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Book reviews

Radcliffe Medical Press, Abingdon2000 (ISBN 1 85775 413 1). Illus. 266 pages

by Ruth Chambers and Gill Wakley £19.95Clinical governance is often talked about and frequentlymisunderstood. Using simple language, clinical governanceis presented here in a sensible, non-threatening andunderstandable form.

The first section gives a clear, relevant definition of clinical governance, linking it to professional and servicedevelopment and how to establish priorities by undertakinga baseline review. The second part is divided into 14modules, each covering a pillar of clinical governance. The final section addresses the challenges of qualityimprovement. The appendix contains helpful informationon electronic and written resources.

Cartoons are found throughout the text, which wrylyreflect practice life. Textboxes give examples and dilemmasfor discussion, which I found very helpful in the con-fidentiality section. I found figure M10.1 ‘Making difficultdecisions about treatment, funding or resources’particularly useful. Many of the 183 references cited seemedintriguing enough to invite follow-up.

This book has been written for doctors, nurses, healthvisitors, therapists and practice managers, as individuals andteams. Reading the book gives insight, but to work through it individually or with a team would be particularly

beneficial. It is chiefly of interest to community therapists,but the sections identifying service and learning needs,confidentiality, coherent team working and meaningfulpatient and public involvement will be relevant to allphysiotherapists.

Each module ends with space to record action planning,outcome evaluation and the learning achieved, consideredfrom the viewpoint of the individual, team and organisation.The book is available in shortened form on line; anelectronic format may be more suitable for some andrecording would be direct.

Most modules could be expanded to become a book;therefore suggestions may appear elementary and should be followed with care. For example: ‘You may encourageresignation or early retirement when the rectifying ordisciplinary actions taken have had insufficient effect and noalternative can be found.’ It would be important to do thiswithin the context of employment law and not contribute toconstructive dismissal. The problem is well addressed bygiving further reading lists. Inevitably, more detail wouldrender the book less reader friendly.

Modules contain ideas for individuals’ actions to establishan aspect of clinical governance. The entire team isincluded; doctors are seen as taking the lead and thetherapists’ contribution is relatively low key.

I enjoyed reading this book immensely and will use it toconsider issues with a variety of staff groups. I feel that usingit would be wonderful preparation for a clinical governancereview.

Catherine Simpson BA MCSP

Making Clinical GovernanceWork for You

Springer-Verlag, Berlin2000, 2nd edn (ISBN 3 540 66395 9). Illus. 402 pages

by Susan S Adler, Dominick Beckers and Math Buck £37At 402 pages, the second edition of this work is a substantialrevision of the first edition published in 1993 with 257 pages.However, the stated intent of the authors has not changed –to provide a comprehensive coverage of practical techniquesin text and illustrations – the result being a highly accessiblebook for both newcomers to and proficient practitioners ofproprioceptive neuromuscular facilitation techniques.

This is a well developed publication. A short introductioncontextualises the authors’ philosophy and approach to PNFthat is clearly based within a ‘lineage’ of these techniquesoriginating from Kabat and Knott in the 1940s. Four

chapters that provide a clear guide to the fundamentalprocedures and techniques of PNF -- treatment planning,design, goals and evaluation, and patterns of facilitation --follow this.

These initial chapters create a sound foundation for theremainder of the publication to illustrate specific techniquesby anatomical region, and greatly expanded (from the firstedition) sections on mat activities and gait. The bookconcludes with two short chapters dedicated to ‘vitalfunctions’ -- facial muscles, speech disorders and breathing(facilitation of thoracic excursion); and activities of dailyliving. In comparison with the rest of the book this finalchapter is a little disappointing, because some excellentphotographs are, I feel, in need of support from moredetailed text.

Indeed, a feature of this revised second edition is the

PNF in PracticeAn illustrated guide

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clarity and quality of the photographs/illustrations, 558 intotal, to support an easy-to-follow and well organised text. Aparticularly useful development from the first edition is theinclusion of summary material in the form of ‘points toremember’ at relevant junctures in the text. The use ofcoloured type to highlight these points, as well as tables and‘caution points’ adds further to clarity and organisation,enhancing the publication’s function as a practical book.One can envisage practitioners ‘dipping’ in and out of thebook, perhaps to clarify issues for novices and as an aidemémoire for the more experienced.

While appreciating the ‘lineage’ within which the authorsframe their practice, it is noticeable that much of the

evidence supporting the text is in the region of 20 years old.However, at £37 this is a book well worth purchasing forindividuals with a specific interest in PNF techniques andcertainly for departmental or university libraries. It ispleasing to witness a further development in presentingtechniques originating from over 50 years ago, which morethan does justice to this extremely flexible, yet perhapsoverlooked intervention whose rationale and applicationremains highly relevant in present-day practice.

John Stephens MEd MCSP

Royal College of Physicians, London2001 (ISBN 1 86016 128 6). 160 pages

edited by Archie Young and Mark Harries £15This book is based on the programme of a conference thatexplored why and how doctors might incorporate anappropriate exercise prescription into the management oftheir patients. It highlights various areas where exercise canand should be used to enable patients at risk to participatein a more active lifestyle. It explains how to implement anexercise prescription in a safe and effective manner in orderto benefit a patient’s health.

The book is directed more towards medical doctors, but isvery useful for all health professionals using exercise as amodality of treatment. All physiotherapists would benefit,regardless of specialty.

The first few chapters look at the physiology and benefitsof exercise in five different types of patients, namely those:

� recovering from injury

� with osteo-arthritis

� with chronic heart failure

� with obesity and diabetes

� working towards a healthier old age.

The next section focuses on delivering an exerciseprogramme for the various patients and populationsencountered. Clinical considerations that need to be taken into account such as dosages, contra-indications andthe like are covered. Each of these (and indeed the wholebook) are based on current research and put forward anevidence-based approach to practice. There is a reference

list at the end of each chapter, making it easy to investigatefurther any particular area; the book also highlights areaswhere further research is needed.

The last section covers aspects relating to the future,exercise instructors, training and even political issues. It is rather disconcerting to notice that the word‘physiotherapist’ is not mentioned once in this book. Thisleads one to question how we view ourselves in the bigpicture and in terms of our roles as exercise givers orenablers. Are there areas where we should be promotingourselves better, if indeed we see ourselves as practitionerswho are specialised as exercise instructors in our particularfields?

The book is well-written and divided logically intosections. The chapters are mostly short. The authors havebeen concise and keep readers’ interest, ensuring thatenough relevant information is given. Though the text isacademic in nature it reads easily. It is not a fool’s guide tosetting up an exercise programme, but rather gives a soundbase of the current philosophies and knowledge needed inorder to implement an exercise prescription.

In the wide variety of topics covered, it is good to see that the opinions of the various authors are consistent. Theevidence that exercise is beneficial is supported repeatedly.Psychosocial factors such as patients’ willingness to changeas well as their compliance with a programme, play animportant role in the success and effectiveness of exercise as a treatment.

This leads one to consider the active role patients need totake in the ‘prescription’ of their exercise. This is an areanot covered in the book.

I recommend this book to all practitioners involved inexercise prescription.

Audette James BSc CredMDT MCSP

Physical Activity for PatientsAn exercise prescription

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