The recent lively debate in Physiotherapy surrounding the current narrative of 'harm' has perhaps made Roger Kerry's words "Will physiotherapy eat itself?" echo louder. 'Harm' has a range of definitions and thus, may be interpreted in a number of ways. This short presentation delves into the tiny amount of evidence and data behind the narrative of 'harm', and comes up with some surprising findings and a message for those purveyors of that narrative. NOTE: The study quoted 'Lessons to Be Learned: A Retrospective Analysis of Physiotherapy Injury Claims' from the Journal of orthopaedic & sports physical therapy volume 42 number 8 Aug 2012. is specific to the New Zealand ACC system. The uniqueness of the data, which were derived from a no-fault treatment-claim system, precludes comparison with data from other classification systems used for adverse-reaction reporting

1. Who is harming who?
Unraveling the ‘narrative of ‘harm in Physiotherapy
Alan J Taylor
@TaylorAlanJ

2. Very few entered the physiotherapy
profession to do harm …
@TaylorAlanJ

3. Yet we keep hearing from
Physiotherapists … that
some physio’s are causing
‘harm’ …
Really?…Why is that?
… and is it true?
@TaylorAlanJ

4. No one actually knows … There’s a theory that it may be linked to
a frustration at the slow pace of change within the profession … but
that remains a theory with only anecdotal evidence to support it.
@TaylorAlanJ

5. WHAT IS …
?
Well … this is the difficult bit, no one seems to know!
What we do know is that:
1. There are multiple definitions and interpretations of harm
2. There is very little actual data on ‘harm’ or harmful treatments
in Physiotherapy
3. Most of the claims for harm appear to be based on
opinion rather than hard scientific data.
@TaylorAlanJ

6. Its tough to find hard data on
‘harm’ in Physiotherapy
To date, we have discovered a lot of anecdotal
talk of ‘harm’, a few single case studies and a
retrospective analysis of actual (defined) cases
of harm from New Zealand
@TaylorAlanJ

7. So what did the Kiwi audit paper have to say?
Oh … the findings were more than a little surprising!
TELL ME MORE ….
@TaylorAlanJ

8. How did they define ‘harm’?
Here’s how …
Source: https://www.jospt.org/doi/pdf/10.2519/jospt.2012.3877?download=true
@TaylorAlanJ

9. Here’s what they
Source: https://www.jospt.org/doi/pdf/10.2519/jospt.2012.3877?download=true
@TaylorAlanJ

10. The key points were:
Claims filed for injury incurred during physiotherapy consultations
showed that the prevalence of exercise-related injuries
exceeded those of other common therapeutic
options employed by physiotherapists.
IMPLICATIONS:
The wide range of physical therapy treatment injuries linked
with exercise activities underlines the need to ensure that
careful consideration is given to exercise prescription and
the level of supervision.
Source: https://www.jospt.org/doi/pdf/10.2519/jospt.2012.3877?download=true@TaylorAlanJ

11. Does that mean that
exercise prescription
is harmful then?
@TaylorAlanJ

12. The short answer is NO!
That is where a risk benefit
analysis comes in
Exercise is shown by evidence to be one of our
most efficacious interventions
and the risks are still relatively small
OK … what have we learnt?
That non evidential claims of ‘harm’ without
appropriate risk/benefit analysis may be actually
detrimental to our profession
Choose your words carefully.
@TaylorAlanJ

13. The bottom line on harm …
• If a treatment or advice is not efficacious … say so (use
RCT evidence).
• If it is uneconomical or costly … say so (use health
economics evidence).
• If it is 'harmful' ... provide a definition, a measure and
data, any data.
• If it is 'dangerous' ... provide data and a proposed risk
assessment strategy, root cause analysis or both.
• Above all ... use plain English, with clear and agreed
definitions.
• Otherwise folks … Physio will eat itself!
@TaylorAlanJ