T.Rex’s ‘children of the revolution’ blasted out through the speakers in the pub where a small group of physiotherapists came together to discuss the future of the profession in New Zealand. It seems New Zealand is not the only country where a profession is grappling with its identity and how it needs to evolve for the sake of its sustainability. In the UK Jack Chew, the physio matters podcast team and connect health recently held #theBigRs event. Check out the hashtag link if you want to find out more.
I think it is reasonable to say that the issues MSK physiotherapy faces are significant and whilst I do not want to sound like I am plagiarizing what was the content of theBigRs I suspect there may be some paraphrasing.
I guess I should start by introducing the premise behind the Physio CPD Revolution. I have been in New Zealand for 5 years now. Since my arrival, I have engaged in conversation with physiotherapists about a variety of issues faced by the profession in New Zealand. The issues are many, to name a few would include: identity, recognition and direction. Personally, I think one that stands out for me is physiotherapy’s affinity with medicine. Physiotherapy has always been subservient to medicine. The profession claims to be autonomous and to possess clinical decision-making skills. Yet physiotherapy is so closely tied to medicine it often relies on medicine to decide. I am not suggesting we break our relationship with medicine I believe that we have enough evidence to be more independent and practice autonomously without feeling subjected to hierarchy.
Take medical imaging for example. There has bound to be an instance(s) in any physiotherapists career (myself included) where they have referred a patient for medical imaging because they are not getting better and to attempt to identify the source of the person’s pain. Yet medical imaging doesn’t tell us the origin of someone’s pain. It may identify a structural change yet it is now known that many members of the population present with the same image findings and report no pain (Brinjikji et al., 2015; Eriksen, Kerry, Mumford, Lie, & Anjum, 2013).
The End of Physiotherapy
If any physiotherapist cares about the future of their profession then I highly recommend you read David Nicholls book ‘The End of Physiotherapy’. I want to highlight a number of quotes from David’s book to emphasize the need for independence.
‘Physiotherapy is one of the most successful professions allied to medicine’
‘Physiotherapists have partnered with doctors and nurses during some of the most significant human events of the 20th century’
‘Alongside medicine and nursing, physiotherapy has provided one of the principal mechanisms for people to restore movement and function, reduce pain and stiffness, return to fitness and regain health’
So, where physiotherapy has had a successful and close relationship with medicine and nursing it is the weakest chick in the nest. The one that will get pushed out by its siblings.
‘Physiotherapy’s longstanding approach towards the body underpins its relative ignorance of itself. Physiotherapists are trained to think of the body in terms of its physical form and function at the exclusion of other ways of thinking’
‘Physiotherapy thinking is and has always been focused on the physical functioning of the biomechanical body’
This is not to say biomechanics does not have its place. It’s just that it’s likely more important in certain circumstances and less as important that was once thought (Lederman, 2010).
So, from a muscloskeletal perspective we can’t continue to peddle a model that has significant limitations and is highly contradictory of its historical understanding.
‘There is a concern that the rapidly changing market in healthcare is escaping the profession’s grasp and that physiotherapists are literally and metaphorically ‘losing touch’
David highlights significantly more challenges that the profession faces and whilst these areas are important it is not for this blog post to continue to share. Instead, I urge you to read his book.
The Physio CPD Revolution is an attempt to address some of the quotes I have highlighted, and to do that means to bring like-minded clinicians together to explore and evolve several aspects:
- To appraise and critique the evidence, to collaborate and identify new ways of delivering care to the masses
- To identify the changing needs of society and adapt accordingly
- To bring clinicians together on a regular basis that share similar opinions about the direction of their profession/development.
- To provide an opportunity to come together to share, and exchange knowledge and experiences and collaboratively learn from each other.
- To not feel exposed to dogma or to be chastised by a higher authority, to speak freely.
- To instil confidence in our ability to be autonomous and that our clinical decision-making is reasoned appropriately at a level that is conducive to the individual needs of every patient.
- To critically appraise our current professional development is it meeting the professions needs, the evidence base and the changing needs of society.
- Come up with a way of physiotherapy that accounts for researched methods and the bureaucratic/financial realities of a work place.
- To integrate client specific needs, via a physiotherapy framework while considering other health provisions, providers, and frameworks.
- In relation to point 4, thus to broaden and develop our knowledge and competence based on a broader framework consolidating with point 8 & point 9.
- To have fun doing it!
The first physio CPD revolution round table talks exchanged several interesting and distressing topics including: new ways of working, broader thinking and evidence based reasoning, lack of autonomy due to bureaucracy, lack of career progression, new graduates leaving the profession, professional identity, feeling undervalued, physio stuck and scared – not wanting to move beyond its boundaries, transformative care rather than “fixing” and many more. All nicely summed up by one member who explained they regularly go through a cyclical existential crisis with physio.
I want to highlight that the physio CPD revolution has been created because physiotherapy is looking wilted and apathetic and has done for a long time. I feel strongly about my professions future and I know many others do to. If physiotherapy wants to be viewed as a key provider at the forefront of providing evidence based care then it must evolve.
I will leave you with a final quote from The End of Physiotherapy
‘The future of the profession is in its own hands. Given its skills in assessment and diagnosis and experience of treatment and rehabilitation it can make the changes necessary for a healthy future. Physiotherapy is like the patient who comes into the clinic with a longstanding problem that is now causing them problems. They have lived with the problem for so long they do not realise that they are perpetuating is by the way they think and move. What feels natural to them is, in fact, making the matter worse.’
Thanks for having a read, as always your opinions are welcome.
The next Physio CPD Revolution #physioCPDrevo in New Zealand is in February 2018. Click the meet up link for more details
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American Journal Of Neuroradiology, 36(4). https://doi.org/10.3174/ajnr.A4173
Eriksen, T. E., Kerry, R., Mumford, S., Lie, S. A. N., & Anjum, R. L. (2013). At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms. Philosophy, Ethics, and Humanities in Medicine : PEHM, 8(1), 11. https://doi.org/10.1186/1747-5341-8-11
Esculier, J.-F., Bouyer, L. J., Dubois, B., Frémont, P., Moore, L., & Roy, J.-S. (2016). Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms. BMC Musculoskeletal Disorders, 17(5). https://doi.org/10.1186/s12891-015-0859-9
Kingma, I., Faber, G. S., & van Dieën, J. H. (2010). How to lift a box that is too large to fit between the knees. Ergonomics, 53(10), 1228–1238. https://doi.org/10.1080/00140139.2010.512983
Lederman, E. (2010). The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain. CPDO Online Journal, 1–14.
Nicholls, D. A. (2018). The End of Physiotherapy. Routledge Advances in Health and Social Policy. Abingdon, Oxon. ISBN 9781138673557