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Some News and a Thought

I have been writing my blog, NPA Think Tank for less than one year.  In that short time, I have been fortunate enough to get some good exposure and a fairly loyal audience.  The Evidence in Motion Group has been very helpful in support of my pursuit.

To them, and my readers, I ‘d like to say, "Thank You!"

Today, I’m happy to announce that my blog posts about Physical Therapy will begin co-appearing directly on the Evidence in Motion Blog at MyPhysicalTherapySpace.com.  I’m excited for a new level of exposure and for a new audience.  NPA Think Tank will still have some posts unique to it, which will help fulfill  the "healthy living… and a vast array of seemingly random topics" part of my tag line.

I have also begun helping out with the Physiospot Musculoskeletal Blog, which is working to be a resource to deliver updates of new research as it breaks.  This is part of a collection of sites worth a visit for Physical Therapists.  Their tag line:  "Assisting health practitioners with evidence based practice and continued professional development."  Physio implying a Canadian-based site in this case.

Finally, and hopefully your still with me, I will direct you to an interesting editorial that appeared in this month’s issue of Contraception, An International Reproductive Health Journal.  (Please, do not read into this…visiting just by chance!)  Anyway, the editorial entitled, "Why We Need to Truly Understand the Medical Literature", lets the audience in on "One of the best kept secrets among health care providers…"

The secret: Many healthcare providers— especially medical doctors — do not have the ability to understand and interpret the medical literature.  I liked the article because it brings up some good questions about training future providers in topics of critical appraisal and evidence-based practice principles. 

Eric

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Oh Brother! "PT's Do Research?"

Teaser: Find out what one MD thinks of Physical Therapy! Please read the whole story: Kind of longish, but entertaining never-the-less.

Recently, my work environment has changed. I’m no longer in the traditional outpatient setting. I have been shifted to a clinic that exclusively treats military trainees. I’m still deciding if I enjoy it or not, but my new office mate has proven to be rather thought provoking.
I now share an office with a Physician. The simple fact that I share an office in this way speaks about how Physical Therapists are perceived differently in the Army vs. civilian life, where I would never be allowed to have a key to the proverbial "Physician’s Lounge." Anyway, this guy, an elder fellow who’s a Family Practice doc, has taken it upon himself to challenge my brain every few minutes. For some, this might be tortuous. For me: Game On!
We have each had our share of victories and defeats thus far. He usually sets me up for wrong answers, so I expect my winning % to increase once I recognize his lead-ins more quickly. Anyway, he loves to impress me with his medical knowledge base. Occasionally, I get to teach him something.
I was reading this very useful case series from the latest JMMT issue. The article is a good representation of how back pain is treated in the hands of expert Physical Therapists. Included is a nice chart about how certain symptoms lead to certain treatments and so forth. I explained this chart to my office mate and answered some of his questions about the research supporting it. His response was mostly quiet, which I have come to take as a sign of my victory in our virtual battle of wits. I sat back happy and gave myself a pat on the back. Unaware that his greatest and most vicious attack yet was pending.
Several hours later over lunch he states, "That article was pretty interesting."
Still I think I’m winning.
He continues, "You know, I never new Physical Therapists did that."
I smirk, "What, classify types of back impairments and treat accordingly with specific, focused treatments because they are backed by scientific evidence?"
"No. I didn’t think you guys did research."  He was being totally serious.
I walked away in stinging defeat. This story is sadly humorous, and of course, limited to this one doctor. But, how many more physicians have the same opinion as my witty office mate? 
Lesson Learned: Talk about the research you read. It not only shows others that you personally are well read, it impresses them about the entire field of Physical Therapy. And, as this points out, we need all the good PR we can get.

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A Sports Cream Fatality

The sad case of Arielle Newman proves that anything taken in excess can be bad.  I have never seen the benefit of sports creams, instead using self-remedies such as stretching and relaxation, maybe an ibuprofen here and there.  I could never imagine that sports creams’ active ingredient could ever cause some one’s death!

