Letters to the editor.
|Article Type:||Letter to the editor|
Hermsen-van Wanrooy, Marianne
|Publication:||Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2004 New Zealand Society of Physiotherapists ISSN: 0303-7193|
|Issue:||Date: March, 2004 Source Volume: 32 Source Issue: 1|
I would like to pass comment on the invited commentary of Brian Mulligan in the November 2003 issue of the NZJP. While I would like to commend Mr Mulligan on this novel approach to manual therapy, I would question the publication of this piece given the broad outline defined in the journal guidelines.
It is stated in the guidelines that such work is to be 'scholarly'. It depends I suppose to what degree you determine the definition of this parameter, however I would suggest that given one of the main points of focus from an academic viewpoint is to examine and report such methodology while providing some reasonable rationale or argument for the findings and observed outcomes. I would also assume that the NZJP wishes to promote itself as a journal of some reasonable quality. Therefore, while Mr Mulligan does attempt to provide some explanation and rationale for his teachings, the quality of this report is unscientific in its regard and unacceptable for publication. It is not good enough to describe techniques and expound the virtues based on nonsensical or unexamined mechanisms. If there are mechanisms for treatment rationale that are valid in their application, then provide and reference them. If the journal wishes to promote itself in a more scholarly light, it is perhaps inappropriate to publish what is ostensibly a nonacademic paper in the journal. I believe the NZSP newsletter is a more appropriate forum for this level of commentary as it is written.
Jon Cornwell is obviously a scholarly man and he believes that my article was in no way scholarly. He questions that the Journal should have published my paper on these grounds even though it would prove useful to physiotherapists actually treating patients. He said that what I wrote was nonsensical. The Oxford dictionary tells me that that means 'it was absurd', 'it surely cannot be true', 'it was foolish'. Oh dear! Really condemning! I cannot believe that if this was so he should have suggested it should have even been published in a local newsletter. Surely in that case it should not have been written. Our Journal has increased in stature in recent years and to have included my 'unscientific', 'absurd', 'foolish' article was wrong?
I think not.
On a more serious note I would suggest that Mr Cornwell forget the fact that he had read my article in our Journal. I can assure him that of all the approaches I have learned from others or discovered for myself, this shoulder girdle technique really was something to write about. It must somehow be shared with therapists at the workface and I am, and patients will be, thankful that the Journal printed it. I would also suggest Jon Cornwell read the article again as a clinician, learn to apply the techniques within with skill on patients, and then use his intellect to scientifically justify the outcomes he will get. That would be truly wonderful not only for me and the profession, but for the patients who must not be denied this treatment.
As an aside, when teaching, I have always state we must have some proof that what we do is effective and this would apply to the technique in my article.
What I can offer is clinical proof.
1. Patient proof. I prove to the patients that what I do is effective. (This tops the list because a satisfied patient will not only return if they have any other problems but will also recommend physiotherapy to others.)
2. Proof to colleagues. I find it easy to prove to colleagues that what I do can be spectacularly effective. In the UK, three years ago, I had an international audience of about 350 who witnessed what 'Mobilisations with Movement' (MWMS) could do on patient after patient. Three months later I had three two hour workshops in the USA with over 750 in each. Every patient that I treated, bar one, responded well as predicted. In total I would have treated over 50 people at this conference. Yes I believe I proved to every manual therapist in the audience that what I had to offer was effective.
3. Scientific Proof. I tell participants that I have made my contribution by adding to the list of treatment skills that we have to offer. I have proved to patients and to colleagues who have witnessed outcomes on patients what the techniques have to offer. I now expect the academics to apply themselves in the appropriate scholarly way and scientifically justify what we do.
If clinicians do not come up with new approaches that make us even more effective, then our profession will stagnate and die. That is why I feel (especially at my age) that I should share new and exciting measures with as many colleagues around the world that is possible. The odd article, like mine, appearing in a scholarly journal would not denigrate that journal unless the journal was produced and read only by the academic and was not for the clinician.
If he does a literature search he will find that the techniques of mine like Mobilisations with Movement are being taken seriously and are being taught seriously worldwide. My web page www.bmulligan.com. will be of assistance. Hopefully Mr Cornwell's letter and my reply should make the readers re-read the article and make a concerted effort to master the techniques. I can assure you that as a result patients will benefit, which was the reason for printing it in the first place, and that it will enhance the public perception of our profession in the long term. If the article had been published in a local Newsletter that would have denied access to the treatment in other parts of the globe.
