Physiotherapy as process, not event

Last week, the National Institute for Health and Care Excellence (NICE) updated its advice on the use of autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee (link).  Perhaps amid all of the other newsworthy events of last week, this announcement passed you by?

In reporting on the announcement, however, the CSP's statement said something interesting.  It said;

The treatment ... is used to help patients with an articular cartilage defect – or early arthritis in the knee – which tends to affect people in their 20s and 30s, often as result of a sporting injury.

But the NICE guidance stresses that surgery should only be considered once non-invasive approaches such as exercise, weight loss, physiotherapy, analgesia and corticosteroid injections have been exhausted (link).

What was notable about this statement was firstly that physiotherapy was defined as an 'approach' to be considered alongside things like exercise and weight loss.  But perhaps more significantly, the report also stated that approaches like this could be 'exhausted'.

Given that conditions like osteoarthritis are by their very nature chronic, it would seem a strange move to have positioned ourselves so closely to the kinds of acute and episodic care so strongly associated with 'heroic' medicine and surgery that we might now be considered redundant if we can't 'fix' the patient's developing pain and functional limitations.

If the same perception exists for other long-standing cardiorespiratory, endocrine, musculoskeletal, neurological and psychological problems, physiotherapy will have an uphill battle to secure the necessary support to work with these people into the future.

And given that the majority of disease burden is now being experienced by people with multiple co-morbidities, having a strong position that allows us to work 'alongside' people with long-term health problems rather than working 'on' them for short bursts of episodic treatment, would seem an important cognitive shift to make.