Winter - Physiotherapy Association of British Columbia

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W inter 2015
A publication of the Physiotherapy Association of British Columbia
Child’s Play: Cycling Succeeds,
Jumping Eludes by Emily Mitchell, MPT
Note: This article is PABC’s first Case Corner on the Virtual
Forum. See page 4 for details.
As movement experts, physiotherapists
help their clients overcome a number of
different movement challenges. Whether
it be regaining full range of motion
following a soft tissue injury, learning to
use a prosthesis following an amputation,
or relearning how to walk following a
head injury, physiotherapists understand
that regaining movement as quickly as
possible is one of the most important
goals for patients.
In pediatrics, there is often the added
challenge of teaching a movement
pattern for the first time. If a child has
never been able to walk before, or stand
independently, or jump, or catch a ball,
it is not simply about relearning a motor
task following an injury, but is about
learning a new pattern of movements that
will enable a new skill to develop.
The physiotherapist, in conjunction with
other team members, must identify
the limiting factors in the child’s ability
to perform the skill. Is it an issue of
strength? Balance? Coordination?
Sensation? Attention? Most often it is a
in this issue
When Om Turns to Ouch........................................................................................ 6
Help Patients Find Your Practice............................................................................ 9
Move More. Sit Less. ............................................................................................. 11
Subacromial Impingement Syndrome – A Brief Overview................................... 20
Professional Development Calendar .................................................................... 24
All issues of Directions are available online at:
www.bcphysio.org/content/directions.
NEW! links to urls and email addresses:
•click on blue links in pdf document to open up urls and email addresses referred
to in articles
• click on titles in the ‘In this Issue’ section on the front page to go directly to
article; click on page number at bottom of article to return to front page
Emily Mitchell
combination of many factors. Because
so many systems must be working
together in a coordinated manner to
successfully perform the skill, children
become frustrated quickly if the activity
is not adapted appropriately so that they
experience success.
Meet Ryder
Ryder is seven years old. Like many
other kids, he likes Star Wars, Lego, and
hiking with his Grandpa. Unlike other
kids, Ryder has autism and mild left
hemiplegia secondary to cerebral palsy.
He shows a strong preference for using
his right side for all climbing, throwing
and balancing tasks. When Ryder first
came into the clinic, he was about to
start kindergarten, was not interested
in playgrounds, had difficulty climbing
stairs, did not ride a bike, could not jump,
and was overall far behind his peers in his
motor skills.
Ryder would watch other kids play,
but appeared scared to try what they
were doing. From the beginning, he
was hesitant to try new activities and
lost interest quickly if they were too
continued on page 4
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
Keeping British Columbians Moving For Life
Directions
bcphysio.org
president’s message
Happy Winter
Jason Coolen, BScPT, BSc(Bio)
President
physiotherapy amongst doctors, and how
to partner with them in some common
initiatives. We were very well received
by all and were provided with some very
positive feedback. RBT also managed
to sneak a snapshot of Dr. Cavers
downloading our Find a Physio App!
Hi folks,
I hope this Directions edition finds you all
well and warm. As I write this we are in
the middle of a wee little cold snap here
in Vancouver; nothing a bluenoser can’t
handle. But I digress.
Our most recent Board of Directors
meeting occurred in December 2014.
That was a little teleconference to
touch base with our directors on all
of the happenings in the provincial
regions. Prior to that, we had a very
productive September meeting. As is
customary in the September meetings,
your Board took the opportunity to do
a thorough review of our strategic plan
with the guidance of a facilitator, John
Nieuwenburg, of W5 Coaching. Having
a facilitator allowed us to take a new,
clean look at our plan and concentrate
on a number of elements that would
allow us to maximize our efforts. One
element that came out of our session
was identifying doctors as an important
strategic partner in the care of our
patients/clients. We currently have a
small task force working at developing
a document tailored for physicians on
the value of physiotherapy. The CPA has
also been involved in this endeavor and
we hope to share this with you all in the
coming months.
Continuing with the physician theme, our
top notch CEO RBT and I met recently
with the president of Doctors of BC
Dr. Bill Cavers, their CEO Allan Seckel,
and their ED of communications Marisa
Adair. This was an opportunity to have an
exchange on how we as physiotherapists
can increase the general profile of
Dr. Bill Cavers, President of Doctors
of BC (formerly BCMA) downloaded
PABC’s new Find a Physio app during the
meeting with PABC President and CEO
had over the past 12 months that will
allow us to support our rural members
more effectively through the Rural and
Remote Committee.
The Branch Presidents met in November
and received a general update from the
CPA. One major announcement was the
official creation of a provincial branch
in Quebec! The Branch Presidents were
very happy to have Quebec join the fold
and look forward to an even stronger
national voice. There was also more
discussion around the support of our
physical therapy assistant brothers and
sisters. CPA acknowledged the need
to provide national support for our
PTAs, and PABC will continue to work
with them for our PTAs to support their
growth and membership. We also had
some discussion on the engagement of
internationally trained physiotherapists.
CPA is presently seeking out further info
from the Canadian Alliance to determine
how we may be able to reach these
physios in order to engage them with our
membership and support their growth
and transition as well. We will keep you
all posted on that one.
Another item our members may be
In conclusion, I sincerely hope you all are
interested in is the Board’s approval of
well, had a wonderful holiday season, and
the terms of reference for our new Rural
I wish you all a happy and prosperous
and Remote Standing Committee. As of
New Year!
December 2014 the committee officially
had representation from all rural regions.
My best to all,
That is great news in order to ensure
Jason Coolen
that the Board hears from all corners of
My email box is always open
the province. This new committee was
[email protected] so please drop
developed in response to the Board’s
me a line.
decision to amalgamate our two
northern regions. This has now
been completed, and in order
to comply with our association
bylaws, a new region was voted
on by the Board. The new
South Fraser Region will include
Surrey, Delta, and White Rock
as part of its geography. As a
board we are excited about
moving forward on this item and
are presently looking for a new
board director to represent that
region come April 2015. I would
like to thank our Board for the
The Branch Presidents and CEOs at the November
work and discussions we have
2014 meeting in Toronto
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
bcphysio.org
Directions
CEO’s message
You Are Which Kind of Therapist?
Rebecca B. Tunnacliffe, MA
Chief Executive Officer
I have a bugbear. When members refer
to themselves as something other than
physiotherapists or physios, it is antipromotional. PABC works to promote
the profession, to differentiate you in a
crowded market, to explain the value
of physiotherapy, and to generally keep
physiotherapy as the first choice in rehab.
When you self refer as a therapist, few
but the inner circle know which kind of
therapist you are.
Patients, physicians, and the general
public know you as physios or
physiotherapists or physical therapists.
I see a worrying trend for you to selfdescribe using alternative terms. I’m
hearing generic variations on our title,
which undermines your wish to be better
recognized. We have a protected title,
and we need to use it.
The Case Corner
I propose we banish the words
in our self-referral lexicon that
make it difficult for those we
treat or wish to treat to know
who we are. They are (and we
are not):
- Therapist. This could
be a psychotherapist,
aromatherapist,
occupational therapist,
massage therapist, speech
therapist, etc.
- Provider: this could be
anyone providing anything,
or someone who brings
home the bacon
- PT: only those inside the tent
know what this refers to
RBT presenting each new grad with a PABC padfolio
containing a business card with their name and new
title “Physiotherapist”. L-R: RBT, Trevor Potts, Jessica
Cheng, Tiger Ye, Kayla Comstock
Just as we want patients, the public,
physicians, health care colleagues, and
insurers to think physio first when they
think about rehabilitation and mobility,
we need to think of ourselves first as
physiotherapists and not a generic
alternative. With every chance you
have mention your profession and your
title, you are promoting the value of
physiotherapy.
Please don’t diminish our professional
recognition by using a term that dilutes
our distinction. Think “Physio” First
(or “physiotherapist”, or “physical
therapist”).
(Please note: this follows from the article on the cover page which continues on page 4)
“Child’s Play” is the first post in PABC’s Case Corner. Our March/April 2014 survey of PABC members revealed that over 60%
of members surveyed want the opportunity to submit and read cases from their fellow members. To support this, we created
the Case Corner on our website, and are inviting you to comment on and to share stories about a recent practice insight or
challenge, and encourage you to ask questions, provide suggestions and share experiences in order to learn from one another. HOW TO GET TO CASE CORNER:
Login to member site > Virtual Forum > Case Corner
www.bcphysio.org/virtual-forum/case-corner
Submissions can be on any professional topic you’d like to talk about, as long as it relates directly to your work and field of
practice, or your professional development and growth. Posts should include an invitation to other physiotherapists to ask
questions, provide input, and engage with the stories.
Learn submission details here:
www.bcphysio.org/sites/default/files/file_attachments/page/Case-Corner-Guidelines-Template-FINAL.pdf.
Interested? Contact us at [email protected] with your idea for a future Case Corner submission.
We have posted two Case Corners to date. Read the first one here by Emily Mitchell, who practices at Abilities Neurological
Rehabilitation, then watch for the second one by Naznin Virji-Babul, PT, PhD (neuroscience) in the spring newsletter or now on the
Case Corner.
Keeping British Columbians Moving For Life
Directions
bcphysio.org
Child’s Play...continued from cover page
challenging, which resulted in avoidance
behaviours such as running around the
clinic, lying on the floor, hiding in the
waiting room or crying. Creativity on
the part of his therapists to adapt and
progress the activities was essential.
It’s like riding a bike
One of the family’s main goals was for
Ryder to learn to ride his bike. Riding
a bike is a complex skill that many
neurotypical children struggle with
initially. It requires adequate strength
and flexibility to push the pedals all the
way around, coordination between each
leg to get the rhythm and to keep feet
on the pedals, balance to stay upright
on the seat and keep the bike straight,
arm strength to hold the handles and
steer, cognitive ability and attention to
safely navigate obstacles and operate
the brakes, and motivation to want to
ride. Ryder had difficulty with each one
of these areas so the skill had to be
introduced slowly.
Leg strength was slowly improved
through games involving stairs,
squatting, and climbing. The coordinated
pedaling rhythm was introduced on a
stationary bike with a passive motor
that moved his feet around and provided
feedback when he was helping push in
the form of changing screen displays.
Balance was addressed using swings,
climbing games, kicking a ball and yoga
poses. Grip strength was improved using
a trapeze swing, pulling a weighted rope
and pushing a weighted cart. Motivation
and attention were being addressed
throughout the sessions in conjunction
with his Occupational Therapist and
Speech Language Pathologist in terms of
taking turns, following instructions, and
completing a task.
Once Ryder masters riding a bike with all
the adaptations in place, they are slowly
removed one by one until he is successful
without added support. Ryder’s
grandparents report he has ridden his
bike with a friend to school and is able
to go on a trailer bike with his mom and
is much more successful at keeping the
pedals going. They also report he now
goes up stairs with no rail, balances on
playground equipment and tries to play
more with other kids.
Once on the bike, various strategies were
employed to make Ryder successful. He
used a bike with training wheels to help
him stay balanced. Small inclines helped
him get the speed needed to keep the
bike moving. Bowling pins acted as
targets to ride into and knock over. Hand
over foot prompts were used to help him
learn to operate the coaster brakes (as
he would initially try to get off the bike
or reach towards me taking his hands off
the handle bars if he was going too fast).
Velcro straps were used on the pedals to
help keep his feet in place. For additional
motivation we rode a short distance from
the clinic to a nearby park.
Ryder has made great gains in his
confidence with climbing activities, stairs,
bike riding and hand-eye coordination.
Our next goal is to help Ryder with his
jumping skills, so critical in many games
and activities of childhood. Difficulty with
jumping is often present in children with
autism.
Teaching jumping skills: What do
you recommend?
As a therapist, what have you done to
teach jumping, or what have you seen
work with other therapists and patients?
