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EIM is excited to announce a new Executive Program in Private Practice Management with optional tDPT Cohort!

40 students from 20 different states kicked off their program in Louisville, Kentucky this month.  Four of this cohort's students are the second or third in their practice to participate in the Executive Program.  EIM's Executive Program enhances the business intelligence and savvy of owners/managers in private practice with practical applications to provide a competitive advantage in the marketplace.  Click here for program details. 

"In today's ever changing healthcare environment with declining reimbursement we found our practice after 9 years on the edge of disaster. Referrals had declined, we were locked into two low paying contracts and our office morale was at an all time low. Using the tools and techniques learned in the EPPM Executive Program has allowed us to essentially restructure our business; we have eliminated our low paying contracts, our marketing efforts have increased our referrals, our net revenues and profits have increased. We are back to numbers of visits we have not seen for some time. Our staff now takes an active role in providing input and direction of our practice and as active participants morale in the clinic has dramatically changed.  Our business is back on the right track and growing again." - Bob Bacci (EIM Executive Program with optional Transition DPT graduate)

To date, a total of 75 have completed the program and, including the new cohort, 72 are currently enrolled.  Interested in the program too?   Apply today for a head start on clinical courses beginning in July.  Email info@eimpt.com for more information.

Orthopedist or Family Practitioner- Who Should I See For My Back Pain?

The article Orthopaedists' and family practitioners' knowledge of simple acute low back pain management is both informative and a great example of why one can go terribly awry simply reading an article abstract and worse yet, only the abstract conclusion. In this case, the primary abstract conclusion was: “Both orthopaedic surgeons’ and family

physicians’ knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners……”. This would elicit a “Tell me something I don’t already know” response from readers of this blog in many cases. However, when you read further you realize that this article doesn’t really provide an answer to that question.

The researchers determined knowledge deficiency in these two groups of doctors (253 orthopedists and 140 FPs) via responses to a questionnaire at their professional conferences (apparently in Israel). The 5 questions related to: 1. use of medication (paracetomol or standard NSAID vs COX-2 meds); 2. Effectiveness of bed rest; 3. Effectiveness of encouragement and advice; 4. Effectiveness of manipulation; and 5. Need for imaging studies. Physical therapy was also listed (whatever that means or includes) but was not analyzed due to conflicting recommendations.

Results? Back then, if a patient saw an Orthopod they were going to receive a lot more COX-2 Meds, X-rays, bed-rest and less encouragement than that would from a family practice doc. Interestingly, more than half of both Orthopods and FPs viewed manipulation as appropriate but that was graded as an inappropriate response by the researchers. Physical therapy: well, what’s that? (ok, we can’t figure it our either so let’ not count that answer.)

A few things to consider: The answers were based on a 2001 Clinical Practice Guideline, the questionnaire was administered in 2005 and this article was published in 2009 (probably not exactly the best data to give us a current understanding of how these two physician groups view and manage patients with LBP).

However, there is plenty of evidence to suggest that imaging, meds and in some cases bed-rest are still frequently used. I do wonder if their perspective on the use of manipulation for acute or chronic LBP is still moderate (51% and 57% for orthopods and FP’s, respectively) or if it has increased, given the recommendations in current US and UK clinical practice guidelines. My own guess is that things haven’t changed much (except spinal surgery, especially fusion and increasingly disc replacement may now be popular, albeit ill-supported choices). How about yours?

Perhaps our patients should see a EBP physical therapist instead.

 

Rob

Introducing EIM's Radiology Course for Physical Therapists

 

Introducing EIM’s Radiology Course For Physical Therapists

EIM's Radiology course encompasses the essentials of musculoskeletal radiology. Common imaging modalities such as Radiographs, MRI, CT, musculoskeletal ultrasound, Bone Scans & DEXA Scans will be discussed. This course helps participants' confidence grow in the areas of common radiographic views and radiographic presentation of common musculoskeletal conditions.

After this course you will be able to:

 

• Describe common musculoskeletal imaging modalities & be familiar with appropriate imaging for a variety of musculoskeletal conditions
• Identify common musculoskeletal conditions on unmarked radiographs
• Recommend appropriate imaging modalities and views for common musculoskeletal conditions
• Describe current clinical prediction rules for when imaging is essential after ankle sprains, cervical trauma & knee injury
• Communicate effectively with referring providers

For more information or to register for the January 2011 course, click here.

 

 

PRIVATE PRACTICE SECTION 2010!



