Celebrating 70 years of the New Zealand Journal of ...

Guest Editorial

Celebrating 70 years of the New Zealand Journal of Physiotherapy ‘A great work has been started and for [seventy] years it has progressed, not always at the same pace, not without mistakes, not without distress, not without personal antagonisms but mistakes and distress stimulate to further effort, and the errors as well as the wisdom of those who have gone before are a challenge to those who follow’ (Roberts, 1949). These words were quoted by M.L. Roberts, founding Principal of the School of Physiotherapy in Dunedin, in her book review of Jane Wicksteed’s 1948 text ‘The Growth of the Profession: Being the History of the Chartered Society of Physiotherapy 1894-1945’ (Wicksteed, 1948) because they spoke both to members of the Chartered Society in England, and members of the New Zealand Society of Physiotherapists in New Zealand. I have used them here because they also speak volumes about the first 70 years of the New Zealand Journal of Physiotherapy that we are celebrating this year. It is tempting on a 70th birthday to think of the seven ages of man, or to make analogies with the three-score-years-and-ten that people are allotted, but it is clear even from reading through past volumes that the Journal is only now arriving at maturity. It had a difficult birth – one that lasted for nearly 20 years – and it had its period of adolescence – when the journal filled out with home grown writings – but it is only in recent years that it has matured into a volume capable of holding its own in the world. Subtly, the Journal has been a barometer of change in the profession, but also in society at large. As the years go by, it has reflected a changing relationship with the medical profession, economic prosperity, threats from other professionals, shifts in health priorities, technological trends, changing professional priorities, and many other themes. In this editorial I would like to shed light on a few of these discourses and illustrate how the Journal served a vital role in mediating between New Zealand physiotherapists and the world at large, whilst also arguing that the Journal helped to define many of these issues. From its inception in September 1938, the Journal operated with the simple rubric that ‘The New Zealand Society of Physiotherapy (Incorporated) controls the affairs of physiotherapy throughout the Dominion [while] the Physiotherapy Board [was] responsible for training and examination’ (Smith, 1960). It would be the mouthpiece of the New Zealand Trained Masseurs Association, and later the N.Z.S.P. As M.I. Lambie, Director of the Division of Nursing at the Department of Health wrote ‘No professional organization is complete without its own organ in which to express its opinions and to bring refreshment and encouragement through its educational programme to its members’ (Lambie, 1938).

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Until the mid-1960s however, the Journal struggled financially, and filling its pages with stimulating content was a constant battle. Originally, the intention was to include two ‘pieces from medical men’, and two from practising physiotherapists, but invariably physiotherapy material did not materialize and the School’s teaching staff was frequently called upon to fill the void. Editors came and went (there were nine different editors in the Journals first 10 years) and the quality of the Journal waxed and waned. For many years there was no ‘style sheet’ as such to follow, and the quality of the product varied greatly. The first great editor of the Journal was Margaret Hollis. Margaret came to New Zealand from England where she had worked with Guthrie Smith, and brought a raft of new ideas about suspension therapy, massage, exercise and movement, particularly to cardiothoracic therapy. Within months of her arrival, she was made VicePrincipal of the School and Editor of the Journal. Over her two-year term the journal grew in size, secured more advertising revenue (not least from the supplier of Guthrie Smith suspension systems that Hollis brought from England), and defined a higher standard of editorial leadership with her newly appointed Editorial Committee. Inevitably though, the pressure to squeeze decent material from the readership proved too much even for Hollis, as became clear in a bitter Editorial published in 1949; It is not out of place at this juncture to remind readers of this journal that although it is printed for them, it is very rarely used by them as a means of expression...Producing the journal is never an easy task, even if one only has the mechanical tasks expected of an editor and the editorial sub-committee, but it becomes a momentous and almost impossible task when all or almost all the articles have to be found by the members concerned in production...Why are New Zealand physiotherapists so reluctant to write of what they know? Why don’t they even write what they feel? Surely among our members there must be some people who are doing work of which the rest would like to know. We don’t ask for long screeds, dry and full of indigestible meat. We only ask for short articles on anything you may like to write about. We offer to correct your English and spelling and even to completely reject your effort if we don’t like it. So produce your courage, take your pen in your hand and write for us. We don’t mind even if you only write to tell us how awful the journal is, as we needn’t print such correspondence! It would be quite a change to be able to say that this is the New Zealand physiotherapists’ journal, and to know that it is

