There is a trend emerging in #DPTstudent education of declining reimbursement and less flexibility and options with clinical placements. As a result, some schools are beginning to offer money to clinics in order to persuade them to accept students. In this week’s #DPTstudent chat, we will discuss the implications of this change, good and bad. Should PTs consider it a part of their job to instruct incoming professionals? Does this practice reduce the #DPTstudent to a commodity? Or is it a necessary change given health care reimbursement decline? You tell us!
RESIDENCIES FOR NEW DPT GRADS FROM CLINIC OWNERS PERSPECTIVE
Residencies seem to the hot topic now that I have entered the third and final year of my DPT program. Residencies are designed to help build a specialization as well as foster mentorship and increase clinical reasoning skills. If completing an APTA accredited residency you are eligible to take the OCS, NCS or other specialization designation test sooner. (More details about that here.) Deciding to pursue a residency after graduating from a DPT program is a big undertaking and should be well researched and understood by the student. You can find a great comprehensive list of residencies in different areas of specialization here. The point of this post is not to discuss to many different kinds of residency models but instead to discuss some topics that #DPTstudents should be aware of before diving head first into post DPT residency.
Let me start with a little background on why I decided to ask clinic owners or hiring managers their thoughts on residencies. I was discussing the many options of post DPT graduation residencies with my husband. With a confused look on his face he said, “I don’t understand. You will have just finished 3 years of a doctorate program but you need to do a year or longer residency to land a job that would pay you exactly the same as if you hadn’t done the residency?” I wasn’t sure how to answer his question. Would I make more if I did a residency? Would I be a better candidate or would I just be considered a silly new grad who happens to be more in debt? Would an employer be willing to help me pay for it? (Please note that there are residencies that pay you as a full time employee and incorporate mentoring hours and clinical hours. In my case, I want to stay in Colorado so I have only been looking into distance based residency programs with weekend hands-on intensives. I also want to begin my career where I plan to live for the foreseeable future just as a personal choice. Ok, back to the topic!)
I made a short survey and with the power of Twitter I was able to get 35 clinic owners or hiring managers to complete the survey and many offered additional comments. The n=35 is not statistically significant but I think it gives a good insight regardless. This is what they had to say.
Question 1: Does completing a residency increase a new grads chance of being hired?
YES. 66.6% said yes, 33.3% said no. Many of the comments that accompanied this question stated that a residency provides more experience and mentoring (read: “less needy”) and therefor the student would be perceived as a better candidate. However, some of the comments were not along these lines such as “I would not give a residency grad higher priority than I would to a well-informed, motivated and articulate new DPT who has not gone through a residency.”
Question 2: Is the salary higher for a residency grad vs a new DPT grad?
You have a 50/50 shot at making more money as a residency grad. The results were split right down the middle (one person did not answer this question). Many of the comments on this question stated that just because a new PT graduated from a residency program does not mean they are able to bill the patient more for their time. One commenter stated that often times residency grads request a higher salary but the skills they bring have not brought extra value to the clinic. This owner/ hiring manager states “you have to look at what type of value/niche the potential PTs residency brings to the practice and community. We pay people based on the individual value they bring.” It’s all about value.
Question 3: As an employer, do you offer any assistance for an employee wanting to complete a residency?
I was really surprised by the answers and comments on this question. The majority (50%) do not offer any assistance on continuing education including a residency, 30% offer some continuing education budget, and 20% of the respondents host a residency in their clinic. Many of the comments posted on this question simply stated that as a small private practice, this is too big of a financial burden to provide a continuing education budget. One responder said they would support an employee wanting to pursue a residency but there would be pay back stipulations if a certain time commitment of employment was not met.
Question 4: Do you have any other thoughts you would like to share regarding new DPT grads exploring residency programs?
I will let these comments speak for themselves:
I think that we do our profession harm if we imply a residency is the only way to specialize. I think it’s great that it’s an option, but it’s too soon (at least in women’s health) to determine a good cost-benefit analysis.
