To act within the scope of practice (1) is a concept that is deemed pivotal for a physiotherapist working within healthcare. A method in which this is achieve is often from the practical skills we deliver for assessments and treatments during a consultation. To be able to deliver a range of practical skills in practice, I have been working to consolidate and refine the performance of complex skills gained from a qualifying physiotherapy programme (2). This has been achieved through learning a range of practical skills such as: suctioning in respiratory physiotherapy (See – Respiratory: Suctioning), eliciting a clonus response during a neurological assessment (See – Skills Journal: Neurological), and a range of exercise prescription skills (See – Skills Journal: Exercise Prescription) where I was able to clinically reason my exercise choices, demonstrating being able to draw upon appropriate knowledge and skills to inform practice (3). In addition to hands on treatment skills that elicited positive responses showing I am able to consolidate  and refine complex skills within a manual therapies, exercise and movement context  (2) in order to expand my MSK related toolbox for effective patient-centred care (See – Skills Journal: Manual Therapies).

In order to continue to refine performance of complex skills (2), I had to learn how to modify a technique in response to feedback (2). My first experience of this was during my first placement where  I had a patient with shoulder pain on abducting the arm to 90 degrees, I initially utilised a manual therapies approach trialling depression glide  due to the convex concave rules of Maitland’s peripheral manipulations (4) which offered no clinical difference. However, I decided to trial some variations and found that a posterior anterior glide with mobilisation with movement that produced a positive response for the patient (See – Skills Journal: Manual Therapies), demonstrating the ability to effectively modify a technique in response to patient feedback (2) . This was interesting as I initially believed that treatments had to be specific but this suggested to me that this wasn’t always the case with a study by McCarthy found similarities with lower back pain (5) that allowed me to think more broadly about a wider range of techniques, rather than a one size fits all approach, again demonstrating the ability to draw upon appropriate knowledge and skills to inform practice (3).

Amongst the traditional practical skills of manual therapies, movement and exercise, opportunities to learn about electrophysical modalities (2) presented itself during out Patient Pathways module in the first year of the MSc Physiotherapy course. We discussed and trialled ultrasound and transcutaneous electrical nerve stimulation (TENS) to which evidence has reported a lack of compelling evidence on its effectiveness in musculoskeletal disorders (6–8). This evidence effectively steered me away from electrophysical modalities due to the lack of effectiveness it appeared to have. However, on placement 4 I had the opportunity to trial shockwave therapy on a patient with plantar fasciitis (See – Skills Journal: Shockwave Therapy) which appeared to have beneficial effects. I decided to do further reading on this (9) and make notes on the topic (See – Shockwave Therapy Notes: Placement 4) to consolidate my knowledge on the use of electrophysical modalities (2). Shockwave appears to be beneficial on a range of tendon related conditions as an adjunct to exercise therapy which makes it more compelling to utilise and refine my knowledge on complex skills on this for the future. Placement 4 also allowed me to trial other kindred physical approaches such as hydrotherapy (evidenced - Hydrotherapy) where I had the oppertunity to take part in a class and help deliver exercises for a total knee replacement and cervical spondylosis which assisted me learn and refine my knowledge against on complex skills and exercise modalities (2).

In addition to learning practical skills specific to my profession, I have also learnt a range of generic practical skills shared with other health and social care workers (2). These skills are still just as important as the clinical expertise I have learnt for the scope of practice for me profession. Learning a range of skills at university such as manual handling (See – Manual Handling) and basic life support training (See – Basic Life Support) and a range of other mandatory training courses (See – Mandatory Training Certificates) in order to ensure safe, effective care for patients. I believe that this range of practical skills from manual therapies and exercise, to basic life support and manual handling have allowed me to succeed in ensuring fulfilment to duty of care of patients (2), as I am now able to treat a range of patients with varying symptoms and conditions with the toolbox of skills I have obtained over the course and placements.

Reference List

1. Charted Society of Physiotherapy. Chartered Society of Physiotherapy xx Professional Values of Members’ Code and Behaviour 2 Code of Members’ Professional Values and Behaviours [Internet]. 2019 [cited 2019 Apr 9]. Available from: https://www.csp.org.uk/system/files/csp_code_of_professional_values_behaviour_full.pdf
2. Physiotherapy CS of. Chartered Society of Physiotherapy Framework [Internet]. 2013 [cited 2020 Mar 23]. Available from: http://www.csp.org.uk/professional-union/careers-development/cpd/csp-eportfolio/my-eportfolio/cpd-
3. Council H and CP. Physiotherapists | The Standards of Proficiency For Physiotherapists [Internet]. 2013 [cited 2020 Mar 24]. Available from: https://www.hcpc-uk.org/standards/standards-of-proficiency/physiotherapists/
4. Hengeveld E, Banks K. Maitland’s Peripheral Manipulation : Management of Neuromusculoskeletal Disorders - Volume 2. Elsevier Health Sciences UK; 2013. 638 p.
5. McCarthy CJ, Potter L, Oldham JA. Comparing targeted thrust manipulation with general thrust manipulation in patients with low back pain. A general approach is as effective as a specific one. A randomised controlled trial. BMJ Open Sport Exerc Med. 2019 Oct 1;5(1).
6. Shanks P, Curran M, Fletcher P, Thompson R. The effectiveness of therapeutic ultrasound for musculoskeletal conditions of the lower limb: A literature review. Foot. 2010 Dec;20(4):133–9.
7. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Vol. 10, Current Rheumatology Reports. NIH Public Access; 2008. p. 492–9.
8. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev [Internet]. 2008 Oct 8 [cited 2020 May 21];(4). Available from: http://doi.wiley.com/10.1002/14651858.CD003008.pub3
9. Moya D, Ramón S, Schaden W, Wang C-J, Guiloff L, Cheng J-H. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Jt Surg [Internet]. 2018 Feb 7 [cited 2020 May 21];100(3):251–63. Available from: http://journals.lww.com/00004623-201802070-00013