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a completely honest statement. At the moment such a statement is not true, and after all this is supposed to be the official journal of the N.Z.T.M.A. What are you going to do about it (Hollis, 1949)? Pressure to produce a journal of consistent high quality led the Society to appoint its second great editor when it employed a professional editor for the first time in 1953. Mrs B.I. Officer of Plimmerton served for almost three years and produced six editions, but clearly in that time even her patience with the profession wore thin; Most N.Z.S.P. members will probably agree with the thought that the Journal, as the medium of expression of the profession in New Zealand, is worthy of the best that can be put into it. In theory this is quite true, but in practice it has proved difficult to attain. The Journal is what members of the profession make it, either by complete and willing co-operation or by indifference and criticism without effort towards improvement (Officer, 1955). It is important to note that before the 1960s the doctor’s word was gospel. It is only relatively recently that we have resorted to extensive reference lists and multiple citations to justify the claims made in medical literature. Thus it was probably even more daunting than it is today to have one’s writing published alongside men whose authority was unquestioned. Consequently the material that was published was either of a distinctly ‘technical’ nature, or it was purely social. For many decades the Journal included notes from the President of the Society, a report from the School, copies of the year’s exam papers, news of the various ‘hatches, matches and dispatches’, alongside learned papers on topics such as ‘War Wounds’, ‘The Sacro-Iliac Joint’ and ‘Postural Control’. Every two years the proceedings of the biennial conference gave the Editor welcome respite from the trials of having to procure material for the Journal. It was in one such paper, titled ‘Physiotherapy in the Treatment of Cardiac Disease’, that the first references appear (Burns, 1941). (Interestingly, many of the papers written about the practice of physiotherapy in the first two decades of the Journal were written by doctors, and the quality of the information was sometimes sketchy at best). Formal guidelines defining a standard for Journal submissions did not appear until the May edition of 1960, and even then it was another year before mention was made of the need for formalized references; References to articles and books should be carefully checked. They should appear in the text as the author’s name, followed by the year of publication. They should be listed alphabetically at the end of the article with the following particulars in order indicated: author’s surname, initials (sic), year, full title of article or book, full title of journal, volume number, and number of first page of article. In case of books, the editin (sic), publisher and place of publication must be stated also’ (Editorial Committee, 1961).  2

It is ironic, but at the same time quite revealing, that the guidelines for contributors should include fundamental proofing mistakes. By the mid-1960s the Journal turned a corner. Publications shifted from an interest in remedial therapies and exercise to an increasing interest in electrotherapy and actinotherapy. This probably mirrored the booming societal interest in technology and the greater availability of disposable income after the long years of rationing after the war. But what is clear is that it opened the Journal to a new market for advertisers, and by 1966 the journal carried high-paying full-page adverts for the latest ‘Uniflex’ Shortwave Diathermy machine, the ‘Oscilloflux 260’ or the ‘Ultratherm 608’. By 1964, the NZSP Council reported that the Journal had made an annual profit of £28 18s 0d, which meant that the Journal fund stood at £119 18s 5d. At the same time, a subscription to the Journal cost 5 shillings per copy and the average salary of a staff physiotherapist was around $800. Stanley Paris placed the first large advert for a course in the Journal of May 1965 (‘Post Registration Course in Specific Spinal Manipulations’ from January 3-14 1966 in Christchurch, and January 17-28 in South Auckland). The 11 day course cost £20. It was in 1964 that the Journal published its first original empirical study. The ‘Joint Measurement Project’ (Morley, 1964) was produced by the 1963 group of students located on placement at the Auckland Subsidiary School – an outreach centre of Otago. This was emblematic of a shift that had taken place in the Journals contents. ‘Filler’ papers on ‘The Application of Physiotherapy to Thoracic Surgery Cases’ (Hollis, 1948) and the like – important though they were at the time – were gradually being replaced by original content from clinicians and nascent researchers. The change was gradual however, and the journal continued to rely on ‘external’ contributions – primarily from doctors and medical technicians – to fill its pages well into the late 1970s. The first flowerings of New Zealand’s independent research endeavour began to appear in the 1960s, but it was not until the 1970s that a raft of new researchers published their first papers in the Journal: Ian Sim’s and Stanley Paris’s writings on mobilization and manipulation techniques; Sheila Glendining’s writings on cardiorespiratory physiotherapy; and Margaret Moon’s on psychology, for example, all showed an independent spirit and a more rigorous clinical science approach to scholarship. But by far the greatest ‘political’ features in the Journal during the 1970s were the battles to establish a second physiotherapy school, the emergence of ACC, and the long-running disputes with chiropractors. New Zealand had been chronically short of physiotherapists since the end of WWII (Roberts, 1944). This had directly led to the introduction of a bursary scheme in 1950 that bonded therapists to public hospitals around the country after NZ Journal of Physiotherapy – March 2009, Vol. 37 (1)

