Physios on Pilates reform – Holly Brasher


Holly Brasher, APAM
Sydney-based sports physiotherapist

Sydney-based sports physiotherapist and Square One Director Holly Brasher says the PHI natural therapy reform will improve Pilates-informed physiotherapy through a renewed focus on assessment, monitoring and outcome measures. While she won’t be changing how her classes are run, she has reviewed her practice processes. And it’s all for the better, she says.

'Having a stronger focus on goals will make us better physios because every time we're seeing a patient we're being reminded of why they're here.'

Can you explain how you use Pilates in your clinic and if that will change as a result of the reforms?

We probably don't need to change ours because the way we run it is physio focused. It's based on a clinical diagnosis. It's based on their impairment. It's based on the patient goals and what they want to achieve and it’s tailored for each individual. Our classes are not just limited to using Pilates exercises. Pilates is a way of branding for us — to get our patients exercising so they can achieve their goals. It doesn't mean clients just do Pilates.

What are you doing to prepare for the changes?

Running of sessions
We're not changing the way we run the classes because the way we run the classes is appropriate as physios. However, we are reviewing our internal processes to make sure that we're all practicing as physios and not as Pilates instructors. This includes our assessment procedure, our note taking and ensuring we have regular reviews and better outcome measures.

Session names
They will be called clinical exercise classes or clinical equipment classes rather than clinical Pilates classes.

Pilates name 
We've removed Pilates from all of our forms, removed them from appointment times and we’ll remove them from our timetables.

Running of sessions 
We’re phasing out mat classes because in my opinion they are more fitness based as opposed to clinical rehabilitation.

Clinical notes
We've changed the way we document what people do in their classes. Like many practices, we have used a combination of an exercise tick list and SOAP notes. We've changed our forms to now be based solely around the impairments/focus/goals for each individual attending. We will tighten up our SOAP notes and make sure every patient has at least one well defined outcome measure to track their progress.

We are making sure we’re including outcome measures and patients are re-assessed when it is clinically indicated. Whether that is at every appointment or every six weeks or six months.

Patient communication
Patients have received emails and handouts explaining the changes and how they may be affected. The main thing that we have communicated is that the way we run our classes will not change because they are run as group physiotherapy with individualised assessments and an individualised program that we progress appropriately. We have encouraged all our Pilates patients to attend a new year assessment to ensure their assessment and goals are current. We have provided this free in January. This should ensure they meet all the criteria to continue to claim for their group physiotherapy classes.

How do you think patients will react to the changes?

I don't think patients will be as worried about it as we are. Ours have all loved having the chance to set some new goals for the year.

Anything else you’d like to add?

We need to look at it as a positive. A chance to continue to progress. Many physios seem to be worried that they can’t use Pilates anymore. We can still provide it. People just can't claim solely for Pilates - but they never could claim for Pilates with a Physio anyway [see APA FAQs]. It’s quite simple: When a physio is delivering a rehab session to a patient – it’s physio. Not personal training. When a physio shows a patient a stretch – it’s physio. Not Yoga. When a physio uses Pilates exercises as part of their overall treatment – it’s physio. There will be several months of some painful administration but we will get there. I am yet to figure out how to market to new patients wanting to do Pilates – that’s my next task.

Read more about how the PHI natural therapies reform and how they will affect your practice here.