March 2016-Terminology

A lot has been happening, the scoping review is well underway, I have been working with two peers,on this both whom are keen to get a first co-authorship.  It has been great to be in a position to help this happen and to offer a bit of support.

The scoping review required us to differentiate between two components of a physiotherapy programme;

1. Therapeutic exercise
2. Non-treatment physical activity

Whilst I am very clear on the technical definition of exercise and physical activity and appreciate that they are distinct and exercise is a sub-category of PA, I'm also aware of how frequently the terminology is misused in practice.  This also seemed to be the case in the research with differing definitions of the the two activities and inconsistent use of the terms.  The other complication was the related to ideas of what constitutes "physiotherapy".  Trying to unpick whether an intervention was (1) or (2) in a "traditional" physiotherapy context was straightforward.  For example, a physio teaching quads strengthening exercises post ACLR; clearly therapeutic exercise.

However, in a more evolved physiotherapy context it was not so simple.  For example, a physiotherapist working in weight management prescribes 30 minutes walking per day, this is clearly physical activity.  It's aim is both the improve the general health of the patient and address the primary goal of treatment.  Other similar examples were found in cancer survivorship, diabetes and other lifestyle-related, long term conditions.

The upshot was that I melted my brain, revised and re-revised the inclusion/exclusion criteria and eventually got to a point that I was happy with.  

It's been a useful learning point though, the evolving nature of physiotherapy, in response to population changes means, I think, that we can no longer refer to general health interventions as "non-treatment" interventions.  In line with policy directives, prevention needs to be embedded, and central to our interventions.  Whilst the current focus on MECC-style preventions gives a useful lever (airtime, funding etc) we should be very careful about separating these interventions from our core practice.

January 2016-Early days

I'm 18 months into my (very) part time PhD and my supervisory team have asked that I record some reflections as I go along.  I can see the value in this, I already struggle to remember my thoughts on various topics & ideas from last year.  Someone described the PhD process to me as being a bit like making candyfloss, you go round and round in circles and feel as though you are getting nowhere but with each revolution there is a subtle change and at some point you have a big pink ball of sugary loveliness to show for your effort....maybe not the best analogy for a public health PhD!

I can certainly relate to the going round in circles bit, I have become immersed in physical activity, health promotion, health conversations, motivational interviewing, IPAQs, GPAQs, SIMPAQs, GPPAQs, I teach it, I read about it, I talk about it, I plan curricula around it, I investigate it, I think about it and I tweet about it.  It's easy to convince myself that everyone knows about it and that everyone is doing it.  I have to remind myself of my own enormous biases and the fact that it occupies so much of my headspace gives me a very skewed perspective.

I have been enjoying do some concrete PhD work recently, having spent so long mulling it's been great to start on a scoping review, the process is clear and the team are taking it all in their stride.  As with many things it has felt like an enormous task but when broken down and chipped away at it has become very manageable and enjoyable.  It's an international scoping review and it was suggested in supervision that I might take the UK findings and take a closer look in a second paper.  This idea really appeals, I have a good understanding of the political, economic and social backdrop to UK healthcare and if there are sufficient papers from the UK I think this would make an interesting article.

I recognise that I need to make some firm plans for after the scoping review, I think one of the things that holds me back is feeling that the main part of my PhD needs to be something awesome.  It doesn't, it needs to be interesting, meaningful research that will develop my knowledge and skills and will result in publications.

I have decided that 2016 needs to be a year of focus, I'm good a spinning lots of plates but I can spend so much time and energy keeping them all spinning that progress with any one task is very limited.  I need to settle, prioritise and focus.