World Physiotherapy: Briefing paper 9: Long COVID, physical activity and exercise

[Mij]

It is not as if people recovering from viral illness have been going for rehab in the past. This is a new initiative driven by the politics of looking as if something is being done. Why, why, why can't they just say sorry, not something we can help with?

I have seen over a dozen doctors and specialists in my 30 years with ME, not one has ever advised or suggested I see a physio therapist. I was told to rest.

 

[adambeyoncelowe]

Yes, at least the wording of the discouragement to exercise is pretty sensible and it is heartening that the NICE draft is being taken note of.

Thank you. I won't comment on the rest, as NICE business hasn't quite wrapped, but I hope we see more people take note of what's in the new guideline.

 

[Trish]

But this is in the context of LongCovid. It would be interesting to know what would happen if all the LongCovid clinics went over just to referring for CBT. I suspect there would be quite a stink. And I am not sure what sort of behaviour the therapy would recommend?

I'm sure Trudie Chalder could advise you. She's busy advising everyone else what to do for long covid.

 

[Jonathan Edwards]

It could of course be to stand on a piece of paper and ....

 

[Sly Saint]

But this is in the context of LongCovid. It would be interesting to know what would happen if all the LongCovid clinics went over just to referring for CBT. I suspect there would be quite a stink. And I am not sure what sort of behaviour the therapy would recommend?

it appears that they don't know either

Highly Specialist Clinical Psychologist in Long COVID/Post
COVID

The Role
This is an exciting opportunity for an experienced Clinical/Counselling/Health/Neuro Psychologist ideally with some experience of working with people with Long COVID/Post-COVID 19 syndrome, or other related long term physical health condition (chronic fatigue, persistent pain, COPD, neurocognitive conditions) to join a dynamic, therapy-led team of physiotherapists, occupational therapists, CBT Therapist, Psychological Wellbeing Practitioners, Medics, Dieticians and Speech & Language Therapists with access to support from clinical psychologists in the wider department.

https://www.jobs.nhs.uk/xi/vacancy/916562032

 

[MEMarge]

Good thing that the main BPS cabal are unlikely to apply. From the Person Specification.

"Ability to manage effectively verbal aggression and abuse from patients, carers etc.."

Willingness to negotiate and ability to handle confrontation effectively and professionally."

file:///C:/Users/debbi/Downloads/3196422_293_IMRS1_1208PS.pdf

Salary:
£52,643 - £58,558 p.a. incl pro rata

 

[Barry]

I'm sorry but I don't understand the value of this. Why not simply say that there is no reason for a physiotherapist to get involved in LongCovid since we have no evidence to base treatment on?

I think the point is that physios are going to get involved anyway, whatever anyone might otherwise think. This paper makes it clear such involvement must not just be the usual same-old same-old, but that physios need to do a brain reset and digest what the paper is saying. Personally I think it could be highly beneficial.

 

[Barry]

Thank you. I won't comment on the rest, as NICE business hasn't quite wrapped, but I hope we see more people take note of what's in the new guideline.

They'd better!

 

[Barry]

it appears that they don't know either

Highly Specialist Clinical Psychologist in Long COVID/Post
COVID

The Role
This is an exciting opportunity for an experienced Clinical/Counselling/Health/Neuro Psychologist ideally with some experience of working with people with Long COVID/Post-COVID 19 syndrome, or other related long term physical health condition (chronic fatigue, persistent pain, COPD, neurocognitive conditions) to join a dynamic, therapy-led team of physiotherapists, occupational therapists, CBT Therapist, Psychological Wellbeing Practitioners, Medics, Dieticians and Speech & Language Therapists with access to support from clinical psychologists in the wider department.

https://www.jobs.nhs.uk/xi/vacancy/916562032

Sounds like a suitably trained plumber, bricklayer, carpenter, etc might find it worthwhile applying - pretty much everyone else is in there.

 

[rvallee]

I think the point is that physios are going to get involved anyway, whatever anyone might otherwise think. This paper makes it clear such involvement must not just be the usual same-old same-old, but that physios need to do a brain reset and digest what the paper is saying. Personally I think it could be highly beneficial.

Ultimately it's a bit of a "can't beat them so join them" thing. The change is not going to be sudden and 100% good, it's going to be piece-meal, like this, actually better than nothing, even if it's not perfect.

Personally I don't think there's any need for that but it's not true of everyone. Ideally over time people would be referred to this less and less but let's not kid ourselves, there will be physicians sending "fatigued" people to physical therapy for the next several decades, it will take at least a generational replacement to remove all the existing zealotry over this. Training people wrong has consequences, who knew?

Better is not perfect but it's definitely better than worse and worse than nothing is all we've had to deal with so far so one bit of progress at a time. At least if records are actually kept, as otherwise it remains too easy to attribute that 90% natural recovery to whatever.

