ggpTEMBER 1978 P H Y S I O T H E R A P Y 3 gplTORIA L V A N DIE REDAKSIE QUALITY CARE T he p h y s io th e r a p is t h a s b e e n firm ly e sta b lish e d as aft o f th e m u ltid is c ip lin a r y te a m in v o lv e d w ith r e ­ h a b ilita tio n a n d h a b ilita tio n o f th e h a n d ic a p p e d . It ems h o w e v e r, th a t it is no lo n g e r e n o u g h ju s t to give n h v siotherapy, b u t th a t th e q u a lity o f th a t p h y s io th e ra p y matters v e ry m u c h — in te rm s o f re su lts o b ta in e d a n d m st-effectiveness. I t is h ig h tim e fo r e v e ry p h y s io ­ therapist to ta k e a n o b je c tiv e lo o k a t h is /h e r w o rk , deciding w h e th e r e v e ry p a tie n t is re c e iv in g th e best treatm ent, g u id a n c e , c o u n se llin g a n d a ssista n c e a v a ila b le at the m o m e n t. In C a n a d a th e p h y s io th e r a p y b o d y itself h a s u n d e r ­ taken a lo n g -te rm a sse ssm e n t o f th e q u a lity o f p h y sio - Serapy se rv ice s d e liv e re d (S a a rin e n , 8 th In te r n a tio n a l in g r e s s , W .C .P .T . Is ra e l 1978). A t th e C o n g re ss th e first re su lts w e re p re s e n te d o f a n o n g o in g stu d y o f facilities a v a ila b le , p a tie n t n e ed s a n d se rv ice re n d e re d by p h y s io th e ra p is ts a c ro ss C a n a d a . T h e fu ll r e p o r t w ill no d o u b t m a k e v e ry in te re s tin g r e a d in g a n d g iv e g u id e ­ lines fo r th e fu tu re . F u r th e r so u th in T e x a s, a re tro s p e c tiv e stu d y o f 95 patients u n d e rg o in g su rg e ry f o r h ip fra c tu r e a t R o s e ­ wood G e n e ra l H o s p ita l in H o u s to n (L iss a n d W y lie Texas M e d ic in e 1978, 74, 6 9 - 7 3 ) , w ith a n a n aly sis of results o f r e h a b ilita tio n e m p h a siz e s th e im p o rta n c e o f early e ffective m o b iliz a tio n in a sp e c ia liz e d r e h a b i li ta ­ tion u n it. T h e a u th o r s c o n c lu d e t h a t th e re s u lts o f a good m o b iliz a tio n a n d r e h a b ilita tio n p ro g ra m m e in a specialized r e h a b i lita tio n n u rs in g u n it r e n d e r s u rg e ry o f hip f r a c tu r e in p a tie n ts o f h ig h age a n d w ith m ed ic al c o m p lica tio n s fe a s ib le , sin c e th e m o r ta lity ra te w as only 5 ,3 % . _ A n o th e r stu d y in B r ita in ta k e s a c ritic a l lo o k a t stroke p a tie n ts re c e iv in g p h y s io th e ra p y , o c c u p a tio n a l th era p y o r sp e e c h th e r a p y a t six h o s p ita ls in S o u th M a n c h este r (B ro c k le h u rst, A n d re w s , R ic h a r d s a n d L aycock, B ril. M e d . J. 1978. 1, 1307 - 1310). I t seem s th at th e a m o u n t o f p h y s io th e r a p y a p a tie n t re ce iv e d was d ire c tly p r o p o r tio n a l to th e d e g re e o f d is a b ility but h a d a p p a r e n tly little o r n o (a n d so m e tim e s a n a d ­ verse!) in flu e n ce o n th e final o u tc o m e . In th is d e ta ile d )idy n o m e n tio n is m a d e o f th e f a c ilitie s a v a ila b le jt o f w h a t ty p e o f p h y s io th e r a p y w as g iv e n o r how , but o n ly w h e th e r o c c u p a tio n a l a n d sp e e ch th e r a p y w ere av ailab le o r n o t. K n o x a n d H o rro c k s (B rit. M e d . J. 1978 1, 1696) c o m m e n t o n th is , as w ell as th e d a n g e r th a t lim ited s e rv ic e u n d e r less th a n id ea l c irc u m s ta n c e s m a y be w ith d ra w n as a re s u lt o f th is stu d y . B ro c k le h u rs t et al. p o i n t o u t in th e i r stu d y as w ell as in a n sw e r to the a b o v e c o m m e n t t h a t th e y trie d to stress th e n eed fo r b e tte r d e p lo y m e n t o f a v a ila b le e x p e rtis e to th o se p a tie n ts w h o c o u ld b e n efit m o st fro m it, w h e re a s p a tie n ts w ith lim ite d sc o p e f o r re c o v e ry c o u ld b enefit as well by tre a tm e n t f r o m less h ig h ly s k ille d p e rso n n e l. T h e e m phasis o f a sse ssm e n t a n d su b s e q u e n t q u a lity o f c are should th u s b e o n d e g re e o f re c o v e ry e n v is a g e d r a th e r th an d e g ree o f d is a b ility . I n th is c o u n try , w h e re m a n p o w e r a n d re so u rc e s a re lim ite d , a n d d ise ase a n d d i s a b ility rife , it w o u ld seem re a so n a b le to assess a ll s itu a tio n s c a re fu lly a n d c ritic a lly in o rd e r to d e p lo y su c h m a n