Published: 02/12/2004, Volume II4, No. 5934 Page 22 23

Phil Gray, chief executive, Chartered Society of Physiotherapy

Dr Nick Summerton's suggestion that health service managers should disinvest in physiotherapists in favour of chiropractors (On the Evidence, page 27, 11 November) is highly irresponsible.

He appears to have based his conclusion almost entirely on a tabloid interpretation of the results of the Frost et al study.

The tone of Dr Summerton's column implies that he failed to look beyond the press headlines surrounding this widely misinterpreted research. Had he done so, he would have realised that the study makes no suggestion that physiotherapy does not work.

The study compared one form of physiotherapy treatment with another and is somewhat misleading in that it implies education and advice is not a routine part of physiotherapy. This is perhaps because the study took place several years ago and does not represent contemporary practice.

Now, thanks to the increasing prevalence of self-referral schemes, many patients are screened by telephone triage by expert physiotherapists. Others are examined by physiotherapists in outpatient settings and, on the basis of this assessment, are given appropriate advice (which might include an exercise programme) and are then discharged to self-manage.

Far from dismissing the effectiveness of physiotherapy, the research actually celebrates the success of physiotherapists as educators and advisors in the management of low back pain.

Lesley Walters, head of physiotherapy services, Lancashire Teaching Hospitals trust

Dr Nick Summerton made an oversimplistic interpretation of the recent BMJ article regarding the efficacy of physiotherapy in the management of back pain.

His conclusion from a single research study was that commissioners should disinvest in physiotherapy and reinvest in therapies such as chiropractice, quoting a 14-year-old paper as part of his argument.

Over the last four years I have provided, in partnership with orthopaedic colleagues, a spinal assessment service for all back pain patients referred into the trust.

Not only did this service reduce the spinal surgeons outpatient waiting time from 42 weeks to eight within three months, but it also produced, because of the skill of my clinical specialist physiotherapists, sound and long-term clinical, functional and social impact on patients.

My real concern in Dr Summerton's assumptions is his apparent lack of knowledge about what physiotherapy actually consists of. My physiotherapy staff assess the full biological and psychosocial picture the patient presents, particularly appropriate with the more chronic patient.

From this they choose the most appropriate management to suit individual needs, often a chronic-pain management approach that may or may not include a range of other 'physical' modalities during the course of the treatment episode.

For my department and, I am sure, most forward-thinking departments in the NHS, this is routine physiotherapy.