What hasn’t worked? I look forward to
hearing your experiences with adapting
activities for success.
How Ironman Led to a Mobile Yoga &
Physiotherapy Practice
by Heather Laine, BScH, MScPT, PYT (c)
Yoga’s popularity has risen dramatically
over the past 20 years in Canada.
With the increasing number of people
participating in yoga, the research and
evidence continues to emerge on the
numerous benefits. Yoga practice has
been demonstrated to improve symptoms
for a wide array of conditions that we,
as physiotherapists, would typically see,
including but not limited to: chronic pain,
cardiovascular disease, neurological
impairment, arthritis and pregnancyrelated pain.
My interest in yoga was sparked over
ten years ago just before entering
physiotherapy school. For years I
experimented with the different styles of
yoga and it was only five years ago while
training for Ironman Canada that I really
started to recognize the vast benefits of
yoga. I attribute much of my success and
a practically injury free year of triathlon
training to yoga. My daily practice provided
me with postural awareness, muscular
balance, gentle stretching, mental focus
and time to rest and recover. It was during
that year that I started implementing
fundamental yoga basics into my
physiotherapy practice with children who
had a diagnosis of cerebral palsy. After
seeing the immediate benefits and their
pure enjoyment of yoga I started integrating
it into many client treatment plans.
therapist Ginger Garner in the United
States. PYT joins western rehabilitation with
eastern yogic medicine forming a medically
grounded, biomechanically sound and
evidence-based approach. During my
training I have learned to use the PYT
biopsychosocial model for assessment
and treatment to provide client-centered
holistic health care.
I am excited to take the next step in this
journey and have recently opened a
Through my journey to learn more about
mobile home-based physiotherapy + yoga
how I could incorporate yoga into my clinical
business servicing clients of all ages in
practice I completed my 85-hour prenatal
North and West Vancouver.
yoga teacher training and embarked
Heather Laine is a Prenatal and Kids Yoga
upon my Professional Yoga Therapy (PYT)
certification. PYT is a postgraduate medical Instructor and a Yoga Enthusiast
www.flowphysiotherapy.ca
program that was founded by physical
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
bcphysio.org
Directions
A New Province-Wide Resource for You and Your Patients
– The UBC Pharmacists Clinic
by Barbara Gobis, BSc(Pharm), ACPR, MScPhm
Do you see patients in your practice who are at risk of medication-related falls or
other drug therapy challenges? Now you can help these patients get more time and
attention to resolve their concerns through the Pharmacists Clinic at the UBC Faculty
of Pharmaceutical Sciences. The clinic is a new, state-of-the-art patient care centre
where pharmacists with advanced training work in respectful collaboration with the
health care team (including the community pharmacist) to optimize drug therapy
outcomes for complex patients. As a new model of pharmacy practice, the clinic is also
a teaching site for students and practicing pharmacists.
Patients are referred to the Pharmacists Clinic either by a health care professional or
by self-referral. Services are funded by the BC Ministry of Health (PharmaCare) and
the Faculty, and provided at no cost to patients. The first appointment is 60 minutes
and follow-up appointments are 30-45 minutes as needed. Services are available to
anyone living in British Columbia by telephone or in person at the UBC Vancouver
Campus, depending on patient preference.
During one-on-one appointments, the pharmacist works with the patient to:
• gather detailed information about all medications (prescription, non-prescription
and natural health products);
• assess how the medications are working;
• identify potential drug therapy problems;
•
provide education and answers to
medication questions; and
• develop an action plan to resolve
these problems in collaboration with
the patient’s health care team.
Follow-up appointments are used to
check on progress and keep patients on
track for the best possible drug therapy
results. All care is documented and
shared within the patient’s circle of care.
You and your patients are invited to
contact the Pharmacists Clinic
Telephone: 604-827-2584 Email: [email protected]
Website www.clinic.pharmacy.ubc.ca
Barbara Gobis is the Director, Pharmacists
Clinic in the Faculty of Pharmaceutical
Sciences, UBC.
Kudos for the November Knowledge Team webinar “Putting Out Fires: Management of
Acute Inflammation” with Alison Hoens and her guest Dr. Shakeel Bhatti, a clinical pharmacist.
View the free webinar recording and course materials in the member site Library at:
www.bcphysio.org/resource/1-putting-out-fires-management-acute-inflammation-pabc-webinar
•
“I am so glad this was recorded so I can review it again. And again! The content was
so rich from both presenters.”
•
“The pre-webinar prep materials on the member site are really helpful. It was great
to get a feel for what was coming, and it’s easier to absorb the material during the
presentation.”
•
“A very good presentation regarding NSAIDs. I have a better understanding of COX-1
and COX-2 and how to answer questions when patients are asking about acute and
chronic injuries.”
•
“I was pleased to learn about a new partnership between PABC and the BC Pharmacy
Association. Joint Action on Joints!”
•
“Such passionate, clear, concise presenters.”
•
“Thanks for providing these free opportunities to learn and stay current.”
Dr. Shakeel Bhatti, pharmacist, and
Alison Hoens, PABC Knowledge
Broker, following a PABC webinar
on Putting out Fires: Managing
acute inflammation.
Kudos for the Librarian:
•
"Thank you so much for your extensive lit search. I read everything you sent and I think my questions have certainly been
answered. I really appreciate all of your time and effort. It was exactly what I was looking for." MK
•
"I have to start by saying wow! The search you did was very impressive and I’m super pleased with the articles it caught." BJ
•
“Thank you so much for your speedy assistance. You're a lifesaver." LT
•
"Your library services are so amazing in that we can access pertinent information in a timely manner." MS
Keeping British Columbians Moving For Life
Directions
bcphysio.org
When Om Turns to Ouch
by Greg Redman, BScPT, BScKin, FCAMT, Sport Physio Diploma, GunnIMS, CAFCI
We LOVE yoga! We have six practicing
yogis in the clinic, and professionally
incorporate it into rehab routines. But
some of our patients are concerned
that they will get hurt practicing yoga.
We asked the question, “Should we be
promoting yoga as much as we are to
improve the rehab/prehab process with
our patients/athletes?”
astronomically; in 1994 about 5 million
people practiced yoga and by 2007 more
than 13 million. I guess it is no fad (4). And
with more people practicing there is more
chance of injury.
Injuries
Close to 9000 Americans reportedly
received medical treatment for yogarelated injuries in 2004/2005
(US Consumer Product Safety
Commission) which according
to American Sports Data
means there are approximately
two yoga injuries reported
for every 10,000 times its
practiced. Not very scary when
compared to the rates of injury
in other sports.
Asanas
We asked PABC librarian Deb Monkman
to help us find out what risks are
associated with yoga, then wrote three
blogs for our site: Risky Business – How
Scary is Yoga?; Spine Snapper – what
types of injuries occur at the top of the
mat; and How to be a happy injury free
yogi. We’d like to share our first blog
here.
The safety of yoga has been questioned
by some respected yoga journals and
reputable newspapers, but really is it
that dangerous? After an exhaustive
few months searching for research into
reported injuries caused by yoga, we
have concluded that there isn’t much
good research out there; the systematic
review only found 35 better journal
articles. We did find out a number of
interesting statistics.
Yoga by the numbers
Fifteen percent of the American adult
population reported practicing yoga
(1) and 30 million people worldwide
(2). Fourteen million Americans have
reported that they were recommended
by their health practitioner to practice
yoga (3). And the numbers are growing
A large proportion of the
reported injuries were from
three positions or asanas (5):
#1 Headstand is the most cited injurious
posture; #2 Shoulder stand, and #3 various
positions of the Lotus pose were higher
risk.
To conclude we found that yoga really
is not that scary when you consider that
relatively few serious adverse events
have been reported in healthy people
compared to the number of people
practicing. Yoga is safe and the benefits
far outweigh the risks (6,7).
Greg Redman is the co-owner of Wave
Physiotherapy in Kelowna.
1. Macy D (2008) Yoga Journal releases
2008 “Yoga in America” market Study.
Yoga Journal.
2. Barnes PM, Bloom B, Nahim RL (2008)
Complementary and Alternative
medicine use among adults and
children: United States, 2007. Natl
Health Stat Report: 1-23.
3. Barnes PM, Powell-Griner E, McFann K,
Nahin RL (2004) Complementary and
alternative medicine use among adults:
United States, 2002. Adv Data: 1-19.
4. McCall T (2013) Working with Students
Who Have Yoga Injuries, Part 1. Yoga
Journal.
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
Little Physios
Allison and Ramsey Ezzat became
new parents on September 13th.
Sienna Margaret waited for her dad
to return from his PABC Business
Affairs Committee before starting full
labour. Allison was a model physio;
she walked to the hospital while
in labour and then walked home
afterwards.
New grad Heather Leslie gave birth
to Freija Victoria on October 27th.
Freija weighed in at 6 pounds 13
ounces.
On November 5th, Jill Longhurst
(Greczmiel) welcomed her son,
Oscar William, from 2:04 - 3:55
am. Although his stay was brief,
he touched many lives. He will be
forever loved, cherished, and missed.
You can read more about the family’s
time with Oscar, and their experience
with trisomy 18, at
http://jillandpeter.wix.com/oscar.
5. Cramer H, Krucoff C, Dobos G (2013)
Adverse Events Associated with Yoga:
A Systematic Review of Published Case
Reports and Case Series. PLOS ONE
Vol 8, Issue 10. 6. Cramer H, Lange S, Klose P, Paul A, Dobos G (2013) A Systematic Review
and Meta-analysis of Yoga for Low Back
Pain. Clin J Pain 29:450-460.
7. Cramer H, Lauche R, Haller H,
LanghorstJ, Dobos G, et al. (2013) “I’m
More in Balance”: A Qualitative Study
of Yoga for Patients with Chronic Neck
Pain. J Altern Complement Med 19:
536-542.
Physio Forum 2015
Save the date – Saturday
April 25 – for our annual day of
education and colleague catchup. Registration opens March 4th.
See page 11 for details.
bcphysio.org
Directions
No Pretzels: Why I made a
Slow Flow Yoga DVD
by Kristie McGregor, BMR-PT, RYT
The last time I wrote for Directions I was
on my way to India to become a yoga
teacher. Three years later, I have just
released my first yoga DVD!
Kristie’s new Slow Flow video
Usually when my physiotherapy patients
hear that I teach yoga, they ask for
a “yoga routine” that they can do to
complement their current rehab. I
excitedly oblige, happy that more and
more people are starting to recognize
the therapeutic benefits of yoga. I used
to draw them a series of stick figures and
then run them through the sequence,
using breath and awareness as the focus
of the movements. Eventually I realized
that I would give a common series of
poses based on what the patients were
coming in to see me for. Usually I would
arrange it into either a neck/shoulder/
upper body sequence, a low back/hip/
lower body sequence, or a general whole
body approach. I even designed “PhysioYoga” workshops using these themes,
adding in some anatomy and education
on common injuries to the yoga class.
Over and over I talked through these
sequences, drew them out, typed them
up with descriptions, demonstrated and
encouraged patients. Everyone seemed
to love them.
So, I decided to put these ideas into
a practical format that patients could
take home with them at the end of their
appointment. The DVD contains three
different videos, each 30 minutes long.
One is for shoulders, one is for hips, and
another is a whole body sequence. What
better way for patients to remember their
exercises than to have someone at home
talking them through it!
I designed the videos to be slow moving,
with emphasis on breath, awareness, and
simple poses. There are very few (if any)
“pretzel” yoga moves, and you will likely
be familiar with a lot of the exercises and
stretches seen in the DVD. I combined
some of my usual physiotherapy exercises
with some gentle yoga poses in a nice,
relaxing sequence. Add some soft music
and a Savasana relaxation at the end of
each session, and patients are feeling
amazing!
