What is the Physio2Future model?
The increasingly apparent vulnerability of physiotherapy, as seen for example in the delivery of effective and relevant healthcare strategies, inspired me to develop the Physio2Future model (P2FM) (1).
To me, the fundamental weaknesses of physiotherapy (PT) are the lack of uniqueness, the internal conflicts of interest within the “best practice” framework, e.g., bio vs. psychosocial approaches, and the often questionable effectiveness of therapeutic strategies with respect to popular ailments (e.g., chronic pain conditions, specific back pain, tendon disorders, etc.) (2, 3, 4). Moreover, the almost all-encompassing economisation that seems to affect the overall quality of medicine today can also be understood as a weakness for PT effectiveness (5 – 7). These barriers slow the unleashing of PT’s great potential for becoming a sustainable, medically relevant, socially recognised, effective, and relevant resource in the health care system.
I conceived the P2FM as a “thought model” to provide a clearer picture and orientation of an attractive and sustainable profession to ambitious and responsible physical therapists in all major areas (science, clinical practice, teaching, management, networking, public relation) (Fig. 1).
For a better understanding of the eligibility of the P2FM, I conducted a qualitative study. This was based on qualitative structured content analysis and conducted with expert interviews. The categories of this study emerged deductively and inductively. The deductive categories correspond to the 6 dimensions of the model. The protocol of the study can be seen here: https://osf.io/edkyp/ .
All six dimensions interact with each other and are equally important. In selecting the variables, which I assigned to the six dimensions, I was oriented to their relevance and their potentials for creating a comprehensive picture of physio2future. The driving force of the P2FM is ‘identification’. All physiotherapists should be able to identify all parts contained in it. If these key points are not sufficient, the model can be discussed with me and adjusted if there is agreement. The functioning of the model as a continuum is accompanied by the philosophical idea of emergence (8). The six dimensions of the P2FM are:
Sustainability represents the current opportunity for responsible and effective PT in the future and, in my view, contains the variables supportive, social, ecological, and economical. Sustainability could show a new and future-oriented competence of PT will emerge, because environmentally friendly, emission-free, and effective medicine is almost synonymous with evidence based, medical and clinically relevant PT. If the value of environmentally conscious PT were recognised, it could enter a field that could catch up with other medical and health care disciplines (9, 10).
Autonomy is to be understood as self-motivated self-regulation (11). I assigned the variables process, motivation, responsibility, and legislation to the dimension of autonomy. The legal basis is crucial for translating the findings from science into practice. In some countries, this is difficult because direct access is prohibited by law. Irrespective of this, motivation, and a sense of responsibility at an ethically and professionally high level are needed to implement clinical, scientific, and bureaucratic processes in a high-quality and goal-oriented manner (12).
Evidence is the driving force of change and consists of the variables quantitative, qualitative, and standardised (13). Evidence-based PT opens doors into new areas of application and provides clarity about misunderstandings and disagreements in a discipline. It also generates autonomous development and teaches how to create competencies and explains how to interpret relevance (14). Evidence related to practice and to the recognition of trends in society that influence PT must be respected everywhere in PT as a quality driver of the profession’s goals. This includes quantitative methods for determining effects as well as qualitative approaches for identifying potentials.
For me, relevance means the productive challenge of PT and the entire health system. I think other dimensions, such as evidence, must be able to withstand the sharp blade of relevance. Thus, the risk of implementing clinically unnecessary and perhaps even damaging methods (e.g., waste of resources, feigned benefit, etc.) could be reduced. I assigned the variables medical, clinical, and social to the dimension of relevance. The clinical relevance corresponds to the minimally significant difference in effect of one method to another. According to my research, medical relevance indicates whether medical treatment is generally justifiable or whether the problem can be solved without medical services (15, 16). Added to this is the social relevance, which helps to clarify the subjective needs (e. g. PT) of people who feel a deficiency (17).
