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Editorial.

Submissions to the Journal have been rising in recent years, particularly international submissions, and at this mid-way point in the year the trend looks to be continuing through 2008. In this month's bumper issue we again have a range of content reflecting the breadth of our professional practice: original research reports in general musculoskeletal clinical practice and the cardio-respiratory field; an insightful professional perspective on clinical education; commentaries on neuro-rehabilitation and orthopaedic topics (Critically Appraised Papers); a germane and, at times, powerful keynote address on autonomy in the past and future of the physiotherapy profession; and practically the whole spectrum of clinical and professional issues in the abstracts of the 2008 NZSP Biennial Conference.

Routine use of standardized, valid outcome measures in clinical practice is still uncommon (Beattie and Maher 1997, Caulfield and Reilly 2003, Mrkness and Korner-Bitensky 2002, May 2003, Monk 2006), despite numerous socio-political pressures in the healthcare environment (Duckworth 1999, Haywood 2006). Reasons for poor uptake include multiple barriers to use, such as clinicians perceptions regarding time and relevance, and the limitations of many available measures with respect to validity and psychometric properties (Feinstein et al 1986, Greenhalgh et al 1998, Greenhalgh et al 2005, Greenhalgh and Meadows 1999, Stratford et al 1996). Given the many important uses for clinical outcome measurement tools--such as monitoring change in patients' status; setting therapeutic goals; quantifying effectiveness of interventions in research; contribution to quality assurance monitoring; justifying treatment to third-party payers; and informing health-care policy--it is encouraging to see another trial of the routine use of outcome measures in clinical practice appear in the Journal. The research report by Hefford et al (2008) leading this issue is another step in the wake of an informative trial in 'the real world' published in the Journal two years ago (Monk 2006). Work in this field is timely, in the context of recent NZSP recommendations (Copeland 2008). This report, and ongoing research by Hefford et al, seeks to provide readers with useful, practical, feasible answers to the perceived problems limiting uptake of routine outcome measure use in New Zealand clinical practice.

Clinical Education is, of course, essential to the production of a new generation of competent practitioners. The pressures facing clinical education have been the focus of recent NZSP Newsletter columns, and in this issue Mooney et al (2008) turn the microscope to the socio-political pressures facing the clinical educator. It is timely that Martin Mdd, in his invited commentary to the article by Mooney et al, is able to inform readers of progress being made toward the formation of new Education Special Interest Group, following a foundation meeting at NZSP Conference (Mdd 2008).

The Journal has a long tradition of publishing the abstracts of the NZSP Biennial Conference, and is developing more recent tradition of publishing salient keynote addresses (Ratima et al 2006). In this issue we publish the transcript of the closing keynote address of the 2008 NZSP Biennial Conference, by eminent ex-patriot New Zealander Professor Stanley Paris (Paris 2008). Two years ago, this journal had the privilege of reprinting Dr Paris's Mary McMillan Lecture (Paris 2006a, Paris 2006b). In this 2008 keynote address, Professor Paris reminds us of the history and importance of autonomy in the profession of physiotherapy. As one of the world's most influential physiotherapists--of which New Zealand has produced many in Dr Paris's generation (Abbott 2006)--instrumental in founding the International Federation of Orthopaedic Manipulative Therapists (IFOMT), the Orthopaedic Section of the American Physical Therapy Association, and the largest physical therapy school in the USA, Dr Paris, at age 71, brings to this address a wealth of wisdom, courage and inspiration. In this address, Dr Paris challenges our profession to respect the rights (and responsibilities) hard-won by our forbears, to confront apathy or external resistance and assert ourselves as "the [autonomous] profession of choice; the primary care practitioners for the restoration, maintenance and enhancement of the physical functioning of the individual" (Paris 2008).

At the Journal, we place a great deal of importance on maintaining the trust of our readers by ensuring all scientific and professional perspective articles undergo rigorous peer-review, including both Honorary Editorial Committee members and external peer reviewers. Sourcing and maintaining a pool of content-area experts across all fields of the profession is a challenge to any journal, as the skills required are specific and relatively rare. However, a growing number of physiotherapists have gained these skills through post-graduate education and the fruits of lifelong learning. If you have published an article before, or have achieved a masters degree or higher level qualification in any field of professional practice or scholarship, you are the peer of many of our authors--and we need you! If you would like to volunteer your services as a peer-reviewer for the Journal, please contact the Editor at editor.nzjp@mac.com. We provide training and guidance for novice reviewers, and will be very happy to hear from practitioners with expertise in general or niche fields of professional practice.

