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A Question of Replication MADAM - I was prompted to write this letter after meeting a fellow physiotherapist who wanted to design a neck school. This physio- therapist was unaware of the existence of any neck schools even after contacting the Chartered Soci- ety of Physiotherapy for further information.

In 1991, while I was working at the Mount Vernon Hospital, Northwood, it became apparent to me that there was a need for a service for those patients who did not respond sign- ificantly to traditional one-to-one physiotherapy. This group included patients presenting with radiological changes indicating osteo-arthritis, a history of trauma (eg following whiplash) or those needing education in general neck care. A neck school was devised with a colleague, Gill Lever MCSP.

All the elements of the neck school were designed to be of a self-help nature and were developed follow- ing the completion of the McKenzie ‘B’ course (McKenzie, 1990). The four main elements of the neck school were mobilising exercises, postural correction, handling and lifting, and relaxation.

In 1997 a need arose at the Royal Oldham Hospital to provide further functional-type schools, in addition to the established back school. I decided to carry out a literature search and review any work done on neck schools (Kamwendo, 1991) or the neck and use that to update the neck school model devised at Mount Vernon in 1991. After two years we are now offering a newer version in Oldham. Changes include the addition of isometric strengthening exercises (Berg et a/, 1994; Leggett et a/, 1991) and a greater involve-

ment of cognitive and coping strat- egies. We are now developing a video to present handling and pos- tural issues as the original slide show was very time consuming for the physiotherapist.

Having carried out this work I was dismayed that the Chartered Society of Physiotherapy was not able to give any information on the subject. Is this a problem of communication? Are there no other neck schools apart from these two?

There is a need for assessing our service provision by audit. If we have the means to improve our service then it would make sense to avoid re- creating facilities every time in each hospital. Would a central database of each department’s services (includ- ing those provided by independent hospitals and private practitioners) allow for information to be commun- icated to those who requested it? Many regions are setting up audit groups and have regional facilitators, and many undergraduates produce audits, but there is no central collation of the information gathered.

If such a central collation system was set up, information on audits could then be cross-referenced for the various types of services offered by physiotherapists and could be continually updated. The ultimate aim is to improve the public service and not encourage rivalry and comp- etition as with recent organisational changes in the NHS. Perhaps a national web site would allow easy access to this type of information. Kevin Wright MCSP Oldham

References Berg, H et a/ (1994). ‘Dynamic neck strength training: Effect on pain and func- tion’, Archives of Physical Medicine and Rehabilitation, 75, 6, 661-665.

Kamwendo, K (1991). ‘A controlled study of the effect of neck school in medical secretaries’, Scandinavian Journal of Rehabilitation Medicine, 23, 143-1 52.

Leggett eta/ (1991). ‘Quantitative assess- ment and training of isometric cervical extension strength’, American Journal of Sports Medicine, 19, 6, 653-659.

McKenzie, R A (1990). The Cervical and Thoracic Spine: Mechanical diagnosis and therapy, Spinal Publications, New Zealand.

Lig ht-hearted Surely we do not always need to be

Learn i ng MADAM - I have always subscribed to the view that physiotherapy should be in all-degree profession, and that research and evidence-based prac- tice are essential for the benefit of our patients, and the survival of the pro- fession.

However, as these ideals have become reality, so the articles in the

so solemn? Peter Bowker’s article ‘Instru-

mented measurement’ (Physio- therapy, August 1998) is a rare exception -erudite, lucid, humorous, and immensely practical. Perhaps one of the reasons he is Dean of the Faculty is because he can make his knowledge easily accessible to the rest of us.

Journal have become ever more Jessica E Ward MCSP turgid, abstruse and painful to read. Oxford

Moving House? Please let the CSP Membership Department know, giving your name, membership number, old and new addresses and the date of the move.

Physiotherapy, June 1998, vol84, no 6