Physiotherapists put their hands up to help relieve load on GPs

Published on www.stuff.co.nz on 11th of July 2022.

Physiotherapists say they could help relieve pressure on general practices by seeing more people with complaints such as soft tissue injuries and joint pain. Palmerston North physiotherapist Fiona O’Connor said they see and treat people without them having to see a GP first. She said part of the problem was that a lot of people were not aware they could go directly to a physiotherapist. If people had an injury such as a sprained ankle, ACC would partly cover the cost of their physiotherapy treatment. If a physiotherapist was concerned there could be a fracture or other serious injury, they could make a referral for an x-ray or scan. “People in the community probably don’t understand they can come to us with something like a sore knee straight away. They don’t have to go to ED for an X-ray.” O’Connor said she had been in touch with the primary health organisation Think Hauora to see how they could work together to promote physiotherapy as an alternative to GP appointments or ED visits. She said physiotherapists could help people with long-term conditions such as osteoarthritis and joint pain, but unless people had relevant health insurance, that came at a cost to the patient.

Physiotherapy New Zealand chief executive Sandra Kirby said there was capacity for physiotherapists to see more people now, while primary health care was under pressure, and in future as the health reforms bedded in. She said there was international and national evidence that physiotherapy could help manage muscle and joint pain, and was better than painkillers in improving people’s quality of life and delaying the need for hip and knee surgery. The problem was that it was not funded. “What stops people asking for us is that they don’t know they can come to us directly, and that it’s not subsidised unless it’s an accident.” She said the establishment of Health New Zealand gave physiotherapists hope that their long-term patients might be funded in future. Physiotherapists were talking to health leaders and primary health organisations, and there were some pilots underway for funded access, but not in MidCentral. “What we are calling for, and what the language being used suggests it might happen, is that people get access to funded primary care from physiotherapists. “But the only way that will happen at the moment is if primary health organisations give us some funding to enable people to access our services.” Kirby said although there was a shortage of physiotherapists in parts of the country, they still outnumbered GPs, and had capacity to help. “If everything was fully funded, then we would need more of us.”

Managing Long COVID in Aotearoa

Published on www.pnz.org.nz on 16th of May 2022.

Research shows that as many as one in eight COVID-19 patients could get Long COVID, which means there are likely hundreds of New Zealanders still experiencing symptoms 12 weeks after testing positive. New Zealand physiotherapists have been working closely with their counterparts overseas to find out more about Long COVID and how best to support those suffering long-term effects.

Physiotherapy New Zealand (PNZ) spokesperson Dr Sarah Rhodes says it is understandable that patients with Long COVID are increasingly frustrated that their recovery is so slow as the symptoms can persist for months and years in some cases. PNZ calls on the government to support people’s access to effective treatment for Long COVID, just as they have supported people through the pandemic. “We know that COVID-19 affects people differently and it is the same with Long COVID. It doesn’t only affect those who are hospitalised with an acute COVID infection. It can also affect those whose initial symptoms are mild and even those who are asymptomatic with the acute COVID-19 infection.”

“The desire to get back to normal life after COVID-19 is understandably important for all of us. With today’s busy lifestyles, it’s often hard to be that person who needs to rest instead of going back to work, getting back into your leisure activities, and looking after children and/or older family/whānau members. However, rest is an essential part of managing an acute COVID-19 infection as it is likely to reduce the risk of developing Long COVID,” says Dr Rhodes.

Members of PNZ’s Cardio-Respiratory Special Interest Group have developed some general tips to help guide people through a prolonged period of symptoms.

Fatigue

This is the most common symptom of Long COVID. Undertaking daily activities which were easily managed prior to COVID-19, such showering, can be exhausting.

