Looking beyond transformed
On Thursday 17 October physiotherapists from around the country came together at the Adelaide Convention Centre to hear from expert speakers about the latest research transforming the profession.
EVENT KICKS OFF
To open the TRANSFORM 2019 scientific conference, APA Acting Chief Executive Officer Anja Nikolic introduced Major ‘Moogy’ Sumner, who became a Member of the Order of Australia in 2014 for his dedication in promoting Aboriginal health and welfare, and youth and cultural heritage. Major Sumner performed a Welcome to Country to pay respect to the Kuarna people, the traditional owners of the land on which the conference was held.
Delegates were shown a video message from Minister for Health Greg Hunt explaining what actions the government, working with the APA, is taking for the benefit of the profession. Minister Hunt encouraged involvement in research programs aimed at keeping Australians out of hospitals and talked about the work between the APA and the government.
‘You have made some strong and tough demands; you’ve done what you should do and put your case forward. You were critical to the re-indexing, not just to physio but for allied health across Australia, of benefits under the schedule,’ he explained of the APA advocacy efforts.
‘We would not have it, I believe, without your advocacy and your work. That can be a little uncomfortable for me at times, but it’s what you should be doing and we’ve been able to achieve these things together.’
APA President Phil Calvert officially opened the conference and welcomed everyone to his hometown. He echoed Greg Hunt’s words and spoke about the APA’s strong advocacy efforts with the decision-makers of the country.
Phil discussed the importance of a strong membership base in being able to achieve good outcomes in Canberra. ‘Growth in membership is important, it represents value, but the most critical thing is that when you go to Canberra … once you start to get 30,000 members, doors get opened for you and you have a far greater opportunity to influence,’ he said.
He also touched on the importance of communicating and using the media to get the message of physiotherapy out there, and the capabilities of a strong membership base when advocating for the profession.
‘Our social media growth and presence over the last 12 months continues to grow. Our communications team has generated nearly 1000 pieces of media in mainstream media circles issued online, which is up 60 per cent from last year,’ he said.
‘These are pieces of media that have been generated by our efforts, and have not just happened. It is us putting out media releases, contacting journalists and media outlets. It is us commenting publicly on policy that has driven that response. We need to continue to do that and continue to strengthen this area.’
Anton Barnett-Harris, CEO of the Australian Physiotherapy Council (APC), also spoke at the opening plenary and gave the delegates a glimpse into what the physiotherapy profession might look like in 50 years.
Anton said it is a significant year for the Council, marking their 50th anniversary ‘and what better way to celebrate this milestone than to leap ahead to the next 50 years. It is what the physiotherapy profession will look like 20, 30, 40, or even 50 years from now that really excites us.’
The APC has recently partnered with business futurist Morris Miselowski and an Australian animation studio to create a video (youtube.com/watch?v=U_tztdUfIBM) that, Anton says, ‘will bring to life what’s on the cards for our profession in the next half century. There’s no doubt this will stimulate discussions, debate and, dare I say controversy. This is a conversation our profession needs to continuously engage in and we feel what better place than the APA TRANSFORM conference.’
BEYOND THE DEFAULT
Dr Jason Fox was named keynote speaker of the year in 2016 and attendees at the opening plenary were treated to an entertaining, insightful and witty address.
Dr Jason Fox.
Jason prefaced his one-hour presentation by declaring that he is a raging introvert. ‘I find that the world of motivational speaking is overly fraught with extroverted alpha males with big teeth who talk about horrendous concepts like big hairy audacious goals and throbbing targets,’ he said.
Humans, he explained, all have default ways of doing things when we are tired, stressed, overworked and busy, but ‘new thinking’ could give us alternatives. If the defaults keep happening and new thinking isn’t identified and celebrated then growth and ‘the atrophy of empathy’ will ultimately lead to the ‘clammy embrace of the inevitable kraken of doom, which feeds upon the sweet nectar of your impending irrelevance. But no one sets out to become irrelevant. Many well-intentioned leaders, individuals and teams find themselves there when they become too busy for meaningful progress.’
