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Hello readers.
Some of you may be aware that there were several posts on Myofascial Release recently on this blog, from February to July of 2008.
Those posts were retracted in compliance with a cease and desist letter and a threat of legal action.
Thank you for reading Evidence in Motion. Have a nice day.
Jason Silvernail DPT
As you know, part of Vision 2020 involves our transitioning to a doctoring profession. I don't know what the exact percentages are, but I suspect about 50% of programs have converted by now. So, a logical question might be whether any states have taken steps toward changing the regulatory designation for licensees from “PT” to “DPT.” Unfortunately, the answer to this question is apparently no.
As you may recall, there was a motion at the 2005 House of Delegates that eventually led to an exploration of the various aspects of what goes into changing the regulatory designation. I was not there to hear the debate, but I am virtually certain it went something like this..."It's not fair if someone else gets a regulatory DPT when I worked so hard to get my academic DPT (hear the usual PT whining tone). That would mean I spent all that money for nothing (because remember, it's not about the training [wink, wink]...it's about the initials) (again, more whining tone implied)." I suspect the questioning went on about how dare we grandfather PTs who didn't get an academic DPT (again, life is more unfair to PTs than anyone else on the planet).
I don't know what stars will have to align before the states shift the regulatory designation to DPT, but I do know that the major barriers to our being a DPT profession are mostly self-inflicted (remember, we are our own worst enemies). Why in the world we don’t simply agree to wake up in the morning and be DPTs is beyond me. Who knows...we just might start acting like it. So, if you're curious why we haven't changed the regulatory credential to DPT, look in the mirror. Thoughts?
John
NYT Well Blog Has Trouble Getting The Facts Right
Two particular articles in the New York Times this week drew my attention. The first was a post on the usually strong Well Blog about the proliferation of Kinesio tape all over the women's volleyball tournament in Beijing. In one match that I watched, all four player were wearing the tape! Well, not so long ago, JOSPT, which is the Journal of Orthopaedic and Sports Physical Therapy included a radomized controlled trial investigating the effectiveness of the tape. The Well Blog jumped all over the results section of the study stating,
"Notably, the study participants who received the real therapeutic tape treatment reported an immediate improvement in pain."
When one views the actual study, the conclusions read,
"Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported."
The researchers had only found short term improvements in shoulder abduction ROM on the order of about 16 degrees. Is it surprising the Well Blog put the wrong spin on the data? Not really. They even got the name of JOSPT wrong! I expect better from one of my favorite blogs.
Here is a great post on the Kinesio tape.
Risks of Cervical Manipulation: 236-Word Sprint Format.
Ahanad O'Connor attempts to deal with the complex issue of cervical spine risks, particular the association of cervical manipulation and stroke in a NYT Science Times piece. Thankfully, only chiropractors were mentioned in this bit, but I kind of feel badly for them as this article has a strong anti-manip bias. 236 words is not nearly enough to even skim the surface of this area of considerable complexity and uncertainty. O'Connor chooses statistics to put down on paper thay belie his bias on this subject: "It estimated an incidence of 1.3 cases for every 100,000 people under 45 receiving neck adjustments."
While he does attempt to bring uncertainty to the issue in a balanced concluding paragraph, the image on the left of the page sets the tone: crack your neck and your dead!
For the record, cervical spine manipulation is a safe intervention, perhaps with an extremely small, if not insignificant, component of risk that might be unpredictable.
The Agency for Healthcare Research and Quality (AHRQ) released its weekly updates yesterday and I was pleased to see an update on the American College of Occupational and Environmental Medicine (ACOEM) Guidelines for low back disorders. These Guidelines can be downloaded from this page at www.guideline.gov Here are just some of their major recommendations: I really like the www.guideline.gov site. It is at times hard to navigate with all the information so I have signed up for the weekly updates email blast here. So how can we get PTs and Family MDs to read these Guidelines? My Top 5 (all dripping with sarcasm) Seriously, how can we get the generic PT and the referring MD to utilize these Guidelines without waiting a decade for them to become accepted? How can we create change?
