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. ) p h y s io th e ra p y . J u n e 1983, vo l 39. n o 2 29 Table 1. Degree of contact with the Department of Physiotherapy Oft en Seldom Never 57. 9% 41.5% 1.3% 66 .4% 33.7% — 61.6%) 31.2% 7.3% The main benefit o f this exercise- was th at it p ro vi de d the o p p o r t u n it y to identify p r o b l e m ar eas existing between physio th era pi sts a n d each o f the selected grou ps. This co uld lead to m utu al u n d e r s t a n d i n g a nd g re at er efficiency in the d e p a r t m e n t con cer ned . m e t h o d T h e Se m an ti c Differential was selected as a criterion of m ea su re m e nt for tw o i m p o r t a n t reasons: • It has been successfully applied in different c o n te x t s s u c h as clinical di agn os es a n d th er a py : c o n s u m e r re act io ns to pr o du c ts and t rad e n a m e s (An ast as i, 1968). • It is not a specific test, but a very flexible a p p r o a c h to o bt ai n scores, a tt i tu d e s a n d o t h e r sentiments. Research wo rke rs can th erefore crea te a se m an ti c differential by using O s g o o d ’s original scales o r bv using their o w n scales m ore suited to their own specific si tuation. The S.D. m e t h o d consists basically o f rep ea te d rati ngs o f on e o r o t h e r con cep t. In this case the co n cep t “ professional ima ge ” was r a te d agai nst pairs of descriptive op p os it e adjectives on a 7-p o in t scale. O n this scale 7 re presented the positive pole a n d I the negative. THE Q U EST IO N N A IR E Originally 93 items were ge ner ate d a n d selected by p hy si o th er a pi st s (clinical a n d t ea ch i ng staff) by using the N om in al G r o u p tec hnique. T h e final list cons isted o f 25 items, a nd these were divided into 6 dimen sions: effectiveness, dy na mi cs, pr o d uc tiv ity , loyalty, scientific a n d professional aspects. T h e final q u e st io n n a i r e was pr esented in bo th official languages, with clear inst ru cti ons , a n d a dd iti on al i n f o r m a t io n , such as oc c u p a ti o n . English- or A fr ik aa n s- s p ea ki ng , as well as the degree o f c o n ta c t with ph ysi ot her ap ist s, was also requested. TARGET G RO U P T h e tar ge t g r o u p c o m p r i s e d p e r so ns in the T y g e r b e r g Hos pital Co m p le x (physicians, pa ra m e d i c a l staff, laymen (patients) a n d p h y si ot he r a pi st s (teaching a n d clinical staff). N u m b e r o f q u es t io n n a i r es processed: Physicians ....................................................... 141 P h y s i o t h e r a p i s t s ........................................... 29 Pa ra me dic al s t a f f ......................................... 186 L ay m en (pa tie nt s) ....................................... 190 T ot a l .................................................. 546 RESULTS AND C O N C L U SIO N S T h e results were processed by a c o m p u t e r a nd are indicated th r o u g h o u t in terms o f average. All 25 items were rated between 4.0 a n d 6,6 o n the 7-point scale. It w o uld therefore a p p e a r th at ph ys iot her ap ist s ma in ta in a positive image of their profession, a n d this a ttitu de was co n fi rm ed by each of the selected groups. A profile of each o f the d im en si on s is illustrated in Fig. I a n d each dimensi on is illustrated se paratel y in Figs. 2-6. P h y s i c i a n s P a r a m e d i c a l s t a f f L a v men F IG . I. D IF F E R E N T D IM E N S IO N S L a y m a n ------------- P a ra m e d ica l----------- P h ysio --------------- Ph ysicians / / : / / ! \ ' / / V - V\ V \ / / ■ / i ■/ / A / \ y % I <■ i \ L____ Li___ I____________ 7 6 5 F IG . 