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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When Does Rehab Stop and Performance Enhancing Begin?

Here is an article about Oscar Pistorius of South Africa, who is petitioning to be allowed to run in the Olympics with two below-the-knee prosthesis. He is, by far, the best para-olympic runner. His time in the 400 is good enough to win the women’s event at the last Olympics. However, rules are rules and there is now a debate about whether or not he should be allowed to run.

As a Physical Therapist I find myself in an uncomfortable place in this argument. I feel professionally bound to fight for the ablement of the disabled. However, I do also respect that in a human competition of physical performance there needs to be a definite line drawn with respect to mechanical aides. Oscar was born without a fibula in either leg, and so learned to walk without legs. This fact probably proves crucial to both his adept running skill and his outlook on the matter.
“I don’t see myself as disabled,” said Oscar Pistorius, a former rugby and water polo player. “There’s nothing I can’t do that able-bodied athletes can do.”

Robert Gailey, an associate professor of Physical Therapy at the University of Miami Medical School was featured in the article as he described the overwhelming mechanical disadvantage it is to run with prostheses. All well and good, except for the fact that the prostheses are performance aids by definition. For now they are a disadvantage, later they may be an advantage. The SPARKy ankle joint is a prime example of a positive energy prosthesis.

I want to be on the side of Mr. Pistorius. I just don’t think I am. That said, we should all take a moment to acknowledge what a gifted athlete this individual truly is.

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What I Think About Floyd Landis

Ok, first a disclaimer: I like cycling. I coach cycling. I like when Americans win cycling events. I liked everything I knew about Landis except that he left the Discovery Team to race for Phonak. I think there is no sport more corrupt, backwards, and overall annoying than cycling. I do not trust Anti-doping agencies, in that they only get budgeted by convicting people. In other words, my personal bias is to not believe most of the recent press about doping in cycling. Finally, and obviously, I am not an endocrinologist or doping expert.

Good. Now, let’s have a discussion. As background for our discussion, I will direct you to an excellent blog post on the science behind Floyd’s positive test at Jake Young’s Pure Pedantry blog. It’s a great overview of the case. Next, I also recommend the blog, Trust but Verify, which is dedicated to covering the events of this case.

An excerpt from Pure Pedantry:

"There is a very legitimate question related to the timing of the positive test. Floyd Landis tested positive on day 17 of the Tour de France — right before he made a miraculous comeback to retake the lead. Some people may speculate that testosterone may have helped him do this. This is unlikely to be the case. Testosterone is used during training periods to gain muscle mass. It is not a stimulant like amphetamines. It is not likely that testosterone would improve performance on such a short time scale, nor has it ever been shown to have that effect."
And that is the most poignant question: Why would all the tests he took during the Tour be negative except for one?

Yesterday during his hearing, defense expert Dr. John Amory had the same concerns:

"The case didn’t make a lot of sense to me," Amory said. "Initially when I saw the documents, I thought there were irregularities, first with the handling of the samples, then with the results."The ratios went from 1.5-to-1 and 1.8-to-1 to 11-to-1, then quickly back below 2-to-1 over the span of 10 days.
"I don’t consider those results to be consistent with the use of testosterone gel over that period of time," Amory said.

The only thing I have read that could even come close to offering an answer to this is that testosterone could potentially hasten recovery. This is exactly what the USADA (U.S. Anti-Doping Admin.) tried to argue with the testimony of Joe Papp, a former low-tier pro and convicted doper. His testimony got a lot of press and I cannot understand why. This case represents the career and reputation of a man on the line. Yet, the prosecution sees fit to attempt to make a case on the subjective reports of one guilty cyclist about the effects of a testosterone gel on his recovery.

So What Do I Think About Landis?
It doesn’t matter what I think. The facts of the case are what matters. I do think one must question the strength of any case which is going to rely on non-blinded testers and subjective single case reports! That’s not really science, now is it?

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The Health Effects of a Forest, or Yoga, or Pilates…


Get to the point, originally uploaded by surfwax.

I happened across this unique investigation in the the Journal of Physiological Anthropology today. Sure, this might not be the most widely read journal, but I thought this little study worth some thought.

Shinrin-yoku or "Taking in the forest" was found to be correlated to reduced blood pressure and reduced salivary cortisol secretion (stress hormone). In other words, taking in the forest was relaxing. The study was proud of the fact that it was able to correlate subjective responses to the forest with measurable physiological changes.

I’m happy because I think this may provide all the scientific evidence I need to open a cardiac rehab unit in my local state forest! Not convinced? Well, go check out the multiple citations in Pub Med on the subject of Shinrin-yoku.

This type of thing also calls to mind the practice of Yoga Therapy. This has gotten some pretty solid press lately, in both the New York Times and elsewhere. In both instances, the subjects of the article were keen on selecting a yoga therapist who was also a Physical Therapist.

"I wonder what kind of evidence supports this yoga therapy?", I asked myself.

Well, here’s some evidence supporting yoga therapy for non-specific chronic low back pain (pdf) in a slightly more well-respected journal, Annals of Internal Medicine. Per the NY Times, the National Institutes of Health has allocated $1.2 million for a second study to see, in part, if the results can be replicated on a larger scale. In fact, there is quite a bit of evidence for Iyengar Yoga Therapy in general. I also found this systematic review.

So what’s my point? Evidence is evidence. Sometimes I’m tempted to shrug off research that speaks about walking in the forest. I know that hiking is relaxing without consulting a journal. But, perhaps it is in this "alternative" research where some basic and valuable lessons are learned. Is there enough evidence for me to integrate yoga therapy in my practice? Not sure, but I better keep a look out!

I leave you with a quote from the news article:

“Anybody can hang their shingle and say they are a yoga therapist,” said Julie Gudmestad, a physical therapist who also practices yoga therapy in Portland, Ore. “Buyer beware. I’ve seen some strange things done in the name of yoga therapy.”

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