Therapists who complete the residency programs may have didactic knowledge, however the clinical translation is a value lost on my practice. I would suggest a 2-3 year level of experience prior to attending a residency as a criteria, a new grad is a new grad- residency or otherwise.
I encourage new grads to do a residency is they have the financial means. If they don’t, then I think they should think twice
I think it’s a great idea to explore a residency if you can support yourself on a potential lower salary for awhile.
I think a residency is a fantastic thing to do for the motivated individual to take their practice to the highest level. However, I do not believe that increased pay or anything to that effect should be the motivating factor to pursue a residency.
If you are in a position to attend one, great. The mentoring and experience should be beneficial. But do not think that it is the only path to excellence. As an employer, I would prefer a keen, passionate and well informed new grad over one who has been groomed to follow outdated paradigms and has become a follower of any one particular technique (i.e. McKenzie, Paris or Dry Needling). I much prefer a strong critical thinker who is willing to apply uncomfortable truths about research and evidence into the practice of PT. I do not see this push in residency programs so far.
I found the results and comments posted on my little research study to be very eye opening. I hope this helps you put things into perspective as it did for me. Attending a residency can be very beneficial in many ways, but think twice and ask many questions before jumping in as a residency is not the only way to success.
#DPTstudent chat for Wednesday, 6/4/14: Passing the NPTE Exam!
Congratulations, you’ve just graduated and earned your DPT – now the hard stuff is over, right? Not so fast! That pesky National Physical Therapy Exam (NPTE) is standing between you and that license! This week we will discuss strategies, resources, and best practices for passing the big test!
Come join the discussion Wednesday at 8:00pm CST and let’s help set each other up for success!
– @TylerTracy10
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MAY 28, 2014: SAY WHAT?
“Oh, you’re in PT school?” …
… “I’ve had this ache in my right shoulder for the last few months, could you take a look at it?”
… “So that means you’re pretty good at back massages, right?”
… “What exercises do you recommend to build up my calves?”
We’ve all had these encounters by now… well-meaning friends, relatives and innocent bystanders who, upon discovering your acceptance into physical therapy school, suddenly see you as an expert on all things pain-/massage-/exercise-related.
And in some ways, these questions are great! We WANT to be known as experts in the field of neuromusculoskeletal disorders. Other times, however, their questions can be misguided or downright offensive (NO I will not rub your feet!!).
How do you respond to such queries when people find out you are a #DPTstudent? Do you take it as an opportunity to explain what PT’s actually do? What’s your best elevator speech?
This Wednesday, May 28 at 9 PM EST, we are taking a lighthearted approach to a common issue: discussing the craziest things people have said to you when they learn you are a #DPTstudent and how you responded!
See you there.
–@LauraLWebb
Manipalooza from a #DPTstudent Perspective
There are some experiences as a #DPTstudent that leave you feeling energized, happy, and confident that you absolutely made the right career choice. This was one of those experiences. This past weekend I had the amazing opportunity to attend Manipalooza put on by Evidence in Motion. Manipalooza is a “3-day festival of hands on learning in manipulation, soft tissue techniques, pain management strategies, sports PT, and practice management. Participants will learn the most cutting edge techniques from experts in the PT field.” I can’t possibly fit everything I learned into a blog post but I am going to recap the many highlights of this experience.
Saturday kicked off with a freestyle rap performed by a CU student on whatever PT topics the audience threw at him. You can see the video here. How someone raps about CT junction manips or G codes is beyond my comprehension but it was amazing and had everyone laughing to start off the morning. After an introduction to the weekend, Dr. Larry Benz kicked off the presentations with one titled “Deliberate Practice: Taking Your Skills from Good to Great”. This presentation focused on how to create a mindset of growth in order to continue to advance. One topic that Larry discussed that I find myself reflecting on again and again is the concept of “normalized discomfort”. This means that you have to fail in order to be able to grow. We must become more comfortable with failure and constructive criticism as we tend to learn the most from it. If we are not challenging ourselves outside of our comfort zone, we will never move closer to where we want to be. I would say that I found the whole weekend challenging and because of his talk, I was able to tell myself “it’s ok that you are struggling with this technique, this is challenging, and you are learning.”