2. D Y N A M IC It is fairly ob vi ous th a t in the d y na m i c di me n si o n the l aymen (pa tients ) te n d e d t o rate a m o r e positive image in c o m p a r i s o n with the o t h e r g ro u p s. T h e ph y sio th era p is ts r ate d themselves less positively on the item enthusiastic. In fig. 3 ( pr od uct iv ity ) there is a m a r k e d ten d en cy by all the g r o u p s to a w a r d a low score to the item easily available. T h is item was ra ted lowest of all the o t h er items: p hy sio th era pi sts (4,6): physicians (4,3): p a ra m ed ic al staff (4.0) a n d laym en (4.5). T he av ailability o f p h y si o th er a pi st s seems to be a pr o b l e m - a r e a . pa rt i cu l a r ly as far as the p a ra m ed ic al sta ff are c on ce r ne d , an d m ay be a tt r i b u te d to several factors. It may be w or th w h il e t o d o an in-d epth st ud y on this issue. Progressive D y n a m ic I n itia tiv e E n th u s ia s tic A c tiv e 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. ) 30 Hard w o rk in g Energetic H e lp fu l Laym an Easily A va ilable In te re ste d W illin g 7 6 5 F IG . 3. P R O D U C T IV IT Y In c o m p a r i s o n t o the p hy sio th era pi sts (5,5) the phvsici' (4,6) rate the p hy si o t h e r a p y p ro fes sio n m ore dependent ( F ^ 5 effectiveness). F is io te ra p ie , J u n ie 1983, d ee l 3 9 n r 2 P r o f e s s io n a l L a y m a n . P a ra m e d ic x P h y s io o P h y s ic ia n o - I - 7 6 5 4 F I G . 5 . P R O F E S S I O N A L A l t h o u g h the physicians r a te d the items specialised a n t f insight positively, they gave a lo we r ratin g than all the o t h e r selected g r o u p s (Fig. 6). T h e p a ra m ed ic al sta ff ra ted insight (5.5) low er th an specialised (6.0). S p e c ia lise d S h o w s in sig h t \ i L a y m a n P ara m e d ic - P h y s io - P h y sic ia n •• -I- F I G . 4 . E F F E C T IV E N E S S 7 6 5 F I G . 6 . S C I E N T I F I C In this item (Fig. 5) the p h y si o th er a pi st s regarded themselves less positively th an the o t h e r gr oups. This i n f o r m a t i o n co n fir m ed the fact th at it was because o f the p h y s i o t h e r a p i s t s ’ u n d e r e st i m a t io n o f their ow n professional image th a t they requested this study. T h er e is a n o t h e r notic eab le de via tio n in this dimensional T h e laymen, who a w a r d e d all the o t h er items the highest, ra tin g, rated the ethical as pect (5,3) lower th an the p h y si o t h er a p i st s (6,1) an d the physicians (5,6). It may be a g o o d idea to a nal yse this area to d e te r m i n e the immediate cause for this low rating. SUM M ARY In this stu dy the image o b se rv at io n o f selected g r o u ps with regard to th e pro fessio n o f p h y s i o t h e r a p y in the Tygerberg H o s p it a l C o m p le x was lo oked at. T h e selected g r o u ps gave a very positive r ati ng o f the p h y s io th er a p y profession. This exercise was c ar r ie d o u t at the request o f the D e p a r t m e n t of Ph y s io t h e r ap y in o r d e r to e va lu ate their a s s u m p t io n that cert ain selected g r o u p s m ai nt ai n a negative image o f their pr of essions. T h e op p o si t e seems to be m o r e acc eptable. The value o f this study lies in the results which indicate t h a t the selected g r o u p s m ai n ta in a positive image o f th e professions o f p h y s i o t h e r a p y . T h e P h y s i o t h e r a p y D e p a r t m e n t , th erefore, n ow has an in dic ati on o f the a tt i tu d e o f the selected g r o u p s t o w a r d s their profession. 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. ) P h y s io th e ra p y , J u n e 19 8 3, , o l 39, n o 2 31 R eferen ce s fis H A. (1964). Field of Appl ied Psychology. ^ M c G r a w - H i l l . New York. A Tist'isia A. (1968). Psychological Testing. The Macmillan Co.. Canad a. Kotler, P. (1972). M a r k e t i n g M a n a g e m e n t . Pre ntice-Hall. New Jersey. O s g oo d , C. E. (1952). T h e n a tu r e a n d m ea su re m e n t o f m eaning. P sychological Bulletin, 49, 197-237. Sp oe lstra, H. I. J. (1976). ’n Bedrvfsielkundige o nd e r so ek na die v e rb ru ik e rs be el d van h a n d e l s b a n k e in Suid-Afrika. P erspcktiew e in B edryfsielkunde, 2, 1-23. INDUSTRIAL/OCCUPATIONAL PHYSIOTHERAPY AN INTERNATIONAL PERSPECTIVE B. M. J A H O L K O W S K I , M.C .S.P .