Safety First: The Future of Manual Therapy & Person-Centered Care with Nathan Hutting

[00:00:00] Things are changing, so the profession is progressing, but I think implementation is very, very important. So we should make sure that we provide contemporary care to our patients and to do so, educational programs are very, very important. Education programs have a very important role in making sure that they teach contemporary care and then of course there's also a role for the clinician to implement it in clinical practice. On today's episode, we're excited to speak with a leader in manual therapy, Dr. Nathan Hutting,

[00:00:26] a physical therapist, associate professor at Han University of Applied Sciences in the Netherlands and vice president of IFOMT. Nathan has dedicated his career to advancing both clinical practice and research with a strong focus on the safety of cervical spine treatments and the promotion of person-centered care in manual therapy. Today, we'll explore the intersection of clinical safety and patient-centered approaches in manual therapy.

[00:00:53] We'll dive deep into his role with IFOMT and discuss how the field can continue to evolve to meet the needs of both clinicians and patients worldwide. Nathan, thanks so much for sitting down with us. We appreciate it. Hi, nice for inviting me. Thank you for inviting me. Yeah. So you just walked off stage here at AOMT 2024. A lot of people asking you some really, really great questions.

[00:01:21] Good energy from the people who are coming up after you walked off stage? Yes, I think it's very important that people have questions and would like to interact with you. If people don't come to you after your presentation, maybe I also think maybe I did something wrong. I think that's a bad sign. Right. Yeah. In the digital world, it's easy to reach out, but there's something different in the way that you do it while you're at a conference, which is this human thing that we're sort of designed to be able to interact with.

[00:01:46] I think that's one of the biggest advantages of conferences, that you can interact with the speakers, easy, accessible, so you can ask those questions and pick their brains. And yeah, I think that's very valuable for athletes. It's exciting. Perfect. So you've been a keynote speaker on the topic of safety in cervical spine treatment, which is a critical issue in manual therapy. Help me understand. Can you explain why safety is such a key concern and how clinicians can best navigate those challenges in practice? Yeah. So the title of the presentation was Safety First.

[00:02:15] So because I think that's very important. And of course, people are always interested in new techniques in manual therapy. And it is also very important because we need to treat patients. So we need some techniques to treat those patients. But on the other hand, safety is very important. Sure. And of course, safety incidents, serious adverse events are very, very rare.

[00:02:37] So the focus of the presentation was in the cervical spine because we know that there can be some vascular serious adverse events happening after treatments, for example. So that is very important that if we treat patients, we do it in a safe manner.

[00:02:52] And although it's not really a sexy subject, I think every manual therapist, every fissure therapist should be aware of those risks and how we can avoid that people will have a safety service adverse events after your treatment. So I think it's a very important topic. Although, as I said before, luckily, these events are very, very, very rare. Yeah. How was it received? What were some of the questions you were getting after that? Yeah, I think it was received well.

[00:03:20] So I think one of the good things, I think, is that I started with a kind of polling. So I just got the opinions of the audience. And then in the presentation, I showed you, showed them their results. And then you also really see that there is some room for improvement also in this audience. But we also know that from scientific literature, there is some room for improvement with regard to the knowledge and skills of manual and also physical therapists.

[00:03:44] And then also people really, now they hear what you say because they just voted and they just give their opinions and maybe their opinions were wrong. And that's maybe, yeah, can be important for them. Oh, well, maybe I need some additional knowledge, for example. So I think it was well received. Person-centered care is another important issue of your work. How do you integrate this approach into your practice and teaching and why is it essential in manual therapy settings?

[00:04:11] Yes, so I think that if you look at person-centered care, it really relates to a biopsychosocial approach and self-management. So I combine these three topics because these are really related to each other. And I think all the treatment we provide, it is focused on the person. It's about the person, of course. And that is very important that we have that conversation with the person.

[00:04:35] And we involve the person in the decision-making process, that we involve them in a goal setting, that we make sure that the treatment is individualized to that individual. And that's not only important for physical therapists in general, but also in manual therapy. So I believe that, and because one of the topics I'm very interested in, and also present a little bit on tomorrow is self-management approach.

