Fysioterapeuten 6-2020

34 FYSIOTERAPEUTEN 6/20 Introduction The recent promotional campaign from the Canadian Physiotherapy Association states that physiotherapists’ work takes them ‘from treating patients to moving people’ (http:// tinyurl.com/ya954p65) . One reading of this is that physiotherapy covers a broad range of locations, from treating patients in clinics and hospital wards to working with people in their homes and communities. Another reading, however, suggests that physiothera- py is fundamentally changing: physiothera- pists used to ‘treat’ people, now we prescribe exercise. Coming at the highpoint of the COVID-19 outbreak, the campaign reminds us how much the crisis has disrupted ‘nor- mal’ physiotherapy, and how the pandemic might be reshaping our practice. Physiotherapists have known crises be- fore, however. And the configuration of modern-day physiotherapy owes much to our response to earlier calamities. World War I played a huge role in cementing phy- siotherapists as the orthodox providers of physical rehabilitation in many countries, and the polio epidemics that ran through the first half of the 20th century gave birth to many professional bodies (1). There are some essential differences between health care in the last century and healthcare today, though, and these differences might mean a very different outcome for the profession. Physiotherapy in the last century benefi- ted from two distinctive external influences: an established medical profession, and the welfare state (1). In centuries before, when there had been epidemics or massive social upheavals, there had been no social safety net to provide essential services for the po- pulation, and no established medical pro- fession to partner with. People mainly had to fend for themselves. In the 20th century, developed countries had sufficient resources to build social welfare systems that, amongst other things, provided the infrastructure to support training and development of thou- sands of new health professionals, including physiotherapists. Over the last 50 years, successive neoli- beral governments have sought to reverse this trend, however, decentralising healt- hcare and reducing the size of the welfare state (2-4). Nation-states have opened up markets to greater competition, increased accountability for healthcare spending, pla- ced more choice and responsibility in the hands of individual citizens, and challenged the historical power of the medical profes- sions. So, notwithstanding the recent out- pouring of support for healthcare workers, many governments throughout the world have been on a decades-long quest to reduce the influence of social welfare and the ortho- dox medical profession. This kind of service reform is only likely to accelerate in the co- ming years, as the costs of the pandemic dig deeply into national economic reserves. Over recent weeks, healthcare workers all over the world have turned to online therapy as the only viable way to engage in practice, and some have wondered whether this re- presents a new market for physiotherapy services? But if people like Daniel and Ric- hard Susskind are right, these innovations in practice might be leading professions like physiotherapy down a dangerous path. In their book The Future of the Professio- ns (5), the authors argue that successive de- cades of technical and work disruptions in industries like manufacturing, banking, and law, have taught us that anything you can practice as a discrete skill, or describe and explain in a language that others can easily follow, will almost certainly be lost to those who are cheaper to train and employ. But this is precisely what scores of physiothera- pists are now trying to do on social media to promote their business. Because therapists can’t be there in person, they are learning to show people how to do it for themselves and thereby showing those practices that may well be the first ones we lose from profes- sional control. And perhaps rightly so. Physiotherapists never owned essential fitness and strengt- hening programmes, tests for flexibility, treatments for minor injuries, or home-ba- sed rehabilitation programmes anyway. Our school curricula have been overloaded for too long with the kinds of skills that made sense when the profession sheltered under a legal, government, and medical protection. But it seems unlikely that physiotherapists will be able to claim expertise and the social capital that comes with it when the majority of our knowledge and skills become open- sourced. We should already be thinking about the impact of this in our future curricula because the healthcare system will look dramatically different in 10 years when today’s gradua- tes are our senior practitioners. WWI and the polio epidemics forced physiotherapy to proliferate and consolidated the profession around a set of skills and abilities that still form the core of the profession’s principles. But today we have the Internet, neoliberal economics, and climate changes, so it is in- FAG ESSAY Is COVID showing us the future for physiotherapy? David A. Nicholls , GradDipPhys, MA, PhD, SFHEA, Professor of Critical Physiothe- rapy, School of Clinical Sciences, AUT University, Auckland, New Zealand. David. nicholls@aut.ac.nz. Karen Synne Groven , Professor, Oslo Metropolitan University; Professor VID Specialized University Yngve Røe , Associate Professor, Oslo Metropolitan University Tone Dahl-Michelsen , Associate Profes- sor, Oslo Metropolitan University Wenche Bjorbækmo , Professor, Oslo Metropolitan University This essay was accepted May 27th, 2020. This is an edited and expanded version of a post published on David Nicholls’ blog page: https://criticalphysio.net/2020/05/06/ is-covid-showing-us-the-future-for- physiotherapy/ The paper was first published online on June 2nd 2020.