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Letters - 20 November 2013

Get involved now by sending your contributions by email to talkback@csp.org.uk or write to Letters, Frontline, 14 Bedford Row London WC1R 4ED.  Letters should be no more than 250 words. Frontline reserves the right to edit letters. Please ensure you include your name, address and a daytime telephone number.

Nice work explained

I would like to comment on the article in Frontline titled ‘Don’t ignore physio-led therapies in female incontinence warning’ (2 October). This highlighted the information from the National Institute for Health and Clinical Excellence (NICE) in CG171, an update on the management of female urinary incontinence, which replaces the original guideline CG40 (2006).

As the specialist physiotherapist on the CG171 guideline development group (GDG), and a member of the Association of Chartered Physiotherapists in Women’s Health, I would like to clarify a few points. CG171 was only a partial update of the original guideline.

There was no new evidence on the effectiveness of pelvic floor muscle training which would have led to a substantial change in the initial recommendations. For this reason, the section on conservative management in CG40 was not prioritised for update.

The focus of the update was on drug treatment, intravesical botulinum toxin injections, various neuromodulation treatments for overactive bladder (OAB), and surgery for stress urinary incontinence (SUI). This was to reflect new evidence for these treatments following initial conservative treatment, if the patient would like further intervention.

The new guideline makes clear that the original advice still stands, that a trial of supervised pelvic floor muscle training of at least three months’ duration should be offered as first-line treatment to women with stress or mixed urinary incontinence (UI).

Routine digital assessment of pelvic floor muscle contraction should be undertaken before the use of supervised pelvic floor muscle training for the treatment of UI.

Although drug treatment for overactive bladder is considered to be part of conservative management, this is not recommended until six weeks’ bladder training (which includes pelvic floor muscle exercises) has been undertaken.

The GDG is a multidisciplinary group of professionals who as specialists in their field of work are able to comment on the evidence collected by the team from NICE on a range of topics prioritised for the guideline update. I found the group very inclusive and we valued others’ expertise in their speciality.

Much emphasis is prioritised for inclusion in the guideline on the importance of an integrated multidisciplinary team (MDT).

The specialist physiotherapist is included each time the team is referred to, indicating the value placed upon our role.

A new recommendation in the 2013 update is that invasive therapy for OAB and/or SUI symptoms should only be offered after an MDT review. This safeguards the patient and clinician and ensures optimal treatment on an individual basis.

In summary, I am confident that the role of the specialist continence physiotherapist is recognised and valued in the treatment of women with urinary incontinence.

However, it is important to remember that we should not work in isolation but work within pathways and establish seamless care in a multidisciplinary setting.

There are many examples of good practice and with commissioning of services.

It is essential to make sure that NICE recommendations are in place in order to offer a comprehensive service.
Stephanie Knight, Airedale General Hospital

Touching response  

I am responding to your article by Gill Hitchcock from the CSP annual conference titled ‘Physiotherapy without touch is like psychotherapy without speech speaker tells delegates’ (page 14, 23 October), As a musculoskeletal physiotherapist, I passionately agree with the wise words of Chris Worsfold, who said: ‘Taking touch from physiotherapy is like taking a scalpel from a surgeon’.

We have the unique privilege of being able to communicate with our patients’ bodies with our hands, backed up with all our training and experience.

The mystery of ‘healing’ or offering the potential for positive change in a person’s system has always involved touch.

As we all know, our patients love it and feel understood.

The reverse is also true: they complain if they have been to a physiotherapist who has only given a sheet of exercises.

Sports therapists or trainers can do this but we are physios and very proud to be so.
Cas Boddam-Whetham

You’ve ADDed...

  • A member responded to a news item titled ‘Mountaineering physiotherapist teaches climbers how to avoid injuries’: Hi, I was wondering if there were any pathways that have been developed specifically for ‘Climber’s finger’ as it is becoming a recognised injury? I’m currently working as a hand therapist and this would prove helpful.
  • The following anonymous comment was added to the news item titled ’Physios key to preventing 300,000 osteoporosis-related fractures each year’: As we as physiotherapists have access to patients who could be developing osteoporosis, we could easily be flagging up good bone health and supporting this with some information about dietary calcium and vitamin D requirements as recommended by the British Dietetic Association.
  • Daniel David made the following comment on the feature article titled ‘Are you sitting comfortably’ (6 November’): This is an excellent idea and hopefully this will encourage and give guidance as to why assessment and seating is so important.  Did you find that managers of care homes needed to buy into this and understand why it is so important for both patients and from staff point of view? Can’t wait till the presentation is available for us to have a look at.
  • Jill Fisher, who helped set and chairs the Physiotherapists Care Skills Group, responded in the following way: We absolutely agree that preparation for teaching the course includes getting the managers on side. Also recognising, and addressing during the course, the particular needs of their staff following discussion with their managers and the course members.

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