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September 27, 2007

A Strike, a VEBA and the Union

I'm obviously not privy to all the details of the negotiated results of the GM strike.  I can see why GM would want to financially free itself of the health care benefits for retirees. 

I'm a little lost with the actual final arrangement.  I would think the final arrangement would cost the Union thousands to restructure their organization - who's going to pay for that?  Is it in a retiree's best interest to have a union negotiating health care contracts?  This is how it is proposed to work  Will it work this way?  Will the Union find value in physical therapy services? What about the other automakers?  Is GM setting a standard?

September 26, 2007

Broadcast your CPR!

If your wondering how effective spreading a message is on YouTube, just ask the Numa Numa Dance Guy who, like it or not, is at 5,856,401 views and counting.  We know he's good at that dance!

Well, some enterprising students at Regis University are hoping the same fame will befall them, and the clinical prediction rule for patients with low back pain who respond to a spinal manipulation.

The video is pretty funny and does an excellent job getting the point across.  If I was unaware of this CPR, I would be very curious to learn more after watching the video, which is the point I think.  Often, you can't tell which of your many efforts to communicate will stick with someone.  Maybe this will be one of those times.  I applaud the people who put together that video and hope to see more like it.  I'm feeling a cult classic in the making if this came out as a series...


ERIC

September 25, 2007

Here's to you, Arthur

And I am not talking the babbling drunken playboy character played by Dudley Moore or the amorphous aardvark of children’s animation.

A little over 3 weeks ago, a legend and somebody incredibly influential in our field and in a lot of my thoughts passed on-Arthur Jones

For you students and “young things” of PT, perhaps you have never heard of him-this is indeed unfortunate. For others, you can only recall his flamboyant character and penchant for “faster plane, younger women, and bigger crocodiles”-this may even be more unfortunate as it dilutes the significant impact that he has had in fitness,strength/body building, and in physical therapy.  Many folks including the WSJ (Sept 1 edition), will try and “throw him under the bus”-but not EIM and those who can look beyond his faux pas and appreciate his legend.

Arthur essentially made extinct Delorme instruction and many of the cockamany things that we were conventional wisdom about body building.  He simply put them and a lot of “gurus” to shame.  He brought strength and training to the modern age when he brought Nautilus to market.  He exposed more athletic trainers and sports medicine folks to on-going, hi intensity fitness training in a few years than has ever been accomplished since.  After selling the company (which has been bought and sold numerous times and now seems to be on solid ground), he ventured into solving the world’s low back pain problems-a well intentioned effort that we should appreciate.  Although he obviously didn’t solve the problem, he brought many items to bear-including the fact that strengthening the lumbar spine is not easily accomplished because of isolation issues (he should know-he and his team tried to manufacture hundreds of different devices) .  It took Edison a thousand failures to get to the light bulb-who has been bold enough to follow Arthur’s lead?

Arthur had an interesting way that he marketed his products-he simply flew people in to his Nautilus studio and his palatal home or research center in the case of MedX (a marketing technique perfected for years by total joint implant companies before the FTC harangued them).  He lectured, entertained, and educated with a very impressive team and I believe this exposure continues to have an impact in sports medicine today.

But, he was a complete character.  Many folks in the PT and sports medicine world (particularly athletic trainers and PT’s) have their favorite memories of Arthur. I have a ton of them and only spent time with him on 3 separate occasions.  I would like to share a few with you and invite you to share yours to this blog’s community.

The first was when I was an 18 year old athletic trainer attending a sports medicine “camp” at Miami of Ohio University in 1980.  Arthur attended every year, co-piloting his own plane and letting his 18 year old girl friend pilot into Hamilton, Ohio.  I can tell you, as campers we were mesmerized by both of them.  Here are some of his precious quotes from that event:

“You can take everything we have ever known and will know about the physiology of building muscle and print it on one piece of paper-its not that complicated-quit acting like it is and get over it” (I think he invented the “get over it” phrase).

“Playing basketball didn’t make Wilt Chamberlain taller.  Some athletes will simply reach their genetic peak and when they do it can be maintained easier than it took to get them there”  (wonder what Arthur thought of Barry Bonds and steroids).