With the growing interest of using yoga
therapeutically, it is nice to know that
there is a safe physiotherapy-oriented
yoga DVD available. There are a lot of
fitness yoga classes and products out
there, and I really wanted to provide my
patients with something beginner friendly
that wouldn’t have them frustrated or
injuring themselves if they wanted to
try yoga. Physiotherapists can easily
see how each yoga pose incorporates
different aspects of our rehab exercise
—breathing, stretching, low impact
strengthening, coordination, balance, and
body awareness all in one.
Aside from the benefits to patients, this
is a great opportunity for physios to try
yoga for themselves. With the growing
interest in yoga, it is likely you have
encountered at least a few patients who
have asked your opinion. Now you can
see what it’s all about; you don’t even
have to stand on your head or twist into a
pretzel in a class. You can feel for yourself
the benefits of yoga. In our fast-paced
profession it is a great asset for us as
practitioners.
If you would like to order for your clinic or
want to know more, I would love to talk to
you. Feel free to call, email, or send me a
message to get in touch.
[email protected]
250-344-1165
Kristie McGregor practices as a
physiotherapist, yoga teacher, and yoga
therapist at Element Therapeutics in
Golden.
In Memoriam
Brenda Tillotson 1927 - 2014
Brenda Tillotson passed away
peacefully on Saturday, December
6th at the Peace Arch Hospital.
Despite failing health in 2012, Brenda
began the research for a proposal
that she presented to CPA in 2014
on establishing a Virtual History of
Physiotherapy in Canada. Her legacy
is now under the PABC banner and is
being continued by a committee of
her peers who share her dream.
Brenda trained in London before
coming to Canada in the early
fifties; she first worked at WCB, then
housed at VGH. In 1959, she moved
to G.F.Strong where she worked with
patients with spinal cord injuries,
poliomyelitis, and with amputees.
She later became the Director of the
department, eventually becoming a
member of the site’s 20-year club.
Although she retired in 1987, she
maintained ties to her profession.
Always an ardent supporter of
physiotherapy in practice and in
leadership, she advocated for a UBC
physiotherapy school, served as the
president of the BC Branch of CPA,
and helped plan CPA Congresses in
Vancouver. In the eighties, she was
made a Life member of CPA.
Rest in Peace Brenda, we will miss you.
Nominate your Colleague for
a PABC Award
Having your professional contribution
recognized by your peers is a peak
career achievement satisfaction. Give this
experience to a colleague by nominating
them for one of the PABC Awards of
Excellence. New this year is the Public
Practice award. Also up for nomination
are: Lifetime Accomplishment, Promising
Young Professional, Leadership, Clinical
Contribution, and Professional Contribution.
The nomination is easy; the form is on the
Members Site at
www.bcphysio.org/content/awards-bursaries
Keeping British Columbians Moving For Life
Directions
bcphysio.org
Birth, Baby, Body
by Gillian Clayton, MPT, BScHE
Gillian with baby Matthias
During a recent PABC course, I finally came
up with the title for this article I wanted to
put together. Don’t you love it when things
just fall into place?
If you read no further, I want you to know
this. When a woman gives birth to a child,
what follows is a tremendous period
of change. It isn’t just sleepless nights,
blurry days, aching body parts, diapers,
and constant worry that you may not be
doing the right thing for your baby. Your
heart and eyes are opened to something
completely new.
What I’ve found to be a bit disheartening
is how fast we want this baby and new
mama stage to pass. Ever heard, “Does
your baby sleep through the night?”, “Is
he or she walking yet?”, and the classic,
“When are you going back to work?”
What is the rush here? Where is the
fire? It’s nobody’s fault – it’s our culture
– but we do have some power here to
make a change as leaders in a health
care field that is positive, practical and
professional.
I thought you had a baby and just got on
with things.
Then I had a baby. Let’s just call it a game
changer.
You spend the beginning of your baby’s
life in a dreamy, heart-bursting, lovefilled state, mixed with soul crushing
tiredness and a constant feeling of being
out of control. Eventually though, a lot of
people asked, “When will you be going
back to racing?”
I struggled with not training like I had. I
began to feel out of shape. At the same
time, I was so much more tired than I had
ever been during Ironman training, so
what was I doing wrong? To be both ‘out
of shape’ and too tired to actually run? I
started to take all this quite personally.
And I know I’m not the only one.
Ever seen a sign for a ‘Mommy
Bootcamp’? Heard ‘how to lose the baby
weight’? These are rhetorical questions.
I know you have. And I do believe, in
clinical practice, we are beginning to see
women with significant problems from
returning to intense sports too soon
because our culture drives us there. And
we’re seeing pelvic floor dysfunction,
back pain, pelvic girdle pain, postural
pain, knee pain, the list goes on.
So let’s support a slower, gentler
approach to the postpartum period.
Let’s realize and recognize how hard this
period of growth for both the baby and
the mother can be. Let’s not worry so
much about getting ‘back on track’ and
be the leaders in supporting this period
of time we get to spend with our tiny,
little, perfect humans.
Gillian has returned to private practice
at The Joint Physiotherapy in the Comox
Valley, and is finding a lovely balance
between work and family life with her
husband Shawn and new babe Matthias.
Post-Adoption Rates for Physiotherapy
PABC has been in discussion with the Ministry of Children and Families over the
past year, seeking a correction of the physio fees such that our hourly rate is posted
rather than the visit rate. This brings physio into alignment with the other therapies
all posting at an hourly rate, and means our members now get fair compensation
($190/hr) rather than being an apple among oranges.
This member expressed both professional and personal gratitude for our efforts:
“I just wanted to send you this short note on how pleased I am with the work you
and PABC has done to increase the funding for post adoption assistance through
MCFD for physiotherapy. Obviously as a private practice owner who sees children
with neurological challenges, it means increased access to our services. However,
as a parent of a 12 year old son with hemiplegia who was adopted through MCFD
and is about to undergo some significant surgical intervention, I cannot begin to
express the thanks that our family feels.
Logan is an engaging and active 12 year old who has learned to swim, ride a
two wheeler, and snowboard through the help of physiotherapy. As his growth
and his condition threaten to affect his mobility and participation in the activities
he loves, physiotherapy is vital to keeping his level of ability. The work you have
done has directly impacted his life and his ability to access consistent high level
physiotherapy care. Of course being a physiotherapist myself I would have made
this happen regardless, but you have eased a significant burden for me which
allows me to continue to focus on giving back to the profession I love.” HB
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
Looking for a
Directions Article?
Remember that Directions article
about physiotherapy in the Chinese
community? Or the ones about
independent contractor and
employee status? Use the new and
improved Directions index to find
them. Simply go to the member
site > Community > Directions
Newsletter (where you can read
Directions as a fun flip-page book
as well as a pdf file), and click on
the Subject Index. Thanks to UBC
Masters of Library, Archival and
Information Studies student Cristen
Polly for creating it.
bcphysio.org
Directions
Help Patients Find Your Practice
by Fiona Chiu, MLIS, PABC Librarian and Member Services Manager
facial retraining, or have worked with multiple sport professionals, musicians, or
dancers, make sure to write something about it in the About Me section of your
Find a Physio profile.
Would you like to work with us in completing your Find a Physio profile? Email us at
[email protected]
Did you know that as a PABC member
you have a free listing on our Find a
Physio online directory? Find a Physio
is a directory on the PABC website, and
it receives over 10,000 page views per
month. The contact information of each
practicing PABC member is listed so that
the public can find a current contact list
of physiotherapists who can treat their
condition. The catch is that you need to
update it with your current workplace and
all the things potential patients want to
know about you.
Help patients find you at your practice
by ensuring that you update your Find
a Physio profile today. It only takes 5
minutes, but it can make a significant
difference to someone in need of a physio
with your expertise:
1. Login at bcphysio.org. You will be
prompted by a notice to update your
Find a Physio profile.
2. Fill out your info. Ensure that
you have indicated your current
workplace, otherwise you won’t
show up in a search, even if all the
other components of your profile are
completed.
3. List your Areas of Practice, and
Credentials.
4. Can’t find what you want to have
listed on your profile? What we have
done to capture the many other
important additional skills that you
and other members have is provide
a Keyword Search. Patients can type
any word in the Keyword Search field,
and if this word is in the About Me
section of your profile, you will show
up in the results of the search. For
example, if you have taken additional
courses, have a special interest in
STAFF CHANGES
Hello from your New Librarian
by Fiona Chiu, MLIS
It’s a brand new year! And with that, I am thrilled to introduce myself in my new role
as the information guru — finding and providing resources for all your physio needs.
Formally, I would like to say hello as the new PABC Librarian & Member Services
Manager.
This new position is a combination of librarian responsibilities from undertaking
Deb’s role, and the web resource management responsibilities from my Member
Services position. Over the past two years at PABC, I have had the pleasure of
interacting with many members regarding website, education, and resource
inquiries, which has helped me learn and understand how I can tailor and deliver
member services that are most valuable to you. In this new role, I am excited to
integrate that experience, along with my academic knowledge (Master of Library and
Information Studies, MLIS), to provide seamless support regarding any information
you wish to seek.
Deb has undoubtedly left big shoes to fill, and we will miss her as she explores
another chapter in her career. See page 14 to read Deb’s article.
For article requests, literature searches and more, feel free to login and contact me
at: www.bcphysio.org/content/request-pabc-clinical-librarian
PABC’s New Office Administrator
Hello, I’m Kimberley Payne, PABC’s office administrator
and the newest addition to the team in a newly
created role here at PABC. I look forward to providing
outstanding assistance to members in a variety of ways,
such as aiding you to navigate the PABC website,
helping you update your profile, and troubleshooting
access/login matters.
A little bit about me: I have been working as an office administrator in the health
field for over ten years, and have just earned my bachelors degree in Justice
Studies from Royal Roads University. On the personal front, I was born and raised in
the Lower Mainland, reside in Vancouver and am a very proud mom of a lively fiveyear-old girl.
I look forward to getting to know everyone in the coming weeks, months and
beyond. Let’s start the conversation by emailing me at [email protected]
Keeping British Columbians Moving For Life
Directions
bcphysio.org
PABC’s WorkSafeBC Liaison
Update
by Jamie MacGregor, BScPT, CHT
We are now six months into the new
treatment model, not without speed
bumps but progressing nonetheless.
Some points to emphasize:
Claim Volume
Since June 1, based on invoices received,
9973 workers have undergone standard
assessment blocks, and 1024 have
undergone post-surgical assessment
blocks. The number of workers still being
treated under the old Stream 1/Stream 2
model that have not yet been discharged
or moved over into the new model has
dropped from 4000 in June, to 196 in
November. We also have seen a drop in
referral from PT to OR1 since the launch
of our new model. In general, claim
volume across WSBC has been slightly
lower than expected for 2014.
Invoicing
One of the bumps encountered early has
been that of invoicing issues. However,
the backlog appears to be improving.
Our thanks to Payment Services at WSBC
for increasing staffing dedicated to PT
invoicing, and for two recent overtime
blitzes to address pending PT invoices.
With that effort it was evident that the
single largest issue causing invoices to
queue for manual processing remains
inaccurate date of service on reports,
with missing/absent reports second. To
limit our invoicing issues, PTs need to
ensure accurate dates of service (re-learn
the Date of Service rules if necessary),
and submit reports. The reports required
in this contract ARE the proof documents
required to receive payment for an
invoice. No report = no payment. Late
report = significantly delayed processing
of invoice. Putting numbers into context,
between June-November for the
new model fee codes only, WorkSafe
processed almost 42,000 invoice line
items on over 12,000 claims.
Reports
Our report content has been very well
received overall by claim owners. We now
provide meaningful information related to
function and assist in return to work. That
said, we are aware that the reports are
10
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
redundant in sections, and also require us
to provide demographic information that
likely isn’t necessary. These reports will
be revised, with the goal of streamlining
the reporting process while maintaining
the excellent information provided. These
reports are showing us in a very positive
light; please keep up the great work.