WOW, hear what the Executive Program 2009 graduates have to say about the program’s ROI following graduation…

“I have always felt like I should get my tDPT but I just could not justify the time out of the office for any curriculum I found.  Then I found the Executive Program.  This program is actually an investment.  I have made much more income from the knowledge gained than I spent on time, effort and money on the course.   I grew from 5 locations to 8 last year and realized a 12% increase in my profit margin.  In my opinion, if you are serious about your business then you HAVE to do this program.  Oh yeah, it is also a blast!” -Brett Tice, DPT, CEO/President, Back To Action, Harlingen, TX

 “We are doing great this year.  We have almost doubled our visits since this time last year and have hired two full time therapists.  I continue to be a huge supporter of the Program.  Please let me know if there is ever anyway I can help out further.” -Patti Rouleau, DPT, President, Orthopedic Physical Therapy Associates, Lakeland, FL

 “PTC is looking forward to the EIM Residency/Fellowship, we are opening another clinic and are due to hire three more PTs.  All is going very well and the EIM Executive Program has set the direction of the path we are headed.  It continues to drive and guide our course.” -Bridgit Finley, DPT, President, Physical Therapy Central, Norman, OK

EIM's Executive Program in Private Practice Management teaches private practice PT owners strategies and provides tools that build competitive advantages.  Courses are taught by faculty with real private practice experience, are affordable and flexible, and will build your long-term private practice community.  Email Marilyn@eimpt.com for more information about this program.  

Stop by the EIM booth - #406- at the Private Practice Section Meeting in DC from Nov. 3-6, 2010 to meet Marilyn Doerr, George Burkley, and Larry Benz and learn more about the Executive Program in Private Practice Management.  

Clinical Consult

Hello all-- anyone have any recommendations or literature review articles for exercise guidelines for patients with multiple sclerosis for general fitness, not for those in a relapse period.  My experience with these patients is limited, and any recommendations would be greatly appreciated.  Thanks in advance

Note:  This post will also be posted in the 'Orthopaedics' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on the blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

I recall that this subject may have already been discussed on the blog but I am unable to find the entry.

I did a lit search on VAX-D, DRX9000 and non-surgical decompression therapy (marketing terms seemed like a good place to start).  There is some evidence:

1. effect on nerve conduction http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11680509

2. mechanism of the treatment http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=8057141

3. I found one RCT which compared VAX-D to TENS http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11680522

4. interestingly there is was case of sudden progression of disc protrusion reported during treatment http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14661685&query_hl=4&itool=pubmed_docsum .
Has anyone done a systematic review on this subject as some chiropractors in my area are doing extensive marketing of these devices and I’d like to know a little bit more about the evidence in support of, or against their use. 

Greg

Note:  This post will also be posted in the 'Orthopaedics' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on this blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions. See you on MyPTConnect!    

 

Clinical Consult

I have been reading the book by Dr. Shirley Sahrmann, entitled, "Diagnosis and Treatment of Movement Impairment Syndromes," and it appears there are at least two impairment-based classifications for the patients with hip osteoarthritis (OA). Specifically, patients in the "femoral accessory motion hypermobility" group (p166) have hypermobility of accessory motions, and their medial/lateral hip rotation may be associated with superior glide of the femur. In contrast, patients in the "femoral hypomobility with superior glide" (page 168) group have markedly limited hip range-of-motion, and these patients usually develop compensatory movements of lumbar extension and rotation while walking because of restriction hip motion. In addition, Dianne Lee describes, in "The Pelvic Girdle," that "overactivation if the deep external rotators of the hip pulls the greater trochanter posteriorly and forces the femoral head anteriorly" (page 102). On the basis of the abovementioned description, I wonder if anyone in the EIM community has used found these classifications to be useful when managing the patients with hip OA. Specifically, I would like to know how confident clinicians are in detecting a superior or anterior glide of the femoral head.

I would appreciate any comments. Many thanks and have a good weekend :P

Yonghao

Note:   This post will also be posted in the "Orthopaedics" group on MyPTConnect.  All comments and questions should be addressed there.  The comments feature on this blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

I have a general question which I believe can be answered by this readership.  In both the recent Spine publication by Whitman et al and the slump sitting article by Cleland et al the frequency of visits were BIW.  Why is BIW chosen vs. TIW or one time per week?  This question often comes up in my clinic as to what is the best general frequency for patients.  Is there research to show one frequency is significantly better than another?

Mark Boncser

Note:  This post will also be posted in the 'Orthopaedics' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on the blog is turned off for this post.  Email us at info@myptspace1t.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

Does anyone know how to perform the "hooking manuever", which is used to clinically diagnose a "slipped rib?"  I can't find the original article that actually describes the procedure, and it's not in any of my orthopedic test texts.

John W. Ware, PT, MS, FAAOMPT
Maller and Swoverland Orthopaedic Physical Therapy

Note:  This post will also be posted in the 'Ortho' group on MyPTConnect.  All comments and questions should be added there.  The comments feature on the blog is turned off for this post.  Email us at info@myptspace1T.com if you have any questions.  See you on MyPTConnect!

Clinical Consult

In Baton Rouge, there are "pain clinics" popping up everywhere and the docs are injecting anything that moves. The internists and primary care MDs are getting marketed hard by the pain docs to send musculoskeletal patients to them.  Of course there is no manual therapy or therapeutic exercise associated with them. Is anyone aware of studies comparing manual physical therapy and/or exercise to epidural steroid injections?

Seth Kaplan PT, OCS, MHA
President and CEO
BRPT-LAKE
Rehabilitation Centers, L.L.C.