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Playing to our strengths
Georgie Oldfield (viewpoint, 6 June) discussed using the biopsychosocial approach in pain management. She suggested it might be necessary to probe into a patient’s past to help solve a chronic pain problem.
We would like to reassure physiotherapists on a number of points.
First, we believe there is no expectation that physios can diagnose psychophysiological disorders.
Rather, physios can help patients make connections between their emotions, their beliefs about their pain and the behaviours they engage in – and then go on to problem-solve with them to improve functioning.
Second, physiotherapists are not expected to become psychotherapists. Delivering cognitive behavioural therapy (CBT) is a skill that requires diploma-level learning (something most physiotherapists don’t have in this area of practice).
However, taking some of the tools and techniques from CBT and applying the approach is feasible.
In essence, this involves asking questions that are open and probing, and which centre on how the client might think, feel or act when experiencing pain.
This is the essence of CBT.
Finally, physiotherapists can play to their strengths.
The flag system, now taught on most undergraduate courses, offers a structured approach that can act as a starting point for physiotherapists to understand their patients more from a psychosocial perspective.
Physiotherapists who are trained and experienced in CBT are well placed to do this.
However, physiotherapists are not expected to make psychophysiological diagnoses, nor are they expected to be psychotherapists.
Simple questions and a clear knowledge of their professional boundaries are all that are required.
Nicola Hunter and Dr Julie Denning (by email)
Use it or lose it
Thanks to Professor Roger Kerry for supporting the use of cervical manipulation by physiotherapists (talkback, 20 June). If anyone in our profession is capable of giving an informed opinion, he is.
In the midst of the debate calling for the abandonment of cervical manipulation, members of the Manipulation Association of Chartered Physiotherapists have been running education for MSK physiotherapists employed by Doncaster and Bassetlaw Hospitals NHS Foundation Trust.
The message from this and Professor Kerry’s letter is that grade V manipulation is well within the scope of the four pillars of core practice.
Sensationalistic and Sun-style headlines such as ‘Stop spinal manipulation for neck pain, warn researchers’ (Frontline, page 10, 20 June) are not helpful.
I suggest the Frontline headline could also have been ‘Evidence shows that patients do benefit from cervical manipulation by physiotherapists - use it or lose it’.
Kevin Banks (by email)
I’m a responder
I read with interest the letter (talkback, 6 June) about the use of volunteers in Sweden who can deal with cardiac arrests in the community. The last sentence reads: ‘Maybe someone out there fancies setting up a similar service in the UK.’
For the information of Frontline readers, the community first responders (CFR) scheme has been operating in the UK since the 1990s. My local group was activated in 1993 and I have been a responder since 2005.
We are trained in cardio-pulmonary resuscitation (CPR) and the use of automatic external defibrillators. When on duty we are dispatched by an ambulance control centre to attend medical emergencies in the immediate area.
As an example of the extent of the scheme in the UK, in 2011 CFRs from the Lincolnshire Lives First Responder Scheme attended their 100,000th call-out.
CFRs with five years’ continuous service received Queen’s Diamond Jubilee Medals.
Allen Mason (by email)
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