- Email: [email protected]
Focus on Research and Information
Focus on research and information Information Resource Centre Opening The long-awaited Information Resource Centre at the CSP is at last almost ready for use. The Centre will be officially 'opened' at the Information Study Day to be held at the CSP on May 17. Members will of course be free to come and use the Centre at any time, for study or browsing, and the room will be open and available to members coming to the CSP for meetings and other business. Since staff involved with the Centre may not always be working in it, those wishing to use the room are asked to register at Reception before using it. For the majority of members who are not likely to come and use the Centre in person, a brief description of what it is intended to be, and how it can help you, may be useful. Resources Research Database The research database, now containing extensive information about physiotherapy research projects will be available, both for staff to use in answering queries-by phone or letter, and for members to search themselves while in the Centre. A database of material housed in the Centre will also be available. Journals The existing collection of physiotherapy journals has been gathered together and assembled for reference. All important English-speaking physiotherapy journals are taken, as well as CSP Specific Interest Group publications and a current copy of many foreign-language physiotherapy journals from around the world. There will also be a small collection of other relevant journals. There is a variable collection of back issues of the English-language physiotherapy journals. A list of all our holdings will be available.
emphasised that this is by no means a complete collection, but that these are unique documents which cannot be loaned. A list of the collection is available, and further contributions to it will be gratefully received.
Services General Inquiries and Help
Books The Centre has neither the funding, space nor intention to be a library in the traditional sense. Although there will be a small 'general reference' collection, textbooks will not be purchased. However, we are very pleased to announce that several publishers who are prominent in the physiotherapy field have agreed to donate copies of relevant new publications to the Centre. At present these include Churchill Livingstone, ButterworthHeinemann and Harper Collins. A small collection of books of historical interest is also available. Theses A small collection of members' dissertations and theses which have been donated to the CSP will be located in the Centre, for reference only. It must be
332
Research and Information Newsletter and Current Awareness Bulletin Plans for our first year of operation include a Research and Information Newsletter and Current Awareness Bulletin.
Staffing The Information Centre will be under the direction of Sue Nayee, research and information officer. Inquiries, database development and online searching will be carried out by Maureen Muir, information officer in the Education Department. Samantha Pym, Information Unit assistant, will also be helping with this service.
Photocopies
Staff associated with the Centre will atiswer'research and information queries by telephone and letter. This will include directing members to other sources of information where appropriate. Help will also be available for those wishing to use the Centre in person.
Photocopies of journal articles and other material may be provided on a limited basis, and as staffing and demand allow. Members should always try local resources first, and apply through libraries where possible (as an inter-library service). A charge will be made.
Online Bibliographic Search Service
Opening Hours
We are at present setting up this facility, and will shortly be offering bibliographic searches on Medline, the British Library CATS and other relevant databases. This
The Centre will normally be available for use during CSP office hours, namely 9 am to 5 pm Monday to Friday. Please register at Reception on arrival.
Forthcoming Events
Documents Relevant and important physiotherapy documents and reports will be collected. This is intended to locate and keep material which is sometimes elusive and hard to access elsewhere. A database of this material will be compiled.
means that we will be able to offer a limited computer literature search service to members. However, a charge will be made for this service, in line with similar services elsewhere, and it must be emphasised that it will under normal circumstances be available only to those who do not have access to a library offering this service, which should now be commonly available.
Sources of Information, Literature Searching and What Next? How to Find Out in Physiotherapy and Allied Health Friday, May 17: CSP offices, London We are very pleased to announce that our keynote speaker for this event will be Mr Michael Carmel, Regional Librarian of South West Thames RHA. Michael will talk about organisational aspects of ensuring access to information following the NHS reforms - a subject of vital importance in the new NHS. Come and find out about the latest developments in information technology. What exactly is CD-ROM and what can it do for you?
0 DOyou know how current changes within the NHS are likely to affect access to information for allied health professionals? O D 0 you know how to carry out an effective literature search, and how to select the most appropriate sources?
0 Do you know what specialist library services can offer you?
Plus
0 Information technology demystified online and CD-ROM. An introduction to relevant sources and current developments in new technology,
0 Demonstrations of online database. 0 The chance to view the new Information Resource Centre and research database.
Speakers will include Stephen Andrews from the British Library Medical Information Service, Graham Walton from Newcastle upon Tyne Polytechnic Library Service for Allied Health Professionals, Phillipa Lane from the Disabled Living Foundation and Andrew Booth from the King's Fund. At the time of going to press, a few places are still available for this important meeting. Can you afford to miss out? Contact Sue Navee for further details. Physiotherapy, May 1991, vol77, no 5
Recent Advances in Electrotherapy .. June 5- 6: Royal National Hospital for Rheumatic Diseases, Bath This two-day conference, aimed at senior or managerial physiotherapists, will examine recent research findings in many aspects of electrotherapy, including muscle stimulation, phototherapy, ultrasound, magnetic energy and pulsed shortwave, and therapeutic heat. Inquiries and reservations to Mrs S Green, Rehabilitation Research Laboratory, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BAl 1RL. cost: f110.
The Society for Research in Rehabilitation The summer meetina will be held in Bristol on June 27-28. For yurther details please contact Mr Ben Toth at Frenchay Hospital, Bristol BS16 1LE (tel 0272 701212)
And
...
Coming Shortly Time and space have not permitted the incllision of several important items in this month’s ’Research and Information Focus’ so look out next time for . . .
