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We're Moving and Improving, Hold Onto Your Hats!

We’re Moving!

NPA Think Tank will be getting a major facelift and a new server home this weekend. We’re switching blog platforms, and servers and so you may notice some downtime. Also, and very excitingly, the site is getting a major design overhaul in honor of this big move.

More Authors and a New Name!!

NPA Think Tank has been my personal blog since 2006. It’s time it grows. We have some exciting changes afoot, perhaps most of all the inclusion of some new bloggers. I won’t spill all the beans here, but when the new site rolls out, you can see for yourself. Down the road, as the final phase of this improvement, NPA Think Tank will become PT Think Tank. Afterall, what the heck is an NPA?!
Thanks for reading, I will keep you abreast of the changes. In the mean time, if you notice any down time of weird things happening, sit back, relax, and await the very cool future of this site!
ERIC
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The Stress – Pain Connection

Matrix
The WSJ Blog had a brief but important bit about the relationship between stress and pain this week. The gist: It's old school to think having pain that is "in your head" is the same thing as faking it or being crazy in any way. The truth of the matter is, all pain is in your head! More acurately, pain is an output from your head.

Scientists recognize now that older models of pain, which could only account for acute injuries, don't work for many of the ways that people experience discomfort. Even in those acute injuries, where a tissue may be damaged, the processing of pain still occurs in the brain. But, for those discomforts that don't seem to arise from any specific tissue damage, like chronic pain, newer models can help explain how such an unpleasant sensory experience is possible.

It seems the experience of pain is a very complex phenomenon, including connections to almost every part of our nervous system. Stress may not be any trigger by itself for pain, but can help enhance any pain we might be feeling. The same goes for fear about pain, or even memories of previous pain that we might connect with a specific activity or body part. In the clinic, I often can get dramatic improvements for patients with low back pain, by simply explaining what they're feeling and helping to reduce the anxiety and fear that occurs with low back pain. It's very cool. In effect, the brain, and its ability to learn and reason, becomes a very powerful pain analgesic. 

The NOI Group out of Australia is a leader in discussions about pain, and modern pain models like the neuromatrix model of pain. I found a neat application on their site called Recognise, which is a flash based program that helps with mental imagery. You see, it's easy for your own representation of a body part to become altered after an injury, and re-training your brain to percieve a normal, pain-free body part can help "re-wire" the altered hardware. 

Photo courtesy of marcos papapopolous via Flickr
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Who Knows Labral Tears?

Everyone! 

Well, everyone will, now that an elite sports star has made the diagnosis part of common sports injury language. Labral tears can be a big problem and have probably contribute to many degenerative hips, but have only recently gotten much attention. They are relatively common in sports, acounting for a significant portion of NFL hip injuries, especially those with persistent adductor strains.

Stephania Bell, Physical Therapist, wrote a nice article about Alex Rodriguez's hip problem, which includes a labral tear, a paralabral cyst, and bony degenerative changes. Bell, questions the optimistic timeline proposed by the Yankees. 

"If his hip muscles have been weakened because of the presence of the paralabral cyst (which has since been aspirated), it may take extra time to get that strength back."

Interested in more about hip labral tears? Check out this summary article in PT Journal.

ERIC
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Physiopedia vs. Medpedia

Physio-pedia

Many of you may already know about Physiopedia, but perhaps some of you do not. Physio-pedia.com is a project, orginially conceived by Rachael Lowe, that she and I, with the help of her technologically gifted husband, Tony Lowe, have been working on for the better part of the last year. Our aim is to create a world-wide, open access encyclopedia written by, and targeted to physical therapist and physiotherapists around the globe. This is a growing, long-term project, but has recently been gaining some good momentum.

This week, a new public wiki site, Medpedia launched publically. I first started following Medpedia in December during their beta phase and was recently approved as an editor for the site. Medpedia has huge finanical backers (Harvard, for example), and is primed to be an excellent resource. It begs the question, is there room for both Physiopedia and Medpedia is this wiki healthcare world?

The following post orginally appeared on Rachael's Physiospot blog: 

A new wiki for health care was launched this week called Medpedia, take a look, it's incredibly impressive and comprehensive, and is likely to become the key reference for the public on medical matters.

You may be wondering why we need Physiopedia when Medpedia is available? Well these are my thoughts in this regard.  With Medpedia being driven by doctors it will not truly represent our profession. It is primarily focused on educating the general public with good quality information about conditions that affect them, also providing a place for professionals to publish their work and create a profile. Physiopedia also offers the opportunity for therapy professionals to publish their work and create a profile, however Physiopedia is also an educational resource aimed specifically at the physio/physical therapy profession. It will provide evidence based information for physiotherapists relating to common conditions, interventions and management options that we come across in our daily practice. With Physiopedia we aim to truly represent, promote, educate and develop the physio/physical therapy profession. So the emphasis of Physiopedia is on developing the profession which is significantly different to Medpedias' emphasis on informing the public.

