MyPhysicalTherapySpace.com - A part of the 1T - the "One Thing" you need for PT practice.

Practice Acts and Imaging

I am interested in generating a discussion about PTs and the use of imaging to enhance our practice.  Specifically, ultrasound imaging, digital fluoroscopic imaging, standard radiographs, and MRI (static and dynamic).

As imaging continues to improve and we are able to analyze dynamic motion or dynamic muscular function with the new technology - our practice acts may need to be adjusted to allow us to continue to use technology to our advantage in order to enhance the delivery of physical therapy.  I am not discussing the use of imaging in the traditional sense to diagnose anatomical abnormalities (I am not trying to generate a discussion about PTs taking a scope of practice traditionally belonging to radiologist) - but to use imaging to assess altered kinematics or muscular function (a traditional PT role).  For example, we have used EMG to understand muscular function - but ultrasound imaging may provide information that is not obtainable from EMG - Is our practice acts evolving to allow new technology to enhance our normal functions?  or - Is our practice acts vague enough to allow for these technologies to be used in the traditional roles of physical therapists?  As a military therapist I am somewhat shielded from the realities of the limitations of our practice acts and would like to learn more about the ins-and-outs of these regulations on your practice.

Evidence-Based Medicine: A unified approach

Download david_eddy_ebmhealthaff_2005012_vol24_no1_p917.pdf

The author, David Eddy, gives a concise summary of the history of the development of the concept of evidence-based medicine.  He makes a good distinction between EBM guidelines and the use of "EBID" ("evidence-based individual decision making").  He proposes the need to unify our approach to these concepts in order to improve the quality of patient care.

Virtual PT for Rotator Cuff!!!

Virtual Reality for PT!!

Not sure if any of your saw this article.  I guess this is the ultimate in "hands-off" PT!  How is it billed?

Does the technique matter?

I have attached an interesting commentary by Cornwall and Mercer from the New Zealand Journal of Physiotherapy regarding the clinical anatomy of the lumbar spine and palpation of the z-joints. Their conclusion- questions should be raised about the proposed specificity of commonly taught manual examination and treatment techniques.
My thoughts exactly!

Josh

Download l_zjt_palpation_nzjp.pdf

We have two new features on this blog that I would like to direct your attention.  Both are in the Rt. hand column.  Through the magic of RSS feeds, physical therapy headlines and hubmed research will both list "real time" feeds and will be updated automatically to give you the latest and greatest links to news and just published research in physical therapy.  We will continue to add value to this blog based on your feedback and suggestions.

Poor surgery outcomes associated with compensation status

Attached is an interesting study recently published in JAMA confirming the commonly held notion that poor surgery outcomes are associated with the seeking of compensation.

John

Download compensation_status_and_surgery_outcome_jama_2005.pdf

NIH Conference on the Biology of Manual Therapies

FYI to the group on this conference at NIH, just 35.00.

Conference on the Biology of Manual Therapies June 9-10, 2005 Natcher Conference Center, National Institutes of Health, Bethesda, Maryland

http://nccam.nih.gov/news/upcomingmeetings/manual-conference.htm

Follow the link for more details and the proposed agenda. Unfortunately, it looks as though only one PT is presenting. Looks very interesting.

Chicago Tribune | Physical therapy schools ramp up for the future

Link: Chicago Tribune | Physical therapy schools ramp up for the future.

Physical therapy schools ramp up for the future More students seek must-have doctoral degrees.

Very good article and promotion of physical therapy in Sunday's Chicago Tribune. 

Musings about Clinical Prediction Rules

I have been reading with great interest the posts which I believe correctly identify many of the issues we have within our profession from a public policy and research standpoint (e.g. the "commoditization" of PT and problems created by the variability in practice).  It is worth noting the great work that many of this blog's authors have done in clincal prediction rules (CPR) and I believe that we must continue to develop more which would greatly decrease the variability in practice.  CPR's work by directing us to a few directions which lead to the best results.  Counter-intuitively, less information can lead to better conclusions and better interventions.  There is some interesting references to this in some recent non-medical books as well as history.

 

More Cents on the Kominski study in Medical Care

If you take a public health perspective, I would generally agree that the data in this study (Download 00005650-200505000-00002.pdf) are at least a reasonable characterization of cost versus benefit (ignoring the argument that direct access PT would have resulted in considerably less cost, even if you presume the outcome would have been no different). I could even go so far to say that if a similar study were replicated today, the results might not be much different. However, if you take this view, then research is primarily limited to just describing current practice, then making some judgment about the effectiveness of current practice in light of the cost. From a pure public health perspective, I suppose this enables 3rd party payors to make informed decisions about how best to allocate scarce resources.