CENTRE FOR PHYSIOTHERAPY RESEARCH
M S c Degree in Research Methods for Remedial Therapists We are now interviewing students for the 1991/92 MSc degree in research methods for remedial therapists. Prospective students can discuss any aspects of the course with those in the first or second year of the degree by ringing 071-836 0354 for contact numbers. Anyone wishing to apply for this course should do so without delay. Judith Cavet‘s work on the first stage of the study on ‘The role of physiotherapy in the care of adults with learning difficulties’ is complete and the preliminary report will be available shortly. We are most grateful to all the people who have helped us in this work, particularly the District therapists who assisted with the pilot study and the therapists working with adults with learning difficulties who helped with the development of forms and questionnaires. We are now sending out the main questionnaire to District physiotherapists throughout England and Wales. Our pilot work suggests there is great variability in this specialist area of practice and the national survey will help in planning services in future. We realise the added burden of another form to fill in, but a good return is essential and we do hope that all those
sent questionnaires will find the time to complete and return them. We shall be contacting the therapists actually working with adults with learning difficulties later this year. We have applied for funding to the Scottish Home and Health Department to extend this study to Scotland and are awaiting the result. The study on ‘Disability and health services: Perceptions, beliefs and experiences of elderly people’ funded by the Nuffield Provincial Hospitals Trust is now complete and the report is available from the CPR for €3. A paper on this work will be presented at the WCPT later this year. Reports of adverse effects of electrotherapy are still coming in and we do urge everyone to report unexpected side-effects of electrotherapy. These, together with clinical trials, will help to get a full picture of electrotherapy in physiotherapy. Further forms to report adverse effects are available from Anita Green at the CPR. A five-year plan is being drawn up to achieve our mission statement as follows: The aim of the unit is to undertake high quality research of both practical and
THE OPEN UNIVERSITY
Monitoring, Research and Evaluation Meeting The Open University Department of Health and Social Welfare is at present exploring the possibility of producing learning materials and developing a distance learning course in evaluation and research, which might be specifically aimed at professionals working in the health field. Following an initiative from a group of physiotherapists interested in marketing a research course project, and discussion with the Health Care Professions Forum, representatives from various health care professions were invited to attend a consultative workshop at the Open University in March, with the aim of exploring the issues and implications of this idea, and discussing potential target audiences. I was pleased to see physiotherapy well represented at this meeting, which also included nurses, occupational therapists, and representatives from radiography, osteopathy and chiropody. Following initial ’scene-setting’, discussions initially centred on the advantages and disadvantages of multidisciplinary research, and the
Physiotherapy, May 1991, vol77, no 5
motivation of different groups and interests. Group work in the afternoon attempted to identify key content areas, issues and skills which might be covered in such a course, what the level should be, and how to achieve a balance between practice and theory. Suitable forms of accreditation and assessment were also investigated, and how course priorities might be achieved through open learning materials. Agreement among representatives of the different professions at this meeting about the pressing need for education in research was unanimous. Common themes to emerge were: the necessity for a broadly-based and ‘non-prescriptive‘ approach; the inclusion of practical examples and relevant case-history material from a variety of professions; appreciation and application of research; rationale for, and suitability of various methodologies within differing professions; the development of a ’reflective’ practitioner; relevance to patient care; the identification and training of mentors and supervisors; ethical and philosophical problems. In concluding and summarising the
0 Medlinehdex Medicus, Why is Physiotherapy not included and what can be done about it? - a response to current concerns.
0 Ethics: Have you had problems recently submitting independent research proposals to local ethical committees? We voice some concerns about this in our next issue.
0 ‘Research in Physiotherapy: The Response to Change’: We have now received a full report of this conference, which was held in Newcastle upon Tyne on October 23, 1990. My apologies for not including it in this issue - there will be a full account next time. professional importance and to investigate all aspects of physical disability and its treatment or management especially in relation to therapy services. We are seeking funds for a number of new research projects in the area of the disability of long-term conditions from a variety of funding bodies. The new emphasis is on interdisciplinary research and the CPR is in a strong position here as many different disciplines are involved in the work of our unit. They include occupational therapists, biologists, neurologists, consultants in care of the elderly, social workers, psychologists and sociologists. The CPR is very pleased to be involved in a new initiative with Sue Nayee at the CSP to organise events on research for clinicians and researchers. The first such occasion was held on April 10 and was considerably over-subscribed. We find it very encouraging in the present stringent financial climate that we are getting more requests for help from District therapists whose response to the present situation is to seek to examine their practice more critically and obtain evidence of the value of physiotherapy.
CECILY J PARTRIDGE PhD FCSP
Director, Centre for Physiotherapy Research
discussion, it was suggested that a potential research course should target three levels: understanding, usiyg and producing research. Academic recognition and practical application are both important requirements of such a course. In his final comments, Professor Malcolm Johnson emphasised that this workshop formed part of a continuing process commonly followed in developing courses at the Open University. Following this, a ‘de-briefing‘ session was held a few weeks later to analyse some of the main issues from the workshop material, and to examine material already in existence, both within the Open University and elsewhere, which might be relevant. A format from which a possible course might be developed was arrived at, and implications in terms of timing, staffing and finance considered. In view of the current demand for flexible and accessible courses on research, this initiative is very welcome. The Open University, with its well-established and respected experience in the field of open and distance learning would be an ideal provider for such a course. However, it will be some time yet, even if the course is accepted for development by the Open University, before it can become generally available.
