Eric Robertson – Page 3

November 3, 2012

Do you MOOC?

In a recent article in the NY Times entitle, “The Year of the MOOC,” writer Laura Pappano describes an exciting, ongoing disruption in education. MOOCs, or Massive Open Online Courses, are quickly becoming the next big thing. I’ve taken or am taking several of these and I very much enjoy the learning process. The ability to engorge your mind with such high-quality content is unmatched. However, don’t think this is simply sitting back and getting fed information. These courses, usually mirrors of the on-campus versions of the courses, can be a lot of work!

There are obvious implications for healthcare within this framework. In fact, the University of Texas System recently joined up as a main partner with EdX, a collaborative including Harvard, University of California Berkley, and MIT. In their press release on the matter, the UT office spoke directly to the idea of including health-based offerings on the EdX platform.

The UT System brings a large and diverse student body to the edX family. Its six health institutions offer a unique opportunity to provide groundbreaking health and medical courses via edX in the near future. The UT System also brings special expertise in analytics – assessing student learning, online course design and creating interactive learning environments.

Within the next year, expect to see MOOCs being offered with options to pay for credits. Within the next few years, expect to see a wholly different educational environment that what we have today. University education is set to undergo a rapid evolution. Here’s to hoping this evolution occurs consistent with the traditionally high standards that have always existed, and here’s to hoping physical therapists can find a way to educate more than just future PT’s using such tools. It’s a clear opportunity for worldwide advocacy.

October 17, 2012October 17, 2012

Can Assumed Postures Help Chronic Pain?

I’m teaching a freshman seminar course this year at Texas State. It’s about introducing students to the university as well as the college learning environment and culture. I was prepping them for some interview and presentation assignments and stumbled across a fine TED Talk by Amy Cuddy about the importance of body language.

The information in this is fascinating. Basically, you can see significant, measurable changes in hormones simply by maintaining a posture for as little as two minutes. It doesn’t seem to matter if you actually feel powerful or weak, but if you hold the power poses, you increase testosterone and decrease cortisol. It also seems that subjects are better able to cope with stress and have superior results in job interviews following this 2-minute posture hold.

If the simple act of assuming a posture can alter the brain, I wonder if having patients in chronic pain can see a similar benefit. Power poses before therapy might just help take that edge off and allow more pain-free motion during a therapy session. Of course, this is just me postulating, but I wonder… Testosterone might not have an obvious connection to pain, but cortisol and resultant stress levels certainly could. Perhaps testosterone could somehow enhance self-efficacy, which is important for function in the face of chronic pain.

June 20, 2012

Thought of the Week: Be Passionate

In this stunningly beautiful, award-winning video work from The Astray, the message is about passion. Relax for a few moments and soak this masterpiece in.

I never set out to be anything in particular, only to live creatively, and push the scope of my experience through adventure and passion.

Passion is part of what drives the people who make change. It’s part of what makes someone work deep into the evening to make it right. It’s the people pouring out ideas in the #SolvePT movement. It’s the leadership of the profession, regardless of how effective you think they are.

For a long time I had no passion for this profession or my career. Moving from job to job, I had little fulfillment. With a little luck and a little self-exploration, I was able to discover which aspects of physical therapy resonated with me. Fortunate. My passion is now strong. This job has become my profession. This blog is an expression of that passion. What is your passion?

Live Creatively. With Passion. Expand Your Experience.

June 14, 2012June 14, 2012

Osteopractor™ Invokes Ire of AOA

Earlier this week, I stumbled across this filing with the U.S. Patent and Trademark Office. It is a notice of Trademark infringement alleged by the American Osteopathic Association (AOA) and its component boards against James Dunning, concerning the use of the term, Osteopractor™, which has been commented on before at this blog.

In the filing, the AOA states:

Applicant’s mark so resembles Opposer’s previously used and
registered marks as set forth above as to be likely, when applied
to the services set forth in Applicant’s application, to cause
confusion, mistake, or deception or to comply that Applicant was
certified or approved by Opposer within the meaning of Section
2(d) of the Trademark Act.

There is, of course, a retort from the accused stating that they disagree. This will be interesting to watch as this debate unfolds.

On a somewhat related note, I find the architecture of the U.S. Patent and Trademark Office to be quite nice.

May 29, 2012May 29, 2012

If You’re Going, You Might As Well Get There

[list][/list]Sometimes, it’s pure and simple logic that prevails as the best solution to something. This was the case in an important new study published ahead of print in Spine. You may have seen the presser released by APTA, AAOMPT on the matter. They’re exuberant, and they should be. Well, mostly.

The study, published by Drs. Julie Fritz, John Childs, Rob Wainner, and Tim Flynn, examined a payor database and looked at over 32,000 data sets of patients with low back pain with the purpose of describing physical therapy utilization in primary care settings. Further, they looked at both associated healthcare costs and the question of whether the physical therapy care being provided was either adherent with practice guidelines for an active treatment or non-adherent. Treatments were classified as non-adherent when they included things like ultrasound that are not proven interventions for patients with low back pain. While not a perfect practice, the researchers used billing codes as their determination factor for treatment adherence.

