Physiotherapists should be looking to establish their role in the treatment of chronic disorders including arthritis which costs New Zealand more than $2.35 billion each year. Fears that ACC cuts will drive hard times for physiotherapists are unfounded, says AUT University Dr Duncan Reid.

Head of School Rehabilitation and Occupational Studies, Dr Reid says the reduction of funding by a third will encourage the country's physiotherapists to work in a different way.

"ACC has created a single stream funder for the majority of private physiotherapy practice in New Zealand," he says.

"The reliance on a single funder has also helped create a narrower musculoskeletal focus in the delivery of physiotherapy."

Dr Reid believes that the private practice sector has been missing opportunities to treat patients with some of the more chronic disorders.

"Physiotherapists now have an opportunity to develop working relationships with PHOs to address factors that would contribute to the successful attainment of the goals of the Government's Primary Health Care Strategy.

"Such relationships would broaden the funding base for private physiotherapy, decrease dependence on the ACC and, most importantly, benefit those patients with more chronic diseases that presently have limited access to private physiotherapy."

Dr Reid uses osteoarthritis of the knee as an example of a condition that may provide an opportunity to gain funding for treatment within the new PHO model.

Currently one in six people are living with one form of arthritis and this prevalence is expected to grow.

"If you have osteoarthritis of the knee or hip, being able to exercise to help fight heart disease, obesity or diabetes is going to be a challenge," he says.

"There is an increasing amount of evidence that demonstrates the benefits of exercise in the management of patients with osteoarthritis knees."

Dr Reid ran a pilot study earlier this year which found that programmes that involved a range of exercises including strengthening, stretching and general activities such as mobility and coordination can lessen pain, increased walking distance (speed and strength) and reduce the use of medication.

"The deterioration of these chronic diseases can be reduced and fewer patients may need joint replacements or other such expensive treatments.

"Patients need manageable packets of physiotherapy care delivered over longer periods of time.

"Unlike medication, physiotherapy has no harsh side effects and is known to improve quality of life.

"Working closely with PHOs to access groups of patients who are living with an osteoarthritis hip or knee and who are almost certainly deteriorating as they linger on waiting lists would seem an opportune initiative for private physiotherapists to consider," he concludes.

From 16 November 2009 ACC will limit the growing funding of physiotherapy by paying approximately one third less to physiotherapists for consultations for ACC clients. Physiotherapists will, however, be able to charge ACC clients a co-payment towards their consultation fees. Notes to editors The physiotherapy profession has been an integral part of the New Zealand health care system since receiving professional recognition in the 1920s. Over the years it has developed significant expertise in three main areas of practice; musculoskeletal, cardio-respiratory and neurological physiotherapy.

Private physiotherapy practice is one distinct part of the health care system. Over the past 30 years the number of physiotherapists, in private practice in particular, has increased significantly (from 26% in 1973 to 55% in 2002). Musculoskeletal physiotherapy has also been seen as the main area of care in private practice (an increase of more than 30% over the 30 years).

While private practice physiotherapists existed prior to ACC commencement, a secure funding base has clearly given physiotherapists the financial stability to choose between salaried positions within hospital boards and the ability to be self determining in private practice.