J O U R N A L O F T H E C H A R T E R E D S O C I E T Y O F P H Y S I O T H E R A P Y

14 BEDFORD ROW, LONDON WC1R 4ED. TELEPHONE 01-242 1941 FAX 01-831 4509

FEBRUARY 10, 1990 VOLUME 76, NO 2

CSP Calls for Resolution to Ambulance Dispute The Chartered Society of Physiotherapy

has called for an end to the ambulance dispute in order to save further suffering for patients.

The CSP says that a settlement must be negotiated as soon as possible. Many whom physiotherapists treat in out-patient departments have, at best, been inconveni- enced by the dispute; at worst, they have missed treatment altogether.

Elderly patients in particular are not getting to day hospitals for treatment in some areas, while stroke patients and amputees are also missing out on regular rehabilitation.

The skills and expertise that ambulance

staff bring to their out-patient work have been sadly missing during the dispute, says the Society. While taxi-drivers and volunteers have done their best to transport people to out-patient departments, they do not have the technique and knowledge of trained ambulance staff.

Although physiotherapists are among the majority of NHS staff whose pay is decided by an independent third party, namely a Pay Review Body, they sympathise with ambulance crews who are having to cam- paign hard for a decent pay increase. The CSP’s sole interest in calling for a speedy settlement is to prevent further disruption to out-patient care.

Health Care Professions Concerned about Government Education Plans

The recently established Forum of Health Care Professional Organisations has expressed its collective concern about the Government’s policies on professional education and training.

Serious concern is centred on the National Health Service Review, Working Paper 10, which delegates responsibil i ty for professional education and training to Regional Health Authorities. The Forum

believes very strongly that the devolution of this responsibility to individual employers is inefficient and will cause adverse effects on patient care.

It is also convinced that standards and levels of care will vary across the country and that research will suffer from a lack of funding. The Forum feels so strongly about this important topic, that it is seeking an urgent meeting with Virginia Bottomley, the Minister of Health, to register its serious concerns and seek to persuade the Government to revise its proposals.

Centenary Miss Liliam Whitham MCSP of Chipping

Norton celebrated her hundredth birthday on December 11.

After working as a schoolteacher, Miss Witham spent many years nursing her sick mother before training as a physiotherapist at St Thomas‘ Hospital and passing the conjoint examination in 1924 at the age of 34.

Originally from Yorkshire, Miss Witham was a private practitioner in London. She moved to Castle View home for the elderly in Chipping Norton 12 years ago.

STOP PRESS!

Pay Review Body Award

Announced

See page 89.

Mothers Mean Money In accordance with the White Paper

encouragement to health authorities to become income generating, North Tees Health Authority has commissioned two videos collectively titled ‘Mums in Shape’.

They were produced under the auspices of Mrs Joyce Wise MCSP, manager of physiotherapy services, and Dr S Walton, senior consultant obstetrician. They show a series of exercise routines suitable for pregnant women and new mothers.

The firm which produced the videos, Quay Productions, is distributing publicity to at least 75% of the women who will be giving birth this year.

It is hoped to publish a review of these videos in a future issue of Physiofherapy. Further videos in the series are planned, on subjects such as back pain, giving up smoking and dealing with stress.

Science for the Remedial Professions Degrees

The following students have completed over several years the BSc and BScHons degrees course in Science for the Remedial Professions at the Polytechnic of Central London:

First class honours: P Collinson. Upper second class honours: S A Jessop,

Lower second class honours: D J Allan,

Pass: W L Close, S Crewe-Smith, G E

R M A Lillie.

S McGhee, D F Minden.

Watkins.

CSP Validated Course Successes The Bath Hydrotherapy Course November 1989

H Arneill, G Buckley, S Gurden, H Lee, R Lochhead, K McKay, M Nicholson, M O’Dwyer, S Emley.

Physiotherapy, February 1990, vol76, no 2 81

&- fi NATIONAL PHYSIOTHERAPY

19 -24 March 1990 With just over a month to go to NPW, we

thought it would be usefu to remind you of the publicity material available and how it can be used.

Don't forget to let Lynn Duxbury in the Public Relations Department know about the events you are planning. We hope t o draw up a comprehensive list of activities throughout the UK for our national press pack.