The findings of this study are fascinating to me. Albeit, many public health studies that look at low back pain and care patterns and/or costs are fascinating to me, so I’ll let you be the judge.

The key findings of the study were:

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For patients receiving physical therapy, early referral (within 14 days) was associated with less overall healthcare utilization, which included lower use of surgery, fewer doctor visits, less injections, and less advanced imaging that those with delayed referral (14-90 days).
For patients receiving adherent care, overall health utilization was also lower, but to a lesser degree that that seen with the early referral group.

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LBP Healthcare Costs — Graph demonstrating health utilization costs related to low back pain. Series 1 is costs for patients in early referral (gray) vs. delayed (orange). Series 2 shows costs for adherent care (gray) vs. non-adherent care (orange).

As you can see by the graph above, significant savings were realized by early referral to physical therapy and by adherent physical therapy care. Logic sure does shine forth here. If you’re going to go somewhere, well you might as well just get there. Significantly, the finding in this study is important because it runs counter to the suggestions by many LBP practice guidelines that suggest primary care physicians delay referral to other services as many patients are likely to improve anyway. Overall trends to reduce the medicalization of LBP are important, but this study reflects a trend whereby physicians are referring about half of patients to physical therapy within 14 days anyway. It turns out, this may end up being an evidence-supported practice.

Not all was rosy, however. Here are some other findings that were important:

Overall patient data sets and 7% utilization for patients with low back pain.

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Overall utilization for physical therapy for patients with low back pain in this data set was only 7%.
Overall healthcare costs were higher for patients receiving physical therapy. This might reflect increased severity, co-morbidities, etc, we just don’t know.
Only 21% of the physical therapy care provided was able to be classified as adherent. This could reflect an imperfect measuring tool, but I suspect there’s a problem here.
Wide geographic variability persists in the management of LBP, including physical therapy utilization and adherence to guidelines.

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This study is full of many other gems. It’s gated at Spine, so apologies for not including a full text link. The good new: Spine is a huge journal and this will be seen. As with many studies, this leaves more questions to ask. Such as, what factors make the patients who are referred early have lower subsequent utilization. The authors hypothesize it may have to do with the concept of self-efficacy. I like it.

I like it so much, in fact, that I’m involed in a related study with some of the authors to examine a similar question in a Department of Defense database. I’m eager to see what we find.

This study was jointly funded by grants from the Orthopaedic and Private Practice sections of the APTA, AAOMPT, and a faculty research grant from Texas State University.

May 25, 2012May 25, 2012

APTA Vision 2020: What’s your grade?

Alan Besselink, blogger and Austinite extraordinaire has written a thoughtful post entitled, “APTA’s Vision 2020: My 12 Year Report Card.” In the post, Alan breaks down the components of Vision 2020 and provides his summary of the progress toward each.

To review, here’s the Vision 2020 statement from the APTA:

“By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.”

I’m sure certain parts of this resonate more with different folks. For Alan, the issue of Direct Access takes center stage. I agree with his critique of the APTA PR machine, which labels 40 something states as having some form of direct access to physical therapists…while in actuality, many of those states are not very gate-keeper free at all. Alan points out that the state we both practice in, Texas, is listed as a Direct Access state by APTA. I consider that false.

Here are Alan’s grades for each section:

Autonomous Practice: F
Direct Access: F
Doctor of Physical Therapy and Lifelong Education: F
Evidence-based Practice: F
Practitioner of Choice: F
Professionalism: A
Overall: F

Now, I’m not sure I agree with Alan on all of these grades (specifically the EBP and DPT grades), but he makes a good argument for each of his choices in his post. My question to you is, what do you think about the progress we’ve made on Vision 2020. As Alan points out, “As they say, if you do what you’ve done, you will get what you’ve got. Sadly, what we’ve got isn’t much different than what we had 12 years ago.” This may be a good opportunity to take stock and make some changes in strategy before we get too close to 2020 to change!

[icon style=”notice”]I’ll summarize the results of this poll in another post prior to the APTA Annual Conference.[/icon]

May 22, 2012May 22, 2012

Phrase of the Day: Prospective Surveillance

Recently, the open-access journal, Cancer, included a special issue: Supplement: A Prospective Surveillance Model for Rehabilitation for Women With Breast Cancer. This model has been described by researcher, Nicole Stout, as a “proactive approach to periodically examining patients and providing ongoing assessment during and after disease treatment, often in the absence of impairment, in an effort to enable early detection of and intervention for physical impairments known to be associated with cancer treatment(1).” In other words, checking early and often so that issues can be dealt with at a mangeable stage and not in a catastrophic end-stage presentation. Theoretically, this model of approach can mitigate many of the known poor related outcomes for patients following cancer treatment.

