p h y s io th e ra p y , J u n e 1983, v o l 39, n o 2 27 EDITORIAL THE FUTURE OF PHYSIOTHERAPY P h v s i o t h c r a p y lias e x p a n d e d in se ope a n d nu m b er s ! l crn ationally. In So u t h Africa it is e x p a n d i n g as well, but IM rapidly en ou gh to cop e with the e xp lod in g health carc n('.(.ls resulting fro m rural de v el o p m en t an d re sultant upgrading o f c o u n tr y a n d mission hospitals. At' present there are less th an 2 000 registered illysiotherapists to service a p o p u l a t i o n o f over 25 million. With seven schools o f p hy si o t h e r a p y qualifying a b o u t 100 physiotherapists a n n u al ly , there seem no ho pe of c at ch i n g up on the backlog, even t h o u g h a n o t h e r school (University of Western Ca pe) will st a r t t a k i n g st u d e n ts in 1984 for a fou r v c a r desrcc p r o g ra m m e . C o m p a r e o u r sit ua ti on for example with that o f H o l l an d wh er e the n u m b e r o f practising physiotherapists trebled in seven years (K e rk h of f. 1982) J'r om 1900 in 1975 to 6 600 in 1982. The phys ioth erap ist: p o p u l a t i o n ratio in So u t h Africa is lame nta ble . In H o ll an d the ratio has been set at 1:3 500. bu t a p p e a r s to alt er this to | 3 000 have been m ad e in o r d e r to decrease patie nt wa iting lists, to shorte n w o rk in g days, a n d to impr ove q ua lit y care. Yet. p hy si o th er a py in South Africa sh ow s the signs o f uneven growth as desc rib ed by Peat (1981). na me ly leaving behind the scientific cor e in the general pur suit o f a gre ater scope o f practice, increased a d m in is tr at iv e c o nt r ol a nd more political influence. T h er e is exp ans ion o f an alr eady extensive a n d impressive area o f clinical practice, but still a search for a well defined identity a n d status. The article on status in this issue clearly illustrates this search. There is also c o n st a n t e xp an s io n o f fields o f pr actice and specialization, as exemplified by the article a n d a b st r ac ts on Occupational Ph ys iot he rap y. This is c o m m e n d a b l e a n d it behoves us to c o n ti n ua lly de velop fu rt h er c ha nn e ls of practice where o u r expertise can be utilized, especially in primary and preventive health care. But the s u p p o r t i n g base of existing p hv si o th cr a py practice is fragile a n d very small. Peat (1981) m a i n t a i n s that the ar t o f p h y s i o t h e r a p y is its soul and the science a nd t ec hni que s are its body. He describes the art in te rm s o f human relationships: the p o w e r of the p a t i c n t - t h e r a p i s t r e l a t i o n s h i p in r e h a b i l i t a t i o n , identifying with a c o m m o n objective but re quiring time: the therapist-therapist in ter act ion , whe re role m o del lin g and /d e m o n st r a ti o n are used to tr an s m it tec hniques. How ever, a v e s t e d interest in a specific tec hni que can resist p e n et r at io n by new knowledge a n d a d a p t a t i o n t o it. A n inverted p yr am id situation can result wh er e a tech ni que b eco m es established in clinical practice befo re its effect has been established. This oiten leads to its a d v o ca te s su p p o r t i n g the tec h n iq ue with scientific kn o wl ed g e from outside p hy si o th er a py ; this knowledge is essential, but not always relevant. Finallv. the pl acebo effect is an effective tool in p h y si o t h er a p y , which dr aw s st r e n g th from a o n e -to -o ne re lat io ns hip with patients. T he p h y s i o t h e r a p i s t ’s a tti tu d e , ability to co nvince the patient an d confide nce in h i s / h e r ow n tech ni que s arc powerful pl acebo influences. This co n st itu te s the ar t o f p h ys io th era py. If we accep t that science is chara cte ris tic al ly an ope n system c o n ti n u a ll y a c c o m m o d a t i n g a nd mod ifying new i n f o r m a t io n in an objective a p p r o a c h a nd by a m e th o d o f r e pr od uc ib le experi men tal result, a conflict with the ar t o f p h y si o t h er a p y mav be experienced. Peart discusses the scientific di m e n si o n o f p h y s io th er a py in ter m s o f six characteristics. T h e acceleration o f scientific grow ih is n ow accep ted to be a d o u b l in g o f kno wle dg e every 10 years: thus ke eping a br