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.