NEW STRUCTURE AND EDUCATIONAL PLAN FOR THE BSPTS
THE BIOPSICOSOCIAL MODEL BEHIND THE BSPTS
Barcelona 22/10/2018 (last modified 14/07/2019)
By Manuel Rigo MD PhD. Chair of the BSPTS
After a failed first trial to give a professional structure to the BSPTS, it is time to go forward with a new trial. Obviously, not all was wrong, there were many positive things in the proposed first model.
With the perspective of time, I have understood about the good things behind the initial project, as well as some wrong things, and I have accepted about my own responsibility in the failure of the project for managing the BSPTS.
The first model was a good mirror for this second trial, which will be hopefully successful, at least this is the spirit behind it. It comes from all what we learned from 1989 and takes into account many of your inputs. It is clear that no model can satisfy everybody but it is time to be pragmatic.
The main objective of this new model is to ensure the long-term standard of the ‘BSPTS-Concept’ in both, its application on patient’s treatment and physiotherapists’ education.
A model like this has to be based on a long-term strategy rather than in short term tactics. There are some underlined points, which serves to describe this strategy. These points have been all defined after a long term ‘reflection time’ and collecting ideas from many informal talks with those forming part originally of the BSPTS. BSPTS was born officially after stopping collaboration with the AKSK and Weiss (2008), but it was there since 1989. I ask new members (those joining the school after 2008) to make an exercise of reflection to understand about the original (initial) philosophy behind the School. We invite all of you to join us in this new project, people able to sum in making the school to progress in this line, but we understand this is not the only possible line of developing in this field and we will respect always that people take a different option, a different line. There are some different options in the field that could full fil better the fair interests of some of the current members of the BSPTS, but we are really convinced that this is the best option, so we humbly ask all of you to stay with us.
These are the main points:
- ‘BSPTS-Schroth based technique’ fulfill the criteria to be included into the list of Physiotherapy Scoliosis Specific Exercises (PSSE) as defined by the SOSORT.
- Our mission is teaching a specific physiotherapy technique to treat patients with some different types of spinal deformity, mainly Idiopathic Scoliosis and Juvenile Kyphosis. When well apprehended, this technique will enrich the battery of tools that the physiotherapist can use, taking part of a multidisciplinary team and working according to a Comprehensive Scoliosis Care Model, as well as establish a background for the treatment of other type of scoliosis (secondary and syndromic).
- Thus, what‘BSPTS-Concept’ is: it is a tool, that in hands of a well-educated physiotherapist enriches her/his capabilities to become a physiotherapist specialized in Spinal Deformities able to work in a Comprehensive Scoliosis Care Model Team. BSPTS Certified Physiotherapists should advocate for an approach based on a Bio-Psico-Social model where the target of the therapy action is the Person and not the scoliosis. We treat people affected with scoliosis, we do not treat ‘Scoliosis’, and although, generally speaking, PSSE would be always good to treat a ‘scoliosis’, it is not always good to treat all ‘person’ who suffer from having a scoliosis.
- What‘BSPTS-Concept’ (BSPTS from now, to simplify) is not: a method of therapy by itself or a sort of ‘alternative system of therapy’, which can be used in substitution of other strategies, to satisfy patients preferences, based on beliefs. Patients treated by BSPTS certified Physiotherapists, receiving PSSE alone or in combination with other therapeutical elements, should be accepted for treatment only after a consent decision, with clear and realistic expectations, ideally taken after the consultation with a MD specialized in Spinal Deformities, working in a Multidisciplinary Comprehensive Care Model and following the principles of the Evidence Informed Medicine (EIM is used here in substitution of the more popular name of EBM) as well as International SOSORT and SRS guidelines.
- Thus, the objective of our Educational Plan is to create a limited body of Certified Physiotherapist fully specialized in this field. It is nowadays apparent that other schools would look for being highly visible in the field, by increasing with no limits the number of certified physiotherapists, spreading to the market with as short as possible and as attractive as possible educational plan for the physiotherapists in order to be well positioned in the marked. This is fair and in some moments, the activity shown by the BSPTS might be fostering this feeling, but this was never the genuine idea behind the original BSPTS. The objective of the BSPTS is not to be in the market for some years, while the current tendency in favor of PSSE is clear, but to live on. Like has happened for centuries, bracing and PSSE will be up and down following the law of the pendulum. Following our philosophy, BSPTS may be will decrease its presence (like some of our members have pointed out in some recent document) but will not die, basically because genuine good techniques, if they really work, they will survive, during good and bad times.
