Eleanor Main UCL’s first ever professor of physiotherapy

Ironically for someone who is now shaping physiotherapy practice, the profession was never one that Eleanor Main had a burning ambition to pursue. 

‘You know how some people from a young age say, “I want to do this by the time I’m 20” and seem to have some sort of career pathway that’s absolutely clear, early on in life? Well I’m not one of those people,’ she says.

Her career path has been shaped by instinct and boldness, with Main taking opportunities as they have presented themselves to her. The first of such opportunities, taken ‘literally days’ after graduating with a physiotherapy degree, was starting work at the Red Cross Children’s Hospital in Cape Town, not because she desperately wanted to work in paediatric physiotherapy but ‘because Red Cross Children’s Hospital was just where I wanted to work.’

Three years and several rotations later, she was ready to see the world and went with her husband – a paediatrician – first to Newfoundland in Canada and then to London ‘for a gap year’ where she started work at Great Ormond Street Hospital (GOSH).

‘We came for a gap year and we’re still on the gap year,’ Main says, and she has now spent more of her life in London than South Africa: ‘It feels very much like home.’

While working as a paediatric physiotherapist at GOSH, Main completed a MSc in research methods, which ignited the interest in evidence-based research she had had during her undergraduate studies. Research, it seems, may have been her burning ambition all along, albeit a subconscious one. 

‘If you look back, there were some very clear patterns,’ she explains. ‘In my undergraduate degree, the bit that I truly focused on was the

research project and it’s the one which I was passionate about.’

And there were other patterns, too: her insatiable curiosity and determination to keep uncovering further evidence.

‘I’ve never finished a piece of research and thought “well that’s the answer”. I’ve always thought “that’s just opened a whole bunch of other questions that need answering” and so you put down one piece of the thousand-piece puzzle and then you go “well now I need the next piece”.’

Fitting together those pieces has built a body of physiotherapy research that has been influencing practice, particularly in the treatment of children with cystic fibrosis, for several years. Most recently, Main and her team have been winning accolades for Project Fizzyo, an innovation that not only makes physiotherapy breathing exercises fun for young people but also gathers detailed raw data. 

Making life easier

Fizzyo is a small sensor that is inserted into the mouthpiece of the child’s usual airway clearance device. As they exhale, the sensor sends electronic signals that control computer games. It started life as a project on a BBC programme, the Big Life Fix, which challenged inventors to create solutions that could make life easier for people with specific needs. Haiyan Zhang, a designer and technologist and innovation director for Microsoft Research took on the challenge of creating something to make physiotherapy less onerous for children with cystic fibrosis. (Daily physiotherapy is vital for people with cystic fibrosis, and the Cystic Fibrosis Trust acknowledges that it ‘is a crucial part of the daily treatment regime required to keep people with cystic fibrosis as healthy as possible.’)

Main explains: ‘While she was doing work for the programme Haiyan approached our team to find out more about airway clearance techniques, and talk about her plans for making a gadget that could be used to play games while doing boring physio treatments. We hoped this would help children adhere to their treatments more. 

‘And I said, “I love gaming, but gaming in itself it is not enough because you can game as much as you like, but if it doesn’t improve the treatment technique and improve clinical outcomes, it’s just gaming.” So I suggested if every breath was being captured to use as a joystick, then we capture it as data. And it was after that we started working together to make a new version, which we could clean and use with patients.’

There are 145 children (aged six and over) from three London hospitals taking part in the Fizzyo project, providing raw data for Main and her team that is giving them, for the first time, ‘this extraordinary window into how people actually do their physio at home’: an insight into the impact and burden of physiotherapy on the children’s lives and overall experience.  

‘This is incredibly unique,’ Main says, ‘the massive variation in the way people undertake their treatments is likely to influence how effective they are.’ And the intelligence is helping to inform treatments and interventions on an individual patient basis.

Main has a strong belief in the value of physiotherapy, and much of her research sets out to identify evidence to support this belief. Her PhD, which marked her full transition from clinical work into research, was aimed at answering some of the questions that occurred to her when she was working in paediatric intensive care. 

‘What I wanted to know was whether all these things that physios do, all the extra hands-on stuff, does that make a difference in treating ventilated children?’ Largely the answer proved to be ‘yes’ but it also depended on how the individual physio chose and implemented specific techniques on the individual patient. 

Shaping the future of the profession

The initial findings from Fizzyo are bearing this out, with the data suggesting, Main tells me, ‘that by using feedback or games, we can nudge some children to do their treatments in a different way. And then if we can nail down exactly what constitutes a perfect treatment, then we can use all of this information to fine tune treatment techniques. It’s pretty cool.’

Main has been chair of physiotherapy at the UCL Great Ormond Street Institute of Child Health – UCL’s ‘first ever professor of physiotherapy’ – since 2015, and is programme director for the university’s postgraduate physiotherapy programme, one of the largest in the world. 

Their student satisfaction levels are consistently high: ‘they love the course,’ Main says, attributing this success to her wider team, who are ‘stupendously brilliant human beings… they’re so clever and so good at what they do.’

She takes her responsibility as programme director seriously, recognising her role in shaping the future of the profession.

‘We have a sense that we’re creating a global physio community,’ she says. ‘Students come from all over the world and we take great care in nurturing these human seedlings. When they leave with their MSc, we feel as if we’re planting these very powerful people. We want them to go and change the world.’

Main also encourages in her students the same courage that has characterised her own career: ‘We insist on boldness. Independent critical thinking is absolutely what needs to happen in our profession.’ 

Further information and some links to a few projects which are listed below:

• Project Fizzyo 
• Cystic Fibrosis Trust 
• UCL physiotherapy