Medical Supplies
For the first time, we now have the
opportunity to bill up to $50 per claim
for required medical equipment for our
clients, without need of approval. While
this is a significant reduction in hassle
for all of us (worker, PT, claim owner),
it is unfortunately being abused by
some in our profession. I am aware of
medical supply companies providing
PTs with a list of ‘billable products’ and
encouraging them to be billed; of PTs
billing $50 exactly on nearly every claim;
and of requests for various products
including creams, therabands, etc. to be
covered. I encourage you all to read the
contract, understand what you can bill
for, and bring pressure on your peers
or employers who are abusing this fee
code. It would be a huge shame for our
members to lose access to this fee code
due to the misuse and abuse of it by
some, and frankly an embarrassment if
we were to prove ourselves unable to
responsibly administer this service. Look
for random audits of the use of this fee
code in the near future.
Communication with
Case Managers
Case managers appreciate the fact
that we now know both the end date
of treatment and initial extension block
without needing to ask, and that we
needn’t call them to clarify either end
dates or approval of the first extension
block. Unfortunately, many clinics
continue to call the case manager
for these two pieces of information,
some on a daily basis. This adds
unnecessary call volume to the case
manager’s desk. Please, calculate your
own end dates based on the contract
terms, and the first extension block is
approved unless you hear otherwise,
assuming you submit your extension
request on time. Remember, you are
required to call the claim owner to
indicate that you are requesting an
extension and why, but you do NOT
need to hear back from them to initiate
treatment in that block.
Finally, thank you to Gabrielle Jacobson
(physiotherapist and Program Manager
for Physio Services), Michele Tedford
(physiotherapist and QA Supervisor),
and Alisha Mawji (Client Rep) for all of
their hard work and effort to support our
members during the roll-out and early
stages of this new model and contract.
We are fortunate to be working with this
dedicated team whom I know to be as
vested in seeing this contract succeed as
we are.
Jamie MacGregor is a hand therapist and
co-owner of Priest Valley Manual Therapy
Centre in Vernon.
Promoting the Value of BC Physiotherapists
PABC has undertaken a number of initiatives to promote the work our members are
doing to Keep British Columbians Moving for Life. Among the 2014 initiatives has
been our Stories of Impact video series highlighting lesser-known practice areas of
paediatrics and arthritis.
We’ve had a wave of kudos from members about the videos, such as: “The video is
great. It’s not too overstated, but still does a great job of demonstrating the value of
PT with Arthritis. GN, and, “Wow!!!! That is a great video. You do such a great job. SL”
If you haven’t seen them, join the thousands who have given a thumbs up on our
social media sites, then host a screening in your workplace to share with colleagues
and the community.
Born to Run – Darren’s Journey www.bcphysio.org/content/born-run-darren-s-journey
Moving with Arthritis
www.bcphysio.org/content/stories-impact-moving-arthritis-how-physiotherapy-helps
bcphysio.org
Directions
ICBC Update
by Marj Belot BScPT, MSc, FCAMPT, CAFCI
Billing without calling: In order to make
the policy of billing without first calling
for authorization smoother, the default
end dates have recently changed from
four months from date of claim initiation
to six months.
Adjuster Training: On October 31, I
had the honour of participating in new
adjuster training at Guilford Corporate
Services in Surrey. An entire afternoon
was devoted to discussion of injury
management. It was a great opportunity
to educate the adjusters about what
we do and why we do it as well as gain
a better understanding of what they
learn in their six-week initial training
process. ICBC asked PABC to send a
representative this year in recognition of
the frequency with which bodily injury
adjusters interact with physiotherapists,
and the improved communication with
PABC over the past few years.
Please continue to contact
member services at PABC or me at
[email protected] if you
have any questions or concerns about
ICBC that are not already answered on
the PABC website.
Marj is a clinical associate at West 4th
Physiotherapy Clinic, and is a registered
instructor with the Orthopaedic Division
of CPA.
NOTE: Marj has been the PABC-ICBC
Liaison since 2008, and after seven years
Marj has given notice that this is her final
year and that she will retire at the PABC
Forum in April. Marj’s attention to this
position has been extraordinary, and
PABC is grateful for the hundreds of hours
she has volunteered.
by Alison Hoens, PABC Knowledge Broker
In response to a call in May 2014 for new PT Knowledge Broker projects, members
of the KB Steering Committee reviewed three proposals in June (myself, PABC’s own
Rebecca Tunnacliffe, and UBC Department of Physical Therapy’s Dr. Jayne Garland).
The proposal selected as the next project facilitated by the PT Knowledge Broker
is the Physical Activity Support Kit Initiative (PASKI). Here is a brief summary of the
project:
Title: Move More. Sit Less: A toolkit to support healthy activity in chronic disease
Scope: A repository of resources (both for persons living with chronic disease and
for clinicians/care providers from multiple disciplines) to promote physical activity and
reduce sedentary behavior in adults with chronic disease.
Structure and Process: The Core Committee will lead the organizational aspects of
the project. This committee includes PABC members Greg Noonan, Dr. Marie Westby,
Dr. Lynne Feehan, Rosalyn Jones and Dr. Kimberly Miller as well as representatives
from the Physical Activity Line of BC and Active Choices of Self Management BC.
Working groups for specific diseases/conditions (see below for proposed categories),
comprising patients (from Patient Voices of Impact BC), clinicians, researchers and
representatives from BC Parks and Recreation will identify and recommend existing
resources that are meaningful and feasible. An Advisory Committee composed
primarily of researchers from multiple disciplines and areas of practice but also
including clinicians, patients and community representatives will ensure that the
recommended resources are evidence-informed. Lists of the Committee members
are available on the websites. The final set of resources will be available online and be
linked from the Physical Activity Line, Active Choices and other sites as appropriate. It
is anticipated that the process will be completed in approximately one year.
Proposed Working Group Categories: The categories (derived from a
compilation of national and international sources including reports from the Public
Health Agency of Canada and World Health Organization) include: neurological,
cardiovascular, respiratory, oncology, mental health, metabolic/endocrine diseases,
musculoskeletal, and ‘other’. For further details, please see
www.bcphysio.org/resource/move-more-sit-less-toolkit-support-healthy-activity-chronicdisease
This is an exciting, albeit somewhat daunting, project. Stay tuned for updates. As always, if
you have any questions please contact me at [email protected]
Physio Forum 2015
Save the date – Saturday April 25 – for our annual day of education and colleague catch-up. Registration opens March
4th. Hear BC physio greats Deb Treloar, Erl Pettman, LJ Lee, May Nolan, Linda Li, Alison Hoens, and Dave Troughton.
Presentations include Practice Insights, Complex Case Conundrums, The Art and Science of Helping Patients Change
Behaviours, award presentations, plus the AGMs of the College and PABC. While PABC undertakes the planning and
logistics, the Physio Forum is hosted by the three pillars of the profession: PABC, CPTBC, UBC-PT.
Keeping British Columbians Moving For Life
11
Directions
bcphysio.org
Public Practice Directions
Physiotherapy: The Missing Public
Practice Puzzle Piece
by Scott Okrainetz, MPT
“There are physiotherapists in the
hospital? I didn’t know physios worked
here. What would a physio do in a
hospital?” As physiotherapists in
public practice we often come across
an identity crisis with the public. Too
often, patients, other practitioners, and
especially students in different health
practices meet us in public facilities and
wonder where we fit into the puzzle.
If you haven’t met me before, I’m Scott
Okrainetz, the Chair of the Public
Practice Advisory Committee. Part of
our role is to build the recognition that
physiotherapy deserves in the public
practice realm. If you ask most people
on the street about physiotherapy, they
won’t point to the hospital behind them.
They’ll think of private physiotherapy,
and throw out one of those questions
above when told of where the other
half practice. This is likely due to many
factors - maybe how wonderfully humble
we physios are, but likely it is about
exposure. Many people who head to
the ER don’t get much further inside
and many ERs regrettably aren’t staffed
regularly by physiotherapists. A patient’s
only opportunity to become accustomed
to physiotherapy in the hospital is if they
are fully admitted or are visiting a patient
benefiting from physiotherapy. That’s our
time to shine…but how?
Show the Scope
We all know the variety of areas of
practice that we work in, but does the
nurse sitting next to you, or the patient
you are helping to walk after surgery, or
even the family member to whom you
are explaining their child’s treatment?
Have you told them all of your many
skills? Have you shown them the multiple
12
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
techniques you could do? If not, why
not? Showing the strength of our scope
of practice not only will benefit your
patients, but also help our profession.
Every day as we treat we are making a
name for ourselves, and you are the one
leading the way.
Be Interactive
Word of mouth relies on the number
of interactions you have day in and day
out. Without those daily interactions
through your day you can very easily
be that physiotherapist, alone on a
deserted island, treating a volleyball
named ‘Wilson’ that floated up on shore.
There are many ways you can be more
interactive in the public setting that
include being more vocal in rounds,
joining new initiatives, even doing
cooperative treatment of patients with
other disciplines. Whether you work in
an inpatient, outpatient, or community
setting there are always ways to spread
the word so that others know how
amazing you are!
Mold the Future
No, you don’t need a DeLorean and
Doc Brown to pull this one off. The
future is in our students – our up-andcoming physiotherapists. Some may
say this is pointless, as the students are
learning about physiotherapy at UBC
and elsewhere. Many students, however,
come into their Master’s program
with an incomplete knowledge of all
physiotherapy can do, especially in the
public practice spectrum. You can always
offer to take that student for a day to
expand that students horizons while on
placement. You also don’t need to limit
this to physiotherapy students alone.
There are plenty of opportunities out
there to interact with nursing, OT, rehab
assistant and even medical students,
all of whom will benefit from having a
greater understanding of what we can do!
Mentorship – Get Involved!
Are you looking for an even stronger way
to spread the word about physiotherapy?
There may be an opportunity to work with
the Public Practice Advisory Committee
and be an Ambassador for your facility. The
Ambassador is the point person for contact
between PABC and our public practice
members, and has the benefit of hearing the
biggest news first hand from PABC. And to
broadcast great things being done in public
practice, PPAC has created a new award:
Public Practice Physio in Focus. Nominate
your peer in this easy yet meaningful
application on the Members Site at:
www.bcphysio.org/content/awards-bursaries
Thanks for reading and enjoy your day
keeping British Columbians Moving for Life!
Try Our New Journals
Search and Tell Us
– Love It or Lose It?
Our new Google-like Journals
Search will be evaluated until mid2015 and we need your feedback
to decide if we should “love it or
lose it”. It’s a quick and easy way
to access PABC’s databases and
journals. Have you tried it? Have
you watched the new tutorial?
Give Journal Search a try at
bcphysio.org/content/searchjournals and a pop-up link will ask
for your feedback, or simply email
Fiona at:
[email protected] This new
search tool does not replace direct
access to databases so if you prefer
to do a “proper” (non-Googley)
search, just access the database(s)
you need directly instead.
bcphysio.org
Directions
We Must Join the EMR Trend to
Remain Relevant
by Jeremy McAllister, BScPT, MHA
As the saying goes, ‘change is the only
constant’. Whether it be one, five, or fifty
years from now, your private practice
physiotherapy clinic will be converting
from paper charting to an electronic
medical record system (EMR). The trend
in medicine is inevitable. In my article
in the Spring Directions, I reviewed
the accelerating progress in medicine
towards interoperable EMR systems.
In this article, we look at the benefits
of adopting EMR and why movement
has been slow in that direction within
physiotherapy.