In other news, check out my shared items section of the sidebar. I marked a number of New York Times Health articles about healthcare: spending, reform, and risk-benefit calculations.  If your reading this blog via e-mail, this means that you need to click the link at the top of this page and go to the NPA Think Tank website.

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How to Permanently Archive Feed Items

I had the opportunity to present to some faculty and students last week on the relationship between good evidence based practice and internet technology. The topic was mainly about using RSS feeds to collect information that could then be used to improve your clinical practice. i called it, Evidence at Your Fingertips: Leveraging Internet Technology to Improve Evidence-Based Practice Skills.

While the simple fact that you are reading this blog indicates you may know a bit about RSS technology, I was a little surprised that the the vast majority of the audience did not. To techies and bloggers, RSS is part of everyday life and so it was unexpected that a whole room of students and faculty did not use it, but that was the case. I hope that I was able to spread a little RSS interest through my presentation and now there’s a whole pile of new RSS fans out there.

Anyway, to continue my Evidence and Technology topic, I will offer some tips from time to time about using different internet technologies.. Of course, I am no expert on this. If you’re really interested, go check out some posts on the Lifehacker or Lifehack blogs.

My Tip of the Day: Permanently Archiving Feed Items of Interest from Google Reader.

Often I find a post that I really like, but for reasons time or energy related, I just skim the post and pass it by for later reference. Google Reader’s absence of a search component sometimes makes it difficult to find these items for later reference. I have been using a little work around and e-mail creativity to overcome this issue.

  1. E-mail the post to your self: Google Reader nicely integrates e-mail with a single click. I simply send the post item of interest to myself. It’s helpful to add a bit to the subject when sending the item to help in creating a filter in the next step. I add the letters "GR" to remind me that this e-mail is from Google Reader.
  2. Create a Filter: In your e-mail client (for me it’s Gmail,) create a filter.

 

The filter should include both a "to" and "from" address that is your e-mail and whatever you added into the subject field ("GR"). I choose the filter to bypass the in-box and tag it with the term "Google Reader Archive."

I can now freely search all of my saved feeds in G-mail, taking full advantage of Google’s product integration and ample e-mail storage space. Never lose a feed you like again!

By the way, if you use Firefox and Greasemonkey, you can go get the Custom Google Reader Search script.

 

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Mainstream Media Targets Spinal Fusion

This blog post over at EIM highlighted a decent "PT as an alternative" research article regarding back pain.  Simultaneously, I was reading the New York Times and Wall Street Journal Health Blog about the famous geographic variability in spinal fusion rates.  The Times piece, entitled, "Healthcare as if costs didn’t matter" made the case that perhaps many of the procedures could be unnecessary.  Even more, it ties this issue into the Presidential Campaign.  Now that’s an issue at the forefront!

Well, neither piece completed the equation that Physical Therapy might be the alternative the market is looking for (but doesn’t yet realize it.)   However, there were some comments on the WSJ post that rather progressively mentioned Evidence-Based Practice.  I lack the marketing power or savvy I presume it would require, but it would be great to jump all over the topic from a PT marketing standpoint.

It would be amazing if the spinal surgery issue became the "poster child" for healthcare reform and the profession of Physical Therapy was ready to pounce and announce to the world that we have the low cost solution!

Are we ready???  Who’s with me?

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The Solution for Elderly Driving Woes

Always up for noble research investigations, Yale University researchers have been studying elderly driving.  Elderly driving, of course, frightens me.  All too often a senior citizen finds themselves slamming on the brake, only to maroon their sedan halfway up a tree by hitting the gas instead!

The research sent elder drivers to a Physical Therapist who enacted a supervised physical fitness program.  Not surprisingly, the participants in the experimental group improved their driving skills.

 
 
The fit elders also had a reduced risk of falls. 
 

