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Professor Eleanor Main - Career Spotlight

Professor Eleanor Main tells us about her exciting career in respiratory physiotherapy

I've been working in physiotherapy for 27 years now and still feel inspired by the job. I think one of the reasons I am still excited by what I do, is that during my career, I have been lucky enough to immerse myself in different aspects of our multi-dimensional profession ? clinical, research, regulation, education and management - all of which have enthused and stimulated. I have also been privileged to have had the expertise and mentorship of extraordinary and wonderful people who supported me or facilitated opportunities at a time in my career when it really mattered (all with the patience and kindness of Saints).

I qualified as a physiotherapist in 1988 and my first job a physiotherapist was at Red Cross Children’s hospital in Cape Town where I spent 3 rewarding years rotating around some pretty challenging clinical environments. After that, a locum job while travelling in Canada and finally Great Ormond Street Children’s Hospital in London. This diverse platform of clinical work provided me with invaluable insight into the variations in physiotherapy practice and education around the world and inspired a career trying to integrate clinical practice, research and research-led teaching.

While at Great Ormond Street, I completed an MSc in Research Methods at Kings College and a PhD in paediatric respiratory physiology at University College London (UCL). These qualifications provided me with the necessary skills to build and support a programme of physiotherapy research and at that point I moved from primarily clinical work to research work at the Institute of Child Health, where I became a Lecturer in Physiotherapy. They also provided me with the skills and confidence to say YES when Jennifer Pryor asked me to assist with running a small cardiorespiratory postgraduate programme at UCL.

I have been involved with all kinds of research at UCL which has resulted in more than 80 peer reviewed publications, and attracted over £2.7million in project grant funding to date. This research started with my PhD study, involving physiotherapy for ventilated children, in which I established that the airway clearance techniques performed by physiotherapists were more effective than routine suction techniques alone. After that we investigated in some detail exactly how chest wall vibrations worked to manipulate airflow and move mucus. And then a fascinating on-call study which identified clinically and statistically significant differences in respiratory outcomes when patients were treated by non-respiratory on-call physiotherapists, compared with their specialist respiratory colleagues. All of this research has resulted in substantive advances in the understanding of assessment and treatment for children who require physiotherapy and in opportunities to improve clinical care for patients - or provide specific training to optimise outcomes.

I have also been committed to clinical research for people with Cystic Fibrosis. Research projects have varied from long term studies on efficacy of airway clearance or exercise interventions, to developing outcome measures or resources to support families of children with CF in adhering to routine physiotherapy treatments. We have just received a big grant from the CF Trust to work as a Strategic Research Centre in finding out more about the barriers and limitations to exercise and physical activity in adolescents with CF.

The small cardiorespiratory physiotherapy postgraduate programme that Jennifer asked me to contribute to in 2005 has also grown exponentially in size and reputation since then and now includes two additional pathways in postgraduate Paediatrics and Neurophysiotherapy. MSc students are encouraged to identify research projects that are clinically useful or relevant and likely to be publishable at the end of their studies. This is in order to embed the concept of research enquiry informing clinical practice. It is also to consolidate transferable research and dissemination skills through success in articulating research findings in a ‘real-world’ scientific forum.

This year alone there are 53 students enrolled to do postgraduate studies from all around the world and 99 additional students have come to study single modules as Short Course students. That’s a much bigger cohort than the one I started with in 2005, so now I find myself working with the best team in the world. These are talented and creative educators, who are completely committed to nurturing the development of future leaders in physiotherapy. Students say that they feel advantaged by studying at UCL because the programme leaders and tutors are all active in research and publication and are thus able to advise directly and from experience.

Other interesting things have spiced things up along the way too. I served as Paediatric Champion for the ACPRC for several years, helping develop guidelines and strategies, and promoting the exchange of ideas in respiratory physiotherapy for best practice. In this role I gained insight into the limitations of postgraduate training opportunities for paediatric physiotherapists in the UK. I was able to address this in part by introducing a paediatric postgraduate study pathway at UCL. I was also very grateful that the ACPRC recommended to the CSP that I was awarded a Fellowship of the Chartered Society of Physiotherapy in 2011 for ‘distinguished service to the advancement of clinical, educational or research boundaries in physiotherapy’.

It was also a real privilege to be invited to co-edit the 5th edition of ‘Physiotherapy for Respiratory and Cardiac Problems: Adults & Paediatrics’ with Professor Linda Denehy from Melbourne. This core international cardiorespiratory textbook has always been an important text for undergraduate students around the world but is also an enduringly valuable reference text for both experienced and novice practitioners involved with cardiorespiratory care. While there have been some difficulties coordinating editorship from two continents, the book is now in full production and should be on the shelves by June this year. Exciting - no wonder I love my job!

I am currently a member of the physiotherapy task force for the European Respiratory Society HERMES project (Harmonised Education in Respiratory Medicine for European Specialists). Respiratory physiotherapy is not yet defined or structured as a sub-specialty across many European countries. The HERMES project aims to develop a European respiratory physiotherapy curriculum by the end of this year, which closely follows the development strategy for educational standards defined through the ERS.

The variety of my day to day job doesn’t end there! I also served as a partner on the HCPC for 12 years, helping to make professional decisions on matters of eligibility for admission to the professional register and fitness to practice. The HCPC sets standards of professional training, performance and conduct, and this role has been very useful in my mentorship of students and colleagues in relation to professionalism in postgraduate and advanced practice.

I am now Professor of Physiotherapy at UCL. This was the first ever chair of physiotherapy at UCL, and I feel delighted that the university has recognised the contribution of our profession by this fantastic affirmation. I hope this is just the first of many such promotions in future. There is no job more fun, interesting or rewarding and I am completely committed to contributing to the integration of clinical excellence, research and education in physiotherapy for as long as I am able.


Eleanor Main, Professor of Physiotherapy, University College London