There is clearly an international movement towards change in this area – however it is also clear that, whilst the legislative barriers may be being removed, there are still cultural (principally relating to the relationship with medical practitioners) and structural (often relating

to funding) barriers which prevent direct access. The commonality of the issues that we face internationally is far greater than the differences. In Australia, Canada and Denmark, for instance, there is a common funding barrier where third-party payers like worker’s compensation bodies continue to insist on a doctor’s referral to physiotherapy. Ku-0059436 manufacturer This is despite the fact that a referral is not legally required and can delay the treatment process for patients who need early physiotherapy intervention. The APA and many other international associations are lobbying actively against Protein Tyrosine Kinase inhibitor this requirement as it is an obvious impediment to efficient and efficacious care. Although it is now more than three decades after some physiotherapists

first gained the right to autonomous practice, there still persist legislative, economic, and cultural challenges across the world that prevent physiotherapists working to the full extent of their education and experience. Through networking and the sharing of ideas and strategies it is only a matter of time before the majority of physiotherapists ADAMTS5 internationally have this right. When that day arrives the visionary struggles of pioneers such as Prue Galley will be well and truly vindicated. “
“In many developed countries, physiotherapists are one of the few health professional groups to have the privilege of being able to practise independently of their interdisciplinary colleagues. This privilege brings with it the responsibility to provide the very best care we can for our patients. Keeping up to date with

changes in evidence, acting to overcome barriers to implementation of new and better practices, and cessation of ineffective interventions are considerable challenges for us all. Practice accreditation and departmental or hospital audits of services exist in many centres. These systems of review measure service performance, but whether they also measure the quality of care we provide for our patients is more difficult to determine. In this context, quality means the degree to which a health service increases the likelihood of desired health outcomes for patients, is consistent with current professional knowledge ( Lohr and Schroeder 1990), and adheres to existing evidence-based guidelines ( Duncan et al 2002). In recent years, increasing attention has been paid to the development of national quality of care audits and registries across a range of disease groups.