physiotherapy association of british columbia physiotherapy association canadienne de...

Winter 2006

CanadianPhysiotherapy

AssociationDirectionsirectionsirectionsirectionsirectionsI N P H Y S I O T H E R A P Y

Associationcanadienne dephysiothérapie

A Publication of the Physiotherapy Association of British Columbia

INSIDE

Continued on page 2

By Jacek Kobza and Patrick Embley

Over the years, two physiotherapistsat the Mary Pack Arthritis Centre inVancouver have been interested inmanual therapy, muscle imbalancesand stability retraining. Followingpost graduate training, conferencesand research review, and a stronginfluence from many of the world’sleading researchers in these threefields, we’ve been involved in theclinical application of these princi-ples to the arthritis population. Ourspecial interest is clients with OA ofthe spine, hips and knees.

The use of the term “core”strengthening has becomeincreasingly popular amongphysiotherapists and the public.However, “core strengthening”appears to have different meaningsto different people. In some cases itappears to be confused withanother term - motor retraining.We’d like to share our journey andthe terms we think are mostaccurate.

Working with many clients whohave OA of the spine, hip and kneehas allowed us to successfully applythe principles of motor retrainingand core strengthening to thispatient population. Our interestevolved to a new level following a

review of patients in an OA backclass that focused on genericstability retraining exercises.Following the program, thepatients who did not improve wereprovided specific exercises basedon an identified movementdysfunction problem. The resultingsuccesses led to an extensiveresearch review on spinal stabilityretraining, classification systemsfor low back pain, proprioceptiondeficits and rehabilitationstrategies. However, we found nodirected studies identifyingchanges in OA spine and the issuesof poor spinal stabilization.

Osteoarthritis joint changes arethought to advance for manydifferent reasons; amongst these isthe emerging evidence of the roleof increased shear forces to thecartilage.

From San Antonio to Rome…

From Motor Retraining toCore Strengthening

Jacek Kobza at World Congress of Manual Therapy in Rome

Quick Response Team .................... 4

A Victoria member on themultidisciplinary QRTdescribes its success.

Orthotics Thoughts ........................ 5

Three members share theirinsights.

Favourite Outcome Measures ....... 10

A host of members tell whythey prefer certain OMs.

New Teleconferencing Options ..... 14

Learn how a new lectureseries will now reach you bytelephone.

PABC’s Annual General Meeting ... 19

In Burnaby this year, the AGMoffers 2 free courses, andyou’ll meet our new Libarianand two Physician advisors.

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PRESIDENT’S REPORT

Brian RiemerPresident

Let me begin by wishing all of youand your families a happy andprosperous 2006.

As physiotherapists, we are greatgoal setters. Not only is goal settingimportant clinically, but also in theworkings of our Association. Ourgoals, and subsequent strategies, arelaid out in the Strategic Plan that isreviewed many times throughout theyear and re-worked every two years(you can review the plan on theMember’s Only side of the website).

One goal that remains on thestrategic plan is to provideopportunities to mentor and trainnew leaders. But what are theobligations of leadership, not onlyfor up-and-coming leaders, but alsofor members currently in leadershippositions?

• The first is to bridge the gapbetween our members’ views ofissues and the views of those whoseek to earn the right to leadthem.

• The second is to ensure theleadership team has access to acommon stream of informationfrom members that allows themto understand members’ views.

• Providing a coherent stream ofinformation back to themembership is the thirdobligation. This allows membersto understand not just whatdecisions are made, but therationale behind them.

• The last obligation of leadership isto understand that in thevoluntary nature of anAssociation, members choose toengage because they perceive it isin their best interest to do so.

These thoughts came from a one-daygovernance course sponsored by theCanadian Society of AssociationExecutives, taught by US consultant

Dr. Stan Leete, MD, FRCSEducated in England, Dr. Leete’s earlypractice there was followed by work inrural and urban Ontario, then with theBritish Royal Air Force in the Maldivesand Christmas Island in the Pacific,which experiences left a lastingimpression on him. Awarded theCanadian Fellowship in OrthopaedicSurgery, Dr. Leete became a ResearchFellow studying spinal surgery beforegoing into private practice in spinalsurgery and joint replacement. InCampbell River since 1979, he is thestaff Consultant in OrthopaedicSurgery for hospitals on the NorthIsland. He has been on BCMAcommittees and is a member of theWCB Medical Review Panels.

Dr. Leete says: “I have always workedin closely with physiotherapists,relying on their expertise for therehabilitation of my patients.”

We thank member Caroline Leetefor recruiting her father.

Dr. Peter Culbert, MD, FRCPC After graduating from the UofT, Dr.Culbert interned in Edmonton andthen spent five years in generalpractice in BC. He obtained hisFellowship in Internal Medicinethrough UBC, then returned toWilliams Lake to practice as a generalinternist, and was the President of theMedical Staff at Caribou MemorialHospital for 10 years before hisretirement in 2003. He was alsomedical coordinator for Intermediateand Extended care facilities DiabetesTeaching Program, and the Tatla LakeNursing Outpost, and sat on severalBCMA committees.

Dr. Culbert says “Physiotherapists arean essential member of the team;patients couldn’t move on withoutthem.”

We thank member Betty Donahuefor recruiting Dr. Culbert.

Bud Crouch, that Rebecca and I hadthe opportunity to attend at the endof November (PABC won the ticketsat the ACE Award ceremony).Throughout the day, we had theopportunity to reflect on and discussnot only how we as an Associationfunction, but how we can continueto improve PABC for all members.

We currently have many avenues tofacilitate our leadership obligations:through direct email, the newsletter,our website, town hall meetings,district meetings, and the annualAGM. Do you believe that we, asleaders of PABC, are fulfilling thesefour obligations to the best of ourabilities? We sincerely invite yourinput; our record shows that welisten and respond. I ask you torespond to me directly [email protected].

Good News!Doctors in the House!We have two physicians who havejust joined PABC leadership.Orthopaedic surgeon Dr. Stan Leeteis our first-ever External Director onthe Board, and Internist Dr. PeterCulbert is our Physician Advisor forour Communications AdvisoryGroup. PABC’s objective for 2006 isto build on our exceptional clinicalrelationship with physicians, and towork on key initiatives with our newphysician partners to promote theprofession to our target audiences. We believe that by improving ourcommunications with physicians,and learning from them how we canincrease recognition, we will soar.

Directions

Winter 2006 3www.bcphysio.org

CEO REPORT

Rebecca B TunnacliffeChief Executive Officer

After five years of working with theUBC Library to provide PABCmembers with access to referenceresources, we found a solution, andone that surpasses our dreams.Thanks to the generosity of ananonymous Foundation, we havethree year funding for our ownOutreach Librarian. After anextensive search and interviewprocess, we are fortunate to haveEUGENE BARSKY as our very ownLibrarian starting this month.

Eugene has his Master of LibraryInformation Studies degree fromUBC, which followed his BA inpsychology from Ben GurionUniversity of the Negev in Israel,where he also studied computerprogramming. Eugene’s studies andwork experience in a variety ofhealth library settings (St. Paul’sHospital, UBC Life Sciences, BenGurion University Family MedicineResearch Centre, and most recentlyQLT) proved a winning combination.

I know you will be as impressed aswe were on the selection committeewith Eugene’s quick mind. Histhorough preparedness for theinterview and high-level responsesindicate he will delve into yourquestions with a vigour that willenrich your library experience.

The Physiotherapy OutreachLibrarian Position will be based atUBC’s new Irving K Barber LearningCentre, and Eugene will also spendtime at the PABC office.

Together with UBC Library, we willdevelop an implementation plan tobring you and Eugene together,both electronically and through aseries of Town Hall meetings. Wewill provide you with details onmaking the most of our newresource, and we welcome yourinput along the way. Our long-termgoal is to make such extraordinaryuse of the Outreach Librarianposition that the funding isextended, or an alternativeresource is made available.

Meet Our New Outreach Librarian

Continued on page 16

From Motor Retraining to CoreStrengthening

Continued from page 1

Models developed by MohamarPanjabi and Kirkaldy-Willis wereutilized to help guide therationalization for spine stabilitywith OA back patients. Weextrapolated their findings to thelumbar spine. We then submitted anabstract to the American College ofRheumatology in 2004 in SanAntonio titled Clinical Examinationand Treatment of OA of the LumbarSpine based on MovementImpairment System.

Interest from the conferenceprovided invitations to present at theCanadian RheumatologyAssociation’s Annual GeneralMeeting in Quebec in March 2005,and poster presentations at the 2nd

International Movement ImpairmentConference in Edinburgh, Scotlandin September 2005 and the WorldCongress of Manual Therapy inRome, Italy in October 2005. TheEuropean conferences broughttogether many of the world expertsin the field of stability retraining andthe spine such as Peter O’Sullivanand Shirley Sahrmann whounderlined the importance ofclassification systems. Paul Hodges,Lorimer Mosely and others discussedthe role of motor retraining,dynamic retraining of the spine andpsychosocial influence in themanagement of the spine.

