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Who is harming who in Physiotherapy?

The recent lively debate in Physiotherapy surrounding the current narrative of 'harm' has perhaps made Roger Kerry's words "Will physiotherapy eat itself?" echo louder.

'Harm' has a range of definitions and thus, may be interpreted in a number of ways. This short presentation delves into the tiny amount of evidence and data behind the narrative of 'harm', and comes up with some surprising findings and a message for those purveyors of that narrative.

NOTE: The study quoted 'Lessons to Be Learned: A Retrospective
Analysis of Physiotherapy Injury Claims' from the Journal of orthopaedic & sports physical therapy volume 42 number 8 Aug 2012. is specific to the New Zealand ACC system.

The uniqueness of the data, which were derived from a no-fault treatment-claim system, precludes comparison with data from other classification systems used for adverse-reaction reporting

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Who is harming who in Physiotherapy?

  1. 1. Who is harming who? Unraveling the ‘narrative of ‘harm in Physiotherapy Alan J Taylor @TaylorAlanJ
  2. 2. Very few entered the physiotherapy profession to do harm … @TaylorAlanJ
  3. 3. Yet we keep hearing from Physiotherapists … that some physio’s are causing ‘harm’ … Really?…Why is that? … and is it true? @TaylorAlanJ
  4. 4. No one actually knows … There’s a theory that it may be linked to a frustration at the slow pace of change within the profession … but that remains a theory with only anecdotal evidence to support it. @TaylorAlanJ
  5. 5. WHAT IS … ? Well … this is the difficult bit, no one seems to know! What we do know is that: 1. There are multiple definitions and interpretations of harm 2. There is very little actual data on ‘harm’ or harmful treatments in Physiotherapy 3. Most of the claims for harm appear to be based on opinion rather than hard scientific data. @TaylorAlanJ
  6. 6. Its tough to find hard data on ‘harm’ in Physiotherapy To date, we have discovered a lot of anecdotal talk of ‘harm’, a few single case studies and a retrospective analysis of actual (defined) cases of harm from New Zealand @TaylorAlanJ
  7. 7. So what did the Kiwi audit paper have to say? Oh … the findings were more than a little surprising! TELL ME MORE …. @TaylorAlanJ
  8. 8. How did they define ‘harm’? Here’s how … Source: https://www.jospt.org/doi/pdf/10.2519/jospt.2012.3877?download=true @TaylorAlanJ
  9. 9. Here’s what they Source: https://www.jospt.org/doi/pdf/10.2519/jospt.2012.3877?download=true @TaylorAlanJ
  10. 10. The key points were: Claims filed for injury incurred during physiotherapy consultations showed that the prevalence of exercise-related injuries exceeded those of other common therapeutic options employed by physiotherapists. IMPLICATIONS: The wide range of physical therapy treatment injuries linked with exercise activities underlines the need to ensure that careful consideration is given to exercise prescription and the level of supervision. Source: https://www.jospt.org/doi/pdf/10.2519/jospt.2012.3877?download=true@TaylorAlanJ
  11. 11. Does that mean that exercise prescription is harmful then? @TaylorAlanJ
  12. 12. The short answer is NO! That is where a risk benefit analysis comes in Exercise is shown by evidence to be one of our most efficacious interventions and the risks are still relatively small OK … what have we learnt? That non evidential claims of ‘harm’ without appropriate risk/benefit analysis may be actually detrimental to our profession Choose your words carefully. @TaylorAlanJ
  13. 13. The bottom line on harm … • If a treatment or advice is not efficacious … say so (use RCT evidence). • If it is uneconomical or costly … say so (use health economics evidence). • If it is 'harmful' ... provide a definition, a measure and data, any data. • If it is 'dangerous' ... provide data and a proposed risk assessment strategy, root cause analysis or both. • Above all ... use plain English, with clear and agreed definitions. • Otherwise folks … Physio will eat itself! @TaylorAlanJ

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  • MadeleineBoots

    Jun. 13, 2019

The recent lively debate in Physiotherapy surrounding the current narrative of 'harm' has perhaps made Roger Kerry's words "Will physiotherapy eat itself?" echo louder. 'Harm' has a range of definitions and thus, may be interpreted in a number of ways. This short presentation delves into the tiny amount of evidence and data behind the narrative of 'harm', and comes up with some surprising findings and a message for those purveyors of that narrative. NOTE: The study quoted 'Lessons to Be Learned: A Retrospective Analysis of Physiotherapy Injury Claims' from the Journal of orthopaedic & sports physical therapy volume 42 number 8 Aug 2012. is specific to the New Zealand ACC system. The uniqueness of the data, which were derived from a no-fault treatment-claim system, precludes comparison with data from other classification systems used for adverse-reaction reporting

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