HEALTH WORKER OF THE FUTURE
In plenary two, Professor Joanne Connaughton, APAM, led a discussion with APA Honoured Members Melissa Locke and Gillian Webb, academic clinical and health psychologist Jane Fisher, and Ryan Ebert, APAM.
Joanne asked Jane Fisher, Finkel Professor of Global Health at Monash University, what challenges she sees plaguing healthcare providers in the future. ‘There are so many it’s hard to select a few,’ she replied, although she went on to say that the ones that stood out for her were an ageing population, and meeting the health needs of the increasing number of women who are giving birth between the ages of 35 and 40.
Melissa Locke, Jane Fisher, Rian Ebert, Gillian Webb and Joanne Connaughton.
A final challenge Jane mentioned is the ‘rise of e-mental health and mHealth and the enormous push to reduce fees for individual services and to promote self-management, self-care and how this can be done in an evidence-based way.’
Melissa Locke then gave her thoughts on what the changing face of healthcare patients will mean for physiotherapists of the future. She explained that physiotherapist need to embrace digital technologies and the ability to treat via telehealth to remote areas, something that Melissa has adopted.
‘If I look at my practice as a paediatric physio in the last month, I have treated in Fiji, Orange in New South Wales, and Bundaberg, all remotely, from my practice rooms. And also just down the road where one of my patients was too ill and too unstable for the mother to be able to get them to the practice,’ she said.
Technology, in its simplest form, is transforming the way clinicians treat and Melissa urged physiotherapists to embrace it.
Another highlight of the day was the mini keynote presented by APA members Katia Ferrar, a researcher at the University of South Australia (UniSA) focusing on social determinants of health, and Matthew Beard, the lead physiotherapist at the Spinal Assessment Clinic at Royal Adelaide Hospital.
Katia started by defining the concept of health inequity and inequality and explaining that the two are not interchangeable. ‘If we think about equality, that’s probably more about giving everyone the same thing to try and achieve a health outcome in that situation,’ she explained.
‘And then if we, on the flip side of that, think about trying to promote health equity, then we actually might need to give people additional resources to give them the leg up they need to then have the same outcomes as everyone else around them.’
Katia talked about the Open Door Health Clinic in Adelaide which, in partnership with the Salvation Army, provides pro bono physiotherapy and podiatry for people experiencing homelessness. It is fully run by UniSA physiotherapy and podiatry students.
‘I would like to hopefully inspire some of you, if not all of you, to consider physiotherapy in your practice, or even in the world, through a bit of a social justice lens,’ she said.
Matthew Beard then talked about his work. Currently, Matthew splits his time between private practice and the public hospital role as the lead physiotherapist in the Spinal Assessment Clinic. He touched on his public health career, which for the last 20 years has seen him try to evolve different pathways for clinicians, but also mentioned his private practice career. ‘Not all of us want to press on, seeing one and two for the rest of their life, and not all of us want to sign pay sheets. So what else can we do?’ he pondered.
Matthew outlined the orthopaedic spine service, for patients with spinal disorders who are referred for assessment by a medical practitioner via internal referrals. And he also spoke about his work in prisoner health, a patient group that can be often overlooked, but have similar conditions to what he was seeing in the general population. ‘One in four prisoners are First Australians. Now if you realise how many First Australians in the population, in that sense, they’re disproportionately represented,’ he says. ‘Of all the prison population, one in three have a chronic conditions, so they’re not very well, and two in five have a mental health condition. So it seemed to me to be an important patient cohort that we weren’t considering regarding care.’
Day two began with the awarding of APA honoured membership, which, as Phil Calvert said, is the ‘highest accolade that the Association can bestow on one of our members’ to recognise excellence and exceptional contribution to physiotherapy.