Effectiveness clarifies the honorarium and at least the benefit of PT, in addition to relevance. The variables timeless, efficiency and cooperation mean for me the basis of effectiveness. The value of effectiveness is determined by efficiency. The key is to reliably answer the question of which method requires the fewest resources (time, energy, costs etc.) and is generally effective at any time of the day (18, 19). Methods of PT that apply now must always be effective. They can improve, but the causality should be given already now (compare, the effect of insulin in diabetics or the anaesthetic used before operations, etc.). This is achieved, among other things, by paying attention to the relevance dimension, because it supports the sensitiveness and investment for gaining quality. Without efficiency, the power of effectiveness is lower and the effort is higher (20)
This dimension includes the variables qualitative, interactive, appreciative, and meaningful. Motivated and responsible physiotherapists seek meaning in their work that excites them (21). Otherwise, the risk of negative consequences, such as burnout, etc., could increase (22). This ensures the basis for clinical quality, potential development of individuals and facilities. The appreciative interaction between professionals, physicians and managers are significant for this (23). From my conversations with colleagues, it appears that they have become physiotherapists because they want to manage serious problems, as injuries and other health limitations cannot be better described. Employee-centredness, for me, seems to be at least as important as the patient-centred approach.
The interviewed physiotherapists confirmed the eligibility of the model as an orientation tool for sustainable PT in the future PT. However, physiotherapists also advised removing the dimensions “effectiveness” and implementing “ethics” and “politics” as essential dimensions of the model. Autonomy and human-centredness are interpreted with concerns about enforcement.
These dimensions should help to show the potential of PT. This means PT should use its potential and increase the quality for the physiotherapists themselves, the patients, and the healthcare system. PT could take the lead in some areas that are becoming increasingly important, as I think it could in organisations such as Health for Future, musculoskeletal medicine, pain prevention, health counselling, etc. The focus should be on how effectively they are examined, cared for, sensitised to their interaction with the environment, and managed for sustainable health success. PT should break through its own barriers and use its potential in every relevant section. It does not matter, if it is science, teaching, clinical practising, networking, leading etc. At present, the argument of the mathematician J.M. Keynes on the likelihood of implementing the P2F model: “The difficulty is not in understanding new ideas, but in escaping old ideas.” If the potential of the model catches the interest of responsible conscious physiotherapists, it could it help them to actively develop the impactful and sustainable quality of PT.
- Nicholls., D. (2021). CPN Digest 169 – 172. Critical Physiotherapy Network. Blog article. Last seen on 31/08/2022: https://criticalphysio.net/network-blog/
- Hayden, J. A., Ellis, J., Ogilvie, R., Stewart, S. A., Bagg, M. K., Stanojevic, S., Yamato, T. P., & Saragiotto, B. T. (2021). Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. Journal of physiotherapy, 67(4), 252–262. https://doi.org/10.1016/j.jphys.2021.09.004
- Walton D. M. (2020). Physiotherapists’ Perspectives on the Threats Facing Their Profession in the Areas of Leadership, Burnout, and Branding: A Pan-Canadian Perspective from the Physio Moves Canada Project, Part 3. Physiotherapy Canada. Physiotherapie Canada, 72(1), 43–51. https://doi.org/10.3138/ptc-2018-0061
- Barth, C. A., Donovan-Hall, M., Blake, C., Jahan Akhtar, N., Capo-Chichi, J. M., & O’Sullivan, C. (2021). A Focus Group Study to Understand the Perspectives of Physiotherapists on Barriers and Facilitators to Advancing Rehabilitation in Low-Resource and Conflict Settings. International journal of environmental research and public health, 18(22), 12020. https://doi.org/10.3390/ijerph182212020
- Hensher, M., Canny, B., Zimitat, C., Campbell, J., & Palmer, A. (2020). Health care, overconsumption and uneconomic growth: A conceptual framework. Social science & medicine (1982), 266, 113420. https://doi.org/10.1016/j.socscimed.2020.113420
- Lüscher., T. F. (2020). Die Ökonomisierung der Medizin: Ist die Heilkunst ein Business? [The Economization of Medicine: Is Medicine a Business?]. Praxis, 109(3), 197–201. https://doi.org/10.1024/1661-8157/a003413
- Schiller., S. (2021). The emergence of physiotherapy in Germany from the mid-19th to the mid-20th centuries: A “female profession” concerned with movement in the health care arena. Physiotherapy theory and practice, 37(3), 359–375. https://doi.org/10.1080/09593985.2021.1887061
- Fromm., J. (2004). The Emergence of Complexity. Kassel University Press.
