In our previous blog we explored some of the guiding principles for developing early years practitioners in the field of strength and conditioning. In particular we gave more detail on the importance of leading by example, effective communication and optimal challenge and support for the individual. More specifically, we highlighted the importance of creating a rich learning environment to support employability moving forwards. This blog will explore the experiences of our graduate physiotherapist reflecting on their experiences and thoughts on the transition from university study to clinical practice.
Having recently graduated from university and started my first job as a qualified physiotherapist I have had a chance to reflect upon what I have studied, my placements and now, the real world of work. What I have noticed the most, is the vast difference between what we are taught at university, the treatment that is delivered on placement, and that delivered in a private MSK sports injuries clinic.
One four-week placement I completed was in a rheumatology outpatients’ clinic where virtually every patient was treated with Megapulse, a form of electrotherapeutic modality which works with pulsed shortwave therapy. It was used without consideration of the evidence for this modality on rheumatology patients. In reality, the evidence does not support its use in rheumatology patients and the evidence that does support its use in general is not reliable, as it was not done in a way that allowed for conclusive results. This fundamentally means that their treatment was not based on the evidence. What was more surprising was that even when no results were seen week after week, this treatment was still used on these patients. I wonder why some therapists do this?
We have all treated what we see when a definitive diagnosis is not clear, however, being critical of your diagnosis, treatment and outcomes is essential. So, what does being critical mean? Evidence based practice allows this critique but what does that actually mean? The term evidence-based practice (EBP) has been developed from the term evidence-based medicine, and a commonly used definition is the conscientious, explicit, and judicious use of current best evidence in making decision about the care of individual patients (Sackett et al. 1996). The definition suggest that a practitioner must integrate the best research available, their clinical experience, and most importantly, patient choice. In theory, theory and practice are the same, in practice they are not!
If you treat the symptoms and it resolves, it does not mean that then you can diagnose based on the response to a treatment and vice-versa. We must all ensure that we do not cut corners in diagnosis of conditions by having a hypothesis based on bias which is inevitable sometimes. Being biased by a previous experience, a recent course or paper you have seen, or a pre-diagnosed patient is normal, but it our responsibility to challenge these preconceptions and rule out any other possible condition rather than test things that support this hypothesis.
There are an awful lot of special tests that are used in diagnosing conditions, but we have been finding more and more that many of them are not reliable in diagnosis or ruling in or out conditions. Using clusters of specific tests has been found more valid but even so, you must select the right cluster based on the evidence. This is a task that takes some research and time, but allows for practice to be meaningful making it worth the time.
As a physiotherapy department at Millfield Institute of Sport and Wellbeing (MISW), we want to ensure that the diagnosis, practice and treatment is all based on the most current evidence. Our aim is to support our treatment with facts and evidence and ensure we are offering the most effective and purposeful treatment techniques. Most importantly, we offer this information to our pupils to allow them to make an informed choice on their treatment pathway. We use testing to explain results and return to play protocols to pupils and this allows them to be on board with our joint decision making and trust our judgment and in turn allows a better rapport with pupils and greater compliance. We must remember we are not all-knowing and that we need to ensure we are critical of evidence presented, but most importantly, be critical of ourselves. In practice, it is the ability to balance theory and practice to optimise the best outcome for the pupil.
Millfield Institute of Sport and Wellbeing 