I’ve only ever been to APCP conference previously and I was really excited to attend Physiotherapy UK to get a mixture of perspectives from other areas of physiotherapy.
Firstly I would like to say thank you to the APCP West Midlands Region for funding my place at Physiotherapy UK 2019. It turned out that only three members entered the ballot for the West Midlands bursary but I still felt very lucky to be awarded the bursary!
I’ve only ever been to APCP conference previously and I was really excited to attend Physiotherapy UK to get a mixture of perspectives from other areas of physiotherapy.
The conference was a great showcase of physiotherapy. I do think though that topics that cross the generations could be improved further if adult and paediatric physios were invited to work together to deliver joint symposiums in the future.
I would like to share some of my and other colleague’s highlights of attending.
Myself and colleague attended a number of the focused symposiums as described below.
‘Enabling the next generation through activity, gaming & empowerment’
I even took the next generation along to this symposium. Baby Ruben seemed to enjoy himself!
It was fantastic to see APCP members from the West Midlands Region involved in research and to hear about an innovative idea for data collection of their research via crowd funding (Marilyn Bradbury at Birmingham Community Trust). The patient journeys and their real life use of the ICF in terms of participation were fabulous and included the inspirational story of a child’s horse riding leading to an adulthood trek to base camp at Everest.
‘First Contact Practitioners (FCP): First point, second point or no point at all’
This symposium demonstrated lots of different FCP models. It posed some controversial questions, such as: 'Is it solving the GP crisis?' and 'If the potential of self-referral to physiotherapy had been realised would FCP be needed?'
The data presented from pilot FCP projects included ‘friends and family’ outcomes being positive and in line with other NHS services. There was some discussion around FCP just shifting the GP work load to other staff, and leaving GPs with the most complex patients. The opinion of the symposium panel was that FCP is government driven and so the brakes aren’t likely to be put on its ‘roll out’. Personally I think physiotherapists are perfectly capable of this performing this role. It is an extension of our core knowledge base, but being a FCP in a primary care setting is rather different from ‘physio’s core business’. The benefit for patients to have immediate access to specialist MSK physiotherapy assessment and advice is a potential NHS game changer. I’m a paediatric physiotherapist and I wouldn’t expect FCP’s to be rolled out to paediatric patients at this time, but would FCP’s mean that the patients ‘follow the right pathway’ more successfully, and physiotherapy departments spend more time treating the right patients?
‘The long view: Understanding cerebral palsy from a life course perspective’
This symposium highlighted the lack of recognition of this patient group in terms of specialist staffing / charitable support (in comparison with MS & Parkinson’s). There were some truly inspirational case histories of the real life challenges of aging with CP including functional deterioration, pain and barriers to health care. There needs to be better access to professional review and support to improve conditioning thus function.
‘Managing paediatric chronic pain – preventing a future of disability’
This symposium was inspirational, with excellent pace and flow throughout. My colleague described it as ‘exceptional’ and being ‘totally blown away’, and I would agree. Kate Dunn’s presentation of the statistics related to the epidemiology of pain in children and young people really focused my priorities of this patient group. Mick Thacker’s perspective and explanation of the neuroscience of pain made me really consider the additional complexities of the paediatric pain patient but also their potential for recovery as they have a ‘plastic’, ‘non-mature’ neuro-framework. Rhiannon Joslin’s case study of a patient’s journey literally had the whole audience in tears.
This symposium made realise that I need to amend my approach to this patient group from an approach that want to ‘fix’ them to one that support them to set their own agenda for recovery ... so no more: ABC recipe approach for me (de-sensitisation, ROM & weight bearing). Instead I will do more active listening, ensure a child sets their own 0-10 of functional recovery targets and aim to support them on a ‘meaningful adventure’ to recovery.
‘Which pathway to follow? Managing paediatric musculoskeletal conditions’:
This was a fantastic symposium, pulling together MSK screening from three different perspectives. I feel really motivated following this symposium to push forward with my work with our local commissioners to get our young people on the ‘right pathway’ of care. Vicky Mercer’s presentation of ‘pGals plus’ project is very exciting and clinically valuable. I believe it has fantastic potential to help to ensure that children receive more direct access to care in a more timely fashion. Anish Sanghrajka’s whistle stop tour of paediatric orthopaedics was a great synopsis of paediatric conditions that present with MSK pain and when these need orthopaedic fast-tracking. Heather Foster's presentation of the considerations, role and value of physiotherapy in young sportsmen and women was superb. It is fantastic that Bath University recognises the value of investing in athletes when they are at their most vulnerable in their anatomy, psychology and development as a sports person, and I hope that its recognition in adult sport continues to grow.
Overall I think the level of specialism in paediatric physiotherapy shouldn’t be underestimated and as we continue to drive forward our area of expertise from university, health and sports settings, access and care to services for children and young people will improve.
‘Understanding & managing syndromic joint hypermobility in adults’
A well-balanced symposium with a good overview of the ‘state of play’ in terms of current diagnostic labels for Hypermobility Spectrum Disorder and hEDS. From the information presented, adults tend to have a delayed diagnosis (average 22 years), but more access to rehabilitation compared with paediatric patients. Paediatric representatives see the opposite of diagnosis potentially too early but with higher thresholds for rehabilitation. This provoked some discussion during the Q&A session around over diagnosis / misdiagnosis and the impact of this on rehabilitation. It would have been helpful to have a paediatric representative on the symposium panel and would be useful to do something cross-generational in the future.
NOTE: The Royal College of Paediatrics and Child Health (RCPCH) - Establishing a correct diagnosis of Ehlers Danlos Syndrome hypermobility type (hEDS) in children and adolescents – position statement (March 2019) provide s the current recommendations for diagnosis in the paediatric population. It is advisable to use this source for paeds hypermobility due to key differences between children/adolescents and adults.
Poster Presentations
In addition to symposiums there were several hundred poster presentation and it was fantastic to see so many coming from our paediatric colleagues.
I was particularly interested in the ACL rehabilitation poster from the Evelina team, who implemented and reviewed an ACL pathway. Only 5 patients had used the pathway so far, but the rehabilitation pathway appears very comprehensive and has featured on iCSP.
I was also really pleased to see a poster on 'Developing an Allied Health Core Outcome Set for Paediatric Rheumatology'. This found consensus of outcomes between tertiary centres for most domains identified (including Quality of Life: Peds QL & MSK HQ) and a pilot in 3 tertiary centres using these is planned.
Overall, my conference experience was really positive and I hope that APCP will continue to build on this experience to ensure that paediatrics continues to feature in the programme at Physiotherapy UK.
Caroline Watkins