333
RESEARCH AND CLINICAL PRACTICE
Three different group techniques were used during the workshops:
Research Presentation Day and Workshop
Three 'snowball' groups, led by Dr Cecily Partridge, examined possible ways in which the CSP could seek to encourage research activity within the profession. Several areas were identified in which it was felt that the Society could assume a leading role. These included: the promotion of education in research at all levels, and information about the availability of research courses; the continued development of the Society as a point of contact and information for those engaged in research activity within the profession (the initiation of the Research Database and Information Resource Centre was noted); information about funding and how to apply (CSP funding guide lines are at present being revised); involvement of CSP Specific Interest Groups in research and the development of standard assessment procedures; the promotion of research both within and outside the profession; support for the development of a recognised career structure for physiotherapists specialising in research.
A joint initiative between the Chartered Society of Physiotherapy and the Centre for Physiotherapy Research at Kings College, London, this research presentation day and workshop was held at the CSP on April 10. Thanks to sponsorship by the Physiotherapy Research Foundation of the UK we were able to keep the cost as low as possible, and were pleased t o welcome a capacity audience. The aim of this important event was to provide a forum for research in t w o major areas of physiotherapy - neurology and respiratory care. It was intended to be an opportunity for some of those involved with research to present their projects, and for physiotherapists particularly in clinical practice to hear about some of the work which is currently being carried out in this setting. The format of this action-packed day also included a variety of afternoon sessions designed to allow delegates to participate in group discussions to investigate current issues, and to explore ways in which research i n clinical practice can be encouraged and supported. Following an introductory address by Dr Cecily Partridge, director of the Centre for Physiotherapy Research, eight research projects were presented:
Respiratory Care 1. Alison Gallen 'The evaluation of chest percussion in the treatment of patients with copious sputum production' 2. Ken Chatham 'Inspiratory muscle training in ventilatory insufficiency'
3.Julia Bott 'Use of nasal pressure in patients with respiratory failure due to an active exacerbation of chronic obstructive airways disease' 4. Juliette Hussey 'Is there a relationship between specific chest physiotherapy techniques and oxygen saturation postcardiac surgery in children?'
Neurology 5. Lorraine de Souza 'Multiple sclerosis'
6. Sheila Frazer 'Reasons for disability in GBS (Guillain Barre syndrome) patients One year post-onset'
7. Cath Sackley 'Visual feedback after stroke: Effects on stance symmetry, sway and function' 8. Fiona Collen 'Does physiotherapy help mobility late after stroke? Results of a controlled trial' Both the content and presentation of all these projects were most impressive, and very well received by the audience. Questions were curtailed by time, and more opportunity for discussion would clearly have been appreciated. Many of those who gave the presentations were themselves working in clinical practice, and were therefore able to talk at first hand about their experience. Common themes emerged, and speakers drew attention to problematic issues: Julia Bott tackled the contentious ethical problem of withholding treatment, and several
334
speakers spoke of difficulties with rating scales which were found t o be not appropriate for physiotherapy or not validated. Sheila Frazer, who is working on a multidisciplinary study, discussed some of the problems she had encountered with differing approaches to follow-up treatment in local rehabilitation centres. All the speakers were clearly most enthusiastic about their work, and demonstrated a strong commitment to investigation and improving physiotherapy practice. Lorraine de Souza, manager of the ARMS Research Unit, has worked for some time building up a database of patients with multiple sclerosis as part of a longitudinal study of physiotherapy involvement in this area, which is in itself ill-defined and subject to change. During the course of her research project at the Stroke Research Unit in Nottingham, Cath Sackley had found herself becoming increasingly interested in a behavioural approach which has so far been little explored i n physiotherapy research, investigating the effect of the physiotherapist on patients' attitudes to treatment. Fiona Collen spoke of the advantages and possibilities of research in the community, and in common with others, the ultimate aim of improving patient care and the quality of life. Many of these projects are still developing or at a very early stage of analysis, and we look forward to hearing more about them. Further information and contact addresses are on the CSP's research database. (Please contact Maureen Muir, information officer, for details.)
Afternoon Sessions Following a much-needed lunch break, and short address by Dr Anne Parry, chairperson of the Physiotherapy Research Foundation Research Committee, delegates re-convened for a variety of afternoon workshops, organised by Sue Nayee, the CSP's research and information officer. Issues tackled by different groups included ways in which research activity could be promoted and encouraged, and, in particular, to consider the means by which support mechanisms, including those provided by the CSP, could be enhanced.
Presentation Skills Are you presenting a paper at the WCPT Congress? Have you presented a paper at an international conference before? If not, would you be interested in joining a group to discuss your presentation and be able to rehearse in front of a small, friendly audience? If a sufficient number of people are interested we shall organise such a group on the lines of the very funny and informative John Cleese video on presenting a paper. If you are interested please get in touch with Sue Nayee at the CSP.
'Brainstorming'groups, led by Dr Anne Parry, considered means by which improvement in research skills could be achieved. Further national and regional research days were called for, some possibly in conjunction with other health care professions. There was also perceived to be a need for 'intermediate' level courses in research, and continued efforts to de-mystify it. A 'more structured' approach to raising the level of research awareness among physiotherapists was also perceived to be necessary, particularly among physiotherapy managers leg regarding the value of staff time spent on research activity). In common with the 'snowball' groups, the 'brainstorming groups' considered the research content of Physiotherapy journal to be crucially important. The remaining groups, directed by Sue Nayee and Maureen Muir, used a 'nominal group' technique to consider and attempt to rank in order of importance the current barriers and opportunities for those attempting research, particularly in clinical practice. It was interesting that among these groups barriers and opportunities often turned out to be opposite sides of the same coin, depending on perception, and, not surprisingly, a substantial consensus existed between the groups on this subject. Lack of identified paid time, resources, support, experience and career structure scored high on the list of barriers; current emphasis on improving and substantiating clinical practice and possible support for research in this was top of the list of opportunities; paradoxically it was felt that funding might now improve in certain areas, and that raised awareness of the importance of research was also increasing peer group support and the availability of research courses, advice and information. This was altogether a successful, enjoyable and stimulating occasion. A word of consolation for those whom we had to turn away because of numbers - don't worry! There will be more.