* SUMMARY An overview o f th e d e v e lo p m e n t a n d p r a c tic e o f Indu stria l/O cc u p a tio n a l P h ysio th e ra p y in G reat Britain, Australia, New Zealand, Finland, Sw eden a nd D e n m a rk is given. Training fa c ilitie s a nd courses available in each c ountry are m entioned. B arbara M c P h e e ’s recom m endations f o r the development o f this f i e l d o f p h y sio th e ra p y are q u o ted as suitable f o r S o u th A frica. IN T R O D U C T I O N Industrial ph y si o t h e r a p y m ay be seen as a pa rt of occupational health. P hy s io th e ra pi st s all o ve r the worl d should become m ore a w a r e o f their pot ent ial in this field in the face of increased empha sis on pr e v en tio n, b o t h from the medical profession a n d ind ust ria l concerns. Increased technology is leading to increased h a z a r d s at the m a n / m a c h in e interface. Preventive medicine is slowly being suppl an ted by “ to tal w o r k e r well-being” in O c c u p a t io n a l or Industrial Heal th D e p a r t m e n t s . GREAT BRITAIN The first ind ustr ial p h y si o th er a pi st star ted w or k in 1923 in •the medical division o f A r t h u r G ui n n e ss a n d Son in Du blin. From 1923 to 1947, when the As soc iat ion o f C h a r te r e d Physiotherapists in In d u s t r y ( A .C .P .I .) was f o r m e d as a Specific Interest G r o u p o f the C h a r te r e d Society of Physiotherapy (C.S .P .), industrial ph y si o t h e r a p y grew slowly, rema ini ng basically a d u p lic a tio n o f the hospital outpati ent d e p a r t m e n t in an ind ustria l setting. By 1979 A.C.P.I. m em be rsh ip s t o o d at over 100. D ue to the present econom ic sit ua ti on in Britain A .C .P .I. m em b e rs h i p has fallen to 70 in 1982. In du str ial ph y sio th era pi sts in 1979 were employed in over 14 different types o f in dustries a nd business concerns (see Table) The ratio betw een p h y s io th er a pi st s a nd em ployees was determined by the A .C .P .I. as o n e fulltime ph ys io th er a pi st to 4 0 0 0 e m p l o y e e s f or t h e r a p e u t i c , r e h a b i l i t a t i v e a n d preventive tr ea tm e n t. Chris H a y n e received a Fellowship from the C.S.P. in 1977 f or his d is se rt at io n entitled “ T he Physiotherapist in M o d e r n I n d u s t r y ” . He n o w specializes in Private pract iti on er, C a p e T o w n Received 26 F e b r u a r y 1983. O P S O M M I N G ’n O o r s ig van die o n t w i k k e l i n g en p r a k t y k van In d u strie le /B e ro e p sfisio te ra p ie in G root B rittanje, A ustralie, N u-Seeland, Finland, S w ede en D enem arke, w ord gegee. O pleidingsfasiliteite en k ursusse b e sk ik b a a r in e lk e la n d , word genoem. B arbara M cP hee se aanbevelings vir die o n tw ik k elin g van hierdie veld van fis io te ra p ie w ord aangehaal as g e s k ik vir S u id -A frik a . I N D U S T R I E S E M P L O Y I N G I N D U S T R IA L P H Y S I O T H E R A P I S T S IN U.K. (1979) Chemi cal s 13 Steel 13 C o n s u m e r Pr o d u c t s I 1 M o t o r a n d allied 10 Large offices 9 En g in eer in g 8 I nd u st ri al H e al t h units 4 Oil 3 A ir p or ts 4 D e p a r t m e n t stores 4 A t o m ic En erg y 1 Ai rcraft P r o d u c t i o n 1 P h a r m a c e u t i c a l 1 C on f e ct i o n er y 2 T o b a c c o 2 Film ( K o d a k ) 1 Fo rklift tr u ck s 1 F r o m T h e P h ys io th e r ap is t in M o d e r n I n d u st r y (1977). Fel low ship C.S.P. di sse rt ati on , C h ri s Ha y ne . O c c u p a t io n a l H e a l t h a n d E rg on o m ic s. He sums up the role o f the p h ys io th er a p is t in m o d e r n in dus tr y as being one of te a m w o r k with o t h er m em be rs o f the H e al t h a n d Safety G r o u p . H e says there a r e three m ai n fu nc tio n s o f the p h ys io th er a p is t in industry: • T o provi de a fully c o m p r e h en s iv e service for employees, be ing re as o n a b l y loca ted in r ela tio n t o their place o f work. • T o pr ev ent disease a n d injury, especially o f oc cu p a tio na l origin. 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. )