A specialist physiotherapy service must have at its foundation considerable experience of orthopaedic medicine, which facilitates the quick and effective management of the simplest of sports injuries right up to the management of chronic pain disorders. The knowledge base must include detailed knowledge of the role of investigations in musculo-skeletal disease, the role of surgery, the recognition of potentially serious disease and an accurate perception of other healthcare workers' roles.
We believe it is vital to manage the whole person, not just a person's disorder. Such management of an individual lies in identifying the biological, psychological, social and occupational factors driving a person to seek health care. To this end, time must be spent on taking a meticulous history, performing a thorough examination, working through differential diagnosis and explaining the diagnosis and treatment plan to the patient in a way that is both understandable and meaningful.
We recognise that it is important to be part of a team, managing an individual's problems, particularly working in partnership with a person's GP.
Delays in receiving an accurate diagnosis and treatment is often disabling, distressing and leads to disappointing results. We therefore believe that specialist physiotherapy care should be available within days of referral, a detailed report being sent to the referring General Practitioner after the initial consultation.
Care should be driven by the latest evidence based practice guidelines where available, such as the RCGP Guidelines on the management of acute low back pain and the national guidelines for the management of osteoporosis.
Our goal is not just the alleviation of acute symptoms, but also the prevention of chronic pain and disability. Obstacles to recovery must therefore be recognised early and addressed accurately, the biological components of a person's problems often needing to be tackled within a cognitive behavioural framework.
A specialist physiotherapy service may also provide the opportunity of a second opinion, for example, offering advice to the patient and/or GP on the need for investigation, a surgical opinion, a pain clinic opinion or reinforcement of reassurance.
Treatment methods must be evidence based where evidence is available, eg: the role of spinal manipulation in the management of acute mechanical back pain, and targeted at both the relief of symptoms and the early restoration of function.
The evidence suggests that unnecessary and/or a prolonged course of treatment particularly when using passive modalities such as manipulation or electrotherapy may be more harmful than no treatment at all. We therefore, as well as providing pain relief, emphasise self help, independence, active rehabilitation and the early return to normal activities.