In doing so it reinforces and encourages the high standards and ideals of the profession by celebrating those members who make a difference through their achievements and leadership.
This year’s recipients were Professor Mary Galea, Dianne Wilson and Dr Mary Magarey.
Mary Galea has been an APA member since graduating in 1972 and is a founding member of the Victorian branch of the Neurology group. She has taken up a number of APA roles including chair of the Journal of Physiotherapy Editorial Board and chair of the Physiotherapy Research Foundation Grants Review Committee.
Mary Galea was emotional as she thanked the APA Board of Directors and said that she was very honoured to be ‘admitted to the pantheon of distinguished members that form the honoured members of the Association.’ Mary said that the profession has been very important in her life and she was pleased to see the continuous rise in research.
Dianne Wilson was the next to be announced. Having been a continuous member of the APA for over 50 years, joining in 1969 as a student member, she has been a tireless contributor to the APA and an inspiring leader of the profession. Dianne said she was ‘very humbled’ and thanked everyone else who put in countless hours and hard work into their roles at the APA and within the profession.
And last but certainly not least, was Mary Magarey, who taught for 40 years in the Master of Musculoskeletal and Sports Physiotherapy at the University of South Australia. Like the others, Mary has a long list of achievements in the profession. Her passion for clinical excellence and ongoing education has shaped her involvement with the APA, which is clear from her contribution to the Australian College of Physiotherapists and professional development courses.
Mary dedicated her award to the numerous people in her life who have shaped who she is today. She also thanked Phil Calvert and the APA Board: ‘You didn’t have to accept this nomination, so I thank you very much and I’m very grateful that you did.’
The three inspiring women received a standing ovation from the delegates in the packed plenary hall.
Next up in the morning plenary was the inaugural Physio Pitchfest hosted by James O’Loghlin, best known as the host of The New Inventors on ABC TV, and for his witty and entertaining programs on ABC radio.
Funded by the Physiotherapy Research Foundation (PRF), the Physio Pitchfest aims to foster innovation that meets a clinical need. Five shortlisted applicants were invited on stage to pitch their idea for a chance to win $15,000. A judging panel of three assessed the three-minute pitches and the audience were able to vote for a ‘people’s choice award’.
The five pitchers were Phebe Liston with her Facebook physiotherapy chatbot, Jonathon Newman with his injury-reducing football boot, Brodwen McBain with an orthosis for patients with upper limb injury, Erin Bricknell and Matt Wingfield with their neurology podcast, and Leo Ng with a time-saving research screener.
While the judges pondered over the impressive line-up of ideas and the audience voted, James O’Loghlin talked about the importance of innovation and the five barriers: I’m too busy, I’m not innovative, it’s too hard, habitual thinking, and fear of failure.
James said, ‘When you see a staff member, a patient, yourself, whenever you get frustrated, write it down. It’s an opportunity to do things better.’ He also encouraged attendees to challenge their assumptions.
‘Every time you drive through a green light, you can’t see the other light, you’re assuming it’s red. You’re assuming that people see it and obey it,’ he said.
‘What assumptions are you making about your industry? About the best way to communicate with patients? About what patients expect about the level of interaction and knowledge that they might have before they come and see you.’
Then it was back down to business. The overall winner of $15,000 was Brodwen McBain for the pronosupinator orthosis that holds the forearm at a stretch in either supination or pronation. The product is made of a hinged aluminium frame, soft arm cuff, wrist wrap and elastic straps, which allows the wearer to move out of their stretch position for short bursts of movement, before returning them to end-of-range upon relaxation. Competitor products either lock the elbow at 90 degrees or restrict movement of the hand entirely.
Brodwen was excited to be part of the inaugural Pitchfest and grateful to have been chosen as the winner. ‘The funds will allow us to continue to develop the pronosupinator, and help more people achieve optimal outcomes following injury,’ she said. ‘A big thank you to the PRF and all involved with such a great initiative.We feel fortunate to have shared the experience with some very innovative physiotherapists.’
