Can we use Twitter to #SolvePT

Can we use Twitter to #SolvePT
Recently, a new hash tag has emerged in the physical therapy twittersphere: #SolvePT. Selena, via the Evidence in Motion Blog, shared her thoughts in a post The Pulse of Physical Therapy. Dr. E of the Manual Therapist also briefly highlighted this new hash tag in a post.

#SolvePT

Initially, discussions focused on financial issues of physician owned physical therapy services (POPTS), student loans, payment, and educational costs. But, today involvement and content was rich with various contributors and topics. Physical Therapist Twitter regulars such as myself (@Dr_Ridge_DPT), Larry Benz (@PhysicalTherapy) and @SnippetPhysTher were present. @PTThinkTank even tweeted a few insights. Other tweeps included:
Topics discussed today were extremely broad and covered many areas of practice:
  • Education: Cost, Length, Effectiveness, Organization
  • Clinical Education: Models, Need for change, Payment
  • Financial: Debt vs. Income, Payment by Setting, Incentives, Payment Models
  • Best Practice: Defining, measuring, incentivizing, and teaching
  • Outcomes: Which ones? How to Measure?
  • Value: Cost Savings, How to measure, How to communicate
A very interesting question that I took from the discussion was: Who is the physical therapy consumer or customer? I made the point that physical therapy has many consumers at various levels of the care delivery process. An individual receiving care from a physical therapist is an obvious and direct consumer. But, other customers of our services include referral sources, other health care providers, payers, hospitals, entities we work for, the health care system, and society as a whole. Our care, but also our knowledge or advocacy, can directly or indirectly affect these various stake holders.
Web 2.0 principles allow us to crowd source and brainstorm with a much wider audience; geographically, practice setting, and expertise. This hashtag will allow for the recording and analysis of a wide range of view points and ideas. We can follow the evolution of topics over time. This stream and  medium could be leveraged by larger, more formal organizations (are you listening APTA?) for idea generation  to guide future task forces and initiatives. In fact, some of the issues, solutions, and thoughts for future direction are solid. #SolvePT is already evolving into a task force.

My Insights and Thoughts

There was a lot of focus on "best practices" in physical therapy. Defining, measuring, communicating, and then teaching best practices is extremely challenging. Todd Davenport of @PacificDPTweet, made the observation that "best practice" is a moving target given the evolution of research, science, and understanding. I agree. Further, who defines best practice? I think we must look beyond a specific patient and episode of care when defining, analyzing, and teaching best practice. In addition, we must look at multi-level outcomes. For example, for an outpatient perspective we can not just look at the patient specific outcome of that episode of care, the time/number of visits, and it's cost. That is a too narrowly focused frame of reference. We should broaden our lens, and our potential for impact. We need to also need to consider (and target?) recurrence, future health care costs, risk reduction for other medical conditions, and overall health/fitness. Cardiopulmonary fitness is maybe the most dramatic modifiable factor to prevent disease, morbidity, and mortality. I brought up the topic of physical therapists in hospital intensive care units. Johns Hopkins performed a quality improvement project where they staffed 1 physical therapist for a 16 bed medical ICU. Their estimation is that by decreasing ICU length of stay and increasing patient mobility/function the hospital, and thus the health care system, saved an estimated 5 million dollars over a 1 year period. The internal investigation lead to the hospital staffing 2.2 full time physical therapists solely in a 16 bed medical ICU. This is a dramatic change in practice focused not on productivity or reimbursement, but on VALUE, risk reduction, and other broader outcomes. Unfortunately, in discussing best practice no attention was brought to the actual content of current PT programs. In my opinion, pain science/physiology, basic neuroscience, critical thinking, philosophy of science, cognitive biases, and metacognition are vastly lacking from our curriculums. The teaching and study of pain should be integral in all PT education, both didactic and clinical. We have neuromuscular, musculoskeletal, cardiopulmonary, and or medicine tracks in our programs. Why do we not have a specific pain track? Or, at least a focus and integration of neuroscience and pain physiology into our other courses? Regardless of practice setting, the majority of our patients will have a primary or secondary complaint of pain. Joe Brence, who blogs at ForwardThinkingPT, started an online petition regarding this exact topic. I recommend you sign it HERE. In order to be "evidence based" (or more accurately Science Based) we need extensive training in the philosophy of science and critical thinking including prior plausibility, research design, and article analyses. To assume that students entering PT programs received such instruction as undergraduates is, to put it nicely, a huge assumption. How are we to make appropriate clinical decisions if we do not understand our inherent cognitive traps and biases? How are we to correct them, if we can not even recognize them? The skill of appropriately analyzing a single article based on design, statistics, and results in the context of plausibility, basic science, and the state of other literature AND THEN applying that to everyday clinical practice is what being a master clinician-scientist is all about. And, that is what we need to strive for. The title of Tamara Little and Todd Davenport's recent editorial in the Journal of Manual & Manipulative Therapy sums it up quite nicely: Should we be expert clinicians or scholars? The answer is yes.