ea st with new kn owl edge to prevent obsolescence is a real treadmill. Dilution o f the scientific base o f p h y si o t h e r a p y t ec hn iq ues o r ig in a tin g from a physiological co n cep t is very real if the tech ni que is refined, e la b o r a t e d a nd d ev elo ped to the d e tr im en t o f the basis. Term inology sh o u l d have a specific m ea n i n g an d be generally accepte d if c o m m u n i c a ti o n o f kn ow le dge is to be effective. T h u s a cle ar definition o f terms is essential. Qu a n t it a ti v e objective m easurem ent o f the criteria that d e m o n s tr a t e efficacy o f t r e a tm e n ts a n d a cc ur ate re cording a n d analysis o f clinical d a t a need to be d ev elo ped f o r sv s te m s unique to ph y si ot her ap y. Research a n d advanced studies to va lidate t r e a tm e n t te c hn iq u es (before prescr ip tio n and a p p li c at io n ) a n d to acqui re technical skills, arc lacking. Ph y s io t h e r a p y research to validate clinical pr actice is still limited in v ol um e a n d quality. Th er e is also inadequate publication o f results, especially o f original research. T ec h ni q u e s arc t au g ht in th cr a p is t-t h c ra pi st in teraction, ra the r th an t h r o u g h the m e d iu m o f print. Finally. Peat c o nc lu d es th at science an d art arc essential for the survival a n d d e v el o pm en t o f p h y si o th er a py . T o this end he suggests focusing in the futu re on research in the universities as a m a j o r c o m p o n e n t o f their p r o gr am m es : devel op ing u n d e r g r a d u a t e curri cu la th at will c n eo u r a g e critical e v a l u a t i o n a n d c o m p a r i s o n o f clinical m et h o ds ; the acqu isition o f ad di ti o na l ac a d em ic a n d research skills by faculty: es tablishing g r a d u a t e p r o g r a m m e s with a clinical Contents - Inhoud The F u tu re o f P h y s io th e r a p y ............................ 27 B o o k R eview ............................................... ........ 39 A S tu d y o f the P ro fe s s io n a l Im age ................ 28 A n In v e s tig a tio n o f O n -D u ty In ju rie s .. ........ 40 In d u s tria l/O c c u p a tio n a l P h y s io th e ra p y ........ 31 P o s t-M e n is c e c to m y R e h a b ilita tio n ___ ........ 42 O c c u p a tio n a l T h e ra p y — W o rk A sse ssm e n t 35 C o rre s p o n d e n c e ......................................... ........ 47 An A p p lic a tio n o f P h y s io th e ra p y .................... 38 C la s s ifie d ....................................................... . . 48, 49 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. ) 28 F is io te ra p ie , J u n ie 1983, d ee ! 39, n r 2 scicnce e m ph a sis in o r d e r to di sse m ina te scientific knowledge a n d its ap pl ic at io n to clinical p ro bl em s. Clinical research can only be c o n d u c t e d in the clinical e n v ir on m en t, for exam pl e by sys tema tic e n qu ir y as described by Go n e lla . Research c o - o r d i n a to r s could assist in the design an d analysis o f research projects, which sho ul d o c c u r in both clinical a n d a c a d e m i c e n v ir o nm en ts . Research can be e nh an c ed fur th er if specialization is en co ur a g ed by for mal g ra d u a t e e d u c a ti o n , e lim in a tio n of clinical ro t at i o n , formal professional identification o f a rea s o f specialization and recognizing e m p l o y m e n t o p p o rt u ni ti es . T h e profession will have to set a n d recognize s t a n d a r d s o f specialization and c o n ti n u in g e d uc a tio n cours es at r e aso na bl e cost at att rac tiv e ho ur s will have to be p ro v id ed to m ain tai n qu ality c are and c o m pe ten cy . Hence we will have to c o m e to ter m s with science as a growi ng , c han gi ng p h e n o m e n o n a nd its cons eq uen t instability, co nf usi on and a m b ig ui ty that upsets so-called established truths. If p hy si o th er a py is t o be credi ble, it has to p r o g r e s s i v e l y a c c u m u l a t e i n c r e a s i n g q u a n t i t i e s o f kn owl ed ge, de velop a n d use precise m e a su r e m e n t svstcms a n d be subje cted t o a r g u m e n t, discussion a n d an alysis in or d e r to pr o d uc e factual evidence t o s u p p o r t b o t h the art an d the scicnce. References K er k