One of the biggest dilemmas facing the physiotherapy profession today is how to keep it alive. Given the unrelenting pressures to reform, cut costs, and redesign practice, it's hard to know whether to push the profession's stability, history and established culture, or to promote a radical new professional image. And faced with healthcare innovations that seem to be dissolving old certainties, it's hard to know whether we like it or not. Imagine, for instance, that robots were shown to be more reliable manipulators than physios, or that a low-cost assistant could do the work of post-op respiratory physiotherapy just as well as an expensively trained clinician. Would we promote it? In some instances, like this recent trial by a 'short-stay rehab unit based at a Nottingham care home' that 'managed to cut 90-day hospital … [Read more...] about Should we give up physiotherapy?
Perhaps one of the biggest points of difference in current debates around the future of physiotherapy involves the question of whether physiotherapy should be evidence-based. It is self-evidence - so some say - that physiotherapy practice should be based on the best available evidence, since to practice otherwise might put people at risk, or damage the reputation of physiotherapy as a science. One of the less-well-often discussed issues with this argument is how much people - and by this I mean the public, our professional colleagues and peers, and the organisations that fund us and legislate for us - actually care whether some therapeutic practices are evidence-based. An article today on touch by Steven Phelps, Associate Professor in the Department of Integrative Biology at the University of Texas, in the digital magazine Aeon, … [Read more...] about The politics of touch
There's been a recurring theme in many of my blogposts this year, and a Facebook post by Adam Meakins on Wednesday summed it up beautifully. In the post (here), Adam was responding to an earlier post by Brent Brookbush promoting a new educational video of a muscle tissue release technique, to which Adam made this comment; The continued illusion or delusion of therapists thinking they can find 'nodules' 'trigger points' 'knots' 'taut bands' 'scar tissue' ''gristly bits' 'snotty shit' 'gammy areas' still astounds me in 2016... these are just soft tissue sore spots of an unknown origin... Meakins (2015) http://bjsm.bmj.com/content/49/6/348.full.pdf The issue that I've been grappling with repeatedly this year is that we have been using our physical therapy techniques for over a century now, and yet what we really know about them is … [Read more...] about Sore spots
Like most people, I'm still feeling the shock of Donald Trump's US presidential election win last week. Once all the dust has settled, and people have started to face up to what has been called the 'post-truth' era in politics (see this or this), there will have to be some real soul searching about what this all means for the future of our societies. Big issues like environmental degradation, personal security, tolerance for others, and health, will play out alongside more 'local' issues like paying the weekly bills, dealing with family problems, and managing our busy lives. Amidst all this 'noise' its worth reflecting on something subtle but highly significant about this recent election and the Brexit vote that took place in Britain in late June, and that is the decline of truth, as we have come to know it in the 'developed' … [Read more...] about Trump, Brexit and physiotherapy
In this final 30DoS for 2016, Director of Professional Policy at WCPT - Tracy Bury - writes about the seminal work of David Sackett and how it influenced her critical thinking. The publication of Evidence based medicine: what it is and what it isn’t (Sackett et al) in 1996 was the culmination of a growing discourse on the challenges of integrating research evidence with clinical expertise for the benefit of patients. The authors also referenced EBM’s philosophical origins in mid-19th century Paris whilst describing it as a young discipline. The definition for EBM that was set out is now universally recognised. The importance of clinical experience, competency and judgement were applied to decision making in the face of the best available evidence and the individual patient context. Whilst doing a Masters in Health Science in the … [Read more...] about Tracy Bury – EBM: What it is and what it isn’t – 30DoS #30
In this post, CPN member Carley King writes about Ian Leslie's article The Sugar Conspiracy. This “long read” article from the Guardian outlines how in 1972, John Yudkin raised concerns about sugar being the greatest danger to our health instead of fat. However, his research findings were ridiculed, and fat continued to be labelled as the likely cause of obesity and the numerous conditions associated with obesity. It outlines how the scientific community embraced a certain school of thought and disregarded any subsequent evidence that suggested otherwise, i.e. saturated fats are particularly bad for your health. It suggests that this tide of movement was predominantly driven by certain personalities in the field of nutrition, or gurus. The gurus in the field were able to influence guidelines, despite the key messages not … [Read more...] about Carley King – The sugar conspiracy – 30DoS #18
Perhaps the greatest mind in the entire history of the world - well in my estimation anyway - once argued that it is the the things that are the most obvious and seemingly benign that we should focus all of our critical attention upon, because these are the things that are doing the best job of concealing the immense power that allows them to become so seemingly obvious in the first place. (If you hadn't realise already, that man is Michel Foucault). Well of all the seemingly obvious, taken-for-granted and largely unchallenged ideas currently pervading physiotherapy, evidence based practice must surely be one of the most obvious ideas needing critical scrutiny. Fortunately, a few physiotherapists are raising their heads above the parapet to challenge the primacy of EBP, evidenced by the latest editorial in Physiotherapy Canada … [Read more...] about Is it time to end the tyranny of evidence based practice?