Based on current research in stabilityretraining, there is a clear distinctionbetween motor retraining and corestrengthening. Motor retrainingfocuses on the specific timing andrecruitment of the deep spinalstabilizing muscles that should betrained separately from othersuperficial muscles under low load,

1500 Members ——— $200,000

750 Members ——— $100,000

375 Members ——— $ 50,000

TV Ad Levy Update

see Ad details on pg. 6/7

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CLINICAL DIRECTIONS

The Quick Response Team(affectionately known asQRT)By Margaret McLynn, BHSc, PT

Victoria nestles on the southern tipof Vancouver Island. People from allover Canada and other parts of theworld flock here to live because ofthe beauty and the benign climate.In response to this ever-swellingpopulation and the increaseddemand for healthcare services, theinnovative Quick Response Team wasformed in 1986. Initially, the teamprovided home-based health carequickly to people older than 60 yearsof age and to chronically disabledpeople 18 years and above. In 2002,the team was expanded to serve thepopulation at large, with the goal ofpreventing hospital admissions orassisting with early discharge. Theteam operates 8 a.m. to 11 p.m.,365 days per year and has amandate to respond to urgentrequests within three hours.

Today’s team is comprised of 14.1nurses, 5.63 physiotherapists, 3.31occupational therapists, 4.7 socialworkers and one respiratorytherapist. Team members have accessto a pharmacist who also attendsteam conferences. Referrals come

from Emergency Room and hospitalward staff or hospital liaison nurses,as well as other health careprofessionals in the community suchas case managers, doctors, andhome care nurses. Referrals are alsoaccepted from the family or friendsof the patient. The referrals arescreened by a health professional inthe “Central Intake Division” ofCommunity Health and come to theQRT when the patient requiresurgent or intensive service. In 2002,the McCreary prize was awarded tothe QRT for “InterprofessionalTeamwork in the HealthProfessions.”

The physiotherapist is a valuedmember of the team who performsa range of tasks, including: doingfunctional assessmentsof patients, providinginformation to otherteam members, choosingappropriate equipmentfor patients in theirenvironment, checkingsplints, casts, wounds,swelling and bruisingetc., authorizing homesupports and preparingcare plans for homesupport workers,designing exercise programs,

progressing mobility, problem-solving all ADL issues and makingreferrals to other team members orother programs (i.e. geriatricservices, out-patient or privateclinics, Community RehabilitationServices or case management). Thephysiotherapist may be the onlyteam member involved with apatient too sick to be maintained athome, and makes the decision tosend them to hospital byambulance.

Communication with GPs, otherprofessionals, family members andother agencies is a big part of thejob. Little may be known about thepatient to begin with and detectivework is necessary to put the piecesof the patient’s history together.The most innocent-looking referralcan turn out to be “a disaster”while visa-versa, the most complex-

looking referral canturn out to be “abreeze.” Thisfrontline work can bestressful at times, butteam members areconstantly in touchwith each other ortheir managers bycell phone toproblem-solvedifficult situations.Computer access to

information is available to all teammembers.

The most amazing recoverieshappen even in the most elderlypeople who have sustaineddreadful injuries. People seem tolike recovering “at home.” Somehave caring friends and familyaround them, but even if they donot, they have their own “things”nearby, such as the telephone, theirown remote control, a good cup oftea and a little bit of TLC from theQRT.

New Membership HighRenewals for this year are the highest they’ve ever been at 1491.Comparative numbers do not include students.

2005 2004 2003 2002 2001 2000

1491 1414 1409 1440 1466 1480

Student membership is at 84%, also the highest on record. This year, 95members will be over 60 years of age. Our members’ median age is 45.

DO YOU KNOW

Are there otherteam programs

out there?Let PABC know...

[email protected]

Directions


ASSOCIATION DIRECTIONS

Business Affairs Committee,Best Practices Task ForceUpdateBy Therese Leigh

Happy New Year from the WADImplementation Team! We are happyto have produced an evidence-based,comprehensive clinical practiceguideline (CPG) on WhiplashAssociated Disorder (WAD) thatshould have arrived in your mailboxeslast month.

The purpose of the CPG is to providea tool that members can use to:

• guide treatment;

• provide uniform, evidence basedbest practice in BC;

• reference for other resources; and

• refer to others, such as ICBC orWCB.

This CPG package is the end productof two years of hard work that beganwith my Master’s thesis in 2004. TheWAD Implementation Task Force hasbeen busy over the past year,developing the member version,holding town meetings andinforming physicians of theguideline. All members of the clinicalpractice and implementation teamshave generously contributed theirtime and knowledge and I would liketo thank them all.

In May, I presented the guidelines atCPA Congress, and in September, Iguest-lectured at UBC on the newCPG, spending the majority of thetime on therapeutic (deep neckflexors) exercises. The thesis wasmodified to the user-friendly versionyou received from PABC, and whichalso went to insurers and otherstakeholders. Please take the time tocarefully review the package, whichcontains the CPG, the NDI outcome

measure and other handy clinicaltools. The questionnaire includedin the package will help us measurethe success of our project, and wewould appreciate a lot offeedback!

The primary message of the WADguideline is that manual therapy,therapeutic exercise andeducation successfully rehabilitatewhiplash associated disorderpatients. Physiotherapists are theexperts, so let’s ensure we provideclients with best practice, evidence-based treatment. Pleaseincorporate the clinical practiceguideline into your practice.

Endorsement: Leading BCphysiotherapist Carol Kennedy,nationally reputed for herexpertise in manipulative andmanual therapy, champions thisinitiative:“When all of us consistentlyfollow the WAD Clinical PracticeGuidelines, we will clearlydemonstrate and communicatethe high level of knowledge andquality of practice that mark ourprofession as key experts inneuromusculoskeletalassessment and rehabilitation. Iencourage you to make theguidelines an integral part ofyour evidence-based andeffective clinical practice.”Carol Kennedy, BScPT FCAMT

At PABC’s AGM April 29th, CarolKennedy and Therese Leigh willlead a course on Best Practices inTreating the WAD Patient. MeenaSran and Susan Paul will leadsections on Outcome MeasuresMade Easy, and College Tips forTreatment. RSVP through PABC.

Orthotics ThoughtsIn the wake of our recent win withPacific Blue Cross in being givenprovision to prescribe orthotics, weasked our three leading orthoticsexperts about their thoughts on thetopic, and we specifically askedabout their opinions on plaster vs.foam.

Eugene Henry, Eugene HenryPhysio Corp, Campbell River

All of a sudden orthotics seem tohave slipped into the generalpublic’s cross-sights as a possiblemeans of combating foot pain andfoot deformities, thanks in part toTV ads by such companies as TheGood Foot Store. Physiotherapistsmay be questioned about the types,manufacture, cost, effectivenessetc. of orthotics, so some generalinformation about the deviceswould be useful to those not usedto dealing with orthotics on a dailybasis.

Orthotics can be divided into threecategories: (1) off the shelfproducts; (2) customized; (3)custom-made.

1) Off the shelf products can bepurchased at drugstores, sportsstores and include all the typessold in shopping malls, tradeshows and store-front outletssuch as The Good Foot Store,regardless of what type of“assessment” was done, such asink impression, standing onscanners etc. In the end, theproduct is ready-made.

2) Customized means that an off-the-shelf (OTC) product hasundergone some post-manufacturing changes such asthe addition of metatarsal pads,varus or valgus posts etc., andmay be tailored to a specifictype of footwear such as skiboots.

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“Accurate casts are now the

gold standard. If you are

going to use foam boxes, you

might as well save your

money and just trace an

outline of the client’s feet.”

TV Ads ReportContinuing with the ‘The BodySpecialist’ theme, the TV ads are acombination of ten-second ClosedCaptioned, and two fifteen-secondplayed back-to-back and separately.The $71,000 budget for air timecovers three periods, with thebiggest expenditure at the end of2005 to recover from the year thatwe were “off-air.” It is divided into$35k for Winter 2005, and in 2006$26k for Spring, and $10k forSummer.

Nine million viewers were reachedin the Winter 2005 media on CBC,Global and Shaw. Progams includedNature Of Things, This Hour Has

3) Custom-made orthotics shouldinvolve a full gait analysis by acompetent health professionaland should result in theproduction of a 3-D mould ofeach foot, usually a NWB plastercast or a foam box impression.The moulds are sent to aregistered lab (check with PFOLAto see if the lab is listed withthem). Insurers are shying awayfrom computer-generatedmoulds, arguing that they donot give a true 3-D image of thefeet.

As of January 1st, physiotherapistscan prescribe orthotics for patientswith appropriate Blue Crosscoverage and this gives us a widerscope in the treatment of footrelated disorders with minimalexpense to the patient.

Please contact me if you have anyquestions or wish to get furtherinformation on any aspect of thissubject. I am more than happy tohelp [email protected]

John Hamilton, Summit Injury,Victoria

In my opinion, orthotics made fromnon-weight bearing plaster castsare more effective than those madefrom a foam impression orcomputer imaging. An orthoticmade from a plaster cast can bebetter customized to accommodateor correct faults in a person’sbiomechanics. Hence, an accurateorthotic cannot be properlyprescribed without completeassessment of the biomechanicalchain.

Thus, the person prescribing andproviding the orthotic needs to beable to perform a completebiomechanical assessment of aperson’s gait. There are manyextrinsic factors to the foot itselfthat must be considered, and the

type of correction in an orthoticmust reflect both intrinsic andextrinsic factors.

