Physiotherapists and fitness professionals often behave like neighbours who never speak: existing side by side, sharing common ground and just occasionally crossing paths.
The two professions tend to act independently, in relative isolation from each other, often skirting around an element of tension over who holds the professional lead on exercise therapy.
Until now, perhaps, when circumstances are calling for a closer friendship to be formed.
‘NHS expenditure is currently unsustainable,’ says Dr John Searle OBE, chief medical officer of the Fitness Industry Association (FIA), ‘but with exercise we have identified a tool to reduce it.’
Evidence shows that exercise is a vital component in both the prevention and treatment of many health conditions.
Yet, despite the unequivocal research base, healthcare professionals are not always sure how to take advantage of it. Exercise is passively promoted, but practical pathways for active referral remain unclear.
Glenn Withers, chair of the Association of Chartered Physiotherapists in Exercise therapy (ACPET), believes the solution is for physiotherapists to foster a more formal relationship with the fitness industry.
‘If a physio refers someone to a consultant they will always write a letter. But I see many physios sending people to gyms without any communication.
No letter, no talk-through about the client and no discussion about what their needs are. We really need to start engaging in a referral process with the fitness sector,’ says Glenn.
To this end, the CSP and the FIA set up a joint working party in 2009. The group is currently drawing up referral guidelines, designed to bridge the gap between the two professions and promote appropriate referrals from the medical community.
The resulting guidelines should provide a useful resource for both parties, leading to greater clarity and understanding.
Dr Searle, who sits on the working party, believes that there is ‘much to be gained’ from the CSP and FIA working together.
He hopes the guidelines, due to be published in March, will provide a catalyst for change. However, he emphasises the importance of a collective effort at the grassroots level.
‘Physiotherapists and fitness professionals at the coalface need to begin to talk to each other and work together,’ he says.
Collaboration is already occurring in a number of places, such as wellness centres, where GPs, physiotherapists and fitness professionals all work together.
Similarly, gyms and leisure centres often employ in-house physiotherapists or have close ties to local practitioners.
The Register of Exercise Professionals also receives regular enquiries from physios who are interested in signing up or training as instructors.
Emma Elstead is a physiotherapist for Premier Health and Sports Therapy, a network of clinics located in gyms throughout London. She works closely with gym staff and says ‘it works really well’.
Her team provides advice to fitness instructors, enabling them to take over patients’ rehabilitation. They also carry out full functional movement assessments for people embarking on exercise programmes.
‘We work closely with personal trainers who bring their clients to us for a full musculoskeletal assessment,’ she says.
‘We pick out any muscle imbalances or areas of dysfunction so they can work specifically on those and prevent injuries occurring.’
Glenn Withers, who also sits on the CSP/FIA joint working party, backs the increasing number of physiotherapists who deliver preventive injury programmes as well as rehabilitation.
‘Given the changes in public-health policy, physios with an interest in exercise really need to make sure that they are skilled enough to be at the forefront of exercise, in whatever form that might be,’ he says.
Vicky Johnston, specialist physio in falls prevention at NHS Great Yarmouth & Waveney Community Services, deliberately forges strong links with the fitness industry, liaising with gyms, leisure centres and exercise groups to find appropriate provision for her patients.
‘My experience of working with exercise instructors has largely been positive, but I think it is reliant on making good links, communication and joint working,’ she says.
Vicky recommends arranging face-to-face meetings, becoming familiar with how a class is run and setting up a constructive two-way dialogue about patients.
‘It’s about being able to break down barriers, just by saying “Come and see what I do and I’ll come and see what you do I’ve got a few people I might want to send your way”.’
Occasionally, in complex cases and always with the patient’s consent, she will write a letter to a fitness instructor on a patient’s behalf. Vicky says this allows her to share in-depth information and communicate important details.
This is precisely the approach the CSP/FIA joint working party hopes to encourage.
Glenn Withers explains: ‘It’s just a simple matter of saying “This is my client, these are the issues I’m working on, these are the issues I would like you to work on if you’re not happy then please send them back to me at any time”.’
As well as the referral guidelines, the CSP is also exploring other avenues of collaboration.
Clare Claridge, CSP professional adviser, says: ‘We are also working with the fitness industry as part of the Move for Health initiative, which aims to support members to incorporate preventive and public-health measures, in particular the promotion of physical activity, into their physiotherapy practices.’
Also, it has recently been announced that the CSP will be formally represented on the joint consultative forum of the medical royal colleges and faculties and the fitness sector. As a result, the CSP will have an active role to play in producing standards on exercise referral for the Department of Health. This is an excellent opportunity for the CSP to highlight the benefits of physiotherapy, especially in light of the radical reforms to NHS structure that will see primary care trusts replaced by GP consortia.
Glenn Withers is looking forward to the publication of the CSP/FIA guidelines. Bolstering relationships between the two professions is likely to benefit both groups. Not only will it ensure a higher quality of client care, it will also enhance awareness of the specific skills and expertise that each profession has to offer.
‘The most important thing is getting the best for the client,’ he says. ‘We have to keep hold of that and not be blinded by protecting our caseloads. Instead we need to ask what is in the best interest of the client and who is the best person to do that?’ fl
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