Be kind to yourself. Don’t take on too much. Ask for help.
Working out which tasks require more or less energy can help you prioritise your time and activities so that you stay within your available energy levels. Keeping a diary of how you feel after each activity can be useful in identifying which activities make you more or less fatigued.
Pace yourself by doing small tasks or breaking up activities and allowing yourself to take rests in between. Choose some activities that you give you pleasure to help support your mental well-being.
Plan out your week to allow for periods of activity and periods of rest and recovery.
Take regular breaks throughout the day and if you need a rest, listen to your body. Don’t push through the feeling of exhaustion.
When fatigue is worsened by physical or mental effort, this may indicate you have post exertional symptom exacerbation (PESE). Exercise is not recommended for rehabilitation of people experiencing PESE as it can worsen symptoms. A physiotherapist can help support you in managing your fatigue.
Remember that some activities, like being with friends, may contribute to symptom exacerbation. Connecting with others is important for your mental well-being so you may need to reduce the time you spend with others to conserve your energy for other activities in the day.
Adapt activities to make them easier. e.g., sitting down to prepare the vegetables for dinner.
Getting outside and spending time in nature can have benefits for both your mental and physical health.
Breathlessness

Breathlessness is another commonly experienced symptom in those with Long COVID.

Feeling breathless can be a frightening experience.
Seek support from a physiotherapist about positions and breathing techniques that can help alleviate feelings of breathlessness.
It is important to get an individual assessment of your breathing as a one-size-fits-all approach doesn’t work.
A physiotherapist can also screen for disruptions in your pattern of breathing that may contribute to some of the symptoms you are experiencing.
Muscle and Joint Pain

Some patients with Long COVID experience muscle aches and joint pain. Gentle stretching and yoga may help relieve these symptoms.
Check with your health professional before starting any exercises.
Return to exercise

Exercise is not recommended if it worsens your fatigue.
If you are not experiencing worsening symptoms, a cautious approach to commencing exercise is recommended. Your response to exercise should be monitored carefully. A safe return to exercise requires careful clinical decision making and a physiotherapist can support you through this.
Physiotherapy can help manage symptoms of Long COVID. However, for some patients a multi-disciplinary approach, involving other health professionals, is recommended.

The Physiotherapy New Zealand Cardio-Respiratory Special Interest Group represents cardio-respiratory interests among the physiotherapy profession. Cardio-respiratory physiotherapists are present in ED, the acute wards and ICU, where they are fully involved in the acute care of patients admitted to hospital with COVID-19 symptoms and help with their breathing and rehabilitation needs. Cardio-respiratory physiotherapists also work on rehabilitation wards in hospitals and in the community.

Returning to Exercise after a Covid-19 Infection

Published on www.axissportsmedicine.co.nz on 11th of March 2022 by Dr Mark Fulcher.

Slow and steady

Generally, COVID infection symptoms settle over 3-7 days within the infectious period. When a patient feels that their illness has resolved, most are safe to start returning to some physical activity. Given that the SARS-CoV-2 virus can  involve a number of systems, including the heart, kidney, blood, brain and wider nervous system, the resumption of activity should be slow and steady. The duration and intensity of activity should be guided by both physical and psychological factors. Increasing the volume and intensity of activity too quickly can prolong fatigue and other symptoms, making getting back to even the most basic activities of daily living difficult and frustratingly slow. It should be highlighted that prolonged rest can also be counterproductive. This can lead to significant morbidity including persisting fatigue, weakness and other symptoms.

Fortunately, here in Aotearoa, we have the experience of clinicians managing return to activity, exercise and sport in other countries where COVID has been around for two years. Their experience, and those of their patients, has helped shaped best practice and safe management.

Recovery can take 3 – 6 weeks. Pace yourself

Returning to a normal level of activity or sport generally takes about 3 weeks but can often take much longer for those who have had a more severe illness, especially those who have been hospitalized. As a rule you should wait 7 days after being symptom free before starting to ‘exercise’ again. The important message is that returning to activity and exercise is important for recovery of physical and psychological wellbeing, but must be in a step wise fashion, ensuring you are able to recover well from each exercise bout without ongoing symptoms before progressing to the next level. Adequate sleep, good nutrition, hydration and social connection are also vital to help you recover well. Some practical tips are to:

  1. Try to remain active while you are isolating at home (if your symptoms allow).
  2. Start with small volume of low-intensity aerobic exercise, walking is an excellent option.
  3. Avoid returning to more intense exercise, for example heavy resistance training or running, for at least seven days after your symptoms resolve
  4. Plan a graded return to activity, for example start by increasing your walking distance and intensity, progress to include some bouts of running within your walk, then increase the amount of running.
  5. You may feel more tired than normal, listen to your body and make sure that you get enough rest.

