Improving education and training by working closer together for the management of musculoskeletal disorders in the Asia Pacific Region

Professor Gillian WebbChair, Asia West Pacific Region, World Confederation of Physical Therapy

Introduction

• Region of Physiotherapy• Costs of MS dysfunction• Role of Physiotherapy• Education and practice• IPE education and practice• Way forward

◦ AsiAsia Western Pacific Region of WCPT

Physiotherapy in the AWP region• 26 countries

• West: Middle east

• West: Sub Continent

• North: Taiwan ( China)

• East: Philippines, Pacific Islands

• Central: Indonesia, Malaysia, Thailand, Singapore, Hong Kong

• South: Australia and New Zealand

• Cambodia became a member 2 years ago

• Vietnam not a member yet

◦ Asia Western Pacific Region of WCPT

Musculoskeletal disorders

• Cost to individuals▫ inability to participate in activities of daily living

• Cost to families▫ Loss of income, family members disabled

• Cost to Communities▫ Loss of productive work force

• Cost to governments▫ Health costs

Asia Western Pacific Region of WCPT

Education of Physiotherapists

• Mostly 4 year degree programs

• A few 3 year diploma programs

• Post graduation specialisation, Masters and Doctoral programs▫ E.g Musculoskeletal, Sports, Women’s Health, Paediatrics,

• Research degrees▫ Masters and PhD

◦ Asia Western Pacific Region of WCPT

Education• Strong emphasis on biomedical sciences▫ Anatomy, physiology, pathology, pharmacology

• Movement sciences▫ Biomechanics, exercise and exercise physiology,

applied anatomy and kinesiology, motor learning• Social Sciences▫ Psychology, sociology

• Research▫ Ethics, Evidence based Practice

• Clinical Education

Asia Western Pacific Region of WCPT

Accreditation and regulation

• Accreditation of educational programs▫ Standards of practice, competencies, quality

assurance

• Regulation▫ Protection for the public▫ Protection of the title

Role of Physiotherapists• Primary health care providers

• Physiotherapy provides services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by ageing, injury, diseases, disorders, conditions or environmental factors. Functional movement is central to what it means to be healthy.

• WCPT 2012

Asia Western Pacific Region of WCPT

Role of Physiotherapists

• Physical therapy is concerned with identifying and maximising quality of life and movement potential within the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. This encompasses physical, psychological, emotional, and social well being. Physical therapy involves the interaction between the physical therapist, patients/clients, other health professionals, families, care givers and communities in a process where movement potential is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists

Roles of Physiotherapists

• Physiotherapists are qualified and professionally required to:

• undertake a comprehensive examination/assessment of the patient/client or needs of a client group

• evaluate the findings from the examination/assessment to make clinical judgments regarding patients/clients

• formulate a diagnosis, prognosis and plan• provide consultation within their expertise and determine

when patients/clients need to be referred to another healthcare professional

• implement a physical therapist intervention/treatment program

• determine the outcomes of any interventions/treatments• make recommendations for self-management

Role of Physiotherapists

• Physiotherapists operate as independent practitioners as well as members of health service provider teams. They are able to act as first contact practitioners, and patients/clients may seek direct services without referral from another health care professional in a large number of countries.

Asia Western Pacific Region of WCPT

Role of Physiotherapists

• The education and clinical practice of physiotherapists will vary according to the social, economic, cultural and political contexts in which they practice.

• However, it is a single profession, and the first professional qualification, obtained in any country, represents the completion of a curriculum that qualifies the physiotherapist to use the professional title and to practise as an independent professional

Musculoskeletal Physiotherapy Practice• Physiotherapists work in a large variety of settings and

across the life span.

• Emergency departments

• Screening clinics – orthopaedics, neurosurgery, paediatrics

• Able to order X-rays and diagnostic tests

• Able in some places to inject joints and have limited prescribing rights

Asia West Pacific Region, WCPT

•

Physiotherapy Practice

• Specialist Physiotherapists▫ run screening clinics prior to orthopaedic surgical

consultation▫ evaluating and determining management for patients with

back pain▫ run telephone triage services ‘PhysioDirect’ (UK)

• Physiotherapists▫ administer joint and soft tissue injections▫ educate General Practitioners on referral▫ Botox injections for spasticity

• Consultant Physiotherapists provide clinical and research leadership

Australian Practice

Australian studies have demonstrated better use of physiotherapists’ knowledge and clinical skills in:

▫ Orthopaedic and Neurosurgery Clinics▫ Emergency Departments▫ Falls Assessment▫ Paediatric Orthopaedic Clinics

Further opportunities▫ Movement disorder clinics▫ Non invasive ventilation service▫ Urology/continence▫ Tele-rehab▫ Mix of traditional medicine with western medicine

IPE education and practice

• Physiotherapist work as independent practitioners but also in teams

• Essential in the health environment that all professional work in teams

◦Asia Western Pacific Region of WCPT

Inter-professional Learning and Practice

Inter-professional learning

• Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of patient care

• CAIPE 2005

▫

Asia Western Pacific Region of WCPT

• Is the process by which we train or educate collaborative practitioners

• Changes how health care providers view themselves

• Is a complex process that requires us to look at learning differently

• Requires the health provider to practice in a way that allows for and accepts shared competencies

• Requires interaction between and among learners.

