What is physiotherapy anyway? As I now find myself guiding the direction of the worlds most used professional physiotherapy reference this question is with me everyday. This personal reflection was written on the return from WCPT Congress in 2017 and the following words have been quietly residing on my computer for over a year now and it has taken another long haul flight to finally ready them for sharing.
I am not your usual physiotherapist, I do not work clinically any more but I do engage with the global physiotherapy profession on a daily basis. In the past week I have been involved in delivering courses to physios all over the world, in high resources settings as well as the worlds most conflicted contexts including Syria, Yemen and Iraq. I have had desperate emails from members of the public asking for help with their cauda equina, “bulging discs”, chronic post surgical pain, and failed orthopaedic rehabilitation. I have tweeted, written code, edited websites, collected data, considered research, marked assignments and created resources to share knowledge. In all these situations I have asked questions and answered questions, I have listened and I have spoken. I am constantly reflecting upon my own experiences, the conversations I see going on between members of our profession and the things that physiotherapists all over the world tell me.
Over the past few years I have interviewed many of the world’s most respected physiotherapists about their research, their practice and their clinical recommendations. Despite the unique nature of each individual interview there are three themes that crop up in every conversation:
There are many ways to elaborate on each of these aspects of our practice, and many have, but I am one for keeping things simple and offer short thoughts on why these may be considered to be core to all that we do:
Communication has long been considered core to the role of the physiotherapy professional and is often prioritised within professional standards and legislative requirements (e.g. Physiotherapy Board of Australia and Physiotherapy Board of New Zealand, 2015). Effective communication leads to trust, trust to a relationship, a relationship to a collaboration and a collaboration to results. In the world today emotional intelligence and cultural sensitivity are the key foundations of effective communication.
Once we have formed a collaboration education can take place. Most professional standards focus on educating colleagues and the general public (e.g. APTA Standards of Practice for Physical Therapy) but one might argue that any client/physiotherapist interaction is an education experience for both parties involved. Our clients must be educated on their conditions, how to take responsibility for their own health and how to manage the conditions they present with to return to health. However, education is a two way skill, we must not preach, we must learn to listen, we need to be both teachers and learners in all that we do.
I use “Exercise” here as this is the term that I hear the most in conversations, however Activity and Movement are also housed equally within this group. Organisations are now fully supportive of promoting activity and movement (e.g. WHO’s BeActive; CSP’s LoveActivity, and Physiopedia’s JustKeepMoving campaigns), however we must not forget exercise. The term that we use in the clinical situation depends on the individuals specific needs. For example, the post surgical ACL needs rehabilitation exercises; the sedentary need activity; the person in intensive care needs movement. The skill here is knowing what to give and when, how to progress and how to regress, being skilled at this will lead to effectiveness.
Is this what physiotherapy is? Are these are the core skills that every physiotherapist needs to develop and pursue to effectively contribute to the health of their clients. I am not the first to talk about this and I don’t wish to dismiss the value of our toolkit that extends beyond these areas, but it feels like we must become effective practitioners at applying these core skills before we consider other adjunct interventions.
Finally, I cannot end this post without including a word on assessment. This often gets a fleeting mention as if it is taken for granted. That may be due to the fact that it is completely at the core of what we do. We are experts in using the deep knowledge that we have to continually assess and clinically reason. We make and test clinical decisions and move forward through the complex maze of injury and ill health on a collaborative pathway with our clients to reach agreed goals.
As I return to these words in late 2018 the question is still very present with me and I am delighted to see the public conversation more regularly evidencing my thoughts (e.g. a recent discussion highlighted here). Looking forward to more conversations on this topic….