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

Shrinkage- At least it's not harmful

Intradiscal electrothermal therapy (IDET) is increasingly being used in the management of chronic spinal pain, to the tune of about 40K procedures a year in North America. IDET is performed under video fluoroscopy and involves placing a catheter needle in the “symptomatic” disc and heated to 90 C. The thermal energy has been shown to coagulate neural tissue, shrink collagen fibrils and thereby potentially reduce both the nociceptive and mechanical components of discogenic pain. However, the recent high quality double blind RCT by Freeman and colleagues (Download IDET_Placebo_RCT_Spine_2005.pdf) demonstrated no benefit of IDET over placebo. It was interesting that these individuals had relatively high disability scores and yet less than 30% had received physical therapy prior to enrolling in the trial (see Table 3). There were no reported complications from the procedure so despite being ineffective it appears that IDET is a relatively safe procedure.

Tim

Drug reps and cheerleading?

Pharmaceutical sales if a fiercely competitive business. Does evidence or beauty market this industry? There is nothing inherently wrong with utilizing effective marketing strategies, but does such an approach eventually contribute to Vioxx fiascos. Larry is from Kentucky. Larry, what's going on at UK?

John

Look Before You Speak

I was discussing the treatment patients with neck pain and associated headaches a while back with someone, when they posed a question about effectiveness of manual physical therapy for migraines. I knew there was evidence for the effectiveness of this intervention for cervicogenic and tension headaches, but was always under the confident impression there was no benefit for migraine headaches.

Nothing like having to speak on a topic to make you do a little digging. Although I am sure there are many criticisms that can be made regarding diagnostic criteria, methods, etc., this latest Cochrane Review on the topic by Bronfort and Colleagues (located initially in the Index of Cochrane abstracts…very helpful) provides evidence for the effectiveness of manual physical therapy for all 3 types of headaches. In some cases, more so than standard use medication (amitriptyline)…..does this sound familiar?. 

Anyway, this just reinforces to me the fact the saying that “The problem used to be there wasn’t much evidence, now it is more often the case that evidence is available that we just aren’t aware of”. Another reminder to look before we speak too emphatically about a subject we think we know about if we haven’t looked in a while.
 

Rob

Animal Physical Therapy

Animal physical therapy anyone? I'm not convinced that calling this 'physical therapy' helps us very much when it comes to achieving Vision 2020. I find myself chuckling when I see stories like this. What do other health care professionals think when they see this labeled as 'physical therapy'? I could handle 'therapeutic exercise' or some other less specific term. Perhaps I am just being insensitive to all those animal lovers out there? Is this good for the profession?

John

Medical Errors

Lest we think our health care system is the best in the world, check out this recent study published in Health Affairs. The US has the highest rate of medical errors among the 6 countries in this survey when it comes to access to care, patient safety, and care process coordination.

John

Download Schoen-HealthAffairs-2005-QualityMedicalErrors6Countries.pdf

Exercises for the Ipod

From one of Dr. Child's del.icio.us tags, you can get free video downloads of exercises for the new video-enabled ipod.  The videos are very good and include core and swedish ball.  If we can get more exercises in this format, it would be a good adjunct to our more "techno" oriented patients.  Perhaps even a level of customization of exercises could be done in the future.

Please also don't forget our physical therapy "tag" in the left hand column of this blog that gives your real-time listings of all the physical therapy references in the blogosphere and includes pictures via buzznet and Flickr which are excellent open-source pictures.  Flickr has gained a lot of news lately and is now owned by Yahoo.

Larry

Pubmed and RSS - A Must Learn

Pubmed is quickly adding some very cool EBP tools. The most recent one I've come across is the ability to create search-specific RSS feeds. Once created, these feeds can be easily added to any RSS reader. Have a look at the interface and the result using the Yahoo! reader. Click on the pictures for a larger view screen shot. Very cool - and an incredibly efficient means to keep up with the evidence. Note that the first article appearing in the Neck Pain RSS feed was just published by Rob and colleagues in Physical Therapy. It was added to Pubmed 1 minute ago. At the time of this posting, the issue was not even posted on the Physical Therapy website! It doesn't get any more timely than this!

John

Interface:

Result:

Clinical Reasoning

Rick Jemmett provided some interesting thoughts on clinical reasoning in response to a previous post from Rob titled 'Physical Therapy in Thin Slices...When Less is More'.
His comments are based on ideas presented in his recent text titled Physiotherapeutic Management of Lumbar Spine Pathology. Because these comments were posted sometime after the original posted (hence buried at the end and perhaps unread by much of the blog readership), I thought it was worth sharing again as an original post. I have pasted his comments in their entirety below.

John

What's in a Name?

Doctors Demystify - I know nothing of this organization other than from a flyer in the mail. They may well offer excellent educational opportunities, but the name struck me in an odd way. Perhaps I am being overly sensitive, but evidence-based practice rarely needs demystifying. The name also wreaks of the 'doctor knows all and teaches - allied health professionals learn' mentality that plagues the psyche of many physical therapists today. Thoughts?

I hesitated before blogging on Thanksgiving Day morning. I promise - my family is still asleep. I will get off my computer soon! Happy Thanksgiving to all!

John

Thanksgiving

I know I have a lot to be thankful for and I'm not going to list everything.  From a strictly professional view, I'd like to thank all of you for your insight, your skill/talent, your passion and the time you are taking to make a difference in this profession.  I appreciate the ability to read the articles that are shared by many of you because I don't have access to those journals.  I also think it is pretty cool to be able to have a network of people that I really don't know but can definitely count on to snag an article that I need to substantiate a clinical decision that I need to make on a patient.  I'm someone who goes into the clinic and attempts my best and the work all of you have done and the sharing that all of you have done is making my role easier when it comes to clinical decision making.  The beauty of it all though is that the reality of your efforts are extended to the patient - who is probably more grateful than me.    Thanks.