[00:05:01] And some people then say, hey, you are a manual therapist, self-management. How is that possible? But I do think that such an approach is also important for manual therapists. So to make sure that the patients have the skills to lead their care, to be involved in their care, and to have a huge influence on their care. And then they need those kind of self-management skills.

[00:05:28] And also in manual therapy, we should support people in, yeah, have a leading role in their care. It sounds like you're saying you're not only manual therapy. Manual therapy is a part of how you provide care, not all of how you provide care. Do I have that right? Yes. So I think that it is a component. And basically, from my perspective, I think it can be an important component, but not in all patients. So some people don't need manual therapy.

[00:05:55] They can need exercise or they need other approaches or just only need some support with regard to self-management, some education. But I think a combination of approaches, I think that is the way to go. And that is dependent on the patient how much manual therapy is needed. Maybe a little bit, maybe a little bit, maybe some more manual therapy. But I do think that education, exercise and self-management support are always very important components in such an approach.

[00:06:20] Yeah. As a physical therapist, researcher, associate professor, you balance many roles. Those things are vastly different, right? How does your clinical work inform your research and teaching? And how do you stay grounded in patient care while leading academic initiatives? It feels like you're spinning, they're spinning three different plates. How do you keep that all together? Yes, I think it's also an advantage because sometimes you see those researchers who are not active in practice anymore. So they're not really working as clinicians anymore.

[00:06:50] And that can be difficult because I think it's important not to lose the feeling with the clinical practice. Sure. So I practice physical therapy, manual therapy one day a week. So I still have that experience with patients every week. Not too much of course, but every week, one day. And you learn a lot of that, of course. And it's also good for me as a researcher that the things that we develop can be implemented in practice. Sure.

[00:07:18] It's not that I think about something and just throw it over to the clinicians and they figure it out. Yeah, figure it out. I need to work with that myself as well. So that's also a good experience, of course. But I think it's an advantage to have different roles because you have different perspectives on the topics that I'm working on. And now the structure, we're at the AOMT conference, but AOMT belongs to iFOMT. I have that correct, right? Yes. And you get to act as the vice president of iFOMT.

[00:07:45] What do you see as the biggest challenges from that perspective and opportunities for advancing manual therapy on such a large scale? And how does iFOMT help guide clinicians worldwide to adopt those best practices in manual therapy and patient care? Yes, I think that one of the biggest things iFOMT can do is also develop some guidelines, frameworks, as was also done with regard to safety, for example. Because it's important that the knowledge is distributed to the whole profession all over the world.

[00:08:14] I think that's very important. So we can, iFOMT can really play an important role in that. And of course, growth is also important. So there are many, many physical therapists in many countries, but iFOMT is still rather small. So expanding to other countries is also very important. And yeah, we are working on that at the moment. So I hope that in the future we can also have more member organizations.

[00:08:40] So first you start in iFOMT as a registered interest group, and then you can progress to an associate member organization and then a full member. And I hope that many, and I also had a conversation yesterday about potentially a new registered interest group. So that's very important that we grow. But also that iFOMT is, and we do that luckily, provide some support to grow from that registered interest group to the full member status. Because that can be challenging. Sure. But yeah, we provide support.

[00:09:10] So if this also maybe goes to other people around the world, and you would like to join the iFOMT family, please free to reach out to iFOMT because there is support available. Yeah, yeah. And today that distance can never be closed, right? With a phone, you can learn from far away. That's got to feel pretty good to have a global reach with an organization like iFOMT and iFOMT. Yes, I think that's true. So nowadays, with all the digital possibilities, it's quite good.

[00:09:40] Although we should also think about that this is normal for us. Right. But in some other countries, low or middle income countries, it's not normal maybe. Right. But we are progressing that in those countries as well. Let's talk about clinical practice and education. You've got extensive experience in both of those areas. We talked about that before. What changes or innovations do you foresee in the future in how we teach and train manual therapists, especially in light of evolving safety protocols, safety first, and person-centered care? Yeah.