ho ff . A. H. M. (1982). H u i s a r t s en fisio thcr apc ut. M edisch Contact, 33, 991-997. Peat, M. (1981). Ph ys iot he rap y: art o r science? Physiother. Caiuid, 33, 170-176. A STUDY OF THE PROFESSIONAL IMAGE OF THE DEPARTMENT OF PHYSIOTHERAPY AT THE TYGERBERG HOSPITAL COMPLEX E. M O U T O N . B. Verpl., B.A. (H on s. Sielk.) (Stellenbosch)* SUMM ARY In this stu d y the p ro fe ssio n a l im age o f the D e p artm ent o f P hysiotherapy as observed b y physicians, physiotherapists, p a ram edical s t a f f a n d laym en (patients) was lo o k e d at. The N o m in a l Group Technique (N.Ci.T.) was used to develop the S e m a n tic D iffe re n tia l (S .D .) which was used as the criterion o f m easurem ent. In the results, the a fo re-m entioned groups in d ic a ted a p o sitiv e im age o f the D epartm ent o f P hysiotherapy a n d there seem s to be a m in im a l difference in im age observation am ongst the d iffe re n t groups. t I m age research has been used in the past f o r different projects, p ar ticu la rly in the field o f m ar k e ti n g research in o r d e r to s t im ul a te t wo -w ay c o m m u n i c a ti o n between c o n s u m e r a n d p r o d u c e r (An as tas i, 1964). “ Im a g e " is a c on cep t which refers to the co nce pt ua liz ed no tion o f w h a t we know. An image is t h ere for e the c o n n o t a t i o n o f wha t we believe t o be the t r u t h (Sp oelstra, 1976). In the l ite rat ur e on the subject different a p p r o a c h e s to the co nc ep t im age are foun d. These v ar y fro m a per son ali ty sp ec ula tio n o f the c o n ce pt o n the o n e ha n d , to a tr en d t o define “ im a g e ” as an atti tud e, on the ot her. By using the term prof ession al image, the e mp ha sis mo ves t o w a r d s the pro fession a n d its a t t e n d a n t behaviour. In this stu dy the pr ofessional image as a reflection o f the a tt itu de s o f in dividuals to w a rd s the D e p a r t m e n t of Ph ys io t h e r ap y was l oo ke d at. A t t it u d e s arc of ten de fined as tendencies to react f a vo u ra bl y or u nf a v o u ra b l y to specific " ' D e p a r t m e n t o f P e r s o n n e l D e v e l o p m e n t , T y g e r b e r g Hos pit al. Received II O c t o b e r 1982. O P S O M M IN G In hierdie studie w ord die professionele b e e/d van die D e partem ent Fisioterapie soos w aargeneem deur dokters, ftsio te ra p e u te , p a ram ediese personeel en le k e (pasiente), beskou. D ie N om inate G roeptegniek (N .G .T .) is g e b ru ik om die S e m a n tie se D ifferensiaal (S .D .) wat g e b ru ik is as die m e tin g s k r ite r io n , te o n tw ik k e l. In die r e su lt a te het bogenoem de groepe 'n positiew e b eeld van die D epartem ent F isioterapie aangedui en daar b ly k ’n m inim ale verskil in beeldw aarnem ing tussen die verskillende groepe te wees. stimuli (A n a sta si , 1968). It was possible t o use on e o f s e v e r a l a vaila ble a tt i tu d e m ea su r e m e n t t ec hni que s for this s tu dy by' viewing “ im a g e ” as a fun ctio n o f a tti tud es . T he Sem ant ic Differential de ve lo pe d by O s g o o d (1952) as a cr ite ri o n for the psyc hological m e a n i n g o f co nce pts , has been used in the past for sim ilar pu rp ose s. Im ages arc the simplified i m pr es sio ns o f people o f an oth erw is e complex entity ( K o tt le r . 1972). It was these “ im p re ss io n s” which were m e a s u r e d in this study. T h e different pro fessio nal g r o u p s used in this st u d y were well k n o w n to the D e p a r t m e n t o f Ph y s io t h e r ap y as can be seen fro m T ab le I. It c o u ld t h ere fo re be expected t h a t the selected g ro up s w o ul d in dicate cert ain a tti tud es , a ss u m p t io n s , a c ti on s a n d preferences in respect o f th e D e p a r t m e n t o f Phy sio th e ra py a n d w oul d thu s have a cert ain image o f the profession. A c co r d i n g to Spo el str a (1976) the i n f o r m a t io n ga in e d by image research can be used for several pur poses: • p la n n i n g a n d p r o m o t i o n strategies • e v al u at io n o f efficiency a n d inte rn al r e -o r g a ni za tio n a n d • as a c o m m u n i c a t i o n m e d i u m for be tte r m utu al u n d e r s t a n d i n g a m o n g s t c o n ce r n ed parties. 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. )