The idea that one approach to practice is superior to another is a powerful discourse in physiotherapy today. Last week I was talking with a colleague who thinks of himself as a 'critical thinker', and we were debating the merits of active rehabilitation over passive treatment. So called 'passive' treatments (some forms of massage, manipulation and electrotherapy, for example), in which the patient has treatment done to them rather than taking responsibility and actively engaging, have been the subject of much criticism in the profession for some time now. There is, I was told, indisputable evidence for the benefits of active approaches over passive treatment, and that those who … [Read more...] about Going beyond good and bad practice
Today's image was suggested by Cath Cruse-Drew. Click on the image to open it to full size. You can then save it and turn it into a desktop background by following these brief instructions. … [Read more...] about 30 Days of September: Day 5
There are many powerful critical arguments about health professional practice. Anyone who has studied how health professionals came into being, whose interests they served, or how they've adapted to the broader changes happening in society, can't fail to be shaken by the belief that the fight to become the agents of our own destiny is one with many casualties, many of whom are the people we earnestly claim to serve. Perhaps one of the most powerful arguments pertaining to physiotherapy - especially those areas of the practice that relate to long-term illness and disability - comes from disabled people themselves, who, for more than half a century, have been vocal in their criticism of … [Read more...] about Are health professionals parasites?
It's quite common these days to see advocates of a more 'holistic' healthcare practice championing the Biopsychosocial (BPS) Model. In areas where healthcare has become increasingly complex - where people's individual values and beliefs can't be avoided, and where people's social context affects their lives so palpably that a biomechanical approach to assessment and treatment is simply inadequate - the BPS model is promoted as a way forward. But is it as sound as people seem to think? The BPS model was initially proposed by George Engel as a ‘unified concept of health and disability’ (Engel 1960) and was based on a very particular form of positivist psychology called General Systems … [Read more...] about Is the Biopsychosocial Model all it’s cracked up to be?
In this post, CPN Exec member Simon Kirkegaard, writes about the problem of stubborn (chronic) pain. Many bright minds have contemplated on the complexity of pain for millennia yet even in 2016 we are still looking for a really effective and efficient way to alleviate stubborn (chronic) pain. There is a tendency to rely heavily on passive treatments and medication for pain which produce great results for short term pain and injury but dependency and more pain for the more stubborn pain that approximately 1/5 of population of the western world live with. A new exciting systematic review by Adriaan Louw et al. (2016) provides strong evidence for pain biology education as part of … [Read more...] about Simon Kirkegaard – Pain neuroscience education – 30DoS #25
A very interesting thing has been happening with the CPN blog in recent weeks. After publishing two relatively controversial blogposts - one on Six useless treatments and the other titled There are no new treatments in physiotherapy, we saw a big spike in members and enquiries through our email service. The post There are no new treatments in physiotherapy has been accessed more than 15,000 times on Facebook, and Six useless treatments nearly 13,000 times. These might not be particularly big numbers for Justin Bieber, but they are for most groups in physiotherapy. What is it about these posts that made them so popular? Based on some of the emails we received after they went … [Read more...] about Desperately seeking evidence
The Australian Physiotherapy Association (APA) recently pronounced that six interventions commonly used by physiotherapists are useless and were no longer being supported (link). As part of the Choosing Wisely initiative, the APA has decided that requesting imaging for certain instances of non-specific low back pain, cervical pain, and acute ankle trauma; plus the routine use incentive spirometry after upper abdominal and cardiac surgery, electrotherapy in cases of lower back pain, and manual therapy for patients with frozen shoulder, are all now discouraged. There are some interesting aspects to this decision that warrant some more thought. Firstly, there is the … [Read more...] about Six useless treatments