• Chris Purcell

What your physio should look like in 2020

The start of 2020 sees me commence my 15th year as a physiotherapist and it also means that since graduating in 2005, my physiotherapy career has now spanned across three decades.


This got me thinking about all of the change that I have seen in the physiotherapy profession across this time. One of the great things about physiotherapy is our continued reference to evidenced-based practice. Our dedicated colleagues in university land continue to provide us with high quality studies that help guide our clinical practice so for the most part, the changes we have seen have all resulted in better quality treatment and patient care. Our self-reflection and critical review of our practice methods means physiotherapy continues to be a leader in the allied health cohort So with all of this in mind, here is a summary of some of my thoughts on what your physiotherapy treatment should look like in 2020, the changes that have occurred and my opinion on what really matters when it comes to providing high value care.

1. Individualised Treatment

The biggest thing I have learnt in my private practice career is that patient connection is paramount to achieving great outcomes. This means treatment should be one on one with the whole amount of your treatment time spent with your physiotherapist. Generally speaking, I have found spending a good amount of time on the initial consultation (say 30-45mins) generally provides a nicer patient experience and allows quality care to begin on day 1. A business model that puts too much pressure on therapists in terms of patient volume and appointment times will mean that therapists are unable to build any connection with their patients.

The days of therapists running from room to room should hopefully be behind us, and personally over the course of my career, I do not feel that physiotherapy assistants play a role in private practice. The sooner our patients get to know, like and trust us, then sooner we can get down to the business of rehabilitating their injury. This does not occur in a non-individualised environment. Therapists need to be good listeners, and need to connect. Patients’ who have had prior “poor” experiences with physiotherapy is typically in my opinion due to a lack of connection with their therapist. They either did not know what their treatment plan was, or did not trust the process.

2. Hands on treatment still has a role but it needs to be outcome based In recent years, the role of hands on manual therapies such as soft tissue and joint mobilisations has been questioned. Noting my points above regarding connection, it is my strong belief that hands on care can still be of use, particularly in building trust with patients and having an early impact on their issue. If a patient comes in with a really stiff and sore neck and physios have some treatment techniques that can improve this situation for them, even if temporary, it is my strong belief that they should still be used. This treatment needs to be outcome based though, and once pain and range of motion are restored then treatment needs to focus on more long-term impactful modalities such as exercise and movement.

3. Heat packs and electrotherapy machines are dead.

Heat, ice and even TENS can have a role for patients. Some patients really like these modalities for pain relief however providing these in clinic during paid therapy time is low value care. Heat, Ice and TENS (if needed) should all be self-management techniques used by patients at home. Therapy time should be outcome focused and consist of high value care that the patient cannot do themselves. Evidence for the use of most of the previously used electrophysical agents is now poor, which is why they were removed from our clinic once it came under my ownership.

4. Exercise is king, but the prescription is the key.

The beneficial role of exercise to the health and rehabilitation of our patients is now extremely well established. Whilst the allied health profession continues to argue over who the “experts” are in terms of exercise based management the important take home message should be that it is the quality of the exercise prescription that matters. Exercise prescription cannot and should not be a one size fits all approach, it needs to be individualised and outcome focused. What we do know from research is that dosage and loading matter almost as much as which particular exercise modality you are doing. Thankfully, physiotherapy has shifted away from only prescribing low load, motor control based exercises and we are now more confident in loading our patients correctly as they progress. With our excellent understanding of musculoskeletal pathology, physiology and functional anatomy it is pleasing to see physiotherapists taking a stronger lead in the prescription of exercise to our patients. We should be the trusted advisors in this space. The evidence is now strong that exercise prescription is the key, so if your physiotherapist is not confident or able to integrate exercise prescription into your rehabilitation plan, then you should probably be finding another physiotherapist.

5. Gadgets will come and go, so focus on things that matter.

When I started my career, the must have gadgets for physiotherapy clinics were real-time ultrasound scanners (for helping patients visualise their deep abdominal activation), whole-body vibration machines and pressure biofeedback units (PBUs). Graduates these days would barely know what these devices look like let alone know how to use them. More recently, so called “modern” clinics are claiming things like shockwave therapy machines and lasers are the way forward and the latest must have therapy items. Before my time, there were microwave diathermy, interferential and high voltage stimulator machines. Most gadgets are introduced to the profession based on some research and then years down the track research will then suggest their use is questionable. The moral of the story here is that gadgets will come and go so the focus of rehabilitation needs to be to have a positive effect on the problem at hand. In 2020, physiotherapists should now be clear on what providing high value patient focused care means. We have a body of evidence behind us to help guide our clinical decisions. At Out of the Box Physiotherapy, we have built our clinic around focusing on the things that we know matter, which is why we have longer initial consultations, one on one treatment time with no running between patients and why we built a rehabilitation gym that is literally 2 steps away from our treatment rooms. Our physiotherapist designed exercise programs are bespoke and purposeful and are achieving the outcomes for our patients that they deserve.

If you have any further questions about our clinic or would like an opinion on your current rehabilitation plan, then please reach out to us, we are more than happy to help.

Yours in health and happy new year

Chris

© 2018 Out of the Box Physiotherapy 

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