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Google's Frantic Pace

Google has a reputation for doing things differently, such as innovative workplace design.  I was reading this piece in the New York Times about how Google continually tweaks its search engine to improve it. The man featured in the article, Amit Singhal, is the master of Google’s search ranking algorithm. For anyone who knows even a bit about Google, this guy is pretty high up.   
In the article, Mr. Singhal attributed much of Google’s success to their relatively "breakneck" pace of research in contrast to the more leisurely pace observed at universities and institutions.
“I spent the first three months saying, ‘I have an idea,’ ” he recalls. “And they’d say, ‘We’ve thought of that and it’s already in there,’ or ‘It doesn’t work.’ ”
Now, while this is the technology field we’re talking about here, I can’t help but to think about this issue in terms of healthcare research. Yeah, healing occurs over time and human research has its own time limitations; but I think we must ask ourselves, "Can we do more research in less time?" How is it that some investigators seem to have several publications per year and others once every couple years?
Perhaps it is simply a case of some researchers behaving more like Google, and others behaving more like…well, a researcher. I can imagine researchers dealing with issues of project management, technology assistance, quality, and maybe even figuring out how to exist on 4 hours of sleep.  Admittedly, I am not a researcher and am only surmising here.
Here is my own example of how research sometimes proceeds slowly:
 
I’m writing a case series about a group of patients at my work. In order to proceed, I need to contact our institution’s Department of Clinical Investigation. They have a series of hoops and trainings to jump through, checklists to complete, and signatures to obtain. All to perform a formal write up of treatments that have already happened. They estimate this process takes 1 month to complete.
Grrrr. I could have been finished in 1 month!

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EIM Makes A Move!

This post from the Evidence in Motion group announced that they have hired a CEO, a sure sign of growth for their business.  Congratulations to EIM for their success and optimism about the profession of Physical Therapy.  Their mission is a noble one, and the profession will benefit from their efforts.

I found the announcement interesting not so much for the CEO notice, but for the comments about differentiation of the profession.  They even go so far as to suggest that "we have to shrink our role and be identified as experts in neuromusculoskeletal medicine" to enable our profession to grow.

Hmmm.  Grow and shrink in the same thought!  Now that’s something special.

First, we might be well served to think about educating consumers about what the term "neuromusculoskeletal medicine" means.

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Finding Scientific Papers for Free

Here is a fine series of posts from DigitalBio over at Science Blogs. They outline a case study and mini-investigation on how to find scientific papers for free. A very pertinent topic, as more and more journal are relenting to pressure and offering more content online. Initially planned to be a three part series, a question arose during the investigation that required a 4th part. Find out how to find scientific papers for free, and find the answer to this interesting and pertinent question:

"Do Pub Med and Pub Med Central return the same papers when you limit the Pub Med search to Free Full Text?"

Part I.

Part II.

Part III.
Bonus Question, Part IV.

I performed the same type of analysis that digitialbio did on two different search terms. I searched both "Physical Therapy" and "Manual Therapy" and then did this again limiting the search to Randomized Controlled Trials or Reviews. The graph below shows the % of each search result that was available for free (blue) and % of total literature returns that were free AND RCTs or Reviews (red).

Through my completely non-scientific, but fun analysis, it seems a greater proportion of free articles are of a high quality of evidence. It also seems that there is a slightly greater percentage of the Manual Therapy research that is freely available. Not surprising, as JMMT offers a lot of content online!


The Raw Numbers:


"Physical Therapy"

87335 -Total Results
4363 -Links to Free Full Text (4.9%)
15151 -Review, RCT
1280 -Review, RCT, free full text (8.4%)


"Manual Therapy"

28523 -Total Results
2065 -Links to Free Full Text (7.2%)
7241 -Review, RCT
775 -Review, RCT, free full text (10%)

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Serendipitous Science is my Favorite

This week, the Mar Rover had a wheel lock up. In the process the wheel slid along the ground in a scraping manner. What it turned up appears to be the best evidence yet of the former existence of water on our red neighbor.
I always appreciate new research, but I find myself continually fascinated when apparent strokes of luck lead to exciting new discoveries. Incidentally, Silica is rather expensive here on Earth. Maybe we could begin trucking it in from Mars and lower the cost, which is the largest single barrier to a worldwide move towards solar energy.
As an after-thought: Isn’t it amazing that we can talk about this, skipping right over the amazing achievements of the Mars Rovers. I mean, the regular pictures of Mars and the x-ray spectrometry occurring millions of miles away from any human is pretty profound!

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