SUSAN NAYEE MSc BA ALA IInfSci
Research and Information Officer
physiotherapy, May 1991, VO/ 77,IK) 5
physiotherapists have a responsibility to evaluate their own practice. An academic environment is the place where undergraduates can learn physiotherapy techniques and learn to be objective and evaluative. Hopefully the departments of physiotherapy will be able to draw on the expertise of academics from disciplines with a research tradition until they can be self-sufficient. Eventually, the departments of physiotherapy will be able to offer supervision to postgraduate physiotherapists who will undertake higher degrees which are physiotherapy-specific. University or polytechnic lecturers of physiotherapy will undertake their own research and will be able to employ physiotherapists as research assistants using the research grants for which they have successfully competed. University or polytechnic departments of physiotherapy will be the obvious sources of skill provision and support for clinical physiotherapists who want to undertake research. Ideally, academic departments and local clinical departments will liaise, resulting in an interchange of need fulfilment. Eventually, newly qualified physiotherapists will be well versed in research methodology and hopefully be in a position to influence their senior colleagues. At a later stage, some of these newlyqualified graduates of university or polytechnic departments of physiotherapy will become senior physiotherapy managers, with a real understanding of the difficulties and importance of research. They will also have the political influence to facilitate research within their own domains. A contribution to current knowledge and a proven ability to conduct research
(and publish results) may even become a requirement for those hoping to be promoted to senior clinical or managerial levels. When a research philosophy and tradition has been established in physiotherapy it will be as a result of a deep change in the way physiotherapists think. The researcher physiotherapist will be a different animal from the physiotherapist who 'does research'. This change in the nature of physiotherapists will result from the change in the context in which physiotherapy is taught to undergraduates. This in turn will enable those of us with diplomas (a dying breed anyway) to catch up if we are prepared to make the painful transition and are willing
to change our self-concept. The CSP can help. It can continue to provide a forum in which discussion can take place regarding the needs of clinical practice, education and research. (As a research philosophy develops these needs will become common.) It can also continue to encourage the development of an undergraduatecurriculum which encourages a critical, objective approach to physiotherapy. What the CSP must not encourage is the idea that physiotherapists can be taught to be researchers overnight, or that a series of short courses, self-learning packages, top-up courses, etc, can replace a thorough grounding in an academic environment.
~
Mrs Susan Nayee, CSP research and information officer, comments: I welcome this visionary point of view about the development of physiotherapy research, with which I wholeheartedly agree. I am very pleased that the Research Workshop on April 10 stimulated such a response. The CSP will continue to support the development of research, and we are actively considering how support and encouragement can be most effectively provided. Following the workshop we are considering several ideas for other events to raise the profile of physiotherapy research, and to provide a platform and a forum for research presentation and discussion. The opening of the new Information Resource Centre at the CSP and development of the Research Database are intended to further the advancement of efficient and effective access to information for and about important research matters, including funding and education.
While I entirely agree that the magnitude of the changes needed and standard of the skills necessary to support that development should in no way be underestimated, such a revolution cannot be achieved overnight. However, I believe that simple basic information for those for whom research is an entirely new and daunting subject, although a different matter, should not be disregarded. We are at present revising our existing introductory guide lines on research, and considering how we should respond to those who, while they are not seeking to become 'overnight researchers' are nevertheless seeking guidance in a complex field for which they have received little or no training. This in no way undermines or seeks to replace the important task we have to support the development of physiotherapy research as a rigorous discipline, and the needs of researchers active in clinical practice, the academic field and education throughout the profession
Robert Williams International Award l991 The Chartered Society of Physiotherapy is pleased to announce that the following individuals have been awarded a Robert Williams International Award in respect of the named papers, which will be presented at the World Confederation for Physical Therapy International Congress being held at the Barbican, July 28-Aug~st 2, 1991.
Dr P Arnell 'The accuracy of visual gait assessment' Ms C Blowman 'Genuine stress incontinence: A pilot study using neurotrophic stimulation in the treatment of genuine stress incontinence' Ms J Bott 'The use of nasal intermittent positive pressure ventilation in the treatment of respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease' Mrs K J Dick 'Investigation and evaluation of physiotherapy intervention in acute bronchiolitis of infancy' Ms M Donaghy 'The effects of different forms of exercise on the fitness, mood and memory of a sample of problem drinkers'
Physiotherapy, May 1991, vol77, no 5
Mrs A C B Ferguson 'The use of the flexion withdrawal reflex in spinal cord injured patients' Mrs J Hall 'A double-blind placebo-controlled trial to assess the efficacy of low power laser in chronic rheumatoid arthritis of the finger joints' Mrs K M Jackson 'The unreliability of sensory assessments' Mrs L C Laidler 'STARS - Clinical audit (Stow Assessment Resource System)' Mrs J Moffett 'A double-blind controlled study to evaluate the effectiveness of pulsed shortwave for pain relief in osteoarthritic hips and knees' Mr A A Mugglestone 'The role of pulsed shortwave diathermy in the management of undisplaced fracture of the neck of humerus' Dr I Musa 'Electrotherapy skills: Their importance in the - undergraduate curriculum' Ms R H Mushet 'The reliability and validity of a portable EMG unit' Dr A Parry 'Redeeming expert knowledge: The application of cornputerised decision-support systems to physiotherapy' Mr D R Scrutton 'Trends in the management, during childhood, of chronic movement disorders' Miss A P Walker 'Physiotherapy in primary care' Miss B A Webber 'Evaluation and inflation in respiratory care'
335
emphasised that this is by no means a complete collection, but that these are unique documents which cannot be loaned. A list of the collection is available, and further contributions to it will be gratefully received.