New Study Into How Kiwi Women are Recovering from Knee Surgery

Published on www.stuff.co.nz on 6th of April 2022.

A new study into how Kiwi women are recovering from knee surgery involves a groundbreaking rehab programme especially tailored to sync with a woman’s menstrual cycle.

Knees are the bane of a sportswoman’s career. Just ask netballers like Monica Falkner, Georgia Heffernan and Bailey Mes, Black Stick Kelsey Smith or Football Fern Hannah Wilkinson. And Black Ferns Ruahei Demant and Ariana Bayler, who’ve both had their knees rebuilt three times. Each year, around 3000 New Zealanders undergo surgery on their anterior cruciate ligament, better known as ACL. Almost half of those knee reconstructions are on women. But the most worrying statistic is that it’s happening more to teenage girls than any other age group. Research in 2019 showed over the past decade, there’s been a 120 percent increase in the number of 15 to 19-year-old girls undergoing ACL surgery.

There’s also growing concern that females aren’t recovering from their surgeries as well as males are. And a big part of that problem is, as most sport science has been dominated by male-based research, most rehabilitation programmes for ACL injuries are tailored for men. What hasn’t been studied well is the role a woman’s menstrual cycle can play in her recovery. So physiotherapist Emma O’Loughlin has created a study as part of her PhD thesis at the Auckland University of Technology to better understand how the menstrual cycle affects rehabilitation after ACL surgery. With the help of physiotherapy professor Duncan Reid and renowned female athlete physiologist Dr Stacy Sims, she’s designed a rehab programme specifically for women, now being trialled around New Zealand.

“Women are more likely to not be doing as much activity after their surgery as men do, and are not as likely to return to sport afterwards,” says O’Loughlin, who’s also an ultra runner. “And on a more simple level, they aren’t as strong, so they don’t have as much recovery of their muscle strength after surgery. “So that’s what we’re looking at. We’re gathering women from all around the country, then working with surgeons and physios to give them a female-specific rehab programme. “Every woman who does her ACL – whether they’re a sportswoman or a mum who’s hurt her knee bouncing on the trampoline with her kids – should be engaging in high quality rehab. And that’s what we’re providing.” It’s a strengthening programme, working in combination with phases of a women’s menstrual cycle.

O’Loughlin is still looking for women who are aged over 16 and have a regular menstrual cycle. Six weeks after their surgery, they engaged in the 12-week rehab programme through a physio. “We’re working with their physiology to get them do strengthening exercises, measuring before the trial and after, then comparing them with people who are engaging in normal physiotherapy,” she says. So far into the trial, the evidence points to women returning stronger having done their exercises timed with their menstrual cycle.

“From day 1 to 14 of your cycle, you’re building levels of oestrogen – which is like a female version of testosterone, an anabolic that helps to build muscle. Once you release the egg, for the second half of your cycle, you’re releasing progestin that opposes the oestrogen, and stops it working so well to build muscle,” O’Loughlin says. “What the evidence says so far is that, by and large, if you carry out a lot of your resistance training – your squats, leg presses, lunges, knee extensions, bicep curls – in the first half of your cycle before you release your egg, and you repeatedly do that for three to four months, at the end of the trials women have an increased strength through menstrual cycle-based rehab training.

“There are stages of our cycle where we feel better, or a bit grotty. It may be a good time based on how we’re feeling to carry out those high intensity sessions between the first day of your period and ovulation. “Alongside that, there’s some evidence that it might increase lean body mass – actual muscle bulk.” O’Loughlin is quick to point out that cycle-based rehab isn’t “the golden ticket” that patient wants – a quicker rehabilitation. Most athletes take between nine and 12 months to return to sport. “We look at whether the injured leg has the same strength as the other leg, or if there’s less than 10 percent difference around the six to nine-month mark. What we expect is women are better placed to pass the criteria tests at that time,” O’Loughlin says.

Duncan Reid says O’Loughlin’s study is critical for developing rehab programmes that work for women. “Women are not only behind the eight ball because they’re not as strong as men. The programmes developed for ACL rehab are all based on men, which is a problem,” Reid says. “And if you don’t get the strength back in your knee even though you’ve had it repaired, you’re predisposing yourself to quite significant osteoporosis further down the track. “Women are going to be more likely to have a knee replacement at a younger age. You’d expect women in their 70s, but I’m seeing women in their 50s because of injuries they sustained as young people.”