Physiotherapists are ideally trainedto recognize all factors in theprescription of custom footorthotics.

Susie Mortensen, WhistlerPhysiotherapy Group of Clinics

Diversification in private practice isa hot topic these days forphysiotherapy associates and clinicowners. As clinicians, we all knowour patients stand to benefit themost if we have a large collectionof tools or skills at our disposal.One new area receiving attentionlately is orthotic prescription.

At our group of clinics, we refer tothis as “Biomechanical Assessment,Prescription and NeutralSuspension Casting” as thedispensing of custom madeorthotics requires much more thanpressing a client’s feet into foamboxes and sending the boxes to alab. As physiotherapists we areuniquely qualified to carry out adetailed biomechanical assessmentof the low back and lowerquadrant and place specialemphasis on the foot and ankle.We are also trained to assess andinterpret abnormalities in a client’sgait pattern. Learning how to castthe feet in subtalar neutral is a skilllearned (like taping for example) ina good course, made better withlots of practice. Like my podiatristfriend from Texas said, “Accuratecasts are now the gold standard. Ifyou are going to use foam boxes,you might as well save your moneyand just trace an outline of theclient’s feet.” Harsh words maybe.Take some courses.

Try not to miss the PFOLA(Prescription Foot Orthotic LabAssociation) World Congress, and getthe podiatry community’s views onthe latest advances in the industry.Learn how to recognize a functionalhallux limitus, plantar-flexed first rayor adducted forefoot. Find a goodlab to fabricate your orthotics andspend some time with them. They areclever people. We use Paris Orthoticsin Vancouver, with great success.Find a lab that works for you (thereare a number to choose from) andstick with them. Learn how to fill outa detailed lab form so that your labhas ample information with which tofabricate the best custom orthoticsfor your clients. Good luck and happycasting!

Directions


What do other membersthink about this issue? Whatexercises would be moreappropriate than sit-ups?Should physiotherapists betaking some initiative aroundthe issue of school PE? If so,how can we encouragechange? Should this be onan individual basis or as aninitiative from ourAssociation? We invite yourfeedback.

22Minutes, Fifth Estate, CBCMorning News and News Sunday,BCTV Morning News, Noon Newsand NewsHour Final. Bonus: Duringour first week of programming, CBCreplaced our current eventsprograms with the CFL WesternFinal featuring the BC Lions, fiveHockey Night In Canada and fourGrey Cup Parade spots; thecombined audience figures, 1.63million, were more than double theexpected audience numbersplanned. The total audience inWinter 2005 was 10.6 million.

For the 50% of members who havenot yet paid, please send your twoyear funding of $150 immediatelyso that we may continue to air theads past this summer.

School PE and the PervasiveNature of Sit-upsBy Sue Bloxsome, CourtenayPhysiotherapy

As a physiotherapist and parent Iapplaud any efforts to increase thelevel of physical activity in schools,with programs such as ActionSchools! BC (Fall Directions). Onearea I think needs to be addressedhowever is the content of PE classes,and in particular the emphasis onfitness tests.

One element of the fitness test isthe timed “sit-up.” A full sit up isoften used, as it is easier tostandardize. However, the danger isthat with 20 kids in a class, it isdifficult for the teacher to monitorfor proper form and speed, andconsequently the exercise may beperformed poorly. In addition, sit-ups or crunches can be aninappropriate exercise for childrenwho often have tight pectorals andhip flexors, and a neck-forwardposture. It is unfortunate if childrenfeel they are failing PE because they

don’t do well on these tests. I havenoticed many of my clients seemobsessed with the idea of needingto do sit-ups or crunches, andsometimes the excessive use ofthese exercises is contributing totheir neck or back pain. PE classesmay be contributing to thisobsession.

Recently, my son’s Grade 6 teacherinvited me to show some “core”exercises for PE. I took a few Swissballs along to make it more fun,and the next week the teacher toldme she had ordered 20 balls! I willbe giving an in-service to theteachers on ball exercises, but I’mglad I’m not responsible for someof those wilder kids. Still, they didhave fun!

Can We Help Our Athletes?By D. “Scotty” McVicar

During and after the OlympicGames in Athens, I kept hearingabout the lack of funding for ourathletes’ training and competitionleading up to the Games. As aphysiotherapist, I’ve had theopportunity to work with world-class athletes and I recognize thesacrifice they make to compete atthe Olympic and Commonwealth

Games level. I wondered how myclinic could help make it easier forour athletes to prepare andcompete? We don’t have deeppockets for this like The RoyalBank, Shell or Telus.

After some research I found thatThe See You in Athens Fund hadprovided a great amount offinancial assistance to athletesleading up to the Athens Games. Agood friend who representedCanada there has since told methat this fund provided him withhalf of his funding for training andcompetition prior to the games.Inspired, I contacted The See Youin Torino Fund and committed tomaking a $100 monthly donation.(The See You in Athens Fund isnow The See You in Torino Fund,and will become The See You inBeijing Fund, and so on).

The target for the fund is toprovide $6,000 for each athletewho applies. Athletes can applytwice per year.

If just nine other physiotherapistsor clinics can give $100 a month,we could support one athlete fromwithin the PABC membership. Itwould be great if one athletewalked into the Olympic OpeningCeremonies time totally supportedby BC physiotherapists or clinics.

We have taken the first stepand I encourage both your or yourclinic to become contributors.Please contact Jane Roos, The SeeYou in Torino Fund, 721 QueenStreet East, Suite 210, Toronto,Ontario, M4M 1H1 or call 1-866-YES-2006.

Scotty owns OceansidePhysiotherapy & WorkConditioning Centre

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BOOK REVIEW,“Auto Accident - Survivor’sGuide for British Columbia,”PABC was asked by the author,Jill Franklin, to review herrecently published book.Thisbook could serve as a resourcefor individuals involved in motorvehicle accidents who requirefurther information about theclaims process and entitlementto benefits. Those seekingfurther research to makeinformed decisions regardingthe medical and legal systemswould have many of theirquestions answered. ICBC’sphysiotherapy coverage andbenefits are reviewed briefly.The book would benefit thosewith more serious injuriesinvolved in litigation; some ofthe recommendations are notcommonly advocated by atreating physiotherapist. Asalways, every case is unique andneeds to be treated as such.

At local bookstores for $28, orPABC members get a 30 - 40%discount & free brochures [email protected].

Lisa Rahn

PRIVATE PRACTICE DIRECTIONS

ICBC REPORTWe met with ICBC for our quarterlyLiaison meeting on Nov 8, 2005.Marie Dayton, our long-time contactand Manager of Bodily Injury is onextended leave, so we met herreplacement, Glen Pers. Alsoattending as usual were RegionalManager Mario Micelli and BodilyInjury Manager Anita Gill, as well asBrenda Hudson on behalf of theCollege.

Presentations:

1. PABC guest Jane Cole presentedthe Incontinence Task Force’sreport, with an overview ontreatment and information aboutphysiotherapists who focus onthis dysfunction. Jane made clearthat the relevance to ICBC is fairlysmall as a result of injuries yet theresultant impact on quality of lifeis quite significant and needs tobe addressed for optimalrecovery.

2. Last year, ICBC had asked for ameans to determinephysiotherapy expertise in theneurosciences. Presentingguidelines written by theVancouver Neurosciences Division,we stressed that while allphysiotherapists are well-trainedin treating neuro conditions andall PABC members can treat MVAswith neuro implications, neuro-physios focus their practice in thisniche area and generalists referpatients to them for conditionsthat require complex care.

3. We also gave a presentation onthe now-completed WADGuidelines, and ICBC is anxious tosee the impact on their clients. Wecontinue to have a good workingrelationship with ICBC and theWAD Guidelines should be veryeffective for maintaining this, so

please spend some time reviewingand applying the principles.

The Disability Duration Guidelines:

The DDG continue to be a measurethat ICBC is using to guide theirreturn to work timeframeexpectations (see Summer andNovember 2004 Directions for anexplanation, or check outwww.disabilitydurations.com). Forclients you are treating past therecommended timeframe, you maystart to see the form letter they haveput together with client-specificinformation pasted in and the DDGof their condition plus their jobdescription attached. The letter asksyou to contact the adjuster to explainwhy they are outside the norm andtherefore require an extension oftreatment. This should work wellwith the WAD information youreceived last month from PABC.

Communication:

This continues to be a big issue. TheICBC adjusters want to hear from youthe therapists treating the client, notfrom your front desk staff. Returncalls are prioritized when they arefrom physios, not from staff. Onceagain, please don’t ask for the “enddate;” the adjuster wants you to givean end date. The adjuster is notcutting off treatment when recordingyour end date on their computer; it istheir only way of tracking the moniesgoing out for a claim. Tocommunicate, ICBC recommendsusing e-mail or voicemail to savetime. Give objective measures and aplan so they have a good reason whythey should fund continuedtreatment. Be sure to do this yourselfif you want the best result sincedirect communication avoidscommunication errors and gets theirattention.

Billing Practices:

Please make sure you are billingproperly for additional areas andprolonged visits, and chartappropriately. ICBC is watching thebilling and noting irregularities.Review the guidelines for ICBC onthe website. The therapist and theclinic are responsible for the billingsand could be audited at any time.Reminder - ICBC must pay $46 for aCL20 if they have requested it.