Remember to take photographs of your events to send to local newspapers and do let the PR Department have copies. We hope to publish the best, and a synopsis of what happened during the Week will appear in the April Journal.

Good luck with all your activities during N PW.

Posters

We now have a range of posters for use in the run up to and during NPW. They are:

Blank posters - for use in advertising, meetings, events and week activities. Or even to count down the weeks/days.

Logo posters - advertising the Week generally. A2 extra large. A3 large. Eddie Edwards - general poster promoting physiotherapy.

Careers posters 1 Physiotherapist with elderly person. 2 Physiotherapist with children. 3 Physiotherapist working with student. 4 Physiotherapist with physiotherapy student (Danny Thomas, ex-football star).

NPW celebrity poster - showing some of the celebrities who have agreed to be patrons of the Week.

A5 NPW leaflet - for the general public, explaining who physiotherapists are, where they work, what they do and whom they treat.

Lapel stickers - for decorating stands, noticeboards, letters, envelopes and the public during NPW. Six to a sheet.

Balloons - for stand decorating, balloon races, giveaways to children and general p~iblic. Packs of 250.

Adwce Leaflets

There is a range of preventive advice leaflets available for distribution to the general public. They are free of charge but are limited to a maximum of 250 of any one leaflet.

Ski-wise - for those taking to the slopes. Take the Stress Out of Driving - for drivers. Take the Strain Out of Gardening - for both amateurs and professionals. Keep Fit for Work - for office workers.

Audio-visual Aids

'Physiotherapy - Taking care of you and your family' - tape/slide presentation. 'Physiotherapy - A career in a caring profession' - video.

Both are available on loan, free of charge, from the CSP Public Relations Department.

Unforeseen Delay Apologies to all those who ordered

medium and large CSP sweatshirts. The original batch was quickly snapped up and we had problems obtaining further supplies of the same quality. You should, however, have received any outstanding orders by now.

If you want any of the above materials for National Physiotherapy Week, please contact the PR Department at the CSP. The sooner we have your order, the sooner it will be dispatched. We cannot dispatch goods after Friday March 9, as we can't guarantee delivery in time for the Week.

Bursaries in Thames Region Education bursaries are available for

qualified nurses and pi-ofessionals allied to medicine working in the Thanes Regional Health AU t ho r it ies.

Bursaries of between f 100 and f1.000 are offered to individuals wishing to pursue their professional developmeiit beyond basic training through either a recogniscd course or a systematic period of study.

For further information please send a stamped addressed envelope (about 12 in x 9 in) to Christine Davies at the King's Fund Centre, 126 Albert Street, London NW1 7NF.

The Volvo Award for Low Back Pain Research 1991

In order to encourage research in low back pain, the Volvo Company of Goteborg, Sweden, again this year has sponsored three prizes of USS9,OOO each. Awards will be made competitively on the basis of scientific merit, in one or more of the following three areas:

1. Clinical studies. 2. Bioengineering studies. 3. Studies in other basic science areas.

Papers submitted for the contest must contain original material, not previously published or submitted for publication. A multiple authorship is acceptable. The manuscripts should be in the form of a complete report, including original illustrations, not exceeding 30 typewritten pages, double-spaced, and in a form suitable for submission to a scientific journal. One original and five copies of each paper submitted in full should reach the address given below not later than November 30, 1990.

One of the authors should be prepared, at his own expense, to go to Heidelberg, West Germany, at the time of the meeting of the International Society for the Study of the Lumbar Spine, May 13-16, 1991, to present the paper and to receive the award.

The board of referees will contain members from the fields of clinical medicine, bioengineering and biochemistry.

All correspondence should be addressed to Professor Alf Nachemson, Department of Orthopaedics, Sahlgren Hospital, S-413 45 Goteborg, Sweden.

3ODUCED BY TORBAY SUB-BRANCH. CSP

Torbay Poster Torbay sub-Branch has designed a special

Doster for National PhvsiotheraDv Week . . (shown left). It is available nationwide in two sizes:

A4 - 5p each (white and assorted colours)

A2 - 60p per copy (white only) A 4 is about the size of one Daae of this Journal, A 2 is four times as big-

Post and packing costs €1.50, orders for more than 100 all post free. Cheques should be sent with orders, payable to 'Torbay Sub- Group CSP', c/o Physiotherapy Department, Torbay Hospital, Lawes Bridge, Torquay, South Devon. Orders should arrive by March 1.