Proponents suggest that both quality of
care and efficiency of practice benefits
accrue with EMR adoption in both facility
and community practice settings. In
regards to quality of care, the benefits
of EMR are well documented in the
literature. These include improved
legibility, improved record searching,
decreased medical errors, opportunities
for clinical decision support, improved
handoffs between healthcare workers,
and opportunities for streamlined
outcome measure collection and
research. While all of these are important,
quality of care is likely to most improve
when our system reaches a state of
interoperability. Interoperability is the
ability of diverse systems to exchange
and use information. Currently under
development in BC, for example, are
portals for health professionals to
access diagnostic imaging reports and
import them to the patient EMR in clinic.
Getting the separate components of the
health system to talk to each other is
an incredible challenge on many levels,
but this vision is presently driving the
investment of a substantial amount of
effort and resources.
In addition to improving quality, EMR
adoption is heralded to improve the
efficiency of medical practices. Largely,
this is thought to transpire through the
decreased handling of paper, decreased
pulling of and searching for charts,
improved intra-clinic communications,
and reduced office staff requirements.
Although vendor advertising would
have us believe substantial office
benefits are a ‘fait accompli’ of EMR, the
literature indicates that improvements
in operational efficiency are largely
dependent on the multitude of decisions
made throughout an EMR adoption
process.
In summary, improved efficiency is likely
but less certain than improved quality
with EMR adoption. And therein lies the
challenge of EMR adoption in private
practice physiotherapy. The uncertainty
of efficiency benefits and how to
proceed through an EMR conversion
create a hurdle too high for many clinic
owners to surmount. A sense of unease
accompanies the consideration whether
to adopt electronic records. How much
will it cost? How do I choose the right
system? What will it save? How will I
manage the change? Are my staff and
associates ready for this change? How
would it work logistically? What about
privacy? Security? Backups? Power
failures? Do I use tablets, laptops,
desktops? And so we remain ‘paralyzed
in paper’ while the world rapidly
advances around us.
The Doctors of BC recently faced the
same dilemma. Many in the past ten
years would have liked to proceed with
EMR adoption, but the uncertainties
were daunting. EMR conversions were
limited to practitioners with international
influence or higher-than-average
technological competence. It was not
until the association developed the
Physician Information Technology Office
for clinic support and secured subsidies
from the Ministry of Health that rapid
EMR adoption took place.
To date, most of the physiotherapy
community’s consideration of EMR has
focused on the potential efficiencies
that might be provided by a paperless
environment. But we need to take a
bigger view of how EMR is foremost a
quality initiative, helping to keep our
profession relevant and connected to a
quickly changing medical system. The
efficiencies for business operations are
very likely, but may on their own not be
convincing enough to propel us to act
as quickly as we should. It is exciting to
know that PABC and CPA are currently
considering how practices can be best
supported in EMR adoption. Keep your
eyes open for new developments on this
front in the months to come!
Jeremy McAllister studied the EMR and
physiotherapy practice for his Master
of Health Administration degree; he
was the recipient of the PABC/CBI Peter
Huijbregts Bursary for professional
development. He practices at Fraser
Valley Physiotherapy and Rehabilitation
Centre in Chilliwack.
EMR Task Force Formed
Jeremy presented his EMR insights
and recommendations to PABC’s
Business Affairs Committee in
December. The BAC members were
very impressed and determined to
help members adopt the EMR in
practice. Jeremy kindly agreed to
be the Task Force Chair. If you are
interested in joining the task force
and helping us create a toolkit for
members, email Rebecca at
[email protected]
Keeping British Columbians Moving For Life
13
Directions
bcphysio.org
Library and Information Technology Directions
Soup’s On! 5 Years of Library
Evolution & Goodbye from Deb
by Deb Monkman, MLS, BSc, Clinical Librarian
It’s Winter and I’m thinking about soup. There is the rich broth without which soup wouldn’t be soup, and then there’s the addition
of colourful vegetables of all shapes and sizes that provide the texture and interest, and of course the seasoning. Well, “Soup’s On”
at PABC! Members have had a lovely broth since 2007 when your first librarian (Eugene Barsky) secured subscriptions to essential
online library database and full-text journals through the newly-formed Electronic Health Library of BC (e-HLbc). Now, many years
later your soup is textured with colourful vegetables and rich with seasoning; so much has changed, much of it in the past 5 years
since I’ve been your librarian. Did you know you can access all of these resources listed below (and more) — free as a benefit of
membership — on the member site? Have you partaken of this repast? Grab your soup spoon and delve in.
Did You Know You Have…?
Tool
To Access: Member
site > Click on
Library, then…
Anatomy
> Browse eLibrary
Resources > Special
Library Guides >
Anatomy
Books
> Browse eLibrary
Resources > Special
Library Guides > Books
Databases
Home Exercise
Program Sheets
How to Critically
Appraise an
Article
How to Use the
Library
Journals
14
> Browse eLibrary
Resources > Popular
QuickLinks
> Browse eLibrary
Resources > Popular
Quicklinks > Rehab
Reference Center
> Browse eLibrary
Resources > To learn
how-to > How to find,
appraise, and apply
evidence to practice >
Journal Club
> Browse eLibrary
Resources > To learn
how-to
> Search Journals and
Articles
Knowledge Broker
Toolkits and
Guidelines
> Knowledge Broker
Mobile Apps
> Browse eLibrary
Resources > Special
Library Guides >
Mobile Apps Treasure
Trove
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
Why use it?
3-D anatomy images you can manipulate and
demonstrate to your patients or use for your
ongoing professional education.
Even though we are a virtual-only library, you
will find online books such as Modalities for
Therapeutic Intervention, Therapeutic Exercises,
and Developing Cultural Competence in
Physiotherapy Practice.
PABC has Medline, CINAHL, PsycINFO and
Cochrane Library, and CPA has Rehabilitation
Reference Center.
Rehab Reference Center via CPA has “Exercise
Images” that allow you to customize a home
exercise plan and email or print (from Visual
Health Information).
The Knowledge Team webinar series called
Journal Club instructs you how to critically
appraise RCTs and systematic reviews, with
Alison Hoens and her guests.
Watch brief tutorials (1 – 5 min) on the lit search
process, how to find info in the new library, etc.
PABC subscribes to over 3,000 full-text journals
through e-HLbc. If it’s not free on the web,
PABC may have it and if not, we can usually get
it for you. Use the new Journal Search to
explore.
Created by and with PABC members, there are
19 practical toolkits on topics such as Achilles
tendinopathy, Canadian C-spine rule, safe
handling, safe mobilization, TJA OMs,
wheelchair guidelines.
Members recommend and review mobile apps
for the Mobile Apps Treasure Trove. Find a new
app to try or send us your recommendation.
What’s New in the
Library?
Visit Library News on the
member site for these recent
free resources:
1. Tutorial – How to use the
library to find journals and
practice resources
2. PABC Toolkit in
development – “Move
More, Sit Less: The Physical
Activity Support Kit Initiative
(PASKI)”
3. Knowledge Team webinar
recording – “Putting Out
Fires: How to Manage
Inflammation”
4. How-to guide – Access
physiotherapy books
5. CIN webinar recording –
“Implementing communitybased exercise programs for
cancer survivors”
Contact your new PABC
Librarian, Fiona Chiu, at
[email protected] for
assistance at any time. See page
9 for a new look at her familiar
face.
bcphysio.org
Directions
Outcome Measures > Browse eLibrary
Resources > Special
Library Guides >
Outcome Measures
Overview of
> Browse eLibrary
Physiotherapy
Resources > Popular
Management
Quicklinks > Rehab
Reference Center
Patient Education
Rehabilitation
Reference Center,
a Point-of-Care
Tool
Topic of Interest
(e.g. Achilles
tendinopathy,
arthritis,
cardioresp,
open/closed kinetic
chain exercises,
inflammation,
EPAs)
Value of
Physiotherapy
> Browse eLibrary
Resources > Special
Library Guides >
Patient Education
> Browse eLibrary
Resources > Popular
Quicklinks > Rehab
Reference Center
> Search PABC
Practice Resources
and
> Knowledge Broker >
Webinars by Topic
> Browse eLibrary
Resources > Special
Library Guides > Value
of Physiotherapy
A Goodbye from Deb
Together with Alison Hoens, we have created a
guide to using OMs, from how to find them to
how to apply them to clinical practice.
Rehab Reference Center via CPA has Clinical
Reviews that provide a good overview of
treatment for most conditions you see such as
ankle fracture, pelvic girdle pain in pregnancy,
etc. Do a search, then click on the “Clinical
Reviews” button.
We have selected resources including translated
patient education in many languages, Rehab
Reference Center’s Patient Education, plus
general health resources for patients.
Rehabilitation Reference Center is a point-ofcare tool with a suite of physiotherapy resources
to use in a busy clinic. PABC has created
tutorials on the 4 Essentials that we recommend,
plus the rest.
So many topics, so little time – explore the
richness PABC brings you: do a search of
hundreds of PABC’s practice resources. For
Alison’s webinars, you can browse by topic and
then spend an hour updating your knowledge on
a topic of interest to you.
This resource has current articles of interest,
plus how to find more in the research literature
and media – good resources to use for advocacy
with other care providers or in your social media
communications. Send us any good info you
find and we’ll add it.
informed practice, always looking for
the best information that will benefit
I am pleased to pass on our “new and
your patients. I have had personal
improved” library to Fiona Chiu, your
contact (via your email requests and
Member and Information Services
webinars) with more than 80% of
Manager and now also Clinical Librarian,
the members — the average health
after five years in what I’ve always said
librarian contact is 20-25% and
was the perfect job for me. I’d like to
the BC College of Physicians and
offer a few personal reflections, my top 5
Surgeons is 40%.
favourites about my time with PABC.
2. Working with
Alison Hoens, our
Knowledge Broker,
has truly created
synergies that
benefit members,
as well as given
me a strong ally
and friend. I love
that together we
demonstrated
evidence-informed
practice all the way
from asking a good
PABC Knowledge Team celebrate Deb’s 5 year stint as
clinical question to
librarian. L-R: Fiona, Deb, RBT, Stephanie, Alison
applying evidence to
practice.
1. You are the most engaged group of
3. There has been an explosion of
health professionals I’ve ever worked
resources for your practice. No
with, keenly interested in evidence
longer must you rely on Medline,
CINAHL and Cochrane (the
three essentials), but you have
at your fingertips so much more,
as the table above attests. Can
you believe there are hundreds
of PABC Practice Resources?
Together with members, and
especially with my LAB Partners
(Library Advisory Board), we have
evaluated resources and added the
best.
4. You have become tech savvy!
When I began, I received numerous
emails beginning, “I am one
of the over 40s who doesn’t
know how to...” Rarely do I see
that now as you send me your
reviews of mobile apps for the
member-created PABC Mobile
App Treasure Trove, and you do
your own searches. (Thankfully,
you’re happy to have your librarian
— the information expert — do lit
searches for you too, so you — the
clinical expert — can focus on
clinical practice.)
5. PABC is a dynamic and fun
organization to be a part of, always
innovating, always adding that
personal touch. Professionally,
I’ve had the opportunity to
share member-inspired library
innovations at the Canadian Health
Library Association, the Canadian
Library Association, and Canadian
Physiotherapy Association
conferences, and I’ve been on both
the Management and Steering
Committees of e-HLbc which
enables us to purchase databases
and journals at a steep discount.
PABC is Rebecca and the Board
and the staff and all of you too,
and I’m grateful to have been a
part of it under Rebecca’s inspiring
leadership.
Some of you have asked me what’s
next. That remains to be seen but rest
assured I will be moving more and
computering less — dog walking, yoga,
Nia dance, Pilates — and I’d especially
like to say thanks to the physios who
have treated me and given me personal
demonstrations of how all of this
evidence/research/reading makes its
way into practice and actually does help
me to Keep Moving for Life.
Keeping British Columbians Moving For Life
15
Directions
bcphysio.org
Convocation Speech to the MPT Class of 2014
by May Nolan, BScPT, MClSc,[Manip], Dip Manip, FCAMPT
Thank you for inviting me here on
your special day. This is your day, but
I think it is the highest level of peer
recognition to be asked to speak here
and I do appreciate that you chose me.
