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
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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]

Is physiotherapy blog too cynical?

I wonder if this blog is too cynical when I look at some of the other offerings out there. I set this blog up in response to the lack of blogs physical therapy blogs and the few "physiotherapy" blogs out there seem to be written by people still in love with the profession and its ideas. I can see a lot more of the shortcomings in physiotherapy than they can. Some physiotherapy material seems to be an extension of the treatment room with therapists offereing advice about exercises and treatment. I heard the other day about a site (and i don't know the name) which sounds a con. For a certain amount of money it is supposed to be possible to enter a health problem and the online clinician will give professional advice and a diagnosis. Guess they must be heaps better then me to be able to give out advice to unseen individuals with vague problems and then charge them for it! It stikes me as a bit of a risk because there is no regulation of the internet and anyone can set up a website in a country which does not have any regulations of physical therapy and then take whatever money they want for dealing out any old trash for advice. The internet is cool for finding large amounts of info but poor for ensuring the quality of the info. It's all down to the individual to be careful.

Autonomy of the physiotherapy profession

I've read today that we've just passed something of a milestone for the autonomy of physiotherapy in the UK. According to Frontline it is 30 years since the British Department of Health made the first moves towards giving physios autonomy. I'm not quite clear about how some people link this with patient self referral in the NHS. The profession has had true autonomy for a number of years but this has existed in non-NHS independent healthcare. This idea of NHs self referral is not primarily an issue of autonomy but about the way free physiotherapy is accessed. It's not autonomy that's the issue but NHS housekeeping arrangements. Allowing everyone to refer themselves to an NHS physio puts local NHS departments in direct competition with private healthcare facilities but I don't suppose that in too many parts of the UK self employed physios will be losing sleep over it. Many NHS physiotherapy departments have long waiting times and opening themselves up to self referral will make no difference to the public.The service will remain effectively inaccessible. If you have to wait 4 or 5 months to be seen on the NHS for an acute problem it will make no difference if your GP decided to send you or if you decide to take yourself there.