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

Upcoming Blog and Website Updates

I just wanted to let everyone know about a few blog and website updates that are forthcoming. Many of you have suscribed to our Bloglet feature, which automatically provides you with daily email updates in a summary format. If there is more than one post in a day, you only get one email, and if there are no posts for the day, you don't get any emails. This minimizes excessive email clutter in your inbox. Although the Bloglet feature works quite well for indexing new posts, it does not provide updates for the comments that are added. As a result, although there is a typelist on the main blog page that indexes recent comments, many readers may not be aware that comments have been posted. Blog technologies are quickly evolving to overcome this limitation. Two of the services that we are experimenting with now are ChangeDetection and WatchThatPage. More to come, but it won't be long until you will be able to recieve automatic updates of both new posts and comments, which should facilitate the sharing of current evidence, best business practice, and other information pertinent to contemporary physical therapy practice.

We are also adding podcast capabilities from Talkr. All blog posts are transcribed into voice each evening, permitting you to read or listen to the blog! We will also be looking to add a service that allows you to download blog posts to your Ipod or other.mp3 player so that you can take the blog with you whereever you are!

Finally, we are nearing the release of a major upgrade to the main Evidence in Motion website. We will have a page that features all current physical therapy news and research. If you have not already done so, we would encorage blog readers to also subscribe to our mailing list. You can subscribe at www.evidenceinmotion.com or on the blog (email subscription underneath the Bloglet tool). We will notify you when the new website has been launched.

We look forward to our continued partnership with you and welcome any feedback on how we can improve our service. Thanks for your loyal participation. "Pass the blog on" to your colleages!

John

An alternative to EBP

The post on Seth Godin’s blog the other day entitled “Where do you get your advice” reminded me that people in every field as well as every day life are always in need of and looking for advice. http://sethgodin.typepad.com/seths_blog/2005/07/where_do_you_ge.html

Adverse Reactions To C-Spine Manipulation

All, here is an interesting RCT by Chiros in the 1 July issue of Spine. The study is a 2×2×2 factorial design study of 336 patients from a health maintenance organization (HMO) randomized to receive either manipulation or mobilization, with and without heat and/or EMS for 10 minutes, in the treatment of neck pain to ascertain adverse effects within 24 hours and 2 weeks of treatment. Outcomes included VAS Pain scale, NDI, Expectation of treatment (0-10) scale, and SF-36. Adverse reaction was determined at 2 weeks by asking patients about unpleasant sensations or discomfort using an 10-point numeric scale. Categories of adverse effects included increased neck pain, stiffness or soreness, radiating pain or discomfort, tiredness or fatigue, headache, and neurologic symptoms. The majority of symptoms disappeared within 24 hours of onset and did not impair activities. Patients assigned to manipulation were more likely to report adverse symptoms than were those assigned to mobilization (OR, 1.44; 95% CI, 0.85 - 2.43).  Despite the fact that the majority of the adverse reactions reported were mild and lasted <24 hrs, the authors actually encourage a more conservative treatment approach to cervical spine pain in favor of mobilization rather than manipulation. This seems like quite a change of tune for the chiropractic community. It is interesting to note that the authors make reference to the Hoving et al study that would lead readers to draw a distinction between "Physical Therapy", "Manual Therapy", and "Manipulation." No mention of manipulation as a treatment by PTs can be found anywhere in the article...no surprise.

CliffDownload c-spine_manip_spine_Jul_1_05.pdf

Chronic back pain, exercise helps a little. Not for acute back pain

Link: Chronic back pain, exercise helps a little. Not for acute back pain.

Cryptic article in Medical News that mentions Cochrane, NIOSH, and TENS in the same article.