A few years later, I got to visit his nautilus studio (this was still before I became a PT).  I distinctly remember 3 instances. The first was his comments regarding specificity of exercise and relating it to shooting elephants in the Congo: “the notion is ridiculous, just like you can’t train the ways and positions that you have to when you shoot an elephant”.  The second was his expository on guns,ammunition, and their impact on various biological parts when fired from close range which still leaves me squeamish and I spent 5 years in the Army.  Lastly, his fascination for crocodiles and and the on-going perplexity of his visitors over their sunning themselves with their head above water in extremely hot weather “God didn’t give them much of a brain but He put something better between their eyes-an internal thermal regulator that when exposed to the sun cools them off. Unlike a lot of humans, at least they maximize the little brain that they have”. 

However, my most fond memories of Arthur came years later as we went on the journey back to Florida to see his MedX equipment and research institute.  These were some real gems:

-He showed a slow motion video of some unfortunate volunteer going very quickly on a cybex back machine  (I hope that there is not one of these devices in the world still in existence) and the flailing away of the person’s head as they were attached to that bombastic device and reproducing tons of repetitions of “whiplash” to the cervical spine. “Let me tell you something about acceleration that you will never forget. Let’s say that I place my fist against your forehead and push as hard as I can (by the way, I was the volunteer that he put is fist against my forehead), you will not find it painful and in fact it is tolerable. However, give me 3 feet and allow me to accelerate my fist into your head and I will break your skull (by this time I had backed away 10 feet). That is the problem with the fast speeds of these machines and acceleration.” (note:  I have never forgot).

-In response to my questions about average strength (or torque or something).  “Let me tell you something about averages. Let’s say I am flying my plane and I have two men who will parachute into a defined and safe target. Let’s say the first one misses the target by 250 ft. to the right and he dies. Let’s say the second guy misses the target by 250 ft. to the left and he dies. What was their average?”  (note:  the term average has never meant the same in my measures of central tendency lexicon).

-When asked by an attendee about a mistake thought was evident, Arthur’s response: “Mistake?  Let me tell you, I only made a mistake once. I thought I was wrong about something”.

Absent his machine (which was the only true method and he had data to prove it), Arthur pulled me aside and told me that the best way to strengthen the spine was in the sense of stabilizing the pelvis while doing extension in a Roman chair or in the case of a patient, a prone short motion extension exercise while also stabilizing-a technique that many incorporate every day.

You don’t always have to agree with a person to appreciate them and you have to appreciate the legacy of Mr. Jones.

Thanks Arthur, you will be missed

 

Larry@physicaltherapist.com

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

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***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 29-30, 2007***
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Nov 3-4, 2007***
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Evidence-based Examination and Selected Interventions for Patients with Cervical Spine Disorders

Sep 29, 2007***
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New Milford, NJ (USA)

Feb 29-Mar 1, 2008
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Evidence-based Examination and Selected Interventions for Patients with Upper Extremity Disorders

Oct 26-27, 2007***
Ft. Lauderdale, FL (USA)

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

Nov 10-11, 2007
New York, NY (USA)

May 2-3, 2008
New Braunfels, TX (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

Fpteimsupport_3

September 19, 2007

How Many Does this Reach?

Does the public read this?  The News 

For the specific population of those receiving total hip arthroplasties, will the majority of the audience receive the above message?  Was this the best avenue for the message for the targeted audience?

I believe a good message was sent... will it be received by a vast majority of the target audience though?

September 16, 2007

Ahh. No wonder they still do so many spinal fusion surgeries!

Question_grafitti I'm linking to an article in the New York Times magazine written by Gary Taubes, entitled, "Do we really know what makes us healthy."  It is a thorough and useful article examining epidemiology.  I've already commented on this article in detail at my newly re-designed NPA Think Tank (shameless self-promotion) so I won't include a lengthy diatribe here.  I will, however, comment that while the article uses the backdrop of hormone replacement therapy to make an argument, I was thinking about low back pain treatment. 

