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$45,000 for a Squeaky Ride!?

Ceramichippressuretest
A squeaky hip replacement, that is!  [Link, New York Times]

“It can interrupt sex when my wife starts laughing,” said one man, who
discussed the matter on the condition that he not be named.

Ceramic materials have some cool properties and have been heralded as the best option for joint replacement.  As a physical therapist, I argue that the best option for a hip replacement is avoiding one in the first place!  Hip manipulation and mobilization can help keep that hip moving nicely, and hip strengthening is a critical part of exercise as one ages. 

All that said, it is interesting to see this problem getting some big press.  You would be hard pressed to speak to a PT who has ever cared for hip replacement patients who hasn’t heard the squeaking.  They squeak.  Squeak = Friction.  Hmmm.

Click here for a very excellent YouTube video of a squeaking hip.

ERIC

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Disabled Athletes

Chicagomarathonrecord
AOL Fanhouse has a cool bit on disabled athletes in competition.  It is worth a quick visit.  They were inspired by a female lower extremity amputee who qualified for the Olympics in swimming.

Our favorite amputee runner, Oscar Pistorius, recently appealed his case the the CAS, the highest court for sport in the land.  He should hear his answer in the next couple of weeks, but in the meanwhile, has been named to TIME Magazine’s 100 Most Influential People list. [Link to List]

Pictured is Amy Palmerio-Winters, who likes to shatter her own records running marathons, and is arguably the best female amputee marathoner in the world.

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MyPhysicalTherapySpace Goes RAW!

Last week a very interesting discussion took place on the Orthopaedics Discussion Group on MyPhysicalTherapySpace.com.  The discussion was provoked by the abstract listed after the break, and specifically the following statement:

"The clinical prediction
rule proposed by Childs et al. did not generalise to patients
presenting to primary care with acute low back pain who received a
course of spinal manipulative therapy."

Description of the CPR in question on YouTube

MyPTSpace is a free online community and this debate sure showed how valuable community discussion can be.  This conversation was priceless and reminded me of a recent PT Journal Debate between Tim Flynn and Chris Maher, except in more of a WWE RAW style!

Central to the discussion is the question of whether or not the CPR applies to populations outside of those used to develop and study it thus far.  Just about all of the authors of the studies up for debate checked in.  One important hot topic was the fact that the researchers proposed to study the CPR as "proposed by Childs et al" but only used high-velocity thrust manipulation in a small percentage of patients, as opposed the the 100% utilization in the Childs’ study.  This discrepancy provided fuel for the debate as the question was asked, if the researchers applied the rule correctly.

Many chimed in with comments. Most notably, Josh Cleland provided a list of the points he’s pondering:

"I appreciate the dialogue on
this topic. I think we all can appreciate the efforts put forth by both
the Childs team and that of Hancock and colleagues. Certainly I have a
bit of bias here but after critically and objectively analyzing both
articles I walk away with a few thoughts.
 
1. Perhaps the CPR is only specific to thrust manipulation and not to non-thrust techniques.

2. Perhaps the CPR is only specific to the thrust technique used in the original study and not other thrust techniques.

3. Perhaps the CPR doesn’t apply to patients who are not recruited
from a military setting (we can argue the generalizability of this for
days)
4. Perhaps the exercise used in the Childs study was crucial to success.

5. Perhaps the lack of standardization of techniques is a recipe for failure.

6. The Hancock study does not test the CPR as it was originally developed.

7. Perhaps the rule doesn’t predict response to thrust manipulation
(although the Hancock results to do provide adequate evidence to
suggest this)."

Josh’s summary was generally accepted by all the debaters as a balanced viewpoint.  Though there were some other interesting points made as well…

"However, I do find your “more blind faith” comment a bit patronizing and yes, I have read both papers."

"While the scientific method
is intended to provide control, minimize confounding factors, and limit
our biases, we still bring our biases into our scientific endeavors
(including published papers). With this in mind it is helpful to remind
ourselves that clinicians and researchers will generally agree much
better on data than inferences drawn from the data."

"So- evidence exists to
support the use of thrust manipulation in the management of a
particular subgroup of patients. However, therapists in Australia who
are well aware of the evidence fail to use it (even when they were
instructed that they had to use manual therapy). I expect if we gave
therapists control of which techniques to use here in the US we would
see the same magnitude of under utilization."

"…I’m sorry you apparently don’t like chicken sandwiches.  😉  It might just be an American thing…"

"Given you don’t use plain
language words as they are defined in English dictionaries and others
do not use scientific terms as they are defined in scientific texts it
is unlikely we will ever understand each other, let alone reach
agreement."

This was all great fun and if you want to find out who said what in the above statement, go see for yourself. [Link to Discussion]

And here’s one last quote, which I think should be pondered for a while:

"It might just be me, but one
of the reasons I think that the Hancock study has resulted in this
level of discussion is the rather sensational quality of the statements
within the abstract."

I hope you didn’t mind the long post, it was fun for me!
ERIC

(Click on to read the abstract)

Continue reading “MyPhysicalTherapySpace Goes RAW!”

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Poor Michigan!

The inherent conflict of interest that this man has in the issue of physical therapist direct access in Michigan should be enough to make him keep his mouth shut…or at least be excluded from an interview on the subject.

"It’s a safety question, according to state Sen. Tom George, a physician who heads the state’s health policy committee.

"What the law is, in Michigan, is to protect the consumer," George
said, "to make sure they’ve been properly diagnosed and examined by a
physician first."

A typical case for a physical therapist might involve shoulder pain,
he said. It could be a skeletomuscular problem, but it could be just a
symptom of a more serious problem.

