Translating Therapy

A UAB partnership strengthens physical rehabilitation in China
By Rosalind Fournier
Photo of Chinese city
A UAB partnership strengthens physical rehabilitation in China
By Rosalind Fournier

Chuan Wang made his first trip to the United States as a 17-year-old member of the Chinese National Swim Team competing in the 1996 Olympic Games in Atlanta.

He turned in an impressive performance in the pool, placing seventh in the 1,500-meter event. Meanwhile, in the Olympic Village, Wang met someone who, unexpectedly, would help chart the course of his career: a physical therapist enlisted to work with the Olympic swimmers.

He was the first physical therapist Wang had ever encountered.

“At the time, I don’t think there was a physical therapy profession in China,” he explains. “I was very impressed.” For Wang, who had long suffered from a shoulder injury, earlier access to physical therapy could have made a difference, he says. He had been discouraged from surgery because his coaches knew that without rehabilitation afterward, an athlete would likely never compete on the same level again.

In Atlanta, Wang was intrigued by the transformative value of a well-trained physical therapist. “I thought, ‘That’s what I want to do,’” he says. After studying athletic training, Wang came to UAB’s School of Health Professions (SHP) to earn a doctorate in physical therapy in 2010.

Photo of Chuan Wang working with a patient.Chuan Wang directs therapy for a patient in Beijing. Photo courtesy of Chuan Wang

A Disaster Strengthens Ties

Now an orthopedic certified specialist in Beijing, primarily working with athletes, Wang exemplifies the growing, evolving ties between the SHP and China. Some 30 years ago, Howard Houser, Ph.D., now professor emeritus of health services administration and a former SHP associate dean, was hired by Project HOPE—a U.S.-based medical relief organization—to help China develop programs for health-services education. It became a lifetime calling, with Houser—and his wife, Shannon Houser, Ph.D., who is Chinese and a UAB associate professor for health information management—continuing the relationship to this day. They have a home in Beijing and over the years have helped bring countless Chinese students and others to UAB to observe and study.

C. Scott Bickel, Ph.D., associate professor of physical therapy in the School of Health Professions, credits the Housers with laying the foundation for the unique partnership with China. But fast-forward to 2008, and a natural disaster—a 7.9-magnitude earthquake in Sichuan Province—spurred new calls for UAB physical therapists to become involved.

“It was devastating,” Bickel says. “Lots of people died; many people sustained catastrophic injuries including brain and spinal cord injuries; many others lost limbs. The Chinese government realized they weren’t equipped to handle the long-term rehabilitation needs of these types of patients.”

Bickel, along with Jennifer Christy, PT, Ph.D., UAB associate professor of physical therapy, was part of an interdisciplinary team that visited China to evaluate post-earthquake rehabilitation needs. They developed a plan recommending that Chinese rehabilitation professionals spend time at UAB learning about its clinical and educational programs. Christy and Bickel both personally mentored rehabilitation physicians from China.

Animated gif showing English translation to ChineseIn China, an estimated 30,000 rehabilitation professionals serve a population of 1.3 billion

For perspective, Bickel points out that the U.S. has about 200,000 physical therapy jobs, not counting occupational therapists, rehabilitation physicians, and others, for a population of around 300 million. In China, “the best estimate is 30,000 rehabilitation professionals—including all the physicians, physical therapists, occupational therapists and others who work in rehab—out of 1.3 billion people,” Bickel states.

Photo of Jennifer Wilson with Chinese colleagues.Jennifer Wilson (center) works closely with a team of therapists at a Beijing rehabilitation center. Photo courtesy of Jennifer Wilson

Changing a Medical Mindset

Bickel, Wang, and others from UAB agree upon at least one explanation for this disparity: Many Chinese physicians—and patients—tend to have the mindset that physical activity following injury or surgery undermines, rather than improves, chances of recovery.

That attitude seems to be changing, says Jennifer Wilson, PT, D.P.T., a 2008 UAB alumna who now holds a prominent position at a Beijing rehabilitation center. She describes her colleagues as “very kind and welcoming—open to new ideas and eager to learn and develop.” Wilson, who had lived in China for two years in her early 20s and become fascinated by the culture, teamed with Bickel on trips to train Chinese health-care professionals. When she received a job offer from the Beijing center in 2013, it felt like a natural transition, she says. In June 2014, she became the center’s acting therapist director, making her, for the time being, the only non-Chinese staff member.

While most of Wilson’s fellow therapists “see the importance of active rehabilitation and focusing on functional mobility,” she acknowledges she has also run up against the traditionally passive approach that is routine for many physicians.

From Wang’s perspective, it’s hard to overstate the gulf between Chinese and Western medicine on this point.  “The old way is that if patients had pain, the doctor prescribed pain medicine,” he explains. “Or if they got a fracture after surgery, the doctor sent them home to rest. There’s a saying in China that with a fracture, you need 100 days before the fracture heals.”

To Western-trained therapists, the problem with a patient resting 100 days for a fracture is obvious: “The bone heals, but the function is lost,” Wang explains. “They can’t walk right. They limp. They have every kind of function loss. Even now, a lot of doctors in China have trouble understanding what physical therapy is, so their advice is very conservative.”

Photo of Scott Bickel working with a Chinese patient.C. Scott Bickel participates in a physical therapy session with a Chinese patient. Photo courtesy of Scott Bickel

Transpacific Training

In the years since 2008, the relationship between UAB physical therapists and China has continued to flourish. Early on, a series of Chinese rehabilitation physicians, representatives from the Project HOPE office in China, and government officials came to UAB to observe. Bickel—whose mother is Chinese—spent as much time as he could with these visitors and in turn began making regular visits to China. “I’ve taken small teams of UAB medical personnel and done training in a hospital, and we’ve done community outreach with small medical teams of therapists, nurses, and doctors,” he says.

In spring 2015 he is planning a three-month sabbatical to work at Wuhan University in Hubei Province. “I hope to see something develop out of that visit,” Bickel says. “I envision at least an ongoing relationship with students coming to train at UAB and vice versa.”

He hopes that Chinese faculty will enroll in programs within UAB’s Department of Physical Therapy as well. “If Chinese institutions want to start new educational programs,” he continues, “then it’s not enough to teach some students and send them back. China needs to train qualified faculty who can train students there.

“There’s a big disparity in the Chinese health care community’s ability to serve their population’s rehab needs compared to Western countries,” he continues. “China recognizes this need. So our focus is on how we can partner with them to change that.”

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Published January 2015