Physiotherapy, like many other healthcare professions, is reinventing itself as patients’ needs change and their interactions with physiotherapists become more holistic. Emma Stokes, associate professor of physiotherapy at Trinity College Dublin and president of the World Confederation for Physical Therapy, is well placed to understand these changes.
“The conversation with patients and clients is changing from ‘Let me tell you what you need to do’ to the solution coming from within the person. Our role is to empower and evoke change with the clients themselves,” says Stokes.
As well as lecturing at Trinity, Stokes also trains physiotherapists in leadership and advocacy skills.
“The key is finding out how to motivate clients to change. A lot of people don’t do the exercises that a physiotherapist sets for them. So, we have to have a nonjudgmental conversation with our clients about exercise,” she says. “We need to ask questions like, ‘Were you given exercises before?’ ‘What did you find tricky?’ ‘What would be helpful this time?’ ”
Some people might prefer to follow a video on their phone while others might prefer to have detailed instructions written down for them. “It’s important to realise that my solution might not be your solution,” says Stokes.
Health behaviour Physiotherapists deal with all ages from premature babies to new mothers (postnatal incontinence is one important issue here) to older people living in the community, so how they respond to clients is important. “We have this phrase now – ‘Make every contact count’ – to enhance health behaviour change.
“We deal with neurological diseases [such as multiple sclerosis and motor neurone disease], respiratory diseases [such as cystic fibrosis and chronic obstructive pulmonary disease], rheumatoid or osteoarthritis, traumatic brain injury and spinal-cord injury as well as muscular-skeletal conditions, from stroke to sports injuries.”
One relatively new area of care is with people living with HIV.
“The longer people are living with HIV, the more likely they are to have episodic periods of disability, so we can help with joint aches, balance problems and fatigue management,” says Stokes.
Chronic diseases
Physiotherapists are also key practitioners on cardiac rehabilitation programmes and chronic disease management programmes. “More and more people are presenting with chronic diseases, so we have a role in managing these conditions,” she says.
She also believes that like other health professionals, physiotherapists have to address wider issues such as obesity when seeing their clients. “We need to talk to clients about their levels of physical activity, smoking and alcohol use as part of our overall assessment.”
Encouraging more physical exercise is significant. “People need to create opportunities for exercise, to be mindful of how long they spend sitting, and to build physical activity into their daily lives. Group classes work for some but not for others, so you have to be respectful of that,” Stokes says. “You have to also think about things such as set-dancing classes for people who don’t enjoy exercise, standing on the Luas home from work, and walking up stairs.”
Regulation
One big issue for physiotherapists in Ireland is that they are not as yet regulated by the new State registry board, Coru. In theory, this means anyone can call themselves a physiotherapist but in reality most people are aware that physiotherapists practising here are members of the Irish Society of Chartered Physiotherapists.
“We are awaiting a decision on the protection of the title,” says Stokes, who is a member of the physiotherapists’ registration board at Coru.
Around the world, “physiotherapist” and “physical therapist” are used interchangeably. The majority of countries describe what we refer to as physiotherapists as physical therapists.
However, in Ireland, there is a separate training and qualification for physical therapists, who deal mainly with sports injuries and other musculoskeletal conditions. Physiotherapists here also work as part of the private and public healthcare system while physical therapists in Ireland work in private practice.
Another issue that the Irish Society of Chartered Physiotherapists is keen to highlight is the low number of physiotherapists here compared with other similar-sized countries.
“For instance, when you compare Ireland with Denmark which has a population of 5 million, you see it clearly. Ireland has 3,500 physiotherapists compared with 11,000 physiotherapists in Denmark,” says Stokes.