To get here today you have met a
standard and proven your ability.
You have put in a few tough years of
study and exams and have had a lot of
support from faculty, family and friends
to get through it all.
The difference between today and
yesterday is the professional mantle
you are now wearing. There is now an
expectation of conduct, competency
and specialised knowledge.
You are now part of the physiotherapy
community and with that comes a new
responsibility to comport yourself as
a representative of that community,
adhering to a standard of care with
good judgement and a strong moral
compass. But with that responsibility
will come support, camaraderie and
mentorship and a new community of
peers. Yesterday you were a student,
and today you can now be an expert
witness in a court of law. Your reports,
references and recommendations will
be given consideration and weight with
your new designation.
So what lies ahead? You are well
prepared to treat your clients/patients
but there are a few other aspects I
thought I would mention. You will
become part teacher, part advocate,
part counsellor in addition to hands-on
treatment. You will hear confidences
in the treatment room as people relax,
knowing they are safe, and their injuries
and concerns will be taken care of. Job
satisfaction is guaranteed.
I sometimes get asked the next steps,
courses, exams to take and I know this
now; there is no course that will provide
you with magical treatment techniques,
but it is important and part of your
professional obligation to be up to date
16
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
in your knowledge and skill set and this
will increase your career engagement
and job satisfaction.
Probably your best education will come
from life lessons you will learn along
the way, partnership, parenthood, grief,
loss, age milestones will all increase your
emotional intelligence and will furnish
you with valuable life skills. This will lead
to a holistic treatment approach with
realistic goal setting and expectations.
I am reminded of the patient who once
compared me to a hairdresser and
wanted low maintenance exercises to
match her low maintenance hairstyle! (I
was more thinking I would like to meet
her hairdresser, because clearly mine is
not on the same page!).
So what is this emotional intelligence? It
is the ability to see things from another’s
perspective, it is understanding non
verbal cues; it is not holding a grudge
against the rude and angry patient.
Pain changes behaviour; often these
are the nicest people and will be your
strongest ally once pain is resolved. It
is recognising that the new mom feels
a sense of accomplishment just having
made it to an appointment, fully clothed
and in matching socks and knowing
that the overweight patient is perfectly
aware of the extra 50lbs and needs a
gentle hand. It is also recognising when
you feel that everyone is a nuisance
and bothering you, to take a step back
and question your own attitude on that
day. Self knowledge and knowing your
limitations are key to a happy career too.
For a satisfying life and career, think of
professional reinvestment, be a mentor,
volunteer, be active and helpful to your
association, assist in research, join PABC,
attend your AGM, vote.
Collaborate with your peers and don’t
view them as the Competition; rather,
when we stay united as a profession we
will rise to greatness. Interprofessional
collaboration has led to some of the
great medical advances of our time such
as open heart surgery. Collaborate with
your patients in goal setting but don’t
forget they need your lead and are
reliant on your expertise. Use technology
wisely and sparingly when there is a live
patient in front of you. People need us
to actively listen and observe without
distraction. Adopt the PABC motto:
Keeping British Columbians Moving for
Life. We are all aware of the beneficial
effects of mobility on the cardiovascular
system, the musculoskeletal system,
mental health and overall well-being
but mobility is so much more than
the perfect biomechanical alignment.
Mobility is dignity, the dignity of self
care and the life preservation in an
emergency situation such as the recent
fire at a seniors home in Quebec.
I for one am looking forward to
witnessing the greatness that is to come
from your group. I have already seen
your inventiveness, your thoughtfulness,
your creativity. I have met some of you
at physiotherapy forums in BC and
Alberta and this is all even before you
graduated! I have seen some fabulous
apps that you have invented that
will enhance patient education and
satisfaction and I feel very lucky to have
had the privilege to teach your class
and be a part in some small way in your
education.
Lastly, sign your name today on
something, a napkin, anything; add
all your credentials and step back and
admire it, revel in it because when you
have signed your millionth chart that
novelty will wear off!
Congratulations everyone and welcome
to our physiotherapy fold.
May Nolan is Clinical Associate Professor
in UBC’s Department of Physical Therapy
at the Faculty of Medicine, and an
Associate Physiotherapist at Oakridge
Physiotherapy.
bcphysio.org
Directions
University Corner
Clinical Education
by Sue Murphy, BHScPT, MEd, Associate
Head
Over the last few years, the number of
traditional 1:1 placements (one preceptor
paired with one student) has decreased,
as students are placed in a variety
of different placement models. One
common variant on 1:1 is two students
paired with one preceptor; this 2:1
model can be very effective and have
advantages over 1:1 for both the students
and preceptor.
In a 2:1 model, there may be more
upfront work getting to know the
students, assessing their individual
levels of competence and developing
objectives. There are huge paybacks
as the placement progresses, however,
as the paired students take on more
of your caseload. Ideally, by the end of
even a Level One placement, a student
pair can effectively take over 50% or
more of your caseload. The key to a
successful 2:1 placement is not to fall into
the trap of structuring the experience
as two concurrent 1:1 placements but
to use the concepts of team and peer
learning. Paired students may or may not
know each other well but it is a program
expectation that they can work together
as a team in the clinical setting. When
setting objectives, there should be some
objectives which are shared between the
two students as well as some which are
individual; examples of shared objectives
could include becoming competent with
two-person assist transfers, collaborative
assessment and treatment planning,
and taking on a shared caseload.
Collaborative learning experiences could
include collaborative patient treatment
and problem solving, practise of
techniques on each other, shadowing and
critiquing each other. Students should be
encouraged to go to each other first to
problem solve (rather than simply ‘asking
the supervisor’), as this mimics what
happens in actual clinical practice.
As a clinical supervisor of a 2:1
placement, you may need to deal with
an imbalance of skills and knowledge
between the two students, and it is
important to be flexible in adapting
your approach to individual as well as
combined needs. Having the stronger
student “coach” the weaker student
can be effective but needs to be done
with care in order to respect and
acknowledge the individual strengths of
each student.
As always, we are more than happy to
chat about strategies and pointers for
2:1 placements, and can also provide inservices on topics such as this. Just let
us know what you need and we will be
happy to help!
Life Lessons from
the Physiotherapy
National Exam
by Marcia Denhoed, MPT, Student
Columnist
As the UBC MPT Class
of 2014 transitions to
the working world,
one last hurdle
stood in our way;
the Physiotherapy
National Exam, aka
the PNE, or known
to students as a
sweet slice of hell.
November 16 passed
in a blur of stations
and emotions but I
feel there are some
important lessons we
can take away from
the PNE experience:
Marcia Denhoed,
Valedictorian,
giving the class
address at the
graduation
reception
1. Don’t sweat the small stuff. First of
all, it ruins nice dress shirts. Also, with
seemingly catastrophic PNE experiences,
minutes or days later, you realize it really
wasn’t the end of your life. We’ve all
worked with patients whose life has been
derailed by serious injury or illness and
these people serve as reminders that
most of what we face is the small stuff.
2. Just breathe. Despite endless studying,
a PNE station can quickly decompose to
resemble a bad Monty Python sketch. You
are treating the wrong joint on the wrong
limb and can’t seem to figure out why
you are asked to re-read the question.
Many times in our careers we will be
faced with choices that don’t go well.
Don’t dwell on what didn’t work. Take a
deep breath (perhaps using a pursed lip
technique) and move on.
3. Have each other’s backs. The day
of the PNE was stressful for everyone
but we managed to maintain our cool
by exchanging encouraging words and
nervous humour. When the going gets
tough, this class has demonstrated great
support for each other and it is this
bonding that kept us (relatively) sane
over the past 26 months. In the spirit of
‘we are all in this together’ I am certain
we will continually support each other’s
success throughout our careers.
4. Think on your feet. Even with
meticulous planning, the best laid PNE
plans can go awry. For example, rushing
into a station and firing questions to your
patient without realizing they are on a
ventilator, or having to do your treatment
on a Raggedy Ann doll. Practical exams
can sometimes require unbridled
creativity, and the ability to think on
your feet is a priceless skill. Success as
a physio demands adaptive treatments
and flexible thinking since no patient fits
into any one box.
5. Give thanks. Not all PNE stations
are hard won and sometimes you get
a slam dunk. Pat yourself on the back
and transfer this confidence to the next
obstacle. Be proud of your successes but
remember they don’t happen in isolation.
Express gratitude to those who helped
you along the way and find ways to both
give back and pay it forward.
So some may feel that practical exams
like the PNE are contrived but I may
disagree. Isn’t life all about opening
doors without knowing what’s on the
other side? Striding with confidence,
or at least perceived confidence,
towards an uncertain future? Much of
personal growth is throwing yourself
into uncomfortable experiences with
uncertain outcomes and the PNE exam
sure fits the bill!
Keeping British Columbians Moving For Life
17
Directions
New Graduates
Update
by Trevor Potts, MPT, New Grad
Columnist
Trevor (R) with his Northern Rural Cohort
peers at the MPT graduation reception
bcphysio.org
I extend this challenge:
Take a look around your practice site
and find a way to help another peer
reach their goals. Make a call, look
something up, spend five minutes
simply listening. WHY? In doing so,
you’ll have confidence that you’ve got
a team willing to assist and guide you
through to your own goals. Regardless
of your tenure or the loftiness of your
goals, this will be a good thing. If
nothing else, stir the pot of great ideas
that are surely out there waiting to be
pursued.
Looking forward to happy days in one
heck of a profession!
Darryl Caves is celebrated by his MPT
students, in their “minions” shirts, for his
extraordinary mentoring as he moves from
GF Strong to VGH. L-R: Andrew Burkholder,
Jonathon Carkner, Darryl, Todd Van der
Star, Sophia Chadwick, and Tara Klassen.
This is my first entry as the new grad
columnist, aimed at keeping PABC
members connected with the class of
2014. And I have a challenge for you
later in the column that is about helping
strengthen our bond of physiotherapy.
Leaving the safety of Friedman
classrooms at UBC is another step, like
elementary to high school. Change is
inevitable and at times uncomfortable.
New patients, balancing a caseload,
starting a business, planning for
retirement, taking courses...WHOA! As so
many readers can relate, it’s the team of
classmates that helps us through school.
Looking back it would have been a lot
tougher without a great group. As we
begin our practice life, stepping into a
new group that is welcoming, supportive,
and helpful to assist with the challenges
faced with being a new or new-again
professional eases this discomfort.
(Thank you to my workplaces and thanks
PABC!)
Things outside that bee-hive can now
settle. Schedules, days/nights off, pay
cheques, and relationships all can have
regularity. The hope is that the ties to
fellow students will remain and that the
necessary connections with fellow pros
will help us all get to where we need to
be as individuals. The value of staying
connected with friends and fellow
physiotherapists may be difficult to
measure, but I think we can agree that it
is integral to our success.
18
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
RBT presents PABC awards at the grad reception to Jessica Cheng and Mandi Lamanes
PRISM: A new Rural Education Initiative
by Angela Pace BScPT, CWCE
PRISM – Prince Rupert Interprofessional Student-led Model (PRISM) clinic has a
new clinical instructor - me. I have taken leave from my position at Kitimat Hospital
to supervise students from UBC’s Northern and Rural Cohort. Located at the
Prince Rupert Regional Hospital, the clinic is going well, with its aim to provide
rural rehab services where they are needed. The clinic operates on an integrated
primary health care approach to increase access to services along the continuum
of care. Patients receive team-based rehabilitation services along the continuum:
in the hospital, in the community or in a patient’s home. One of our targets has
been the seniors’ center where the students have put on weekly chair and balance
exercises for the seniors. The turnout has been excellent with 28 in our first
session. The students receive hands-on training too as shown below.
