Your comments: 5 August 2015

I read the news article titled ‘Children still wait too long for wheelchairs’ (page 12, 15 July) with interest as the clinical manger of a wheelchair service and the specialist physiotherapist responsible for provision for children. 

 

The aim for children, or anyone, to have their wheelchair within a day of referral is unachievable. To provide a wheelchair for a child who is growing, to take account of posture management (even for those with minimally affected mobility) takes time, otherwise they may end up with a wheelchair the wrong size.

 

This will lead to deformity, reduced independence and pain; not ‘transform the life of a young person and their family’ as stated by Kathie Drinan in the article and the aim of wheelchair service therapists.

 

Wheelchair provision is dependent on suppliers. We have a very good relationship with our main manufacturer and receive standard adult and paediatric wheelchairs within a week. More specialist ones take longer and bespoke ones take more time as they are made to measure. This is obviously very high end seating and wheelchairs but a lot of ‘off the shelf’ seating and wheelchairs may also take time to be received as keeping all the sizes and shapes of backrests or cushions is not possible and requires manufacturers signing over thousands of pounds of loan stock to services.

 

All wheelchair services strive to provide the best possible service to their clients, both adults and children, and do so under huge pressures from families, the NHS and commissioners. There are many good wheelchair services in the country and this was acknowledged at the Wheelchair Summit last November. We do look for ways to improve our service to our communities, but over-simplified reporting and misunderstanding have made this a difficult process. We all have our clients’ best interests at heart.

 

Keeping accurate records detailing our continuing professional development (CPD) is a headache for most physios. The CSP website and Frontline is full of detailed and helpful articles to support physios with CPD.

 

For some physios who come out in hives at the mere thought of CPD (I used to be one!) some short, bullet-point type tips might be less scary than a detailed article.. For those people who consider themselves to be CPD veterans, my tips might also be helpful 

 

Rip and tear: many of us would like the time to read Frontline word for word but few of us do. I imagine many copies are stacked on shelves at home for reading ‘at some point’ (usually before a job interview, I find!) However, most of us can find the time to scan through copies and identify articles that are relevant to us (especially those physios who have specialised). These articles can be ripped out and put in our bags or diaries, for, for example, reading when we have a spare 30 seconds (between patients, waiting for the bus, just before lunch and so on). 

 

They can also be pasted into a scrapbook and ideas can be written around them for further reading and action. This could even be taken a step further and a picture could be taken and posted onto PebblePad.

 

Reflection on the move: smartphones and iPads, for example, make CPD so much easier. Create a link to PebblePad on your phone or iPad and you’re one click away from writing a brief piece of reflection or even making a list of ideas to explore further. 

 

Audiobooks and voice memos: listen wherever you are. I have a 40- minute drive to and from work and, rather than listen to the radio, I listen to audiobooks on topics that will help towards my MSc, such as critical appraisal and research methods. That way I clock up around five hours and 20 minutes of study time each week (over four days) in what used to be ‘dead-time’. 

 

In response to recent letters (page 5, 15 July and page 4, 4 March), evidence-based practice (EBP) does not solely rely on research publications. 

 

EBP integrates clinical expertise with the best available evidence from clinically relevant research. The hierarchy of evidence ranges from anecdotal evidence and expert opinion to randomised controlled trials and systematic reviews.

 

The innovative and experimental approaches that Helen referred to tend to be developed using unpublished, anecdotal evidence and expert opinion.

 

Many physiotherapy interventions are complex and, therefore, the evaluation process is lengthy and complicated. Often these interventions are insufficiently defined in the literature, making existing studies difficult to replicate or build upon.

 

We can justify our interventions by using validated outcome measurements, thus providing the evidence on an individual patient level. 

 

If we routinely collect outcome measurement data, and specify our interventions, then ‘somebody’ could use the data to produce the robust evidence.We just need more ‘somebodies’ to speed up the generation of high-quality evidence.