- In consequence, according to the new Educational Plan, we will be certifying BSPTS only at the end of the program, once the full cycle of education has been completed, once a Physiotherapist has reached a proper level in her/his technical capability, to use this ‘technique’, integrated into a multidisciplinary working team in accordance with SOSORT Comprehensive Scoliosis Care Mode. We have to stop using terms like ‘BSPTS-Schroth physiotherapist’ or ‘Schroth Therapists’ defining yourselves or defining others you certify under the BSPTS name. This term is associated with a ‘Therapy by it-self’, something quite common in the Physiotherapy world, but something not well accepted in the medical field. I strongly recommend all of you changing the way you define yourselves, from the term ‘BSPTS-Schroth Physiotherapist’ or even the one, which could be considered more correct ‘BSPTS Certified Physiotherapist’, by the more general term of ‘Physiotherapist Accredited in the Field of Spinal Deformities by the BSPTS’. Be proud about both things, your Profession‘Physiotherapy’ and your Specific Field of Action ‘Spinal Deformities’. In the future we would advocate for this ‘Specific Field of Action’ to become an academic Specialty (however, as far as Physiotherapy Specialties have been already defined in some countries in accordance with some Specific Academic Curriculums – for example Australia -, we must admit this is not yet possible in those countries. An example of a place where it would be possible is Israel, where BSPTS-Concept has been already recognized by every big National Insurance Company as the Specific Physiotherapy for Scoliosis and other Spinal Deformities. Thus, in Israel BSPTS Certified PT have an easier way to define themselves as Specialists, soon or later)
- PSSE in general and BSPTS-Concept in particular are based on 3D self-correction, stabilization and integration into the ADL. The key-words here are: 3D Correction, Stabilization and Integration, and this is why when defining BSPTS-General Principles (What we do?) we use this words. What characterize BSPTS-Concept from other similar techniques, sharing these general principles is, how we do it? in other words, the General Principle of Correction as well as the Specific Principles of Correction. BSPTS follows Dubousset Concept of Scoliosis being a Horizontal Plane Deformity that can be described by the term `Torsion`, and according to that defines a general principle of correction, but always considering some scoliosis being a very complex deformity that possibly combine different pathomecanism (For example, it is known that in adult scoliosis, associated to degenerative changes, we can observe ‘uniplanar’ collapses, nothing related to torsion). Thus, as a whole, we are talking about a Concept defined by General Principles and Specific Principles of Correction to correct always considering individual pathomecanic factors. It is all about ‘the Art of Individual Correction’and we must admit that this is very difficult to teach, in fact is something that has to be learned. This is about time, experience and knowledge. We must create the background to ensure that this happen. The original Schroth was, at least theoretically, also based on this principle of correction (The classical Schema of Blocks from K Schroth allows this interpretation), but the evolution of the current Schroth Method in its other two branches, AKSK and Best Practice from Weiss, have taken a different way nowadays, so we must state here that, as far as we do not feel with the right of taking for us the name of Schroth, ‘BSPTS-Concept’ is not ‘Schroth’ when looking at how the Schroth method is currently known and used by Physiotherapists and other professionals certified by AKSK and Best Practice. In consequence, I think it is more ethical not to use the word ‘Schroth’ in the name of our technique, although, of course we must say, when announcing courses and explaining principles that the BSPTS-Concept is a concept inspired and based on original Schroth Principles and comes from somebody (Dr Rigo) who was teaching Schroth Method for 20 years.
- Becoming a physiotherapists specialized in spinal deformities means both, apprehending the maximum level of knowledge about the issue and managing with quality and efficiency as many as possible physiotherapy specific techniques, among them, BSPTS-Concept. From our courses we can provide knowledge about at least some of the main disorders included in the general term of Spinal Deformities (Idiopathic Scoliosis and Juvenile Kyphosis) and the same time, the main information for understanding and using correctly this specific Concept.
