Summer 2021 Faculty Profile

Marilyn MacKay-Lyons: To be honest, physiotherapy wasn’t on my radar until I ruptured a hamstring (long head of biceps femoris) while training for the 1973 Canada Summer Games. The knowledge, skills, and caring demeanor of the physiotherapists I worked with left an indelible impression on me that sealed my fate. I have had no regrets about that decision!

Sandra Curwin: I ‘fell’ into physiotherapy by accident over 40 years ago, and never meant to stick with it, yet here I am retiring 40+ years later, still a physiotherapist.  

Sandra Curwin: I graduated from physiotherapy a long time ago (1976) with a Diploma, then got a BSc, then a MSc, then a PhD. In many ways, my ever-expanding academic degrees parallel the changes in our profession over the last 40 years - from knowing a bit but able to do it well, to knowing a lot more but realizing how much more there is out there.

I graduated with a 2-year Diploma in Physiotherapy from Dalhousie. We had two instructors, Ken Hill and Hazel Lloyd, who, like many physiotherapists in Canada at the time, had emigrated from the UK and Ireland. Our education in anatomy, electrophysical agents and exercise prescription was quite thorough, but we received zero education in diagnosis of musculoskeletal conditions, and my knowledge of research was almost non-existent. My MSK assessment ability was gleaned through ‘on-the-job’ training and continuing education. I owe a great thanks to Dr. Bill Stanish for the former. I’ll never forget the day he asked me to examine a patient’s knee and tell him what the issue was, and how he then patiently said ‘let me just show you a few things……’ when it was obvious I was clueless. Great learning opportunity.

Marilyn MacKay-Lyons: I have always had an academic interest in the science and practice of physiotherapy. My inquiring mind was particularly nurtured during my MSc experience at the University of Southern California back in the early 1980s. Soon after that transformational experience, ‘evidence-based practice’ became a major buzzword that I found super exciting. After ~20 years in clinical practice, I pursued a PhD in physiology with the goal of establishing an independent research program. Becoming a member of the Dal SoPT gave me a platform to contribute to: the education of future physiotherapists, the evidence behind the art of physiotherapy, and the service of the university, the profession, and the community. I am indebted to the many students, staff, faculty, and clinicians I worked with over the past 44 years, all of whom have enriched my professional life.

Marilyn MacKay-Lyons: A lot of things have changed since I began my physiotherapy education in a 2-year diploma program. Clad in the requisite uniform (short-sleeved white shirt, scooter skirt, bobbie socks and sneakers), the class of 1977 (17 females) spent long days in classes and labs in the windowless bowels of the Tupper Building. The program quickly transitioned to a BSc and later to a MSc, bolstered by a broader physiotherapy-specific knowledge base and technological advances in education. We made sure that the uniform went the way of the dodo bird. The escalating public demand for physiotherapy services justified a steady increase in the class size. The student body is gradually becoming more representative of the populations we serve in terms of sex but has only recently begun to reflect society’s cultural and ethnic diversity.   

Sandra Curwin: Physiotherapy education has evolved over the years and now uses evidence-based assessment techniques and PTs have become one of the main MSK diagnosticians in the health care system. All students learn both the science and skill of assessing patients. Everyone has an undergraduate degree before they begin the MSc-PT program. They learn to read and interpret a research paper, and the School now has more than a dozen PT faculty - all with graduate degrees and research experience.

And we are no longer in the basement of the Tupper building, or wearing uniforms based on Ms. Lloyd’s measurements!
 

Sandra Curwin: PT used to be ‘ordered’ by physicians, who wrote prescriptions much like those for medications. There was considerable debate among physicians (and PTs) about how specific these prescriptions should be, and they ranged from including the number of repetitions of an exercise to the often-seen ‘Treat at your discretion’ -much preferred by most of us. Legally, a prescription was required for physiotherapy treatment. Today, PTs are direct-care practitioners, no referral is required, and physicians assume we know how to assess and treat a patient.

I first started practice in the out-patient department at the Moncton Hospital in late 1976, at that time, almost all physiotherapy was delivered in hospital settings. The demand was huge, there was usually a waiting list of 150 patients, and it could take many weeks before one could see a physiotherapist. No one (except Helen Sweet, a UK-educated PT who had a private practice in Dartmouth) thought that patients would actually pay for physiotherapy when you could get it for free by waiting a few weeks.