qualification (NZSP Executive, 1950). By the 1970s the problem had become chronic and endemic however; ‘For some years there has been a shortage of between 20 and 25% of staff physiotherapists on hospital board establishments throughout New Zealand’ (Gardiner, 1971, p. 3). The problem lay in the lack of available places for training and the limited numbers of trained teachers. By 1961 teachers were no longer required to travel to England to train, but the need for Charge Physiotherapists to reduce their salary to work as Trainee Teachers continued to prove a barrier. This problem made it harder to justify the need for a second school, but by May 1971 the Journal was openly promoting the idea of a school in Auckland, and by 1973 not only did the profession acquire its second school, but control of the funding of physiotherapy education transferred from the Minister of Health to the Minister of Education (Gardiner, 1973), which made the possibility of a University education in parallel with the medicinal profession a distinct possibility. In the same year, Ian Campbell (Secretary of the Workers’ Compensation Board) wrote a paper titled ‘The Accident Compensation Act 1972: Its implications for Rehabilitation’ (Campbell, 1973). This immediately preceded an address by Justice A. O. Woodhouse himself, titled ‘Accidents and the Problem of Compensating the Injured’ (Woodhouse, 1973). These papers heralded one of the most significant changes to take place in New Zealand physiotherapy, and a telling phrase from Campbell forewarned of a battle that would continue in the profession for the next 35 years; ‘When the Act is discussed it is a matter for regret that all attention seems to be focused on compensation and the probable cost thereof, to the exclusion of the positive features of accident prevention and rehabilitation’ (Campbell, 1973, p. 19). The ACC Act certainly had a positive effect on the growth of private practice in New Zealand, as was made clear by the publication of Ian Tayler’s paper ‘Private Practice’ in 1975 (Tayler, 1975). Despite this it seems antipathy towards ACC appeared in the Journal as early as 1979 when Mike Lamont, then editor, wrote; …physiotherapists, particularly in the private sector, have become upset at the inept and bungling way in which the Accident Compensation Commission has attempted to control alleged financial abuses by private practitioners. In the October 1977 Medical Newsletter (circulated to doctors only) the Commission stated that it was concerned at the high cost of paramedical services, notably physiotherapy…The Newsletter continues: “stricter control of expenditure in this area can be expected” (Lamont, 1979b, p. 3, italics as original). A ‘Manpower Survey’ published in the Journal immediately after the enactment of ACC legislation showed that of 646 respondents, only 28 worked NZ Journal of Physiotherapy – March 2009, Vol. 37 (1)