Dear Mr Cornwall Thank you for your letter, which raises two important questions for members of the Editorial Board of the NZ Journal of Physiotherapy to consider: what constitutes a 'scholarly paper'; and at what point does a manuscript cross the threshold and become acceptable for publication in the Journal, the content of which is diligently reviewed for academic rigour.
Brian Mulligan's paper was scholarly in that it asserts innovative and original practice. It describes a novel technique that may benefit patients who present with this type of shoulder pain. As such, the paper is a first step, an exploration of a clinical concept (with accompanying anatomical rationale) that needs to be developed in future publications by the examination of hypotheses and the release of robust, empirical data. It was considered suitable for publication because of this originality, because it was written by an acknowledged expert in the field, and because potential advancements in clinical practice need to be recognised and disseminated to a wide readership. There is certainly an ethical issue in allowing innovative therapies to be widely adopted without proof of efficacy--however, no-one is suggesting that this technique be free from scrutiny. Rather, this paper provides the genesis for the long, resource-intensive and somewhat complicated process to unfold. We welcome Brian Mulligan's contribution to the Journal which showcases our new 'Invited Clinical Commentary' category, and look forward to more innovative thinking from our contributors.
Honorary Scientific Editor
I would like to thank Phillipa Neads for her review of my book Babymoves, NZ Journal of Physiotherapy--July 2003. Vol. 31, 2.
I would also like to respond to her comment about the lack of referencing.
In the bibliography at the back of the book, I have referred in particular to the books of Dr Vaclav Vojta, Czechoslovakian neuro-paediatrician and Dr Emmi Pikler, Hungarian paediatrician.
Both of these researchers and writers have proven the importance of allowing babies to develop without adult assistance or, as they see it, hindrance. The references are too numerous to mention and I therefore decided to give the titles of these books. In the modern world parents or anyone can quickly go on the Internet to find out what they want about these researchers of child development. I have given readers the option to contact me should they require more detail and I am very pleased to say that already many have made use of that opportunity.
The World Health Organisation has praised Emmi Pikler for her work in Loczy, Budapest. Although there are some differences between Emmi Pikler's work and mine, due to the influence of Dr Vojta's work, I definitely use it as the basis for the treatment of all children I work with, no matter what their condition. The parents, seeing the difference in their children, when following this approach, feel upset that they have never been told about this before--hence the book.
In Europe this way of working with children is more widespread. In New Zealand I have only come across professionals in Early Childhood Education with an awareness of Emmi Pikler's philosophy and they are embracing it.
I was invited as guest of honour to a four-day specialist intensive workshop on infant and toddler development held in Auckland in August 2003. The New Zealand Childcare Association and Maureen Perry Dip Tchg (ECE) brought Diana Suskind Ed.D Senior Fulbright Scholar and specialist in the work of Dr. Pikler and her colleague Magda Gerber to New Zealand.
Early Childhood professionals and students from around New Zealand attended this workshop and left convinced of the need to change our approach to child rearing. Diana ran workshops in many New Zealand towns in the North as well as the South Island.
My book was considered to be of great value in this process of transformation.
It may be helpful to Phillipa and your readers to go back to an article published in the New Zealand Paediatric Physiotherapy Journal, July 1996, Vol. 10 No.3, on page 2. Titled: New Visions in Motor Development, B Zukunft-Huber, which I translated from German into English.
The information about hip dislocations due to side lying positions for sleeping was not referenced as this reference again was only available in German. For Phillipa and your readers: Gefahren der Seitenlage im ersten trimenon, B Zukunft-Huber, published in: Sonderdruck aus Sozialpadiatrie in der Padiatrie fur Praxis und Klinik 15, Nr. 5, 298-301 (1993) Verlach Kirchheim, Mainz, Germany.
Babymoves is the result of 30 years experience working with parents and learning to understand what they need to empower them to look at their babies with a good understanding of their development and a common sense approach. The feedback in general is of gratefulness.
Marianne Hermsen-van Wanrooy
Babymoves Treatment Centre
180 Atawhai Drive
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