Is what would be saved to the health care system with a 20% reduction paid to PT industry. This is certainly not a good way to help save significant dollars to the health care system. High time policy wonks looked elsewhere.
Uwe Reinhardt’s estimate of physician’s take home pay to the health care system is approx 10%. I generously put ours at 2%.
From the op-ed article in USA Today Doctors’ Pay Cuts Save Little in Health Care Costs by Kevin Pho of KevinMD blog fame.
After over a year of hard work by many, many highly talented and skilled professionals, we are pleased to be able to share the following:
Evidence in Motion is credentialed by the American Physical Therapy Association as a post-professional clinical residency program for physical therapists in Orthopaedic Physical Therapy.
Obviously, we are extremely excited and proud to be able to share this exciting news!! For us, this is an important step for EIM in our work and mission to elevate the physical therapy profession and the role of physical therapists in health care delivery. We seek to partner with and equip individual practitioners and physical therapy practices with premiere resources and training necessary for becoming leaders in evidence-based practice while creating and promoting a culture of evidence-based practice within the physical therapy profession.
Plain and simple, we believe that post-professional residency and fellowship training for physical therapists is the most effective and efficient way to accomplish and realize the goals stated in APTA's Vision 2020 and we are committed to the task. We also believe our programs are unique in the ability to make accessible and provide post-professional residency and fellowship training to large numbers of physical therapists, including new graduates, who otherwise would not be able to take advantage of this important aspect of professional development which is critical to the future of our profession.
Our programs are centered around an advanced distributed distance learning model that utilizes the BlackBoard Learning Management System for didactic instruction, group projects, and Virtual Grand Rounds. For the clinical mentoring component of the program, we partner with high quality Network Partner practices across the nation that support and facilitate locally the clinical mentoring process for residents who are affiliated with or assigned to those Network Partner practices. The end result is that PTs who are motivated to the task but don't want or are unable to move from their current location or place of employment now have the opportunity to participate in a world-class post-professional residency or fellowship training program.
Our next class starts in January of 09. If have an interest in pursuing residency and fellowship training and would like to learn more or want to take the next step, you can find further details about our program on the residency/fellowship link of our website. Obviously e-mail and phone calls are always welcome.
Once again, thanks to the many folks who have made this achievement possible and we look forward to working with our current and future residents and fellows as well as our valued current and future Network Partner practices in order to make a lasting impact on our profession.
Rob Wainner PT, PhD,
EIM Residency Director
Julie Whitman PT, DScPT,
EIM Fellowship Director
Imagine this.... you're going along, minding your own business and enjoying your day.
The day was great until.... WHOA.... you found your name on both a forum AND within multiple blog comments! This was within the world wide web, so your closest colleagues and a million other friends would learn of this communication within the same time period as you. (This COULD be a good thing, but in this particular instance, your name was out there for all to see as though you were a defendant in a legal case.) Yuck!
You probably experienced the element of surprise... which then probably turned into anger, especially when you learned that an attorney was responsible for the written communication. Yuck!
We all know some hilarious attorney jokes because for some reason that particular profession seems to have poor public perception. Granted, not all attorneys are horrible, but the actions of a few create lasting memories that contribute to lack of the public immediately trusting attorneys.
I wonder... what effect occurs when an attorney chooses a behavior that appears to convey false statements, such as:
"has trained over 1/3 of the physical therapy profession" yuck! - how the heck does he know that?
"never been one injury" yuck! - no reported injuries? how was injury defined? what data or evidence was used to deem "never" OR could it be interpreted that there was never one injury but instead 50 injuries?
not taking a course apparently suggests any therapist in disagreement has "no foundation or credibility from which to speak" yuck! - I've never jumped out of a plane, but I'm very sure that if I don't have use a parachute, I'm going to have issues
"a complaint has been prepared against them and all others" yuck! - you can't prepare a complaint against all others in the same complaint when a complaint is initially filed - it's not like an open claim or something
MFR "is revered with much respect by many healthcare professionals and patients as revolutionizing the Physical Therapy Profession" yuck! - hmm, news to me... where is the data supporting this statement?
finally "these individuals will consider exploring all the educational opportunities available to be fully informed." yuck! - who are the individuals? the ones that are "all others" and exactly how does one go about exploring all educational opportunities? All of them will fully inform? Hmmm...