- Evolution of the BSPTS-Concept, part I: The evolution of the BSPTS-Concept has happened in relationship with the long-term practical experience of some of us, in constant contact with patients. This, in combination with the acquired knowledge on the 3D nature of Idiopathic Scoliosis. As a whole, ‘the art of individual correction’is a capability acquired in the long-term, but only when revisiting constantly the old and new knowledge related with the disorder, and having always an historical perspective. Thus, it is a must that the BSPTS-Instructor learns about the State of the Art regularly and share experience with other Instructors. However, this should be mainly for personal education and evolution but not with the intention of rapidly adding this information into the program of the BSPTS. The important thing here is the technical aspects of ‘the Concept’ and, although it is an open ‘Concept’, the new knowledge produces only little changes in the technical aspects time by time.
- Evolution of the BSPTS-Concept, part II: The objective of the courses is to educate about the BSPTS ‘Concept’. The ‘Concept ‘is still based on ‘the ART OF INDIVIDUAL CORRECTION’ using a single General Principle, called ‘DETORSION’, activating muscles in correction and integrating it. The Learning Curve for any Physiotherapist who starts using this technique is a long one, and in case of not being supervised by an experienced master (I write by purpose master and no Master, remembering that in the scoliosis fields there are no Masters but we are all pupils), the risk of involution is very high. Standardization will be always imperfect, no matter how many times we look for better and more clear ways to describe the technique, mainly due to the full individuality of every patient suffering the disorder. As a part of the Standardization task we have re-defined the so called Specific Principles of Correction, which can be used for a deepest understanding of what ‘Detorsion’ means and how it works. Every Specific Principle of Correction includes some Pre-Defined Strategies of Correction, which are different depending on a Specific Classification or Categorization of CLINICALtypes (G1, G2: 3C, 4C, N3N4 and G1-2). This classification has a correspondence with some Radiological Classification (Following SRS terminology and the Moe-Kettleson-Lonstein Terminology to define radiological curve patterns), but it is not a radiological classification by itself, because the way a physiotherapists apply individual corrections is based on clinical observations rather than on radiological features. Using the BSPTS Clinical classification, the physiotherapists will be able to understand better the meaning of the Pre-Defined Strategies of Correction, but we must admit that the way to technically use these strategies, the way we introduce it, the tempo, the amount, intensity and proportion they are combined to get individual correction is impossible to pre-determine. Thus, not only for standardization with educational purpose but also in terms of defining protocols for scientific studies, it is an illusion of objectivity just to describe some starting positions, exercises and programs. ‘The Art of Correction’ is based on the observation of the 3D trunk/spinal deformity and 3D postural disorganization. Physiotherapists need to be aware about how difficult and long is to get the necessary Clinical Experience to produce a consistent therapeutical effect. It is not about a mechanic application of a protocol or list of instructions, like it could wrongly be interpreted by somebody when looking at the way it is presented: 4 Listed General Principles of the BSPTS; 3 Specific Principles of Correction; 5 Strategies of Pelvis Correction, etc.… somebody with long experience is not correcting according a fixed sequence of corrections but making that it happens all at the same time, when reorganizing posture and harmonizing shape. This is a very complex idea. This evolution continues, however, it does not mean that every change is made in the correct direction for evolution, some observed changes introduced by modern Schroth Instructors could be better defined as involution, this is obviously just an opinion, meaning with involution the fact of coming back into the history to perform something that was already empirically tested and abandoned. The argument against, and this my opinion, could be that the reason why somethings were abandoned was ‘people using wrong a good idea’. It is true, this could be right for some strategies used in the past and abandoned later, so I am not closed to re-take some old strategies, but only when having a consistent suspicion about the idea was used wrongly. In fact, I recommend looking back into the History. The historical perspective could allow us to re-take some good ideas that were abandoned just because performed technically not in the best way. Knowledge about history of scoliosis treatment is very important and its study shows how some pretended ‘evolving’ changes could be better defined as involution.
I ask all the current and future members of the BSPTS to consider this the foundational document of the BSPTS. But this is not an immutable creed (BSPTS is not a religion). For sure, it might change in the future in some details, but hopefully not in the main philosophy behind it.International BSPTS Document I