As you read the article, consider the problem of effective treatment for low back pain and the ability of the field of epidemiology to guide us.  To me, low back pain and its many subtleties is  a perfect storm for weak observational analysis and an over-reactive media (and public).  In light of a broad awareness of treatment classifications and physical therapy treatments supported by good research, we are always apt to find people hanging upside down on over-night infomercials and other health professionals treating seemingly every low back pain patient with cold lasers. 

I know we've got some evidence...we just need an outlet...or a lucky epidemiological study!

ERIC

September 14, 2007

Where is PT in the debate of self-referral?

Apparently and unfortunately, not in this Sept 12th WSJ Health Blog (subscribers or available for 7 days), Feds Crack Down on Physician ‘Self-Referral” per this document from the Centers for Medicare and Medicaid Services (a mere 500+ pages for those who are into this stuff), self-referral arrangements are “corrupting medical decision-making” by creating incentive for doctors to refer patients who don’t really need procedures.

Asp part of a proposal that could go into effect soon, it would largely target joint ventures between doctors and hospitals as well as so called specialty hospitals that are owned by physicians.

The poster child for documenting the huge overutilization of MD owned facilities, Jean Mitchell (health care economist at Georgetown Univ) is quoted, “Self-referral arrangements represent an inherent conflict of interest for physician investors”.

Only problem is that PT is not mentioned either in the article or in the CMS document merely because while performed in a physician office it is considered “incident to”. Congratulations-once again to our great branding image.  We should be proud to tell our grandchildren that we are “incidental”.

Many of us have been saying that to fight physician self-referral you have to couch it with other services that are in this mix (namely specialty hospital, imaging centers-those that are much more then just a single MRI, and hospital/MD joint ventures).

Where is our national association’s response to these on-going news reports?  Wouldn’t you just love to see national press releases with appearances in various news services and TV shows citing this article and bringing to the forefront Physical Therapy as a self-referral victim as well? (ok, I realize that this couldn’t generate the over 20+ sources that wrote on backbacks and return to school but I can hope). Aren’t we a noticeable omission in this debate?

Lastly, and perhaps more importantly, get your dollars talking.  The Foundation for Physical Therapy needs your money to help in making a call to the Jean Mitchell’s of the world to conduct a self-referral analysis similar to what was done years ago in the PT world which documented similar patterns.

Larry@physicaltherapist.com

September 11, 2007

Does the solution to fixing US Health Care lie in Holland?

I'd like to thank daily blog reader Chris Kramer, for pointing us towards this interesting article (pdf) from the Iowa Hospital Association. 

I found several things particularly interesting in this article.  One, the concept of managed competition for health insurers.  Two, that this concept was originally proposed 3 decades ago!  And three, that it seems to be working in Holland.  In all, this is a quick, but insightful read reminding us that very few ideas are really new. 

What matters is that ideas get action, and get viral!

For those very interested in the managed competition concept, check out Alain Enthoven's faculty bio page, particularly the press releases at the bottom.


ERIC

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)Icon_articulate


Sep 29-30, 2007***
Evansville, IN (USA)

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

Nov 17-18, 2007***
Greenville, SC (USA)

Mar 29-30, 2008
Portland, OR (USA)

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

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

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

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


Oct 27-28, 2007***
Evansville, IN (USA)

Nov 3-4, 2007***
San Luis Obispo, CA (USA)

Nov 17-18, 2007
Fairfield, CT (USA)

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

Oct 26-27, 2007***
Ft. Lauderdale, FL (USA)

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

Nov 10-11, 2007
New York, 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

Fpteimsupport_3

Can't Beat 'em Join 'em

From WSJ (free for 7 days), Dr. Benjamin Brewer in The Doctor’s Office makes a compelling case for retail clinics and in fact will be starting one.

Except for the fact that he is a family physician, this article can be aptly applied to physical therapy.  Please note:

-politics including stopping referrals goes into play

-profitability of practice is gradually declining due to rising costs and flat reimbursement from the government and private insurers

-Initiatives from insurers and government to track quality are poised to drive up our overhead without any real pay increase to cover the extra expense

and so it goes.

Larry

 

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