Inter-professional Educationducation

Features of collaborative practice:

• the use of appropriate language when speaking to other people

• understanding that all health providers contribute to the team or collaborative unit

• demonstration of respect and building of trust among team members

• recognition of the assumptions we make about others

Asia Western Pacific Region of WCPT

Collaborative practice

Mounting evidence that Collaborative Practice improves outcomes in a number of patient populations studied to date:

Geriatrics, STD Screening, Adult Immunization, fractured hips, neonatal ICU care, mental health and in simplifying medications

(Zwarenstein et al., 2004)

Asia Western Pacific Region of WCPT

Collaborative Practice

Requires active participation of different professional groups in decision making and delivery of patient & family-centered care

Is responsive to patient & family goals, has opens mechanisms for continuous communication among health providers, optimises staff participation in clinical decision making within and across disciplines and fosters mutual respect among professionals

Asia Western Pacific Region of WCPT

IP Patient Centered Practice

• Health human resources: – Looming shortages of health care

providers

– New ways of practicing

– Shared competencies

• Complexity of diseases and new technologies

• Chronic disease management

• Emphasis on primary health care

• Safety

Asia Western Pacific Region of WCPT

Drivers for Change

World Health Organisation (WHO)

• WHO study group on IP and Collaborative practice established produced “Framework for Action on Interprofessional Education & Collaborative Practice 2010”

World Health Organization report (2005): Preparing a Health Care Workforce for the 21st

Century: The Challenge of Chronic Conditions.

Types of competencies1. Common competencies▫ Required by all health professionals

2. Complementary competencies▫ Relate to specific disciplines

3. Collaborative▫ Require the different professions to work

effectively together

▫ Asia Asia Western Pacific Region of WCPT

Inter-professional competencies

• Collaborative practice

• Change agent skills

• Creativity and innovation

• Teamwork and communication(Barr 2003)

Asia Western Pacific Region of WCPT

Key issues in inter-professional practice

• Team work• New ways of dealing with increasing complexity

of patients and technology• Collaboration between professions and between

professionals and patients• Increases in the skill mix of the workforce• Support for innovative workplace learning

strategies• Patient safety

◦ Asia Western Pacific Region of WCPT

Collaboration

• Core purpose of the education of health professionals is to enhance the performance of health systems for meeting the needs of people and populations in an equitable and efficient manner.

• Collaboration between Education Institutions and Health systems and those who work in them

Health and education

• Interdependence in education

• From isolated academic work to harmonisingeducation and health

• Use of world wide networks, alliances and consortia

• Harnessing of global flows of educational content, pedagogical resources and innovations

Health professionals of the 21st century

• The agenda for healthcare in all countries in the 21st century will be dominated by a vision of quality which seeks to address the deep seated problems of the past . . . The need for health services to give priority to developing health professionals equipped to practise in a new way and thrive in new organisational environments requires a rapid response to reshape curricula and training programs . . .

• Health care in the 21st century will require a new kind of health professional: someone who is equipped to transcend the traditional practitioner – patient relationships to reach a new level of partnership with patients; someone who can lead, manage and work effectively in a team and organisationalenvironment; someone who can practice safe high quality care but also constantly see and create the opportunities for improvement.

Donaldson 2003

Health Professionals

• New professionalism for the21st century should promote quality, embrace teamwork, uphold a strong service ethic and be centred around the interests of patients and populations

• Health professionals should be agents of change

▫ Asia Western Pacific Region of WCPT

Curricula for Health Professional Students

• Patient and population centredness• Competency based curriculum• Inter Professional and team based• IT empowered learning• Policy, management and leadership skills

▫ Asia Western Pacific Region of WCPT

The way forward

• Sharing of knowledge for education and practice• Development of academic staff• Collaborative research on best practice in health

professional education and training• Development of standards of practice and

accreditation of educational programs• Policy development and advocacy for different

structures for team based, patient centred health care teams

Summary

• Health professionals should be educated to mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population centred health systems as members of locally responsive and globally connected health teams.

Asia Western Pacific Region of WCPT

• Thank you