In my last blog, Reflections of a quantitative researcher on the CPN Salon, I suggested that we needed to build bridges not walls and encouraged CPN to have more connections with the biomedical quantitative physiotherapy world. Although there was general buy-in to the idea, I was vague in my last blog and wanted to follow up by getting more specific and expanding on the why and how I see this connection happening. Specifically, I wanted to address the risks to the CPN, reasons why the CPN is best positioned to reach across the divide and make some practical suggestions.
Considering the risks to the CPN in reaching across the divide
One of CPN’s objectives is to critique the traditional physiotherapy paradigms that they see as problematic. Given that, would building bridges into the conventional world possibly clash with CPN principles? When thinking about this question, I recall a parallel scenario, a conversation that I had with David Naylor the Past President of the University of Toronto. He had co-authored a paper entitled “Medical education for the 21st century” (http://www.thelancet.com/commissions/education-of-health-professionals). This was a Lancet Commission that highlighted a call from 20 professional and academic leaders for major reform in the training of healthcare professionals for the 21st century. Changes were needed because of fragmented, outdated, and static curricula that produce ill-equipped graduates. In a thoughtful discussion about this paper, I argued the importance of scope of practice and raised issues of encroachments by other healthcare professionals on physiotherapy scope. Dr. Naylor interrupted me in mid-sentence pointing out that the purpose and identity of a profession was ‘completely irrelevant’. The one and only consideration and focus should be what is best for the patient. That was the last time that I advocated for the profession to serve the profession. For example, I am staunch advocate for rehabilitation services in Canada for individuals with lung disease but I do not advocate for our profession to be the singular or even the main practitioner in this area.
A parallel can be drawn from this conversation. The issue of identity and purpose of CPN should be less relevant (or dare I even say irrelevant) than considering what is best for the patients. Reaching across the divide and infiltrating the traditional physiotherapy way of thinking would result in better outcome for the patient and that should be the sole purpose that drives the discussion.
Understanding the term critical
I realize that there is a whole body of literature on critical analysis that I am not familiar with. When I first heard about the Critical Physiotherapy Network, I thought about the act of criticizing and judging a situation or person’s work. That concept automatically results in a “back up” attitude. But what I believe CPN is about is an evaluation of a theory, practice or research approach in a detailed and analytical way. There is no question that some of the conventional physiotherapy paradigms are problematic but I am confident that there are some aspects that we can agree on. As we reach across the divide, understanding of the term “critical” by those that are not part of the CPN is important. The objectives of the CPN were very helpful in helping me understand their purpose (https://criticalphysio.net/cpn-constitution/).
Reasons why the CPN is best positioned to reach across the divide.
Many of the members of the CPN have been trained in quantitative/biomedical sciences before learning the language of critical thinking. For that reason, I feel that they are best positioned to reach across the divide. Let me use another parallel to explain this. During my graduate studies, I was trained in basic/experimental sciences, looking at neuronal activity in the brain of a cat. It wasn’t until I did my post doc that I started working in clinical population. Because of my training in basic science, I can speak their language and I understand experimental sciences. Most basic scientists have not done clinical research and therefore have no idea of “our” language, strengths and weakness. Because of my familiarity, it is much easier for me to reach out and engage them in aspects of research that a clinical researcher cannot address. That is exactly why CPN members are in a better position to reach out to traditional researchers as they understand that world, given that many of them trained in it.
Suggestions for next steps
Here are some suggestions for practical next steps:
- At the micro level, connect with some conventional researchers who would welcome their ideas. For example, in our randomized controlled trial of balance training in pulmonary rehab that stretches across 3 continents, I would really value the thoughts and ideas of a CPN member on the issues of “adherence” in terms of how to conceptualize it. I am aware of other quantitative researchers in Australia, Canada and the UK that would value the perspective of CPN members within their research group.
- The CPN members should consider writing editorial in physiotherapy journals about their ideas. In fact, there is a group of international physiotherapy editors and they have written articles together that have been published in multiple journals. Is it time to consider writing an article possibly about evidence based practice or qualitative research that would be published in all these journals simultaneously? It would be important to choose the topic carefully, focusing on improving patient outcomes.
- Connect with PEDro to see what role CPN would play in their organization. When reviewing articles, could the CPN contribute to a different perspective than the traditional quality indicators?
- Consider having a CPN representative on the special interest groups of WCPT.
- Let’s encourage and organize a debate at the next WCPT Congress or local physiotherapy conferences. A debate is healthy for the profession, would attract more than just like-minded people and expose CPN beyond the converted group.
- Let’s consider a joint blog by a member of CPN and a conventional researcher debating and discussing different views on a topic.