in private practice, whilst 425 staff (66%) worked in public hospitals (Briggs, 1975, p. 13). This bias towards public sector employment remained evident in the volume of literature published that was relevant to the hospital physiotherapist. Manipulative therapists were punching above their weight in the Journal however, evidenced by the appearance of the first advertisements for postgraduate courses, information on the formation of I.F.O.M.T. and the N.Z.M.T.A. It was in part this growth in interest and expertise that led to the profession’s concerns for the expansion of chiropractic in New Zealand, as reported by Don McKenzie in 1976: Within the past twenty years New Zealand chiropractors have made eight well organized attempts to gain official recognition from Government, including submissions made to two Royal Commissions…It is a common experience for both medical people and the general public to be confused by the polemic arguments surrounding the legitimacy of chiropractic as an alternative health service to conventional medicine. Most of these arguments remain unsupported by research or controlled studies, which accounts for chiropractic’s continued professional insularity despite its 80-year history (McKenzie, 1976, p. 13). Disputes with the chiropractic profession did not go away (see, for instance, the ‘Report of the Commission of Inquiry into Chiropractic’ published in November 1979, pp. 9-10), nor did the ‘challenges’ offered by ACC legislation (likewise, McKenzie and Ingram’s submission to Cabinet/Caucus Committee on review of the Accident Compensation Scheme August, 1979 in the same edition, pp. 7-9). The education of students also remained a constant source of tension over the ensuing years, but by the end of the 1970s the Journal had matured to the point where it smoothed out the editorial, proofing and stylistic issues of its first three decades and began to expand both figuratively and literally. In November 1979 it moved to a new, metric, A4 format that immediately presented a more scholarly face. And while the change was made to give a ‘better utilization of paper at the same cost’ (Lamont, 1979a, p. 5), the die was effectively cast. The appointment of L.C. Gardner as editor of the Journal in 1965 marked the end of an era for the Journal. Gone were the willing but relatively unrefined efforts of successions of rotating ‘volunteers’. In their place came a series of long serving appointees who brought consistency and poise to the position. L.C. Gardner’s successor, Mike Lamont, also heightened the political leanings of the Journal by heralding in debate on legislative and social reform. Mike was the first Editor to come exclusively from private practice and it was under his tenure that musculoskeletal physiotherapy began to eclipse hospital-based care as the primary interest of students and emerging practitioners (Wilson, 1981). By 1980, 303 of the  3

960 respondents (31.5%) to the Manpower Survey were in private practice (Department of Health, 1983). The number would be 47% of the workforce by 1985 (Morris, 1986), of which 50% were in sole practices (Lamont, 1986). Similarly, during the 10 years following the enactment of ACC legislation, expenditure on physiotherapy services increased by 174% with an increase of 36% in the number of services offered – much of that going directly into the private sector (Lamont, 1983). Despite this, the relationship between the profession and ACC had soured considerably, as this commentary suggests; The Accident Compensation Corporation has been around since April 1974 and the profession enjoyed good relations with the Corporation (then the Commission) until 1979 when restrictions began to be placed on our practice. This culminated in December 1983 in the Society obtaining a High Court Injunction preventing the Corporation from undertaking certain actions which were unreasonable and unjust. The relationship with the Corporation is still far from satisfactory with the payment of fees being a major problem (Lamont, 1986, p. 6). By the early ‘80s, the ‘society pages’ had disappeared, along with the stories of physiotherapists’ exploits overseas. In their place came strict instructions for authors, notifications of postgraduate courses and the officers of the N.Z.S.P. Job and equipment advertisements remained, despite the observations of one letter writer who commented that ‘Advertising in the journal is probably not all that good value for advertisers anyway because few physios would make an equipment purchasing decision on the basis of an advertisement’ (Jenkins, 1981). Despite these efforts the Journal did not enter Index Medicus. The Journal now consistently published empirical research. In the April 1982 edition, for example, there were four papers published. Of those four, three were empirical; ‘A Two Year Study of Type I “Clicky” Hips’, by Dene Hancock; A clinical study of Chondromalacia Patellae by Richard Hopkins, and a ‘Post-Basic Education Questionnaire Survey’ commissioned by the Education Committee of the Society. With Mike Lamont’s departure, the editorial style of the Journal shifted slightly. The volume of research diminished and a battery of full page adverts for ultrasound machines and lumbar rolls appeared. (The August 1985 edition, for example, included 15 pages of adverts before the Editorial). The editor, Rockie Lowdon, populated the Journal with reports and news, and introduced the first colour inserts to brighten up the display. In 1986 the physical appearance of the Journal changed again, retaining the black and white frontage, but moving to a glossy cover and a return to the traditional layout of the contents. Advertisements were fewer and moved to the back.  4