The people’s choice award went to Leo Ng for his research screener, an innovative web app that uses machine learning (ie, algorithms and statistical models that computers use to perform a specific task without the need for instruction, but instead relies on patterns and inference) in the form of natural language processing to semi-automate abstract screening in a systematic review. Leo won a year of paid APA membership.
BRIDGING THE GAP
During the Friday afternoon sessions, a packed hall of delegates welcomed Professor Andrew Briggs, FACP, Dr Christian Barton, Professor Ewa Roos from Denmark and Dr JP Caneiro, FACP, to talk about what clinicians can do to bridge the gap between what they know and what they do in clinical practice for osteoarthritis (OA).
Andrew began the session with asking: ‘Should osteoarthritis be a key focus of health system reform?’ He finished by saying ‘yes, but … we should not consider it in a vacuum that fails to also consider system constraints, like the amount of money available, and the emerging demands, particularly around multi- morbidity. We should not consider OA in a condition silo or a body part silo, so we really should be looking at musculoskeletal health more broadly.’
Christian spoke about implementing high- value care in OA in Australia, looking at a bottom-up approach rather than a top- down approach. He said ‘the bottom-up approach driven by physiotherapists can change things; top down has to come at some point, but we need to probably start with bottom up to make something happen now … but we need to work together, and that’s really important.’
JP Caneiro’s advice was to change the narrative about OA in clinical practice, more specifically that the beliefs of people with OA are not reflective of the evidence. He presented his research, which was recently published in the British Journal of Sports Medicine (tinyurl.com/y575rcnm) and discussed how clinicians can change the message, the treatment focus, and give more power to the patient so that they have a positive understanding about their condition and they realise ‘that the triggers of tissue sensitivity and pain are not only [due to] the fact that the joint is damaged.’
Ewa Roos presented her bottom-up approach, which is the Good Life with Arthritis: Denmark program, or GLA:D as known by most. GLA:D is an education and exercise program developed by researchers, including Ewa, in Denmark for people with hip or knee OA symptoms. She said the GLA:D program ‘has been a success story in implementing clinical guidelines into clinical practice, and changing and transforming clinical practice in Denmark.’
Ewa presented research from the GLA:D program, which found that patient-reported symptoms reduced by 32 per cent after partaking in the program. Other favourable outcomes included less pain, reduced use of pain killers, and less sick leave or absenteeism. Ewa said ‘if we have evidence that we should change clinical practice then it should happen … within the top- down setting.’
TRIALS IN FOCUS
Day three began with the Journal of Physiotherapy Oration delivered by Professor Chris Maher, FACP, who began his talk by thanking the APA for supporting the Physiotherapy Evidence Database (PEDro) from the very beginning. ‘It’s become the pre-eminent source of evidence for physiotherapy around the world,’ he added.
Chris went on to talk about the PACE trial, a placebo-controlled trial of paracetamol for acute low back pain. He prefaced this by saying ‘it may seem a strange choice for a physiotherapy conference but, around the world, lots of professions are thinking about the issue, should they go down the pathway of prescribing medicines for their patients.
‘We were interested in doing this trial, because at this point in time, your go-to first-line treatment for acute low back pain was paracetamol. Every guideline around the world says that that’s what you should do,’ he said.
The trial was designed to assess the efficacy of paracetamol taken regularly or as-needed to improve time to recovery from pain, compared with placebo, in patients with low back pain. Chris and the research team assembled about 1650 people, and they were randomised to one of three groups. The first group received sustained release formulation of paracetamol (eg, Panadol Osteo), and they took the medicine in a time continuant, or regularly. The middle group took an old fashioned form of paracetamol, which is the immediate release formulation, and they took it as required. The last group were in the placebo group.