"The leading cause of death in Michigan is heart disease," George
said. "Shoulder pain can be an indicator, so they should see a
physician first."

Yep, that’s right, it could be a heart attack, we’ve got to check everybody!  Are we to assume that Tom George thinks that a physical therapist cannot tell the difference between heart disease and shoulder pain?  Who voted this scoundrel in?

Who let’s him serve on a policy committee?  Time to rally the troops Michigan!

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Physical Therapists and Fantasy Sports

Arodhomer4391174_yankees_v_tigers_2
Physical Therapists have always been closely associated with the rehabilitation of professional athletes.  Even today, the Google news feed is littered with references to A-Rod and the physical therapist he plans to meet.  The stakes are pretty high when a sports team entrusts you with the health of their $275 million investment!  It’s nice to think of the impact physical therapists have on sports, even if it is in a behind-the-scenes role.

As a fantasy football fan, I regularly use my own knowledge to make judgments about player injury status.  I think it gives me an edge.  I stumbled across this blog by Chris Neault, who ties his love of baseball and PT background to offer fantasy baseball advice.

Of course the reigning queen of fantasy sports physical therapists is Stephania Bell, whose platform on ESPN is just awesome.  She offers her PT injury analysis skills to the world of sports, from the world leader in sports.

It’s impressive to witness a physical therapists actively engaging and contributing to our nation’s sporting health on the national scene. Their expertise not only aids athletes in recovering from injuries but also enhances their overall performance and well-being. A sports masseuse also provide therapeutic massages that helps relieve muscle tension, improve circulation, and promote relaxation to athletes. By working closely with individual athletes, these professionals play a vital part in preventing injuries, and ensuring that they are in peak condition to compete at the highest levels.

While their crucial role in rehabilitating thousands of amateur and youth sporting injuries often goes unnoticed, it’s just as noteworthy as handling high-profile cases like A-Rod’s quad strain. Moreover, obtaining a sport specific training certification could further enhance their ability to address the unique needs of athletes at all levels.

I’m motivated to quote the APTA poster hanging in my office,

“Attention, all weekend warriors.  We’ll (physical therapists) be in bright and early Monday morning to treat your back pain.”

ERIC

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Marketing The Profession?

If any readers of this blog do not read the Evidence in Motion blog, go read this post for some thoughts on how to, and how not to market the profession.

My two-cents can be illustrated in two additional links.

The first, at BEAPT.ORG, is the video embedded below. 

Obviously, this is an APTA marketing video designed to attract people into the profession.  While I admit I skimmed through some of it (10 min was just a bit too long), I was careful to look for anything that remotely resembled a PT treating low back pain.  I did find it at about the 5th minute for 10 seconds or so, without being specifically mentioned.  I don’t know why I thought it would be.  We never treat low back pain, and most physical therapists are not employed in outpatient orthopaedic settings, right?

The second example is a little more on target.  It is an opinion letter written by APTA President, Scott Ward on the USA Today website.  In the piece he mentions high-value issues for our profession and, in plain language, promotes the physical therapists.  This is good grass-roots marketing, though perhaps one without great reach.

ERIC

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Some Surgeons Can't Access Physical Therapists

Surgery1
At least one group of surgeons is fighting to increase access to physical therapists.  The American Association of Oral and Maxillofacial Surgeons (AAOMS) has gotten a bill sponsored:  the "Medicare Oral Health Rehabilitative Enhancement Act of 2008" (H.R. 5590).

Currently, Medicare rules prohibit referrals to physical therapists from dentists.  It seems strange to me that Medicare would allow these fellows to operate on someone, without simultaneously providing them with the ability to rehabilitate their own patients.  I wonder which groups, if any, actually oppose this bill.

Oddly, I couldn’t find this bill on the APTA Legislative Action Center website.  But, you can always write your congressman and urge them to support the bill! 

ERIC

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Get Strong, Interact

Weightlifting_2
I found this handy collection of strength training videos from the Mayo Clinic. Browsing through the videos, I thought they were well done and can help you answer questions like, "Does the bar go in front or behind your head when doing lat pull-downs."

I would love for someone to point me to such a nice collection of Physical Therapy videos.  Perhaps we can make one together?!

Some NPA Think Tank Interactivity

just installed a new tool called Snap Shots that enhances links with visual previews of the destination site, interactive excerpts of things that I think are cool.  In a flash, you can see if its cool enough to go visit. [Update:  Discontinued by popular demand!]

Should you decide Snap Shots is annoying, just click the Options icon in the upper right corner of the Snap Shot and opt-out.

I also added a little Share This icon in the post footer.  This little trickster enables you to easily share my posts with your favorite social media site, or to e-mail good content right from my blog.

Enjoy!

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Taking the Hard Road

In my life I’ve always held to the mantra that in academics, the easy road is often the wrong one.  I’ve used this thought to drive me through most of my education, especially those times when I was taking extra courses and auditing classes just to cram in as much learning as I could. 

I was inspired and reminded of this approach by Seth Godin’s latest blog post, "Getting vs. Taking," where he writes:

"A few people, not many, but a few, take. They take the best education
they can get, pushing teachers for more, finding things to do,
exploring non-defined niches. They take more courses than the minimum,
they invent new projects and they show up with questions."

The same principle applies not just to students, but for patients as well.  Those patients who enact a truly remarkable recovery have usually gone and taken it, not waited for it to occur. 

I wonder how that can be captured as part of a research study…

Here is a link to an old post I wrote where I considered the pace of work.  [Google’s Frantic Pace]