Daphne Scott, leadership extraordinaire, then took to the floor with a presentation called “Change, Willingness…and Love”. Daphne lead the group through an exercise where we took a complaint we had about work or life, and showed us how to analyze and redirect the complaint and turn it into something more productive but to also stop wasting creative energy on blaming ourselves and instead just recommit to your goal. We discussed how change is hard and how upwards of 70% of companies who try to implement change fails.
After the short morning presentations, you had the choice of 3 different sessions: manual therapy of the foot and ankle (ortho track), neuromuscular intervention for chronic ankle instability (sports track), or time management and the illusion of time (business track). TJ and I decided to go to the ortho track, but I wish we could have been at all 3! Some of the techniques we went over I had previously learned in school but it was really nice to see a few modifications as well as get a nice refresher! I was also exposed to several techniques that we did not learn previously.
After lunch I decided to switch tracks (the afternoon classes that were offered were manual therapy of the knee, Eval of athletic movement: the ACL, and Career development: Yours and Theirs) and attend the business track on career development lead by Daphne Scott. It was a small group and Daphne asked all of us to tell her what we wanted to get out of the session. TJ and I were the only DPT students in the room (in fact, there were hardly any students at the event at all! Maybe 8 total for the Saturday session and just the two of us on Sunday!) and it was interesting to hear clinic owners talk about developing their staff. We also talked a lot about passion and spotting the employees who find their position to be a job, a career or a calling. A job is something you do to make money. Scooping ice cream when I was 15 was a job. A career is something you are trained in and have room for advancement but would quit if you won the lottery. My previous profession of an accountant was a career. A calling is what you think you were meant to do and you would still pursue it if you won a few million bucks. For me, this is my future in physical therapy- I am passionate about it so much that even if I were to become rich by investing in the Best Investment Apps UK, rich I would still be a physical therapist (granted, one that takes super fancy vacations). I was able to leave that session knowing what I am looking for as far as career development goes and how to be sure that my values align with a potential employer.
The Sunday sessions were equally as fun! We kicked off the morning with 4 hours of thoracic and rib cage manual therapy and manipulations taught by Tim Flynn. The afternoon was 4 hours of cervical manips taught by Jason Rodeghero, EIM’s orthopedic residency director. Both sessions integrated clinical reasoning alongside of the manual techniques. What I absolutely loved about all of the lab sessions is how many EIM faculty were there to help! I had personalized attention from at least one -but most times 2 different faculty helped- on every single technique. I was offered advice on how to modify skills based on my size, how to adjust my hand placement, and several times a faculty would place their hands over mine to make sure I was where I was supposed to be. Jason even taught us a little trick to help with speed of manipulations by using a water bottle to practice the small quick movements! I have been doing this with my water bottle every day…but make sure the lid is on tight enough or else you have water all of the floor…not like I did that or anything.
I was introduced to some of the techniques in school but I left on Sunday with many more skills in my proverbial PT toolbox and a greater sense of confidence about using my hands on a patient. In fact, I thought to myself many times, “I had no idea this many manual techniques even existed!” As I said before the weekend was challenging. TJ and I would talk through each technique in regards to when you would use it on a patient before practicing on each other. With many of the techniques we struggled at first, but with deliberate practice (Thanks, Dr. Benz!) and amazing faculty there to help us we were successful with all of the techniques before we left. We ended Sunday by attending the complimentary managers reception at the host hotel where we were able to chat with the EIM faculty and other participants.
Unfortunately, I had to high tail it back to Wyoming for clinical on Monday, so I missed the last day. However, one of the best parts about Manipalooza is that EIM gives you online access to their Moodle which is an online classroom and I was able to download all of the slides from the sessions I missed!
I would argue that Manipalooza is one of the absolute best conferences a DPT student could attend. The clinical reasoning, hands on labs, and amount of fun is unparalleled. If you want to take your manual skills to the next level before graduation this is the place to go The personalized attention allowed me to leave with a sense of confidence in the skills that I learned. Manipalooza will be an event that I attend year after year. It is just too good to miss!
