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"Every American is our patient..." Really?!!!

Or, I could have entitled this blog post: 

I went to school for a lot of years, got a doctorate degree, learned your anatomy inside and out and for that, I can tell you "Go out and play an hour a day."

It just seemed a little wordy.

These were the words of Rear Admiral Penelope Slade Royall, PT, MSW, as part of her keynote address Wednesday night at PT 2007, the annual conference of the APTA.  The headline of the speech was her "telling the considerable crowd that physical therapists are public health's "first responders" for fitness."  Royall is the US Deputy Assistant Secretary for Health in the US Department of  Health and Human Services.

Well, is EVERY American our patient?  Is physical fitness our specialty?  Will Physical Therapists speaking as one voice about physical activity guidelines really help our profession and our patients?  I'm not so sure.

Or, is the ideal set forth by the Evidence in Motion working group, "that to improve our caliber as a profession, we have to shrink our role and be identified as experts in neuromusculoskeletal medicine" one that will help our profession and our patients?

Reading headlines such as "PTs: First Responders to Physical Fitness" seems to me to be suggesting our role to Americans is really one of a personal trainer.  Personal trainers do physical fitness better than Physical Therapists.  Perhaps this is because they specialize in it.

This goes back to an old question of strategy:  Should one try to do everything well, or should one do just a few things expertly?

You know, thinking more about the contents of the keynote address, I really feel like Royall is speaking about Physical Therapists in a light that will further her own agenda (and here) rather than our profession's agenda.  I would do the same in her position; so would most.  If a government representative like Royall views Physical Therapists as Physical Fitness Responders, then what are we really?

This post is more questions than answers.  This is deliberate, as I think a public debate about how PT's are marketing their profession is required.  We should all spend some time asking ourselves some questions about this issue.

ERIC

Saddle up for a little manip

Now if vets are manipulating horses, surely PTs should be manipulating humans. I can already hear the Animal PT SIG cheering, 'validation'. Perhaps PTs in Washington and Arkansas can keep up their skills a bit working with vets. Speaking of which, when will we see the practice acts of Arkansas and Washington revised (among other states that have problematic language issues)? There are always timing issues involved in politics, but at some level, there is no time like the present to shed our peace genes, raise cane, and take ownership of our profession for the betterment of our broken health care system.

John

How do you get your evidence?

I am employed by an academic institution with a fine health science library. I belong to several sections of the APTA as well as the AAOMPT. Through these affiliations I am able to get my hands on quite a few journals and read full text articles when I like.

I was thinking the other day, about how many allied health professionals do not have access to such a library of content. This would include those working in private practice, non-academic hospitals, rehab centers, local school systems, etc. How do these folks get their dose of evidence? How difficult is it to get access to an important new article?

There is PEDRO, and the Cochrane Database, and the APTA resources such as Open Door, but these are far reduced from what I use. They also suffer from lack of use among therapists. A scattering of journals offer free text, but usually there is a time delay or restriction with this. A service like InfoPOEMs is kind of expensive and not rehab focused even if it is useful in theory.

A colleague recently left the hospital system that I'm in and now works at a corporately owned outpatient clinic. She has no access to journals.

Barriers lead to inactivity. Inactivity leads to the failure of the principles surrounding Evidence-Based Practice. How much of a professional duty is it for health care providers to pay their own $$ for access to evidence? How much of that burden should fall on the employer?

If I assume that a majority of the Physical Therapy work force is in practice settings with limited access to rehab/ortho journals. Does this mean that the majority of the profession does not keep up with new evidence?  Regardless of that being true or not, I think these barriers need to come down somehow.

Any thoughts on access to literature among Physical Therapists?

ERIC

Image: Arnold Bernhard Library, Quinnipiac University, Hamden, Connecticut

What should we do with this window?

Rockefeller Plaza is some pretty valuable real estate. It looks like the APTA has got their hands on 115 square feet of it for the month of June in the form of a picture window. The window's content is about Physical Therapists' ability to help prevent diabetes:

"The oversized panels also explain how physical therapists can help people with type 2 diabetes by designing a safe and thorough physical activity regimen that meets individual needs. The centerpiece of the window display is a life-sized female mannequin, who demonstrates the proper "fit walking," technique. She is standing in front of a video illustrating the various ways people incorporate physical activity into their daily lives."

