Forming, an opinion

It’s nice to receive the first review of my book (in the Journal of Biomechanics) that I’ve been able to read easily (the only other one I’m aware of is in French and was really a little beyond what I’d learned in school over thirty years ago).

It’s interesting that Steve has picked up on the issue of the omission of sample paperwork which he feels would have been useful. My original intention had been to include a whole suite of procedures and protocols which could have been copied and pasted into service level documentation folders across the world. The first thing that prevented me was very straight forward; I had a page limit to work to from the publishers.

The other thing that made me change my mind, however, was the growing realisation that the process of writing service level documentation is actually more important than the result. Sitting down and writing such documents is an extremely useful exercise and doing it properly ensures that you have thought through the issues for yourself. I’d suggest that it’s much better for gait analysis service teams to produce such documents for themselves than to rely on what some “expert” has written for a different service operating in a different context.

Take a Referral Form for example. In some ways this is simply a piece of paper that tries to force the referring clinician to tell you what you need to know about the patient so that you can do your job properly (don’t get your hopes up – I don’t know of any gait analysis service in the world that actually gets useful information from referrers however well-structured the form).  On the other hand though, it reflects the relationship you want to have with your referrers and may include an implicit or explicit specification of the patients you feel qualified to assess. You can just pinch a copy of someone else’s form, but it is much more valuable to work through these issues for yourself and develop your own form that reflects the characteristics of your service. Thinking about what you do is at least as important as doing it.

There is a similar issue with normative reference data (see YouTube video of my presentation last year to GCMAS on the subject). The main reason for collecting normative reference data is to learn from the experience. Putting 30 able bodied volunteers through the lab, reflecting on the mean traces and variability around it and comparing this with data from other service is a learning and quality assurance exercise that all services should go through (and should repeat every so often). Pinching someone else’s data simply so you can have those nice grey bands in the background of your own graphs is missing the point entirely. It still amazes me how many services do this.

As this post’s title suggests, this is purely my personal opinion. Maybe specimen forms that could have been adapted would have been useful. Maybe I should have made these available but in .pdf format so people would at least have to do the word processing for themselves! The page limit argument is a bit ridiculous in a world of electronic supplements. What do you think? Maybe if enough  people demand them through comments here I’ll work on it for the next edition (if people buy enough copies to make Mac Keith want to publish one!)



  1. Richard,
    it must be great if you make referral forms for us. it would be a reference and standard forms for other services. I am pretty sure that there still have a lot of services that still not know which information should use and report it to the doctors. we could use your form as a guideline and adapt its for our own services.

  2. Hi Richard

    Basically agree with your point that labs need to go through the learning process of developing their service rather than copying some standard. But there is also a need for labs to agree some common standards. I would be interested on your view as to where the boundary is between these interests?

    1. Interesting comment Matt. There is clearly a grey line here. To my mind the standards should be fairly brief, general and high-level whereas the level of documentation I’ve been thinking about is quite detailed and specific. Where this distinction falls down somewhat though is if we want to take standardization to a level where data exchange is possible (which I’m generally in favour of). In this case we probably do need quite detailed and prescriptive standards.

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