Fast forward a few years, after a move to Halifax, some advice from Helen, and a bit of research into insurance coverage of PT services, I opened a private practice in 1980. It was considered a pretty wacky idea at the time, with more than a few moral and ethical considerations, along with whether you could make enough to support yourself (though my bank manager thought it was a great idea). Now, of course, private practice is the largest practice area for PTs, and there are hundreds just in Atlantic Canada alone. We still have the moral and ethical debates, of course - for example, should practice owners have productivity standards for their employees that require seeing 4-6 patients per hour? I’m not sure the increase in private practice has always led to the improvement in service quality that I assumed it would. How can we improve this? Or should we? Like I said – moral and ethical debates.

Marilyn MacKay-Lyons: Perhaps the biggest change in clinics and hospitals has been our enhanced autonomy of practice. Gone are the days of physicians’ referrals and ‘orders’ (and hospital uniforms!). Direct access was achieved through the steadfast conviction of our worth as independent, competent, and responsible practitioners. Domains of practice/specialization have broadened, use of technology (including telerehab) has expanded, collaborative practice has been embraced, and advanced practice is emerging. We are definitely maturing as a profession.  

Marilyn MacKay Lyons: A major change that has catapulted physiotherapy-related research to new levels was the redistribution of research funds by the Canadian government and other agencies – from largely basic science to applied research, knowledge translation, and implementation science. This reallocation was the result of growing interest in the clinical relevance of research studies, and, with it, more emphasis on patient-reported outcomes and direct engagement of patients and administrators on research teams. As well, we are finally beginning to collaborate more effectively with our research colleagues across Canada. These collaborations have leveraged huge benefits – gaining richer, pan Canadian perspectives; attracting larger research grants; reducing administrative costs; increasing research capacity; and expanding sample sizes (‘bigger data’ amplifies the generalizability and clinical utility of our findings). These spin-offs have definitely enhanced our research productivity and the respect of our colleagues.

Sandra Curwin: Research knowledge was not considered necessary for us early physiotherapists. Outcome measures were unknown. Treatment sometimes extended indefinitely (no wonder the waiting list was so long). But, functional performance was considered very important – otherwise, what was the point?

Research in PT really only got going in the 1980’s (though there were some early pioneers, like Shirley Sahrmann in the US). There were not many (or any) publications specific to Physiotherapy beyond Physical Therapy (US), Physiotherapy Canada, and Physiotherapy (UK). Other early publications, like the Journal of Orthopaedic and Sports Physical Therapy, were still in their infancy. They have evolved a great deal over the past 40 years. The quantity of PT-specific publications has exploded. Where it used to be tough to find any research, now the challenge is to sift through it all. The research is improving all the time and helping today’s practitioner make evidence-informed decisions rather than having to rely solely on PTs with more experience (or charisma).  

Sandra Curwin: More people need access to physiotherapy expertise. Forty years ago, private practice was a ‘new model’ for PT care that improved access to care, but I think it is now time to add some new ways of doing things. I would like to see a swing back to ‘public’ physiotherapy, by which I mean accessing physiotherapy services at no, or low, cost. This does not mean just hospital-based services, but also community-based services. Can private practitioners look beyond their current model of care to see how they can help provide this ‘public’ care? It can be tough to provide low-cost programs when it involves cost with no revenue. How about writing grants for clinic-based fitness programs for people with physical limitations? There are many accessible PT clinics around. Or how about using PT departments in rehab centres, long term care facilities and hospital for community-based fitness outside ‘regular’ hours?   We need to think creatively about what our communities need and how we can provide this care. I know our young physiotherapists have some great new ideas – let’s work as a profession to support them. I’m looking forward to seeing how we move forward.

Marilyn MacKay-Lyons: I’m confident that physiotherapy will continue to mature as a profession. From my somewhat biased perspective, I strongly belief that research drives professional advancements (including remuneration for the services we provide). Generation of new evidence catalyzes innovation and credibility in practice; lack of on-going research breeds stagnation and relegation to technical rather than professional roles.