My personal conference highlights included a an amazingly constructed and delivered McMillan Lecture by Dr. Andrew Guccione, and getting to catch up with some of my former classmates and professors from Quinnipiac University. I also had the opportunity to present two educational sessions. One session was with Dr. Tim Noteboom from Regis University on Collaborative Web Tools, and another was with Rachael Lowe on the future of text books and Physiopedia.

Head on over to Physiopedia to check out our slides from that presentation! I’ll be posting the slides from the web tools talk in a day or so.

So do the tools really make the technique more effective than traditional STM? The literature results are extremely limited. Only one study directly compared STM and the Graston Technique ®:

Burke et al. compared Graston Techniques ® to regular STM provided by the therapist’s hands for the treatment of Carpal Tunnel Syndrome. They resulted no clinical differences between the two groups, but did substantiate the clinical efficacy of conservative treatment for mild to moderate CTS.

Perhaps the effectiveness of the Graston Technique ® occurs from the ability to detect adhesions better than manual palpation alone. Users report feeling vibrations or hearing clicks as they move the tools over adhesions that were not detected by palpation. There are a few case studies that report solely on the effectiveness of the Graston technique.

Hammer reports on the ability of the Graston Technique ® user to both feel and target treatment on areas of degenerated tissues in three cases involving plantar fasciitis, Achilles tendonosis, and supraspinatus tendonosis.

Aspergren et al. effectively used thoracic (HVLAT) manipulation and the Graston Technique ® to treat a collegiate volleyball player with acute costochondritis. Although the authors did not compare to thoracic manipulation plus manual STM, pain and functional levels improved.

Other foreseeable benefits include the ability to really dig-in during STM and saving your own joints as a PT, benefits that may also be found in simple massage tools. The side effects include being too painful for many patients and causing bruising in some patients. In all, more research needs to be performed comparing the technique to regular STM by independent examiners.

Bottom line: for now, trust in your hands – they have been around since before medieval times, and are the most powerful tool a PT possesses.

1. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1):50-61.

2. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-256.

3. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321-325.

In today’s rapidly changing healthcare arena, the timing of this event couldn’t be better. Providing input from the physical therapist’s perspective is important as so many decisions are about to be made. The day has started out well, with some excellent breakfast at the Russell Senate Office Building. Present were the leadership of representative organizations. Left to right: Jay Irrgang (APTA-Orthopaedic section) Scott Ward (APTA) and Bob Rowe (AAOMPT).

Posted via email from Eric’s posterous

Link to Video on YouTube

The follow-up video response is strangely entertaining as well.

Also check out this video [via GrassRoots AAOMPT SSIG blog]

Link to video on YouTube.

Jake Magel was featured in the article which discussed the conservative management of back pain:

“If people get proper care up front, they tend to use less health care in the years following,” he said. “They visit physicians less, take fewer medications and miss less days at work.”

By the way, Jake Magel is the lead faculty for my virtual rounds course in the EIM Fellowship program in addition to his role as the director of the Intermountain Orthopedic and Spine Therapy Clinic at Intermountain Medical Center. Go, Jake!

Last night’s 60 Minutes program aired a piece highlighting the amazing work being done in the U.S. Department of Defense to revolutionize prosthetics. The segment featured the DEKA Arm, developed by everyone’s favorite Segway inventor, Dean Kamen. He’s had some success making transportation so simple a chimp could use it! So, I was looking forward to seeing what his nimble mind could come up with.

The DEKA Arm

Dean’s DEKA Arm is being developed as part of the DoD’’s DARPA Program, which is a very cool website to go explore. There are seemingly programs for everything futuristic you could imagine! This specific program comes from the Defense Sciences Office, in the Revolutionizing Prosthestics Project. The DEKA Arm allows users to pick up such delicate items as a grape, yet still be strong enough to power a drill. Even the interface with the residual lmb has been re-designed and is presumably superior.

The key point to these new prosthetics is the interface between the highly powerful processors living inside lightweight, high-tech materials and the human’s neural system.The DEKA Arm looks like it could be a big breakthrough in technology that’s previously been out of reach. The wrist alone contains 3 PC’s worth of processing power! I’m proud of the DoD for their efforts on this project.

The most interesting quote from the 60 Minutes program was this:

“I’m not really learning [to use the prosthetic arm] as much as the computer is.”

Wow! I’ve been searching all morning for rehabilitation programs that combine biotechnology and physical therapy degrees. No luck so far.

The Biotechnology PT

I think the Biotechnology Physical Therapist is coming soon to a clinic near you. I’m curious to see how technologies such as this will alter the landscape of traditional rehabilitation. This is a bit more specialized than strapping on a prosthetic device that was designed in 1940, even if the fundamentals of movement are the same. Modern rehabilitative specialists will need to understand and be able to affect sophisticated neural interfaces and computerized devices. Imagine that instead of strengthening a hip muscle, I only need to alter the output on processor #3-C to invoke the gait pattern I desire for the patient!