Some sports, like netball, have developed injury prevention plans in partnership with ACC. NetballSmart, for example, has reduced the incidence and severity of injuries by getting players to do a 15-20 minute dynamic warm-up. “Netball is really interesting because there’s a lot of really good work being done to reduce the number of injuries,” says Reid. “But netball is also the perfect storm for rupturing your ACL because you only take two steps and you twist and turn. Even with the best intentions, as you see at our elite levels, people will still rupture their cruciate. “The other part of this puzzle is the second rupture. If you’ve done it once you’re predisposed to the second one. But we’re hoping across the world better designed rehab programmes will reduce the chance of having a second or third event.

“Because they cost hugely – both financially and the personal cost. After nine to 12 months rehabbing with the first one, the thought of going through that for a second time is just depressing.” In the study to help women return from knee surgery stronger, there’s another hurdle facing both patients and physios – talking about periods. “When we designed the trial, we learned physios see the menstrual cycle as something they don’t know a lot about, but it’s something they’re super interested in learning about,” O’Loughlin says. Some cultures still consider it taboo to talk about menstruation, but technology is helping.

“A lot of the female athletes are now tracking their cycles through apps on their phone, like FITR Woman, Flo and Clue. A lot of the female physios are too,” O’Loughlin says. “It’s become more normalised to talk about it in the last few years.” There are now more than a dozen women involved in the trial, with numbers increasing in Auckland since sport and elective surgeries have returned, after been cut during the Covid lockdowns. O’Loughlin hopes to have around 50 women rehabbing to their menstrual cycles by the end of the year.

ACC Claims for Home Workout Injuries More Than Triple to Over $1m Post-Covid

Published on www.stuff.co.nz on 21st January 2022.

Experts have cautioned Kiwis to take care with their home workouts as ACC data shows claims more than tripled to over $1m after lockdowns began. The rise in popularity of home-gyms, recently predicted to be a top fitness trend of 2022, has seen a massive increase in ACC claims tagged with “home” and “workout”. ACC data shows the number of new claims in 2021 was 1,574 – an increase of more than 300 per cent since 2019, which saw only 508 claims.

The total costs of active claims for home workout injuries has increased almost 400 per cent, with the total cost in 2021 $1,027,856 compared to just $268,858 in 2019. New home injury claims correlate with the timing of lockdowns due to Covid-19 in New Zealand. Claims increased by more than 100 percent in April 2020 compared with the same month in 2019.The number of claims also rose significantly in September through to December 2021. Auckland-based personal trainer Alistair Boyd said Covid-19 has resulted in more people focusing on their health and realising the convenience of working out at home. But he said doing so can lead to injury if people were didn’t understand the fundamentals of movements or workouts. “Training yourself, without any prior knowledge or experience can be dangerous,” he said, adding that often an exercise will feel right to somebody, without realising they’re making mistakes. “That’s when those injuries can occur.”

Even when training at home, Boyd advised seeking help from a professional in order to avoid injury. “The key thing where a trainer or coach adds value and benefit is checking technique, form and injury management,” he said. Soft tissue injuries were the most common injury, with 1,532 claims in 2021. Backs were the most reported injury site, with 524 new back and spine claims in 2021.

Auckland led the country in the number of home workout claims, with 858 new claims in 2021 – almost a 400 per cent increase from 2019. ACC Injury Prevention Leader, James Whitaker, said homes are the most common place Kiwis get injured. He stressed the importance of injury prevention when working out at home. “If you haven’t been active for some time, start small and work up to longer workouts. Building strength and mobility just a little bit each day will add up quickly and prevent injuries.”

ACC Data Shows Huge Cost of Avocado-Related Injuries

Published on www.1news.co.nz 10th January 2022.

You’ve guac to be joking! Pays to avo’ think next time you’re preparing brunch…

From a toast topping favourite to a key ingredient in some of our go-to dips, avocados are becoming a staple of New Zealand food culture. But new data shows avocado-related injuries are costing hundreds of thousands of dollars each year – and climbing. Figures from ACC show a record 626 Kiwis lodged an avocado-related claim in 2020, with claims that year totalling $680,000. That’s up from $392,000 in 2019, when 525 Kiwis lodged accident claims.

