Re: Marwaha K, Horobin H and McLean SM (2010) Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations.


This letter raises a number of issues which appear to relate to two main areas of concern for Senthil Kumar. Firstly he critiques the paper by Marwaha et al (2010) and secondly he critiques the editorial processes employed by IJPTR. These will be dealt with in order.

Critique of Marwaha et al (2010)

We would disagree that there are any serious ethical issues with this study. Ethics approval was sought and obtained from the Dissertation Management Group at Sheffield Hallam University (SHU) but permission to undertake the study was also sought and gained from an appropriate manager at the hosting hospital in New Delhi. This permission from the hospital manager to undertake the study on hospital premises is not an ethics issue but a matter of formal politeness and has therefore not been mentioned in the article. In addition there is a clear account of informing and consenting procedures during the recruitment procedures (see page 10 of the article in the paragraph entitled “Setting and Recruitment”). The use of patient information sheets and the signing of consent forms is implicit in the process of informed consent and was part of the ethical protocol agreed by the SHU ethics committee for undertaking this research. This has been strictly adhered to.

We certainly do recognize that there are a number of limitations in this paper (pg 16 of article in the paragraph entitled “study considerations”). It is impossible within the word limits to make mention of and discuss all limitations, but we have addressed what we consider to be the main limitations namely the disadvantages of using a single focus group and a lack of data saturation. This we feel strongly correlates with the small number of participants in this study accurately identified by Senthil Kumar. We document in our study that the inclusion of further subjects using further focus groups would benefit this study and allow for a fuller exploration of factors which might explain patient non-adherence. We agree with Senthil Kumar that this would then allow greater potential diversity of participants which would have an overall benefit for the validity of the findings. We also document recommendations that future research investigating physiotherapists from a more diverse background than New Delhi alone would benefit the wider understanding of racial, cultural or societal issues leading to non-adherence.

Finally, the paper by McLean et al (2010) is a systematic review investigating strategies for improving adherence, and therefore lies slightly lateral to the focus of this study which investigates physiotherapists’ perception of factors which may lead to non-adherence with physiotherapy. Therefore we have referred copiously to similar papers including one of our earlier systematic reviews by Jack et al (2010) investigating factors leading to non-attendance in physiotherapy outpatient clinics, which is more directly related to the topic. Our discussions do touch on strategies that Indian physiotherapists might use, but we hope that we have conducted a focused discussion on that topic which does not require the support of McLean et al (2010).

Critique of IJPTR editorial process

As the editor of IJPTR I have final responsibility for each edition that is published and consequently I have a hand in decision making in all the articles that reach publication. And so it is with Marwaha et al (2010). Of course this is not ideal, but as a new journal with limited resources, IJPTR currently has a single editor. In due course there may be a need for a second editor, which will hopefully eliminate this element of potential bias, though this may not occur for some time yet.

One of IJPTR’s unstated aims is to publish work that reaches, as a minimum, the standard of a good quality dissertation thesis. We consider that there may be many high quality undergraduate and postgraduate dissertations that are worthy of publication in IJPTR and this may represent the first publication of many of these novice researchers on their road to an academic career. In the first edition there were at least 3 publications presenting the dissertation work of 8 postgraduate students namely; Qaqish and McLean (2010); Mclean et al (2010) and this current study. In this second edition there are at least 2 namely; Altaim and Littlewood (2011) and Karnad and McLean (2011). We expect to publish many more similar types of studies in the future and we hope that they will be submitted by researchers from around the world. The important editorial factors are that the work should be of good quality, that the authors should recognize the limitations which are inherent within the work and that the conclusions drawn from the study should not be overstated. Whether the work is submitted by a student or not is a redundant item.


Jack K, McLean S and Klaber Moffett J (2010) Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual therapy, 15(3);220-228.

Marwaha K, Horobin H and McLean SM (2010) Indian physiotherapists’ perceptions of factors that influence the adherence of Indian patients to physiotherapy treatment recommendations. International journal of physiotherapy and rehabilitation, 1(1);9-18.

McLean SM, Burton M, Bradley L and Littlewood C (2010) Interventions for enhancing adherence with physiotherapy: A systematic review. Manual therapy, 15(6);514-521.

McLean S, Taylor J, Balassoubramanien T, Kulkarni M, Patekar P, Darne R, Jain V (2010) Measuring upper limb disability in non-specific neck pain: A clinical performance measure. International journal of physiotherapy and rehabilitation, 1(1);33-41.

Qaqish JH, McLean SM (2010) Foot type and tibialis anterior muscle activity during the stance phase of gait: A pilot study. International journal of physiotherapy and rehabilitation, 1(1);19-29.

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