- Palstam., A., Andersson., M., Lange., E., & Grenholm., A. (2021). A Call to Include a Perspective of Sustainable Development in Physical Therapy Research. Physical therapy, 101(3), pzaa228. https://doi.org/10.1093/ptj/pzaa228
- Maric., F., & Nicholls., D. A. (2021). Environmental physiotherapy and the case for multispecies justice in planetary health. Physiotherapy theory and practice, 1–12. Advance online publication. https://doi.org/10.1080/09593985.2021.1964659
- Tezuka., K. (2014). Physicians and professional autonomy. Japan Medical Association journal : JMAJ, 57(3), 154–158.
- Sandstrom., R. W. (2007). The meanings of autonomy for physical therapy. Physical therapy, 87(1), 98–106. https://doi.org/10.2522/ptj.20050245
- Veras., M., Kairy., D., Paquet N. (2016). What Is Evidence-Based Physiotherapy? Physiother Can. 68(2):95-98. doi: 10.3138/ptc.68.2.GEE.
- Abdull Wahab., S.F., Ismail., A.R., Othman., R. (2018). Qualitative, Quantitative or Mixed: Which Is the Most Preferred for Healthcare Studies. In: Duffy, V., Lightner, N. (eds) Advances in Human Factors and Ergonomics in Healthcare and Medical Devices. AHFE 2017. Advances in Intelligent Systems and Computing, vol 590. Springer, Cham. https://doi.org/10.1007/978-3-319-60483-1_33
- Armijo-Olivo S. (2018).The importance of determining the clinical significance of research results in physical therapy clinical research. Braz J Phys Ther. 22(3):175-176. doi: 10.1016/j.bjpt.2018.02.001.
- Lieb., K., Klemperer., D., Ludwig., WD. (2011): Interessenkonflikte in der Medizin, Hintergründe und Lösungsmöglichkeiten. Springer Verlag. Robinson A, McIntosh J, Peberdy H, Wishart D, Brown G, Pope
- Kornwachs., K., Coy, W. (2009). Gesellschaftliche Relevanz. In: Herzog, O., Schildhauer, T. (eds) Intelligente Objekte. acatech DISKUTIERT. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02220-3_9
- Haik., M.N., Alburquerque-Sendín., F., Fernandes., RAS, Kamonseki DH, Almeida LA, Liebano RE, Camargo PR. Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis. Diagnostics (Basel). 2020 Nov 10;10(11):928. doi: 10.3390/diagnostics10110928. PMID: 33182699; PMCID: PMC7696199.
- Kumar., S. (2019). The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review. PLoS One. 13;14(12): e0226227. doi: 10.1371/journal.pone.0226227.
- Bailey., C., Yeoman., R., Madden., A. et al. (201). Review of the Empirical Literature on Meaningful Work: Progress and Research Agenda. Human Resource Development Review. 18(1):83-113. doi:10.1177/1534484318804653
- Burches., E., Burches., M. (2020). Efficacy, Effectiveness and Efficiency in the Health Care: The Need for an Agreement to Clarify its Meaning. Int Arch Public Health Community Med 4:035. doi.org/10.23937/2643-4512/1710035
- Owczarek., K., Wojtowicz., S., Pawłowski., W., & Białoszewski., D. (2017). Wiadomosci lekarskie (Warsaw, Poland: 1960), 70(3 pt 2), 537–542.
- Chamangwana, I. C., Jere, D., & Kazembe, A. (2021). Experiences of health care workers’ on interprofessional collaborative practice at Mzuzu Central and Ntcheu District hospitals. Malawi medical journal: the journal of Medical Association of Malawi, 33(Postgraduate Supplementary Iss), 10–15. https://doi.org/10.4314/mmj.v33iS.3