Lisa Rahn, PABC’s ICBC liaison

Directions


The Public Practice AdvisoryCommittee (PPAC) met on January18th, but not before the printdeadline.

Since the November report inDirections, PPAC has compiled theCommunity Care survey results into aReport of Findings, and hasconducted the Paediatric survey thatis now being compiled into a report.

The Hospital Survey was the first ofthree surveys, and with Communityand Paediatrics now complete, wewill have the most up-to-dateperspective of publicly fundedphysiotherapy in Canada. No otherprovince has taken on a project ofthis scope. Thanks to each publicsector member who helped PPACunderstand your practice issues,concerns and passions.

PUBLIC PRACTICE DIRECTIONS

Fee Team: Randy Goodman, Perry Strauss,Marc Rizzardo, Rebecca Tunnacliffe at the WCB offices in

December 2005

Status:Hospital Practice – ExecutiveSummary results were circulated inthe Autumn Directions.

Community Care – Summarywritten, Executive Summary in thisWinter Directions.

Paediatric Practice – Surveys beingcompiled, summary to be written,Executive Summary in SpringDirections.

At the HSA offices on January 10th,Rebecca Tunnacliffe and Irepresented PABC at a meeting withvarious other health associations thathave HSA members. The union wasseeking input for its contractnegotiations with the government.Concerns PPAC’s three public practicesurveys were the foundation of whatPABC put forward as priorities.Consistent throughout the feedbackfrom our members in public practiceis an unhealthy relationship betweenincreased demand for services andincreased patient acuity, anddecreased resources and decreasedhands-on treatment time. To be anattractive employer forphysiotherapists, the government willhave to address this imbalance.

Scott Brolin, PPAC Chair

Penny Wilson and Pat Lieblich at their Open Houseto celebrate the 10th anniversary of their Women’s Health

Centre Continence Clinic

WCB REPORTWe are happy to announce MattWright Smith is our new Liaison.Matt owns two clinics, HealthX inWhistler and Langley, and both hisacute and OR1 streams give him awide knowledge of WCB. Matt wason the PABC Business AffairsCommittee’s (BAC) Best Practices TaskForce that created the WADGuidelines. Matt will now sit on BACas the WCB Liaison. We werefortunate to have five highlyexperienced members volunteer totake on the Liaison position. Matt’swork with BAC, his independentclinic ownership and experience, andhis proximity to Richmond were allfactors BAC believed would bestbenefit the membership.

We are currently in contractnegotiations, and will resume Liaisonmeetings when the Agreement issigned.

New-Look WebsitePABC’s New-Look Website to be launched February 2006! The site hasbeen reorganized to help you find what you need for more easily. Wehave also eliminated the double login for the Member Profile Access.The new single member login will require your User ID# (aka secretcode) and your CPA# as the password. If you have forgotten your UserID# please email [email protected]. Check out the new look atwww.bcphysio.org and let us know what your think!

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“We routinely use a variety ofoutcome measures at SurreyMemorial Hospital. We use the LowerExtremity Function (LEF) and UpperExtremity Function (UEF) for anyorthopaedic condition, mainly jointreplacements and post-op surgical.Berg Balance is used for anycondition where we are looking toimprove balance reactions, as it haspredictive ability as well as indicatesprogress. The Community BalanceMobility is used with higher-levelbalance issues due to Berg’s ceilingeffect. The Chedoke McMasterHemiplegia Assessment Form haspredictive as well as progressindicators. The Clinical OutcomeVariables (COVS) is used in a varietyof conditions, especially where thereis expected change in transfers andambulation, and treatment isexpected to occur over a longerperiod of time, e.g. output or rehabsetting. The Timed Up and Go (TUG)and Elderly Mobility Scale (EMS) aremainly used in long-term care andextended care settings.” TerryVanApeldoorn

“I use the Berg Balance Test the mostas part of safety assessments in theelderly or neurologically impaired.Good to measure progress”. MariaMuhr

My favourite is the COVS, which isused in the rehab setting. It gives asnapshot of a client’s functionalmobility that includes assessing aclient’s walking ability, walk aids plusspeed of walking over two minutes.It is easy to administer (as it is part ofwhat we assess daily anyway)without much equipment. It is niceto show the clients an actual scoreon how much they change over their

inpatient rehab stay. Sarah Rowe

In my ER setting, one of the needs Ifind is to assess patient’s mobilitystatus; the EMS useful for thisbecause we see lots of elderlypatients. This scale also is a way ofmeasuring their progress while inhospital, which can further debilitatethe patient’s ability to move. I alsouse the Berg balance scale, especiallyfor recent strokes and again I cancompare them when they first arrivein the hospital and when they leave.Claudia Solovenco

My favourite is the Roland MorrisQuestionnaire or the Neck PainFunctional Scale, because it gives mea good indication of what particularfunctional abilities a patient hasdifficulties with, it is fast and easy toadminister, and can be compared atdifferent times to showimprovement. Anne Wong

I use functional outcome measuresthe most, as I work with injuredworkers mostly. Kathleen McKinnell

My favourite is the Berg, due to itsability to measure fall risk. JennyRobertson

I tend to use the Neck Disability Index(NDI) the most, mainly for MVA/ICBCcases because it helps in writingmedical legal letters. Next to that,the Roland Morris, same types ofcases, same reason. Sharon Clarke

My favourite is either The Epic SpinalFunction Sort or The Epic HandFunction Sort. I use them with allOccupational Rehabilitation, WorkConditioning and RehabilitationManagement clients. This gives aperception of the individual’s abilitiesand with that I am able to placethem within a Physical Demand Level.

When this is used on two consecutiveoccasions, usually a couple of weeksapart, it can be a great learning toolfor the individual and they can learnthat they indeed have madeprogress. As an outcome measure itcan also be compared against theindividual’s physical abilities. Forexample, while doing the SpinalFunction Sort, they indicate they arelimited in lifting a 5lb weight fromwaist to shoulder level, but then theydisplay the ability to do so throughsome functional testing. This can beidentified to them and they can beencouraged to continue progressing.Scotty McVicar

My favourite is patient self-report ofhow they are doing. I am currentlywriting a paper on manipulation andneck strength. Stan Metcalfe

Favourite is the VAS for pain - quickand easy. Leigh Johnstone

I like the EMS for a quick objectiveevaluation of an elderly patient’sreadiness for discharge and howmuch assistance they will require.This has proved to be useful inemergency as well as at ward roundsduring multidisciplinary teamplanning. Alison Bowman

With every patient I choose one ortwo OMs and reassess them beforeand after performing a treatmenttechnique; it is usually one activerange of motion, and one passivetest, and maybe a functional activitythe patient has told me they havetrouble with. Then there is thereassessment at next treatment. Thatway I have instant feedback of theeffectiveness of the technique. Seemspretty “objective” to me!! JennieSutton

My favourite is the Gross MotorFunction Measure (GMFM) for usewith children who have CP because itis straightforward to do, requiresminimal equipment, is easy to

Outcome Measures:Members Share Favourites

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calculate and in a form thatmakes sense to a parent. It alsotranslates well into goals andobjectives. Chris Smerdon

The OM I use the most is the BergBalance Assessment as a tool todetermine risk for falls, strategiesto prevent falls and as anoccasional validator of using awalking aide-mainly in the frailelderly. Anne Linton

I use two scales routinely – the P4scale (more sensitive to changes inpain than the Visual AnalogueScale (VAS) and the PatientSpecific Functional Scale. I like thisone for the very reason that it ispatient specific and not regionspecific i.e. lumbar vs neck vslower extremity. It is quick to useclinically which is also importantand doesn’t require that I find adifferent form for each person oreven have to decide which one touse!! I am working on writing upcase reports that demonstrate theclinical application of evidenceand explain why it is not yetpossible to be evidence-based inpractice yet it is important to beevidence-informed. In my opinion,the clinical ‘art’ is not getting

Kudos From Members:Make sure you and your staff giveyourselves a pat on the back for ourever increasing numbers. It is areflection of how great a job you aredoing in the office and across theprovince.

Janice “a member since Igraduated” Morrison

I just finished reading through theWAD package, and I have to thankthe committee for a job well done!! Ido hope that this time, privatepractioners across the provinceembrace and employ this, morereadily than we did during the CL20project. It’s very exciting and longoverdue.

Petra Lehmann

I rarely watch TV. As a result, I rarelycatch our ads! While editing my [Finda Physio] profile, I thought I wouldhave a look online. The ads are great.Great work to all involved.

Barbara Beatty

We held a little mini in-service at theclinic to go over the WAD packageand to do the ‘before’ survey etc.We’ve made a pact to try to use theguidelines and be more diligent withour use of outcome measures!!Good job!

Timberly George

Wanted to take a minute andcongratulate you and PABC onreceiving the CSAE AssociationCornerstone of Excellence award.There are just so many positivehappenings in your package. Greatletter to Grads, impressiveparticipation in COBS and thePhysiotherapy briefings for physiciansis excellent, as usual.

