Letters: 4 February 2015

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Missed opportunity

Regarding the article hemiplegia in children (page 28, 21 January), I was very disappointed to note that constraint induced movement therapy (CIMT) was not discussed.
As a treatment modality, CIMT is one of the most evidence based treatments for upper limb hemiplegia in both adults and children. Parents routinely report that therapists are often dismissive of CIMT as a treatment, or even actively discourage it with reasons such as ‘it doesn’t work’ or ‘it is cruel’. 
Such ill-informed thinking is indicative that some therapists fail to keep up to date on current research, and these misjudged comments may provide a barrier to parents seeking effective treatment for their children.
I would strongly urge all therapists involved with hemiplegic patients – children or adults – to read the growing evidence base and gain a thorough understanding of the treatment technique and the reasoning behind it.
From first-hand experience I have seen the rapid and significant results that can be gained by providing an appropriate CIMT programme. Karen Leslie, senior therapist, CIMT.co.uk

A mature view

Paul Watson’s historical overview of the treatment of pain management over the past decades rang true (page 6, 7 January).  
Since qualifying, I have searched for knowledge and understanding to improve the management of patients. I recall the advancements of electrotherapy in the 80s, excitement of McKenzie’s message after Maitland’s more passive treatments, and then the idea of neural tension proposed by David Butler et al. I attended one of Louis Gifford’s early courses, and was impressed with his message of graded exposure. I chose to be a clinician rather than a researcher or teacher, and I still find my work inspiring and learn new things from the cases I see, and my clinical skills have evolved through both experience and study. Yes, there are the ‘simple’ cases that respond to fairly basic ‘advice and exercises’, or some manual therapy. After two or three sessions they leave my clinic, happy and confident to get on with their lives.
My measure of success is that they come back when there is a new problem, as they know we solved it the last time. However, the more complex, chronic, challenging cases require extra skill in clinical reasoning, as well as a generous ‘toolbox’ of methods/techniques, and it is our search for solutions for these cases that can bring forth new ideas.
While I would not consider exploring some of the methods Paul listed, I do consider it important to keep an open and questioning mind.  
As I wrote (page 7, 19 November 2014), surely our profession is intelligent, as well as mature, enough to justify our autonomy of practice? Ingela Jacob

Taking pressure off A&E

The media have recently been full of articles detailing the stresses on A&E and GP services. One way of reducing the burden on GPs would be to allow physios the right to issue Fit notes for musculoskeletal conditions. 
I frequently encounter patients who just see their GP for either a prescription or a Fit note, when these services could easily be offered during physio consultations. The recent change to legislation has addressed the issue of prescribing for physios but the Fit note issue remains. I call on the CSP to campaign for a change in legislation. Marcus Bateman
The CSP responds: Legislation enabling physios to take decisions affecting statutory sick pay as part of their assessment would support GPs and hospital consultants. This was attempted during the development of the AHP Advisory fitness for work report and we will continue to raise the issues. See here for more information.  

You’ve added...

  • A news item titled Physio on Public Health England leadership programme (online,15 January) wants to focus on better health messages for patients prompted the following comment: This sounds like an excellent opportunity, well done to all physiotherapists getting involved in Public Health. Hopefully this opportunity will become available in other areas, so that more physiotherapists can become involved. fionawhite1
  • valeriesparkes congratulated Philippa Ford, CSP public affairs and policy manager for Wales, who was made a Member of the Order of the British Empire (MBE) in recognition of her services to physiotherapy. She noted: Very well deserved.
  • Sandra Wright responded to a letter titled Shedding a load (21 January). Would it be possible to find out what software the community trust were using on their iPads S1, Lorenzo etc. Our trust will be transferring to Lorenzo in April 2015 ...  

Corrections & clarifications

In the Gaza alert article published in the 21 January issue of Frontline, the name of physio Zoe Clift was changed to Zoe Clifton at the end of her profile. This has now been corrected in the online version.
Frontline Staff and various

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