Since there were WAY too many yuck instances, I decided I'd educate myself a bit on Professional Conduct for Pennsylvania attorneys (according to internet law, I believe, since we are in all different states and since the attorney that posted here and elsewhere didn't specifically state where he held licenses. He technically may need to comply with Professional Conduct in all 50 states - but we'll ignore that to just keep things simple, okay?) Information available for the public: Disciplinary Board of the Supreme Court of Pennsylvania. The most current Professional Conduct Rules do have me pausing and wondering if this attorney followed conduct rules. As I look through that long document, I'm curious as to how the disciplinary board would view a couple of the comments and posts by a particular attorney. In particular, how about these specific professional conduct rules?
Preamble 4: A lawyer should keep in confidence information relating to representation of a client except so far as disclosure is required or permitted by the Rules of Professional Conduct or other law.
Preamble 5: A lawyer should use the law's procedures only for legitimate purposes and not to harass or intimidate others.
Preamble 7: A lawyer should strive to attain the highest level of skill, to improve the law and the legal profession and to exemplify the legal profession's ideals of public service.
Preamble 8: ... preserving client confidences ordinarily serves the public interest....
Considering what some of us would legitimately view as an outcome of professional suicide for MFR, was 1.0 (e) considered? informed consent.... explanation of material risks of and reasonably available alternatives...
What about the choice of communication 1.0 (h)? ... denotes the conduct of a reasonably prudent and competent lawyer.
Rule 1.6: confidentiality of information
Rule 4.1: truthfulness to others
Rule 4.2: communication with person represented by counsel (IF there was counsel representation)
Rule 4.3: dealing with unrepresented person (if no one was represented)
Rule 4.4: respect for rights of third persons - a) in representing a client, a lawyer shall not use means that have no substantial purpose other than to embarrass...
Rule 7.2: advertising
Rule 7.3: direct contact with prospective clients
Honestly, all I can think is "Yuck!" I would think that there were better alternatives available than the option chosen by the attorney.
Now, the next part is confidential... if you are motivated to take steps to report the potential multiple breaches in professional conduct, you can confidentially! Shh... for those of you that just happen to have a problem understanding confidential... you report the behavior but you don't communicate in public that you reported the behavior. We're not supposed to know! You can complete an online form.
I'm confident many of you are motivated to defend evidence based practice. In this particular situation, maybe the most we can do is send a message that we aren't going to let some attorney bully us and our thoughts. My main reaction to this attorney's communication via the forum and blog was... Yuck!
photo by leafy tenement via Flickr
Selena Horner
A recent investigative report published in the New York Times yesterday highlights the alarming increase in methadone prescriptions. How much you ask? Try a 700% increase from 1998-2006. Why? Methadone was once limited to use in addiction treatment centers to replace heroin, but today it is frequently given out by physicians to manage spine and joint pain. The result has been a shocking increase in methadone related deaths. In Florida alone, methadone was a cause in 785 deaths in 2007, up from 367 in 2003. That is in only 1 of 50 states... yet one more piece of evidence that the medical management of spinal pain in this country is a failure. Please see the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) press release on this topic. Also come join the AAOMPT at our annual conference in Seattle in late October.
Tim
A frequent topic on this blog is physical therapy marketing and PR. I thought that a recurring discussion regarding this topic would be appropriate.
One of my favorite magazines is Fast Company. They always seem to be on the cutting edge of technology and present a full ranges of stories that you just don’t get from traditional media sources.