Thank you again to EIM for such an amazing event!
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MAY 21, 2014: TIME MANAGEMENT AND STUDY TIPS
Congratulations!
You’ve been accepted to physical therapy school and are ready to embark on a great adventure. Or perhaps you have finished your first (or second) year and are looking to fine-tune your approach for the remainder of your time as a #DPTstudent. Whatever the case may be, this Wednesday we are looking for incoming, current and former students to share their study tips and time management strategies that have helped them achieve success.
See you there!
–@LauraLWebb
Data Quality: Garbage In = Garbage Out
Measuring and objectifying observations and phenomena. Numbers. Data. These are the cornerstones of analytics. The presentation and appearance of (apparent) objectivity. Whether in research, health care policy, economics, business, or clinical practice, data is important.
The data doesn’t lie.
But, sometimes the people that interpret it do. Not that they mean to. It’s not done on purpose (except when it is). So, yeah, unfortunately, the numbers can lie. And, they will lie to you if you are not conscientious about assessing them more deeply.
“What gets measured, gets managed.” Peter Drucker
Data Quality
Questions of why this works, or, maybe, more importantly, “does this work as proposed? Does the explanatory model make sense?” are not inherently built into the evidence based approach. Yet, these questions are vital to integrating and understanding outcomes research, while evolving our theoretical models. Such a task mandates metacognition and critical thinking. Failure to critical assess the quality, and potential meaning, of data, will result in improper conclusions.
The evidence hierarchy is sorted by rigor not necessarily relevance –EBP and Deep Models
But, the questions and issues surrounding data quality and interpretation transcend assessing the literature within the context of the evidence based hierarchy. Much like the research literature, the data collected, analyzed, and utilized everyday warrants critical appraisal. It all requires assessment; data encountered inside and outside the clinic, data utilized for decision making and understanding. The concepts of scientific inquiry should be wielded routinely, including assessment of quality, source, and limitations of the numbers. Only then, can proper interpretation and subsequent decision making occur.
Is it accurate?
Is it representative?
Where did the numbers originate?
What do the numbers actually represent?
What conclusions can or can not be concluded from a data set?
The evidence based practice hierarchy is concerned mainly with questions of “what works?” and “what is effective and efficacious?” These are necessary, important, big questions. But, the term “evidence” as utilized by most clinicians and researchers is focused mainly on randomized clinical trials, systematic reviews, and meta analyses of randomized control trials. Outcomes based research. This is a necessary and obvious step forward from purely observational, experienced driven clinical practice and education. Despite the obvious importance of experience (or more accurately deliberate practice) in clinical decision making, analysis based on experience or clinical observation only is prone to errors such as confirmation bias and convenience. Clinical observation alone is limited in it’s ability to ascertain phenomena such as a natural history and regression to the mean. And thus, this issue is related not only to data quality, but proper data interpretation. Understanding data quality assists in assessing “what works”, but also in tackling the complex question of “why does it appear to work?” Both questions are inherent to, and reliant upon, the quality of data.
Numbers, Data, and Objectivity
In attempting to objectively measure the world, has the potential accuracy and quality of data been forgotten? Overlooked even? A number seductively presents the appearance of objectivity and accuracy, but does not guarantee it. Big Data provides an excellent example of data quantity with relatively overlooked quality. Astounding data-sets through avenues such as social media and search engines afford researchers and large companies the opportunity to analyze data-sets that would literally explode your lab top. For example, in 2008-2009, based on web search data Google Flu Trends more accurately and quickly predicted and modeled flu outbreaks than the Centers for Disease Control (CDC). Well, until 2012-2013 when it wasn’t so accurate, over estimating peak trends. In big data are we making a mistake? Tim Harford explores the scientific and statistical problems still present (even when the size of a data set requires it to be stored in a warehouse):
But a theory-free analysis of mere correlations is inevitably fragile. If you have no idea what is behind a correlation, you have no idea what might cause that correlation to break down. One explanation of the Flu Trends failure is that the news was full of scary stories about flu in December 2012 and that these stories provoked internet searches by people who were healthy. Another possible explanation is that Google’s own search algorithm moved the goalposts when it began automatically suggesting diagnoses when people entered medical symptoms…
Statisticians have spent the past 200 years figuring out what traps lie in wait when we try to understand the world through data. The data are bigger, faster and cheaper these days – but we must not pretend that the traps have all been made safe. They have not…
But big data do not solve the problem that has obsessed statisticians and scientists for centuries: the problem of insight, of inferring what is going on, and figuring out how we might intervene to change a system for the better.
