Back to the future

 

It has been described as Australian physiotherapy’s coming of age—a golden era during which saw Sydney host the 10th World Confederation for Physical Therapy Congress and the subsequent emergence of the Physiotherapy Research Foundation. Next month, the impact of those two combined events in the ‘80s will be felt on the world stage. Melissa Mitchell reports.

In today’s terms, the profit generated from the APA hosting the 10th WCPT Congress in Sydney would be worth more than half a million dollars. Back in 1987, the $225,000 garnered from hosting the prestigious event was also considered a lot of money. Just where that incredible windfall would be best invested became a question that evolved into the PRF thanks to the incredible foresight of some of Australia’s top physiotherapy minds.

Rewind more than 30 years to a time when Sydney was the focus of the world’s physiotherapy gaze. It was the late 1980s and the city was buzzing as it played host to a huge gathering of the profession’s international and national movers and shakers. Planning for the 10th WCPT Congress had been more than four years in the making; the late withdrawal of India as host in 1982 saw several key Australian physiotherapy influencers, Honoured Member Doreen Wheelwright (nee Moore) and the late Brian Davey among them, step up to lobby for the event to come to our shores.

By all accounts it was a huge undertaking, and one that required the WCPT to allow an extra year in its four-year Congress schedule so that venues in Sydney could be booked, so that accommodation for attendees could be sourced and so that organisers could populate the committees needed to manage the single largest gathering of physiotherapists ever to have been held in Australia at that time.

As the then-Congress convenor Doreen recalls, the New South Wales branch of the APA was instrumental in facilitating the Congress once Sydney won the bid for the event. Doreen’s influence and reputation in international physiotherapy circles was well-known; Doreen had been WCPT president from 1970–74 and had also held the presidency of two professional associations. She was president of the Canadian Physiotherapy Association from 1968–69 and she became National President of the APA from 1978–79. Doreen also had strong ties to New South Wales as it was at Sydney’s Royal North Shore Hospital that she began her physiotherapy career.

‘The thing about the [1987] Congress was that it was considered a landmark Congress. People from other parts of the world said the Congress changed the way congresses were run.’
- Elizabeth Ellis.

Simultaneously working as head of the School of Physiotherapy at the then-Cumberland College (now the University of Sydney) and as convenor of the WCPT 10th Congress, Doreen surrounded herself with committees of highly capable people to pull the scientific program and concurrent events together. The Congress ran from 17–22 May 1987 with the theme ‘Beyond 2000’ and was tremendously successful due to the significant contributions of Congress organising committee members Doreen Moore, Brian Davey, Elizabeth Ellis, Ann Weeks, Lesley Benger, Mary Glendinning, Barbara Fisher and Anne Deans, and Congress co-ordinator and assistant coordinator Elizabeth Rich and Tracey Bailey respectively. The event was supported by national executive members Doreen Bauer, David Worth, Joan Cole, Barbara Fisher, Sandra Mercer and John Price.

‘It really was a remarkable event; for years afterwards we would hear people talk about the Congress and say “when I was in Sydney” or “when I was in Australia this happened …”. It was so well attended, better than we’d even hoped,’ Doreen says.

Honoured Member Elizabeth Ellis, who headed up the then-Congress Organising Committee’s scientific program, says many new, innovative initiatives were introduced at the Sydney event such as interactive roundtable workshops to compliment the traditional presentations given by international speakers. The first student forum also took place at the Sydney Congress, and organisers also published the Congress Daily News, a daily newspaper which highlighted the activities of APA branches in each state and territory and afforded them the opportunity to promote physiotherapy in their region to the global Congress community.

‘The thing about the [1987] Congress was that it was considered a landmark Congress. People from other parts of the world said the Congress changed the way congresses were run,’ Elizabeth says.

‘We had decided that it was crazy getting all of these experts from all over the world and not providing them with more meaningful ways to interact and help progress the profession. Just having them sitting in lecture theatres or going off to do courses … was a waste of a resource,’ Elizabeth says. ‘We set up roundtable workshops, we did all kinds of interactive things where we had people at the end of it come up with some recommendations for the profession to help guide the development of the profession—it was really quite something.’