So, while Medpedia may be getting all the press right now, Physiopedia maintains its awesome potential to be a great resource for physiotherapists. But, just as the Medpedia sites grows as more contributions by authors are made, Physiopedia needs your content. Come on physios! If the medical community can do it, then so can we. Let's show them just how valuable our profession is.

Join in the Physiopedia efforts. 

Come collaborate with us!!  www.physio-pedia.com

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DIY Healthcare?

DoItYourself

Yesterday, a NYT article about the comraderie of Physical Therapy. Today, an article about the group of young uninsured who are resorting to do-it-yourself healthcare. We’re so close! Just put those two concepts together and physical therapists emerge as a viable option for those with limited insurance coverage.
I love this quote:

“It’s not an intimacy we would choose. But, shoved out of our private, busy lives, whether reluctantly or gratefully, we fall into their strong, skilled, waiting hands.”

I don’t love this quote:

“I could have gone to a major university for a year. Instead, I went to the hospital for two days.”

Young adults are the largest group of uninsured Americans. It’s a serious problem. Thankfully, physical therapy sessions don’t cost the equivalent of a year of education. And, for the record, Caitlin Kelly: physical therapy really isn’t that painful…at least it shouldn’t be!

We get rid of pain, not cause it.

ERIC
image courtesy of mkgillman via flickr
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APTA Programming Satisfies Members

I've already talked about my experiences at the APTA Combined Sections Meeting (CSM) on my other page, so I won't re-hash that, but I thought it pertinent to recap just how awesome the programming was. CSM is the premier confernce of the year for the profession, and there is just a ton of programming available. You could learn about almost anything you could think of…

APTA_Orgasm

Special thanks to my photographer, who had to endure a few shaken heads while getting the lighting just perfect.

ERIC
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Physical Therapists Move Forward

Move Forward PT

By far, the most exciting event at the APTA Combined Sections Meeting in Las Vegas was the launch of a new brand for the profession. The brand itself is pretty slick, but the exciting part lies simply in the fact that this is the first time in the history of the profession that such a monumental effort to define physical therapy has been undertaken. 

Move Forward
Physical Therapists Bring Motion to Life
Most times that I think of a brand, things like Wal-Mart or McDonalds or Pepsi come to mind. Brands in these instances are logos and obviously very corporate. That type of brand will not work for a group of health professionals. What's needed is a definition, a spoken truth that comes across from all person and parts of the profession that conveys to everyone who's listening, just what that profession does. With that in mind, I do think the message linking physical therapists to motion is apt. We truly do live in the world of human motion and are experts without equal in this area. So yes, we are about motion, we help people move, and that motion brings quality into the lives of the people we serve. I will have no trouble telling people I'm an expert in motion…in fact, I already do (though whether or not they listen is a different story…).

Find Out about Physical Therapists
Physical Therapists who are APTA Members can check out the members only site which is chock full of useful information about the brand, market research, and contacts and talking points. Everyone else can check out the brand new website, MoveForwardPT.com. This site will be growing over the next year or so, hopefully adding more rich content for consumers.

Brand Criticisms
Some in the profession have expressed to me that they don't think the brand goes far enough in its mission to qualify us as the healthcare experts of the neuro-musculo-skeletal system. Absent from the brand is mentions of pain, diagnostic skills, and common conditions like stroke and low back pain. I do agree to an extent with this, though quickly looking through the websites I listed above, it's obvious that those issues are addressed. In essence, the broad nature of "motion" is adaptable by many of the different interests within the profession and so I think it stands a pretty good chance. Regardless, unless everyone plays the game, we won't be able to ever tell if it's a good brand or not.

The Bottom Line
There was much that happened at the confernce, and much about to happen in the profession. I'm excited. I truly believe that physical therapists are of enormous benefit to the healthcare system, but one that is currently very underappreciated. I'm eager for a change!

ERIC

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World Cancer Day: My Two Perspectives

Breastcancerstamp2
Today, February 4, 2009 is World Cancer Day. Head over to the website for the Internation Union Againt Cancer to view a striking video and to find out more about their campaign to help promote a healthy, active lifestyle. It seems I've never stopped to take note of World Cancer Day before, but this year it seems more than appropriate.  

My Perspective
Cancer has touched my life before on several occasions, and was the cause of demise for more than one of my grandparents. I've followed Lance Armstrong's illness and subsequent world cycling domination and campaign from the start. I always purchased the breast cancer stamp, as if my 8 cents would offer some benefit. Still, I never really felt that I was effected by cancer, and I knew somehow I was lucky for that.

This past summer, my mother was diagnosed with breast cancer. She's been undergoing treatment and is doing well with a good prognosis, but through this process I've gotten a stark view of how truly tough cancer is, even for someone with a good prognosis. From the uncertainty during the diagnostic process to the painful, agonizing chemotherapy and the endless small battles one must endure, cancer is hard. My mother even lost her job due to her illness. Cancer rocks your world in a bad way, and its claws reach beyond the cancer patient into their family and friends. When one person suffers with cancer, many more suffer alongside. I think that's how it should be.

