Hand in hand
Author: Jessica Hoadley
Patients can benefit from a close working relationship between GPs and physiotherapists.
Physiotherapists use evidence-based care to assess, diagnose, treat and prevent a wide range of health conditions and movement disorders. However, other healthcare practitioners may not necessarily be aware of some of the specialties within physiotherapy, or some of the conditions for which patients can be referred to physiotherapists.
‘The scope of physiotherapy is a wide one,’ Aidan Rich, an APA (Australian Physiotherapy Association) Sports Physiotherapist, told Good Practice. ‘We’ve got 22 national special groups and 19 different disciplines of physiotherapy.
‘The conditions people would liaise with their GPs about would vastly differ across those groups.’
These varied disciplines within physiotherapy include musculoskeletal, neurology, occupational health, sports, cardiorespiratory, paediatric, gerontology, and many others.
‘There is often a physiotherapist who will be able to help with a specific type of medical condition,’ Rich said.
Julianne Pegler, National Chair of the Australian Physiotherapy Association for Paediatrics, has a passion for community education about physiotherapy.
‘Sometimes people think that we just do things like massage and ultrasounds, but some physiotherapists have specialist training [and] are very well placed to provide evidence-based medicine,’ she told Good Practice.
The relationship between GPs and physiotherapists is an important one that can result in improved continuity of care for individual patients.
‘GPs are that central part of the wheel,’ Rich said. ‘Physiotherapists rely on GPs for a lot of our referrals, and we also utilise GPs in terms of asking their opinions about certain conditions or medications, prescriptions, radiology referrals, or referrals for other investigations.’
The APA is currently working on fact sheets to educate healthcare professionals, as well as the public, about physiotherapy’s effectiveness in treating a broader range of conditions.
Benefits of partnership
Dr Stephanie Muller, a GP who previously worked as a physiotherapist, believes a strong relationship between these different professions can be especially beneficial in terms of improved patient outcomes, particularly in the event treatment does not progress as expected.
‘The physiotherapists I work with and refer to don’t hesitate to communicate with me if they’re not happy with how things are progressing, which is a really good thing for the patient,’ she told Good Practice.
‘Having a good relationship means that [the physiotherapist] is confident about feeding back to me – “This is not progressing well” – and then I can take action on that. We trust each other to work that way.
‘That’s the informal team approach. If either party thinks something isn’t making sense, perhaps we need to review the diagnosis and consider further investigations.’
Pegler takes the same type of approach with her referring GPs.
‘I feel like GPs and physiotherapists are ideally suited for each other, to work together to get the best outcome for the patient,’ she said.
‘I never work in isolation; I try to correspond with whoever I receive the referral from. There’s open communication.
‘I’m never reticent about suggesting further investigation or specialist referral.’
Having spent four years working as a physiotherapist prior to beginning her general practice training, Dr Muller continued her physiotherapy practice until she graduated as a GP.
This experience means she is well placed to refer her patients to more specialised physiotherapists.
‘Generalist physiotherapists, much like GPs, have a bit of knowledge about a lot of things, but there are physiotherapists who are experts in their fields,’ she said.
The general practices at which Dr Muller works as a GP have created ‘address books’ to keep note of the specific interests of their consultant doctors, specialists and allied health professionals in order to aid in referring patients to the most appropriate healthcare provider.
‘There are, for example, groups of female physiotherapists in Melbourne who do purely pelvic floor and continence, and that’s their specialty. It’s nice to know they exist and to understand what they do,’ she said.
‘And there’s benign paroxysmal positional vertigo [BPPV], which is a condition that is really well treated by physiotherapists using ongoing vestibular rehabilitation exercises.
‘There are also experts in vestibular rehabilitation specifically for this problem, which is treated with some simple manoeuvres.
‘The rehabilitation exercises are quite specific and I think people do better if they have an expert involved.’
Rich agrees that there are many more medical conditions that can be referred to physiotherapists than those with which other healthcare practitioners may be familiar.
‘For example, people with neurological conditions such as multiple sclerosis or Guillain-Barré syndrome, or people who have survived a stroke, can benefit dramatically from physiotherapy intervention,’ he explained.
‘And people with chronic pain; there has been a huge amount of research into pain science and pain rehabilitation.’
Greater levels of education or updates for GPs about the scope of, and evidence for, physiotherapy would ultimately be beneficial for patients who require a referral.
‘Both of the professions are always changing,’ Dr Muller said.
‘So we can always become better practitioners in the response to new evidence and new learning.’