Measurement Matters
Now, just because it can be measured, does not mean it should be measured. Measurement alters behavior. And, the change is not always as envisioned or desired. As soon as a goal is set to alter a metric, incentives apply. This concept transcends clinical care. It applies to business, management, and clinician behavior. Enter the cobra effect.
The cobra effect occurs when an attempted solution to a problem actually makes the problem worse. This is an instance of unintended consequence(s).
So, is the goal to change that specific metric only? Or, is the actual goal to encourage specific behaviors that appear to directly affect, or are correlated with, that metric. Regardless of the goal, care must be taken in defining success. This requires a clear definition of what is measured and why. Again, deep analysis of data quality and interpretation are necessary to properly interpret results of process changes. Due to the appearance of objectivity in the presentation of numbers, it is easy to make inaccurate or far reaching conclusions. This is especially true when care is not taken to assess all the components of the data:
What does the data actually represent?
Who or what measured it? Who or what entered it?
How was it initially assessed and subsequently interpreted?
What other data needs to be considered or measured?
Now, even with reliable and accurate data input, inaccuracy can occur. The wrong conclusions can be “output” because of the misinterpretation regarding what the data is representing or signifying. Wrong numbers = wrong analysis = wrong conclusion = wrong interpretation = misguided application.
Steer away from subjectivity
The complexity of even the simplest data sets is astounding. Ever present are questions such as: Is the data valid? Does the data represent the assumed construct or principle? What potential bias is involved? Is it reliable between people; between subsequent measurements? Is it actually measuring what we think it’s measuring? Can it answer the questions we are posing? Measured and presented data is rarely as simple as a concrete number.
The attempted objectification and simplification of subjective, individualized, complex phenomena such as happiness, satisfaction, engagement, or pain may be tragically flawed. Commonly, over reaching conclusions are based on assumptions of accurate and/or complete representation. The data presented is merely a measurement, a number produced via the tool chosen.
A tool misused produces data that’s unusable
That tool may, or may not, accurately convey the construct it was initially designed to represent. In the case of patient report questionnaires, the individual filling out the tool will always be biased; influenced by the environment, their expectations of what should be conveyed, influences from others (explicit and implicit), as well as complex incentives depending on their needs, goals, and expectations. Further, most data encountered on daily basis, including clinical outcome measures (whether patient performance or patient report), is not collected in controlled environments with explicit processes. Bias will always affect reporting and recording. Questions of the accuracy, reliability, and validity apply not only to the tool, but also to the person recording the measurement. It quickly becomes complicated. The Modified Oswestry Disability Index never seems so messy when presented as a straight forward percentage.
Compare the stark contrast between how an outcome measure is collected within a research trial vs. everyday clinical practice. In order to minimize both error and affects of bias, outcomes in a trial are collected by a blinded assessor. A standardized set of directions is utilized, with a pre-defined process for administration and measurement. But, even in more controlled, direct data collection environments, what is being measured and what that actually illustrates, is not straight forward. Representation is not always linear. Even in randomized, tightly controlled, double blind studies bias and flaws are present. This does not inherently make the data useless. Leaps of logic need to be recognized.
If data is sloppy enough it is beyond useless. It’s harmful.
Why? Because, unreliable, variable data that is not truly measuring or representing the phenomena one assumes will ultimately lead to inaccurate conclusions. Regardless if the data is positive, negative, or neutral it is misleading.
How? Because, the data itself can not be representative of what we think it is measuring, purely by the the fact that the data itself is unreliable, overly variable, and “sloppy.” Further, if the assumption is made that a measure represents a certain construct, but it actually does not, it has no validity. Without reliability, validity is unobtainable. Without validity, reliability is misleading.