Left: Complete poster

Right: Detail (from bottom right corner)

82 physiotherapy, February 1990, vol76, no 2

LEGAL WORK PACK Legal Issues from The Chartered Society of Physiotherapy

With the development of the autonomy of the physiotherapy profession and the increase in l it igation, members have increasingly been involved w i th the legal process in a variety of ways. The Society has become increasingly aware of this through inquiries to its Industrial Relations and Professional Affairs Departments. This resulted in a factsheet 'Reports for Legal Purposes' which was produced by the Professional A f fa i rs Depar tment in November 1988

However, the range and complexity of cases using the expertise of physiotherapists continues to increase. A small group of physiotherapists w i th a range of 'legal' experience convened by Mrs Pippa Sage has therefore set about pooling their knowledge and experience. With legal advice they have put together a set of sheets which cover the legal situations with which physiotherapists have had to deal.

This legal work pack gives information to members on how to deal w i th solicitors' letters, be a witness of fact and an expert witness. It gives information on writ ing reports, appearing in court, fees to charge and a glossary of terms that members may encounter within the legal arena. Sections of the pack wil l be updated as necessary when relevant changes in the law or other changes occur. The cover is illustrated here.

This pack was introduced t o a group of senior physiotherapists across all areas of physiotherapy at a seminar in November 1989. The response was extremely encouraging and w i th a few amendments, this pack is now offered to members to

purchase at f 5 per pack plus updates for t w o years, or €40 for ten copies. This is available from Mrs P Hall, Professional Affairs Department, The Chartered Society of Physiotherapy, 14 Bedford Row, London WClR 4ED. Cheques should be made payable to 'The Chartered Society of Physiotherapy'.

The expertise of the sub-group which produced th i s pack, w i t h Penelope Robinson, director of the Professional Affairs Department, is available to members who become involved w i th legal cases and it is

1990 Congress Plans Well in Hand

hoped gradually to build up a network of members w i th this expertise. However, members are requested in the first instance to contact Mrs Robinson, who will be able to put one member in touch with another if appropriate.

If Branches or other groups of physio- therapists wish to discuss the pack or surrounding issues, members of the sub- group would be willing to meet them - requests should be addressed to Mrs Robinson.

The Society also wishes to produce a register of physiotherapists w i th expertise in legal work, either as witnesses of fact and/or expert witnesses including those giving information on compensation as well as negligence. Members who have such expertise and are willing to assist members new to this work are also asked to contact Mrs Robinson.

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Members Can Be Even Better Informed!

Two new leaflets mark the start of a campaign to ensure that members are better informed about their Society.

'Services for Members' and 'Rules of Professional Conduct' are designed to give information about the CSP in a simple, concise but eye-catching format. The next one in the series will be about professional liability insurance and future leaflets will cover such topics as the interpretation of specific Rules.

The new leaflets are available from the Professional Affairs Department (Rules) and the Membership Department (Services) at the CSP.

Plans are well in hand for this year's Annua l Congress in Bournemouth, September 27-29.

This year's Founders' Lecture will be given by Robin McKenzie FNZSP, while keynote addresses wil l be given by Elizabeth Condie MCSP, lecturer at the National Centre for Training and Education in Prosthetics and Orthotics at Strathclyde University; Christine Hancock, general secretary of the Royal College of Nursing; and Pat Davies MCSP.

The 1990 theme is 'Forward to Basics'. The Founders' lecturer and keynote speakers will cover some of the main areas of practice today and in the past, namely musculo- skeletal, neurology, disability, and the relationship between physiotherapists and nurses in the new NHS.

Each main address wil l be followed by discussions in workshops and other speakers on the same theme. It is also hoped that members will bring controversial views on professional and clinical issues to the Congress for discussion in small groups. For example, the role of massage in physio- therapy today, arguments for and against the Pet0 approach, different approaches t o lifting and handling training, and so on.

There wil l be a stimulating and varied social programme, which wil l include a pre- breakfast dip in the sea followed by buck's fizz, a Congress disco, a Congress dinner, receptions and pub outings.