Valerie Handren,Branch President, PEI

enough credit as we strive to bescientific. There will always be aplace for clinical reasoning basedon tests yet to be shown to bereliable, valid or sensitive – wetreat human beings, not bodyparts. Diane Lee*

Favourite outcome measure for mypopulation in the MS Clinic, UBCHospital is the Berg Balance Scale.It serves dual purposes. I can easilycompare with their last annual visitscore, and I can get a quickoverview of function as theyperform the different test items. Itgives me a good picture of whichaspects of balance they are havingtrouble with, and where I mightwant to go in focusing on theirhome program revision/update.Sandra Brunham

* A couple of good references for painmeasures: Spadoni G, Stratford P W,Solomen P E, Wishart L R, The evaluationof change in pain intensity: a comparisonof the P4 and single-item numeric painrating scales. J Orthop Sports Phys Ther.2004 34(4):187-93; and Stratford P, GillC, Westaway M, Binkley J 1995 Assessingdisability and change on individualpatients: A report of a patient-specificmeasure. Physiotherapy Canada 47:258-263.

Winning StoryI was surprised to win the AdSurvey Contest back in May. Thank you for arranging ourweekend getaway to the DeltaWhistler Village Suites. Theweather looked promising so wechose to travel on ourmotorcycle. Nothing comparesto the unobstructed view fromthe bike! The scenery wasspectacular as we rode fromKelowna to Kamloops, then viaLillooet over the Duffy Lake Road

to Whistler. The hotel was lovelyand we enjoyed walking,shopping, dining and spendingtime together away fromeveryday life! With the weatherchanging, we chose lowerelevations and rode home viathe Fraser Valley and HopePrinceton taking in the fallcolours and smells along theway. It was a wonderfulexperience! I’ll be sure to answerthose surveys in the future!

Thanks again, Karol Elliott

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Graduate Education InResearchBy Teresa Liu-Ambrose, PhD, PT, Post-doctoral Research Fellow, SFU Schoolof Kinesiology; UBC Department ofPsychology; Vancouver Coastal HealthResearch Institute [bold ital]

More physical therapists than everbefore are pursuing their graduatedegrees. If you are thinking aboutgraduate education in research, suchas a Masters of Science or Doctorateof Philosophy, you should consider thefollowing to ensure your graduateeducation experience will be bothpositive and productive.

1. Personal interests and goals: Taketime to consider how a graduateeducation in research fits into yourpersonal and professional interestsand growth. As well, consider time,finances, and support. While aMaster’s program may not appearvery daunting on paper, it really isa full-time commitment if youwant to complete it in therecommended two-year timeframe!

2. Find a supervisor: Successful entryinto a graduate program is oftennot only dependent on your GPA,qualifying examination score, andreference letters, but also onwhether a faculty member of theuniversity agrees to be yoursupervisor. Thus, you need to spendsome time finding out who youwould like to work with (i.e., youfind their research programinteresting). Contact theseindividuals and arrange a meetingin person, if possible, or bytelephone. During these meetings,determine the following:

a. Are they taking new graduatestudents at this time?

b. Are your research interests in linewith the overall research

Among the MPT-2 students, it seemsunanimous that 2006 is the year we’vespent our lives waiting for – it’s theyear we will graduate! With the recentmemory of the last set of 2005 finalexams still fresh in our minds, werelish the thought of leaving all thoselong hours of studying far behind. Theend is in sight. We just need to survivefour more five-week placements, asemester of school and a systematicreview (a.k.a. Mount Everest.)

Over the past year we’ve had manymemorable lessons (many of whichwere actually at school), but onelesson in particular stands out asappropriate for this column. It came inethics class, on the afternoon of theGreat Debates. Our class was givenfour current hot issues inphysiotherapy to deliberate over and

ACADEMIC DIRECTIONS

program? Is so, is there aresearch project you can take onas your thesis research project atthe time you start your program?

c. Is funding available for you and/or for your thesis researchproject? Funding is an importantissue. For example, if you areresponsible for securing fundingfor your thesis research project,this may significantly prolongyour length of study.

d. Will the two of you get along?This may be hard to tell at theinitial meeting, but it issomething you need to considerand assess to the best of yourabilities.

In addition, if at all possible, arrangeto meet with the current graduatestudents working in the laboratory.Have a chat with them and find outthe general laboratory environmentand what it is like to work with your

STUDENT DIRECTIONS

potential supervisor. Also, find outwhat former graduate students aredoing now, as their current status is agood indicator of the mentorshipreceived during their training.

3. Funding: To maximize yourchances of securing scholarshipfunding, you need to start theabove processes at least a full yearprior to your planned start date.This is because scholarshipapplications require a proposal ofyour specific research project andoften require the CV of yoursupervisor. Furthermore, thedeadline for scholarshipapplications often precedesadmission deadlines. For example,the deadline for the Michael SmithHealth Research Foundation is inNovember of every year. For furtherinformation on potentialscholarship funding, check out thefollowing websites:www.nserc-crsng.gc.cawww.cihr-irsc.gc.cawww.msfhr.org.

each of us was assigned to theaffirmative or negative regardless ofwhere our hearts and minds trulyresided. The topics ranged fromregulation of physiotherapists toensure the use of evidence-basedpractice to whether a master’s entry-level program would move our (soonto be) profession forward. Clearly,critical subjects to be taken veryseriously; however, given the nature ofdebate and the fact that somebodywould win, our thoughts quicklyshifted to victory.

Our game plans were as much aboutfinding the perfect power suit as theywere about researching our topic and,come the big day, image paid off asrichly as cold hard facts. On themorning of the debates we all feltR R R E A D Y T O R R R U M B L E.

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However, come the moment of battlewe were soon to understand thatpublic debate takes more courage,confidence, and preparedness than wecould have reasonably predicted.Public debate is as much about howyou speak as what you say. I wasquietly amazed at how an intelligent,well-formulated argument could becompletely blown to pieces by afunny, well-timed but relativelysuperficial comment. At the end of theday, I found myself thinking about therecent advertising campaign forphysiotherapy in BC and howimportant it is to our profession. Afterall, I had just witnessed how powerfulimage can be, even in a situationwhere evidence and critical thinkingare held in utmost esteem.

Rhonda Cooper, MPT2, Student Contributor

SCHOOL CORNERAs we enter 2006, we anticipateanother busy and challenging year atthe School. As you read this, the firstcohort of our MPT students, now halfway through their second year, isscattered throughout the provinceexperiencing 15 weeks of clinicalfieldwork. First year students haveentered their second term, which isperhaps the most challenging withrespect to the amount of academiccontent to be covered. Accreditationof the MPT program is underway; theself-study report has been submittedand preparation for the site visit inMarch is in full swing.

In the last accreditation of ourundergraduate program in 2002, UBCwas awarded the highest level ofaccreditation, and we are hoping forsimilar success with the MPT program.We are confident the School providesan excellent program for studentswithin the external constraints wehave to work with.

Discussions regarding programexpansion continue (albeit not asfast as some of us would like!) Forincreased enrollment to occur inVancouver, we require additionalspace on the UBC campus. This ismost likely to occur with a move tothe renovated Friedman building,which the PT program would sharewith the School of Audiology andSpeech Sciences. Discussionsregarding expansion of the programwith additional cohorts of studentsin other locations (e.g. UNBC) alsocontinue.

M E M BM E M BM E M BM E M BM E M B E R SE R SE R SE R SE R S

Dr. Linda Li has joined us thisJanuary as incumbent of the HaroldRobinson Chair in Arthritis. Linda’senthusiasm for her areas of interest,which include the translation ofknowledge from research to clinicalpractice as well as her interest inarthritis, is infectious, and we lookforward to her participation at theSchool.

As always, if you have any questionsabout the School, please do nothesitate to contact me [email protected].

Sue Murphy

WHAT MEMBERS AREDOINGDoug Linklater and BiancaMatheson from Squamish PhysioSports & Spinal Manipulation Centreare off to the Olympics! Doug hasbeen working as physio and coachwith the Canadian National Ski Teamsince last summer in numerousinternational locations. He is theofficial physiotherapist to theCanadian Ski Team for the TorinoOlympics.

Bianca has been working with theAustralian Ski Team for the pastnumber of years, and joined them inAustralia in December as theirphysiotherapist for the TorinoOlympics. Good luck to both memberswho represent the exceptional highstandard and dedication of ourprofession in BC.

Six PABC members were on the hostmedical team for the World JuniorHockey Championship series inVancouver last month. Helping the

>>>

MEMBERS IN THE NEWS –Caroline van de Poll made theBurnaby News Leader in a feature onher post graduate education intreating incontinence.

Denise Morbey had an “Ask theExpert” section in November’sRunner’s World magazine, which hasinternational distribution.

Sally Lindley-Jones marked herclinic’s 25th anniversary with a 3-pagespread in the Oliver Chronicle. AlisonCoupe was also featured.

Nadine Plotnikoff and Wendy Eppwere on City-TV talking aboutreadying for a workout with pre-activity assessment.

Janet Ross’s practice in paediatricswas featured in the ChilliwackProgress.

Pieter Rijke wrote about torticollis inthe Kelowna Capital News.

Guess which PABC leader said thisQuotable Quote:

“Try to force change, not beforced to change”

Winter 200614

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team win their Gold were Wendy Epp(physiotherapy organizer), NadinePlotnikoff, Ron Mattison, TravisWolsey, Tyler Dumont and KevinSchalk. Wendy left shortly thereafterfor the last world cup event beforeTurino (Olympics). She turned downthe Olympic opportunity in favour ofher forthcoming second child.However, she will be in Park City forthe week working with the NationalFreestyle Ski Team as they peak for theGames.