Data Quantity vs. Data Quality
So, should the focus remain on quality or quantity in data? Both. Is more data always better? Well, that depends on the quality. But, what is quality data? Quality is a relative term. Collecting, analyzing, or using data is only part of the equation. Once collected, questioning validity, reliability, representativity, and relevance is necessary. In the cases when data has already been collected and potentially presented, it’s time for some serious skeptical inquiry. Understanding what data actually represents and illustrates assists in proper critical appraisal. Proper critical appraisal allows proper interpretation. Proper interpretation is the foundation for effective utilization. Less controlled data collection environments do not necessarily produce unusable data, and in fact can be quite useful in the realm of health services and care delivery models. Yet, the conclusions drawn on effects, mechanisms, and efficacy need to be tempered. Focus on understanding exactly what a data set can and can not illustrate given the data collection environment and design and metrics.
Unreliable and invalid data in, wrong conclusions out. Always. Any accurate representation will be by chance alone. But, in these instances, the probability of attaining an accurate representation will often be less than chance. Limits are always present, and can not be avoided, but understanding the limits of the data assists in drawing conclusions that are the least wrong. While the data itself is important, what is done with the data, and why, is almost more important. And, these principles apply whether you are assessing your clinics “outcomes” or tracking disease outbreaks with big data. Focus on improving the quality and accuracy of data collection on the front end. Train those measuring, collecting, and entering data. Improve analysis and inquiry on the back end. In addition to asking “where’s the data?” we should be asking “where did that data come from?” and, “what does it actually illustrate?”
Be skeptical. Garbage in = garbage out.
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MAY 14, 2014: PAYING FOR A DPT DEGREE
As the next class of DPT students enter schools around the country, they are likely facing the highest tuition costs yet, while possible changes to forgiveness programs are on the horizon. Is the DPT degree still worth it? We certainly think so, but financial responsibility is still a huge concern. What can students do to minimize the cost of their DPT degree well before they graduate? What loan repayment options are out there? Will PSLF still be an option? Are there still clinics offering loan repayment assistance or is competition for jobs making these benefits more scarce? We will pose these questions (and more!) on Wednesday, May 14th at 9 PM EST. Join in the discussion!
Precision in Language
Language is obviously important as words are the basis of explicit communication. As is such, specificity in language and word definitions is vital to interaction. But also, specificity in meaning is required for accurate scientific research. Thus, terms are often operationally defined in studies. It is an attempt to clearly communicate how the researchers are defining, utilizing, and investigating a construct. Hopefully, ensuring appropriate interpretation and application of results while bundling theoretical constructs through explicit definitions.
I’m no expert in linguistics, philosophy, or even language, but I think this is an important professional topic. Now, admittedly, physical therapists deal with complex physiologic systems and phenomena. Some concepts can elude specific definitions physiologically and linguistically. Pain is a perfect example.
The lived pain experience is an emergent, individually experienced phenomena dependent on a myriad of interacting physiologic, psychologic, environmental, social, cultural, and linguistic components. It’s not merely resultant from nociception nor tissue damage or even injury. Yet, the presence of such complex systems and phenomena should not preclude striving for specificity of language. Vagueness does not help us. Investigating form, meaning, and context of language assists in research, education, and patient interaction. Luckily, the International Association for the Study of Pain created a taxonomy, and is attempting to more robustly define terms related to the painful experience. The list includes hyperalgesia, hyperesthesia, noxious stimulus, peripheral sensitization, central sensitization, and neuropathic pain among others. Some terms, such as allodynia (“pain due to a stimulus that normally does not provoke pain”), are considered “clinical terms” and purposefully absent of proposed mechanisms. Other terms, such as nociceptive stimulus (“an actually or potentially tissue-damaging event transduced and encoded by nociceptors”), are mechanistically more specific.
As a more concrete, basic science example, what would result if 100 physical therapists & 100 physicists were charged to define strength, power, acceleration, stability and balance? How many definitions? How much similarity would they display?
