Yesterday (Friday) I was one of 20,000 delegates at the online Therapy Live CPD event for Physiotherapists hosted by Physio Matters. It was an excellent day with a large amount of information being disseminated to like minded folks.
This is pretty much off the top of my head- it doesn’t detail every lecture I attended. I have also bought access to the rest of the lectures, which I look forward to listening to in my own time over the next couple of weeks.
In all, it was an excellent event; Jack Chew, The Physio Matters team, and all the people involved should be congratulated on a job well done. This was a massive undertaking – any criticism about laggy connections and inability to connect need to be caveated with the knowledge this was a free event on a scale not before seen in this context.
Again- these are initial thoughts, and I’m happy for them to be questioned, my conclusions queried etc – but I’m not going to take rudeness or questioning of my professional integrity.
General Conference/CPD thoughts
In terms of conferences like this, I wonder if personally, a new approach needs to be thought about. There was a significant amount of noise on social media of people who have certain biases for each stream bigging each other up. Yes, I know that they want more people to see their stream, but if you spend your entire life immersed in the strength side of therapy or the upper limb- surely this is an excellent time to learn something about something you know little about?
(I had this thought on a post conference stroll)- if you know what talk you want to listen to, why don’t you sit down prior to the talk, write down what you think it will be about, what you reckon the lecturer will say (the less you can think of ,the better, but equally, the more you write, the more your biases might be challenged!) when you listen to the lecture, see if it confirms your biases, is all the information you wrote down in there? Ok there might be a couple of clinical “gems” but otherwise, are you merely nodding along? Have you been challenged? If not, ok it might not be a waste of your time exactly, but would your time have been better spent learning about something else, being challenged by another speaker, or are you just listening to people in your own bias bubble?
Siloed treatment streams came up a fair bit in the conference- (funnily enough, within the siled treatment talks…) especially the way in which physio should really not be as siloed as it is. Traditional models of physiotherapy have very much followed orthopaedic leads in terms of speciality. Professional development has also followed the same track with therapists specialising in more and more specific areas. Ok. this isn’t a bad thing in terms of someone knowing the most there is to know about finger pulleys, or metatarsalgia etc. but a lot of the conversations yesterday focussed on the fact that we should maybe look more globally in terms of rehab. Shoulders aren’t just about shoulders, etc. (I know there has been a lot of debate and pooh-poohing of things like Vleemings slings etc, but general rehab should perhaps be looking more into that?).
Pelvic health is a massive issue, and can be quite a taboo subject- one that we as therapists find quite difficult to overcome our embarrassment about. Yet, it may well have a huge impact on rehabilitation of the rest of the body. Not only that, but in terms of long term health deficits, it may be the thing that stops patients from getting out there and preventing themselves from getting metabolic issues. If a patient can’t walk or run for more than 2000 steps without leaking, or have issues doing any kind of exercise without fear of embarrassment, that is going to have an impact on their exercise decision making, and long term metabolic health.
Not only that, but pelvic dysfunction is indeed the centre of the body- effectively connecting upper limbs to lower limbs. There was a fair amount of focus on it when “core training” was all the rage, but since then with a growing body of literature that says that you don’t have to contract transverse abs ALL the time, the pendulum seems to have swung the other way. Proponents of various strength focussed physio have ridiculed the idea of training people to breathe properly etc. yet, looking at the vast number of people who are affected by pelvic floor issues across the world- this is an eminently intelligent place for rehab to focus on.
Staying with Pelvic health (yes, I addressed my biases and spent a lot of time on that stream), the main place that people get their information about pelvic/sexual health is Gwyneth Paltrow’s Goop site and Advertisements from Incontinence pad makers. This is clearly not helpful or health-ful. (not a word, but it works in this context). It is the equivalent of Nestle, Monsanto, Cocacola and Maccy D’s sponsoring the WHO and telling us how to get nutritionally balanced meals….
Let’s not get into that.
The question is: How to get actual information that is useful and not based on making money for Pad companies and Gwyneth out there to a larger population.