Rod Hidlebaugh moved to Australiato complete further studies, to work ina small practice and “try to get usedto the incredible tropical heat.

Linda Lee Joy has opened SynergyPhysiotherapy on Lonsdale in NorthVancouver

Newly retired Scott Leyland of Trailran as a Green Party Candidate for theFederal Elections. Barb Desjardin ranfor city council.

PROFESSIONAL DEVELOPMENT DIRECTIONS

Calling all members outside theLower Mainland! We have heard yoursuggestions to offer more access tocourses that won’t break youreducation AND travel budgets. InNovember we began a series of newteleconferencing opportunities -bringing the cutting-edgeinformation from Michael Shacklock’sresearch on neural testing to phonelines and web pages across BC.

This new tele-course option enablesyou to to listen-in to the courselecture in Vancouver and view thePowerPoint images seen in the UBCclassroom on your computer via theInternet. The first offering was asuccessful start with approximately20 members involved at a distanceacross the province. We also learnedhow to ensure smoother and moreeffective future offerings.

What’s New with Teleconferencing?

Teleconferencing technologies havedeveloped quickly in recent years.The combination of audio and visualinformation along with handouts e-mailed to each registrant offers amuch more complete courseexperience than early teleconferenceofferings.

We realize many of you are familiarwith the teleconferencing sessionsoffered by CPA and certainly do notwant to compete with this service.The key difference between our newcourses and the CPAteleconferencing series is that theCPA sessions are not offered simulta-neously as a face-to-face course. Ourintention is to offer both options tomembers: attending in person, orparticipating via the phone and web

lines. Regardless of the deliverymethod you choose, you willhave access to new informationand the opportunity to interactwith speakers and fellowtherapists. See below for detailson the new Wednesday eveninglecture series.

New Grads Flock To BCNot only are UBC grads staying in BC, butwe are also enjoying an influx of 21 newphysios who trained outside BC (or 27%of our increased membership). Did theyhear there are 150 vacancies in BC? Didthey hear what a dynamic profession weare here? Some came from BC and arenow returning, others are just discoveringthe Beauty of BC. Here are two stories:

I am one of the new UofA grads returningto BC. I went to high school in Kelowna,completed my BSc in animal biology atUBC, and my MScPT in Edmonton. As forVancouver, I am very excited to beback! Why am I back?...simple. Despitethe rain (which I’m far from despising), Ican run by the ocean, in shorts, everymonth of the year. I’ve recently started atMarpole Physiotherapy Clinic.Dee Malinsky

New Teleconferencing Options In Our Courses

What we will do to supportyour teleconferencingexperience:

• send you the logininformation for your phoneand Internet access

• send you the handouts inadvance along with afeedback form

• coach the speaker so thathe/she stays near themicrophone and structuresthe session with specificQ&A sessions

I too am a new grad from the UofA. Igrew up in Nanaimo and graduated fromUBC with a BSc of Human Kinetics. Afterworking various health related jobsthroughout Victoria and Vancouver, Iheaded back to school. As UBC did nothave an intake of students in 2003 (dueto the change over to the Master’sProgram), I decided that Edmonton wasclosest to home and a good program toboot. After my wife and I spent two and ahalf years without mountains and trees,we were chomping at the bit to return toBC. She is a UBC SLP grad. We came tothe Shuswap where we both got jobs. Iwas extremely fortunate to have severalgreat offers, and I decided to hook upwith a great Mentor in Judy Fullerton ather newly opened Easthill Physiotherapyand Acupuncture clinic in Vernon. I amnow entering my sixth week of mynew career and am extremely happy. Jeff Orchard

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COMMUNICATIONS DIRECTIONS

A new PABC advisory group hasbeen formed to review ourassociation’s communications planand guide its implementationongoing. The first meeting of theCommunications Advisory Group(CAG) – comprised of PABCmembers Joseph Anthony, AlisonEadie, Diane Jacobs, ScottyMcVicar, May Ly, Stacey Miller, FredSamorodin, and Kate Stebbings –was held via teleconference onJanuary 10th.

PABC’s communications plan wasdeveloped to ensure all ourassociation’s communicationsactivities support the Board’sstrategic plan. Our objectives are:

• To raise awareness amongtarget audiences of the benefitsof physiotherapy, the expertiseof physiotherapists, and whereto get more information.

• To encourage physicians torecommend/endorsephysiotherapy.

• To raise our profile with insurers(ICBC, WCB), raising ourcredibility and ensuring theyendorse our services.

• To encourage government andhealth authorities to includePABC in planning/developmentof appropriate projects andprograms.

• To raise awareness amongphysiotherapists of the benefitsof joining PABC.

• To ensure that PABC membersfeel connected to andsupported by PABC, andinterested in being involved inPABC initiatives.

• To encourage satisfied clients toendorse/recommendphysiotherapy to others.

After reviewing the objectives, theCAG recommended organizingthem into two streams:organizational and member-relatedobjectives, and prioritizing them.Communications with physicianswas discussed as an importantfocus, as it would encompass notonly direct communications withthat audience group, but supportof members (with materials, keymessages etc.) in their owncommunications with physicians.To this end, CAG recruited aPhysician Advisor, Dr. Peter Culbert(see pg. 3 for details). The group’snext teleconference, to evaluateexisting and past physician-relatedcommunications and discusscommunications strategies, isFebruary 7th. New to CAG is ourphysician advisor Dr. Peter Culbert.For more information on ourcommunications plan orthe CAG – or to give us yourthoughts or ideas on how PABCcommunications initiatives can bestserve members’ needs –please contact Rebecca [email protected]

Bev Holmes, PABC’sCommunication Consultant

What you can do to ensure yourteleconferencing experience is aspositive as possible:

• arrange to use a speaker phoneand invite friends/colleagues to joinyou. Make an evening of it andlearn together while sharing thecost!

• follow the instructions to muteyour background noise

• engage in the Q&A session just asyou would if you were in person

• complete the feedback form e-mailed to you so that we canincorporate your suggestions infuture courses.

What’s scheduled for 2006and beyond?Evening Lecture Series –Polishing the Professional

• Feb.15: Changing Perspective onYour Professional Practice withKathy Scalzo

• Mar.15: Making a Case for PubliclyFunded Physiotherapy Services withScott Brolin

• Apr.12: Working with ICBC: ALawyer’s Advice with Joe Murphy,QC

NOTE: Prices for the lecture series arereduced thanks to a newteleconference provider:

Fee for all three sessions:$60 (at Robson Square),$125 (teleconference)

Fee per session:$25 (at Robson Square),$45 (teleconference).

PDAC would like to continue thisevening lecture series, focusing ontopics that do not require a hands-onexperience. Please contact us withyour topic suggestions. We hopeteleconferencing these types of shortlectures will complement the currentrange of clinical and symposia coursesin our education program.

Anne Linton, PDAC Chair,[email protected]

PABC Communications Advisory GroupSets Priorities For 2006

Let the search begin...Thanks to David Laschuk for hissuggestion that we add a searchfeature to the online Find aPhysio directory. The public nowcan search by their postal codefor the closest Clinic to theirhome or workplace.

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From Motor Retraining to CoreStrengthening

Continued from page 3

Classified AdsDirections is published 4 times per year. Forinformation on classified ads, display ads orwebsite ads please contact:

Phone: 604-736-5130Toll Free (BC) 1-888-330-3999Fax: 604-736-5606Email: [email protected]

PRIVATELY SPONSORED COURSESDetails on www.bcphysio.org

Continuing Studies Calendar

• UBC online Master of RehabilitationScience courses

• McMaster University – Graduate Studies- Ontario

• Supervised Clinical Hours at TreloarPhysiotherapy

• Naming and Claiming Spirituality – Theinvisible Ingredient in Health-Healing

• Integrated Spinal Manual Therapy• FITforeGOLF – Las Vegas and San

Diego• Mulligan Concept - Upper Quadrant

usually described to be less than25% of MVC. Core strengtheningspecifically involves the coordinatedcontraction of the local and globalmuscles at the same time withforces higher than 25% of MVC.

The implications from emergingevidence for stability retraining inthe area of arthritis are profound.Based on the Kirkaldy-Willis modeldescribing the processes ofdegenerative changes in the spine,it is believed that in the early phasesof the OA 1st and 2nd stage we aredealing with hypermobility to thejoint and consequential increase intorsional and shear forces thoughtto progress OA changes. A case maynow be made that the use of jointstabilization principles can possiblyslow down OA joint changes andcan be applied to all joints from theACL reconstruction of the knee tothe c-spine and shoulder asexamples. Further research isneeded to assess if we are indeedable to slow down the OA changesin the joints due to increased shear-related forces.

It is important that physiotherapistsspeak the same language when weare talking about motor retrainingand core strengthening, particularlywith physicians and third partypayers.

Jacek and Patrick work at the MaryPack Arthritis Centre – VGH. Patrickalso works in private practice, andJacek also works at BentallPhysiotherapy.

They wish to extend a special thankyou to their Mary Packphysiotherapy colleagues SusanCarr, Catherine McAuley and KateHepburn in the preparation of thissubmission.

