physiotherapy blogging is a waste of time?

I'm not sure I've got the point of blogging. I don't have a deep emotional need to see my words on the internet and I have a number of other things I'd rather do that sending words into cyberspace. I achieved the number 1 spot on Google for a few weeks running but I could not be bothered to keep it up. I originally had an illusion of making heaps of money from advertising but lost interest in it. I've increasingly been drawn to researching for a potential non-fiction publication and cant see the point of doing a blog. I don't want to make heaps of vitual online "friends" and the virtual world is not nearly as attractive or interesting as the real world. The only reason I'm writing this today is to ensure that the blog remains active on Google in case I need it in the furture to promote my real world writing. As for blogging about physical therapy, the whole thing seems to be so small and narrow minded that it seems a waste of time.

physiotherapy cartoon #4

I wish the NHS would treat me like a person and not a number...


© 2008

physiotherapy blog goes economic-2008-2009 pay award for physios

I've heard rumblings that the pay award for NHS physiotherapists will be set over 3 years and below 3% for this time. I cannot understand why the health unions are so willing to accept anything that seems to be offerered. I'm bothered by the fact that 3 years seems a long time in financial terms and there's a lot of chance for fuel and housing prices to go up by large amounts when many NHS workers will be in effect on fixed incomes. The proposals I saw (or were they the final agreement?) said that there had been some negotiations about reducing working hours, somewhat ironic since Agenda for Change has only just increased them. I don't know how the negotiators or government expect us all to react at the prospect that in real terms we will be accepting a pay cut as we see our income reduced by above inflation rises in council tax, utility bills and energy costs. We still have to live with the concept that inflationremains less than 5%, something which increasingly seems like an figment of the politicians' imagination. The reality is that those things on which we spend the biggest amount of our incomes go up by amounts much larger than so called inflation. Result? The negotiated impovement in NHS salaries acheved by Agenda for Change will over the coming years be clawed back though setting wage settlements below the rate of inflation.

working for a healthier tomorow

When I wrote Physiotherapy Blog on 17 March referring to the issuing of "fitness notes" by GPs I did not realise that on the same day a report was being published. Working for a Healthier Tomorrow , published 17 March, reviews occupational health within the UK. The principles it tries to address are correct but as with much political discussion about health it fails in the details because of a fundamental limitation in the understanding of the complexities of healthcare and the contradictory priorities which exist. Unless there is a willingness to intiate reform which crosses over multiple government depertments then there is the risk that this report will initiate a knee-jerk reaction in the formulation of new policies which fail to address the issue of long term sickness and return to work. In particular there needs to be a coordinated approach between the health and social security systems in the same way that the report states the need for cooperation between the different agencies in the healthcare system. If my reading of the executive summary is correct then its proposals seem to excessively focus on the "micro management" of long term sickness and return to work without sufficiently looking at the ways that government agencies also are failing to address the problem. A regular annoyance for me is having to fill out Work and Pensions agencies forms for patients. I am annoyed on two counts. Firstly (and the minor complaint) is that I am not allocated time within my workload to do these forms so the whole system is inefficient because they have to wait for theit turn within my order of priorities, so if there is a conflict between doing an urgent letter to a doctor reporting a patient's progress or one of these Work and Pensions agency forms then the former will always get m time. However my biggest dislike of these forms comes from the fact they ask the wrong questions both in terms of what I can answer about the claimant and in terms of trying to address disability. It is without a doubt that physiotherapists have a huge potential role in helping return to work but their input will be limited unless there is a shift within the national culture regarding long term sickness and claiming benefit. In this there needs to be a central govenment lead not only in terms of telling health agencies that they have to work better together but also in putting their own house in order.