Fit Walking Technique??? Well, at least my membership dues didn't pay for this. The window space was donated by Executive Health Exams International. Which is also interesting.

In other news, an angry mob of internists was seen accosting a group of APTA members near Alexandria, VA. As the attack was taking place, the internists could be heard chanting, "You're experts in muscles and bones, leave the diabetes to us..."

ERIC

Unfortunate Weekend News Roundup

Browsing through my various news feeds this weekend lead me to the following two instances of Physical Therapists making news headlines:

• New pain relieving technique comes to Summit.

This is about a new facility in Summit County, CO now offering Primal Reflex Release Technique. Click here for a somewhat disturbing video and an opportunity to sign up for a home study course in this technique.

• Health care fraud charged.

Three individuals, including two Physical Therapists, were arrested and charged with health care fraud, allegedly billing for services not performed and billing for Physical Therapy performed by a massage therapist. At least the FBI knows all about our profession. That's good, right?

How are we doing policing ourselves as a profession? When instances like these happen, the concept of professional autonomy is undermined as the trust we demand from society is eroded. These are fairly extreme instances (and in one case, criminal,) but how do we do in situations that are not so obviously concerning? Such as: Treating too many people simultaneously to bolster a bottom line, over or misuse of modalities, not keeping up with current evidence on a particular condition or patient type? Do Physical Therapists, or any health care profession for that matter, really have a good system in place to help police the rank and file?

Anyway, perhaps that is too much philosophy. All I really want is some Good Press!

ERIC

At least LBP "cures" don't have side effects

Lots of words in the press about the Michael Moore movie Sicko-unfortunately, the movie only digs up very old news that has been rehashed hundreds of times.  It offers no practical solutions and even suggests that Cuba's health care system is superior to the U.S.  Irrelevant arguments abound including the statistics on life expectancy and infant mortality rates which are not measures of our health system but American lifestyle.  More on Sicko later.  I want to talk about obesity.

I believe obesity is a good analogue of LBP.  The majority of Americans are overweight and the majority of Americans will experience LBP at some point in their life.  Entire fringe industries have been created to cure both.  Books, products, pills, centers, and even endorsers of products are ubiquitous yet data points to both of these maladies show they are occurring in greater numbers.  Drugs have been put on the market and then taken off for serious side effects (e.g. phen phen and Vioxx).  There is great evidence to support certain interventions for both but these treatments are seldom sought.  Everybody wants a quick fix and each condition can lead to the other (obese patients have higher incidence of LBP and LBP can lead to a sedentary lifestyle which can lead to obesity).  I think you get the point.

 

Which leads me to this very interesting article appearing in the Health Journal portion of the WSJ (available for non-subscribers for 7 days) by Tara Parker-Pope.  Apparently the Drug Alli ("ally") is reporting brisk sales.  This is a new non-prescription drug that purports to prevent the body from breaking down and absorbing fat.  The downside of the drug is that the fat has to come out of your body in some ways which can be embarrassing (gas with oily discharge and loose stools).  The drug's web site even says that it is a "smart idea" to wear dark pants and bring a change of clothes to work if you use Alli (perhaps Michael Moore was on Alli during the filming of Sicko).

More to the point, there has been about 100 trials involving 30,000 subjects of this drug whose main ingredient is Orlistat.  After one year Orlistat users lost 19 pounds compared to 13 for a placebo group (no mention as to how many more pairs of clothes they had to purchase or friends lost).  As you might expect, the dieters couldn't keep the weight off during the second year.  Even the consultant to Glaxo concludes "It's not for the average person who wants to take it and doesn't want to change their diet.  It's for someone who is committed to making a change in diet and lifestyle".  If someone is that committed, they certainly don't need Orlistat and there is strong evidence supporting basic lifestyle changes in losing weight.

Add a screening question about Alli on your next LBP patients.  If the answer is yes, watch your step.

 

Larry

Technology has NOW automated physical therapy!!

Automated physical therapy is here!  It has been automated by a guy with a PhD.  This gentleman is in the big, 'ol state of Texas and has physicians referring patients for his automated physical therapy!  I suppose if you invent some machine maybe all the red-tape involved with becoming a licensed professional to USE the thing on the public isn't necessary?

the News!