And people wonder why I spend so much time investigating every new technology I discover. Neural interfaces, stem cells, genetic scaffolds are technologies that are here already. I’m excited to see what the future brings!

Last week, the WSJ Health Blog was abuzz about announcements by a group of high-powered companies entering the home care market. GE, Intel, Google, IBM, Microsoft have all recently entered the home-health monitoring arena. This is serious stuff for telehealth initiatives, and one can only assume that the introduction of corporate backing into an arena that’s been here-to-fore largely neglected will have some significant impact. Check out these links for more information on this subject.

• APTA article on Telehealth
• Intel-GE Alliance
• Continua Alliance

Do you think these companies are serious about this initiative? Check out this quote from Intel President and CEO, Paul Otellini:

“Most of the healthcare discussions today focus on the integration of more technology into traditional healthcare settings. While those investments are necessary and will create a more efficient healthcare system, it is not sufficient to meet the growing needs that are about to impact a system that is already at a saturation point. The GE and Intel partnership will not only help seniors and the chronically ill, but will also take a giant step forward in changing how healthcare is delivered.”

The current health system is in trouble. It may be that a big part of the fix will be by companies who are outside of the traditional health system, who see entrepreneurial opportunities to offer reform. Let’s hope so, because the physician-controlled model that we’ve been operating under doesn’t seem too eager to change.

Telerehabilitation?

So how does this impact physical therapy? There’s been an increasing presence in the body of scientific literature from a rehabilitative perspective, some articles even coining the term, “telerehabilitation.” However, most of these initiatives don’t mention physical therapy, focusing more on medical management of patients. Some state practice acts even have barriers in place that might prohibit physical therapists from performing off-site healthcare delivery. The physical therapy profession needs to be open and ready for these changes, and eager and capable of embracing the technological advances that will be part of a new model of healthcare. We also need to be better connected to these corporate initiatives. We might even need an iPhone app, as Selena Horner pointed out on the EIM blog.

By the way, last week I attended a talk on technical writing at the Refresh Augusta meeting. Part of that talk focused on localization of language, or making your writing appeal to different groups of people. One strategy offered by the speaker was to always use the first definition of a word, and avoid common slang.  Well, as part of my research for this post, I’ve discovered a very terrible example of what can happen when these rules are not followed. Check out this image!

Wanted: Wordsmith, No Experience Needed

Well, before we word-smith “autonomous” and label it as bad, it’s probably helpful to be clear about why the concept is part of the vision in the first place. To me, this centers around the “self-governing” aspect of the profession. Too long, have physical therapists been positioned under the direction of other professionals. This doesn’t make much sense to me.

Consumers would be surprised to know that even if I know a better, evidence-based intervention for their condition, I’m legally bound to follow the direction of the physician’s prescription. Is it correct for me to have to follow a prescription written by a doctor for treatment interventions that are ineffective, not evidence-based, and a product of the 3 hours of rehabilitative education that person received in medical school? What about working as an employee of a physician referral source, who profits from every referral he makes to his employee? Is that a good idea? What about having the inability to perform certain techniques based solely on the strengths of oppositional lobbies, regardless of scientific support in our favor? Is that fair?

Autonomous is Patient-First, (sort of…)

Are these situations of limited autonomy good for healthcare costs or patient outcomes? NO! Being autonomous, having the ability to self-govern, is about putting the decision making ability of physical therapists in the hands of physical therapists, not people who don’t know the particulars and science supporting our profession. Is “autonomous” patient-first? Of course not. This is about the internal management of the profession. Do patients benefit from physical therapist autonomy? Of course they do. When I can follow my own treatment protocol for your chronic foot pain, for example, instead of a podiatrist’s order for anti-inflammatory transdermal medication…the patient benefits. When self-referral is eliminated, costs go down. This helps everyone. When physical therapists are allowed to see patients with back pain first, needless imaging, tests and procedures can be avoided, and the risk of surgery may be reduced.

That said, I don’t like the word autonomous practice. It has bad connotations and the potential to provoke needless defensiveness by other parties. What we’re really talking about is the profession’s ability to self-govern. Gaining the rights and privileges associated with being a licensed professional with a doctorate-level education. No one is ever “autonomous” in healthcare…or in today’s flat world, for that matter! And, who can fault someone for wanting the ability to self-govern your own profession?

So Now What?

Revise the autonomous practice statement. Be clear about what we’re talking about. The current statement for autonomy is too broad. It needs only be one sentence:

Vision for Physical Therapist Practice

Physical Therapists will have the ability to self-govern the profession and practice of physical therapy in all clinical settings, including self determined professional judgment within one’s scope of practice, consistent with the profession’s Codes and Standards and in the patient’s/client’s best interest.

That leaves me with a better taste in my mouth, and leaves out a word I have to continually explain to folks.

In my humble opinion…