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• W2053216751 abstract "‘It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.’ (Charles Darwin) Although Darwinism might not seem a very obvious philosophy with which to consider physiotherapy research, the notion that successful species respond and adapt to their environments seems an interesting premise upon which to consider our past and future physiotherapy research. Over the past decade much has been written about the difficulties and challenges facing physiotherapy research. Editorials in various professional physiotherapy journals have raised issues concerning the need for and adequacy of research training, balancing clinical workloads with research activities, and have offered strategies for collaborations between researchers and clinicians. More recently, these discussions have included issues relating to education and the uptake of evidence-based practices within our profession. If such discussions are viewed as ‘snapshots’ of a changing profession, what evolutionary changes exist in our past research behaviours, what evidence is there that our profession is responding successfully to wider societal changes, and which research behaviours might equip us for the future? Common descent: from the early origins of our species we have had very close ties with medicine, and in many ways medical practitioners might be viewed as our common ancestors. Rather than a land bridge disappearing and isolating groups of common ancestors, with one group developing into medical or surgical practitioners and the other developing into physiotherapists, our forebears responded to a violent world environment (two world wars and poliomyelitis epidemics) to develop skills in the rehabilitation of respiratory, neurological and musculoskeletal disorders. These large-scale societal events allowed the development of a new species adapted for providing a service in a changed environment. Rather than competing for the same resources (in this case patients or perhaps a traditional medical education), a symbiotic relationship has developed between medical practitioners and rehabilitation therapists. Multiplication of species: the physiotherapy profession arose in the early nineteenth century, long after the requirement for children to inherit the occupation of their parents was past. Consequently, our species multiplied predominantly by ‘budding’, in which new physiotherapy populations were founded via migration both within and between countries. Where these new populations were geographically distant or isolated from the original groups, the potential existed for the evolution of new species which responded and adapted to local conditions. Hence, although physiotherapy as a profession shares many common traits throughout the world (usually underpinned by political relationships between countries), differences exist in nomenclature, educational requirements and in the depth and scope of competencies expected in different countries. Gradualism and natural selection: rather than the sudden creation of a new kind of individual, evolution occurs through the gradual change of populations. Such change occurs over generations and it can be difficult to identify in the short term. Our relatively young species has developed over time as a function of wider societal changes in welfare, education and healthcare systems. An essential requirement for natural selection is diversity of traits within each generation. Individuals who have the best-adapted combination of inheritable characteristics are more likely to survive to pass them on to their offspring. At any given time, the population of physiotherapists both at a macro- (country, city, town) or micro- (department or practice) level is likely to include variability with respect to undergraduate training, work experience and generational expectations (Generation X, Generation Y or Baby Boomers). In terms of successive generations of physiotherapists, the traits that favour continuation of the physiotherapy species are unlikely to be inherited, but perhaps these traits, skills or behaviours are ‘endowed’ to the next generation of physiotherapists through formal and informal education and professional culture. Common research descent and gradualism: apart from anecdotal descriptions and documents describing specific physiotherapy interventions, the earliest examples of physiotherapy research do not just mirror research undertaken by our common ancestors but were often initiated and led by medical practitioners. Studies of physiotherapeutic techniques were predominantly simple, experimental, pre–post designs undertaken with small groups of subjects in order to determine short-term effects or proposed mechanisms of actions. In many cases, physiotherapists were involved only to administer the intervention. As our species gained greater autonomy through professional recognition, the need to initiate, manage and disseminate our own research began to develop. Initially and predominantly focused upon specific or individual physiotherapy treatment regimens, physiotherapists began to be seen to lead research studies. A quick stroll through the contents pages of long-established physiotherapy journals reflects the changing focus and evolution of physiotherapy research from narrative descriptions of ‘How to manage x’ to ‘How to measure y’, followed by an experimental period of ‘How reliable is measure z?’ on to ‘Comparisons between treatments “a” and “b” ’ alongside ‘Long-term follow-ups, clinical efficacy and quality of life studies’ and, more recently, ‘Randomized controlled trials, systematic reviews with or without meta-analysis and epidemiological population health studies’. Similar to our common ancestors, our research history predominantly reflects quantitative approaches, with relatively small representation of