Critical observations of health, science, and the physical therapy profession.
How bad is bed rest for your back?
So bad that it can make a healthy back go bad! Yet surprisingly, many general practitioners, and even the APTA’s own website prescribe exactly this for an onset of low back pain.
The study I’m linking to had healthy subjects spend weeks in bed. After only 14 days, these otherwise healthy people had serious muscle deficiencies consistent with what is seen with back pain. Keep those backs moving!
Labels: back pain, physical therapy
An entertaining article in Slate magazine by Emily Yoffe, describes her experiences as a "standardized patient" for a group of Georgetown medical students conducting their first physical exam. Yoffe is well known for immersing herself into the issues she is covering, having previously entered the Mrs. America pageant as part of her coverage of the event. This time, she may have been in for a little more than she expected:
"Then he stood in front of me, looked at my gown like a colonel contemplating an incursion, and struck. He peeled off the top of the gown, dropping it into my lap, slipped the bra off my shoulder, and left me hanging while he protractedly listened to my heart."
This story is good comedy and speaks to both patients, and anyone who has ever had to learn how to perform a physical exam.
Labels: misc.
Or, I could have entitled this blog post:
I went to school for a lot of years, got a doctorate degree, learned your anatomy inside and out and for that, I can tell you "Go out and play an hour a day."
It just seemed a little wordy.
These were the words of Rear Admiral Penelope Slade Royall, PT, MSW, as part of her keynote address Wednesday night at PT 2007, the annual conference of the APTA. The headline of the speech was her "telling the considerable crowd that physical therapists are public health’s "first responders" for fitness." Royall is the US Deputy Assistant Secretary for Health in the US Department of Health and Human Services.
Well, is EVERY American our patient? Is physical fitness our specialty? Will Physical Therapists speaking as one voice about physical activity guidelines really help our profession and our patients? I’m not so sure.
Or, is the ideal set forth by the Evidence in Motion working group, "that to improve our caliber as a profession, we have to shrink our role and be identified as experts in neuromusculoskeletal medicine" one that will help our profession and our patients?
Reading headlines such as "PTs: First Responders to Physical Fitness" seems to me to be suggesting our role to Americans is really one of a personal trainer. Personal trainers do physical fitness better than Physical Therapists. Perhaps this is because they specialize in it.
This goes back to an old question of strategy: Should one try to do everything well, or should one do just a few things expertly?
You know, thinking more about the contents of the keynote address, I really feel like Royall is speaking about Physical Therapists in a light that will further her own agenda (and here) rather than our profession’s agenda. I would do the same in her position; so would most. If a government representative like Royall views Physical Therapists as Physical Fitness Responders, then what are we really?
This post is more questions than answers. This is deliberate, as I think a public debate about how PT’s are marketing their profession is required. We should all spend some time asking ourselves some questions about this issue.
Labels: APTA, physical therapy, PT Publicity Project
I am employed by an academic institution with a fine health science library. I belong to several sections of the APTA as well as the AAOMPT. Through these affiliations I am able to get my hands on quite a few journals and read full text articles when I like.
I was thinking the other day, about how many allied health professionals do not have access to such a library of content. This would include those working in private practice, non-academic hospitals, rehab centers, local school systems, etc. How do these folks get their dose of evidence? How difficult is it to get access to an important new article?
There is PEDRO, and the Cochrane Database, and the APTA resources such as Open Door, but these are far reduced from what I use. They also suffer from lack of use among therapists. A scattering of journals offer free text, but usually there is a time delay or restriction with this. A service like InfoPOEMs is kind of expensive and not rehab focused even if it is useful in theory.
A colleague recently left the hospital system that I’m in and now works at a corporately owned outpatient clinic. She has no access to journals.
Barriers lead to inactivity. Inactivity leads to the failure of the principles surrounding Evidence-Based Practice. How much of a professional duty is it for health care providers to pay their own $$ for access to evidence? How much of that burden should fall on the employer?
I will assume that a majority of the Physical Therapy work force is in practice settings with limited access to rehab/ortho journals. Does this mean that the majority of the profession does not keep up with new evidence? Regardless of that being true or not, I think these barriers need to come down somehow.
Any thoughts on access to literature among Physical Therapists?
Image: Arnold Bernhard Library, Quinnipiac UniversityHamden, Connecticut
Labels: physical therapy, Research
Famously in 1990, the Spotted Owl was declared an endangered species. It is generally assumed by some that this ruling and the subsequent ban on logging old growth public forests contributed to a decline of the entire northwest logging industry.
6/27/07: Update: Today’s CSM has a great article on this issue. They obviously read my blog and considered it big news!
Labels: environment, Questionable Practices
Rockefeller Plaza is some pretty valuable real estate. It looks like the APTA has got their hands on 115 square feet of it for the month of June in the form of a picture window. The window’s content is about Physical Therapists’ ability to help prevent diabetes:
"The oversized panels also explain how physical therapists can help people with type 2 diabetes by designing a safe and thorough physical activity regimen that meets individual needs. The centerpiece of the window display is a life-sized female mannequin, who demonstrates the proper "fit walking," technique. She is standing in front of a video illustrating the various ways people incorporate physical activity into their daily lives."
Fit Walking Technique??? Well, at least my membership dues didn’t pay for this. The window space was donated by Executive Health Exams International. Which is also interesting.
In other news, an angry mob of internists was seen accosting a group of APTA members near Alexandria, VA. As the attack was taking place, the internists could be heard chanting, "You’re experts in muscles and bones, leave the diabetes to us…"
Labels: physical therapy, PT Publicity Project
Browsing through my various news feeds this weekend lead me to the following two instances of Physical Therapists making news headlines:
This is about a new facility in Summit County, CO now offering Primal Reflex Release Technique. Click here for a somewhat disturbing video and an opportunity to sign up for a home study course in this technique.
Three individuals, including two Physical Therapists, were arrested and charged with health care fraud, allegedly billing for services not performed and billing for Physical Therapy performed by a massage therapist. At least the FBI knows all about our profession. That’s good, right?
How are we doing policing ourselves as a profession? When instances like these happen, the concept of professional autonomy is undermined as the trust we demand from society is eroded. These are fairly extreme instances (and in one case, criminal,) but how do we do in situations that are not so obviously concerning? Such as: Treating too many people simultaneously to bolster a bottom line, over or misuse of modalities, not keeping up with current evidence on a particular condition or patient type? Do Physical Therapists, or any health care profession for that matter, really have a good system in place to help police the rank and file?
Anyway, perhaps that is too much philosophy. All I really want is some Good Press!
Labels: current press, physical therapy, PT Publicity Project
Labels: public health
I like to keep a lookout for when the smart economists provide some of their thoughts on health care. Ultimately, it is these economists that the government consults with to initiate ideas about how to manage our health care system.
Tyler Cowen, a well respected economist, checks in with a piece called, Smart thoughts on health care. He doesn’t say too much, but it sure sparked a conversation in the comments!
When I read this, I try to read between the lines about what people are saying and see how Physical Therapists might act to fill a need economically.
My favorite line from the comments:
"90% of the time I see a doctor it’s to tell them, "I have X, and I need a prescription for Y." After reviewing my symptoms and medical history they always agree with me and write me the prescription. So why am I paying an extra ~$100 just to get a medication I already knew I needed, for a condition I already knew I had, before seeing the doctor? It’s just a waste of my time and money."
Perhaps it is this lack of perceived value in routine care which prohibits a move to a retail-like system.
Labels: health policy