Are patients getting ineffective physiotherapy to save NHS money?

Immediately upon experiencing shooting sensations in her legs, Jeannette Meyers contacted her primary care physician.

However, after the 69-year-old from Ashford described her symptoms, a general practitioner at her local surgery advised her over the phone that she should instead see a physiotherapist.

Disappointing Physiotherapy Experience

Jeannette states, “I was referred to a physiotherapist in a room behind a local chemist, who provided me with a sheet of exercises but failed to demonstrate their execution.” “By downloading them from the internet, I could have avoided the entire journey.”

“I returned six times because the pain was not alleviating, but the physiotherapist never performed a physical examination or tried a different technique.” He simply continued to assign me new exercises that were ineffective.

Private Chiropractor Intervention

Jeannette eventually visited a private chiropractor, who observed an amelioration of her symptoms. She further states, “I would not return to a physiotherapist for my condition.” Without a doubt, there are 

a significant number of outstanding physiotherapists in the world; however, I have yet to encounter one.

Jeannette is, sadly, not alone. Dr Ellie Cannon noted in her column last month that physicians were divided on social media regarding the advantages of physiotherapy. Readers inundated her with letters recounting their personal experiences in response.

Varied Experiences

Specific individuals lauded the physiotherapists who assisted them in conquering immobility. An 80-year-old individual recounted how a physical therapist helped him after a severe tumble onto the ice, which caused ligament ruptures in both knees.

A second pattern, however, emerged. Many patients were referred to physiotherapy upon contacting their primary care physician’s office without seeing the doctor. They awaited an appointment for weeks before receiving printed exercise sheets to perform at home, which did not affect their discomfort.

Others were dissatisfied that physiotherapists no longer provided muscle tension-relieving massages, which many claimed to have enjoyed in the past.

Many more individuals expressed dissatisfaction with the lack of in-person access to physiotherapists, stating that they were merely directed to a website, given advice via email, or contacted via phone.

Lack of Hands-On Approach

A reader stated, “I visited a physiotherapist when I developed severe pain in my right arm.”

“Instead of performing a physical examination, the physiotherapist advised me to perform an arm raise and lower while holding a can of baked beans in each hand,” she recollects. He stated that strengthening the muscles would alleviate the discomfort.

After one week, mottled, black discoloration covered the upper portion of my right arm. A second physiotherapist examined my arm and determined that a ruptured tendon had rendered it immobile; I was merely required to wait for the arm to recover. The tone was highly dismissive.

“In the months that followed, it was difficult for me to raise my arm above my head, and I am still unable to swim to the same extent as before due to limited joint mobility.” The tendon might have been salvageable if I had consulted a physician sooner. Since then, attending an NHS physio seems to have misused my time.

Challenges in NHS Physiotherapy

The National Health Service conducts over five million physiotherapy appointments annually. To strengthen the pelvic muscles of patients recovering from a stroke, cancer treatment, joint replacement, incontinence, or incontinence, the treatment consists predominantly of being instructed on how to perform specific exercises. The most frequent cause, however, is joint or back discomfort.

According to NHS data, chronic joint pain affects approximately nine million individuals in the United Kingdom; however, lower back and neck pain are the leading causes of disability.

The NHS declared its intention in 2018 to permit patients to refer themselves to physiotherapists to alleviate the strain on general practitioners. However, experts assert that the augmented burden experienced by physiotherapists resulted in certain instances where it compromised the standard of care they delivered.

First-Contact Physiotherapists

Christopher Banks-Pillar, an Oxford University researcher, states, “Patients may have to wait up to fifty weeks before receiving fifteen minutes of instruction from a physiotherapist who provides them with an exercise sheet.” As an illustration, if physiotherapists observe the patient more often, the treatment is more likely to be effective; they can modify recommendations if exercises fail to produce the desired results. However, this becomes difficult when one has limited time with the patient.