Readers, of course, subject our content to their own peer-review whenever they read an article. Critical reading, and challenging interpretations, is something required of every true professional, and is certainly something we encourage at the Journal. So I am delighted to see a surge in Letters to the Editor in recent months. When a reader is so moved by our content to respond via a letter, it engages all of our readers in the debate, so these are something I would love to see more of. In this issue, turn to Letters to the Editor to see a response to a past Critically Appraised Paper by the author of the original article appraised; debate on the effectiveness of therapeutic ultrasound; and a wonderful correspondence from an avid international reader of the Journal, remembering back to content in long past issues. I look forward to more correspondence from readers stimulated by our content.

REFERENCES

Abbott JH (2006): Editorial. New Zealand Journal of Physiotherapy 34(3): 117-118.

Copeland J (2008): Outcome measures and treatment justification. New Zealand Society of Physiotherapists Inc. Newsletter. http://www.physiotherapy.org.nz/IndexO2/ members /PDF%20Files/OutcomeMeasuresResearch%20 Column%20NZSP%200utcome%20Measures%20and%20 Treatment%20Justification.pdf [Accessed 20 July, 2008].

Beattie P and Maher C (1997): The role of functional status questionnaires for low back pain. Australian Journal of Physiotherapy 43: 29-38.

Caulfield B and Reilly C (2003): Outcome measurement in physiotherapy--why and how? Physiotherapy Ireland 24: 8-11.

Duckworth M (1999): Outcome measurement selection and typology. Physiotherapy 85: 21-27.

Feinstein AR, Josephy BR and Wells CK (1986): Scientific and clinical problems in indexes of functional disability. Ann Intern Med 105: 413-420.

Greenhalgh J, Long AF, Brettle AJ and Grant MJ (1998): Reviewing and selecting outcome measures for use in routine practice. J Eval Clin Pract 4: 339-350.

Greenhalgh J, Long AF and Flynn R (2005): The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory? Soc Sci Med 60: 833-843.

Greenhalgh J and Meadows K (1999): The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review. J Eual Clin Pract 5: 401-416.

Haywood KL (2006): Patient-reported outcome: Measuring what matters or just another paper exercise? Musculoskeletal Care 4: 63-66.

Hefford C, Lodge S, Elliott K, Abbott JH (2008): Measuring patient-specific outcomes in musculoskeletal clinical practice: a pilot study. New Zealand Journal of Physiotherapy 36(2): xx-xx.

Kidd M (2008): Invited commentary on Mooney et al (2008): The tensions of the modern-day clinical educator in physiotherapy: a scholarly review through a critical theory lens". New Zealand Journal of Physiotherapy 36(2): xx-xx.

Kirkness C and Korner-Bitensky N (2002): Prevalence of outcome measure use by physiotherapists in the management of low back pain. Physiotherapy Canada 54: 249-257.

May S (2003): An outcome audit for musculoskeletal patients in primary care. Physiotherapy Theory and Practice 19: 189-198.

Mooney S, Smythe L, Jones M (2008): The tensions of the modern-day clinical educator in physiotherapy: a scholarly review through a critical theory lens. New Zealand Journal of Physiotherapy 36(2): xx-xx.

Monk C (2006): Measurement of functional improvement in patients receiving physiotherapy for musculoskeletal conditions. New Zealand Journal of Physiotherapy 34: 50-55.

Paris SV (2008): Autonomy and the future of physiotherapy. New Zealand Journal of Physiotherapy 36(2): xx-xx.

Paris SV (2006): In the best interests of the patient. New Zealand Journal of Physiotherapy 34(3):119-130.

Paris SV (2006): In the best interests of the patient. Physical Therapy 86:1541-1553.

Ratima M, Waetford C, Wikaire E (2006): Cultural competence of physiotherapists: reducing inequalities in health between maori and non-M New Zealand Journal of Physiotherapy 34(3): 153-159.

Stratford PW, Binkley FM and Riddle DL (1996): Health status measures: strategies and analytic methods for assessing change scores. Phys Ther 76: 1109-1123.

J. Haxby Abbott, PhD, MOT, FNZCP

Editor, New Zealand Journal of Physiotherapy
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Title Annotation:outcome measure use in clinical practice.
Author:Abbott, J. Haxby
Publication:New Zealand Journal of Physiotherapy
Article Type:Editorial
Geographic Code:8NEWZ
Date:Jul 1, 2008
Words:1483
Previous Article:1. Practical Evidence-Based Physiotherapy.
Next Article:Measuring patient-specific outcomes in musculoskeletal clinical practice: a pilot study.
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