The Dr. Sanker Story - inventor AND treating practioner?  What exactly IS he?  Amazing to learn that one can go from "invalid" to "athlete" because of the PTA!

Check out the peer-reviewed stuff!  (From a guy with a PhD no less!)

You Texan Physical Therapists have some some issues down there that need addressing!  Licensing issues (is it really safe for some guy that has a PhD to be delivering supposed physical therapy?), referral issues (why are physicians referring patients to him?), efficacy issues (since when have the magic modalities been THE wonderful component in reaching positive outcomes?).

I certainly hope that I can be publicly humiliated for believing that this "news" is actually true.  I'm crossing my fingers and hoping I have a big "L" on my forehead!

The search for the elusive magic bullet

The search for the elusive 'magic bullet' and 'holy grail' cure for back pain goes on and on. Even Reader's Digest gets into the act, while many of the solutions for the enormous problem of back pain are already in our midst and have good evidence for their use. When will we listen? If history is a guide, I am not an optimist that the pursuit of non-sense answers will stop anytime soon. Thanks, Jim, for sending along the link.

John

Check Out the Upcoming EIM Courses!!!

Check out upcoming Evidence in Motion courses currently open for registration! Learn more about MyEIM and our new Articulate course format!

Download WhatIsMyEIM.pdf

Download ArticulateFormat.pdf

***Indicates course open for internal registration only. Contact facility POC listed on website.

Evidence-based Examination and Selected Interventions for Patients with Lumbopelvic Spine and Hip Disorders

Sep 15, 2007
Medford, NJ (USA)

Nov 3-4, 2007***
Hawthorne, NY (USA)

Evidence-based Examination and Selected Interventions for Patients with Cervical Spine Disorders

Aug 17-18, 2007***
Davenport, IA (USA)

Aug 18, 2007***
Russellville, KY (USA)

Sep 15-16, 2007
Burlington, NC (USA)

Sep 15-16, 2007***
Houghton, MI (USA)

Sep 29, 2007***
Everett, WA (USA)

Evidence-based Examination and Selected Interventions for Patients with Upper Extremity Disorders

May 12-13, 2007
Jacksonville, FL (USA)

Oct 26-27, 2007***
W. Palm Beach, FL (USA)

Evidence-based Examination and Selected Interventions for Patients with Lower Extremity Disorders

Aug 25-26, 2007
Jacksonville, FL (USA)

Sep 8-9, 2007
Concord, NH (USA)

Evidence-based Exercise for the Management of Musculoskeletal Disorders

Jul 28-29, 2007***
Charlotte, NC (USA)

Sep 15-16, 2007
Manitowoc, WI (USA)

Evidence-based Examination and Selected Interventions for Patients with Knee Disorders

Aug 25-26, 2007***
Bronx, NY (USA)

We encourage early registration to insure a seat. Extensive hands-on lab sessions are included.  Visit us on the web at www.evidenceinmotion.com to get more details, learn about other 2007 course dates and locations. Register online today!

Feel free to email us at courses@evidenceinmotion.com if you have any questions or need additional information. Consider passing this post on as an email to your colleagues who might benefit from this information. Hope to see you at an Evidence in Motion course in 2007! We sincerely thank you for joining with us to translate evidence into practice.

The Evidence in Motion Team

An Economist Checks In on Health Care

I like to keep a lookout for when the smart economists provide some of their thoughts on health care.  Ultimately, it is these economists that the government consults with to initiate ideas about how to manage our health care system.

Tyler Cowen, a well respected economist, checks in with a piece called, Smart thoughts on health care.  He doesn't say too much, but it sure sparked a conversation in the comments!

When I read this, I try to read between the lines about what people are saying and see how Physical Therapists might act to fill a need economically.

My favorite line from the comments:

90% of the time I see a doctor it's to tell them, "I have X, and I need a prescription for Y." After reviewing my symptoms and medical history they always agree with me and write me the prescription. So why am I paying an extra ~$100 just to get a medication I already knew I needed, for a condition I already knew I had, before seeing the doctor? It's just a waste of my time and money.

Perhaps it is this lack of perceived value in routine care which prohibits a move to a retail-like system.

ERIC