Physiotherapy - The Journal of Indian Association of Physiotherapists

EDITORIAL
Year
: 2018  |  Volume : 12  |  Issue : 2  |  Page : 49--52

Expanding the horizon of physiotherapy profession


Sanjiv Kumar 
 Department of Neuro Physiotherapy, KLE Institute of Physiotherapy, Belgaum, Karnataka, India

Correspondence Address:
Sanjiv Kumar
Department of Neuro Physiotherapy, KLE Institute of Physiotherapy, Belgaum, Karnataka
India




How to cite this article:
Kumar S. Expanding the horizon of physiotherapy profession.Physiother - J Indian Assoc Physiother 2018;12:49-52


How to cite this URL:
Kumar S. Expanding the horizon of physiotherapy profession. Physiother - J Indian Assoc Physiother [serial online] 2018 [cited 2019 Apr 20 ];12:49-52
Available from: http://www.pjiap.org/text.asp?2018/12/2/49/247610


Full Text

As everyone claims of limited knowledge of physiotherapy in the current era, it has evolved from the times of the great Hippocrates who used various physical methods for physical impairments.[1] What started at a snail's pace has now evolved faster than the speed of light into various sectors of health. The profession emerged as a service to help the patients suffering from orthopedic-related problems. As and when the years passed, it was realized that the fraternity of physiotherapy comprised of a large body of knowledge and a wide array of symptoms that could be treated, hence changes in the profession took place in leaps and bounds and thus became an important component to cater the various needs of people such as neurological, cardiorespiratory, gynecological, geriatric, oncology, community, and pediatric conditions. This particular profession has a great role in prevention, intervention, and rehabilitation. However, extensive areas still remain unexplored or underexplored in this profession. At present, most part of physiotherapy management is intervention based; however, there is a lacuna in terms of diagnosis, prevention, and rehabilitation aspects which we need to ponder on.

Some areas which we need to contemplate on are the role of physiotherapy in oncology, ENT, dermatology, ophthalmology, lifestyle disease, headache, physical fitness, and mental health. We should not forget, in the past, the scope of practice was too narrow compared to today. Earlier, after completing physiotherapy education, the uncertainty of employment, underemployment were a matter of concern but not anymore as numerous opportunities in various physiotherapy specialties have opened up. We have picked up few aspects, which are poorly focused, although having high potential in terms of treatment and rehabilitation. The institutions having good clinical material should evolve, channelizing physiotherapy data right from the first visit of the patient for clinical services to the final outcome. To achieve this, they must create proper machinery, evolve treatment protocol and expected outcome and record the data which can subsequently be analyzed. This will give a strong platform for various types of research studies and will imbibe research culture among professionals. The common culture of pushing the research squarely on postgraduate and PhD students is totally unjust. The clinician and academician must take the lead for conducting long-term research projects. Institution conducting research must develop a network to share the information and conduct multicenter trials. There is a need for expanding our research involving physiotherapy as a diagnostic tool, instruments that are used and also verifying their effect on physiological, biochemical, physical, and mental aspects. At any physiotherapy clinical setup, there should be a facility for counseling and prevention, physical and clinical diagnostics.