The model of prospective surveillance has been developed over the last decade at the National Naval Medical Center in Bethesda-now part of the Walter Reed National Military Medical Center. It’s the standard of care for all patients there and serves as a great base for research into the clinical effectiveness of this approach. While bottom-line cost savings numbers aren’t apparent yet, this seems a likely outcome, as overall, patients consume less care when issues are dealt with in early stages when their prognosis is still strong. Regardless, it’s a cool phrase!

The prospective surveillance model attempts to cover many aspects of cancer treatment, including awareness of known side-effects to the sometimes persistent upper extremity pain and dysfunction that so many women share following treatment for breast cancer. Describing and quantifying the séquelle of post-treatment effects that are common following treatment that can be ameliorated through rehabilitation are part in parcel in studying this model, and are dealt with as well in the supplemental Cancer issue. Check it out and get smart!

This issue hits close to home for me. My mother is a breast cancer survivor. As she recovered, I was well aware of the musculoskeletal dysfunction in her upper extremity, yet was confounded at the lack of attention that received from her care providers. Research into this area is a critical, emerging field of physical therapy and one that makes me proud.

As an aside, Nicole Stout is a member of the APTA Board of Directors (Scroll to Bottom). She is in candidate status this year and I’m sure would appreciate any support one could be in the position to be in as elections approach in June. She does important work.

1. Stout NL. Cancer prevention in physical therapist practice. Phys Ther. 2009; 89( 11): 1119-1122.

May 21, 2012May 23, 2012

Alphabet Soup Redux

In 2009 at the Annual Meeting and Exposition of the American Physical Therapy Association in Baltimore, MD, the Oxford Debate took up the issue of alphabet soup. The issue debated was, “Are the use of multiple credentials a distraction or an attraction to our profession?” The team in favor of eliminating the excessive use of credentials included, Robert Landel, PT, DPT, OCS, CSCS; Stephen C. F. McDavitt, PT, DPT, FAAOMPT, and Robert H. Rowe, PT, DPT, DMT, MHS, FAAOMPT. A well-credentialed bunch, indeed.

I recall siding with that team, as I have always had an eye toward PR and branding and consider too many credentials as being bad for a brand. Successful branding includes paying attention to your brand’s identity, as Philip Davis points out in this well-crafted blog post. This can be anything from making sure your fonts and colors are the same to making sure you dress according to how you want your brand to be perceived. If fonts and colors are important, a myriad of obscure credentials are most certainly critical as well.

This weekend’s visceral debate on Kyle’s post brought this larger issue to the forefront once again. What do you think about this issue of alphabet soup? Join the #SolvePT discussion tomorrow, hosted by @SnippetPhysTher.

[icon style=”notice”]Update: Check out the summary of the tweet chat on 5/22/12 here. [/icon]

May 13, 2012April 16, 2024

Happy Mother’s Day: Get Real

[icon style=”notice”]Update: Be patient with the Samahope.org site as they roll out over the next few days… [/icon]

Welcome to PT Think Tank’s new website design and Happy Mother’s Day to all the mom’s out there!

Today, we’re going to jump right in and get real on Mother’s Day. So real, in fact, that we’re going to talk about fistulas. Obstetric fistulas, to be specific. The kind that form mostly in impoverished countries after childbirth, we’re birth trauma causes tissue death and connects parts of the mother’s pelvic anatomy that should never, ever be connected. Women suffering with obstetric fistulae are ostracized by husbands and communities and suffer from infections, poor quality of life, and even death.

According to The Fistula Foundation, the occurence of new obstetric fistulae number about 50,000-100,000 annually, while the global capacity to treat this condition is only around 20,000. While this condition is extremely rare in developed countries, the World Health Organization estimates that between 2 to 3 million mothers in poor countries struggle with it. While the cause of obstetric fistulae are complex, with as little as $450-$1000, the condition can be effectively repaired surgically.

My very compassionate and talented fried, Michelle Greer let me know about Samahope. Samahope.org is attempting to tackle this problem. This new venture is working to crowd-fund this procedure for women who can’t afford it. In an elegant interplay between philanthropy and technology, Samahope.org allows donors to select the individuals you want to help, donate simply using PayPal, and even track the outcomes for the surgeries they helped fund. Samahope.org is a project of Samasource.org, a non-profit based out of Silicon Valley who is working to reduce poverty through creating jobs via the innovate idea of mircrowork, connecting people with jobs over the internet. Leila Janah, the founder of Samasource, spoke recently at a TED event in Brussels:

[youtube id=”319sQ9s-lyQ#!” width=”550″ height=”300″ align=”center”]

Get involved and for this Mother’s Day, in addition to that nice pot of flowers and brunch we all like to confer upon our maternals, give the gift of life. If you’re feeling a bit quirky, consider browsing through some Weird Gifts to add a delightful twist to the traditional Mother’s Day celebrations. Those who are looking for custom gift options may consider visiting sites like Swagify to see more items.

Samahope.org is beginning their rollout today. In fact, they have but one tweet. It says, “How can you help change a life with only $20? Easy… I just did.“

[button style=”green” link=”http://www.samahope.org/donate.php” target=”_self” align=”left”]Donate Now[/button]

February 13, 2012May 14, 2012