Following the success of last year's Representatives Conference, when over 50

motions were debated, we hope you are already looking forward to making a con- tribution to this year's conference. That means thinking of good motions now, discussing them in your Specific Interest Groups and Branches, submitting them on time, and attending the conference to speak. If you are considering becoming a voting delegate, do remember that there wil l be 'training workshops' for you this summer.

Chartered Society of Physiotherapy Representatives Conference 1990

This year's conference will be held on Friday and Saturday, September 2 8 and 29, during the Bournemouth Congress. Barbara Edmonds was elected chair for 1990 by last year's conference and Margot Hawker and Mandy Squires were elected vice-chairs.

Full details of how to put down motions and how to nominate representatives as well as other information about the conference are available from the secretaries of Boards, Branches and Specific Interest Groups, the Students Board and Regional groups of students, Regional stewards, and from Harriet Barlow at the CSP office.

This information has also been sent t o Branch and Group chairmen w i th a leaflet on drafting motions.

Motions and names of representatives should be sent to the CSP secretary by May 2 7 at the latest.

NI Insignia for OCPPP Chairman Mrs Jean Christie MCSP, Northern

Ireland's regional officer of the Organisation of Chartered Physiotherapists in Private Practice, and chairman of its regional committee, was presented w i th her insignia at a ceremony in the Belfast Europa Hotel.

The insignia represents Northern Ireland enclosed in the 'caring' hands of a physio- therapist arid was sponsored by the Northern Ireland Electricity Service for which many local OCPPP members have provided services.

Guest of honour at the presentation ceremony was Mrs Margaret John MCSP, president of OCPPP.

Above: M r s Christie wearing the new insignia at the Belfast ceremony

physiotherapy, February 1990, vol76, no 2 83

Groups Association of Chartered Physiotherapists

in Psychiatry: Has your membership lapsed? Subscriptions were due on October 1. Please send yours (f 7.50) to Mrs S Steele MCSP, Membership Secretary, ACPP, Bangour Village Hospital, Broxburn, West Lothian, Scotland.

Next year the subscription has to be increased to €10 (€15 overseas membership) but this will be allowable against tax.

Association of Chartered Physiotherapists in Sports Medicine: Annual membership subscriptions were due on January 1. Will all members who have not yet paid their subscription please send a cheque for f10, payable to 'ACPSM', to Mrs L Daley, Membership Secretary, 119 Douglas Road, Long Eaton, Nottingham NG10 4BE.

Organisation of District Physiotherapists: Officers elected at the AGM are: president, Diane Robinson [Oxfordshire); vice- president, Nancy Goldthorpe (Harrogate); honorary secretary, Sue Barrel1 (West Surrey and North West Hampshire); honorary treasurer, Ann Cox (North Lincolnshire); and honorary PRO, Jean Alvis (East Dorset).

Riding: The Chartered Society of Physiotherapy, Specific Interest Section, Riding for the Disabled has changed its name on becoming a Clinical Interest Group to The Association of Chartered Physiotherapists in Riding for the Disabled or ACPRD.

The chairman is Mrs Elizabeth Mitchell, 42 Tandle Hill Road, Royton, Oldham OL2 5UX. The secretary is Miss G M Walker, The Orchard, Broadlands, Lower Paice Lane, Medstead GU34 5PX.

Please contact either of the above officers for more information.

Epidermolysis Bullosa Study Fiona Mullett MCSP of The Hospital for

Sick Children, Great Ormond Street, returned from her Winston Churchill Travel Fellowship at the beginning of 1990. She had studied treatment of epidermolysis bullosa in the USA. As patients with this condition often develop severe deformities of the hands, she looked at hand therapy in three of the five centres she visited - Harmaville Rehabilitation Centre; Pittsburgh; The Hand Care Centre of Indiana, Indianapolis; and the Hand Surgery Unit, Louisville.

While at Rockefeller University, New York, and Stanford University, San Francisco, Fiona was able to exchange ideas on man- agement of this disorder. Clinicians were able to share views and establish good communication allowing future research and developments in this area to be passed on more easily.