Reporting to the Clinical Coordinator or Section Head of Physiotherapy, you will use your compassionate and meaningfulapproach to promote physical function, fitness and motor performance to contribute to our patients' overall cognitive,perceptual, social and emotional well being. Your essential role will be to return children and youth to healthy, normallives by meeting their needs through individualized education and training, improving self-care and acting as a resourceregarding physiotherapy best practices. You will practice as part of our multidisciplinary team, using a family-orientedcare model to develop functional solutions and support treatment objectives, clinical research, discharge planning andpatient and quality improvement activities. You will deliver on your promise and commitment to your patients and theirfamilies by fostering optimal progress through establishing support, collaborative and therapeutic relationships, as wellas providing advice and interventional techniques. Your efforts will extend to participating in quality improvement andrisk management initiatives related to physiotherapy and utilizing outcome measurements in the most efficient andeffective manner. Present positions are available in our Intensive care Unit and in-patient units.This invaluable role calls for a compassionate and committed expert, who displays the fortitude and knowledgerequired to take on the challenges of dealing with a diverse, young patient population. Your expertise should be builtthrough completion of a baccalaureate degree in Physiotherapy or Rehabilitation Services and current licensure withthe College of Physical Therapists of British Columbia. Adding to your clinical acumen are the ability to completecomplex patient assessments and a desire to work with children and their families to improve quality patient care andenhance and build healthy futures.If you have a passion for improving the well being of the community and are looking to make a true difference in thelives of children and their families, then we invite you to explore the challenges and rewards of joining thiscompassionate effort. Please forward your resume, quotingCompetition #HSA 05-12-2167, to: PHSA SpecialtyRecruitment, Suite 800 - 1441Creekside Drive, Vancouver, BCV6J 4S7 E-mail: [email protected] or Fax: 604-875-7253.Deadline for applications: until position filled.

To discover more about our opportunities please visit ourwebsite: www.phsa.ca

Help Us Build a Healthier British Columbia

PhysiotherapistBC Children’s Hospital - Vancouver, BC

The BC Children's Hospital is an agency of the Provincial Health Services Authority (PHSA), whichplans, manages and evaluates selected specialty and province-wide health care services across BC. Asan established and expert therapist, you possess the compassion, outstanding knowledge andexpertise needed to excel in the following dynamic role, while furthering our physiotherapy efforts andadvancing your career through an organization committed to professional growth:

www.phsa.cawww.bcchildrens.ca

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WHIRLPOOL FOR SALEVERNON

Stainless Steel Therapy Whirlpool (WhitehallManufacturing) Model H75’s (Stationary) 42”x 20” x 28” (Lower Body Immersion) 1996Model. Low, Low usage $2500.00

Contact: 250-558-9998

VACANT POSITIONVERNON

Associate PositionBusy Manual Therapy/Sports Therapypractice in Vernon, BC has an opening foran energetic, enthusiastic, Full-time or Part-time Associate Physical Therapist for Spring2006. Manual Therapy skills essential.

Apply in confidence to:3607– 31Street

Vernon, BC V1T 5J4

VACANT POSITION

Back in Motion Rehaba progressive rehabilitation and disabilitymanagement company, has an excitingphysical therapy position available in theLower Mainland of British Columbia. Wehave a dynamic team, and assist staffmembers to achieve their vocational andeducational goals; mentorship opportunitiesare available. Our corporate culture is oneof excellence, mutual respect, integrity,teamwork, and commitment to people. Weare a growth-oriented company, offer cuttingedge services, and provide our staff withnew and innovative experiences with whichto become involved. Clinical duties for thecurrent position include: (1) evidence-basedassessment and rehabilitation services forclients with physical and functionaldisabilities; (2) conducting interviews andestablishing exercise programs; and (3)participation in team conferences andleading group education classes. Clientsinclude individuals with a range of injuriesand disabilities, including complex, multi-faceted problems. The physiotherapist maybe involved in non-traditional roles that couldinclude delivering workshops and working inproject teams with other healthcareproviders to implement quality improvementand promotional initiatives.The successful candidate will have excellentclinical, interpersonal and organizationalskills; be able to multi-task and prioritize witha focus on customer service; and workeffectively with in-house physicians,kinesiologists, occupational therapists,vocational rehabilitation consultants,administrative staff, counselors, andpsychologists. We are looking for anenergetic team player with a Bachelors orMasters of Physical Therapy degree andwho is registered (or eligible for registration)with the British Columbia College of PhysicalTherapists, and with an interest inorthopedics. A comprehensive trainingprogram is offered and no experience isnecessary.Salary is competitive and commensuratewith experience; profit sharing is available. Ifyou are interested in learning more aboutthe position, pleaseContact Dr. Ken HemphillPhone: 604-574-8279Fax: 604-575-2272Email: [email protected]

www.vch.ca

● Acute ● Community ● RehabM38246

We’ve got the perfect place for you . . .

One of Canada’s largest health care providers, Vancouver Coastal Health (VCH) serves more than a million people in Greater Vancouver and the scenic

communities (including Whistler) up the coast to Bella Bella. From world-class cities to small coastal towns, we have diverse opportunities in acute, community and

residential care. And our health care professionals are among the best compensated in Canada, with access to training and career development opportunities to help them grow in

their chosen fi elds.

Physiotherapist – Grade IISpine Unit, GF Strong Rehabilitation Centre - 1.0 FTE (Temporary until Sept 2008)

Your recent experience (3+ years) specializing in spinal cord injury rehabilitation will be invaluable in this Transition Support role as will your strong interpersonal skills as you provide leadership and guidance to our committed team.

Physiotherapists – Grade I & Grade IIFull- and part-time opportunities are available in the following specialist areas:

● Acute and Sub-acute ● Community A/OA & ICY● Home care

● Residential care ● In-school special needs● ABI / Spine Unit

Casual PTs are also urgently required.

For all positions, a Bachelor’s or entry-level Master’s degree (or equivalent) in Physical Therapy or Rehabilitation Sciences, accompanied by registration (or eligibility) with the College of Physical Therapists of BC, is required. Registration with the Canadian Physiotherapy Association would be an asset.

This is the time to get your career moving forward and this is the place to do it. Relocation assistance may be offered to candidates assuming diffi cult-to-fi ll positions.

Visit our website at www.vch.ca, click on “Careers”, and then on “Rehabilitation Services”. Or contact Employee Engagement at 604.875.5152 (local) or 1.800.565.1727 (toll free).

Winter 200618

Directions

www.bcphysio.org

VACANT POSITIONS

Always there for youSince our humble beginnings over a decadeago, Francis & Associates started with justone idea in mind. That idea was to providethe healthcare industry with the very finestprofessionals for contract and permanentplacements across Canada.We continue to specialize in placingprofessionals in a variety of healthcare andrehab settings.At Francis & Associates, we employ apersonalized, comprehensive approach toyour employment search.You will benefit from our extensive marketknowledge, career-planning capabilities, andrefreshingly direct approach to professionalrecruitment.Whatever your reasons for contacting us,the personal attention and dedication webring to your search is key. Our objective isto find you a position that best allows you tomeet your personal and professional goalswith outstanding employers. To find outmore about us and opportunities:Contact: Francis & AssociatesPhone: 416-267-5626Toll-Free: 888-837-2624Fax: 416-267-9446Email: generalinfo@francis associates.comWebsite: www.francis-associates.com

VACANT POSITIONMAPLE RIDGE

Position: 0.8 FTE Pediatric Physiotherapist,Early Intervention Program Temporary(Maternity Leave)

This is an opportunity to work not only as ateam member in a family-centred way but todemonstrate and further develop leadershipcapability.

Qualifications:• Graduation from a recognized

university with a Master’s Degree,Bachelor’s Degree or diploma inphysiotherapy plus 2-3 years ofrecent, related experience workingwith young children who have a widerange of special needs

• Registered with the College ofPhysical Therapists of B.C.

• Current and valid B.C. Driver’sLicense.

• Current and valid First Aid Certificate• Criminal record checkSalary:As per HSA paramedical scaleStart Date: March 2006Please forward resume to:Brent FawdryRidge Meadows ChildDevelopment Centre12854-232 Street,Maple Ridge, B.C. V2X 6T9

Fax: 604-463-0026E-mail: [email protected]: www.rmcdc.com

VACANT POSITIONABBOTSFORD

Full Time Associate Physiotherapists• Full time associate position available.

Come join our multidisciplinary team ofthree Physiotherapists and twoKinesiologists.

• Position offers a great teach opportunityfor those interested in pursuing the PartA and B exams.

• Friendly, dynamic, and busy workenvironment.

• Mainly Orthopaedic and Sports Injurycaseload.

• Well-equipped 4000 sq. foot facility with8 treatment rooms and a large rehabgym.