Services General Inquiries and Help
Books The Centre has neither the funding, space nor intention to be a library in the traditional sense. Although there will be a small 'general reference' collection, textbooks will not be purchased. However, we are very pleased to announce that several publishers who are prominent in the physiotherapy field have agreed to donate copies of relevant new publications to the Centre. At present these include Churchill Livingstone, ButterworthHeinemann and Harper Collins. A small collection of books of historical interest is also available. Theses A small collection of members' dissertations and theses which have been donated to the CSP will be located in the Centre, for reference only. It must be
332
Research and Information Newsletter and Current Awareness Bulletin Plans for our first year of operation include a Research and Information Newsletter and Current Awareness Bulletin.
Staffing The Information Centre will be under the direction of Sue Nayee, research and information officer. Inquiries, database development and online searching will be carried out by Maureen Muir, information officer in the Education Department. Samantha Pym, Information Unit assistant, will also be helping with this service.
Photocopies
Staff associated with the Centre will atiswer'research and information queries by telephone and letter. This will include directing members to other sources of information where appropriate. Help will also be available for those wishing to use the Centre in person.
Photocopies of journal articles and other material may be provided on a limited basis, and as staffing and demand allow. Members should always try local resources first, and apply through libraries where possible (as an inter-library service). A charge will be made.
Online Bibliographic Search Service
Opening Hours
We are at present setting up this facility, and will shortly be offering bibliographic searches on Medline, the British Library CATS and other relevant databases. This
The Centre will normally be available for use during CSP office hours, namely 9 am to 5 pm Monday to Friday. Please register at Reception on arrival.
Forthcoming Events
Documents Relevant and important physiotherapy documents and reports will be collected. This is intended to locate and keep material which is sometimes elusive and hard to access elsewhere. A database of this material will be compiled.
means that we will be able to offer a limited computer literature search service to members. However, a charge will be made for this service, in line with similar services elsewhere, and it must be emphasised that it will under normal circumstances be available only to those who do not have access to a library offering this service, which should now be commonly available.
Sources of Information, Literature Searching and What Next? How to Find Out in Physiotherapy and Allied Health Friday, May 17: CSP offices, London We are very pleased to announce that our keynote speaker for this event will be Mr Michael Carmel, Regional Librarian of South West Thames RHA. Michael will talk about organisational aspects of ensuring access to information following the NHS reforms - a subject of vital importance in the new NHS. Come and find out about the latest developments in information technology. What exactly is CD-ROM and what can it do for you?
0 DOyou know how current changes within the NHS are likely to affect access to information for allied health professionals? O D 0 you know how to carry out an effective literature search, and how to select the most appropriate sources?
0 Do you know what specialist library services can offer you?
Plus
0 Information technology demystified online and CD-ROM. An introduction to relevant sources and current developments in new technology,
0 Demonstrations of online database. 0 The chance to view the new Information Resource Centre and research database.
Speakers will include Stephen Andrews from the British Library Medical Information Service, Graham Walton from Newcastle upon Tyne Polytechnic Library Service for Allied Health Professionals, Phillipa Lane from the Disabled Living Foundation and Andrew Booth from the King's Fund. At the time of going to press, a few places are still available for this important meeting. Can you afford to miss out? Contact Sue Navee for further details. Physiotherapy, May 1991, vol77, no 5
Recent Advances in Electrotherapy .. June 5- 6: Royal National Hospital for Rheumatic Diseases, Bath This two-day conference, aimed at senior or managerial physiotherapists, will examine recent research findings in many aspects of electrotherapy, including muscle stimulation, phototherapy, ultrasound, magnetic energy and pulsed shortwave, and therapeutic heat. Inquiries and reservations to Mrs S Green, Rehabilitation Research Laboratory, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BAl 1RL. cost: f110.
The Society for Research in Rehabilitation The summer meetina will be held in Bristol on June 27-28. For yurther details please contact Mr Ben Toth at Frenchay Hospital, Bristol BS16 1LE (tel 0272 701212)
And
...
Coming Shortly Time and space have not permitted the incllision of several important items in this month’s ’Research and Information Focus’ so look out next time for . . .