Contents were now routinely published on the back cover. Despite this, Billie McLeod wrote in her editorial that ‘The Education Committee…sees no need to change drastically the format of this journal. It is hoped to continue presenting reports of research, of clinical observations, educational progress and administrative matters of professional concern’, and in a comment reminding us of the luxuries and possibilities offered by today’s modern technology; ‘As possibly a majority of members have no access to overseas journals, it is proposed to provide abstracts and summaries of their contents which may inform, and stimulate the interests of, (sic) readers and researchers’ (McLeod, 1987). Bryan Paynter sat in as Honorary Editor, one edition after he had begun his longstanding involvement in the Journal’s Editorial Committee and, having seen the Journal make one stylistic change, heralded in another, with the move to the new ‘graffiti’ cover. The Journal retained its predominantly black cover design, but now the name shifted to the upper half of the cover, and amidst the blue lettering was the word ‘physiotherapy’ emblazoned in gold (a point that Bryan was to return to in his closing editorial – see below). Without causing offence to those who went before or came after Bryan, I believe it is fair to say that Bryan’s editorial style remains unmatched in the history of the Journal. He brought a linguistic flair to his writings and accompanied this with the professional eye of a copy editor. Take this passage from his first full editorial as an example of his style. Writing about the impending move to degree education, Bryan wrote; …some people who consider desultory reading a more pleasant pastime than sitting in front of TV and being advertised at, may, like joggers who could have got there by walking, acquire an urge to accelerate the pace, and apply themselves to studying for a university degree (Paynter, 1988). To read Bryan’s editorials was an education in itself. Yet the Journal changed little from its established style. Throughout the ‘90s the formula remained the same until the December edition of 1995, when Bryan retired. Bryan was editor for nine years and 27 issues, and his tenure was marked by remarkable consistency and a professional eye for detail. Indeed in his closing editorial he wrote; Apart from a change of cover style (which occurred without my knowledge and consent early on) and of typeface (which occurred at my insistence later on), there have been no great variations in format or content in all that time. Some things, of course, never change, such as a regular shortage of contributions (Paynter, 1995). Bryan left a legacy that was hard to follow, but he also laid down a template for the professional editorial values of consistency, accuracy and attention to detail that have been the hallmark of the Journal ever since. Sandra Bassett took over NZ Journal of Physiotherapy – March 2009, Vol. 37 (1)

the role of Honorary Editor and instigated at least two significant changes to the Journal. The first was to move to another new format. In April 1998 the Journal moved away from the predominantly black and white cover, to a cream and teal design. A cleaner paper was purchased but Bryan’s typesetting changes were preserved. The second was to formalise APA (American Psychological Association) formatting for all articles, replacing the previous Vancouver convention. Notwithstanding the cover design changes that came into effect in March 2003, the Journal looked the same then as it does today. Seventy years is a long time in anyone’s life, and over that time there will inevitably be changes. This is no more true than in the Society’s Journal, which is the living record of the profession’s history. It has recorded training, graduations, marriages, Society battles, research findings, administrative debates, political tensions, commemorations, celebrations and deaths over more than 150 editions. It spanned many of the major social upheavals of the latter half of the twentieth century in New Zealand, and made connections with the physiotherapy world at large. More than anything though, it has been the glue that has bound the Society’s members together and it is testimony to the legions of editors, authors and organisers who have poured heart and soul into it over the last 70 years that it still speaks for New Zealand physiotherapists and offers our story to the world. David Nicholls PhD MA GradDipPhys Chair, New Zealand Physiotherapy History Working Group Senior Lecturer AUT University Auckland

References

Briggs, J. (1975). Report on the Manpower Survey of Physiotherapists 1974. New Zealand Journal of Physiotherapy, 5(2), 9-16. Burns, C. R. (1941). Physiotherapy in the Treatment of Cardiac Disease. New Zealand Journal of Physiotherapy, 1(6). Campbell, I. (1973). The Accident Compensation Act 1972: Its implications for Rehabilitation. New Zealand Journal of Physiotherapy, 4(5), 19-21.