Contact: Robyn WellsGlenn Mountain Physiotherapy#105 – 2526 Yale CourtAbbotsford, BC V2S 8G9Phone: 604-557-0198Fax: 604-557-0199

CLINIC FOR SALE• Busy, well established practice,

supports 1 to 2 Therapists• 5 rooms, and small well equipped

gym area• 16 years in this location, with large

referral base• Located 30 minutes southeast of

Vancouver• Owner retiringPhone: 604-592-6070Email: [email protected]

CLINIC FOR SALEON BEAUTIFUL

SALT SPRING ISLANDMove to the “Hawaii” of Canada, warm,beautiful and friendly community ofapproximately 10,000 in the winter and30,000 in the summer!Motivated to sell, for health reasons,any reasonable offer considered.• 10 years in the same location• 11 family physicians• Turn key operation• Established, well equipped clinic• WCB, ICBC, MSP and Private

caseloadContact: MichellePhone: 250-537-1087 or 250-537-1464Email: [email protected]: www.ssphysioworks.com

Two Vacant PositionsPhysiotherapist

1. Permanent Part Time(starting January 2006)

2. Locum (February, 2006)(East Vancouver)

Edward Wong PhysiotherapistCorporation. Position available inJanuary 2006 five half days a week.Manual skill and orthopedic experiencepreferred.

Contact: Edward WongWork: 604-251-6437Fax: 604-251-7406Email: [email protected]

Catch our AGM PainSeminar, April 29th 8:30amRise early to catch Neil Pearson’sfree seminar on Managing Clientsin Pain. This presentation willaddress four key factors -motivation, readiness to change,beliefs, and understanding of painneurophysiology. Effective andproven techniques will bedescribed to increase yourunderstanding, improve youroutcomes, and decrease yourstress when treating people whohave developed this complexbiopsychosocial problem.

Directions


Directions in PhysiotherapyDirections is published four times in 2006: Winter, Spring, Summer, and Autumn.

We welcome information of interest to the PABC membership. Please e-mail copy tothe PABC office by the deadline. Articles are limited to 500 words in length.

The editor retains the right to determine content. Unless specifically indicated,statements do not reflect the views or policies of the Association. Services or goodsadvertised are not endorsed by the Association.

Published byPHYSIOTHERAPY ASSOCIATION OF BRITISH COLUMBIA

Suite 402, 1755 West Broadway, Vancouver, BC V6J 4S5(604) 736-5130 / 1-888-330-3999 Facsimile (604) 736-5606

E-mail: [email protected] Website: http://www.bcphysio.orgProduction: Margaret Corrigall

TOLL FREE FOR MEMBERSPABC: 1-888-330-3999 / CPA: 1-800-387-8679

NEW Print DeadlinesSpring: April 1, 2006 Summer: July 1, 2006

For a rate card, please contact the PABC office at [email protected].

PABC BOARD 2005-2006President

Brian Riemer

Vice-PresidentGreater Vancouver/

Peace River Liard DirectorMeena Sran

Chair of FinanceKootenay Director

Kirby Epp

Okanagan DirectorJoan Russell

Public Practice LiaisonFraser Valley/Sunshine Coast Director

Kathy Doull

Private Practice LiaisonGreater Vancouver/

Peace River Liard DirectorRebecca Meeks

Central Interior DirectorDavis Rodrigues

Northwest DirectorMallory Glustein

Vancouver Island DirectorLynn Barton

Student DirectorSarah Adamson

Student Director DesignateCorinna Lee

External DirectorDr. Stan Leete

Chief Executive OfficerRebecca B Tunnacliffe

PABC Annual GeneralMeeting & Trade Show

Saturday, April 29th

8:30am – 4pm

Come to a stimulating day with yourcolleagues at a new location.

Metrotown Hilton is not only a lovelyhotel, it is on the Skytrain line, and

easy access by car from the Valley andNorth Shore. The hotel also has

discount taxi service.See insert for details.

Schedule:8:30 Treating and Motivating the

Patient in Pain, Neil Pearson10:00 PABC/CPTBC WAD II Case

Study Course, Carol Kennedy1:00 AGM and Awards2:30 Outreach Librarian, Eugene

Barksy3:15 Private and Public Practice

Updates

This year’s AGM is proving VERYpopular. We already have 125

registrations, and the room only holds200. The day includes complimentary

breakfast, lunch, and refreshmentbreaks. And meet our new

physician advisors.

Contact Stephanie [email protected] reserve your spot.

SPOTLIGHT ON DIRECTIONSBy Rosanna Frasson,Directions Coordinator

With a change in the format andfrequency of Directions implementedin early 2004, PABC surveyed themembership asking for feedback onthe newsletter and its content. As thenew newsletter coordinator, one ofmy first jobs was to tabulate thesurvey results and compare them tothe goals and objectives of thepublication. We received 105 re-sponses (6% of total membership)with many interesting comments andsuggestions. Here are the highlights:

Overall Impression:excellent (62%); good (36%)

Directions as a Source ofInformation on:

Physiotherapy: 83% rely onDirections. Rebecca’s email missives(46%), and PABC’s website (41%) arealso relied upon sources.

Professional Development: 86% useDirections, and 25% use PABC’swebsite.

Content Relevance: 70% findDirections useful and informative;85.5% read each issue, although notcover-to-cover, and the majority(64.5%) skims and reads specialinterest content only.

Answers to “What do you likeabout Directions?” ranged from aflattering “Everything” and “I thinkit’s great!” to:

• Keeping up to date and in touchabout colleagues, current topics andissues, courses.

• Short, interesting articles, not tootechnical like the boring CPA journal.

• Exposure to other areas of practice,PTs in developing nations andalternative techniques.

• Updates on fee negotiations andliaison reports.

>>>

Winter 200620

Directions

www.bcphysio.org

PABC/UBCProfessional Development Courses

• PABC communicates our priorities as anassociation.

• BC focused, awareness of currentpractice issues.

• Voices from the membership.

What should be improved? 26%expressed a variety of wishes rangingfrom:

• more candid discussions aboutongoing issues, more scientific basedevidence articles, more clinical articlesand more letters to the Editor (We doprint those we get, so please sendthem in!),

to more specific issues such as:

• c-sp manipulation and injury;• specific business articles on selling/

buying a practice, improving thebottom line, marketing;

• increase focus on real problems inprivate practice, such as low insurerfees that do not reflect the value of ourservice, etc;

· more info on long term care.

Some of the suggestions have alreadybeen implemented, including:

• book reviews;• a research update;• a section on different programs in BC• increased focus on alternative practices.

Ranking of content in order ofinterest

Member Services/Need to Know (72%)PD articles (67%)Cover clinical article (63%)What Members Are Doing/Members inthe News (56%)Academic Directions (54%)Private Practice (53%).Classified ads (57% sometimes read;37% always read)

Surprisingly, only half the membershipsometimes reads the President and CEOreports (56%), while some always readthem – Prez (41%) and CEO (33%).

We thank everyone who participated inthe survey. We value your input andencourage comments and suggestions atany time.

2006

February25-26 Mobilization of the Nervous System – NOI Level 1 Course This course

explores modern pain science research and offers a fresh understanding of,and management strategies for, common syndromes such as plantar fasciitis,tennis elbow, nerve root disorders, carpal tunnel syndromes and spinal pain.

Instructors: Sam Steinfeld and Laurie Urban. 8am-5pm, School ofRehabilitation Sciences, UBC. PABC Member Rate $450.

February – March – AprilInteractive Evening Lecture Series: Polishing the Professional

15 FebruaryChanging Perspective on Your Professional PracticeSpeaker: Kathy Scalzo. 6:30-8pm, UBC Robson Square. NEW Member Rate$25 on-site; $45 for teleconference.*

15 MarchMaking a Case for Publicly Funded Physiotherapy ServicesSpeaker: Scott Brolin. 6:30-8pm, UBC Robson Square. NEW Member Rate $25on-site; $45 for teleconference.*

12 AprilWorking with ICBC: A Lawyer’s AdviceSpeaker: Joseph Murphy, QC. 6:30-8pm, UBC Robson Square. PABC MemberRate $25 on-site; $68 for teleconference.*

*Register for all three evening lectures and pay only $60 onsite and $125 forteleconference.

May6-7 Anatomy Refresher – The Spine Take advantage of the gross anatomy lab

facilities at UBC. This course features hands-on time and instruction with thecadavers and clinician speakers to link theory to practice. Instructors: Dr.Donna Ford, Randy Celebrini. Sat. 8:30–5pm, Sun. 8:30–noon, UBC School ofRehabilitation Sciences. PABC Member rate: $350.

July18-19 The Sensitive Nervous System - NOI Level 3 Course (previously titled Explain

and Manage Pain). Prerequisite – Mobilization of the Nervous System. Learnabout pain neurotags, pain ignition nodes, homuncular refreshmenttechniques and virtual body exercises. Updated active and passiveneurodynamic techniques focusing on the cord, nerve root and some oftenneglected peripheral nerves are also taught. Instructor: David Butler. Tues. &Wed. 8:30am–4:30 pm, Location TBC. PABC member rate: $575.

20-21 Explain Pain You’ll be introduced to the newest knowledge about painneurotags, brain ignition nodes, zinging and zapping nerves, smudging in thebrain and backfiring nerves. You will learn about how the immune,sympathetic and cortisol systems can be critical in pain experiences. Instructor:David Butler. Thurs. & Fri. 8:30am–5pm, UBC Robson Square. PABC memberrate: $575.

For more information or to register, visit www.cstudies.ubc.ca/rehab, call604-822-1459, fax 604-822-0190 or e-mail [email protected]. Note:Student members receive a 40% discount when they fax a copy of theirstudent card.

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