After more than a decade of questioning conventional wisdom in physiotherapy, University of Nottingham academics Roger Kerry and Alan Taylor have finally seen the fruition of their labours.
After years of hard-work including international academic debate, thirty-plus peer reviewed papers, three book chapters and countless invited and keynote international lectures, the dynamic duo have recently seen their research and opinions influence health policy at an international level.
Their work has been used as the basis for a unique international clinical standards document related to diagnosis and risk assessment of patients suffering from neck pain and headache. The document is the result of a working party from the International Federation of Orthopaedic, Manual and Physical Therapy (IFOMPT). Roger Kerry is a key member of the working party which formed in 2007 at the World Confederation of Physical Therapy Congress, Vancouver. Other party members are from the USA, Australia, Canada and New Zealand, and it is chaired by Dr Alison Rushton of the University of Birmingham. The document has been sanctioned by party members as well as all 22 countries who are member organisations of IFOMPT. It is due for official release at the next IFOMPT Congress in Quebec, 2012.
The pair, from the Division of Physiotherapy Education (School of Nursing, Midwifery and Physiotherapy) have had long-standing clinical and research interests in the diagnosis and assessment of complex neck and head complaints, which are highly prevalent and costly health problems world-wide. There have been a number of serious adverse events associated with manual therapy management of patients with such conditions, e.g. patients suffering stroke following certain therapeutic procedures. Over the years, these events have led to fear and uncertainty within the physiotherapy profession which has resulted in widespread confusion as to the risk and benefit of physiotherapy interventions. This has manifested in both continual occurrences of adverse events, and – despite very good evidence for its effectiveness - the withdrawal of physiotherapy care for patients with neck and head pain due to the fear of doing harm. Roger and Alan’s work has led to simple key outcomes: a better understanding of risk and benefit, together with better patient diagnosis results in better and safer care. The result has been better education linked to improved clinical reasoning and practice.
Their work has included re-interpretation of existing scientific data related to blood-flow in the cervical arteries and brain together with their own blood-flow studies; analysis of risk event rates and predictive risk factors; and development of a context-specific clinical reasoning model. Many of their findings contrasted sharply with existing thought and practice in this area. They see their work as a functional example of the integration of research evidence and critical thought into clinical practice.
Roger commented, "We were delighted with the inclusion of our work in the IFOMPT document and to see how many of our own recommendations have been taken up by an international panel”. Alan added, "It seemed much of the previous work was based on history and tradition rather than the evidence base and when we begun to question it we were met with many barriers to change. It has been a long journey but it has been worth it".
Their research programme has now led on to further associated areas. A recent physiotherapy post-graduate student, Baljit Kaur, has conducted a nation-wide survey of education practice investigating the inclusion of Roger and Alan’s work into UK physiotherapy curricula; Roger and Alan have also now completed work on a new classification model to facilitate the profiling of patients for clinicians. Further work has developed into measurement of head-neck movement in complex sensory-motor dysfunction. This has so far culminated in another post-graduate student, Mags Wigram, recently presenting measurement data at the World Physical Therapy Congress in Amsterdam.
The process is a salient case study for those attempting to challenge current academic wisdom in any discipline, the key message being - Believe in yourself and stick to your guns, it may take some time!
Posted on Monday 4th July 2011