Whiplash: JOSPT Special Issues Highlight the Challenges Facing Clinicians, Patients

The Journal of Orthopedic and Sports Physical Therapy (JOSPT) recently released a special issue on the topic of whiplash-associated disorders (WAD). This July 2017 publication followed up on the October 2016 issue, both with guest editors Dr. James Elliot, an associate professor at Northwestern University, and Dr. Dave Walton, an associate professor at the University of Ontario. This rare opportunity to have outside editors underscores the challenge that not only clinicians are facing when treating WAD, but the imperative need that patients with WAD struggle with on a daily basis. From an overarching perspective, the special issues highlight that WAD is not simply an orthopedic condition, yet one that encapsulates the physical, social, and cognitive aspects of the patient at hand, which works to complicate the treatment approach further.

Whiplash-associated disorders are common neck injuries, most often seen in motor vehicle accidents. In Europe and North America, WAD is seen in 300 per 100,000 individuals in an emergency room setting.1 The annual cost of personal injury claims in the United States alone is estimated to be around $230 billion.1 In addition, consistent international data suggests that approximately 50% of those who sustain a whiplash injury will actually not recover and continue to report ongoing pain and associated disability one year after the injury.1 This low rate of improvement underscores the idea that whiplash has other psychosocial components. A 2014 article in the Journal of Physiotherapy discuss that of those who have sustained a whiplash injury, many concurrently are affected by mental health concerns, as well. 25% of those with WAD have post-traumatic stress disorder, 31% have a “major depressive episode,” and 20% have generalized anxiety disorder.1 This combined psychiatric involvement leads to poorer outcomes, secondary to the elevated levels of disability, chronic pain, and physical activity that these patients have.

Talus Media’s Eric Robertson had the opportunity to interview Elliot and Walton recently to discuss the special issues, as well as the current landscape of WAD in a physical therapy setting. The conversation discussed many components of WAD, including the approach that clinicians take when treating patients. Elliot stated that:

“Considering whiplash as a homogenous type condition and treating it as a homogenous condition is really at the crux of really why we haven’t seen fantastic results of management strategies.”

The two also argued that therapists should not be looking at whiplash from a biomechanical or tissue-focused perspective, “It might be more valuable to take an approach that moves away from the tissue at fault, because so far that has proven to be a fool’s game, and move more toward the question of ‘what is the likelihood the patient is going to get better.'” Elliot and Walton did, however, state that they do believe there may be the involvement of some specific tissues in the body. “We do have some fairly compelling evidence that it looks like in some discrete number of people with chronic problems that their white matter in their cord may have been damaged or certainly involved in some of these changes in muscle structure and function.”

The two JOSPT special issues are available online from both October 2016 and July 2017. In addition, the full interview with Dr. Elliot and Dr. Walton is available on Talus Media Talks. What is your experience in treating WAD? Do you feel as if there is something missing in the treatment of these patients? Let us know what you think on our Facebook page.

 

References:

  1. Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother. 2014; 60(1):5-12.

Photo by Vladlane Vadek

What’s the Cost of Quality? New ABPTRFE standards mean an uncertain future for Fellowships.

Back in February at the Combined Sections Meeting, the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) announced their new quality standards for post-graduate education. The release of the new standards marked ABPTRFE’s first step towards its initiative of revamping old policies and procedures. According to Tamara (Tammy) Burlis, Chair of ABPTRFE, the intent is to“ultimately enhance patient care and support overall goals of the physical therapy profession”. An external consultant company specializing in accreditation and compliance solutions for higher education helped with the development of the new standards. After a 6-month call for comments, the standards were finalized and are now slated to take effect on January 1, 2018. Residency and fellowship programs have until January 1, 2019 to comply. Physical therapy news outlet Talus Media News featured this story in their August 14th episode.

Behind the buzz of the shiny new standards, however, is the discontent expressed by some fellowship directors. The biggest concern regards the change in admission criteria into fellowship programs. Historically, there were three ways to be considered for admission into fellowship: (1) complete an accredited residency, (2) earn board certification in a related field, or (3) have adequate prior experience as judged by the program directors. The new standards have removed the third option, leaving residency training or board certification a mandatory requirement prior to applying for fellowship.

