RRReflection's on all things R’s

RRReflections on all things R’s…….

What a week it has been for the team at Sports Injury Fix! We have travelled far and wide to support our friends and colleagues involved in #TheBigRs and celebrate the launch of MSK Reform.

But before we tell you about our week and indeed what lies ahead, it’s prudent to go back in time, as we all know, the best place to start any story is at the beginning, and who else should explain the story other than our very own ambassador and the driving force of the movement Jack Chew……..

“Between June 2014 and June 2017, a feedback loop had formed around the Musculoskeletal (MSK) Physiotherapy interview show The Physio Matters Podcast and its surrounding social media. Having a podcast in common often helped the 20,000+ clinicians, patients, educators and policymakers to involve themselves in discussions, even around topics infamous for causing conversation breakdown.

Chews Health, the Manchester-based healthcare company responsible for the podcast, partnered with Newcastle-based healthcare company Connect Health to host an event that they hoped would channel this energy. Fifty invitees discussed a variety of topics central to contemporary MSK practice at the inaugural event ‘Reasoning, Responsibility and Reform’.

The event was a huge success and interest beyond the room was clear from the immediately trending hashtag #TheBigRs, which the resultant movement was known as.

A further invitational event in May 2018 saw 100 innovators in the field look to identify mechanisms for change as they explored the question of whether a reformative agenda was emerging from the discussions on and offline. Following this event and a further 150-strong conference in November 2018, it was clear that there was momentum behind the movement.

The collective was also privileged to have the involvement of many great leaders, five of which were selected to head up individual Working Groups made up of volunteers for a bold new project”.

And so, a year later, and following a phenomenal amount of work by so many, on Wed 16 Oct 19, SIF director Mike James boarded a train for London, to support working group members and other involved parties to launch the “Manifesto for Reform” at a Parliamentary reception in Westminster.

A fantastic experience and a privilege to walk the esteemed corridors of power and celebrate the start of what will hopefully be the start of a new era in MSK care in the UK, and potentially further afield.

We even got to witness a parliamentary session from the public gallery!

The next morning, 3 of the SIF team, packed and prepared to head north to Manchester for the Reforming MSK Practice 2019 Conference. Mike was already due to attend as a delegate, but Malcolm and Tom were attending as we were honoured to have been invited to exhibit at the conference.

We were proud to line up next to the impressive list of fellow exhibitors that included Designed2Move, MSK assist, BASRaT, Physio Fast Online, Rheumatology Physio and PAL Physio Advisors

Although the programme was heavily weighted towards Physiotherapy, naturally due to the parties involved to this point, it was repeatedly mentioned throughout the conference that the “who” of reform must include a wide cross section of MSK professions including:

·         Occupational Therapists with special interests

·         Nurses with special interests

·         Chiropractors

·         Osteopaths

·         Sports Physicians

·         Sports Therapists

·         Health trainers

·         Fitness trainers

·         Massage therapists

Day 1

The conference programme had been cleverly arranged to dovetail superbly between clinical sessions from some of the very best the industry has to offer, and sessions where the manifesto chapter authors outlined their work to date and the recommendations of the working group within the manifesto.

As always, the organisers were innovative and inventive, combining invited critics and the delegates to discuss and debate each session.

Following a typically articulate opening address Jack, the scene was appropriately set, and the audience was engaged and excited to here from  Dr Emma Salt, chapter author discussing “Reforming Evidence”.

Emma outlined the value and importance of Evidence based practice (EBP) and the recommendations of her impressive team for the manifesto. Of note, aiming for MSK service providers to ensure at least 5% of clinical staffs working week is protected learning time highlights level of reform that the manifesto seeks to implement.
The general consensus from the room was of support, but a valuable point was raised by Neil O’Connell who stressed the importance of improving the evidence literacy skills of the clinician in order spend that 5% protected time most effectively.

Ann Green asked the very valid question of what data can private practise use to make the business case to justify this time away from patients?

And so, with the day off to a flying start, we were treated to our first clinical gold session. And what a session it was. Very few clinicians receive the consistent praise and recommendations Seth O’Neill does.

And almost immediately it was obvious why! Seth blew us away with his presentation on “Tensions in Tendinopathy”, highlighting the conflict that exists within tendon research, and how individual the response to treatment can be. He left us with some fantastic take homes too!

He did however reveal his darker side……….and I think the rest of the delegates would join us in wishing Mama O’Neill’s Achilles the very best of health.

It was then time for a break, and anyone who has attended an organised event by the Physio Matters team knows that this is guaranteed to involve some tasty treats. They did not disappoint…. a theme that continued for the duration of the conference at each break, lunch and indeed the evening party!

