Tidy's Physiotherapy E-Book

Stuart Porter

• Publisher: Churchill Livingstone
• Year: 2013
• ISBN:
  9780702049491
• Edition: 15
• Topic: Medicina
• Subtopic: Fisioterapia, medicina fisica e riabilitazione

A classic textbook and a student favourite, Tidy's Physiotherapy aims to reflect contemporary practice of physiotherapy and can be used as a quick reference by the physiotherapy undergraduate for major problems that they may encounter throughout their study, or while on clinical placement. Tidy's Physiotherapy is a resource which charts a range of popular subject areas. It also encourages the student to think about problem-solving and basic decision-making in a practice setting, presenting case studies to consolidate and apply learning.

In this fifteenth edition, new chapters have been added and previous chapters withdrawn, continuing its reflection of contemporary education and practice. Chapters have again been written by experts who come from a wide range of clinical and academic backgrounds. The new edition is complemented by an accompanying online ancillary whichoffers access to over 50 video clips on musculoskeletal tests, massage and exercise and an image bank along with the addition of crosswords and MCQs for self-assessment.

Now with new chapters on:

• Reflection
• Collaborative health and social care / interprofessional education
• Clinical leadership
• Pharmacology
• Muscle imbalance
• Sports management
• Acupuncture in physiotherapy
• Management of Parkinson's and of older people
• Neurodynamics

Part of the Physiotherapy Essentials series – core textbooks for both students and lecturers!

• Covers a comprehensive range of clinical, academic and professional subjects
• Annotated illustrations to simplify learning
• Definition, Key Point and Weblink boxes
• Online access to over 50 video clips and 100's of dowloadable images (http://evolve.elsevier.com/Porter/Tidy)

• Online resources via Evolve Learning with video clips, image bank, crosswords and MCQs! Log on and register at http://evolve.elsevier.com/Porter/Tidy
• Case studies
• Additional illustrations

Chapter 1

The responsibilities of being a physiotherapist

Ceri Sedgley

Introduction

This chapter provides an insight into what it means to be a physiotherapist and a member of the physiotherapy profession in the United Kingdom.

The chapter explores the development of the profession and how physiotherapy acquired the privileges and responsibilities of autonomous practice, and explores the consequences of that for contemporary professional practice.

Finally, the chapter considers how the changing shape of health services in the UK and society's increasing expectations of health professionals to deliver safe, high-quality health services within finite resources and which patients can trust are shaping physiotherapy practice. The ways in which physiotherapists can demonstrate the quality of both, practice and service delivery, through clinical governance, play a vital role and this is also discussed.

The term patient has been used throughout this chapter to describe the individual to whom physiotherapy is being delivered. It is recognised that at times the term service user is more acceptable for some groups to whom physiotherapists provide intervention, e.g. in illness prevention. The term physiotherapist has been used throughout the chapter, but it is recognised that the chapter will also be of relevance to students and support workers, and others involved in delivering physiotherapy services.

Background to the chapter

Tidy's Physiotherapy has been a key text for physiotherapists over the years. Earlier editions have provided prescriptive descriptions of what physiotherapists should do in particular situations or for specific conditions. This prescriptive approach has become less relevant to the delivery of contemporary healthcare and recent editions of this chapter have demanded critical thinking from the reader. This reflects the development of the profession and the diversity of roles and settings physiotherapists deliver services within, both alone and within teams, providing healthcare for a diverse range of conditions. This change has been reflected in the education of physiotherapists focussing on developing analytical and clinical reasoning skills individualised to the patient.

No two patients, clinical situations or professional roles are the same; each requires the physiotherapist to use their skills and knowledge to determine the most appropriate action. In a clinical situation, physiotherapists must use their skills and knowledge to carry out a full and accurate assessment and, using clinical reasoning skills and considering the individual patient, offer appropriate options for management. Throughout the decision-making process the patient should be educated and informed of the options available, and be given the opportunity to participate fully in their management. This includes consideration of the indication for managing the patient in physiotherapy, discharging them or referring them on. The responsibility for this decision-making process lies with the physiotherapist and the physiotherapist is accountable for this decision, hence the dichotomy of autonomy as both a privilege, i.e. the ability to act independently, and a responsibility, i.e. having accountability for the decisions made.

Accepting the responsibility requires maturity and an understanding of the implications of this responsibility. The individual physiotherapist must also understand the concept of scope of practice, competence, and the individual nature of scope (CSP 2008). An individual's scope will change throughout their career and competence must be maintained through career-long learning, through self-evaluation of both the physiotherapist's learning needs and the service required, for example, maintaining currency with the most effective interventions. This commitment will maintain the trust of the patient and the public in both the individual and the profession.