Pieter Kroon, program director and co-owner of The Manual Therapy Institute (MTI), a fellowship program started in 1994 for advanced manual therapy training, spoke up in an interview on Talus Media, “I understand where [ABPTRFE] wants to go with it but…there are some nasty consequences that come with that which threaten the viability of the physical therapy manual therapy fellowship programs…We have given input, but we always have the feeling it doesn’t get listened to a whole lot at the ABPTRFE level.” According to Pieter, fellowship directors don’t seem to have much of a voice in the decision-making process at ABPTRFE. The way in which program directors currently share their concerns is akin to a bad game of telephone. The manual therapy fellowship program directors share their thoughts in their Special Interest Group (SIG) meetings. SIG representatives then report to the Board of Directors at the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). After that, it is AAOMPT’s responsibility to talk to ABPTRFE and pass the messages along. It’s not hard to imagine why Pieter describes the communication between program directors and ABPTRFE “tenuous at best”. Of note, AAOMPT declined to comment on the potential impact of the new standards.

The consequences Pieter referred to are a few in number, but of primary concern to fellowship programs is sustainability. Or, as Pieter more bluntly puts it: “we would be out of business”. To illustrate his point, 95% of the fellows that graduated from MTI in the past five years were admitted via review of prior experience, the route now deemed obsolete. Without such a large section of the cohort, his program would not have had enough overhead to be self-sustaining. Pieter shared off record that he runs his program because he loves teaching and helping clinicians become their best; the revenue the program generates is marginal. The new standards pose a big bottleneck to fellowship admissions, limits student accessibility, and places programs like his on a pathway to an uncertain future.

But what makes fellowship programs think they won’t get enough applicants?

Though there has been a paradigm shift in recent years where clinicians are looking towards residency training soon after entering the work force, there has yet to be an identifiable fiscal incentive for clinicians to become experts in the field given their low ceiling of professional compensation. Furthermore, time is of the essence. The American Board of Physical Therapy Specialties currently only offers certification exams once a year. So, not only are the additional certification exams expensive, it also requires foresight and planning to fit it into one’s professional and personal timelines. There is additionally a current lack of evidence that suggests being a resident-trained therapist and/or having board certification contributes to being a more prepared fellow. Though that’s not to say there won’t be evidence of this in the future, it does call into question how this new admission standard was arrived at. Did it consider any of the current evidence in post-graduate education? Or, was it developed with more philosophical underpinnings? To that end, it remains to be seen…

PT Think Tank community: the point of this piece isn’t to say that the new admission standards are “bad”. Rather, I hope it makes us consider how its proposal potentially overlooks the current reality of the residency/fellowship climate. What parameters are in place, if at all, to help address the worries of Pieter and other program directors? What will be in place to aid them during this period of transition?

I’ll end it here, but do think on this last part of ABPTRFE’s position on the new admissions criteria: “Our goal is to support residency and fellowship programs, while addressing and planning for the future…As a part of our own continuous improvement process, we will continue to monitor the data that occurs as a result of this revised change. We will go back to this concept if we find that it has been detrimental to fellowship programs.”

Pieter and Tammy’s full interviews are available on Talus Media Talks.

#BadAssMary: Mary McMillan in 8 Memes

Mary McMillan is a founder and the first president of the American Physical Therapy Association. She wasn’t the first person to practice physical therapy, but as Mildred Elson stated in her 1964 McMillan lecture, “She thought in terms of the whole country and foresaw its great civilian need for physical therapy.”

She’s also a bad ass.

Here’s her story, in memes. 

Note: The majority of this re-telling of Mary McMillan’s history has been pulled from her speech in 1946, entitled “Physical Therapy from the Embryo on Three Continents,” and the 1944 annual conference proceedings at which Mary McMillan was awarded an honorary active lifetime membership in the APTA. The proceedings were published in Physiotherapy Review, now the Physical Therapy Journal. 

Mary McMillan was raised in England and completed her studies at the University of Liverpool Gymnasium, where they were offering a 2 year course in physical education. She also took a break from these studies to head to London for further courses in neuroanatomy, neurology, and psychology.

1.

At the outbreak of World War I, Mary applied for a Voluntary Aid Detachment (VAD) unit out of the University of Liverpool. Fortunately for physical therapy in the United States, she failed the medical examination and decided to travel to Boston…during the war, in a convoy, under complete blackout conditions.

After arriving in the US, she met Marguerite Sanderson, another important figure in the development of physical therapy. She was put to work at Walter Reed Hospital, and matter-of-factly states: “That was the beginning of physical therapy in the US Army.” Physical therapy was accorded as a health service in 1917 by the US Army.

Mic drop.

2. 

Dr. Everett Beach, from Reed College in Portland Oregon, wanted Mary to come teach the 200 potential reconstruction aides (the original name for physical therapists) he had signed up for an emergency course to assist with the war effort. Mary immediately applied for a leave of absence from the Army to go where she was needed. When the Army dragged its feet, she threatened to resign. Within 24 hours, she was granted a leave of absence, and left for Portland.

So that’s how that’s done.

3. 

