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Editor's Notes |
Somewhere in time, we became like a football team with a porous defense—or perhaps more like marathon runners who overslept. We found ourselves playing catch-up alongside other health care professionals who were doing the same. We found ourselves providing services that we could not justify. We had only our traditions and our anecdotes.
We had to play catch-up to survive. We entered into what I call "the age of justification." Regular readers of the Journal know the pleas for research and evidence, for practice refinement, for justification based not on testimonials but on data. However, unlike sports teams—for whom, as Vince Lombardi was fond of saying, winning isn't everything, it is the only thing—the physical therapy profession has a more complex challenge.
For 20 years, we have raised money for research through the Foundation for Physical Therapy. Those monies have had a remarkable impact on the training of researchers, and, as a result, those researchers have obtained many millions of dollars from other sources to study questions of interest to physical therapists. In addition, many researchers have clarified issues through the use of Foundation monies. Because of Foundation-supported research, for example, we now have a better understanding of the effect of electrical stimulation on wound healing. Two clinical research centers have provided us with an extraordinary amount of information, at a fraction of the cost of similar, federally sponsored research.
But something is missing. The Foundation, like the profession it reflects, has responded to immediate needs. We know we need to examine the effectiveness of treatment, and the immediacy of this need cannot be questioned. But what about our far horizon? What do we need to know beyond our immediate needs? What do we need to know beyond having ammunition to argue with insurers and federal agencies? The problem is not with the Foundation or with APTA in general. The problem is in our collective view of what must be done here and now. Yes, we need to justify and examine. But we need to do more.
We need to develop sex appeal. Before you decide that I've finally lost my mind, bear with me. Do we capture the public's imagination, allegiance, and financial support when we speak of our need to examine what we already do? I suspect not, even though the task is vitally important. I think that most patients actually believe that therapists, like physicians, have evidence to support what they are doing. If you doubt that, talk to people after another news report about what to eat or not to eat, what surgeries work and do not work, what medications are now known to be dangerous. People are frustrated by these reports; they believe that physicians should get all of this straightened out. The public's belief is based on the assumption that someone should have known what was best right from the beginning because of research. (As all health care practitioners understand, this is not necessarily true.) There's nothing sexy about public arguments regarding treatments. In fact, such arguments (you'll pardon the expression) scare patients to death. Some of the arguments are necessary; some can be precluded.
Even as we systematically assess our current interventions, we must look to the massive number of Americans who in the next 2 decades will go from being the baby boomer generation to being the largest geriatric population our nation has ever seen. Maintaining the status quo will not be enough when the boomers begin to devour health care resources like locusts devouring wheat. The only way we can ensure care in the future is to provide evidence for what we do today and to pioneer new methods, new strategies, and new interventions for the conditions we will see in unprecedented numbers—hip fractures, cerebrovascular accidents, cardiovascular disease...
Think of what we could offer society if we spent less time arguing about the effectiveness of already questionable interventions for low back pain and instead developed new methods! Imagine our profession unveiling a treatment for which there is evidence before we put it into general use! Innovation has been the hallmark of physical therapy ever since we were called reconstruction aides. All I am suggesting is a new type of innovation. The application of theory, creativity, and science in moving beyond today's pecuniary issues and fixations with old arguments is accepted elsewhere. As a profession born from the efforts of innovators, we can do it, too—but only if we look beyond immediacy and fear-driven inquiry toward entirely new approaches that are of value not because they are "new" but because they work better, faster, cheaper.
In 1938, President Franklin Delano Roosevelt established the March of Dimes not only to develop better ways to manage poliomyelitis but to eliminate the disease. The promise of cure or prevention meant that summer would no longer be a time when parents feared every fever and bout of weakness and wondered whether their child was about to become paralyzed. Those of us who lived through those times remember the swimming pools being closed, the movies theaters thought to be too dangerous to enter, and the images of people living within iron lungs or encased in heavy metal braces. The great vision of the nation—a vision heavily influenced by the work of physical therapists, by the way—was on a cure and a future free of fear.
That vision is similar to the vision of a cure today as AIDS and new strains of tuberculosis run rampant in urban areas throughout the world. The seemingly miraculous treatments for a variety of ailments both capture the public imagination and enchant politicians and donors. Monies spent in these efforts seem to offer extraordinary hope. You may wonder how this is relevant to those for whom physical therapists provide interventions. Many of our patients are not even "sick"; they have impairments leading to disabilities. Cures are offered for only some of the conditions we treat. We may view our activities as distant or without relation to the great efforts to cure today's diseases, but that is a function of our myopia and our inability to see far into the future.
Although our research efforts might not lead us in the near future to injections that cure the effects of a CVA or to a Star Trek–like medical device that is waved over the femur to heal hip fractures, our research could offer new hope for rehabilitation. Wouldn't it be a grand goal to find a way to return people home following a CVA with twice the function and within half the time?
Justification is not enough. It is time to explore new ways so that we can offer something better in the future. Unless this becomes a collective vision for the profession even as we gain greater knowledge about what we do today, we will be forever playing catch-up—and we will watch the rest of the world move beyond us. A great profession deserves a great vision that includes explorations beyond those we have imagined, explorations that will allow us to offer our patients benefits we cannot even contemplate today. Now that's sexy.
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Physical Therapy 2000 80: 711.
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