Long-term Benefits of McKenzie Approach

MADAM - I read with considerable interest the article entitled 'A perspective qn mani- pulative therapy' by Robin McKenzie in your August 1989 issue. As an orthopaedic surgeon who has utilised Mr McKenzie's techniques for the past ten years, my spinal pain patients and I have a very high regard for his assessment and treatment methods.

He has always stated that the model of disc nuclear mechanics underlying the pain behaviour that occurs so commonly is merely conceptual, although the circum- stantial evidence supporting it is substantial and growing. Nuclear response to flexion and extension compressive forces have been demonstrated in cadaver studies by Shah, Kramer and Krag and with discography studies in asymptomatic discs by Schnebel.

McKenzie's remaining explanations for pain response to repeated end-range test movements are all consistent with well- substantiated tissue responses that occur in other peripheral joints of the body.

In the past four years, at least six com- parative studies have been performed comparing McKenzie with other types of treatment for low back pain. While not all are flawless in their design, in every circum- stance the McKenzie approach shows strong superiority over its study-counterpart. Importantly, at least three studies (Nwuga and Nwuga, 1985; Stankovic, 1988; Roberts, 1989) demonstrate the long-term benefit of McKenzie in terms of fewer recurrences and/or decreased disability at the time of recurrence compared to other treatments. Other than the short-term benefits wi th manipulation, no other treatments have ever been scientifically demonstrated to be better than spontaneous recovery without treatment and no other non-operative treatment has ever been shown to have any long-term benefit.

These studies are consistent with my experience with the McKenzie approach and demonstrate its uniqueness over all others in terms of effectiveness in resolving the present episode and in preventing recurrences.

I am also in agreement w i t h Mr McKenzie's perspective that manipulative therapy creates dependency which is detrimental to the patient. Once the patient's disorder is properly analysed, the experience of abolishing pain with self-treatment is unsurpassed in effectively teaching the patients the nature of their disorder, giving them a clear understanding of how it began as well as how to prevent its return in the future.

Anything we do to patients, even though it may diminish symptoms, can create dependency and interferes with patients' understanding of the need to take responsi- bility for their spinal care in an effort to prevent future problems. This all-important point is the basis for the long-term benefits of the McKenzie approach now being demonstrated in comparative studies. The prevention of recurrences or minimising disability from them owing to the patients' abilities to self-treat avoids return to the health care practitioner.

In a subsequent letter from Jean Buswell and Kate Haswell of Auckland Institute of Technology in New Zealand, it was stated that McKenzie's approach was based on 'hypothetical dogma, marketing and zealot support'. My opinion is just the contrary: Mr McKenzie's position is the one that is best supported by the current spine literature as well as recognised mechanical pain phenomena. It is the remaining physical therapy approaches which are for the most part unfounded and without evidence of benefit.

After ten years of interaction with physicians and therapists involved in spinal care, I have found those who are not enthusiastic about their patients' response with use of McKenzie's evaluation and treatment methods are always those who are deficient in their knowledge of and experience with the approach.

RONALD G DONELSON MD Assistant Professor Spine Section Department of Orthopaedics State University of New York

REFERENCES

Krag, M, Seroussi, R e ta / (1987). 'Internal displacement distribution from in vitro loading of human thoracic and lumbar spinal motion segments', Spine, 12, 10.

Kramer, J (1981). lntervertebral Disk Diseases, Yearbook Medical Publisher, Chicago, Illinois.

Nwuga, G and Nwuga, V (1985). 'Relative therapeutic efficacy of the Williams and McKenzie protocols in back pain manage- ment', Physiotherapy Practice, 1, 99-105.

Roberts, A P (1989). 'The conservative treatment of low back pain', Unpublished doctoral thesis, University of Nottingham, United Kingdom.

Schnebel eta/ (1988). 'A digitising technique for the study of movement of intradiscal dye in response to flexion and extension of the lumbar spine', Spine, 13, 3.

Shah, Hampson and Jayson (1978). 'Distri- bution of surface strain in the cadaveric lumbar spine', Journal of Bone and Joint Surgery, 600, 246-251.

Stankovic, R (1988). 'McKenzie method of treatment versus education in 'mini back school' for acute low back pain, a controlled prospective clinical trial', Abstracts of lnternational Federation of Manual Therapy, Cambridge, United Kingdom.

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84 Physiotherapy, February 1990, vol 76, no 2