CENTRE FOR PHYSIOTHERAPY RESEARCH
M S c Degree in Research Methods for Remedial Therapists We are now interviewing students for the 1991/92 MSc degree in research methods for remedial therapists. Prospective students can discuss any aspects of the course with those in the first or second year of the degree by ringing 071-836 0354 for contact numbers. Anyone wishing to apply for this course should do so without delay. Judith Cavet‘s work on the first stage of the study on ‘The role of physiotherapy in the care of adults with learning difficulties’ is complete and the preliminary report will be available shortly. We are most grateful to all the people who have helped us in this work, particularly the District therapists who assisted with the pilot study and the therapists working with adults with learning difficulties who helped with the development of forms and questionnaires. We are now sending out the main questionnaire to District physiotherapists throughout England and Wales. Our pilot work suggests there is great variability in this specialist area of practice and the national survey will help in planning services in future. We realise the added burden of another form to fill in, but a good return is essential and we do hope that all those
sent questionnaires will find the time to complete and return them. We shall be contacting the therapists actually working with adults with learning difficulties later this year. We have applied for funding to the Scottish Home and Health Department to extend this study to Scotland and are awaiting the result. The study on ‘Disability and health services: Perceptions, beliefs and experiences of elderly people’ funded by the Nuffield Provincial Hospitals Trust is now complete and the report is available from the CPR for €3. A paper on this work will be presented at the WCPT later this year. Reports of adverse effects of electrotherapy are still coming in and we do urge everyone to report unexpected side-effects of electrotherapy. These, together with clinical trials, will help to get a full picture of electrotherapy in physiotherapy. Further forms to report adverse effects are available from Anita Green at the CPR. A five-year plan is being drawn up to achieve our mission statement as follows: The aim of the unit is to undertake high quality research of both practical and
THE OPEN UNIVERSITY
Monitoring, Research and Evaluation Meeting The Open University Department of Health and Social Welfare is at present exploring the possibility of producing learning materials and developing a distance learning course in evaluation and research, which might be specifically aimed at professionals working in the health field. Following an initiative from a group of physiotherapists interested in marketing a research course project, and discussion with the Health Care Professions Forum, representatives from various health care professions were invited to attend a consultative workshop at the Open University in March, with the aim of exploring the issues and implications of this idea, and discussing potential target audiences. I was pleased to see physiotherapy well represented at this meeting, which also included nurses, occupational therapists, and representatives from radiography, osteopathy and chiropody. Following initial ’scene-setting’, discussions initially centred on the advantages and disadvantages of multidisciplinary research, and the
Physiotherapy, May 1991, vol77, no 5
motivation of different groups and interests. Group work in the afternoon attempted to identify key content areas, issues and skills which might be covered in such a course, what the level should be, and how to achieve a balance between practice and theory. Suitable forms of accreditation and assessment were also investigated, and how course priorities might be achieved through open learning materials. Agreement among representatives of the different professions at this meeting about the pressing need for education in research was unanimous. Common themes to emerge were: the necessity for a broadly-based and ‘non-prescriptive‘ approach; the inclusion of practical examples and relevant case-history material from a variety of professions; appreciation and application of research; rationale for, and suitability of various methodologies within differing professions; the development of a ’reflective’ practitioner; relevance to patient care; the identification and training of mentors and supervisors; ethical and philosophical problems. In concluding and summarising the
0 Medlinehdex Medicus, Why is Physiotherapy not included and what can be done about it? - a response to current concerns.
0 Ethics: Have you had problems recently submitting independent research proposals to local ethical committees? We voice some concerns about this in our next issue.
0 ‘Research in Physiotherapy: The Response to Change’: We have now received a full report of this conference, which was held in Newcastle upon Tyne on October 23, 1990. My apologies for not including it in this issue - there will be a full account next time. professional importance and to investigate all aspects of physical disability and its treatment or management especially in relation to therapy services. We are seeking funds for a number of new research projects in the area of the disability of long-term conditions from a variety of funding bodies. The new emphasis is on interdisciplinary research and the CPR is in a strong position here as many different disciplines are involved in the work of our unit. They include occupational therapists, biologists, neurologists, consultants in care of the elderly, social workers, psychologists and sociologists. The CPR is very pleased to be involved in a new initiative with Sue Nayee at the CSP to organise events on research for clinicians and researchers. The first such occasion was held on April 10 and was considerably over-subscribed. We find it very encouraging in the present stringent financial climate that we are getting more requests for help from District therapists whose response to the present situation is to seek to examine their practice more critically and obtain evidence of the value of physiotherapy.
CECILY J PARTRIDGE PhD FCSP
Director, Centre for Physiotherapy Research
discussion, it was suggested that a potential research course should target three levels: understanding, usiyg and producing research. Academic recognition and practical application are both important requirements of such a course. In his final comments, Professor Malcolm Johnson emphasised that this workshop formed part of a continuing process commonly followed in developing courses at the Open University. Following this, a ‘de-briefing‘ session was held a few weeks later to analyse some of the main issues from the workshop material, and to examine material already in existence, both within the Open University and elsewhere, which might be relevant. A format from which a possible course might be developed was arrived at, and implications in terms of timing, staffing and finance considered. In view of the current demand for flexible and accessible courses on research, this initiative is very welcome. The Open University, with its well-established and respected experience in the field of open and distance learning would be an ideal provider for such a course. However, it will be some time yet, even if the course is accepted for development by the Open University, before it can become generally available.
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RESEARCH AND CLINICAL PRACTICE
Three different group techniques were used during the workshops:
Research Presentation Day and Workshop
Three 'snowball' groups, led by Dr Cecily Partridge, examined possible ways in which the CSP could seek to encourage research activity within the profession. Several areas were identified in which it was felt that the Society could assume a leading role. These included: the promotion of education in research at all levels, and information about the availability of research courses; the continued development of the Society as a point of contact and information for those engaged in research activity within the profession (the initiation of the Research Database and Information Resource Centre was noted); information about funding and how to apply (CSP funding guide lines are at present being revised); involvement of CSP Specific Interest Groups in research and the development of standard assessment procedures; the promotion of research both within and outside the profession; support for the development of a recognised career structure for physiotherapists specialising in research.