Larry

treatment choice & outcomes in non-specific LBP

Here is a recent article from JMPT analyzing RCTs of manual therapy for LBP to determine if giving the clinician the choice of technique/intervention (vs. protocol) has improved outcomes. The authors found no difference with choice (vs. no choice). The authors describe weaknesses of the meta-analysis and the available RCTs. I found the discussion about subgroups (including the CPR of Flynn et al (2002) & Childs et al (2004)) very interesting. They pose 2 possibilities for the negative outcomes: Choice does positively effect outcomes, but there is no consensus on subgroups; or tailoring Rx has limited impact on the outcomes. They also touch on the divergent classifications, treatment-response vs. pathoanatomical, in the search for & directions of research in the appropriate care of the NS LBP patient. Britt

Download choice_outcomes. Jmpt.05, kent p, et al..pdf

knife in the back

Speaking of history...I have used this article by Jerome Groopman from the New Yorker to discuss the demise of the AHCPR guidelines and other issues around care of chronic low back pain patients. The piece is abit dated, but the discussion, including candid discussions with Richard Deyo MD about the concerted efforts by members of AAOS to 'de-fund' AHCPR and the guidelines process, is fascinating and absolutely relevant to our discussions of the health care system. Have a good read.
Britt

PS. I first used the article 3-4 years ago. I have discovered that Groopman is Jerome Groopman MD, professor of medicine at Harvard. Download knifeinback.pdf

History of LBP Classification

I have attached an article that was recently published FACETS, a magazine published by the School of Health and Rehabilitation Sciences at the University of Pittsburgh. It has an interesting article in this quarter's issue related to the history of the low back classification system. Those of us who use the system to improve the management of our patients with back pain and those of who are involved in further refining the system's precision through research owe a great debt to the pioneers who went before us, several of whom remain actively involved in our profession. At the risk of surely leaving someone out, some of the names include Bowling, Erhard, Delitto, and Rose - members of almost anyone's list of physical therapy "hall of famers". If you get the chance, pass on a word of thanks to those who were developing the foundations of evidence-based practice long before the term ever became a part of the standard healthcare lexicon (Tony - delittoa@upmc.edu) and Dick, affectionately known as "Dr. E", - erhardre@upmc.edu).

Although already familiar with much of the history, I enjoyed the read and the reminder of a long "research heritage", without which many of us would have never become involved in low back pain research in the first place. On behalf of thousands of physical therapists who I am certain would agree, our profession owes you an eternal debt of gratitude. Enjoy the history lesson.

John

Download lbp_classification_history.pdf

Lessons in Life, Givers of Hope

 

I had the privilege and honor last week of helping my 84 year-old grandmother make funeral arrangements for my great-grandmother who died at the age of 106. My grandmother herself is still a very active and independent woman who lives by herself in her own home and who’s driving includes local destinations as well as 3 hour road trips!

 

Consumer Driven Health Care

What exactly is consumer driven health care (CDHC)?  I know I increasingly hear about it, but it seems it has taken on multiple meanings depending on the circle of discussion. However, it does have a specific definition.  This publication from the National Center for Policy Analysis (NCPA) discusses some very interesting (revolutionary?) CDHC concepts that, in my opinion, have the potential to transform health care in such a way as to make the current system seem archaic.

How is our profession thinking about CDHC and what steps are we taking to engage in it?

Thoughts, anyone?

Rob

Download ConsumerDrivenHealthCare.pdf

One of the few textbooks worth having...

For those of who identify with evidence-based practice, you should not be a big fan of textbooks, instead preferring to stay up-to-date by reading clinically relevant research published in the peer-reviewed literature. Sackett in fact advised in the "little blue book" (or "red book", I can't recall which one) that we burn most of our textbooks since most of them are no longer current by the time they reach our bookshelf and rarely are based on the available evidence in the first place.

A rare exception to the rule has just been published - Josh Cleland's textbook Orthopaedic Clinical Examination: An Evidence Based Approach for Physical Therapists. This text will quickly outpace its competition (no need to mention names) because of the user-friendly evidence tables that are replete with useful diagnostic accuracy statistics (sensitivity, specificity, and postive and negative likelihood ratios) and precise operational definitions of test procedures. More than just a laundry list of every test known to mankind, you can begin to hone your exam to include only the most powerful clinical examination procedures. Josh is a good friend and colleague of ours, so feel free to take my recommendation with a grain of salt. Check it out yourself at http://store.netterart.com/1929007876.html. Unlike almost all other textbooks you may own, I assure you this is one textbook that will regularly come off your shelf.

John