New Zealanders are now eating more avocados then ever – industry group New Zealand Avocado reported earlier this year sales had doubled over a five year period, from $30 million in 2015 to $60 million in 2020. “Avocados are getting more popular year-on-year and injuries are going up accordingly,” says ACC Injury Prevention Manager James Whitaker. “People are holding the avocado in their hand and they’re cutting it while it’s in their hand and then that cuts their fingers, their thumbs and their wrists.”

The number of avocado-related claims has increased by a third between 2016 and 2020, with more than a quarter of these injuries occurring in December and January. As of October 31 last year, there had already been more than 500 avocado injury claims. Danielle Rangi, a chef at Fidel’s Café in Wellington says most people make mistakes when removing the stone. “They’re probably hitting it too hard, missing the stone, slip, cut.” ACC recommends always using a chopping board when slicing up an avocado. “Those injuries are preventable, at least 90 per cent of the time,” says Whitaker. “Take the time to have a step back, think about how you can do it safely, and then get into it.”

Golfer’s Elbow (Medial Epicondylitis)

Golfer’s elbow is defined as chronic degeneration of the tendon on the inside of the elbow, usually due to overuse. As its name implies, it is a condition common in golfers. However, as with all sporting injuries, this condition can affect anyone. Golfer’s elbow is similar to tennis elbow, occurring on the inside of the elbow rather than the outside.

What are the symptoms?

Typically, someone suffering from this condition will experience pain on the inside of the elbow, forearm and possibly extending down to the hand. The pain will be worst with activities that require gripping of the hand and movements of the wrist. Less common is the experience of pins and needles in the hand.

How does it happen?

The exact cause of this condition is unknown, however it is generally thought to occur when the forces transmitted through the tendon become too great. This can be due to increased demands on the tendon or reduced quality of the tendon tissues. As the tendon is attached to muscles that bend the wrist and provide grip strength, activities such as golf, rock climbing or manual work that involve gripping objects can easily create forces that damage the tendon. Conversely, factors such as poor blood supply or simply the normal processes of aging can reduce the quality of the tendon. If the tissue is not functioning well, then even simple but repetitive movements in an office job can cause Golfer’s elbow. There are a few other known contributing factors for Golfer’s elbow, such as poor posture, neck dysfunction, a recent change in activity and a history of trauma, such as a fall onto an outstretched hand.

What is the treatment?

Golfer’s elbow usually develops slowly, and healing can be a long process. The first step to effective treatment is accurate diagnosis, as many other conditions have similar symptoms and need to be excluded first by a medical professional. Once a diagnosis of golfer’s elbow has been confirmed, treatment is aimed at allowing tissues to heal and regenerate. This will require a certain level of rest, and changes to the forces affecting the tissues, sometimes through bracing or taping. Specific exercises have been shown to assist tissues in coping with and responding to load; these are called “eccentric” exercises. Other treatments include increasing blood flow to the area to promote healing. In chronic and severe cases, injections of corticosteroids are used, and in severe cases surgery may be undertaken.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

Physios Head Back to Work in Alert Level 3 Areas

Published on www.rnz.co.nz 21st October 2021.

People who have waited patiently – and often painfully – for weeks in lockdown are finally able to access face-to-face care physios and other allied health professionals. The government has relaxed alert level 3 rules, affecting 2000 practitioners in Auckland alone across 43 professions. The decision comes after weeks of frustration among these providers in Waikato and Tāmaki Makaurau – and a petition with 13,000 signatures.

Director-General of Health Dr Ashley Bloomfield was asked why the services could not open up sooner. “Early on in an outbreak when, certainly in Auckland, we were trying to effectively stamp it out and get back to zero, the controls under alert level 4 and the first part of alert level 3 were designed to minimise contact between health professionals and people as much as possible,” Bloomfield said.

“It has now reached a point – and certainly talking with our DHB colleagues up there – that enabling access to some of these allied health services in the community will help with conditions progressing to a point where they might need hospital care.” Mt Eden physio Patrick Peng’s patients have been in agony awaiting hands-on care. “I didn’t realise how bad it was until I started practising again,” he told RNZ today.