A joint initiative between the Chartered Society of Physiotherapy and the Centre for Physiotherapy Research at Kings College, London, this research presentation day and workshop was held at the CSP on April 10. Thanks to sponsorship by the Physiotherapy Research Foundation of the UK we were able to keep the cost as low as possible, and were pleased t o welcome a capacity audience. The aim of this important event was to provide a forum for research in t w o major areas of physiotherapy - neurology and respiratory care. It was intended to be an opportunity for some of those involved with research to present their projects, and for physiotherapists particularly in clinical practice to hear about some of the work which is currently being carried out in this setting. The format of this action-packed day also included a variety of afternoon sessions designed to allow delegates to participate in group discussions to investigate current issues, and to explore ways in which research i n clinical practice can be encouraged and supported. Following an introductory address by Dr Cecily Partridge, director of the Centre for Physiotherapy Research, eight research projects were presented:
Respiratory Care 1. Alison Gallen 'The evaluation of chest percussion in the treatment of patients with copious sputum production' 2. Ken Chatham 'Inspiratory muscle training in ventilatory insufficiency'
3.Julia Bott 'Use of nasal pressure in patients with respiratory failure due to an active exacerbation of chronic obstructive airways disease' 4. Juliette Hussey 'Is there a relationship between specific chest physiotherapy techniques and oxygen saturation postcardiac surgery in children?'
Neurology 5. Lorraine de Souza 'Multiple sclerosis'
6. Sheila Frazer 'Reasons for disability in GBS (Guillain Barre syndrome) patients One year post-onset'
7. Cath Sackley 'Visual feedback after stroke: Effects on stance symmetry, sway and function' 8. Fiona Collen 'Does physiotherapy help mobility late after stroke? Results of a controlled trial' Both the content and presentation of all these projects were most impressive, and very well received by the audience. Questions were curtailed by time, and more opportunity for discussion would clearly have been appreciated. Many of those who gave the presentations were themselves working in clinical practice, and were therefore able to talk at first hand about their experience. Common themes emerged, and speakers drew attention to problematic issues: Julia Bott tackled the contentious ethical problem of withholding treatment, and several
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speakers spoke of difficulties with rating scales which were found t o be not appropriate for physiotherapy or not validated. Sheila Frazer, who is working on a multidisciplinary study, discussed some of the problems she had encountered with differing approaches to follow-up treatment in local rehabilitation centres. All the speakers were clearly most enthusiastic about their work, and demonstrated a strong commitment to investigation and improving physiotherapy practice. Lorraine de Souza, manager of the ARMS Research Unit, has worked for some time building up a database of patients with multiple sclerosis as part of a longitudinal study of physiotherapy involvement in this area, which is in itself ill-defined and subject to change. During the course of her research project at the Stroke Research Unit in Nottingham, Cath Sackley had found herself becoming increasingly interested in a behavioural approach which has so far been little explored i n physiotherapy research, investigating the effect of the physiotherapist on patients' attitudes to treatment. Fiona Collen spoke of the advantages and possibilities of research in the community, and in common with others, the ultimate aim of improving patient care and the quality of life. Many of these projects are still developing or at a very early stage of analysis, and we look forward to hearing more about them. Further information and contact addresses are on the CSP's research database. (Please contact Maureen Muir, information officer, for details.)
Afternoon Sessions Following a much-needed lunch break, and short address by Dr Anne Parry, chairperson of the Physiotherapy Research Foundation Research Committee, delegates re-convened for a variety of afternoon workshops, organised by Sue Nayee, the CSP's research and information officer. Issues tackled by different groups included ways in which research activity could be promoted and encouraged, and, in particular, to consider the means by which support mechanisms, including those provided by the CSP, could be enhanced.
Presentation Skills Are you presenting a paper at the WCPT Congress? Have you presented a paper at an international conference before? If not, would you be interested in joining a group to discuss your presentation and be able to rehearse in front of a small, friendly audience? If a sufficient number of people are interested we shall organise such a group on the lines of the very funny and informative John Cleese video on presenting a paper. If you are interested please get in touch with Sue Nayee at the CSP.
'Brainstorming'groups, led by Dr Anne Parry, considered means by which improvement in research skills could be achieved. Further national and regional research days were called for, some possibly in conjunction with other health care professions. There was also perceived to be a need for 'intermediate' level courses in research, and continued efforts to de-mystify it. A 'more structured' approach to raising the level of research awareness among physiotherapists was also perceived to be necessary, particularly among physiotherapy managers leg regarding the value of staff time spent on research activity). In common with the 'snowball' groups, the 'brainstorming groups' considered the research content of Physiotherapy journal to be crucially important. The remaining groups, directed by Sue Nayee and Maureen Muir, used a 'nominal group' technique to consider and attempt to rank in order of importance the current barriers and opportunities for those attempting research, particularly in clinical practice. It was interesting that among these groups barriers and opportunities often turned out to be opposite sides of the same coin, depending on perception, and, not surprisingly, a substantial consensus existed between the groups on this subject. Lack of identified paid time, resources, support, experience and career structure scored high on the list of barriers; current emphasis on improving and substantiating clinical practice and possible support for research in this was top of the list of opportunities; paradoxically it was felt that funding might now improve in certain areas, and that raised awareness of the importance of research was also increasing peer group support and the availability of research courses, advice and information. This was altogether a successful, enjoyable and stimulating occasion. A word of consolation for those whom we had to turn away because of numbers - don't worry! There will be more.
