How physiotherapy lengthens lives and cuts costs

Opinion: Physiotherapy services should be at the centre of policy development

Chartered physiotherapists are uniquely positioned within healthcare to offer expert advice and treatment to people with a variety of health conditions. Photograph: Thinkstock

Chartered physiotherapists are uniquely positioned within healthcare to offer expert advice and treatment to people with a variety of health conditions. Photograph: Thinkstock

 

Chartered physiotherapists are the only health professionals with expertise in movement and exercise throughout the lifespan and across the health spectrum. Physiotherapy services lead to improved population health outcomes and decreased health and social care costs – but they are underused in Irish healthcare.

Access to physiotherapy leads to earlier discharge from hospital and can keep patients out of hospital. By reducing the length of a patient’s stay in hospital, chartered physiotherapists free up resources within the health service and improve the effectiveness and efficiency of public healthcare.

There are only 55 physiotherapists per 1,000 of the population in Ireland. This is among the lowest in Europe, placing Ireland alongside Estonia, Greece, Hungary, Slovakia and Slovenia. At the same time, Ireland is falling behind international standards in respect of health outcomes.

This year, the World Health Organisation forecast that Ireland was on course to become the most obese country in Europe.

A more integrated approach to dealing with Ireland’s health problems – in which the value and usefulness of physiotherapists is recognised – would reduce costs and improve results.

In order to transform and achieve improved health outcomes, increased resourcing and funding must be provided for physiotherapy in the public health system. Instead of the current underutilisation of physiotherapy as part of a wider healthcare strategy, it should be placed at the centre of policy development.

Health problems

Physical inactivity is among the most significant global health problems of the 21st century. It is the fourth-highest cause of mortality worldwide and is in the top 10 causes of death and disability in moderate-to-high income countries.

Worldwide, it is estimated that physical inactivity causes between 6 per cent and 10 per cent of the major noncommunicable diseases (NCDs) – such as coronary heart diseases, type 2 diabetes, breast and colon cancers – making physical inactivity as risky as obesity and smoking in terms of health outcome.

Last year, the economic cost of obesity and physical inactivity in Ireland was estimated at €1.1 billion per year.

Chartered physiotherapists are uniquely positioned within healthcare to offer expert advice and treatment to people with a variety of health conditions. A significant proportion of common conditions and diseases are most effectively treated with a treatment plan that includes physical activity both within medical facilities and in the community.

As experts in movement and exercise, and with a thorough knowledge of functional anatomy and pathology and its effects on all systems, they promote, guide, prescribe and manage exercise activities.

Chartered physiotherapists facilitate early intervention and help to prevent episodes of ill-health and disability developing into chronic conditions. Given the centrality of physical activity to improving health outcomes across the population, physiotherapy services should be an integral part of health strategy.

A modest deployment of resources to physiotherapy services can have a profound impact on the treatment of musculoskeletal disorders. For example, the provision of 24 chartered physiotherapists in the public health system led to more than 48,000 orthopaedics and rheumatology patients being removed from consultants’ waiting lists between October 2013 and May 2015.

Advice and treatment from a chartered physiotherapist soon after diagnosis of MS can reduce disability, maximise independence, improve the viability of employment and reduce the impact that the disease has on health and quality of life factors.

In particular, their expertise in physical activity and exercise is effective in providing treatment to people with MS and improving their personal and professional lives.

Cost-effective

Chronic Obstructive Pulmonary Disease (COPD) is expected to be the third leading cause of death worldwide by 2020 (it is currently the fourth). Pulmonary rehabilitation programmes are clinically effective and cost-effective in improving health and quality of life, reducing length of hospital stay and reducing the number of hospital readmissions for people with COPD.

These programmes are most efficient in situations where they are self-managed following treatment and advice from a chartered physiotherapist.

Physiotherapy-based cardiac rehabilitation programmes are clinically effective in reducing mortality figures improving population health and quality of life, reducing the length of hospital stay for patients, and reducing the incidence of hospital readmissions.

The chartered physiotherapist’s experience is critical in the assessment of cardiac patients, as many present with non-cardiac conditions such as arthritis, back pain, joint replacements, stroke and respiratory problems. The exercise elements of a cardiac rehabilitation programme lead to better healthcare outcomes than traditional healthcare.

Chartered physiotherapists have a major role when it comes to improving health, especially in tackling the problem of increasingly sedentary lifestyles, advising schools and industry about office and classroom ergonomics, as well as health behaviour change and exercise.

Health policy- and decision-makers need to recognise the intrinsic value of chartered physiotherapy, which has the capability to influence significant cost savings and reduce waiting lists in the healthcare system and play a lead role in preventative healthcare. Jill Long is president of the Irish Society of Chartered Physiotherapists

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