursing Council / Ramsden framework): the practitioner examines their own culture, power and biases, and the recipient of care determines whether care is culturally safe.

Te Whare Tapa Whā (Durie): four walls - taha tinana (physical), taha hinengaro (mental/emotional), taha whānau (family/social), taha wairua (spiritual) - plus whenua as the foundation.

Te Pae Mahutonga (Durie): Southern Cross model with six stars - Mauriora, Waiora, Toiora, Te Oranga, Ngā Manukura, Te Mana Whakahaere - used for health promotion planning.

Hui process: mihimihi/whakawhanaungatanga before business, karakia may open and close, and kanohi ki te kanohi (face-to-face) is preferred for significant discussions.

Equity vs equality: equity allocates resources according to need; Māori and Pacific peoples experience higher burden of musculoskeletal and respiratory disease and later access to rehabilitation.

Interpreter use: professional interpreters are required for informed consent; family members, especially children, should not be used as interpreters except in emergencies.

Health literacy: teach-back technique confirms understanding; plain-language written materials should be pitched at approximately a primary-school reading level and offered in te reo Māori or Pacific languages where available.

Subjective: OPQRST (onset, provocation/palliation, quality, region/radiation, severity, timing) plus red-flag screen and 24-hour behaviour pattern (morning stiffness, night pain, easing with activity).

Red flags: age <20 or >50 with new onset, unexplained weight loss, night pain unrelieved by rest, fever, history of cancer, bowel/bladder dysfunction, saddle anaesthesia, bilateral leg symptoms, progressive neurological deficit.

Yellow flags: catastrophising, fear-avoidance, low mood, work dissatisfaction, passive coping - assessed with tools such as the Orebro Musculoskeletal Pain Questionnaire.

Hypothesis-oriented assessment: generate 2–3 competing hypotheses before examination, then choose tests that discriminate between them rather than a fixed routine sequence.

Validity: sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); likelihood ratio positive = sensitivity / (1 − specificity).

Inter-rater reliability statistics: Cohen's kappa for two raters, weighted kappa for ordinal data; kappa <0.20 slight, 0.41–0.60 moderate, >0.80 almost perfect.

Baseline outcome measures: NPRS 0–10 for pain, PSFS for function, DASH/QuickDASH for upper limb, KOOS for knee, ODI for low back, 6MWT for endurance.

Clinical reasoning errors: anchoring, confirmation bias, premature closure, and availability bias; mitigation is deliberate re-evaluation against the initial hypothesis.

Ottawa Ankle Rules: X-ray indicated if pain in malleolar zone plus bone tenderness at posterior edge/tip of either malleolus or inability to bear weight four steps immediately and in clinic.

Ottawa Knee Rules: X-ray if age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex to 90°, or inability to bear weight four steps.

Canadian C-Spine Rule: imaging if age ≥65, dangerous mechanism, or paraesthesia; if none, assess low-risk factor allowing range of motion, otherwise image.

Rotator cuff: Hawkins–Kennedy and Neer for subacromial impingement, Jobe (empty can) for supraspinatus, external rotation lag sign for infraspinatus, lift-off for subscapularis.

ACL: Lachman is most sensitive acutely (higher than anterior drawer); pivot shift is most specific; KT-1000 quantifies side-to-side difference >3 mm as abnormal.

Meniscal: McMurray has high specificity but low sensitivity; joint line tenderness is more sensitive; Thessaly test at 20° weight-bearing is a useful adjunct.

Lateral epicalgia (tennis elbow): Cozen's and Mill's tests; managed with progressive eccentric/isotonic loading, load management, and education; corticosteroid gives short-term relief but worse long-term outcomes.

Tendinopathy loading principles: high-load progressive resistance 3–4×/week, 6–12+ weeks, pain ≤3/10 during and settling within 24 hours is acceptable.

Stroke: NIHSS quantifies deficit; thrombolysis window typically 4.5 hours and thrombectomy up to 24 hours in selected large-vessel occlusion; time is brain.

Upper motor neuron signs: hyperreflexia, spasticity, Babinski sign, clonus, loss of dexterity; lower motor neuron signs: fasciculation, atrophy, hypotonia, areflexia.

ASIA impairment scale: A complete, B sensory incomplete, C motor incomplete with >half muscles below level <3/5, D motor incomplete with ≥half ≥3/5, E normal.

Modified Ashworth Scale 0–4 grades resistance to passive movement; Tardieu scale distinguishes neural from soft-tissue resistance by testing at slow and fast velocities.

Parkinson's disease: levodopa-induced dyskinesia, freezing of gait, cueing (auditory, visual, attentional) and dual-task training are core physiotherapy strategies.

Multiple sclerosis: Uhthoff phenomenon is heat-related transient worsening; fatigue management uses energy conservation and aerobic exercise at moderate intensity.

Guillain–Barré syndrome: ascending symmetrical weakness, areflexia, albuminocytological dissociation in CSF; monitor vital capacity - intubation considered when VC falls below 15–20 mL/kg.

Vestibular rehabilitation: BPPV treated with Epley (posterior canal) or Semont manoeuvre; vestibular hypofunction uses gaze stabilisation and habituation exercises.

Normal arterial blood gases: pH 7.35–7.45, PaO2 80–100 mmHg, PaCO2 35–45 mmHg, HCO3− 22–26 mmol/L, base excess ±2.

Respiratory acidosis: low pH with raised PaCO2; if HCO3− is raised it is compensated/chronic; metabolic acidosis shows low pH with low HCO3− and compensatory hyperventilation.

Airway clearance techniques: ACBT (breathing control, thoracic expansion, huff), PEP, oscillating PEP, autogenic drainage, and high-frequency chest wall oscillation; choice depends on secretion load and patient tolerance.