How do we generate results from this passion and discussion?

  1. How do you think we should #solvePT?
  2. What are the most pressing issues in education, payment, practice, and our evolution?
  3. How can we focus some of the general issues and proposed ideas into specific and concrete action; solutions!?
#SolvePT has been thought provoking. Hopefully, it will continue to grow. I foresee big potential in this type of interaction.
About Kyle Ridgeway

Dr. Kyle Ridgeway enjoys the color purple and is an advocate of Tigers. He currently practices at a private outpatient clinic, University of Colorado Hospital (UCH) as well as a long term acute care hospital. At UCH he is aiding in research, and treating within the confines of a randomized control trial, pertaining to early physical therapy with patients who are critically ill in the intensive care unit and require mechanical ventilation.

 
 
  1. Selena Horner 04/23/2012, 3:05 am Reply

    Hi Kyle,

    Oh, my gosh… it was SO cool to hear what everyone is thinking!

    To figure out a way to concisely snag snippets to summarize the discussion would be gold!

    I’m thinking it may need to grow into a tweetchat kind of thing… maybe? And with that a defined topic. :) The discussion was all over the place in a good way!

    The beauty… it’s there 24/7. I love that! And could you feel the passion?? We have so many passionate people in our profession!

    ~Selena

  2. Kyle Ridgeway 04/23/2012, 7:14 am Reply

    Here is a post over at Science Based Medicine about being skeptical clinician:

    http://www.sciencebasedmedicine.org/index.php/the-skeptical-clinician/

    Applicable to the current discussion I imagine.

  3. Eric (kintegrate) 04/23/2012, 7:02 pm Reply

    It used to be that we relied on the APTA and the combined effect of our pooled monetary resources to assist us with marketing, maintaining our “market share” of referrals, overseeing practice standards and justifying our existence to politicians and the public. However, this model of governorship and leadership is destined for a change.

    IMO two major factors loom over us that will force us to change our business models. 1) The day of reckoning for payment by insurance for our services 2) A changing landscape of how people access information and the value they recognize in it.. I heard that Medicare services fund is set to be bankrupt in 2024 (twelve short years)!! In CO that would kill 90% of the independent providers of PT w/o such a change.

    The previous institutions that guided our profession remain petrified in the business models of the past. They will probably remain so until the very last minute or die in their downfall. Don’t get me wrong there will always probably be a role for the APTA.

    Perhaps it is time to see if we can go outside of these traditional channels. This #solvePT seems like a start. Yet how do we move past the only the chatter of our professional gripes to effect other clinicians to effectively and honestly outreach the public.

    From what I have seen by the “traditional physical therapists/clinics”(present company excluded) is that they use most of social media as an internet megaphone to pipe one way information to the consumer and not as an enriching opportunity for dialogue communication and development.

    The “non traditional therapists/clinics”(present company) whom access and maximize their utility of social media are inadvertently loosely linked by shared values and standards. I think you did an excellent job of summarizing some of those values.

    To me the question now is for #solvePT is can we harness evolving technology to create a culture that surrounds our profession that can excel past the effectiveness of the institutions of the past.

    These being:
    1) Traditional culture of con ed.
    2) Traditional ways we absorb and understand the research.
    3) The traditional ways we market, brand ourselves and outreach the public i.e. the consumer/patient.

    For me, something that would make me excited is what if we could create an interactive PT conference. We could use the #solvePT to generate the discussion that fueled such a conference. The drawback of only existing on the web is that we are a profession for as long as I can see needs face to face and physical contact. If we could create a mini conf that was modeled and mirrored on the dynamic discussion that occurs within social media then I think we would be truly on to something.

    Regardless it will be interesting to see how this develops.

  4. Kyle Ridgeway 04/23/2012, 7:23 pm Reply

    Eric,

    Most thoughtful and articulate comment I have read in a while. This really stuck out to me:

    “To me the question now is for #solvePT is can we harness evolving technology to create a culture that surrounds our profession that can excel past the effectiveness of the institutions of the past.”

