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

Educating Referral Sources II

Here's one way to do some education to your referral sources. At my hospital based outpatient clinic in the US Army, we have a Fellowship training program in Sports Medicine for physicians. Here is a briefing I gave to them about the use of manipulation and stabilization exercise in the management of low back pain in physical therapy. It covers the manipulation CPR and Lumbar Stabilization training, cites some current literature, and tries to help educate them about our approach. These physicians are quite good at musculoskeletal evaluation, so they were ready to go into detail about some of the issues surrounding the treatments of these patients. We had a very interesting discussion about the use and possible mechanisms of action of both manipulation and stabilization exercise. I had a feeling as I spoke that they did not know PTs were this detailed and knowledgeable in their approach. Of course, this is just the tip of the iceberg for those of us who read and post here, but I think it went a long way toward helping inform them about who they could look to to help them manage and rehabilitate their patients. Maybe you will find the presentation of value, also. As in the previous presentation, the abbreviation DOD/VA LBP CPG or LBP CPG refers to the Department of Defense/Veteran's Affairs Low Back Pain Clinical Practice Guideline.

I hope this is helpful for everyone, please use as you see fit.

Download manip_and_lx_stabil_in_back_rehab_2005.ppt

Jason.

What was the Sports Section thinking???

Perhaps someone can help me understand what the Sports Section was thinking when it titled its 2005 Team Concept Conference "The Art of Sports Physical Therapy". I fully recognize there will always remain an art to our profession - the day when all decision-making takes the form of a binary 'yes/no' based on best evidence will never arrive in our lifetime. However, although many questions remain, there is plenty of science to guide decision-making in sports-related rehabilitation now.To bring such attention to the 'art' when the profession is shifting to 'science' doesn't make much sense to me. Just struck me as odd when I got this in the mail.

John

Download SPTSBrochure.pdf

Clinical Trials: what's going on, where to find them, and how to volunteer

If you want to get a peek into  clinical trials that are taking place or being planned, this site will get you there http://www.ifpma.org/clinicaltrials.html. 

Not only can you search a subject term and get a listing of upcoming and ongoing projects, but you can also get info on volunteering if you are interested (and have a study location near you).  At first pass it looks like it is dedicated to only pharmaceutical research, but don't let that fool you.  Type in "low back pain" under the search term and you will be amazed at what comes up.

By the way John, I took a look and John Iams name didn't show up here either.

Enjoy,

Rob

John Iams Garbage

Perhaps I have had my head in the sand and not been in touch with the rise of today's generation of John Barnes and Barrett Dorko - welcome John Iams. I received the attached marketing gimmick in the mail today and was quickly reminded about some of the real problems that remain in our profession, at least in my opinion. At least in my opinion, in 6 pages of marketing non-sense, he details his discovery for the cure of pain! This guy must be extraordinary! He did it without an ounce of published data! If what he is saying is true, we should give him the Nobel Prize in medicine now. Perhaps he even deserves the Nobel Peace prize as well, because you have to think that world peace shold break out all over if our pain problems go away.

This is America - he is welcome to do whatever he wishes. I just wish he would call himself something other than a physical therapist - perhaps 'miracle worker' or 'cure-it-all' would be a more appropriate professional designation. I imagine there is a fringe in our profession just salivating at the opportunity to learn about his 'holy grail' find - he even uses these words! To top it off, he compares himself to Einstein, saying "For the last 40 years, I've been up till 3, 4, or 5 in the morning doing research - sometimes I'd even kiss my wife hello when she woke up to make my 3 boys their breakfast." He reports spending over 4,000 hours to 'break the code on pain'.

This is a farce in my opinion, representing the worst of our profession. Research? What research is he referring to? A quick search on Pubmed came up empty when looking for evidence to support PRRT. It's also disappointing that he indirectly leans on the credibility of reputable institutions in our profession like the physical therapy program at USC and the Orthopaedic Section to support his claims.

John Childs

Download JohnIamsCrap.pdf

Educating Referral Sources

The below response from a physician, after having seen the flash file outlining how to use the manipulation prediction rule to improve decision-making, indicates that much work remains to align current thinking about LBP with current evidence. Here is the response written to the PT that introduced him to the flash file:

'Confusion. The CPR that you sent out is for spinal manipulation, logical in those cases where perhaps facet are misaligned. However, this is a very small part of lower back pain patients, the vast majority being paraspinous muscle spasms. The difference is clear to me, but may not be clear to others.  If we only sent you patients with central pain (which according to the picture is high lumbar), that would likely eliminate 95% of referral to PT. On the other hand, if you are suggesting that this is all you do in PT here for lower back pain, and do not address the muscle spasms, then we have a problem. But my experience with you so far suggests that isn't the case. But, thanks for the program. It was nice to watch.I'd like more info on the fear avoidance scale if you have one of those available.'

I would be willing to bet that many of us have encountered a similar response. Attempts to attribute mechanical LBP to underlying pathoanatomic mechanisms remains the primary framework for decision-making in the care of patients with LBP, despite overwhelming evidence that this basis for decision-making is flawed and may even increase risk of harm. The lesson for all of us is that educating referral sources (and those in our own profession who have a similarly misguided understanding of LBP) about current evidence to support physical therapist practice involves much more than just leaving copes of studies at the front office or passing along copies of flash files. We must actively engage them in the process, else even the most potent messages will be muted.

John

OMT and The Big Elephant

Bob Boyles sent this to me in a separate email, and I thought it was worth sharing. Bob astutely pointed out that all healtcare professions are undergoing similar growing pains with the implementation of EBP. Although well intended, Dr. Bledsoe is misguided in his response to a recent study published in the JAOA demonstrating no added benefit of Osteopathic Manipulative Treatment (OMT) in patients undergoing rehabilitation after knee arthroplasty. He refers to an earlier study that showed no added benefit of OMT over sham treatment for chronic low back pain, concluding that OMT must be altogether ineffective.

Dr. Bledsoe makes the common error of throwing the 'baby out with the bathwater' when it comes to interpreting the results of clinical trials, failing to appreciate the importance of sub-grouping in clinical research, an issue that it too frequently ignored. Our simple minded human nature drives us to want a 'black and white' answer to a question whose answer is almost always 'gray'. The relevant question is not "Is OMT effective?". The relevant question is "For whom?" and "For what condition?" Unfortunately, clinical researchers bear much of the blame for misguided interpretations. We lead many well intended clinicians astray when we imply that a treatment is or is not effective for heterogeneous groups of patients. The good news is that for many musculoskeletal conditions, the onion is slowly being peeled back to elucidate which types of patients benefit most from physical therapist management. The only certainty is that the answer is rarely 'all' or 'none'.

John

Download omt_response.pdf

Just e-mail it!

This tip is for those who may find a relevant study(s) while searching in PubMed, want to follow-up on it, but are in a hurry and don’t feel like going through the copy/cut-n-paste/bury in your file system never-to-be-found again routine.

Pub Med will allow you to conveniently e-mail the abstract of a study to yourself (or anyone else for that matter by simply selecting the option on the drop down menu located in the right hand side of the menu options, just above the title of the article

It worked great this weekend when I took a peek at the newsfeed link on the blog and found the study above by Werneke and Hart (PMID: 16208861) It looks like an interesting study I need to read but heck, it was Saturday AM and I was in a hurry to get to an appointment. Simple: just e-mail to myself and that way I can have the abstract right in my in-box this Wednesday when I can actually get around to pulling the article.

Cheers not only for another PubMed user-friendly EPB feature, but also for some great “Push” source info courtesy of the blog newsfeed. By the way, has anybody read that particular study already who would like to comment?

 

Rob