‘We had a really unexpected result,’ Chris explained. ‘Counter to our initial thoughts, there was no difference between the two dosing regimens of paracetamol, and even more surprising was that they weren’t different to placebo.’ This trial created a huge splash in mainstream media around the world. The results of the trial were published on the front page of the London Times, which is rare for a clinical trial. The findings of this trial suggest that regular dosing with paracetamol does not affect recovery time compared with placebo in low back pain (for the full study visit tinyurl.com/yxorpxfq).
Chris also shared with the audience the PRECISE trial, led by Associate Professor Christine Lin, APAM. This trial was the first to examine the efficacy and safety of the drug pregabalin in sciatica, and provided clear evidence against its use for this condition. The results ruled out any clinically worthwhile treatment benefits and showed that taking the drug is linked to an increased risk of adverse events compared to placebo in patients with moderate-to-severe sciatica.
‘In terms of whether it works for low back pain, whether it works for lumbosacral radicular syndrome, we’ve got high-quality evidence that it doesn’t,’ Chris said. ‘So these medicines are ineffective. We’ve also got high-quality evidence that they increase the rate of adverse events. If I was to reflect on why I think this is an important trial, I think it came at an important point in time when we were thinking about policy initiatives in terms of the safe use of these class of medicines for people’ (for the full study visit tinyurl.com/y2q2xop6).
Zoe Mckeough, Mark Elkins, Freddy Lam.
Two Journal of Physiotherapy awards were then presented. The reader’s choice award went to Freddy Lam for the systematic review on whether physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia. The paper of the year was awarded to Zoe Mckeough, APAM, for her cohort study of sedentary behaviour and health outcomes in people with COPD.
TECH CHANGING LIVES
Dr Jordan Nguyen was the morning keynote with an inspiring talk on the abundance of uses for technology. Drawing on his experience from almost breaking his neck, Jordon developed a mind-controlled smart wheelchair for people with high-level physical disability.
Now, as a founder of Psykinetic, he designs life-changing, inclusive technologies. Jordan’s mission is to change the world, but his immediate mission was to give attendees an insight into how the many advances in science and technology can transform lives, and how to embrace it.
‘I can see that artificial intelligence, technology, science, virtual reality, robotics, all of these different fields are going to have a big part to play in your future, too,’ he said.’
Jordan spoke about the time he almost broke his neck, but luckily only tore a few muscles, which still impeded his ability to roll over and get out of bed.
‘Every time I found myself stuck in bed, I was thinking very differently about all those moments [and] all the things I’d taken for granted. Just being able to walk down the street, go and play sport, hang out with my friends. Everything started changing.’
This led Jordan to start thinking about people who couldn’t move any part of their bodies, except for eye movements, or ‘locked-in syndrome’.
Jordan said he started a project in 2006 to design a wheelchair that could be controlled by the power of the mind using the brain’s electrical signals and artificial intelligence technology.
‘And this is why I started Psykinetics,’ Jordan said. ‘Psykinetic is psych and kinetic; putting mind into action. I wanted to take these areas of research and the technologies I was getting to work on and seeing out there, and get it to the people.’
Since then, Jordan has been focusing on injury, disability and aged care, successfully creating the mind-controlled wheelchair, a musical instrument that enabled a friend with cerebral palsy to play music with her eyes and through blinks, and devices enabling people to drive cars using only the tiny electrical signals created from eye movements.
‘We’ve got to keep looking outside our own bubble,’ he urged. ‘We’ve got to look outside to find what technology, what advancements in science are coming next that might change our lives.’
BEYOND INFORMED TO TRANSFORMED
APA Vice President Jenny Aiken introduced the final keynote before the much- anticipated conference dinner. Robyn Moore’s presentation focused on how communication can change someone’s life. Robyn is a multi-skilled communicator and an educator, who has been changing people’s perception through the power of words for more than 40 years. And she was also the voice of Blinky Bill.