p o w e r a n d re so u rc e s in a m o st effective a n d efficient m a n n e r, a t th e sa m e tim e u tiliz in g less sk ille d p e rs o n n e l effe c tiv e ly to m a in ta in status q u o a n d p re v e n t c o m p lic a tio n s in th o se s itu a tio n s w here little o r n o c h a n g e can b e effected. BIOTERUGRIGTING (Biofeedback) H ie r d ie te g n ie k h e t as ’n te ra p e u tie s e im p le m e n t in g e d ra g sm o d ifik a sie in o n g u n s v e rv a l as gev o lg v a n b u ite n s p o rig e r e s u lta te w a t d a a r a a n to e g e s k ry f is ge- d u re n d e d ie e e rste p a a r j a a r v a n h ie r d ie d e k a d e . D ie a fg e lo p e p a a r ja a r e g te r h e t m e e r v e rs ta n d ig e p ro e f- n e m in g s in d ie k lin ie se situ a s ie w e e r a a n v a a r b a a r h e id a a n b io te r u g r ig tin g v e rle en . V e rsk e ie d is s ip lin e s in d ie m e d ie se en p a ra m e d ie se g e le d ere h e t g e b ru ik g e m a ak v a n of u itg e s p ro k e b io te r u g r ig tin g o f ’n m e e r s u b tie le v o rm d a a rv a n . B a sm ajian , in ’n re d a k sio n e le in le id in g (C a n a d . M e d . A sso c . J., 1978, 119, 8 ), verw y s n a n u w e o n tw ik k elin g s o p d ie g e b ie d , as g e volg v a n n u w e in sig in d ie m eto d e s w a a rm e e d ie m en s b e h e e r o o r v e rb o rg e n e u r a le e n p s ig o s o m a tie s e m e g a n ism e s k a n u ito e fe n . M e e ste p ro e f- n e m in g s in d ie rig tin g d u s v e r h e t e g te r in d ie la b o ra - to r iu m p la a sg e v in d . K lin ie s e p ro e fn e m in g is m e e sa l o p d ie b e h e e r v a n g e stre e p te sk e le ts p ie r gem ik. T w e e rig tin g s is h o o fs a a k lik in g e s la a n , n a a m lik d ie h e ro p le id in g v a n so g e n a a m d e “ v e rla m d e ” s p ie re o f d is k in e s ia s (soos g e v in d in die sla p v o e t v a n ’n p a s ie n t m e t h e m ip le g ie o f ’n p a s ie n t m e t s e re b ra le v e rla m m in g ), en d ie to e p a s s in g in o n ts p a n n in g s o p le id in g in p a s ie n te m e t sp a n n in g s h o o fp y n e , k ro n ie s e r u g p y n o f a n g sn e u ro s e . F i s io te r a p e u te m a a k 0 0 k n o u m e e r en m e e r v a n b i o ­ te ru g rig tin g g e b ru ik en h e t d it in b e id e rig tin g s o n t- w ik k e l. S p ie rh e ro p \e id in g in b o o n s te n e u ro n le ts e ls b ly k n o g d ie m ees e ffe k tie w e r e s u lta te te lew er, m a a r 0 0 k in o n ts p a n n in g s te g n ie k e w o rd b io te r u g r ig tin g al m e e r g e ­ b r u ik . T y d e n s d ie a g tste W e re ld k o n g re s v a n d ie W o rld C o n fe d e ra tio n fo r P h y s ic a l T h e ra p y , g e h o u te T e l A v iv , Is ra e l, is ’n h e le sessie a a n ’n p a n e e l-b e s p re k in g o o r h ie r d ie te g n ie k gewy. D a a r w o rd ta n s h o o fs a a k lik v a n g e h o o r en v isu e le e le k tro m io g ra fie s e se in e g e b ru ik g e ­ m a a k . ’n D rie d a a g s e o rie n te rin g s k u rs u s o o r e le k tro m io - grafie v ir fis io te ra p e u te h e t d ie k o n g re s v o o ra fg e g a a n . ’n M e e r su b tie le g e b r u ik w o rd in g e d ra g sm o d ifik a sie gevind. M a rs h a ll (Canad. M e d . A sso c . J., 1978, 119, 45) b e s p re e k m e to d e s o m p a s ie n te , w a t c h ir u r g ie in 'n h o s p ita a l o n d e r g a a n h e t, te h e lp o m stre m m in g te b e ­ h e er. In fo rm e le , p re -o p e ra tie w e v o o rlig tin g h e t ’n on- v o o rs p e lb a re , d o g v o o rd e lig e in v lo e d . H ip n o s e is b a ie m e e r e ffe k tie f, m a a r o n p r a k tie s w een s d ie lan g op - le id in g w a t b e id e te r a p e u t en p a s ie n t m o e t o n d e rg a a n . P o s itie w e g e d ra g sm o d ifik a sie w o rd e g te r a a n b e v e e l d a a r v e rp le g in g s p e rs o n e e l m a k lik o p g e le i k a n w o rd o m d it to e te p as en p a s ie n te a k tie f b y h u l e ie v e rb e te rin g b e tr e k w o rd en b e h e e r d a a r o o r het. B a ie m e e r m o e t n o g v a n h ie r d ie te g n ie k o n d e rs o e k w o rd , m a a r d it b ly k ’n h a n d ig e en effe k tie w e te ra p e u tie s e im p le m e n t te w ees w a t fis io te ra p e u te in ’n v e rsk eid e n - h e id v a n s itu a s ie s to t v o o rd e e l v a n p a s ie n te en a n d e re k a n a a n w end. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )