. I work in a similar NHS set up... to expect unsupported Physiotherapy
input into some population groups is to ask for poor outcome and frustration
. Other more easily managed groups with generally agreed diagnositc labels
are if the staff ratios are ok managed perfectly well  (and probably better)
in a group situation ... 'knees',osteoporosis,pulmonary/cardiac
rehabilitation etc?

In other more controversial problems which dominate physio lists and get
group rehab?
The ubiquitous back pain for instance who gets individual therapy who gets
put into a group ?
Usually at the discretion of the Physio as there is nothing else that can be
done for those people?
Often it is because the patient has tried the nth manipulation etc and needs
to quite  rightly get back lost fitness and motivation to move....

 Perfectly ok but getting a homegoneous group not so easy ie in the common
situation where patients present with high levels of anxiety and distress
and may not do well without additional support and assessment? Dilemma does
the Physiotherapist 'play' motivating counsellor to try and resurrect some
motivation to change with these groups of people and administer things like
HAD scores etc. Most of us working with challenging groups of people are
aware of the literature but have absoloutley no accesss to 'other
agencies'.... Realistically the groups Physiotherapists are asked to work
with are  often the lowest priority(but often the most costly?) when it
comes to health resourcing but this is another isssue enitirely?!

I thought the article in the last Physiotherapy Journal whos title escapes
me as it is at work ( The Wirral article on wrong label wrong treatment on
conducting classes for patients in Physio depts) discussed much of the above
and raised the important isssue of 'distress'  'somatisation' and
psychosomatic problems which make up a large percentage of a
Physiotherapists caseload?


Regarding postgrad PT  courses yes 90% geared to 1:1 intervention and not
enough postgrad or  undergrad time spent on teaching/education/motivation
which makes up a large percentage of a Physiotherapists time. Some people
are naturals and have no problem some folk need to work at it (like me) and
others may need assistance and guidance as the skills can be taught and are
often more valuable than the ability to localise a certain level of the
spinal coloumn?

All the best - I  visited (by kayak) some of the best malt whiskey
distilleries in Scotland last week  Islay and Jura surely have some of the
best selections in the world... but we will probably agree to differ on that
too !

Ian




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