This month there is a feature article entitled: The Most Valuable Player in Sports Medicine: James Andrews by Chuck Salter. The article details the significant expertise, acumen, and history of Dr. James Andrews who is unquestionable this country’s pre-eminent sports medicine physician. He is not only a skilled craftsman but obviously a great marketer and business generator for all aspects of this part of the health care chain. It also details the problems Dr. Andrews got into with Healthsouth and the $450,000 civil settlement that he paid regarding potential self-referral laws.
The article also points out that two thirds of the patients that are seen at his clinic and in particular the PT clinic are not sports figures but everyday Joe Lunchpales. Dr. Kevin Wilk, who has worked for/with Dr. Andrews for 19 years is somewhat featured (well, at least his picture is in the article and he is mentioned). Without question, Kevin is a noted authority in sports medicine, well published, extremely engaged within our professional association, and lectures internationally. (side note: the online article due to typesetting is portrayed differently than the print copy which shows the athletes that Dr. Andrews has consulted or operated as the front page of the article).
Fast Company is read by thousands of influencers in the U.S. and this is a particularly significant marketing for Andrews and his clinics in Alabama and Florida. You could not buy a better medium to have an article about you or your service.
However, I was particularly disappointed by the lack of emphasis on the rehab component of sports medicine in the article. In my opinion, it is treated sort of like an old school “after care” type of program and approach with the surgeon of course getting the top billing. Perhaps I am being just a little sensitive and defensive of our profession and the fact that many surgeries’ outcomes are driven by the rehab component than the surgery itself. I also realize that the gist of the article was deliberately about the surgeon!
For discussion, I would like to hear the thoughts and opinions of the EIM readership.
Is this article good or helpful for our PT profession? Does it portray PT accurately? Does it put PT as subordinate to physicians? Should we promote this kind of article to the mainstream through press releases and highlights?
PT’s are genetically coded with a peace corps gene and are generally “good people”. Lawyers have a DNA unlike no creature before and are generally bullies.
The above is a stereotype. I know some PT’s that are not “good people” and I know some lawyers that are coded with “peace corps gene” (just a few!).
I mention this because unfortunately, the bully is going to force the “good people” to have to have their comments removed from this blog.
This is a blog about evidence-based practice in physical therapy. We believe it was the first blog having anything to do with PT. We are in the midst of our 1,000th post and our intent was to use multiple authors on this blog rather than the typical one person’s thoughts and opinions. We have often times been critical of PT interventions, our national association, each other, and have often times been irreverent. I plan on doing my part in continuing this for a long time.
Recently, there have been authored a series of posts on myofasial release. They have garnered perhaps the largest number of comments in the history of this blog. My guess is that its popularity are the result of the clash between evidence based medicine and whatever unknown category of medicine that MFR falls into. We are very open to all parties throwing their evidence into the ring and let it be scrutinized. Apparently, this is not good enough for the MFR group who instead want to use the courtroom to go after at least 3 of the commentators. What a shame.
1 Million dollar claims against PT’s? Doesn’t the attorney realize that PT’s are so busy filling out plans of care, counting multiples of 15 and 8 minutes, being careful to not allow support help to breathe on a patient, documenting minutiae, re-inventing group therapy, and buried with other regulations that they don’t have time to deal with nuisance legal suits?
I must confess. I have had very little exposure to MFR during my career. In fact, I am quite taken aback by the lawyer’s claims that 1/3 of our profession has been trained by one PT! My only experience was being a volunteer “patient” at an evening seminar I went to 20+ years ago when a few therapists claimed they could move the sutures of my cranium and that it had a “rhythm” independent of respiration, blood pressure, and hear rate. I wasn’t hurting or anything but I can tell you that since that time I absolutely despise science fiction-books or movies! Prior to that experience, I saw the first Star Wars movie and actually enjoyed it.
Let’s not let bully tactics refrain our desire for continuing our trek to promote and find the best EBP in physical therapy.
My name is larry@physicaltherapist.com and I approved this message.
Thoughts?