To see the report go to:

http://www.workingforhealth.gov.uk/documents/working-for-a-healthier-tomorrow-tagged.pdf

physiotherapy blog offers op art

© 2008

Government crackdown on sickness

Physiotherapy Blog has touched on some of the following issues before. An item on the BBC website says that the UK Government wants to crack down on the growing numbers of people on long tern sickness benefit. There are proposals for the NHS to promote return to work in people who are claiming sickness benefit and the suggestion that GPs give "fit notes" to say what people can and can not do when they are going back to work. Physiotherapists are ideally placed to facilitate return to work and could also support any scheme to assess fitness but there are some huge problems which i have touched on before. Probably the biggest problem is that assessment within a hospital or consulting room is not the same as performance in the workplace. It is impossible to determine the specifics of a work activity within the short period of time in a physiotherapy appointment. The other big issue is the subjective perception of the claimant, especially if it is a pain problem. We probably all know the now old saying "pain is what the patient says it is" but that become a barrier to return to work. Now the NHS exists almost like a machine which tries to move atients through as fast a possible it is no longer well placed to address long term issues such as return to work. The idea that all interventions can be provided as short interventions just does not fit with this model. An approach to physiotherapy based on average episode of care in Britain of 6 physiotherapy sessions breaks down when faced with return to work problems. At present no one is really addressing the contradiction of a Health Service which in the last 10 years has placed waiting time above all other priorities yet isunable to sort out the sickness which is costing the country dear.

The public view of physiotherapy

I read a review in a newspaper today about complementary therapies. To physiotherapists this probably means things like reflexology and the like but this reviewer lumped together acupuncture, Alexander technique, chiropractic and in with these included physiotherapy. What those outside the profession do not understand is the wide diversity of practice within physiotherapy so that now acupuncture is widely practiced by physiotherapists. And this is one of the contrasts between physiotherapy and other "physical" healthcare practitioners, be they regulated like osteopaths or borderline quacks. Physiotherapy has an expanding sphere of practice whereas the "complementary" professions are often build on theories and practices which are in a fossilised state of stagnation. Often these theories are based on clinical experience and nothing else. I've previously writen about the shortcomings within physiotherapy when it comes to evidence based practice. Go into most "alternative" or "complementary" healthcare and you will find there is next to no evidence underpinning practice and in some cases practices continue after there has been evidence of no effect. Usually the "evidence" of results is what is cited as proof that it works a common story being something along the lines "I has a patient with condition X (fill in this blank with a non-acute condition) who had treatment with drug Y (fill in ccommonly used drug) and saw Z (fill in NHS profession) but it made absolutely no difference so Z said they could not do any more for them but I did (A,B,C- fill in with quack treatments) and now they are completely better thanks to MY treatment". (No doubt the complementatry practitioner's bank balance is a lot better as well).

Recipe for complementary practitioner success :
Long appointment time + convinced practitioner + natural recovery process+ psychological influence on condition = patient gets better

What i want to be sure is that the recipe for physiotherapy uses better ingredients.

physiotherapy blog on top?

Physiotherapy Blog was in the top slot on Google under "physiotherapy blog" earlier this week and i was mildly pleased by this but i've learnt something about how this whole blogging game works. Things do not stand still and today Physiotherapy Blog is ranked number 2. I think there's a 3 to 4 week time lapse because this has been pushed out of the top space by a blog written in February telling everyone of its own closure. I'm still looking around for interesting physiotherapy blogs but not having much success. However critics of this blog will say it's not a physiotherapy blog and i would wholeheartedly agree with them because i want to do something bigger than just writing about the best ways to treat sciatica, what to do for shin splints etc etc. Any physiotherapist working in the UK and member of the CSP should not have any need for the clinical type of blog because there is iCSP, one of the best physiotherapy sources on the intenet if you're registered.

I'm not certain where Physiotherapy Blog is heading because unlike what i see in some general blogs, I don't want to sit down every day in front of the screen putting my thoughts down so eveyone in the world can read them. I'm interested in creating writing, interestedin evidence based practice and even after rather a lot of early ranting in this blog, I still get mad about the self deception displayed by some members of the profession when it comes to the effectiveness of their interventions.

