First let me clear away a misconception. As ContinuingProfessional Development is a term much used at presentit may be thought that Professional Development refers toour individual development as professionals. Although it is true that the profession develops in and through the professional and personal development of itspractitioners, we are referring here to the rather differentconcept of ‘professionalisation’. This is generally taken tomean the process by which any new occupational grouptakes on the characteristics of a profession. And we arestill a relatively young profession in many ways.

Professions are usually distinguished from mereoccupations by the extent to which they fulfil criteriawhich describe the characteristics of long-establishedprofessions such as medicine or the law. In this issueRichardson reminds us that these are: autonomy ofpractice, an exclusive knowledge base, occupationalcontrol of rewards, an ethos of service to the public, andself-regulation of standards of practice. The notion ofprofessionalisation allows us to regard each of thesecriteria as a continuum along which we can travel towardsfull professional status. No doubt we could have endlessdebates about the degree to which we each feel that ourprofession has achieved every criterion.

Knowledge BasePerhaps the professional hallmark which exercises memost is the requirement to lay claim to an exclusiveknowledge base. All the articles in this issue have aperspective on this topic. Richardson’s articles are largelyconcerned with the individual professional’s preparationand participation in the development of the profession.If, as she urges, contributing to the growth of theprofession is an integral responsibility of being aphysiotherapist, then we will all want to fulfil thatresponsibility in some way. For clinicians the requirementto reflect on and evaluate our own practice has alwaysbeen there. But can we be certain that we do not give theimpression that we have been driven to it by the newculture of accountability in clinical governance? Where is the published evidence that we are an evaluativeprofession?

In the new client-centred health care culture, the timelyarticle by Dalley highlights the tensions between client-centred evaluation, which appears not to make muchcontribution to knowledge, and our professional need toevaluate our interventions more specifically. Dalley

concludes that there is probably a need to evaluateoutcomes both specifically and globally. However wemight also consider conceiving of our knowledge basemore broadly. How easy would it be to find an example ofphysiotherapists’ documentation which gives a clearpicture of the therapy which has undoubtedly takenplace? Do we record a comprehensive evaluation or do weconfine ourselves to joint ranges, muscle powers anddisembodied ‘functional activities’, important as theseare? We may give the impression that we do notrecognise and publicly value the interpersonal andcontextual aspects of our activities. Do we know how touse measures which can evaluate our contribution moreholistically?

On the RecordThe notion of documentation is important. Until the lastfew years our culture has been informal. Knowledge hasbeen passed on orally from one practitioner to anotherwith not much written down. The professional knowledgewhich was embedded in practice was visible only to anobserver, and so almost invisible. Unless an expertclinician also taught post-graduate courses, or contributedto textbooks, their personal knowledge of physiotherapywas never passed on in a coherent way. In effect it retiredwith them!

Richardson warns that the drive towards evidence-basedpractice carries with it a threat to our professionaldevelopment in that we have so little researched evidencefor many of our interventions. Although we may, likeothers, be paying the price for our failure to investigateour practices and publicly demonstrate their efficacy, weare grateful for the foundation that our forebears havegiven us. Retrospective recriminations are inappropriateas they take little account of the climate and culture inwhich physiotherapists found themselves years ago. Whilethere have been many physiotherapists who individuallyhave made a contribution to professional knowledgethrough research and publication, and who should beacknowledged, it seems to me that it is only in recentyears that the profession has collectively recognised thatwe have to subject our practices to objective scrutiny.

We would do well to recognise that the profession ofphysiotherapy can only gain from our own carefulinvestigation of our practices, and publication of ourfindings. Professional knowledge is ‘public, proceduraland propositional’ as Richardson again reminds us. In

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Physiotherapy September 1999/vol 85/no. 9

Professional Knowledgein ProfessionalDevelopment

by Christine Bithell MA MCSP DipEd

Scientific and Clinical Editor,Physiotherapy

From time to time it is pleasing to be able to devote an entire issue to articles that focus on a singletopic. This issue affords us the opportunity to look inward at ourselves and consider our developmentas a profession.

Physiotherapy September 1999/vol 85/no. 9

our culture this kind of knowledge is accorded higherstatus than experiential knowledge, which we oftendismiss as ‘anecdote’. Perhaps it should not be so, but forthe moment it is. We must continue to developmethodologies which are capable of demonstrating thedifferent facets of our practice.

Bower illustrates a series of studies employing bothdescriptive and experimental methods which togetherhave increased our understanding of the variablesinvolved in providing effective treatment programmes forchildren with cerebral palsy. Her article also providesinsight into the difficulties in beginning such research, inthat there was little on which to ground an experimentalstudy. The need for qualitative, descriptive studies both toincrease our knowledge of practice and to build a firmerfoundation for more definitive outcomes research isclearly illustrated.

Lettinga and colleagues have developed a completelydifferent approach to published professional knowledge.By re-examining two well-known texts in neurologicalphysiotherapy based to different degrees on neural andmuscle physiology, biomechanics and experientialphysiotherapy knowledge, they uncover the relationshipbetween science and experience, and depict the ‘tangled’connections between scientific theories and practice. Intheir analysis science does not underpin or provide astarting point for practice, but rather inspires andexplains the insights of therapists. They contend that itwould be mistaken to judge a clinical approach accordingto the probity of the science on which it is based. This is avaluable insight. However, we should not accept scientificexplanations which would not stand the test within theirown disciplines.

Evidence-based FutureThis leads me to a fundamental conclusion, and the pointat which I should leave you to read the articles foryourselves. As a profession of over 100 years’ standing, ofcourse our practice has been based on transmissibleknowledge. However, it is time that we looked at thisagain. At this point in our development perhaps we areready to understand that on the one hand scientifictheories drawn from other disciplines can at best explainphysiotherapy, and can only become incorporated intophysiotherapy knowledge after rigorous validation of theways that they have been transformed into practicalknowledge. They do not in themselves constitute ourunique knowledge base. Secondly, we could redouble ourefforts to find methodologies which would enable us totransform our personal professional knowledge, whichundoubtedly exists, into credible published evidence. Weare moving forward now – let us move faster.

Lead Article