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PT and the Greater Good

Julia Child PT

Published April 3, 2012 12:06 PM by Dean Metz

I don't do recipes. Not in the kitchen and not in practice. I have a general idea of how to make a proper shrimp scampi or meatloaf, but I know that sometimes a little more of this or a touch less of that can make for a better meal. Such is the case with rehab; some people require a little more attention on one thing whereas someone else needs more time on something else, even if they both have the same diagnosis. The Royal College of Physicians (RCP) seems to disagree.

Today a report came out by the Royal College of Physicians about patients finding group exercise classes beneficial.  I must say, I protested when I read the questions to be asked of patients. I thought they were leading and aimed at getting specific responses. I wasn't disappointed. This study claims that sites around the nation are not using evidence-based practices because they aren't adhering strictly to the Otago or FAME protocols or not issuing ankle weights to patients. These protocols are good and have shown to be effective, but not everyone can perform them nor should perform them.

Our clinic has an individualized program that takes into account a patient's strengths and areas for improvement. We then progress patients as they improve until they've reached their goals or they've plateaued. The RCP states we should have people in exercise classes three times a week for a minimum of 15 weeks, possibly up to one year in duration. Sorry, but who is going to pay for that? The NHS is trying to be efficient, not extravagant! If I can get a patient better in eight sessions of 1:1 therapy, isn't that better than 156 sessions of an exercise class? Not to mention that the National Institute of Clinical Excellence (NICE) Guideline 21 on Falls Prevention states that group exercise is found to be ineffective in the prevention of falling.

Remember last week I said that sometimes the bureaucracy here has my head spinning? Today is one of those days.


I totally agree Dean. I had a patient this week who has attended our clinic due to having mechanical falls.

Following a comprehensive & physiotherapy assessment they have received just 6 sessions of 1:1 rehab which has involved balance & gait training.

On review he has achieved all goals improving balance,gait & confidence! He reports no further falls & was able to be discharged with a home exercise programme!

That's got to be more efficient that 15-52 weeks of classes!

Katy Allan, Falls - Physiotherapist April 5, 2012 1:25 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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