So here's a few ideas of what I want to do in the next few months. I'd like to do some better cartoons and will take off the one about Appendix (I know it's not good but I wanted to see the resolution of the graphics ). I'd like to create links to other sites totally irrelevant to physiotherapy (possibly shopping sites). I somethimes think about promoting the blog; I know that is not the original idea with blogs but who is to say that the rules cannot be re-witten? the final most anarchic idea is to get rid of the blog and to spend the time doing something more useful instead. Unfortunately this option is the least likely because now I've see it on Google it's a bit of a competition to make sure i keep producing content to keep it there.

physiotherapy blog reaches Google top spot

Physiotherapy Blog has just reached top on Google. I'm not sure how I feel about this. Doing a blog about just physiotherapy becomes difficult after a while because I started out thinking that I would be able to write heaps but some of the time I can't be bothered with it and at times I think about closing the blog down. This is why quite some time ago i diversified away from what seemed like endless ranting about the shortcomings of physiotherapy in the UK. But today is different. I think that when I first started the blog it first appeared on Google as a "Googlewack" a one hit listing but now it has the dubious glory of outranking some of the more established so called blogs. I'm thinking about adding a hit counter (not sure if Google will allow it) as i know from checking sources outside Google that people do read Physiotherapy Blog, although I'd like to know how many.

As I'm feeling dizzy headed with the honor of all this I'd like to reflect , as i have done before, on some of these other so called blogs.Quite frankly some of them are not worth reading. There's one class which is just a type of free commercial for physiotherapy clinics. They don't contain any thoughts about anything and exist to persuade you to use their clinic or service. There are some which seem to be on a mission to tell the world about physiotherapy treatments and conditions. Just a few out there are a blog in the original sense of the word. But let's get real. There's no grand set of rules which say what you can or cannot put into a so called blog. All I hope is that more physical therapists will start doing blogs not because they have a mission or commercial interest but because they enjoy writing.

physiotherapy cartoon #3

When all the organs were boasting about their importance Appendix began to feel inferior...
© 2008

Social services are ineffective

Occasionally I come across situations which make me wish that I did not work in the NHS and a recent one made me realise the serious shortcomings in the way health and social care is now structured. The problems began a long time ago with the move called "care in the community" when there was the all out push to get patients out of long stay hospital beds and into the community because this was meant to be better for people but to the senior managers and politicians the greatest attraction was the fact it appeared cheaper than keeping the elderly and patients with chronic conditions in an NHS bed. More recent emphasis has been on eliminating waiting time and thereby reducing every patient into a financial commodity which is moved through the system as fast as posible. The idea of waiting list elimination was devloped around planned admissions for conditions with a clearly defined outcome (mainly surgical treatments) but despite this it has gradually become the overriding model adopted within NHS today even though for many conditions it is not an approprite way of addressing the problems. Now after years of "care in the community" and pushing the NHS to maximum bed turnover the idea of having facilities for residential rehabilitation seems far fetched and outdated. Out patient rehabilitation is meant to be a better alternative. However in reality it can never provide as intensive input as a residential facility which potentially can deliver therapy to one idividual for up to 8 hours per day. The out patient substitute can only provide a fraction of this. And this is why at times I wish I did not work in the NHS because I can see rehabilitation potential in patients which can never be achieved through the high turnover, "care in the community" health and social care system. The limited amount of input which can be provided in home visits, the unnecessary bureaucracy, the narrow minded and unsubstantiated assumptions of the professionals. I have met people whose health and quality of life could be turned around if only there was the chance to see them daily twice a day in an environment set up to provide rehabilitation insead of them receiving "care" in the community, where their rehabilitation potential is never reviewed and wherer Social Services would rather provide loads of expensive equipment to encourage dependence and disability rather than better use their funding on getting people better