Angela Pace is the Rehab
Manager at Kitimat General
Hospital & Health Center,
and she just completed her
Doctor of Physical Therapy
degree and will official
graduate in April.
Angela Pace (centre) directs the PRISM in-service
training session on taping with MPT students
Nicole Warren (L) and Selina Spessot (R).
bcphysio.org
Directions
Retired
Physiotherapists
Partner with PABC
The Making of the Muscle
Memory App: What I did
during Physio School
by Patricia Grohne, retired Physiotherapist
by Jared Hromika, MPT
Merriam Webster says:
his·to·ry noun
• the study of past events
• events of the past
• past events that relate to a particular
subject, place, organization, etc.
or...an account of a patient’s medical
background
What does history mean to you? Does
it sound dry and boring, as in ‘events of
the past’ or is it challenging to you as a
physiotherapist, as in ‘an account of a
medical background’?
A group of physiotherapists, mostly now
retired, are taking a look at the history
of our profession in British Columbia,
and are finding it anything but dry and
boring. More like hugely challenging in
trying to locate and archive the masses
of information out there tucked in
Association Archives and in personal
boxes and papers.
Some of our pioneer physiotherapists are
in their eighties and even nineties and
carry the memories of how the profession
grew and the scope of practice
developed. Our project is to capture
the oral histories and the documented
records of how we came to be where we
are now and to share them with you who
are actively building the profession as it
is today.
When I started my physiotherapy degree at UBC two years ago, I found myself in
anatomy class trying to learn a lot of information about a lot of muscles. My solution
was to make tables of the muscles and their details, which I then studied and recited
over and over. Eventually, I gave them to my wife with the request “Ask me anything,”
and I believe I benefited greatly from the repetitive quizzing.
Prior to pursuing physiotherapy, my career involved a bit of computer programming. I
was constantly trying to streamline my workflow with computer code, so I decided to
use those skills to design a study solution that would allow me to dramatically increase
the volume of anatomy questions I was processing. Two years and a couple of rewrites
later, the end result is an app I’ve dubbed “Muscle Memory.”
The app consists of three main components. First, a quiz section that is highly
customizable and randomly generated. I believe this encourages learning the content
and not just memorizing the questions. There’s also a reference section that can
be used for studying or a quick referral. Lastly, there’s the arcade, which provides a
progression through each region of the body in a bar-style trivia game.
I’m a huge proponent of sharing our knowledge and building our strength together
as a profession. One day I hope to contribute at events like the Physio Forum or PABC
Lecture Series, but until then I’m honoured to be able to provide a tool to encourage
learning some of the crucial details that define our foundation. I am hopeful that at
least some of my new colleagues in this wonderful profession will find it useful in
building and maintaining their knowledge base.
Muscle Memory is an Android application and can be found on the Google Play Store
here: https://play.google.com/store/apps/details?id=com.jhromika.musclememory.full
Jared graduated in November with his MPT from UBC. When not studying or creating
and launching an anatomy app, Jared was planning his wedding in September. We’ll be
watching his star continue to rise as we welcome Jared into his new profession.
RETIRED PHYSIOTHERAPISTS GROUP OF BC
Watch this space for updates from the
project!
Here’s where it has started:
Two of the History
Project members,
Therese Lord
and Margaret
Warcup, join
Stephanie Dutto
in the bowels of
the PABC storage
room searching
for archives.
On June 12, 2014, a group of retired and soon-to-be retired
physical therapists met at Hycroft Mansion in Vancouver for an
afternoon of fun and to rekindle ‘old’ friendships.
The event was a great success and, as such, will be repeated
in 2015.
Mark your calendars for June 11, 2015 from 2:00 pm until
6:00 pm for the second annual gathering of the RPG at the
University Women’s Club of Vancouver at Hycroft.
If you are retired, semi-retired or almost retired and would like
to be on the Retired Physiotherapists Group of BC mailing list,
please email us at [email protected] Registration details to this event will be emailed to those on
the mailing list in March 2015.
Keeping British Columbians Moving For Life
19
Directions
bcphysio.org
Subacromial Impingement Syndrome –
A Brief Overview
by Steve Young BHSc, PT, tDPT(c)
Shoulder pain is one of the more common conditions that physiotherapists treat in an orthopaedic setting, with many patients
describing impingement-like symptoms. Subacromial impingement syndrome (SAIS) is defined as mechanical compression of
structures in the subacromial space with movements above shoulder height. Neer (1) originally proposed the idea of impingement
syndrome and attributed its development to an unfortunate acromial shape: the infamous hooked acromion. We now know that
SAIS has a multitude of potential causes that include local factors (acromial shape and/or rotator cuff weakness) as well as regional
factors (scapula dyskinesis, regional hypomobility and/or multidirectional instability). To the benefit of the clinician SAIS has been
categorized into Primary SAIS and Secondary SAIS. Primary refers to glenohumeral impingement secondary to a mechanical
block, and secondary refers to impingement occurring due to instability as a result of excessive mobility or a loss of motor control.
Typically, SAIS is diagnosed based on a history, with patients describing pain with overhead movements, shoulder stiffness and pain
at night. As with most conditions, clinical tests simply serve to confirm the diagnosis based on the history.
For many years, the Neers and Hawkins-Kennedy tests were considered the best tests for SAIS. Both tests demonstrate good
sensitivity, suggesting that a negative test helps rule out a SAIS (2). Unfortunately, a positive Neers or Hawkins-Kennedy test in
isolation does little to improve our confidence in a diagnosis of SAIS. In recent years, clinical tests for SAIS have been clustered to
improve their diagnostic accuracy.
Park et al. (3) retrospectively looked at patients presenting for surgery and compared their outcomes with presurgical screening
test. They used the painful arc, infraspinatus muscle strength test and Hawkins-Kennedy tests to identify SAIS. If two of the three
screening tests for SAIS were positive, this was associated with impingement findings upon surgical visualization. Park et al. also
found that by replacing the Hawkins-Kennedy test with the drop arm test, the three tests became diagnostic for a full thickness tear
of the rotator cuff. Michener et al. (4) performed a similar study prospectively and found that a cluster of five tests was beneficial in
diagnosing shoulder impingement syndrome. They included the Hawkins-Kennedy sign, painful arc and resisted external rotation
tests as cited by Park et al. They also included the empty can test and Neer’s sign for impingement, with three or more tests
improving the likelihood of diagnosing SAIS. With patients presenting with secondary impingement, the above noted tests may be
positive but there will be other findings such as glenuhumeral ligament laxity or an altered scapulohumeral rhythm observed with
movements.
Park et al. SAIS tests
x Painful arc
x Infraspinatus muscle
strength test
x Hawkins-Kennedy sign
Park et al. full thickness tear tests
x Positive drop arm test
x Infraspinatus muscle
strength test
x Painful arc sign
Michener et al. SAIS tests
x Painful arc
x Infraspinatus muscle
strength test
x Hawkins-Kennedy sign
x Neer’s test
x Empty can
Once a diagnosis of SAIS has been established, here is the great news: our multimodal physiotherapy treatment has equal outcomes
to cortisone injection and subacromial decompression in two recently published papers. Rhon et al. (5) compared the efficacy
of cortisone injections to physical therapy for SAIS. One hundred and four patients were randomized to either receive cortisone
injection or physical therapy. The physical therapy treatment consisted of cervicothoracic and shoulder girdle manual therapy and
exercise as determined by the treating physiotherapist based on each patient’s impairment findings. Both groups demonstrated a
50% improvement in functional outcomes at a one year follow-up. Although there were no differences in outcomes between the two
groups at any point during the trial, those receiving physical therapy had fewer future visits to physicians and fewer repeat cortisone
injections. No significant adverse effects were seen in either group, although a previous study with SAIS patients did identify a risk
of progression of rotator cuff tears from partial thickness to full thickness in patients receiving cortisone injection (6). In a recent
systematic review of the literature (7), four studies compared conservative management with surgical intervention for SAIS. None
of the studies reviewed were of strong methodological quality but they all identified no advantage of surgical intervention over
conservative management, with surgery carrying significant potential risk for the patient. It is noteworthy that one trial compared
supervised exercise with surgical subacromial decompression for SAIS and found no differences in outcomes between the two
treatments (8). Recent research has demonstrated a clear advantage of combining exercise with manual therapy over exercise alone
for the treatment of SAIS (9); it would be interesting to see a trial comparing combined manual therapy and exercise with surgical
intervention for SAIS.
Based on the research, physiotherapy should be an obvious first line intervention for SAIS.
The works cited are available in the online edition of Directions:
www.bcphysio.org/sites/default/files/file_attachments/page/Directions-2015-Winter-Steve-Young-Citations_0.pdf
20
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
bcphysio.org
The Physical
Activity Line (PAL)
The Physical Activity Line (PAL) is British
Columbia’s primary free telephone and online resource for evidence-based physical
activity information and professional
guidance to becoming more physically
active across the lifespan. The mission is
to improve health through physical activity
that is tailored to needs and lifestyles.
The PAL is staffed by qualified exercise
professionals who are university-educated
(i.e., hold undergraduate or graduate
degrees in exercise science) and have
nationally recognized certification in the
field and advanced training in clinical
exercise prescription. Their training
enables them to prescribe exercise to
individuals of all sexes, ages, and abilities,
and do so effectively via the telephone.
The services are open to physiotherapists
seeking exercise advice for their patients.
Directions
“There’s not enough evidence to support
it”: A common McKenzie Myth
by Colin Davies PT and Audrey Long PT
The above myth persists despite
the exponential growth in evidence
supporting the McKenzie Method
(Mechanical Diagnosis and Therapy or
MDT). It is difficult to stay abreast of the
literature, especially when it’s outside
ones current area of interest. For
example, PT’s who practice acupuncture
will likely be able to list a few key articles
addressing this topic but may be less
inclined to review articles in other
methods. While MDT is taught in over
30 countries, few PT’s in BC are MDT
certified. Therefore, the purpose of this
article is to put context to the evidence
for those who have no formal MDT
training.
They offer individualized evidence-based
physical activity guidance, tools for
effective self-management and healthy
living, general health screening (i.e., 2014
PAR-Q+ and ePARmed-X+), and referrals
to appropriate physical activity programs
The PAL will work with physiotherapists to
compliment your practice by acting as:
1. an additional resource for evidencebased physical activity guidance
2. a secondary care option for your
patients by providing motivation,
information and support for your
prescribed exercise program.
3. a wayfinder of suitable activities to
improve patients’ physical activity
level
Callers can self refer to the PAL, and
physiotherapists can refer their patients
to the PAL for one-to-one physical activity
counselling. Callers referred by their
healthcare professional may consent
to information sharing between the
healthcare professional and the PAL (i.e.,
relevant medical information and physical
activity guidance).
If you would like further information
regarding the Physical Activity Line or
promotional items for your practice
please contact us at Lower Mainland:
604-241-2266; Toll-Free: 1-877-725-1149
[email protected]
www.physicalactivityline.com
In the spring issue of PABC’s Directions,
Davies and Rosedale introduced
Dr. Spratt’s Assessment-DiagnosisTreatment-Outcome model for research
design (ADTO). Unlike systematic reviews
that consider only the randomized
controlled trial (RCT), the ADTO model
sheds a spotlight on the flaws of many
RCT’s, and it recognizes the vital role of
other designs necessary for reliability,
validity, classification, and prognosis. The
ADTO model helps us understand why
there are over 1,800 RCT’s for low back
pain, and yet there is no strong support
for any one treatment over another,
though active therapies that empower the
patient seem to be leading the race.
According to Spratt the validity of any
one link in the ADTO model requires that
all previous links have been established
(Figure 1). Key to the MDT approach
is patient empowerment via Directional
Preference (DP) and/or Centralization
Phenomenon (CP).1 These clinical tools
are integral to the assessment/treatment
process and have been well studied.
