Interview with Anju Jaggi
Anju is a Consultant Physiotherapist and Deputy Director for Therapies Research & Innovation at the Royal National Orthopaedic Hospital (RNOH).
What does it take to become a consultant physiotherapist and how does this role differ to that of physiotherapist?
That is an interesting question as the pathway to the role is not as well established as our medical consultants. The framework for the role is not clearly defined but essentially has four key important pillars – clinical expertise, research, education and leadership. My role evolved as a national clinical expert in shoulder rehabilitation and the development of research, and over time this has become more about leading others and developing a departmental wide research strategy. Its key difference is more accountability and perhaps more about the development of others as well as one self.
How do you keep your patients motivated following surgery?
Most of my input with patients is about trying to avoid surgery! An interesting research question could be “are patients more motivated after surgery compared to not having surgery?” Especially in light of recent placebo surgical trials, understanding what motivates you to feel better is way more complex than we think. Essentially the answer to this question is, it is bespoke to the patient – dependant on their beliefs, interests, attitude, drive, etc. A good place to start is listen, agree on shared goals and how you and they will get them where they need to be, challenge appropriately. Behavioural change especially with respect to exercise is a huge area worthy of further research.
There has been talk of remote physiotherapy over Skype type communication channels – are you currently reviewing anything like this?
Yes we currently have a NIHR PhD fellow looking at this with respect to orthopaedic consultations. An initial qualitative study of patients and clinicians attitudes towards the use of Skype in a specialist service for atraumatic shoulder instability was carried out by one of our physiotherapists as part of his NIHR MRes, which showed Skype was acceptable but not to all. His PhD is going to start to tease out some of the benefits as well as barriers to its use – watch this space.
What technological developments have you witnessed that have made a difference to pre and post-operative care and therapy?
We are only at the start of truly embracing digitalisation in the NHS and more so in the field of rehabilitation, the therapy department at the RNOHT however are starting to properly trial this with patients and clinicians. We have found that gamification technology such as the MIRA system can help motivate adolescents with their rehabilitation and is an acceptable adjunct to their therapy. We are currently looking at the usability of an exerciser app with sensor tracking in patients receiving musculoskeletal rehabilitation and initial results are looking promising. However at this stage it looks like patients still want human contact and an element of the patient-clinician therapeutic relationship. We are also working with UCL engineers on the use of hepatic robots and virtual reality in rehabilitation of chronic pain conditions as well as the use of vibration in spasticity in spinal cord patients.
What developments do you envisage are yet to come in the next decade that will impact recovery and rehabilitation?
Wearable technologies with sensor devices to help track exercises, this may help remote monitoring to help motivate patients, make them feel they are doing exercise correctly and confidently.
In more complex conditions with altered neurological control implants to stimulate muscle contractions. Robotics to demonstrate and perhaps instruct patients on how to exercise. Then there is the whole area of pain neuroscience and how can we trick the brain when it comes to pain, fear, anxiety in moving and being able to rehabilitate oneself, so many horizons to explore.
What are your views on prehab, do you think this can be used to improve patient outcomes?
Absolutely! There is a lot of discussion now on reframing MSK problems not seeing surgery as the end point but seeing these problems as long term conditions not dissimilar to conditions like diabetes. So what can we do to prevent or delay onset of back pain, degenerative aging conditions such as tendinopathies – get people to think about lifestyle changes; diet, exercise, not smoking etc. This is not just pre-rehab but rehab for life! Even when you get your new knee or hip replacement you need to look after it and make it last for as long as you can.
What advice would you give to budding physiotherapists considering a career within MSK?
Preventative care and aging population has got to be their focus, how do we help maintain patient’s quality of life for as long as possible and start to see physiotherapy as not always a fix or cure but a way to get patients back on track after injury, de-conditioning. Rehabilitation is multi-dimensional and more patients will come with co-morbidities, perhaps less time on the biomechanics of diagnostics and more time on the assessment of the whole patient – a truly biopsychosocial model of care.
With your experience in mind, what research themes would you be looking to fund if you were on our Scientifics Advisory Committee (SAC)?
The use of technology in healthcare
Understanding the brain psychology and its role in optimising physical function
Behaviour change in rehabilitation
The effect of age/menopause on physical well-being
What advice would you give to those physiotherapists interested in getting involved with research?
- Don’t be scared – if you have a good idea it’s not scary and can be fun
- Ask for help
- Get a good team together – research is never about an individual
- It takes time – planning is everything
- Be patient – it’s worth taking all the necessary steps to get a more robust answer
- Be resilient – you’ll make mistakes, learn from them, take criticism constructively
- Give yourself creative head space
- Look for opportunities – audits, service evaluation projects develop other skills that could then develop into research
- Be prepared to have to work at it and give up your time – success never just gets handed to you on a platter.