Physiotherapy cartoon #2

She could tell it was an exclusive hospital by the theatre gowns
© 2008

Physiotherapy cartoon #1

51 Uses For a Zimmer Frame # 1 Avant-garde fountain © 2008

Evidence for Physiotherapy

OK so last post said that physiotherapy blog is going graphic. I've not forgotten this and I'm working on it, but having just visited a few blogs which talk about evidence based practice .I have a number of points to make. Firstly evidence based practice (EPB) is hard to put into practice within physiotherapy (at least in the UK) because these's a strong tide to fight against, and that tide is the (probably dominant) view that within clinical practice results are the most important thing; as long as people get better when we are "doing" something then we must be doing things correctly. There is also an uncomfortable issue with so called evidence There's evidence for everything within physiotherapy but the problem is the evidence is poor when weighed against the standards being used for evidence quality within other areas of healthcare. Often it's only professional opinion that's the evidence.Significant amounts of physical therapy theory lacks evidence but often what happens is an enthusiast for a treatment technique conducts a "trial" using a small sample , biased selection or fails to blind assessors to intervention and then when the results come back positive it it presented as proof that the technique or approach works. There's another weakness in EBP and that is often the poor critical appraisal skills of therapists. There's a willingness to accept anything which is "evidence" regardless how good the research methodology is. Perhaps the biggest problem is a relucatance to change clinical practice when good evidence becomes available, because the old practices "worked" and in the worst situation no one is aware that the latest evidence strongly supports a change in direction. Let's face it, no one (except an unethical clinician) would spend large amounts of time doing those things which obviously made no difference. The challenge for EBP is to extract the subtle changes and interactions which are occurring within the clinical situation and differentiate them from those changes and interactions which would occur in the absence of a specific clinical intervention. No small feat!

physiotherapy blog goes graphic

blog blog blog
glob glob glob
gobl gobl gobl
gabl gabl gabl
Im tired of all these blog words
Im going to do pictures instead

physiotherapy websites

Can't think of anything happeing within the profession in UK that's worth commenting on other than those things I have already covered. I am adding more websites as much for my own use as for evryone else

LIST OF PROFESSIONAL ORGANISATIONS (English Speaking)
American Physical Therapy Association http://www.apta.org/Education
Australian Physiotherapy Association http://www.physiotherapy.asn.au
Chartered Society of Physiotherapy http://www.csp.org.uk
Singapore Physiotherapy Association http://www.physiotherapy.org.sg
Canadian Physiotherapy Association http://www.physiotherapy.ca
New Zealand Society of Physiotherapy http://www.physiotherapy.org.nz
South African Society of PPhysiotherapy http://www.physiosa.org.za

Warped funding priorities

It said on the BBC news yesterday that the Government will be putting £2 billion into the tube (subway) system in London. I did not hear of any adverse comments being made about this. Yet only a year or so ago when the same Government put just £1 billion more than this into the NHS (an organsation which is vastly bigger than the London tube system) there were statements by politicians implying that the NHS was fortunate to be getting so much money, that the staff had to improve productivity etc.etc. It's the same with physiotherapy inside the NHS.Vast amounts of money are spent on other areas of healthcare (including huge amounts wasted by managers on office refurbishment, useless management seminars and free lunches during management events) and yet physiotherapists are greatful if they get fully funded to do training courses which enable them to do their jobs. Funding priorities are warped!

Evidence Base Practice

evidence based practice
Instead of writing about the problems with lack of evidence and a culture of confused thinking within physiotherapy/physical therapy I am going to start putting onto this blog sources of evidence/research/generally useful websites. These are all ones which I accessed and put together in a list. I had the idea of building a big and successful website with these on but the hosting site closed down and also there's probably not much room in the market for another website unless it is more specialist.Here's a few for starters:http://www.bl.uk/ British Libraryhttp://www.health.library.mcgill.ca/ On line library, McGill University, USAhttp://www.ipl.org/ Internet public libraryhttp://www.isep.org.au/ International Society of Physiotherapy Educatorshttp://www.ncchta.org/Health Technology Assessment Programme (UK Government funded research reports and reviews)http://www.nlm.nih.gov/ National Library of Medicine, USAAnd in case any of you don't know about this one for classics in literature.............http://www.gutenberg.org/wiki/Main_Page Project Gutenberg[You won't find anything about physiotherapy on it]