Such was the popularity of the Congress that there was an unexpected surge in profit for the APA from the event, money the APA decided to invest in a new research initiative for members—the PRF. At that time, the profession had been aware of gaps in the research, of little evidence being available to guide best practice and of the difficulties faced by new or early career physiotherapy researchers to source funding. And at the time the WCPT took just 15 per cent of the Congress takings, meaning the host country got to keep 85 per cent of the profits. When need met deed, the face of physiotherapy research in Australia changed forever.

‘The PRF was very, very important because … the medicos had a stranglehold on the funding that was available from other bodies. At that point in time in the ‘80s, physios would be struggling to get decent funding from those bodies,’ Elizabeth says. ‘So this [PRF] gave them the opportunity … they didn’t have to compete with people from other professions. They were then able to start to put this on their track record and be able to say they already had funding for this part of the study and now they were wanting funding for other parts. It gave them that first foot on the ladder. That was fairly critical for young researchers, particularly.’

From the outset, the APA Board decided the PRF needed to be created as a separate entity and it was allocated its own staff and managed its own budget. A management committee was created to develop the structure of the PRF which included the Grants Review Committee to assess grant applications. Former APA National President and Honoured Member Pat Trott chaired the PRF Management Committee from 1993–2005, during which time she was Head of the School of Physiotherapy at the University of South Australia. Elizabeth, at the time nursing a four week old baby, was voted in as the inaugural chair of the PRF Grant Review Committee, an honour she fondly recalls to this day.

‘I was incredibly touched and kind of gratified that among all of these respected academics that they would choose me to head up the Foundation and I … obviously there was a bit of a tilt to the hat I suppose that we’d contributed to generating it and they may have thought “well if she can organise the Congress she can organise a Foundation”,’ Elizabeth says.

‘We had to establish all those processes of applications and reviewing and trying to do it independently and those sorts of things—and we had to do it quite quickly. They were very keen to get the PRF moving … it might have been as quickly as six to eight months. We looked very closely at the processes that the NHMRC grant had and we adapted and adopted those processes. They were probably were a little too elaborate for our purposes but, on the other hand, because we had to work fast we tried to work from something that might have been considered tried and true.’

One of the first steps taken was to establish the PRF as a charitable trust, which was affected in 1988, and a major fundraising campaign began in order to try and build the corpus up to $1 million. At the time fundraising was something new to the physiotherapy profession and was initially quite challenging. Various modest fundraising initiatives were later embarked upon to build on the initial cash influx, including a raffle with a new car as first prize. Today the PRF is funded largely by donations from APA members, providing the opportunity for practitioners to directly contribute to the research informing their practice. Further investment comes from bequests and directly from the APA.

Seeding Grants, starting from $2000 and initially rising to $5000, proved crucial in terms of providing a springboard for many of the profession’s most-successful researchers. The consolidation of research funds into one pool in 2005 enabled the PRF to commence offering larger amounts. Nowadays, Seeding Grants ($10,000–

$12,000) are offered to new researchers working on established clinical research projects, while Project Grants (formerly Tagged Grants) focus on more experienced researchers. Grants were also offered for memorial funds such as the Beryl Haynes Fund, the Jill Nosworthy Fund and the Marcus J Rosen Fund.

Since the PRF’s inception, respect for physiotherapy has increased significantly in Australia, bolstered by the weight of research to which PRF grants have contributed heavily. To date, more than $1.5 million has been awarded in grants, with 217 grants issued. A significant number of grant recipients have gone on to presented their research findings at a conference, receive further research funding and publish their research findings.

Next month, 11 of those grant recipients will present on the world stage at the WCPT general meeting and Congress in Geneva, Switzerland. They are APA Honoured Member Paul Hodges, Shane Patman, FACP, Professor Kim Bennell, Professor Catherine Dean, APA members Ilana Ackerman, Simone Dorsch, Mark Elkins, Karen Ginn, Breanne Kunstler, APA Occupational Health Physiotherapist Venerina Johnston and APA Sports Physiotherapist Bill Vicenzino. Pat Cosh Trust recipient Sze Ee Soh, APAM, is also presenting at the WCPT General Meeting and Congress in Geneva, which will be held from May 10–13.