As physiotherapy professionals, we are destined to alleviate pain and suffering of individuals seeking our help, within the limits of the profession. As quote by David Wolfe, “Not all scars show, not all wounds heal, not all illness can be seen, not all pain is obvious.” Cancer is one of the leading causes of death across the world and India is no exception. Needless to state, it is one of the most painful conditions which disturbs the sufferer mentally, physically, and emotionally. Cancer has laid its deep-seated roots among the Indian population with a huge number of people being diagnosed with cancer regularly.[2] Globally, prevention is the only priority, so is in India, and this can be achieved if a healthy lifestyle is advocated. Physiotherapy may not be the first thing that comes to mind when a patient is diagnosed with cancer. Rightly so, they would visit and oncologist/oncosurgeon, following which the first line of treatment would be adopted but the physical impairments' seen as a result of cancer, can be devastating. Besides, the medical and surgical management which is lifesaving, it also gives rise to debilitating complications, thus lowering the quality of life (QoL) of the cancer survivor and also leading to physical, mental, and emotional issues. Here comes the role of a physiotherapist who may help to alleviate pain, maintain the range of motion (ROM), muscle strength, cardiovascular endurance, maintain mental health by preventing depression, preventing body image disorders, reduce vascular complication, prevent ulcers, thus maintaining the QoL which is proved with substantial evidence.[3] The prevalence of breast, cervix, ovary cancer in females; oral, lung, and neck cancer in men; and prostrate cancer in elderly males along with its impairments is very high due to lack of awareness and late detection.[4] The most common impairment which goes undiagnosed and treated is fatigue. Patients with cancer-related fatigue are commonly heard saying the term “sick tired, dead tired, having a deathly hangover.”[5] Physiotherapy plays an important role in controlling and alleviating the problems related to fatigue in these patients. Active exercises, PNF techniques, and myofacial release given three times a week for 2 weeks help to reduce fatigue levels among cancer survivors including those who receive palliative care.[6] Structured aerobic, resistance and stretching exercises given for 45 min per session, thrice a week for an average of 17 weeks also help to reduce cancer-related fatigue.[7] Treatment-related fatigue postradiation can be overcome by an exercise intervention which includes moderate intensity, continuous walking for 30 min, 3 days of each week of radiotherapy at a target heart rate of 60%–70%.[8] Physiotherapy helps in treating lymphedema in cancer survivors. Education on lymphedema helped to alleviate its symptoms and reduce the risk of developing it. Education includes details of the lymphatic system, signs and symptoms, and suggestions such as massaging the scar tissue, maintain body weight, avoiding infection, trauma including venipuncture and exercises. Physiotherapy treatment includes breathing exercises, mobilization of the scar tissue, active exercises involving the upper extremity hand, and postsurgical position like keeping the upper extremity above the level of the heart given for 30 min thrice weekly reduces the risk of developing lymphedema.[9] Pneumatic compression devices[10] with short stretch bandaging[11] are some of the advances which have shown significant improvement in the reduction of lymphedema. Low-level laser therapy has also shown some beneficial effects in the treatment of lymphedema. It helps to promote lymph vessel regeneration and lymphatic motility, reduces inflammation, and prevents tissue fibrosis.[12] Hydrotherapy also plays a significant role in the treatment of lymphedema. The principle of hydrotherapy like buoyancy assists shoulder ROM; hydrostatic pressure stimulates lymphatic flow and viscosity strengthens the muscles.[13] Restriction of ROM of the shoulder is seen in postoperative breast cancer and oral and neck cancer. Stretching, resistance exercises, and ROM exercises for shoulder and arm increase the ROM of the shoulder.[14] Joint mobilization such as Mulligan's or Maitland mobilization and other soft-tissue mobilization also improves the ROM.[15] Mobilization of the temporomandibular joint with stretching and strengthening exercises helps to increase the mouth opening and trismus in oral cancers.[16] Aerobic and resistance exercise or a combination of these can contribute to improving muscle strength in cancer patients during cancer treatment.[17] Neuromuscular electrical stimulation helps to improve physical function, aerobic fitness, muscle strength, body composition, and health-related QoL.[18] Pelvic floor muscle training helps to reduce urinary incontinence postradical prostatectomy when given for combined 45 min a week.[19] Transcutaneous electrical nerve stimulation (TENS) for a minimum of four to six times a day for 30 min to 1 h helps to reduce cancer-related pain.[20] Four weeks of pulmonary rehabilitation before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity, thus preventing atelectasis.[21] Noteworthy complication of cancer therapy is peripheral neuropathy. A protocol of 3 weeks, 5 days a week of exercises targeting the lower limbs, helps to improve the balance in peripheral neuropathy. Virtual reality also plays an important role in improving the motor symptoms of the upper and lower limb including balance.[22] As commonly stated that “nothing helps in metastasis,” walking, arm exercises in a chair, marching, and dancing; seated repetitive motion exercises based on a fitness video; group-based circuit training for upper and lower-extremity strength, standing balance, and aerobic endurance; ranging from twice per week to several sessions per day for durations ranging from 2 weeks to 12 weeks increases the endurance and QoL in metastatic cancers.[23] Similar exercises also help improve the exercise capacity and QoL in patients with non-small cell lung cancer.[24] Patients can achieve a minimal level of dependency and maintain their QoL irrespective of their life expectancy after rehabilitation,[3] hence, increasing the awareness among the general population: Young to senile, regarding physiotherapy techniques and its effects on cancer is a must. The most important fact to note here is the role played by a physiotherapist. Therefore, it must be well acknowledged by other clinicians and suitable patients may be directed to a physiotherapist seeking his/her help for the effective management of cancer-related issues.

Other painful condition which causes agony and disability among any individual irrespective of age and gender is a headache (tension-type headache and cervicogenic headache) and physiotherapy has to play a great role in managing it. A headache is a very common condition each of us faces at some point in our lives. The first thing that we do is to pop a pill without knowing the long-term effects. Physiotherapy can play pivotal role in controlling tension-type headache, cervicogenic headache; however, referral remains the main concern. Awareness must be created among the sufferer and referrers about the effects of physiotherapy and its dependable results. Evidence on Oscillation techniques which includes the use of low-velocity, passive cervical joint mobilization, resistance exercises using therabands of different resistance reduces symptoms of tension-type headache.[25] Trigger point treatment combined physical and psychological interventions and aerobic exercises are effective in the treatment of migraine.[26] Aerobic exercise consisting of bike/cross-trainer/brisk walking for 45 min, 3 times/weeks also found effective in alleviating symptoms of migraine and improving the QoL.[27] Supraorbital electrical stimulation when given for 20 min daily helps to reduce pain in chronic type tension headache.[28] Progressive muscular relaxation exercises and TENS is found to be effective in treating tension-type headache.[29] Body awareness therapy is an alternative treatment method that can be securely used to decrease pain in patients with chronic headache and to increase body image.[30] Hence, instead of treating the symptom, treating the cause helps in the complete alleviation of the symptoms.

To conclude, we must state that, commendable work is done in the intervention aspect. With emerging technology and knowledge, emphasis must be laid on the preventive and diagnostic aspects. There is a need for developing suitable instruments as per our requirements in this ever-evolving era, and hence one must recognize research and development as a major thrust area for the sustainability of the standards of the profession. Many areas which are yet to be explored need to be given priority, and one way to do this is to think out of box and venture into newer untamed areas. Future of the profession depends on the growth and development hence cumulative efforts by all will help to make a difference.

References

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