qualitative paradigms and educational research. The most obvious pattern occurring throughout our research history is the lag between research approaches adopted by the wider medical and scientific communities and these being taken up by physiotherapy. The most obvious example is the randomized controlled trial. The first randomized controlled trial described the use of streptomycin for tuberculosis (MRC, 1948; Devereaux and Yusuf, 2003), whereas the first clinical trials in physiotherapy (manipulation for low back pain and wax baths for rheumatoid arthritis) occurred several years later (Moseley et al., 2002). The physiotherapy research philosophy de jour is evidence-based practice, which, again, follows on from a medical practitioner-based initiative. Multiplication of the research species and natural selection: although multiplication of the physiotherapy species appears to have occurred through ‘budding’, the early development of research traits may have been an adaptation to local circumstances, as initiation and participation within research does not appear to be homogenous throughout the world. Historically, physiotherapy has emerged from an apprenticeship model (watch, learn and practice under supervision of an experienced therapist) towards a research model (where research, in its original semantic sense, means to explore thoroughly). It would be unusual under the apprenticeship model for a younger, inexperienced physiotherapist to initiate or lead formal research activities, whereas under a ‘research’ model, young inexperienced physiotherapists are encouraged to participate and potentially lead formal research activities in collaboration with experienced researchers (not necessarily physiotherapists). The inclusion of basic research training within undergraduate training and the potential for advanced research training after graduation has varied, and continues to differ throughout the world. In 2004, the World Confederation for Physical Therapy (WCPT) recommended that undergraduate physiotherapy programmes include research methodologies as a core requirement in order to provide graduates with the basic skills necessary to consider publications critically and potentially to participate in clinical research. In the Australian Standards for Physiotherapy, all entry-level physiotherapists are expected to be able to access, identify, evaluate and apply research findings in clinical practice and, in some cases, participate in basic research projects (Standard Three). These two examples indicate that research activities are not necessarily restricted to participation in formal research studies but include the skills necessary to search thoroughly and systematically. They also provide evidence of formalized endowment, ensuring adaptation of the next generations of our species to the wider health environment. How might our past evolutionary research patterns predict our future? Our physiotherapy species has demonstrated an impressive ability to multiply and adapt to diverse geographic and health service environments. Arguably, from an evolutionary perspective, physiotherapy is not a dominant species leading or driving change in research approaches or healthcare initiatives. However, we appear to be adept at adopting, modifying and applying principles and practices developed by medicine and broader sciences (education, psychology, anthropology and so forth). Perhaps the predominant factor influencing future changes in physiotherapy and the research that physiotherapists do is the availability and priority given to health resources. On a global scale there is a growing divide between resource-rich and resource-poor nations. From an evolutionary perspective, availability and access to resources are key stimuli for adaptation. Resource-rich nations face issues of ageing populations living with chronic diseases, dwindling public health spending and societal expectations of medical and technological advancements for the benefit of those who can afford them. Resource-poor nations, on the other hand, face the issue of keeping a population alive to maturity against a background of political and economic unrest, with healthcare services geared at survival not necessarily quality of life. In both situations it is likely that research methodologies originating in population or public health, epidemiology and health economics will become the skill-set useful for physiotherapists who intend to participate in research. Research approaches which explore alternative modes of healthcare delivery, such as community or individual self-management interventions for specific conditions are likely to involve physiotherapists as part of healthcare teams rather than as the main or sole provider of an intervention. Those individuals within our species who adapt and develop skills in these research approaches could potentially lead and drive future directions not just for our species but perhaps also for healthcare in our relevant nations. The only thing certain in life is change. Based on our past and present patterns there is reason to believe that physiotherapy as a profession, and physiotherapists participating in research, will continue to evolve generation by generation. The decisions we make within our professional species may have little immediate effect upon mature, practising physiotherapists within their employment lifetime. However, the choices we make, and the processes we put in place regarding our profession, are endowed to our professional offspring in order to maximize their chances of being able to respond effectively to their environments. Let's hope that we choose wisely." @default.
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• W2053216751 title "Guest Editorial — Evolution: a useful philosophy for physiotherapy research" @default.
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