Letters

Physiotherapy March 2001/vol 87/no 3

163

CONGRATULATIONS to Stephen Mayon his excellent articles on patientsatisfaction (May, 2001), and placingthat subject and qualitative researchfirmly on the agenda, not just for low back pain patients but also forphysiotherapy in general.

Whatever else, Stephen hashighlighted the importance of an often neglected and poorly understoodissue.

He has shown that it is multi-factorial, but that does not mean that itneeds to be over-complicated, as somepeople make it, or unusable.

Indeed, if we see health as more thanjust the absence of disease or pain,important as this may be, and more asSeedhouse (1988) suggests -- thefulfilling of individuals’ biological,emotional and creative potentials and

health work as a moral endeavour to help them fulfil their potentials --then in the biomedical ‘illness-linked’aspect of this it would lead to truepatient-focused care.

Satisfaction would then necessarilybe a major and not a minor outcomeand treatment/management would increasingly become apartnership.

At present we may be too top-down.As Seedhouse (1994) also says: ‘Why don’t you ask the patients whatthey value most? Don’t use closedquestionnaires with loaded questions –just ask them.’

However we measure them, patients’opinions are as fundamental as anyother outcome, and we now need todevelop tools to help them to expresstheir views and enable them to be

more involved in a partnership tomanage their situation.

Peter Roach MCSPClatterbridge, Wirral

References

May, S J (2001). ‘Patient satisfactionwith management of back pain. Part 1:What is satisfaction? Review ofsatisfaction with medical management.Part 2: An explorative, qualitative studyinto patients’ satisfaction withphysiotherapy’, Physiotherapy, 87, 1, 4-20.

Seedhouse, D (1988). Ethics: The heartof healthcare, Wiley, Chichester.

Seedhouse, D (1994). Fortress NHS: A philosophical review of the NationalHealth Service, Wiley, Chichester.

Patient Satisfaction – The prime outcome

Letters

163

I WOULD like to comment on twoarticles that appeared in the December2000 issue of Physiotherapy.

Harding and Watson have outlinedsome important management strategiesto consider when treating 'chronic'pain conditions using a biopsychosocialmodel. Broadening the approach ofphysiotherapists is necessary, especiallyfor the role we are to play in aninterdisciplinary framework.Importantly the authors encouragedpractitioners without multidisciplinarysupport to incorporate these strategiesinto their practice.

There is an obvious next step thatphysiotherapists need to take in orderto assess and treat pain conditions of all types effectively. Simply,physiotherapists need to stopconsidering ‘acute’ and ‘chronic’ painas separate entities and recognise thatthey are two points (and arbitrary onesat that) on a continuum. Therefore it isrelevant to apply the biopsychosocialprinciples to all pain conditions.Doctors in the USA have had

guidelines to this effect for theassessment of acute low back pain forsome years (Bigos et al, 1994).

Similarly, there is another term thatis problematic. Simmonds (2000)raised the issue of ‘placebo’ and theundoubted role it plays in patientoutcome. We should recognise that thephysiotherapist-patient interaction iscomplex and powerful and theassociation with a much maligned termsuch as ‘placebo’ may reduce thesignificance of, and the need tonurture, this relationship. Perhaps‘non-specific treatment effects’(Gifford, 1998; Simmonds, 2000) is more appropriate and acceptable. As a term, it at least begs the questionfor the clarification and specification of these effects. ‘Placebo’ is widelyaccepted as describing unaccountablechanges. Therefore it remainsundervalued when measuring outcomeand unacceptable as a treatment.

Recognition of the impact ofsemantics may not be the most pressingissue facing the profession but

nevertheless language does have thepotential to influence both ourthinking and our practice.

Lester Jones MScMed(PM) MAPASchool of PhysiotherapySt George's Hospital Medical SchoolLondon SW17

References

Bigos, S, Bowyer, O, Braen, G et al(1994). Acute Low Back Problems inAdults: Clinical Practice Guideline,AHCPR pubn 95-0643, US Departmentof Health and Human Services, PublicHealth Service, Rockville, MD.

Gifford, L (1998). ‘Pain, the tissuesand the nervous system: A conceptualmodel’, Physiotherapy, 84, 1, 27-36.

Harding, V and Watson, P (2000).‘Increasing activity and improvingfunction in chronic pain management’,Physiotherapy, 86, 12, 619-630.

Simmonds, M (2000). ‘Pain and theplacebo in physiotherapy: A benevolentlie?’, Physiotherapy, 86, 12, 631-637.

Classifying Pain, Clarifying Treatment