Post WWI, a letter was sent to the reconstruction aides, asking if they wanted to see a professional association built. The answer was a resounding yes. Here are some cool facts about what they built, from Eleanor Carlin’s 1976 McMillan Lecture:

  • “Whether by design or accident…nothing was said about working only under the direction of a physician” (Carlin, p. 1113).
  • Our founders had the foresight to include policy that would allow the development of chapters, and they almost simultaneously founded the Physical Therapy Journal, ensuring that publication was valued.
  • The Association was originally called the American Women’s Therapeutic Association, but charter members realized that this would be alienating to men, and voted to change the name to the American Physiotherapy Association. The first man was elected to national office in 1942.
  • Women entering the profession were required to have a college education.
  • By 1924 the charter members had discussed the standardization of physical therapy through state registration and licensure. By 1971, practice acts had been established in all 50 states (Blair, 1971).

4. 

Mildred Elson, first McMillan Lecturer, first president of the World Confederation of Physical Therapy, and first president of the Wisconsin Physical Therapy Association, quotes Mary McMillan: “What we need is one unanimous effort in order to establish a high standard for our profession and enthusiasm that knows no bounds.”

Elson goes on to say in her 1964 lecture, “Early members at the first convention did not join & say, “What can I get out of it,” they said, “I intend to join to see what I can make out of my profession and to see what I can do to create and maintain standards.” So on that note, you know the APTA is trying to reach 100k members, right? Check it out here.

5. 

After WWI, Mary answered the call from the China Medical Board of the Rockefeller Foundation to work in the Peking Union Medical College in China. Of course, the Rockefeller Foundation knew who she was, and Mary took charge of the Department of Physical Therapy at Peiping Union Medical College in 1932. She first got rid of the “obsolete apparatus” in the gymnasium, then set about finding people who were up to her standards. In her speech, “Physical Therapy from the Embryo on Three Continents,” she states: “This necessitated that some people must be taken off the payroll—it was not an easy thing to do—it hurt me very much to do it, but it had to be done. I was able to replace these people with more modernly trained nurses and a physical education graduate.”

She also set up scholarships to encourage graduates to apply, and partnered with a physician to head the department.

6. 

November 1, 1941, all Americans were urged to evacuate Peking. Mary, along with several others, wound up in Manila (capital of the Philippines) in a roundabout way to get home, with no chance of sailing before December 20. December 7, 1941, Pearl Harbor was bombed. Mary offered her services to the Army Hospital in Manila, where she was one of the first to assist the dead and wounded upon arrival. Christmas Eve, Manila fell to the Japanese. Mary, realizing what was about to happen, “borrowed” a truck, and with 3 women drove to the hospital to recover drugs, instruments, beds, and bedding. These supplies furnished the internment camp hospital at Santa Tomas. Mary slept on a filing cabinet.

7. 

Mary, who referred to her work in the Japanese internment camps as her “swan song” recalled this episode of patient care:

Excerpt from Mary McMillan’s 1946 speech, “Physical Therapy from the Embryo on Three Continents”. © 1946 American Physical Therapy Association. Adapted with permission. All rights reserved.

8. 

Mary McMillan was repatriated in 1943. When she stepped off the boat, she was met by Dorothea Beck, previous editor of the Physical Therapy Review. She continued to be a source of strength and inspiration to the Association until her death in 1959. She assisted with efforts to found the World Confederation of Physical Therapy and was known to show up at parties. Margaret Moore, the 1978 McMillan Lecturer, recalled: “…a lively party with lots of people, loud music, much dancing, and rattling of glasses was taking place at my home. Who should appear at my front door but Molly McMillan…Within 10 minutes, Miss McMillan was in the middle of the group with her shoes off…I treasure the moments with that fun-loving, warm, and lovely lady.”

 

References

Blair, Lucy. “Past Experiences Project Future Responsibilities.” Physical Therapy 52.5 (1971): 493-99. Print.

Carlin, Eleanor J. “The Revolutionary Spirit.” Physical Therapy 56.10 (1976): 1110-116. Print.

Elson, Mildred, ed. “Twenty Third Annual Conference.” The Physiotherapy Review 24.4 (1944): 148-50. Print.

Elson, Mildred O. “The Legacy of Mary McMillan.” The Journal of the American Physical Therapy Association 44.12 (1964): 1066-072. Print.

McMillan, Mary. “Physical Therapy on Three Continents.” The Physical Therapy Review 40.2 (1960): 140-43. Print.

CSM Inside the Numbers

Busy Crowd

If you were at CSM in San Antonio last week, you know this conference was big – in a variety of ways. The APTA touted record attendance levels. The conference was spread out among a huge convention center, with concurrent sessions in two additional hotel centers. Overflow viewing screens had to be set up in the hallways to accommodate full sessions. The exhibit hall was sold out and always packed. The conference hashtag, #APTACSM was even trending at the #2 spot on Twitter for some time. I guess everything really is bigger in Texas. Let’s investigate the growth of this conference, and who actually attends.

