Matt Low - Knowledge Translation Officer, MACP
I recently attended the prestigious IFOMPT 2024 conference in Basel, Switzerland, alongside members of the MACP, including both long-standing members and newcomers. This brief article only scratches the surface of the depth of the conference but expresses some, though certainly not all, of my personal highlights.
Basel, situated at the intersection of the River Rhine where Switzerland borders Germany and France, was aptly chosen for the conference’s theme: “Crossing Bridges.” Dr Eva Würfel underscored this in her opening ceremony speech.
There was much to celebrate, particularly as the 2020 IFOMPT conference was cancelled due to the COVID-19 pandemic. The organising committee, SVOMP, was instrumental in the conference’s success, working diligently over the past four years. After an intriguing performance by musicians in harlequin masks and animal costumes, it was clear the international representation was strong, as countries paraded in with their flags.
Celebrating 50 Years of IFOMPT: Some of the key contributors to the conference
Celebrating 50 Years of IFOMPT
The opening ceremony featured a 50-year celebratory video that articulated the history of IFOMPT, describing the events and evolution of science, technology, cultural, and societal change.
Dr Claire Ardern’s Keynote: Right Care, Right Place, at the Right Time
Dr Claire Ardern provided the opening keynote, a significant achievement given the short notice. Her presentation, “Right Care, Right Place, at the Right Time,” emphasised listening to people with lived experiences and the global burden of musculoskeletal disorders. She drew from Joetta Belton’s work and the World Health Organization’s call for action, advocating for transparency in science and high-value healthcare that ensures equality and equity.
Dr Ardern highlighted how value care must be evidence-based, timely, available to everyone, and provide the best outcomes. She spoke about the importance of community engagement, empathetic listening, and validation for those in pain. Additionally, she acknowledged Professor Peter O’Sullivan’s work on cognitive functional therapy, a significant advancement for those with persistent pain.
The Evolution of Digital Health and AI
A major focus of the conference was the evolution of digital health, tele-rehabilitation, and artificial intelligence (AI). Dr Eric Robertson from the USA eloquently discussed AI in a focus symposium session. He acknowledged biases within AI code and the ethical challenges but emphasised the necessity of embracing AI. Dr Michael Rowe highlighted the power of generative AI in personalised learning and virtual simulations, cautioning against potential over-reliance on AI and the loss of critical thinking skills.
Dr Rowe warned of the risk of oversimplifying complex topics and the widening gap between education and clinical practice with AI. Ethical concerns about academic integrity and AI-generated content were also raised. However, he suggested that these challenges could be addressed through the careful and clear use of iterative AI prompting. This area was fascinating and insightful and echoed repeatedly in different guises throughout the conference.
Understanding the Future of Physiotherapy: Insights from Professor David Nicholls
I was honoured to chair the second day’s keynote address. Professor David Nicholls, from the University of Aukland, tackled some of the most pressing issues facing the field of physiotherapy today. Although he was unable to attend in person due to postgraduate commitments, Dave delivered an excellent, thought-provoking talk that was recorded for wider accessibility. I am sure that it will be released through the IFOMPT website soon. Given the breadth and depth of his talk, what I mention below gives a glint and an overview of its content.
Contemporary Challenges in Physiotherapy
Dave began by outlining the myriad challenges currently confronting the physiotherapy profession. These challenges encompass social, educational, and technological transformations that impact all healthcare professions, including physiotherapy. Among these issues are chronic complex comorbidities, public funding cuts, declining trust in authority figures, unmet healthcare needs, and a widening social gradient. He highlighted the increasing competition in the healthcare marketplace and the democratisation of knowledge through platforms like YouTube, which now offer vast amounts of information previously accessible only through professional training.
Specifically, he noted concerns about the physiotherapy profession being spread too thin, with a declining status, being encroached upon from other professional groups, and a lack of clear future direction. He pointed out the profession’s limited tools for social, philosophical, and historical analysis and the general disappointment in the outcomes of evidence-based practice. The shift from an acute, curative model to one that handles chronic conditions has also posed significant challenges.
Forces Shaping the Future
Dave identified three major forces radically reshaping physiotherapy: late capitalism, unbundling, and digital disruption.
1.Late Capitalism
Dave explained how the transition from early to late capitalism has created a new market within the body and health. This economic shift has opened healthcare to private practice, turning the body into a market for capitalist expansion. He highlighted the atomisation of the body into numerous problems, each requiring its own expert, leading to increased anxiety and consumption of health-related products and services.
2.Unbundling of Expertise
He discussed the critical view of professions as self-interested and elitist, losing their altruistic image portrayed years ago. The unbundling of expertise has led to a loss of professional monopoly, allowing new experts to emerge and challenge traditional professional roles. He warned of the negative effects, or “professogenic effects,” on society, such as limiting access to healthcare in impoverished areas while clustering services in affluent urban areas. The “professogenic effect” is akin to the “iatrogenic effect” in which a side-effect of treatment manifests deleteriously on the health and wellbeing of a patient. The “professogenic effect” are the negative effects on society that are systematically produced by having professions in the first place. For example, by having professions that limit access to healthcare services they serve to maintain a monopoly control over the market.
3.Digital Disruption
The rise of digital technologies, such as AI and machine learning, is transforming healthcare delivery. He emphasised that these tools, with their vast storage and processing capabilities, are reshaping how people access information and services. He cited examples like AI-driven diagnostic and rehabilitation services, which are challenging traditional physiotherapy models by offering personalised, 24/7 accessible care at lower costs.
Dave then outlined four potential responses to these challenges within the healthcare professions, all of which are unsatisfactory, drawing from his previous work:
Watching and Waiting
This approach involves maintaining the status quo, which, while comforting for practitioners, risks obsolescence and being outpaced by more agile competition.
Modern Heritage
This response advocates a return to traditional practices and core strengths. While it provides a clear identity and continuity, it risks appearing conservative and resistant to necessary change.
Renaissance
This approach calls for a radical redefinition of physiotherapy, moving away from the body-as-machine model to a more humanistic, person-centred practice. However, it risks alienating the medical profession and complicates the understanding of pain and illness.
Hybrid Approach
Combining the best of traditional and new practices, this approach aims to be holistic and expansive. However, it may lead to a loss of clear professional identity and philosophical coherence.
Embracing Post-Professionalism
Dave concluded by urging the profession to embrace the post-professional era as an opportunity for reinvention. He suggested “hollowing out” the profession by removing routine, standardised tasks and focusing on the core intensities that have always defined the physical therapies. This approach involves removing anything that can be easily replaced by cheaper alternatives or automated systems, thereby preserving the unique, most impactful aspects of physiotherapy.
Ultimately, Dave advocated for a future where physical therapies are returned to the commons, made accessible to all, and reimagined in collaboration with human and non-human communities, situated in an ecological landscape. This vision aims not to preserve the traditional professional identity but to make the benefits of physical therapies widely available and adaptable for the future.