@Jerry_DurhamPT has a hypothesis…
101 definitions.
One, exact definition (and likely a formula) from the 100 physicists. And, likely 100 separate, but similar, definitions from 100 physical therapists. These words have explicit definitions and equations within the realm of physics (classical mechanics). As Erik Meira asserts robust, specific definitions are absolutely necessary for science:
I’m not trying to get metaphysical here but we must define our terms in order to be scientific…Poorly defined statements are inherently not scientific. Just because it’s published does not make it science.
Specificity and discipline in language is a necessary first step. It is required for accurate discussion and collaboration within research, clinical practice, and between professionals. This includes other professions (and not just healthcare). But, unfortunately, appropriately defining and subsequently understanding definitions does not account for, nor address, how other healthcare professionals, disciplines, patients, and society perceive certain words. What are their definitions? As an example, lets explore the word “prevention.”
Prevention: the action of stopping something from happening
Within healthcare and physical therapy, true prevention by definition, is kind of a misnomer. But, the health care system, patients, and consumers utilize the term prevention differently. Usually, the concept of “prevention” is actually used to mean “risk reduction.” Thus, the “functional definition” within the context of healthcare and patient interaction is slightly altered. What is actually meant by ACL injury prevention is reducing the likelihood of an ACL tear. Epidemiology provides some insight…
In epidemiology, the absolute risk reduction, risk difference or excess risk is the change in risk of a given activity or treatment in relation to a control activity or treatment. It is the inverse of the number needed to treat. -Wikipedia
In epidemiology, the relative risk reduction is a measure calculated by dividing the absolute risk reduction by the control event rate.
The relative risk reduction can be more useful than the absolute risk reduction in determining an appropriate treatment plan, because it accounts not only for the effectiveness of a proposed treatment, but also for the relative likelihood of an incident (positive or negative) occurring in the absence of treatment. -Wikipedia
Currently, there are no singular interventions to fully prevent the occurrence of most diseases and injuries in normal life situations. In being alive, there is always risk.
So what to do? If other disciplines such as mathematics, physics, or psychology have defined a certain term or construct, I propose it necessary to understand and utilize that definition accurately in professional discourse. The terms above, which originate from classical mechanics, immediately come to mind. We should challenge and operationally alter definitions from other fields only if strong data and logic warrant modification. Further, in research, discussion, and education the most specific, accurate definitions should be sought after. If unknown, questions should arise, discussion should ensue, and operational definitions provided. Science requires precision in language: exact terms. Lastly, the patient and consumer’s definition of certain words needs to be ascertained. Where feasible, more appropriate explanations should be provided to improve public and professional understanding of terminology. Communication is strained, and collaboration limited, if we are essentially “speaking different languages.”
A physical therapist does not need to be an engineer, but understanding the language of mechanics allows for true discussion between fields. It opens the door for increased collaboration.
A physical therapist does not need to be a psychologist, but knowledge of psychological constructs allows for evolved ways of conceptualizing and treating patients. It lends itself to improved research and clinical practice.
A physical therapist does not need to be a linguist, but explicitly defining words is necessary. It helps us understand form, meaning, and context.
We need specificity and discipline in our language. Combining our expertise with the language and concepts from other disciplines fosters the ability to more robustly communicate and subsequently collaborate. This allows us to identify the grey, and step into uncertainty. For then we can truly start to explore the chaos, slowly illuminating specificity. Vagueness, after all, is beyond the limits of logic and reason.
#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MAY 7, 2014: WHAT I WISH I WOULD HAVE KNOWN WHEN I STARTED PT SCHOOL
It’s that time of year when students are graduating, new third years are entering full time clinicals and all of us are reflecting on how quickly school has passed. Every incoming #DPTstudent is eager to learn from others’ hindsight. What do you wish you would have known when you started PT school? What could you have done to learn more efficiently, to save more money and to make better use of your three years? And what did you do right? Do you have any other advice to share with every first year and incoming #DPTstudent? Join in on Wednesday at 9 PM EST to share!