“The four or five patients I’ve seen since we’ve been allowed to see face to face people, they have all been so dysfunctional, in so much pain, and they’ve just been so grateful that they’ve been able to get treatment again.” His colleague, practice manager Amy Schischka, said Telehealth consultations had provided limited help.

“The hardest thing … was dealing with the messages, the emails, [and] the phone calls from patients that were desperate to see you, and we basically had to say, ‘there’s nothing we can do for you’.”

Allied health workers opening up must still screen patients, socially distance where possible, and use PPE.

Relief for Thousands of Women with Birth Injuries

A leading pelvic floor specialist is delighted that thousands of women will be eligible for ACC to cover birth injuries when the legislation changes next year.

Dr Melissa Davidson, New Zealand’s only specialist physiotherapist in pelvic health and a member of Physiotherapy New Zealand, says it’s been frustrating and is extremely unfair that thousands of women have had their lives severely restricted because of the inequities in the ACC scheme.

“The government announcement this week to amend the legislation to cover obstetric injuries will come as a huge relief to the thousands of women who have been suffering needlessly. Physiotherapy can restore function in many cases, but without ACC funding, for many women, it’s unaffordable.

“Extending the ACC scheme to cover obstetric injuries will significantly improve the quality of life for women and improve basic functions that many of us take for granted. These injuries have a major impact on the whole family and I’m delighted that at last, it is going to be easier to get treatment without payment being a barrier,” says Dr Davidson.

Physiotherapy New Zealand chief executive, Sandra Kirby says research shows that women do not always prioritise their own health and needs after the birth of a child, especially in instances when money is tight and there are other children to look after.

“We are looking forward to talking to the select committee about the changes to ensure we get the best possible legislation including ensuring it covers women currently experiencing these conditions as well as in the future.”

Coronavirus: Physiotherapists Call for Level 3 Guideline Change So More Patients Needing Ongoing Care Can Access It

Published on www.newshub.co.nz 6th October 2021.

An Auckland-based physiotherapist is urging the Ministry of Health to reconsider alert level 3 guidelines for opening some health services because there has been an “inequitable reopening” of businesses. Yousif Mansour works at a private physiotherapy clinic in Auckland and hasn’t been able to work throughout levels 3 and 4. He says because clinics can’t reopen, the profession is facing mental and financial hardship and clients are facing worsened and delayed outcomes. As physiotherapists, they can provide healthcare through Telehealth to current or prospective patients.

During level 3, appointments for allied health services such as physiotherapy, podiatry, optometry and Well Child Tamariki Ora services are mainly online or over the phone. Some face-to-face appointments can be arranged on a case-by-case basis as long as health professionals take appropriate measures to manage public health. But Mansour says the eligibility criteria to treat patients in-person is too strict. “In essence, when taking clinical reasoning into consideration, the client has to be in a life or death situation or facing long-term disability from an injury or condition if left untreated,” he tells Newshub. While Telehealth allows physios to diagnose and begin or continue the rehabilitation process, it’s no substitute for face-to-face consultations, Mansour says. Additionally, not everyone has access to Telehealth so uptake isn’t equal across regions.

Mansour says physiotherapists are well-trained in health and safety, including infection prevention controls, and many clinic owners are audited against such standards. Physios can also screen patients in detail, to the point where medical, social, and family history can be taken into consideration to see whether or not a client can be safely seen and treated. Clinics can also be set up in a way where alternate rooms can be used, staff can work alternate shifts, and they can disinfect clinics accordingly between patients, he says. They also have access to full personal protective equipment and know-how to apply it appropriately and accordingly.

Mansour says these health protocols can’t be as effectively done in supermarkets or other businesses that can open during level 3. “It is hard to believe that this can be done while being in supermarket brushing through multiple people, lining up for coffee, or when your food is being prepared or delivered. Not being able to operate properly will soon take its toll on clinics, as the outgoings simply don’t match whatever subsidy is being provided.”