 

[Jonathan Edwards]

I think the point is that physios are going to get involved anyway, whatever anyone might otherwise think.

I am sorry but I actually think physios need to take their ethical responsibilities seriously like anyone else and admit that they have no role here.

In a way I think it is condescending to suggest that it is OK for physios to 'get involved but gently' because after all they are only physios and what do they know. As I have said before, 'First do no harm' applies to all of us. We bang on about bad science and how terrible these professors are. Why is it OK for physios to claim to have a role when there is no evidence?

It seems to me a bit like saying OK we know about climate change but we have to let the airlines fly twice as much as before as long as they don't use plastic cups.

 

[JemPD]

Those who are lucky enough to have good health and don't have a close ties with anyone with chronic health conditions tend to believe that medicine can fix almost everything and do so quite quickly, in my experience at any rate.

Mine too, overwhelmingly so.

Employers expect sick employees to Do Something to improve the situation, and so the employee is pressured to go back to the GP, who in turn tries to help.

Absolutely. The first thing all employers say is 'what does the doctor say?' and 'not much/waiting for tests' is simply not seen as good enough.

Employers like this probably played a big part in the prescription of antibiotics for viral upper respiratory infections for decades.

For sure, i mean as far as my bosses were concerned if i didnt have antibiotics for it then it didnt exist.

 

[Sisyphus]

it appears that they don't know either

Highly Specialist Clinical Psychologist in Long COVID/Post
COVID


https://www.jobs.nhs.uk/xi/vacancy/916562032

So the bureaucracy is putting it self and its own benefit ahead of the patients and their health. What a surprise.

 

[rvallee]

So the bureaucracy is putting it self and its own benefit ahead of the patients and their health. What a surprise.

This is the Iron law of institutions:

The people who control institutions care first and foremost about their power within the institution rather than the power of the institution itself. Thus, they would rather the institution "fail" while they remain in power within the institution than for the institution to "succeed" if that requires them to lose power within the institution.

By institution it mostly means the institutions' original aims and goals, it's fine if the organization continues to exist undetached from the original mission, as long as those with power within the institution consolidate it. An institution is defined first by its decision-makers and their self-interest.

Everything is political, medicine especially so.

 

[Kalliope]

 

[Daisybell]

Good thing that the main BPS cabal are unlikely to apply. From the Person Specification.

"Ability to manage effectively verbal aggression and abuse from patients, carers etc.."

Willingness to negotiate and ability to handle confrontation effectively and professionally."

file:///C:/Users/debbi/Downloads/3196422_293_IMRS1_1208PS.pdf

Salary:
£52,643 - £58,558 p.a. incl pro rata

I actually think this is appalling that these biases against patients are built into the JD for the role…

 

[janice]

In my experience it's employers, channelled through patients.

Employers expect sick employees to Do Something to improve the situation, and so the employee is pressured to go back to the GP, who in turn tries to help.

One example (of many over a working life): about 12 years ago I was signed off with nasty gastric symptoms that made it impractical to work in an office 80 metres from the nearest loo, and was referred to a day clinic for some investigations. The appointment came through within a week, but I had to wait another couple of weeks for the results of some of the tests.

I was called up from work two to three times a week to ask for a progress report, even though all I could tell them was that I wouldn't know until my next appointment on X date. I was put under a lot of pressure to go back to my GP to see if she could tell me anything different, even though it was obvious that she'd be as much in the dark as me until the results came through.

I had a relatively good employer and I could resist pressure to request pointless consultations, but I can see why a more aggressive HR manager would have been sending a younger or more timid patient trotting dutifully back to the GP and asking for some kind of action. Employers like this probably played a big part in the prescription of antibiotics for viral upper respiratory infections for decades.

This reminded me so much of my experiences with the HR department assistant literally jumping up and down in front of me shouting at me to DO something.
I explained as clearly/ calmly as could I could muster that I would have happily given my right arm if I could have got back to work again. (!….. I know I didn’t manage un-emotional I’m afraid )

 

[Invisible Woman]

I actually think this is appalling that these biases against patients are built into the JD for the role…

It really is.

In my student days I once worked in a busy fast food restaurant and usually worked the tills on the busiest shifts covering pub closing times especially at the weekend. The salary is significantly higher but the job description sounds a bit like that.

Except, within a week or so, you learn that life runs much more smoothly if you learn to spot the signs of someone about to get lairy and descalate.

With that price tag I would expect the person to be able to pick up early signs of deep distress and worry, have a good understanding of the problems that person might be facing, use their own communication skills to allow/enable the patient to express how they feel in a constructive way.

The therapist and patient should be and feel like they're on the same side. The only reason for the patient to become confrontational is if they feel dismissed, ignored and that the therapist isn't listening to them or on their side. In that case the therapy is probably less likely to be effective anyway.