Tour answers physio’s questions, raises more

Paul Mayne // Western NewsSchool of Physical Therapy professor Dave Walton hopes the good, bad and the ugly he gleaned from more than 150 physiotherapy clinicians, clients and administrators will have an impact on the practice of physiotherapy in Canada and internationally.

Most professors collect research data from within the friendly confines of their labs; many also collaborate with another institution or a few colleagues.

But when Dave Walton talks about his most recent academic project, he’s talking about a much more ambitious collaboration – about 12,000 kilometres more ambitious.

“It was one of those things where I thought if I’m going to fancy myself a clinical researcher, which I do, I should make sure I connect with clinicians to see what they are doing,” the Western School of Physical Therapy professor said of his ‘Finding Physio’ tour. “I had a 10-year clinical career and it has now been seven years that I’ve been a full-time academic, so the things I considered relevant back then are obviously going to be much different these days.”

Never having had the chance to connect deeply with clinicians outside southwestern Ontario, Walton used his sabbatical last summer to pack up the family, spend two months traversing the country and speak with more than 150 clinicians, clients and administrators.

It was different from what he had expected – and better.

“I had no good sense of what it meant to deliver care to Indigenous populations in Canada, to military, to homeless groups. Canada is geographically diverse enough that there are significant regional differences in what clients want, what’s important to them and what mobility means to them.”

For example, we may think exercise has universal meaning, he said, but when you ask people how much trouble they have walking up and down stairs, context is everything.

“You and I, most likely, envision a regular staircase. But the staircases I saw in Corner Brook (Newfoundland and Labrador), were stairs stuck in to the side of rock going down to a boat. It was very different,” said Walton, a member of Western’s Bone and Joint Institute.

“I spent some time in northern BC with some Indigenous populations and you might ask them, how far do you walk. We would say a few miles, but they would say, ‘I could get down to Sue’s house.’ The concepts are very different.”

Walton was impressed by how clinicians deal with different funding models and innovate to meet local needs. In Winnipeg, he arrived just 48 hours after the Winnipeg Regional Health Authority delisted adult out-patient physical therapy from their hospitals.

“It was remarkable to see the way they say, ‘Here we are, hamstrung by what we want to do, but what can we do (to help)?’” Walton said.

Walton always believed rehab and physical therapy don’t save lives but, instead, have the noble aim of giving lives back. His road trip changed that perception.

“The first two clients I spoke to started to challenge that notion,” he said. “I asked them to describe a time in their life when mobility was affected and both said it was the only time in their lives where they felt suicidal. Hold on, maybe we do save lives.”

Many clinicians along his journey raised the issue of branding, of ensuring the public knows the range and limits of the profession.

“You ask 10 people off the street what a physical therapist does, you’re going to get a lot of different answers and a lot of quizzical looks. You ask 10 different physios what physical therapy is and you’ll also get different answers, in many cases,” he said.

“Physical therapy, at its core, is prescribing exercise, manual stretching, joint mobilization and education. Those aren’t unique to the profession, they’re not exclusive domains. Chiropractors, massage therapists, athletic therapists, kinesiologists – they can do much of the same thing,” he said, adding they too are competing for the same consumer base, often as less expensive alternatives. “As a consumer it makes sense, but where is the evidence my physio outcomes will be so much better than other outcomes? Those are hard to quantify and hard to find.”

Walton said talking about concerns among physical therapists is one thing, but more advocacy is still necessary.

“If we maintain status quo, which we are really good at doing, we risk extinction. I don’t mean to sound hyperbolic about it but I really feel it is at risk,” he said. “There are some difficult questions to be asked: Who do we (physiotherapists) want to be? There are certain roles we may need to give up in order to refocus on the things we really can do, that sets us apart from all of these other disciplinary groups out there.”

He added there are many trailblazing physiotherapists and he is optimistic the passionate thinkers and innovators will come to the fore.