Evidence Based Practice
Evidence base…. Ah. We hear about EBP all the time and Greg Lehman presented an excellent polemic (intentionally controversial talk) looking at knee valgus evidence. He took the same studies that have shown that knee valgus is a movement deficit, and showed how the data could be used to come to the opposite conclusion. Not insane. Just looking at evidence in a different way. This inevitably leads us to the myriad recent arguments on social media etc. about manual therapy being wrong and not evidence based, how dry needling doesn’t have any evidence behind it etc. But then, the stuff that we think does have some evidence- exercise therapy, strength work etc. when you look into it with a different hat on, equally you could argue that it doesn’t have a strong evidence base either. Where does that leave us with EBP? Greg mentions that it should probably be left up to the consumer to read the research themselves and come up with their own conclusions… or leave it up to someone they trust to help with dissemination. – which is fine, but we seldom put our favoured treatments under the same scrutiny as those we have disavowed.
Hand therapy – beyond splinting with Debs Stanton was a refreshing look at helping those with hand issues- an expert telling us what works in her practice- very little attempt to point us towards specific papers for the interventions (but some for tests etc). What works. What doesn’t. Oedema is apparently evil in this context- and the enemy. It would have been nice to get some knowledge behind that simply beyond being told it “gunks everything up and stops movement”- but hey, you can’t have everything. Massage, ice massage, movement, tendon glides etc. to bring the hand back to normal movement. Lovely. Refreshing. Maybe I just like being told what works as opposed to having a huge debate about what has or hasn’t had the greatest treatment effect on a population that isn’t relevant to my patient.
Private Practice beyond Covid-19
Private practice talk/presentation thing was interesting from the point of view that the speakers all seemed to be directors or working for big private practices- multiple employees, multiple clinic locations etc. I’m sure they are very important – but the main focus of the conversation was about how we as therapists should not be afraid of moving into a more video based model of treatment. It somewhat missed the point of the small individual practitioner. We aren’t afraid of going to video consultations – we are doing that as much as we can. We have been told that as autonomous practitioners we should be making our own decisions within the framework…. Yes we are autonomous practitioners but the framework is pretty damn woolly in terms of being able to make cast iron and intelligent decisions on opening up to face to face consultations. I’d like to know that I can make these decisions without being told by someone up the chain that we have endangered someone’s life and then get my livelihood taken away from me…. This is because if I just sit here and tell people that we can do video consultations and phone consultations (which a number of patients are some what astonished that they might have to pay for), we end up losing patients, and indeed our livelihood to alternate professions who seem to be opening up with impunity. I have nothing to counter that- and while some patients are embracing video consultations, this by no means makes up for those who are migrating to others who are open for face to face. Overall, a frustrating session.
Specifics of rehab
Throughout the conference presentations I saw there were a few platitudes trotted out “good rehab looks like good rehab”. No shit. A lot of our evidence base in a number of areas is not to “just do specifics” look globally etc. So for knee pain, should I be focussing on closed chain first? Open chain first? Does it depend? If it depends, does it matter? Am listening to someone who is ultimately going to say “in all honesty we don’t know exactly what to do or how to do it”? In which case, is “following the evidence” just using common sense, loading it however we damn well want in order to make a difference? If so, that’s fine, but don’t go shouting at people who use tape, electrotherapy or manual therapy to the same degree.
The overall message seems to be about communication and listening to the patient- What do they expect, what can I do to make them better, what can they do to make them better- how long will it take?
Overall takeaways at this point
At this point, we are generally getting told to listen to patients and that communication skills are key (which a surprising amount of people seem to still be desperately ignorant of). Have specialist knowledge, but don’t be siloed, be a globally focussed therapist, but don’t forget the specifics. Make sure you follow the evidence, but don’t read it the wrong way, and don’t sit there being paralysed by conflicting evidence by overanalysing it, all the while shouting down all the bad “evidence” being peddled by mass advertising and people with lots of money- at all times ensuring that you maintain a Therapeutic alliance with a patient who wants human contact- without necessarily providing them with human contact.
Perhaps the best conclusion is a rehashed Louis Gifford idea- still shining through after all these years.
Listen to the Patient.
Let them know what you can do to help them.
Let them know what they can do to help themselves.
Give them a rough timeframe.