    This is what we need to focus on. Utilizing that vision to affect the 3 points you bring up.

    Welcome to the future….

  5. Joe Brence 04/24/2012, 5:21 am Reply

    What if we contacted a large company like Google or Skype who have large investments with their facetime applications? We could pitch the idea of developing the first web-based interactive medical conference on how we can #solvept…Maybe it could be hosted at ptthinktank??? They simply provide the platform to host this…We could have online discussions, lectures, etc. about how we can move our profession forward. It will focus on how we can not only solve, but also save PT…

  6. Andy Lodato 04/24/2012, 3:06 pm Reply

    I like Joe’s idea of contacting Google or Skype for a possible web-based interactive medical conference. Why not reach out to other groups who might have a vested interest in the #solvept movement? I saw tweets from members of EIM on this issue or reach out to the PTBA. They may have ideas and resources to come together or leverage technology to push this movement forward. Like Eric said, I think it might be time to move past what the APTA can do for us and start something new.

  7. Kyle Ridgeway 04/24/2012, 6:33 pm Reply

    Joe, Eric, and Andy,

    I think we should make this happen. We have plenty of ideas to get started RIGHT NOW. It doesn’t take much…

    Let’s start planning.

  8. Eric (kintegrate) 04/24/2012, 8:04 pm Reply

    I think web based conferences are a great idea. However, being PTs and knowing how much we use our hands I think that level of interactivity is essential too.

    I have gone to SXSW before they have a tech interactive conference, it is actually where they debuted twitter. I think modeling it after something like that. Using innovative techniques such as shortened presentation times, like the 5 min 20 slide rule. Or using bottom up group directed presentations would really pull people inward and force interaction.

    I think I would be excited if we could have the clinicians and the clinician researchers take center stage. Rather than stodgy academics ;) It is time to change the flow of information within PT from the ivory tower to the minions and create a two way street of communication.

    The one thing that social media has shown me, is that there are plenty of like minded and more than competent interpreters of the research out there. After all we are the ones implementing the research and we should be given a stage to show our crowd sourced wisdom.

    We could call it something like the clinicians interactive conference.

    Eric Kruger DPT @kintegrate

  9. Joseph 04/25/2012, 10:04 am Reply

    Much agreed Eric…

    I say we do joint presentations on each subject…one from a research perspective and one from a clinical research/clinical perspective…

    For example, I am a 40 hr per week clinician but also have 10 current research projects with more academic researchers. We could pick a topic such as central sensitization, which I study. We could have the leading research expert, Jo Nijs, discuss the research end in 20 slides and then I will discuss the clinical relevance in 20 slides. I know that both of us would be on board doing this.

    We then have a live chat or twitter feed as we do this to gauge reactions from the viewers and help answer questions from individuals who may not understand the topic as well.

    We should start this as a purely online conference for year 1 and then allow it to grow into whatever. We start this as a “revolution” and take ahold of our own profession.

    A few nights ago, the moveforward movement of the APTA held a discussion with live twitter feeds on the treatment of low back pain. In this discussion the following statements were made:

    “@mikeryanfitness: Maintain a “C curvature” or good posture, can help reduce or prevent low back pain”

    “@mikeryanfitness: try to define source of pain early on”

    “@mikeryanfitness: strengthening core to reduce low back pain “simple crunches…continue breathing while doing crunches”.

    In a response to how to reduce pain after a sports injury: “Minimize sitting, stay out of soft beds and couches. Sleep on the floor, firm surface”

    I emailed the APTA about the research inaccuracies of these statements and got a response indicating that these are APTA experts from Harvard as well as professional football teams…kinda like, “why would you question them on those statements—they are with more reputable companies than yours”….

    Unfortanetly “they” don’t get it. And I think there is a growing body of clinicians who do get it. This could be a true “PT Think Tank”…

  10. Kyle Ridgeway 04/26/2012, 10:17 am Reply

    Joe,

    That is downright scary, and insulting. Poor form APTA.

  11. Andy Lodato 05/11/2012, 9:20 am Reply

    Eric,
    I agree with what you wrote. I think an online version would be a good start to guage the interest. It would take out some of the headaches with planning a live conference. I also think it is so important to get another voice out there other than the APTA. I don’t mean to bash them, but I have a feeling of stagnation as a member. I would like to see them drive the profession forward in a more aggressive fashion and I don’t see that happening.