We’re taught things at massage and physio school that have been around for a long time. They have been unquestioned pillars of the profession for years if not decades and have been taught as such. With the current trend in Evidence Based Practice, more and more of these “essential” skills are being looked at with fresh eyes, and fairly often, the dogma of what has come before is proving to be incorrect from an evidence based point of view.
This is an interesting conundrum for physios, who claim to be from a science background. (Indeed, the degree is a BSc, not a BA). If the things that we do on a day-to-day basis are not backed up by scientific evidence, yet, anecdotally, and clinically, we are seeing improvements, where does that put us?
Firmly in the realms of the unknown, really.
So how are things progressing?
Well, in terms of Continual Professional Development, there are a myriad of ways in which we continue our learning. The emphasis is really upon evidence now, so anything that has those lovely words “evidence based” in, tends to draw a bit of a crowd. Podcasts are out there with researchers disseminating information, clinical experts give us their take on what is going on in the world of physio, and Twitter (yes, actually twitter) is a great source of new, cutting edge information.
However, I came across a problem with this the other day. There was a conference about shoulders somewhere in the UK and a number of skilled practitioners were in attendance. What was interesting was that something called “scapula setting”, pretty much a key part of shoulder rehab taught in university is now defunct. Not clinically relevant. Not needed. No use anymore.
We (the twitterati) (what a horrible phrase) were told triumphantly that scapula setting is dead. Brilliant. I hated it anyway, I could never do it, and I had never seen anyone ever do it “properly”.
However, this has left us with a bit of a blackhole. 140 characters is a bit short, and so although you can dismiss the education of half a million therapists in a couple of sentences, telling them what they should be doing instead is a bit more of a tall order.
It is all very well proving things that don’t work – in fact that is pretty much what science is about, you try to disprove your hypothesis. However, when you are doing so on an organic human being with thoughts, feelings and psychology – which has a massive influence on whether or not something works or hurts, then you have a whole can of worms to deal with.
Also, when something like that is “thrown out” you leave a fair amount of therapists with a toolbox that is lacking in anything really. At least prior to the revelation the therapist would at least have something to talk about, and a way in which to interact with the patient. Now you have “um… well we used to do this, but there is no evidence, so, until I have enough money to go on a CPD course that tells me what to do, all I have is ultrasound… no hang on, no evidence for that either”. (that’s right, there isn’t a whole lot of evidence to say that ultrasound works as therapy – a switched off ultrasound machine is as effective as one that is switched on) (Hashish, Feinmen et al., 1998).
Not only this, but there are therapists out there who have been using various methods of physio for years and tens of years which are becoming outdated in terms of the new evidence base. Yes, we have the cutting edge of the profession gladly telling some of us what works, and what no longer works, but how does that information get disseminated? How do we get new knowledge to the community physio who barely has time to do CPD let alone keep up with the latest research? Also – how do we get that information to the universities who have been teaching much the same stuff for the last decade, with a few re-writes here and there? It’s a huge question, we don’t have a hive mind – and as much as I want to try to answer it here, I probably won’t do it any more justice that had I been restricted to 140 characters.
The HCPC requires that anyone registered with them needs to keep up to date with CPD, and must provide a written record. Not only that, but any gap of 3 months without CPD must have a written explanation. As a profession, Physio gets audited every couple of years, and a percentage of us are contacted and asked to send in our CPD files.
I’m responsible for my own learning, and while I can’t afford to go on as many courses, lecture series and symposiums as I would like, I am able to keep up to date, and continue learning in other ways. The Physio Matters Podcast, presented by Jack Chew has been invaluable both in terms of giving me ideas to think about and areas in which to direct my learning. I’m also ploughing my way through Pain literature, and have been particularly inspired by the writings of Louis Gifford. Now all I need to do is record what I’ve been learning and work out where I need to look next!
At Global Therapies we are….