[00:10:10] So I have to admit, I am not an experienced teacher. So my main role at university is research. So I'm not a teacher involved in any manual therapy program. But I think things are changing. So the profession is progressing. But I think implementation is very, very important. So we should make sure that we provide contemporary care to our patients. And to do so, educational programs are very, very important.

[00:10:38] And then maybe one example is that in the iPhone cervical framework for safe treatment of the cervical spine, the previously we had that is called positional testing. So VBI tests. And these were frequently used by therapists. And these were deleted from the iPhone framework because they don't have sufficient diagnostic accuracy. So they are not really valid methods to use in your practice.

[00:11:03] But now we also see that still about 60 or 70 percent of the practitioners use these tests in clinical practice. And that also, although these tests were deleted from the iPhone framework, removed from the iPhone framework, still about half of the educational program still teaches these tests in their curricula. And that's also very strange. So I think we should, education programs have a very important role in making sure that they teach contemporary care.

[00:11:30] And then, of course, there's also a role for the clinician to implement it in clinical practice. I think that's very important. And also, maybe, although it's sometimes difficult, cooperation between educational programs, I think that should also be facilitated. Because they can also learn from each other. And that's the way to go. Don't reinvent the wheel every time. But work together. Well, I think you bring up an extra point. When we think of advancing education and advancing care, we think of adding.

[00:11:56] But what you highlight is sometimes removing the things that we have proven not to be as accurate is just as important. The implementation of care is even important. Yeah. So we should stop the things that are not evidence-based or don't have added value. Because that's also a kind of, can be dangerous for the profession, of course. If we do things that are not evidence-based and then people look at them, why do they still do those kinds of things? So I think that, yeah, it's not a good thing for the profession.

[00:12:26] So we should also work on the implementation if necessary. Well said. Let's look to the future again, but in light of your research. As you continue to research and lead in manual therapy, what are you most excited about moving forward? What are things on the horizon? Any upcoming projects or initiative you're particularly passionate about? Yeah. So because I have so many different roles, it's sometimes difficult to have that perspective. But for me, one of the major things I'm working on, major things.

[00:12:54] So with regard to the self-management part, we are now working for example on the Cochrane review for self-management for low back pain. It's a lot of work, but that's something that's very important, I guess. And also in the same topic, we also have, are working on the development of a questionnaire, the Musculoskeletal Self-Management Questionnaire, to assess self-management skills in patients. Because there is no existing questionnaire on that topic right now. So those are very important topics that I'm working on.

[00:13:21] I also would love to continue working on the vascular pathologies. We are also now working on a kind of international survey that we have conducted last year, and also presented some results of that. But we want to get it out published soon, of course. So these are all nice things for the future. And then also within IFOMT, as I said before, growth is very important. But also, some other issues we had in IFOMT.

[00:13:48] We are now trying to solve, for example, we had an election for the new executive committee in the conference in Basel in July last year. And we had an all-male executive committee. So, and with regard to equity diversity, that's not really a contemporary approach. So we're also working on that right now. So those are the kind of things that are very important. And as you might know, and the listeners might know, that IFOMT also has some educational standards. We are revising these educational standards.

[00:14:18] So a lot of things going on also in IFOMT for the future. Good on the horizon. Last thing we do on the show, we call it the parting shot. Is there one idea or one soapbox statement or mic drop moment that we might call? One thing you'd want to leave with the audience to make sure they don't forget? Yeah. So I think maybe they don't forget it, but we have a wonderful profession. And I'm very proud to be a physical therapist. And I believe that sometimes we are undervalued.

[00:14:47] It can depend on the country. I also think we are undervalued in the Netherlands, for example. But don't make that change your opinion of your profession. Be proud of your profession and move forward. And don't look to the past, but look forward to the future. Because I think we have a wonderful future. But we should really work on that. My parting shot for you, of course, is safety first. Don't forget that. It's very important. Nathan, I appreciate you stopping by after giving a keynote here at AX 2024. Thanks.