The health and physical condition of some patients who have acute injuries or long-standing conditions is at risk of being compromised because they can’t receive ongoing treatment, he says.”Clients who aren’t able to be seen over level 3 and 4 go on to have pain or injuries that take a lot longer to settle down than they would if they were seen acutely, and that while they don’t meet the criteria of long-term impairment to be seen currently, it does cause significant distress and an inability to carry on with activities of daily living,” Mansour says. “The impact of not being able to deal with pain and other worsening symptoms can only have negative impacts on a person, which importantly can extend to mental health and social wellbeing.”

Even after the Government announced Auckland’s three-stage roadmap out of COVID-19 restrictions – which includes a phased reopening of people’s bubbles, retail, hospitality, and schools – Mansour says it is “ridiculous” physiotherapists aren’t included in this. He adds that physiotherapist clinics are being challenged financially too since no specific financial help has been offered to the industry. He believes many are worrying about how much longer their businesses can survive and whether they’ll have money to survive.  Sandra Kirby, CEO of Physiotherapy New Zealand, agrees with this, saying allied health services are “suffering” because of the lockdown.

“Physios have been very supportive [of the level 3 guidelines], but level 3 was always intended to be short and sharp, and seven weeks is neither short nor sharp,” she tells Newshub. “The concerns we’ve got are that it’s not sustainable for the long term – so that’s a very definite concern – and that while generally physios have been very supportive of public health measures, there’s concern they’re not being implemented fairly across the health sector.” During level 3, hospitals must operate in line with the National Hospital Response Framework and primary and community health providers can open following the Community Response Framework. Infection prevention and control regulations must be followed. Other health services such as community midwives and dentists are allowed to open, but only in-person for certain types of care.

“We would say people are really focused on hospitality, but actually, there are other businesses much more associated with health outcomes that are not able to work,” Kirby says. She adds that a range of businesses in Auckland, including allied health physiotherapy and other allied health providers, are “definitely suffering” because of the extended lockdown. “While the Government released packages and provided a wage subsidy, that doesn’t cover all of the outgoings,” Kirby says. “This does impact patient health outcomes. We know that, we know that from last year, so we can’t just say everything can wait.”

Dr Martin Chadwick, chief allied health professions officer at the Ministry of Health, tells Newshub maintaining a balance between protecting patients during the pandemic and maintaining people’s wellness has always been a priority.  At level 3, he says face-to-face appointments may be provided for urgent care only, so long as clinicians take appropriate public health measures.

Urgent care for community allied health is defined as:

  • a condition which is life or limb-threatening; or
  • treatment required to maintain the basic necessities of life; or
  • treatment that cannot be delayed or carried out remotely without the risk of significant harm or permanent and/or significant disability; or
  • where failure to access services will lead to acute deterioration of a known condition, or
  • where delay in access to services will impact the consumer’s ability to maintain functional independence and significantly negatively impact the quality of life
  • and it cannot be delivered by a service that is currently operating or by clinicians that are already in contact with the patient for ongoing care.

“For physiotherapists, the threshold for treatment to be carried out has recently been reviewed and the threshold has been modified to include the extra flexibility to support treatment provision if the treatment cannot be delayed or carried out remotely without risk of significant harm or permanent and/or significant disability,” Dr Chadwick says. “While this is a high threshold, it is necessary to reduce the spread of COVID-19.”

He recommends the infection prevention and control measures that could be taken into consideration by health practitioners to safely operate under level 3 include:

  • staff being fully vaccinated
  • understanding the ventilation capabilities of the environment they would be operating in
  • health practitioners have undertaken pre-requisite fit testing and know how to fit check a P2/N95 particulate respirator as part of donning and doffing of personal protective equipment
  • utilisation of the alert level 3 and 4 risk assessment tool has been applied
  • screening patients for COVID-19 symptoms.

In an email from the Physiotherapy Board sent to non-district health board physiotherapists earlier on Tuesday that has been seen by Newshub, Dr Chadwick told them that “initially there is no plan to change advice to physiotherapists at this time and the current level 3 advice provided at the last change still stands”.

“We know this has been an extremely hard time (to say the least) for those of you in Auckland,” the email from the board concludes. “You are definitely doing the hard lifting in fighting COVID – you are at the front line professionally and personally.” In his statement to Newshub, Dr Chadwick says he will continue to work with the sector in operating under alert level 3.