NZ Journal of Physiotherapy – March 2009, Vol. 37 (1)

Davids, L. M. (1985). I’m not good enough to write for the Journal. New Zealand Journal of Physiotherapy, 13(2), 10-11. Department of Health (1983). Physiotherapy manpower data. New Zealand Journal of Physiotherapy, 11(1), 9-11. Editorial Committee (1961). Contributions. New Zealand Journal of Physiotherapy, 3(1), 4. Gardiner, L. C. (1971). Editorial: Which Direction? New Zealand Journal of Physiotherapy, 3(20), 3-4. Gardiner, L. C. (1973). Guest Editorial: What Now? New Zealand Journal of Physiotherapy, 4(5), 3-4. Hollis, M. (1948). The Application of Physiotherapy to Thoracic Surgery Cases. New Zealand Journal of Physiotherapy, 1(14), 7. Hollis, M. (1949). Editorial. New Zealand Journal of Physiotherapy, 1(16), 3. Jenkins, J. (1981). Letters to the Editor: An alternative to the Journal. New Zealand Journal of Physiotherapy, 9(2), 21. Lambie, M. I. (1938). Letters to the Editor. New Zealand Journal of Physiotherapy, 1(1), 12. Lamont, M. K. (1979a). Editorial: Change. New Zealand Journal of Physiotherapy, 8(2), 5-6. Lamont, M. K. (1979b). Editorial: Physiotherapy is a Profession. New Zealand Journal of Physiotherapy, 7(1), 3-5. Lamont, M. K. (1983). Accident Compensation Corporation. New Zealand Journal of Physiotherapy, 11(3), 21. Lamont, M. K. (1986). Physiotherapy Workforce Statistics. New Zealand Journal of Physiotherapy, 14(1), 6-7. McKenzie, D. (1976). Chiropractic - A General Theory of Disease. New Zealand Journal of Physiotherapy, 5(3), 13-17. McLeod, B. (1987). Editorial. New Zealand Jour nal of Physiotherapy, 14(1), 3. Morley, M. (1964). Joint Measurement Project. New Zealand Journal of Physiotherapy, 3(6), 21-22. Morris, A. (1986). Physiotherapy Workforce 1985. New Zealand Journal of Physiotherapy, 14(1), 4-5. NZSP Executive (1950). Executive Report. New Zealand Journal of Physiotherapy, 1(19), 32. Officer, B. I. (1955). Editorial. New Zealand Journal of Physiotherapy, 1(29), 3. Paynter, B. (1988). Editorial. New Zealand Jour nal of Physiotherapy, 16(2), 9. Paynter, B. (1995). Editorial. New Zealand Jour nal of Physiotherapy, 23(3), 4. Roberts, M. L. (1944). Principal’s Report. New Zealand Journal of Physiotherapy, 2(10), 31. Roberts, M. L. (1949). Book review. New Zealand Journal of Physiotherapy, 1(16), 30. Smith, A. P. S. (1960). The New Zealand Society of Physiotherapy. New Zealand Journal of Physiotherapy, 2(6), 3. Tayler, I. A. (1975). Private Practice. New Zealand Journal of Physiotherapy, 5(2), 4-6. Wicksteed, J. H. (1948). The Growth of the Profession: Being the history of the Chartered Society of Physiotherapy 1894-1945. London: Edward Arnold & Co. Wilson, J. (1981). An evaluation of physiotherapy training. New Zealand Journal of Physiotherapy, 9(1), 12-13. Woodhouse, J. A. O. (1973). Accidents and the Problem of Compensating the Injured. 4, 5(21-23).

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