Talking about a recent broken ankle and the many months of physiotherapy she had to go though, Robyn said, ‘You’ve all made an audacious choice to be health professionals. To hold people together, to bring them their health and vitality back so that their families work, so they can go back to their jobs, so that their kids can be happy.
‘What a noble profession you belong to. And I think this is precious, that you’ve all come together under the banner of the APA.’
Robyn talked about her work with Make a Wish Foundation and the power of her voice over the phone to a sick child when speaking like Blinky Bill. She told the children’s stories, she showed photos of them when their wish was granted.
At the end of her talk she said, ‘You’re going to come up with some innovations out of this conference that will transform the future for people and their health. And that’s why this conference has been put together.’
After Phil Calvert officially closed the conference, it was time for the Australian College of Physiotherapists 16th graduation ceremony, where 13 registrars were awarded Fellowship of the College.
New Sports and Exercise Specialist Physiotherapist Miranda Menaspa said she was ‘honoured’ to be selected to provide the Fellows Reply on behalf of the cohort of College graduates.
In her inspiring speech, Miranda equated the process of attaining Fellowship to a concept that Dr Jason Fox had articulated in his keynote. ‘For those that saw Dr Jason Fox speak on Thursday morning,’ she said. ‘I ask you to think about his comparison between a “mission” and a “quest”. In brief, Dr Fox suggested that a “mission” is a linear voyage, from point A to point B, often undertaken with blinkers on in order not to be distracted on the way to reaching one’s goal. A “quest” is an adventure, of which the final destination might be vague and will often change based on the learnings along the way.’
Miranda said Fellowship requires a complete reassessment of the way clinicians think about themselves, their knowledge, the profession, and also their ability to help people and contribute to the ongoing improvement of healthcare in Australia.
She said the training program for specialisation teaches one how to be the ‘captain of a quest’.
‘It teaches us how to shed long-held biases, how to avoid reverting to our default in times of stress and being option to all options, to utilise the skills of clinical reasoning to the fullest, without coming to any foregone conclusions prematurely, of quickly writing down the observations we make that seem unusual or out of place before they leave our head.’
The overarching message in Miranda’s reply was ‘ancora imparo’, which is an Italian phrase meaning ‘yet, I am learning’ and often attributed to Michelangelo. Miranda finished by saying, ‘I feel extremely proud to be a Fellow of the College. Despite the fact that you, Fellows that have gone before us, have achieved excellence, you continue to push, raising the bar for all of those that are following in your wake.
‘Like Michelangelo, you continue to learn and seek new knowledge, always learning. I urge my fellow graduands to ensure we hold up our end of the deal. Ancora imparo.’
A big congratulations goes to all new College graduates:
- Amy Chu: Musculoskeletal
- Jack Perisa: Sports and Exercise
- Kay Copeland: Sports and Exercise
- Lia Giovanovits: Sports and Exercise
- Mick Drew: Fellow by Original Contribution
- Miranda Menaspa: Sports and Exercise
- Peter Caine: Sports and Exercise
- Peter Steggall: Musculoskeletal
- Alisa McLachlan: Musculoskeletal
- Brett Althorpe: Musculoskeletal
- Craig Elliott: Musculoskeletal
- Paula Peralta: Sports and Exercise
- Simon Olivotto: Musculoskeletal.
After three jam-packed days of knowledge translation, talking about the latest research, and transforming perspectives, there was no shortage of physiotherapists having a boogie on the dancefloor during a favourite conference event—the conference dinner.
In Adelaide, the Saturday Night Fever- themed disco dinner provided a much- needed wind down after a big three days.
LOOKING AHEAD: FOCUS 2020
The APA has already been busy getting organised for the FOCUS 2020 conference in Perth from 28 to 30 May next year. Predicting the future is challenging. FOCUS 2020 will provide a foundation to help attendees prepare, understand and manage the challenges and opportunities that may lie ahead. We invite you to take focus, be visionary and share your experience.
Abstract submissions close on 15 January. For more information go to focus.physio.
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