Top grub as always team!

As mentioned, #TheBigRs is synonymous with innovative ways to discuss and debate. And so, we moved onto the final morning session of Day 1 – a thoughtful sparring session between Jack Chew and GP with special interest in MSK Giles Hazan – as charming, engaging and intelligent a man as you could ever wish to meet.

The session was productive and flowing and the back and forth between the two couldn’t fail to prompt thought and discussion going forward to develop and challenge the relationship between MSK medicine and MSK therapy. Engagement from the wider medical world (including the patients which we will come onto later) is vital if we are to drive the service provided forward.

Some of the fantastic topics discussed included how well are PT’s prepared for in key roles of managing uncertainty such as First Contact Practitioner (FCP), as well as questioning the traditional hierarchy and subordination of the medical profession and difficulties in challenging across professional boundaries.

The debate was followed by some exceptional questions and talking points raised by the floor and as any good debate, the session raised many more questions than it answered.

A major take home for us was Giles’ point of how we move forward from here and initiate discussion and conversation with the wider MSK community.

An extremely poignant point of note was recognising that the differences between specialists should be celebrated we need to then work together collaboratively to drive the industry forward.

We were then introduced the second chapter of the manifesto “Reforming influence” Chapter author Ash James highlighted the importance of the who and how we can influence people.

The key point was that there are many stakeholders that we need to be able to get the right messages to: clinicians, the media, the patient and as invited critic Professor Alison Chambers noted – the general public at large that may not be injured or in pain. She also made the distinction that “it doesn’t matter how influential you are - you have to convert the naysayer”.

An exceptional point was raised regarding getting our messages to the next generation also. Ensuring that school children and youngsters are included in out thinking too. We must apologise to whoever made this great point as we didn’t catch the exact direction it came from and cannot give the person the credit they deserve.

As a company we have experience in this area and couldn’t agree more. This is the chapter that we feel we would like to try and be involved with the closest moving forward.

As with all the sessions throughout the conference, positive comments and words of caution were constantly being made that will surely help shape the future of MSKR. The following will definitely be food for thought regarding influencing others:

•  The need to be careful to avoid just making more “noise” amongst the other noise out there - must consider how we stand out from the other noise!
• Being weary of polarised wording and chat regarding being negative about what’s gone before and poor practise - it will deter people coming to the table to chat.

Alison chambers concluded with to action to “make sure we aim high enough, as there’s a chance to make a real change with key stakeholders".

By mid-afternoon, it was time for the breakout sessions. An eclectic mix of sessions were on offer ranging from Motivational Interviewing, pain management in practice and optimising Strength and Conditioning.

We decided to attend all three by dividing the team. We found each session delivered with expertise and enthusiasm, and Mike thoroughly managed to get his biases tickled by the dynamic, engaging and entertaining Andrew McCauley. Andrew demonstrated his exceptional skill in applying S and C to the patient and how the therapists in attendance could immediately apply this in clinic next week.

And so, we moved onto the final session of Day 1. The enigmatic Reena Patel, author and lead of the “Reforming Education” chapter. Once again, the presentation was a clear example of the professional and dedicated approach the working groups had employed in the research and preparation of the manifesto.

As with many of the other chapters the authors had considered the multifaceted nature of reforming education and included the responsibilities and rewards for all involved. In particular, we were drawn to the suggestion of a universal preceptorship pathway for graduates aspiring to MSK excellence.

Again, the invited critic played their part offering challenging and considered rebuttals to the presented chapter. We must praise Dr Sally Gosling for her ability to do these with consummate ease during this session.

Throughout the day there was an energy of excitement and positivity from all to drive MSK practice forward. Whether at our stand or within sessions, we had lots of interest, discussion and feedback from delegates whose careers span the industry- thankyou to everyone who took the time to come and chat to us.

At the end of Day 1, we had a little time to recharge and reflect at the hotel before returning to the Renaissance hotel for The Big R’s Party.

Tradition was upheld as the Chews Health / Physio Matters team dominated the dance floor whilst laying on good music, great food and even better company. Mixing and chatting with colleagues old and new in a different environment is always something that we feel should be encouraged.

Day 2

The day started just as the first ended, high quality and fast paced with Dr Dylan Morrissey managing to even distract everyone from the Rugby World Cup with his clinical gold presentation on the best practice for plantar heel pain.

Another exceptional talk highlighting the talent possessed by so many of our industry leaders who can translate research so succinctly into simple practical advice that the rest of us can apply immediately. However, we will never be able to look at flip flops ever again without thinking of them as “foot thongs”.

