Future directions and challenges.
Author: Stotter, Gill
Pub Date: 11/01/2011
Publication: Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 New Zealand Society of Physiotherapists ISSN: 0303-7193
Issue: Date: Nov, 2011 Source Volume: 39 Source Issue: 3
Accession Number: 288537999
Full Text: Attending the World Confederation for Physical Therapy Congress in Amsterdam in June was a wonderful experience. With over 5000 delegates representing 105 countries, the scene was set for some serious discussion on global issues. It was also an opportunity for us to become more aware of the strengths and diversity of our work. The Congress emphasized that we are all part of the world of physiotherapy; many of our challenges are similar but others are very different, often depending on local politics.

It was a time of reflection and I came away thinking about how we have evolved as a profession and where we are heading in the future.

Some countries envy what we have in New Zealand--our recognition as autonomous health practitioners, with ability to refer for diagnostic tests, and patients being able to self refer for treatment. However funding for rehabilitation in New Zealand has led to a disparity between those patients who have suffered an injury and those who have health related conditions. The funding disparity has also influenced where and how physiotherapists work here and we have a greater proportion of the workforce in the private sector compared to many countries. It was emphasized that primary and secondary health care sector needs to work more closely to provide services for the community. Collaboration through education, research and clinical initiatives are required and were major points of discussion.

The highlights for me from attending the conference were meeting new people and hearing the issues that impacted on their health service and the delivery of physiotherapy in their country; participating in discussion forums and a visit to a private practice. The private practice was on the outskirts of Amsterdam and served a community of 10,000 people. The practice provided a stimulating environment with wonderful rehabilitation facilities and a physiotherapy staff with varying skills and experience in musculoskeletal and sports management, occupational health, neurology, paediatrics, oncology and cardio-respiratory care. Individual assessments and treatment were provided as well as group rehabilitation and supervised gym sessions. Some of the staff worked part time in local hospitals and industry, and they provided combined consultations with the physiotherapists and visiting specialists. The Netherlands has a population of 16 million, there are 5 large health insurers, every citizen has a basic health insurance and the majority has an extra insurance which covers 12 physiotherapy consults per year.

One of the many challenges for the future that emerged is the need to make the right choices for the individual patient on the basis of evidence. Evidence-based medicine cannot be described as one size fits all. It is important to know what works but also to ask ourselves specifically what works on which patient and why. The importance of listening to each patient, their history and what has prompted their need for this particular treatment was emphasized . With the demands on the health dollar growing worldwide we also need to critically evaluate who really needs physiotherapy and who does not.

It became obvious by the wide range and diversity of different cultures at the Congress that physiotherapy has evolved over the past 100 years. We have come of age. We are now a profession in our own right and we need to be the profession acknowledged as experts in physical medicine and rehabilitation. Other presenters discussed the fundamental basis to our knowledge. It was put forward for discussion that we do not always have adequate insight into the underlying mechanics and predisposing factors responsible for the patient's functional limitations and potential recovery. Greater collaboration between research academics and clinicians was highlighted as being needed to understand the important drivers that underlie functional improvement. Psychosocial factors are also increasingly important to help us understand our patients, what motivates them and how they learn. We also need to be far more aware of the health profile of the population we are serving.

Another area of practice that was a major theme at the Congress and the subject of a large number of presentations included chronic diseases, aging, obesity, the health of the young and work-related problems, all of which are becoming major social issues. The presentations demonstrated how physiotherapy can make a tangible difference to counter those issues. It is therefore essential for all physiotherapists to understand these problems and support continued research and development into the efficacy of our interventions.

In conclusion it was acknowledged that if physiotherapy were simple enough to do everything by following clinical practice guidelines then we would be a vocation and trade like motor mechanics. There would be no need for clinical reasoning and patient interaction. It is our clinical reasoning that sets us apart and gives us a significant point of difference from other providers of exercise based rehabilitation.

Everyone agreed at the Congress we cannot continue practising the same way. Physiotherapists must drive change and be leaders in the wider health sector and ensure we are fully equipped to handle the very different environment in which we will be working in the future.

Gill Stotter

President Physiotherapy New Zealand
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