I've had other friends, and family members of friends, who are experiencing first hand interactions with cancer this year. For some reason it seems breast cancer is all around me this year. My friend and blog developer uber-geek, Jessica, has made a web page to keep friends and family apprised of her mother's progress that is ongoing. TogetherPink.com. She comes home from the hospital today!

To all my friends, family and aquaintances who are dealing with, or have dealt with cancer on some level, my thoughts are with you.

My Physical Therapist Perspective
One thing I've noted throughout my mother's treatment is the lack of partnership between the oncologists, surgeons, and physical therapists. As I sat at a chemo treatment with my mother I observed the suffering, weakened bodies all around me and I felt they needed formal guidance. Physical therapists can help maintain strength, mobility, descrease pain through motion, and even improve respiratory health and function through a variety of methods. We need to be right along side cancer patients and their physicians. We can do great benefit for these people. This is not happening yet on the scale that it should be. There needs to be a seamless partnership that serves as a non-obtrusive resource for patients suffering the effects of cancer.1215_breast_cancer

Integration of oncologic physical therapy is improving and physical therapist education includes more of this every year, but still no clinical specialization exists for the oncologic phsyical therapist. Very few among us are considered experts in this area, though the ones that are considered such are very good.

I will be more aware of this opportunity to help those suffering with cancer. I will begin a process to make myself more educated in this field, and I might even join the Oncology section of the APTA. For now, my efforts are best realized by offering this post and a couple links:

What are you doing to help? I think if you just stop and notice, it is a start.

Good luck with your continued recovery, Mom! 
ERIC
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Do Physical Therapists Value Outcome Measures?

ResearchBlogging.org

For over a decade, physical therapists have been urged to use standardized outcome measures the management of patients.  Standardized outcome measures are tools that survey how a patient can perform certain activites.  The tools give the therapist a quatitative way to assess a level of disability and clear ways to track progress.  Many tools have been developed by investigators and education about the measures is an integral part of physical therapist curriculum.  The tools are theorized to improve clinician decision making, improve patient safety, and improve the ability to describe patient progress over time.  Interestingly, they have never been equivocally demonstrated in any sort of controlled trial to improve outcomes that I'm aware of.  Regardless, there are many good reasons to use these tools, but many physical therapists tend not to use them.  The February issue of Physical Therapy Journal includes a nice paper which conducted a survey to assess exactly how many do use the surveys, and why or why not they may do so.

The study, from the University of Vemont's Dr. Diane Jette, sampled 1000 APTA members asking about their usage and beliefs about standardized outcome measures. Utilization_OutcomeMeasures

Overall, slightly less than 50% of physical therapists reported using the measures.  Of the 52% that reported not using outcome measures, only a small portion reported they intended to use them in the future.  Not exactly widespread use!

Percieved Problems

Physical Therpapists reported that the biggest problems with outcome measures were that they took too long to fill out, were confusing or too hard for patients to fill out.  There were also patterns among practice setting, patient age, and clinical specialization, with those who had obtained clinical specialization 2 times more likely to use outcome measures.
ProblemswithOutcomeMeasures

Use-of-Outcome-Measures-by-Patient-Type

So, it might seem that we have clinical specialists treating patients with muscuoloskeletal complaints using these at a higher rate.  Overall, 90% of the therapists who employed outcome measures found them to improve communication.  But still, they are not widely used.

The problems reported seem to be patient-centered in nature and also related to clinic management to install processes for easy adminstration of the measures.  One might surmize that well-intended therapists are simply having problems employing these tools versus not percieving value in their use.  

It can be difficult to decide which ones to use, and managerial support for this might help drastically.  Perhaps automating the completing and scoring in easy to use electronic formats could also help.  This study indicated than only 7% of those who used surveys used computers to complete or score the measures.

Finally, one last bit of interesting data from this survey was the fact that quite a few therapists used "home-grown" or departmentally developed outcome measures.  This seems a little surprising given the vast quantity of validated and tested outcome measures freely available.  I'm interested to learn if those home-grown measures might be easier for everyone to fill out?

If outcome measures are going to be utilized, they need to fit into the busy clinic schedule, be simple to fill out and score, and therapists need to be well-educated in their use and value.  As the authors so politely concluded, "physical therapists have some distance to go in implementing their use routinely in most clinical settings."  For sure!

ERIC

D. U Jette, J. Halbert, C. Iverson, E. Miceli, P. Shah (2008). Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications Physical Therapy DOI: 10.2522/ptj.20080234

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Physical Therapist Talks About Tiger's Rehab

Large_TigerWoods
Physical Therapist and ESPN injury expert, Stephania Bell, is featured in this in-depth article discussing Tiger Woods and his rehabilitation.  The article ranges from Tiger's commitment to understanding the healing process to the basics of core exercise for golfers.  This is a very excellent piece, full of insight, that I enjoyed reading.

The article also features Bud Ferrante, a physical therapist renowned for his golf rehab work.  He provides us with this fun quote:

"I tell the golfers, we [physical therapists] are not here to entertain you," Ferrante said. "We're here to help you focus on the basics and what is specific to your sport."

Tiger Woods has always had a close relationship with physical therapists.  I'm sure that relationship is even more important now.