Dr Sze-Ee Soh

On noticing a gap in international osteoarthritis (OA) guidelines  where  more  emphasis  is placed  on  managing  pain,  weight  loss  and surgery,  Dr  Sze-Ee  Soh,  APAM,  is  focusing on  embedding  falls  prevention  into  routine clinical care for the at-risk older population.

‘The  guidelines  give  little  or  no  attention to  falls  screening  or  prevention,  (and)  this represents  an  evidence-practice  gap,  falls prevention is clearly a missing element in OA care,’  says  the  most  recent  recipient  of  the Pat  Cosh  Trust  Fund  Grant.  The trust aims at helping physiotherapists based in Victoria to advance the education of practitioners and physiotherapy students. Sze-Ee will use the grant to progress her research program, which Arthritis   Australia   funded   last   year, to understand the burden of falls in current clinical practice.

‘It  will  help  me  build  on  this  work  …  and go  down  the  clinician  pathway  to  ensure physiotherapists  are  assessing  falls  risk  in people with OA. We will try and build some e-learning  resources  for  clinicians  that  will give  them  information  on  best  practice  for falls prevention, and test the acceptability of these resources,’ Sze-Ee says.

Sze-Ee chose to investigate falls in people with OA after having previously worked clinically in aged care in Australia and the UK. She is a full-time researcher and academic at Monash University, where she teaches the final year of the undergraduate physiotherapy course.

At WCPT Congress in Geneva, Sze-Ee will present data from the US-based Osteoarthritis Initiative cohort (available for public access) to highlight the risk factors for falls and fractures to encourage clinicians to delve deeper into a  patient’s  background  during  their clinical assessment.

‘If someone has had a fall in the past, they are more likely to do so again, regardless if they have osteoarthritis,’ she says. ‘For physiotherapists treating someone with osteoarthritis, it is important they ask three questions: have they had a previous fall, what other medical conditions do they have and what medications do they use.’

Dr Simone Dorsch

For more than 20 years researcher Dr Simone Dorsch has worked to improve treatment outcomes for patients of stroke and brain injury.

In 2005, a Physiotherapy Research Foundation (PRF) Grant helped the-then PhD candidate investigate if electrical stimulation would strengthen the limbs of patients recovering from stroke. Results from the project ‘The Effectiveness of EMG-Triggered Electrical Stimulation in Increasing Strength and Activity in Acute, Very Weak Stroke Patients’ concluded that while the stimuli did not appear to improve strength and activity more than usual therapy but it was a feasible intervention. In wanting to enhance long-term outcomes for patients whose muscles were too weak to do task practice with their arms, her study increased the evidence-base for physiotherapy practice in stroke rehabilitation.

‘Research grants support the curiosity of researchers, which can only support improved outcomes for patients,’ says Simone, who lectures at Australian Catholic University and is the Chair of the New South Wales Neurology Group.

At WCPT Congress in Geneva, Simone will share evidence from her latest research in the one-day intensive rehabilitation course 1000 Reps a day: Strategies to increase intensity of practice, which she will present with Dr Kate Scrivener from Macquarie University.

‘It explores the evidence for a dose-response relationship between amount of practice and outcomes in rehabilitation, strategies to increase patient motivation and strategies to maximise opportunities for patients to practice,’ she says. ‘The focus is on identifying strategies that increase intensity of practice in rehabilitation without increasing staff or equipment resources.’

Professor Karen Ginn

Professor Karen Ginn has fond memories of the 1987 WCPT Congress in Sydney. From its success, the seed for the PRF was established.

‘Profits from WCPT were directed to set up the foundation to support physiotherapists in research. Doctoral degrees for physiotherapists were becoming more common across the country and research was a burgeoning area for the profession,’ Karen says.

When president of the New South Wales Branch in the mid-‘90s, Karen helped promote the benefits of the foundation to potential applicants and donors. Then, as a recipient in 2005, she was honoured to receive PRF funding to help her investigate the efficacy of passive joint mobilisation applied to the shoulder region joints for the treatment of shoulder pain.

‘Funding for research is very competitive, so having a dedicated fund that physiotherapists can apply for is a great thing … it is good for Australia, being one of the leading countries in terms of physiotherapy research.’