Next up was Paula Deacon – chapter author of “Reforming Governance" who explained in great detail and with great clarity the working groups recommendations for what she so eloquently referred to as “not the topic you share over cocktails”.

Ably challenged by invited critic Sandra Harding, and her brilliant kitchen and restaurant analogy (listen to episode 3 of the Health Matters podcast for full details), the presentation hit home with the message of the clear and significant benefits to all involved in MSK care by creating accountable clinicians.

A hard-hitting lesson to all was Sandra’s simple yet powerful test to highlight the gulf in understanding of governance even within the room! It has to mentioned that this session was excellently facilitated (as were all the others in fact) by some probing and poignant questions from Felicity Thow on how we will implement and sell this chapter to our peers.

As is always the case at The Big R’s events, a vital perspective was sought from the patient contributors in attendance. Tina and Adrian provided excellent ideas on what would be most important from the patient to identify how governance is portrayed from a therapist and how this can promote confidence for a patient in a therapist.Morning break ensued, again spoiling us with refreshment of the highest order, and the conversations continued with fervour between exhibitors and delegates.

Following break, was what we can only describe as a rival to Jo Gibson’s 2018 inspirational presentation. Dr Neil O’Connell entertained us with his funny, light-hearted and engaging talk on the subject of pain research and its application.  Charismatic and on point throughout, the students at Brunel University? Are truly blessed to have such a high-quality operator helping and guiding them.

One pearl of wisdom was his quote "Stop cherry picking research from Pub-med that you haven't read just to win an argument".

Lunch was enjoyed before the final Manifesto chapter – “Reforming Excellence” was presented by Chapter author Matt Wyatt. A truly forward-thinking chapter that recognises defining clinical excellence moves the conversation forward.

Recommendations of a potential digital library of best practise, and that the best MSK therapist for the patient in need is what we should aim for. That therapist role could be filled by a physio, rehab specialist or osteopath etc based on who the best people to is, regardless of background -this resonates with our mission to break down barriers and unite the professions here at sports injury fix.

Perhaps Matt’s most impactful statement was suggesting that reforming chartership into something that actually meant something, rather than being something we simply paid for?

We then moved into the second of the workshop sessions, where the topic of “exerting influence” was divided into influencing patients, clinicians and the media. All were though provoking and indicative of the challenges and tasks we face moving forward.

The sessions were vital to help us understand the importance of getting our message across the right way and to the correct audience.

The final session was truly one of the most memorable of my career. Chris Mercer presented on Cauda Equina Syndrome (CES), powerfully demonstrating why he holds the reputation he does for being a pioneer in this field.

Chris made a poignant point regarding the rising costs of medicolegal management of CES – and that although 92% of cases are against GPs and 70% are successfully defended, we need to be aware that as FCP roles expand, then we need to be more vigilant and diligent than ever.

Chris then introduced Janene Holway – a patient who through bravery and honesty moved the whole room with her story. Never has a patient message been delivered with such impact. Tears rolled on both sides of the stage.

Janene’s story was a great lesson in how these things affect the patient’s life and that of their family to such massive extend. It can never be reiterated enough just how much the person is the priority. What can be a job to us, another patient on the list should always be treated like the first person of the day. Communication with family at large are of great importance.

And so, we were at the end of the formal programme, all that was left was for Jack to draw the conference to a close and explain the move from TheBigRs to MSK Reform. He kicked off with an inspiring film made by the real brains of Team Chew that documented the two days.

Jacks closing address was broadcast live and we could not do it justice if we tried to summarise it. So, we feel the best support we can give it is to simply share it here. But needless to say, he captures and acknowledges all those involved in the journey to this point, and outlines the vision of how to move forward. As always, it is considered, pragmatic and inspirational throughout, and we cannot emphasise enough, the value in spending 20 minutes watching it.

It’s now a day later, we’ve reflected and digested the manifesto and all that it stands for, and we are proud to announce that we support it wholeheartedly and will advocate strongly for all it aims to be.

As always, the Chews Health / Physio Matters Team planned and executed a first-class conference with high quality content and speakers, lots of delegate interaction and endless food for thought.

The manifesto has been launched and it’s never been a more exciting time to be part of change and to shape the future before us: congrats to all who have worked tirelessly to draft the manifesto and to those who will drive it forward in the coming weeks, months and years.

Please please please, if you care at all about being the best therapist you can, visit mskreform.org.uk and read, learn, register and help in whatever way you can.

Download the manifesto, challenge it, test it, disagree with it, but do something and interact with those involved, in fact do more, get involved. Tell your colleagues, peers and many others about it and help the discussions grow.

Thanks to everyone who shared our week, and thanks for taking the time to read this. Have a great week and be the best you can be for your patients…. they deserve it.