Huff: forced expiration with an open glottis; a medium-volume huff mobilises peripheral secretions, a high-volume huff clears central airways; avoid in bronchospasm or unstable airways.

6-minute walk test: minimal clinically important difference approximately 30 m in chronic lung disease; contraindications include unstable angina and resting SpO2 <85%.

SpO2 monitoring: target 94–98% for most adults, 88–92% for those at risk of hypercapnic respiratory failure (COPD); supplemental oxygen is titrated to target range.

Postoperative respiratory care: incentive spirometry, early mobilisation, supported cough with wound splinting, and positioning (upright or side-lying with affected lung up) to improve ventilation-perfusion matching.

Breathing exercises: pursed-lip breathing prolongs expiration and reduces dynamic hyperinflation; diaphragmatic breathing is used cautiously as it can increase work of breathing in severe COPD.

International Classification of Functioning, Disability and Health (ICF): impairment (body function/structure), activity limitation, participation restriction, plus environmental and personal factors.

Falls risk: STEADI and Hendrich II tools; key modifiable factors are strength, balance, vision, polypharmacy (≥4 medications), postural hypotension, and home hazards.

Frail older adult: Fried phenotype uses unintentional weight loss, exhaustion, low activity, slow gait, and weakness; ≥3 criteria = frail, 1–2 = pre-frail.

Sarcopenia: low muscle mass plus low strength or performance; resistance training 2–3×/week with adequate protein (approximately 1.0–1.2 g/kg/day) is the main intervention.

Goal setting: SMART goals co-constructed with the patient and whānau; the Canadian Occupational Performance Measure (COPM) captures self-perceived performance and satisfaction.

Community rehabilitation models: Early Supported Discharge for stroke reduces length of stay with equivalent or better outcomes when a coordinated multidisciplinary team is available.

Pressure injury prevention: Braden Scale, repositioning, pressure-redistributing surfaces, moisture management, and nutrition; staging I–IV plus unstageable and deep tissue injury.

Driving after stroke or injury: assessment considers cognition, vision, and reaction time; clinicians must advise the patient of their obligation to notify Waka Kotahi NZ Transport Agency when a medical condition affects safe driving.

Evidence hierarchy (study design): systematic reviews/meta-analyses of RCTs > RCTs > cohort > case-control > cross-sectional > case series > expert opinion.

PICO framework: Population, Intervention, Comparator, Outcome - converts a clinical uncertainty into a searchable question.

Critical appraisal: check randomisation and allocation concealment, blinding, intention-to-treat analysis, completeness of follow-up, and precision of effect estimates.

Effect sizes: mean difference in original units, standardised mean difference for pooling different scales, number needed to treat = 1 / absolute risk reduction.

Confidence intervals: a 95% CI excluding the null value corresponds to p <0.05; wide CIs indicate imprecision even when statistically significant.

Quality improvement: PDSA (Plan-Do-Study-Act) cycles, run charts and statistical process control; measure structure, process, and outcome (Donabedian).

Clinical practice guidelines: AGREE II assesses rigour; GRADE rates certainty of evidence as high, moderate, low, or very low and separates strength of recommendation.

Audit vs research: audit measures practice against an existing standard and does not require ethics committee review in most cases; research generates new generalisable knowledge and does.

Te Whatu Ora (Health New Zealand) and Te Aka Whai Ora (Māori Health Authority) were established by the Pae Ora (Healthy Futures) Act 2022, alongside the Public Health Agency and Health Quality & Safety Commission.

ACC covers injury-related treatment and rehabilitation under the Accident Compensation Act 2001; physiotherapists must hold a provider contract and use ACC45/ACC18 documentation and the appropriate claim number.

Primary care pathways: Health Care Home model, kaupapa Māori providers, Pacific health providers, and Whānau Ora collectives deliver community-based services.

Referral and scope: physiotherapists can order some imaging and prescribe within approved competencies; prescribing requires an additional endorsed scope from the Physiotherapy Board.

Interprofessional collaboration: ISBAR (Identify, Situation, Background, Assessment, Recommendation) for handover; closed-loop communication for critical information transfer.

Health equity frameworks: Te Pae Tata (Interim New Zealand Health Plan) priorities include access, workforce, and kaupapa Māori and Pacific models of care.

Medico-legal communication: discharge summaries, referral letters, and ACC reports are legal health records and are subject to Privacy Act 2020 and Health Information Privacy Code 2020.

Scope of practice: working outside one's competence requires supervision and training; the Board's competence standards apply regardless of employment setting.

Standard precautions apply to all patients: hand hygiene, gloves, gowns, masks/eye protection based on anticipated exposure, safe sharps handling, and respiratory hygiene.

WHO 5 Moments for Hand Hygiene: before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, after touching patient surroundings.

Transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcal), airborne (TB, measles, varicella) with N95/P2 and negative-pressure room.

Needlestick or splash injury: wash the area, do not scrub, report immediately, and follow local post-exposure prophylaxis pathway (HIV PEP ideally within 1–2 hours).

Manual handling: use hoists and slide sheets, keep the load close, avoid twisting, and follow the facility's moving-and-handling policy; NZ Health and Safety at Work Act 2015 places duties on both employer and worker.

Emergency preparedness: anaphylaxis management with adrenaline 0.5 mg IM (1:1000) in the anterolateral thigh for adults; know the location of the emergency call system and AED.

Clinical risk: incident reporting is non-punitive and should occur for near misses as well as adverse events; open disclosure to the patient and whānau follows the Code of Rights Right 10.

Infection control in rehabilitation: clean equipment between patients, dedicated equipment for known multi-drug-resistant organism cases, and appropriate waste segregation.