SUSAN NAYEE MSc BA ALA IInfSci
Research and Information Officer
physiotherapy, May 1991, VO/ 77,IK) 5
physiotherapists have a responsibility to evaluate their own practice. An academic environment is the place where undergraduates can learn physiotherapy techniques and learn to be objective and evaluative. Hopefully the departments of physiotherapy will be able to draw on the expertise of academics from disciplines with a research tradition until they can be self-sufficient. Eventually, the departments of physiotherapy will be able to offer supervision to postgraduate physiotherapists who will undertake higher degrees which are physiotherapy-specific. University or polytechnic lecturers of physiotherapy will undertake their own research and will be able to employ physiotherapists as research assistants using the research grants for which they have successfully competed. University or polytechnic departments of physiotherapy will be the obvious sources of skill provision and support for clinical physiotherapists who want to undertake research. Ideally, academic departments and local clinical departments will liaise, resulting in an interchange of need fulfilment. Eventually, newly qualified physiotherapists will be well versed in research methodology and hopefully be in a position to influence their senior colleagues. At a later stage, some of these newlyqualified graduates of university or polytechnic departments of physiotherapy will become senior physiotherapy managers, with a real understanding of the difficulties and importance of research. They will also have the political influence to facilitate research within their own domains. A contribution to current knowledge and a proven ability to conduct research
(and publish results) may even become a requirement for those hoping to be promoted to senior clinical or managerial levels. When a research philosophy and tradition has been established in physiotherapy it will be as a result of a deep change in the way physiotherapists think. The researcher physiotherapist will be a different animal from the physiotherapist who 'does research'. This change in the nature of physiotherapists will result from the change in the context in which physiotherapy is taught to undergraduates. This in turn will enable those of us with diplomas (a dying breed anyway) to catch up if we are prepared to make the painful transition and are willing
to change our self-concept. The CSP can help. It can continue to provide a forum in which discussion can take place regarding the needs of clinical practice, education and research. (As a research philosophy develops these needs will become common.) It can also continue to encourage the development of an undergraduatecurriculum which encourages a critical, objective approach to physiotherapy. What the CSP must not encourage is the idea that physiotherapists can be taught to be researchers overnight, or that a series of short courses, self-learning packages, top-up courses, etc, can replace a thorough grounding in an academic environment.
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Mrs Susan Nayee, CSP research and information officer, comments: I welcome this visionary point of view about the development of physiotherapy research, with which I wholeheartedly agree. I am very pleased that the Research Workshop on April 10 stimulated such a response. The CSP will continue to support the development of research, and we are actively considering how support and encouragement can be most effectively provided. Following the workshop we are considering several ideas for other events to raise the profile of physiotherapy research, and to provide a platform and a forum for research presentation and discussion. The opening of the new Information Resource Centre at the CSP and development of the Research Database are intended to further the advancement of efficient and effective access to information for and about important research matters, including funding and education.
While I entirely agree that the magnitude of the changes needed and standard of the skills necessary to support that development should in no way be underestimated, such a revolution cannot be achieved overnight. However, I believe that simple basic information for those for whom research is an entirely new and daunting subject, although a different matter, should not be disregarded. We are at present revising our existing introductory guide lines on research, and considering how we should respond to those who, while they are not seeking to become 'overnight researchers' are nevertheless seeking guidance in a complex field for which they have received little or no training. This in no way undermines or seeks to replace the important task we have to support the development of physiotherapy research as a rigorous discipline, and the needs of researchers active in clinical practice, the academic field and education throughout the profession
Robert Williams International Award l991 The Chartered Society of Physiotherapy is pleased to announce that the following individuals have been awarded a Robert Williams International Award in respect of the named papers, which will be presented at the World Confederation for Physical Therapy International Congress being held at the Barbican, July 28-Aug~st 2, 1991.
Dr P Arnell 'The accuracy of visual gait assessment' Ms C Blowman 'Genuine stress incontinence: A pilot study using neurotrophic stimulation in the treatment of genuine stress incontinence' Ms J Bott 'The use of nasal intermittent positive pressure ventilation in the treatment of respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease' Mrs K J Dick 'Investigation and evaluation of physiotherapy intervention in acute bronchiolitis of infancy' Ms M Donaghy 'The effects of different forms of exercise on the fitness, mood and memory of a sample of problem drinkers'
Physiotherapy, May 1991, vol77, no 5
Mrs A C B Ferguson 'The use of the flexion withdrawal reflex in spinal cord injured patients' Mrs J Hall 'A double-blind placebo-controlled trial to assess the efficacy of low power laser in chronic rheumatoid arthritis of the finger joints' Mrs K M Jackson 'The unreliability of sensory assessments' Mrs L C Laidler 'STARS - Clinical audit (Stow Assessment Resource System)' Mrs J Moffett 'A double-blind controlled study to evaluate the effectiveness of pulsed shortwave for pain relief in osteoarthritic hips and knees' Mr A A Mugglestone 'The role of pulsed shortwave diathermy in the management of undisplaced fracture of the neck of humerus' Dr I Musa 'Electrotherapy skills: Their importance in the - undergraduate curriculum' Ms R H Mushet 'The reliability and validity of a portable EMG unit' Dr A Parry 'Redeeming expert knowledge: The application of cornputerised decision-support systems to physiotherapy' Mr D R Scrutton 'Trends in the management, during childhood, of chronic movement disorders' Miss A P Walker 'Physiotherapy in primary care' Miss B A Webber 'Evaluation and inflation in respiratory care'
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