History of the physiotherapy profession

This section provides an overview of the development of the physiotherapy profession with a particular focus on the development of autonomy and regulation of physiotherapy. An overview of the early days of the profession can be found in the book In Good Hands (Barclay 1994). Further references may be found in The History of the Physiotherapy Profession (CSP 2010), which provides an insight into the development of autonomy and, subsequently, scope of practice.

The Chartered Society of Physiotherapy (CSP) was founded in the UK in 1894, under the name of the Society of Trained Masseuses. It was established as a means of regulating the practice of ‘medical rubbers’. For many years, doctors governed the profession and one of the first rules of professional conduct stated ‘no massage to be undertaken except under medical direction’ (Barclay 1994). The Society used the opportunities created by developments in medicine and technology, and the demands of war to extend its manual therapy skills, and to add exercise and movement, electrophysical modalities and other physical approaches to its repertoire during the early years of the twentieth century (Barclay 1994). This scope of practice, which was legitimised by a Royal Charter in 1920, remains the hallmark of contemporary physiotherapy practice (CSP 2008).

Physiotherapy continued to evolve and consolidate its position during the 1930s and 1940s. This was achieved through ongoing patronage of the medical profession and recognition of physiotherapy's contribution to society's health and well-being. The development of the Welfare State during the 1940s created opportunities for physiotherapy to apply and develop its practice across a growing range of medical specialisms (Barclay 1994). Physiotherapy training moved into hospital-based schools during 1948, which effectively meant that newly qualified physiotherapists were prepared for practice in National Health Service (NHS) hospitals. Over time, the NHS became the primary employer of physiotherapists.

Physiotherapy's quest for self-regulation during the 1950s was quashed by the medics who had effectively established control of its practice through sustained involvement in the CSP's governance structures and ongoing patronage. Following intense lobbying by physiotherapy and other healthcare professions, the Council of Professions Supplementary to Medicine (CPSM) opened a physiotherapy register in 1962 which represented a shift in the power of medicine over physiotherapy. Despite the introduction of state regulation, doctors continued to assert full responsibility for patients in their charge, arguing that ‘professional and technical staff have no right to challenge his views; only he is equipped to decide how best to get the patients fit again’ (Barclay 1994).

It took more than 80 years for the physiotherapy profession to progress from the paternalism of doctors, on whom physiotherapists were dependent for referrals. The first breakthrough came in the early 1970s, when a report by the Remedial Professions Committee, chaired by Professor Sir Ronald Tunbridge, included a statement that, while the doctor should retain responsibility for prescribing treatment, more scope in application and duration should be given to therapists. The McMillan report (DHSS 1973) went further, by recommending that therapists should be allowed to decide the nature and duration of treatment, although doctors would remain responsible for the patient's welfare. This recognised that doctors who referred patients would not be skilled in the detailed application of particular techniques, and that the therapist would therefore be able to operate more effectively if given greater responsibility and freedom.

Eventually, in the 1970s, a ‘Health Circular, Relationship between the Medical and Remedial Professions’ was issued (DHSS 1977). This acknowledged the therapist's competence and responsibility for deciding the nature of the treatment to be given. It recognised the ability of the physiotherapist to determine the most appropriate intervention for a patient, based on knowledge over and above that which it would be reasonable to expect a doctor to possess. It also recognised the close relationship between therapist and patient, and the importance of the therapist interpreting and adjusting treatment according to immediate patient responses, thus securing professional autonomy. This autonomy brought responsibilities and the ongoing need for physiotherapists to demonstrate competence in decision-making, building up the trust of doctors and those paying for physiotherapy services. This was reflected in the inclusion of skills of assessment and analysis as a key component of the qualifying curriculum introduced in 1974.

Two years after gaining professional autonomy in 1977, and supported by the shifts in physiotherapy education towards polytechnics, the CSP opened the debate on all-graduate entry – an identity traditionally associated with professions (Tidswell 1991). All-graduate entry was finally achieved in 1994 following considerable debate about how degree status would benefit patients and ensure the ongoing development of physiotherapy practice (Tidswell 2009).

In 1996 delegation of activities to healthcare practitioners, including some medical tasks, was facilitated by the document ‘Central Consultants and Specialists Committee: Towards tomorrow – The future role of the consultant’ (Marriott 1996). The content of this report, together with the political drivers to contain healthcare service costs and maximise productivity, created new opportunities for physiotherapists to develop new skill-sets to undertake tasks that were previously the domain of medicine. These ‘extended’ roles were typically found in musculoskeletal medicine: physiotherapists working alongside doctors triaging patients on the waiting list or providing ongoing medical management of people with long-term conditions. Over time, these roles shifted into other medical specialisms, such as neurology, respiratory care and women's health – evidence of the clinical- and cost-effectiveness of this model of practice.

Towards the end of the 1990s, conc...