Today, the musculoskeletal anatomist and physiotherapist at University of Sydney’s Faculty of Medicine and Health, leads an extensive research program into the assessment and treatment of shoulder dysfunction. At WCPT, she will join a distinguished panel to present the latest practice, research and education on the treatment of the shoulder and elbow in the focused symposium ‘The Shoulder & Elbow: Advances in Assessment and Management’. She is mindful research can only happen if people are willing to financially support it. ‘Research funding is crucial, without it research opportunities are limited. Australians are leaders in research in physiotherapy and the PRF has contributed to this. But we also need people to continue to donate to the PRF to enable physiotherapists to remain at the forefront of research and global discussion on health practices.’

Proud history of involvement in WCPT

Australia’s contribution to the World Confederation for Physical Therapy (WCPT) can be traced back to the very first meeting of the fledgling organisation in a restaurant in Copenhagen, Denmark, in 1951. At the table of that meeting were representatives from 11 professional associations from around the world—from Australia that representative was a Miss M D Verco.

Through collaboration of the UK’s Chartered Society of Physiotherapy and the American Physical Therapy Association, the WCPT was formed with a raison d’etre to give guidance to the profession, the United Nations and to international voluntary organisations that were sponsoring rehabilitation programs. Australia was an early and enthusiastic supporter of the venture, and by the late ‘60s played host to WCPT Congress in Melbourne in 1967.

At the Momentum 2017 scientific conference in Sydney in 2017, WCPT President Emma Stokes noted that Australia had played a significant role in the progression of the global organisation through many pathways, but most notably through representation and leadership positions in WCPT. There have been three past WCPT presidents from Australia—Sandra Mercer-Moore, Doreen Moore (now Cartwright) and the late Brian Davey—as well as many Australian physiotherapists in key roles, Emma told the delegation in Sydney.

‘You have contributed hugely to the world of physiotherapy. You were a founder organisation. You have given us three presidents. We have our CEO Jonathon Kruger who we persuaded to come to London to be with us for a period of time. We have a regional chair from the APA, Gillian Webb. You hosted two congresses, in Sydney [1987] and Melbourne [1967]. You have brought us through difficult times, your leadership has brought us through difficult times,’ Emma said at the 2017 gathering.

‘Those of you who are familiar with our [WCPT] subgroups and networks, we have 25 of them and you are disproportionately involved in the leadership of those groups, and I thank you for that. We are better because of that,’ Emma says. ‘We have also had two members who’ve been part of the scientific committee—Elizabeth Ellis was the chair of the founding committee when WCPT really took on the management of Congress, and Rob Herbert was a member for the Congress 2015.’

Emma also noted past APA President and Honoured Member Melissa Locke had been a WCPT Board member from 2015–17 and was the foundation chair of the WCPT finance committee. Other key players she made mention of included Prue Galley, Pat Cosh and Rodney Farr, but Emma also noted the list of Australian physiotherapists involved with WCPT was ‘simply too long to read out’.

Surmising that ‘Australian physiotherapists have impacted on practise all over the world’, Emma said this country’s contributions on the world stage helped bring direct access to physiotherapy in many countries where it previously had been only accessible through a referral from a GP. In the early 1980s, the Australian Physiotherapy Association changed to its own code of ethics to reflect this change, which eventually triggered the WCPT to follow suit—but not before the APA was threatened with expulsion from the WCPT for making that change, such was the controversy surrounding it at the time.

From the inception of its Congresses, the WCPT lit a revolving globe at the start of each Congress (pictured), and it stayed in illuminated and in motion until the end of event as a symbol of the unity of physical therapists from all over the world. Now lost to the annals of time, the globe was last photographed at the WCPT Congress in Melbourne in 1957, which prompted Emma to ask Australian delegates at the Momentum conference in 2017 to search their cupboards for it.

‘When I said to people in the office “Where’s the globe?” they asked me what I was talking about,’ Emma says. ‘I said, “The globe in the photograph” and I was told that it had got lost somewhere. So if the globe is in anyone’s wardrobe or cupboard in Australia, could you send it back to us? Because we’d like it back,’ she quipped.

WCPT President Emma Stokes shares a little bit about Australia’s history in the progression of the WCPT during her speech at the Momentum conference in Sydney in 2017. Picture: Michael Blyde.
 

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