In response to the 17,000-strong shortage of general practitioners and the rising demand for physiotherapists, the NHS launched a recruitment campaign in 2019 for a new form of health worker known as a first-contact physiotherapist. They operate within general practitioner (GP) practises and strive to alleviate physicians’ workload by attending to patients who seek an appointment for joint or back pain. In contrast to conventional physiotherapists, these practitioners refrain from active involvement in patient treatment. They evaluate patients, determine whether a visit to the doctor is necessary, and then provide pain management advice and exercises.

As first-contact physiotherapists complete their training in five years, as opposed to the ten years on average required to become a general practitioner. To fill staffing vacancies in the NHS, they can implement more quickly.

Additionally, they are considerably less expensive than general practitioners (GPs), earning an average of £45,000 per year instead of GPs’ £67,000 to £100,000.

Nevertheless, Surgeons are concerned that some patients with underlying health conditions may remain untreated due to this novel approach.

Concerns About New Approach

“Just because a person has joint pain does not necessarily mean they have sustained an injury,” explains Doncaster-based general practitioner Dr Dean Eggitt. Such discomforts may indicate conditions such as pneumonia or cancer. The literature frequently mentions patients advised to see a physiotherapist despite needing immediate medical attention.

Other physicians cautioned that patients frequently did not receive physiotherapy of adequate quality.

“It is concerning that a significant amount of NHS physiotherapy is now administered over the phone,” says Dr Mike Smith, a general practitioner from Hertfordshire. “Unless administered in person, physiotherapy serves no purpose; one can find any information with a simple Google search.”

Although most experts concur that regular exercise reduces pain and increases mobility, the efficacy of prescribing particular practices for particular joint conditions is debatable. Physiotherapy, however, has its place, according to clinical lecturer at King’s College London Dr. Brendon Stubbs: “It is effective for certain conditions.” “Physiotherapy is not a panacea; not everyone will benefit from it.”

Transformative Physiotherapy

There is evidence that physiotherapy can have a transformative effect on patients suffering from various severe conditions. According to research from the United Kingdom, physiotherapy exercises lasting 45 minutes, performed five days per week, efficiently restore mobility after a stroke. In addition to enhancing the motor function of Parkinson’s patients, it can also alleviate cancer symptoms like fatigue.

The majority of NHS physiotherapists no longer provide hands-on manual therapy, which patients enjoy, but which consists of muscle massage to alleviate stiffness, despite the practice’s popularity.

“The impact of manual therapy is typically transient,” asserts Mr. Banks-Pillar. The patient’s discomfort will frequently return by the time they have reached their vehicle. This is, therefore, an approach that physiotherapists are avoiding more regularly.

One issue is that a considerable number of patients mistake the physiotherapist’s hands-on approach for active treatment and a disregard for their condition.

“Many private sector physiotherapists continue to provide massages due to the high volume of requests from patients who believe it to be beneficial.”

Combining Physiotherapy with Weekly Spin Classes

One of the primary concerns raised by experts regarding NHS physiotherapy pertains to patients’ complex compliance with the prescribed exercises. In conjunction with physiotherapy, researchers from Bournemouth University are putting a strategy to mitigate this to the test by providing patients with hip arthritis with a weekly spin class. Following a half-hour of instruction on exercises that can alleviate the excruciating condition, the eight-week programme consists of an additional half-hour dedicated to stationary cycling.

“The classes begin gradually and progress gradually,” explains physiotherapy expert and trial director at Bournemouth University Professor Thomas Wainwright. The patient should be capable of performing an entire spin class by the end.

The patients’ collective participation in the class is critical.

“We are not simply instructing individuals to perform these exercises independently,” explains Professor Wainwright. “If they observe an improvement in the rider next to them, it may encourage them to continue because they know that eventually they, too, will improve.”

Google-backed airship: World’s largest, 400 feet—twice Boeing 747

Leave a Reply

Your email address will not be published. Required fields are marked *