They are achieved via individualized
postures, positions, and end-range
exercises, at times facilitated with manual
techniques.
In the A-D link of the ADTO model, there
are 17 DP/CP reliability studies. In the
D-T link there are 55 studies ranging
from observational to case series,
classification, validation, and prognostic
studies. There are 17 RCT’s in the T-O
link. These numbers are conservative
and include only those studies meeting
Spratt’s criteria. If we considered general
peer reviewed criteria there are an
additional 20 publications in the D-T link
and a further 22 RCT’s in the T-O link.
These less rigorous 42 studies round
out a vast body of knowledge regarding
DP and CP but were conducted on
subjects with “low back pain” without
classification. Remember, RCT’s should
not study symptoms such as “chest
pain” or “knee pain”. Reviewers would
not accept a study if ”knee pain” was
the inclusion criteria (e.g., osteoarthritic
knees should not be in the same study
as ACL tears), yet we continue to see
publication of RCT’s for “low back
pain”. There needs to be improved
rigor in the assessment methods so that
meaningful sub-grouping is completed
before randomization occurs. It is the
reliable classification process of the MDT
method prior to assigning treatment,
and reassessment before continuing or
progressing treatment, that has been
fundamental to its growing appeal to
researchers, clinicians, and patients.
References:
1. Donelson R. Mechanical diagnosis
and Therapy for Radiculopathy. Phy
Med Rehabil Clin N Am 2011;22:”7589 doi:10.1016/j.pmr2010.11.001
2. For all articles noted above, request
reference list: email Colin Davies at
[email protected]
Colin Davies has four McKenzie Institute
accredited clinics in the Vancouver
area, and is a senior instructor with the
McKenzie Institute International.
Keeping British Columbians Moving For Life
21
Directions
bcphysio.org
Board of Directors
2014-2015
Jason Coolen: President
Aart van Gorkum: Vice President,
Greater Vancouver/Sunshine Coast
Director, Private Practice Liaison
Chiara Singh: Greater Vancouver/
Sunshine Coast Director, Public
Practice Liaison
Craig Sully: Kootenay Director, Rural
& Remote Practice Liaison
Jen Bay: Fraser Valley Director,
Finance Chair
Kevin Bos: Okanagan Director
Patrick Jadan: Vancouver Island
Director
Jenny Hogan: Northern Director
Rebecca Lee: MPT2 Student Director
Diane Rizzardo: MPT1 Student
Director
Bill Mackie, MD: External Director
Rebecca B. Tunnacliffe: PABC CEO
Privately Hosted Courses
Details at www.bcphysio.org - Courses
January
 Fascial Manipulation®: Discovering connective tissue's role in pain, movement
and proprioception(1 Day workshop), Vancouver
 The Series with Dr. Linda-Joy (LJ) Lee - The Thoracic Ring Approach & the
Integrated Systems Model for Disability & Pain: Finding the Driver &
Connecting the Whole Person, Vancouver
 Functional Strength and Conditioning, Victoria
 CBIA Post Basic ONE Day Seminar with Mary Lynch Ellerington, Vancouver
 McKenzie Method of MDT - PART B - Cervical & Thoracic Spine, Port Coquitlam
February
 Management of Lumbopelvic Disorders with Dr. John Childs, PT, Vancouver
 Concussion Management Workshop, Shannon McGuire Concussion
Management, Vancouver
March
 The 2015 SERIES with Diane Lee - A Certified Clinical Mentorship Program in
The Integrated Systems Model, South Surrey
 Dr. Stuart McGill 2 – The Detailed Back Assessment: Reducing pain and
enhancing performance, Vancouver
May
 Body Control Pilates Mat and Reformer Teacher Certification, North Vancouver
 Exercise Prescription, Physical Activity and Aging Conference: Research in
Practice, Toronto, ON
September
 Master of Health Management, Part-time, mainly on-line degree program
Board of Directors Positions
Each year a few of the eight elected Director positions come to their term-end. In April, three regional positions are up for
election: Vancouver: Aart van Gorkum is finishing his second term; North: Jenny Hogan is finishing her first term;
Okanagan: Kevin Bos is finishing his first term. While all three incumbent Directors may be interested in renewing for another
2-year term, members from all three regions are welcome to run for election. Email [email protected] for an application form.
Body Control Pilates
Mat and Reformer Pilates Teacher Certification
A seven day course created for health professionals who already teach Pilates,
leading to matwork and Reformer certification (separate assessments). Body
Control Pilates is recognized as a world leader in Pilates education. This course will
build upon your existing Pilates work by giving you further knowledge and skills that
will enable you to deal effectively with early stage rehabilitation progressing to more
dynamic and specific training. It will give health professionals a link between
evolving research in stability training and traditional Pilates mat and machine work.
After successful completion of this course students may wish to explore further
Body Control Pilates courses covering special populations, classical matwork and
more.
Dates: May 1-3 and May 7-10, 2015
Cost:
$3500.00 plus GST
$3100.00 plus GST special early Bird Pricing if paid before March 15th.
Venue: Pro Arte Centre, North Vancouver
Places are limited, so early booking is advised.
For more information contact Susie Higgins at
phone: 604 970 1057 email: [email protected]
visit: perfectpilates.wordpress.com
22
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
Full Time Physiotherapist needed!
Aquatic Centre Physiotherapy is looking
for a Physiotherapist to join our
growing and dynamic team. We are an
established multidisciplinary clinic that
has two convenient locations in a state
of the art Community Centre and a busy
Medical Clinic, both in beautiful West
Vancouver.
We are looking for a full time registered
Physiotherapist for both locations. The
ideal candidate has good interpersonal
skills, background and experience in
manual therapy. Please send cover
letter and resume to
[email protected]
www.acphysio.com
www.oceanwalkphysio.com
bcphysio.org
Directions
Directions in Physiotherapy
Directions is published three times a year: Winter, Spring and
Autumn.
ICBC & Personal Injury Claims
Free initial consultation, no fees until you collect
Articles on members’ clinical practice are welcome. The editor
retains the right to determine content. Unless specifically
indicated, statements do not reflect the views or policies of PABC.
Services or goods advertised are not endorsed by PABC.
Published by:
PABC, 402-1755 West Broadway, Vancouver, BC V6J 4S5
P: (604) 736-5130, E: [email protected]
Website: www.bcphysio.org
Production: Heather MacNeil
For Advertising rates, please contact Stephanie at:
[email protected]
Stephen Lloyd
[email protected]
Ivar Lee
[email protected]
Steve Heringa
[email protected]
Phone:
604.683.1211
Website:
pelawyers.com
1100 - 510 Burrard St., Vancouver, BC V6C 3A8
165
145
No Long-Term Contract
No Up-Front Costs
Billing + Scheduling
Documentation/EMR
Before
After
Business Growth Tools
HCAI/WSIB/Telepan
PQRS-FLR Ready Ready
I’ve been using Practice Perfect EMR
for 6 months
and look at me now!
EMR + Management Software
Get your practice in shape.
Book your demo today:
877.510.7473
www.practiceperfectemr.com
Keeping British Columbians Moving For Life
23
Directions
Knowledge Team Webinars:
Knowledge Team 2014/15 Series
To register for these free webinars, go
to www.bcphysio.org/courses. Note
that all of our webinars are recorded
and made available for free on the
member site for those who have not
registered for the live event.
Tuesday, February 17, 7:30-8:30 pm PST
Better Bones: The Pharmacological
(Bisphosphonates (Bisphosphonates
and VitD) and Nonpharmacological
(Exercise) Management to Enhance
Bone Health
In this second webinar (note: Part 1
is the “Putting Out Fires” webinar,
available as a free webinar recording
in the member site Library), we will
cover the pharmacological (emphasis on
bisphosphonates and Vit D) and nonpharmacological (exercise) management
of bone health.
Alison Hoens is joined by Dr. Shakeel
Bhatti, a well-respected pharmacist,
to provide the most important
information that physiotherapists
require when working with patients with
poor bone health (e.g. osteoporosis)
who are taking, or thinking of taking,
medications to manage it. Dr. Bhatti
is a clinical pharmacist, a Board
Director with the Canadian Pharmacy
Association, and past president of the
BC Pharmacy Association.
Tuesday, March 31, 7:30-8:30 pm PST
Dings in the Brain: What Brain Imaging
can tell PTs about Concussion
In the third webinar of the series, Alison
is joined by physiotherapist Dr. Naz
Virji-Babul and Dr. Michael Borich.
Although research has dramatically
increased during the past decade,
significant knowledge gaps remain
in the diagnosis and management of
individuals with concussion. Advances
in novel neuroimaging approaches have
created new opportunities to further our
understanding of the brain following
concussion. Our presenters will provide
a brief summary of the current state
of the field in relation to changes in
the brain following concussion, and
describe how physical therapists
can use findings from neuroimaging
research studies to inform current
clinical practice.
24
PHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA
bcphysio.org
PABC Professional Development 2015
Evening Lecture/Vodcast Series
Spring 2015
What I Wish I had Learned in Physio School!
February 13*: with John Childs PT, PhD, MBA – *Note this is a Friday night with an
earlier start time: Registration/Refreshments 6:30 pm; Lecture 7:00 – 8:30 pm
In physio school, we learn clinical reasoning, therapeutic skills, and the clinical
decision-making process. While these skills are important, even foundational, they
are not the most important! Join in on a lively and thought-provoking discussion.
Dr. John Childs is a board-certified Orthopaedic Clinical Specialist and a Fellow
in the American Academy of Orthopaedic and Manual Physical Therapists. With
a PhD in Rehabilitation Science, Dr. Childs’ research focuses on injury prevention,
the identification of subgroups of patients with musculoskeletal disorders, and the
development of clinical prediction rules to better inform diagnostic and treatment
decision-making. He currently serves as an Associate Editor for the journals Physical
Therapy, and Orthopaedic and Sports Physical Therapy.
What Would the Expert Do with this Patient?
March 31: with Clyde Smith, BScPT Diploma Sport Physiotherapist
Registration/refreshments/networking: 7:00 pm; Lecture 7:30 – 9:00 pm
You asked for a case-based discussion on what experienced and highly recognized
members would share and how they would manage specific clinical scenarios. Join
us to ask “what would Clyde do?”
Location/time: Paetzold Lecture Theatre, Vancouver General Hospital, 899 West
12th Avenue, Vancouver
Vodcasts: distributed to registrants one week following the live lecture
Fees: PABC members “in person”: $30 (students $10), “in person” with the vodcast
$35 (you must be in attendance to get the vodcast); Vodcast $40; Vodcast “group
rate” per site: PABC members $60; future members $120
Weekend Courses
Neuro for Ortho Physiotherapists: Applying Neurophysiological Research to
Orthopaedic Sports Injury Clientele
May 22-24, 2015 with Deb Treloar and Cathy Eustace – Vancouver
Rediscovering Anatomy: Gross Anatomy Refresher for Physiotherapists
May 9-10, 2015 presented by Discover the Body – Life Sciences Centre, UBC
Manual Therapy Treatment for Lumbar Spine and Pelvis Dysfunction
May 9-10, 2015 with Bob Powls – UBC Friedman Building
Cervical Spine Treatment Pearls – a Case-based Approach
October 24-25, 2015 with Carol Kennedy – UBC Friedman Building
Coming in 2016: Mobilization of the Myofascial System (January 29 – 31 and
June 3 – 5 with Doreen Killens)
Hypopressives – Level 1 Certification (March 5-6 with Trista Zinn and Tamara Rial)
To register for courses or lecture/vodcast series, follow these three easy steps:
1. Go to www.bcphysio.org and click Courses
2. In Presenter box, choose PABC
3. Under the Event column, click the course title you want
For more information, call PABC at 604-736-5130, ext. 2 or email Andrea Reid at
[email protected]
Thank you to our sponsors.

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