Yet another meta-analysis on the effectiveness of NDT has been published and yet again the academics report that NDT is no better than usual care. But this new publication takes a bold step in stating that Deimplementation of NDT is required. And yet again we have to ask - Why are so many clinicians not aligned with these academic findings?
Physical therapists, occupational therapists and speech therapists who all have the same basic undergraduate training as many of these academics, but choose to spend their time in the clinic working with children and families as their priority, continue to value NDT. Therapists continue to value NDT despite the relentless call to stop from academics who therapists otherwise highly value.
Why?
Well I've written about what I think here and here a good few years back now. And this latest publication does nothing to change my opinion. So this time around I thought I would take this question to the streets - or at least the virtual streets in this digital age - otherwise known as social media.
I posted a survey that therapists could choose to answer anonymously or not. The survey platform detects unique responses but does not capture other details unless offered by the respondent.
Therapists were asked if they had done NDT training as a filter question.
If they answered No, they were asked one simple question - why?
If they answered Yes, they were asked when they had done their first and last training, if they valued it and why.
A preliminary look at the first 236 respondents found that 85% of therapist that had undertaken NDT training, rated the value they got from NDT as either 4/5 or 5/5. There was also a significant difference in positive and negative responses between therapists who had or had not done NDT training.
Just over 30% of people who had not done the full NDT training stated mostly money and/or time as their reason for not doing it, with an additional 10% of people stating difficulties accessing training. A few clinicians stated that they already had the skills from working with colleagues and did not need it. About 10% of therapists who had not done NDT training gave reasons such as NDT not being evidence based, not being effective, being too passive or that there were better alternatives available.
For those therapists that had done NDT training, just over 15% said they valued the training for improved effectiveness in therapy outcomes, but the most common value that therapists found with doing their NDT training was improved skills in analysis, clinical reasoning, problem solving and shared expertise across disciplines, with NDT being described as foundational for understanding movement and neurodevelopment.
So what does this mean?
My take away from this little informal research is that most therapist who have done the training highly value it. Therapist who haven't are more likely to have a negative opinion and be influenced by the academics' analysis of NDT.
Or in nutshell..
If you've done your NDT training, you KNOW WHAT NDT IS and you're highly likely to think it's worth doing.
If you haven't done NDT... not so much.
Which really circles back to the original question - why do smart, well trained, highly experienced clinicians who work in the real world, with real kids, everyday, still think NDT is worth it when the research tells us over and over again that it's not?
Could it be that the researchers don't actually understand the NDT concept? Could they possibly be asking the wrong questions? Many times in the research NDT is stated as usual practice and compared to a 'new' approach. I'm not sure anywhere else in our profession do we make the conclusion that since the new approach is more effective we should DEIMPLEMENT practice?!? Usually we integrate the new approach to improve our practice, which is what contemporary NDT therapists do. For me it's like saying well CIMT is more effective than OT so we should deimpliment OT - it's a little bizarre.
Because NDT is not a technique - it's a concept and a framework and philosophy of shared learning across disciplines.
It's not the only way for therapists to develop expertise in pediatric neurodevelopment - but according to the 85% of therapists who have taken the time to do NDT training - it's a valuable way to do so. And pediatrics should be a field where therapist require specialist clinical training. And essentially that's what NDT is.
Why should we care?
The therapist that train as NDT instructors are passionate, smart and experienced clinicians who are constantly striving to stay up to date and pass that knowledge on to clinicians - not academic book knowledge - but clinical skills and insights that can only be gained with time and experience - and only be taught over time in practical, applied courses. The NDT model of teaching and developing therapists clinical skills is valued and valuable. Why are the academics working so hard to deimplement it?
Is there some blame to lay at the feet of the NDT/Bobath organizations themselves?
Definitely!
As an organisation they need to do a better job of research - not the kind of research that is out there presently asking the wrong questions, but the type of research that starts to unpick why smart, scientifically trained, experienced therapist valued their NDT training so much.
What do therapists who are NDT trained gain and offer the children and families they treat that is different to those therapists that aren't NDT trained?
How does NDT training improve a therapists clinical analysis and problem solving skills?
Are therapists who are trained in NDT able to implement new techniques more effectively than those that aren't?
I am over the silly battles of who owns motor control and theories of neuroplasticity, and is it still NDT if you're applying an eclectic approach of many modalities or working with the child and family on participation goals 🤦♀️.
It's time for the research to move away from describing NDT as passive technique frozen in the dark ages.
It's time to shift focus before we lose the art and benefits that NDT has so richly offered to thousands of clinicians and families across the world working in the clinic every day; and the knowledge of an international network of experienced, passionate and dedicated therapists and teachers.
We should be capitalizing on this network of experience, not be trying to deimplement it to suit some academic egos.
Read Part 2 - a reflection on this latest meta-analysis>> HERE
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