Your comments: 17 June 2015

In a recent edition of Supervet on TV a Staffordshire Bull terrier puppy had quite extensive corrective orthopaedic surgery on his elbows. He stayed in the vet hospital for three months and had daily hydrotherapy and animal physiotherapy. The programme mentioned that he had had 126 physiotherapy sessions and had made a fantastic recovery. While this is fantastic news for the puppy, it made my blood boil. 

 

As a private physiotherapist working in Oxfordshire, it struck me that we are being cut back further and further by the private medical insurers to only provide the bare minimum to the patients. If we dare go over the six sessions, we are deemed as over-treating. I can only imagine how my NHS colleagues feel that are even more limited than we are. How can this be right that a dog can have such fabulous rehab paid by the insurance companies, yet humans are so restricted?   Does anyone else feel the same?

 

In a qualitative research project we looked at third-year physiotherapy students’ use of research literature while on clinical placements. What proved interesting wasn’t so much the third years’ use of research literature but their perceptions of how qualified members of staff use it. 

 

We conducted solo interviews with each student and when it came to asking about their experience of qualified staff using literature, the same theme emerged time and time again. The students perceived newly-qualified staff as accessing literature more often and basing their practice on evidence, whereas senior staff were perceived to rely more on their clinical experience than using an evidence-based approach. 

 

I am not saying this is the case but it is interesting that this is the view of students while on placement. This was put into context at the Physio Works event in Aberdeen in March, where Karen Middleton and Sue Hayward-Giles spoke about the need to employ an evidence-based approach and to use that evidence to pitch for increased funding and support for services. 

 

What we need in Scotland is to develop a culture of incorporating research and evidence into our everyday working vocabulary. We need to talk more in the workplace daily about the current research, about the benefits of physiotherapy; we need to question our treatment and debate with colleagues. 

 

Only when we incorporate this scientific, questioning and logical approach into our daily working lives, will we then be able to promote physiotherapy more widely in the medical sphere and to our patients.

 

It is great to see Frontline covering end of life issues (6 May, 20 May). Within our profession it is often perceived that palliative care is synonymous with hospice care, whereas this is not the case. All physios, regardless of what speciality they work in, will be involved with patients who have a palliative diagnosis.

 

Many hospices provide courses and training on the management of palliative illnesses and enhancing communication skills and I would encourage people to make contact with their local hospice or hospital palliative care team to access this and make links with the specialist allied health professionals there. 

 

I recently visited a patient at home who died very soon after I left. I realised that I wouldn’t have known what to do if she had died when I was with her. I discussed this with my boss and we now have a procedure within our lone working policy to cover this situation. 

 

I also became aware that, although I have treated many patients who have died, I have never been with anyone through their death. We discussed this with the ward managers and now have opportunities to work with the nurses as they care for someone through their death or after it (as appropriate).

 

At a recent lecture, most students reported they would feel daunted by a palliative care placement, yet all of them will treat patients with life-limiting illnesses. Therefore, we need to support our profession to feel as comfortable and skilled working in palliative care as they can be. 

 

Musculoskeletal (MSK) physiotherapy has seen an advancement of practice which has led clinicians to be members of numerous special interest groups (SIGs). SIGs that sit within MSK physiotherapy attract similarly- minded individuals to create organisational structures by which exchanging of knowledge, values and beliefs leads to a validation of approach to patient care. 

 

Some SIGs provide clinicians with assurances of practice, but are inherently forums for interactions and clinical exchanges that create sub-cultures with similar goals, mainly improvement in MSK healthcare. These groups are defined differently to other groups by description linked to history and previous leaders in that particular field. Commonly, and historically, this is an individual, such as Cyriax, Mulligan, Mailtand, Kaltenborn and McKenzie, who by clinical evaluation, research and teaching created separate MSK sub-cultures and approaches, dominated by their experience, knowledge and beliefs. This has led to the expansion of SIGs that are all MSK in origin but hold different paradigms in method. 

 

Are we at a point where relevant stakeholders see no relevance in so many SIGs? Perhaps what is required is a joined-up approach and a single community of MSK practice that is led by collaborative evidence rather than historical beliefs and concepts. Should professional groups begin to move towards something far more inclusive and representative and be brave enough to deconstruct some of the rigid barriers, to provide a substantial MSK group that really can influence?

 

Collaboration leads to greater knowledge, constructive research support, strength of voice and ultimately an organisation that has a culture of clarity for all stakeholders. Perhaps it is time to consider a ‘community of practice’ group which could evolve because of members’ common interest, created specifically with the goal of gaining knowledge and advancing MSK care irrespective of historical values. To do this well is it time to provide one MSK group/community of practice that really represents all elements of MSK care and so can be the way in which MSK physiotherapy leads the way in a multidisciplinary MSK community.