CSM 2017 continued to set attendance records this year and has been growing steadily in popularity in the profession. Reports of total attendance have varied for the conference, with talk of over 14,000 in San Antonio. Erin Wendel-Ritter, Manager of Media Relations and Consumer Communications for the APTA, reported registration was over 11,600* for conference attendees. That is a lot of PTs, PTAs, and SPTs! While the number itself is impressive, how does it break down to actual membership? Dr. Sharon Dunn, President of the APTA, tweeted that the Association is at ~98,000 members, with a drive to get to 100k by the NEXT Conference in June. That equates to roughly 11.8% of members attending CSM. There are a variety of reasons why members do not attend yearly conferences, including registration cost, travel, and time off work.

I think we can be more involved as a profession – 11.8% is good, but we can most certainly do better. As Dr. Dunn notes, it starts with increasing the membership of the APTA. Even if we stay at 11-12% attendance, an annual increase in membership of 3% would increase the attendance by roughly 1,000 registrants in 2018. This is no small task, as the rates of membership among other national healthcare organizations, such as the AMA, have suffered recent setbacks in membership rates. From an overall profession standpoint, in 2014 the Bureau of Labor Statistics reported that our profession encompassed around 292,130 Physical Therapists and Physical Therapist Assistants. From that point of view, CSM draws only about 4% of Physical Therapy professionals to attend. And that does not include students.

The student attendance at CSM 2017 was staggering. At times, it almost seemed like a student conference. Erin reported that student registrants accounted for over 4,100* of the total attendees! Student attendance was 35% of the total conference attendance. I think this is great – sort of. CSM is obviously doing a great job of attracting young professionals to a growing conference. Hopefully, they realize the value in the education and networking opportunities and continue to attend as professionals. Students are the future of our profession, and our profession is arguably the future of healthcare. The downside, however, is that it knocks down the number of actual practicing PTs that are attending this conference. If we take students out of the equation, then only about 7,500 practicing PTs and PTAs were in attendance or about 2.5% of the actual PT workforce.

So where do we go from here? The obvious answer is to encourage membership and active participation in the APTA. We can learn a lesson here from the AMA as well, their membership has started to increase in 2015 after a decade-long decline. How did they do it? By attracting student members and becoming more involved with academic institutions. Another solution is to continue to encourage PT professionals to share their voice on social media, which may create FOMO for those not in attendance. I expect students will continue to play a huge role in the development and growth of CSM as a conference in the years to come, and I hope that they continue to be active as graduate Physical Therapists.

*Initial numbers reported to PT Think Tank at the time of publishing. Final attendance numbers will be released on 3/6/17, at which time this article will be updated.

Chronic Whiplash: Is it really a Medical Mystery?

neckpain copy

A small while ago, the well-known and widely read periodical, The Atlantic, published a piece entitled, Chronic Whiplash is a Medical Mystery. In the article, the author, Julie Beck, poses the thematic question, “Being jostled in a car accident should only cause a few weeks of pain—so why do some people suffer longer?” Well, that is a good question, isn’t it?

Over the past decade, tremendous advances in the science related to Whiplash and Whiplash Associated Disorders (WAD, as it were) have been achieved. Recently, this science took a giant step forward with the publication of Part I of a two-part special series dedicated to whiplash in the Journal of Orthopaedic and Sports Physical Therapy (October 2016 issue). This issue featured guest editors, Drs. Jim Elliott, Dave Walton, and Michelle Sterling and an editorial by Gwen Jull. Heavy hitters for sure.

So, it’s not surprising that some of these researchers took notice of Beck’s article in The Atlantic. It’s also not surprising that to these researchers, whiplash might not be the mystery it may seem to others. And so, without further ado, PTThinkTank.com is proud to publish a response piece to Beck’s article, entitled, “Chronic Whiplash: Is it really a Medical Mystery?” Well, that is a good question too, now isn’t it?

Enjoy the essay from Jim Elliott, Peter McMenamin, and Dave Walton. Thank you, sirs, for the contribution.

Chronic Whiplash: Is it really a Medical Mystery?

What Problem Does The Human Movement System Solve?

Apparently evolving from the new vision statement, the APTA and the board of directors introduced the “human movement system” as the potential professional identity and rallying cry for physical therapists. The definition of the human movement system is:

The human movement system comprises the anatomic structures and physiologic functions that interact to move the body or its component parts.

Chris Powers, PT, PhD, FAPTA recently discussed the concept of the human movement system on Karen Litzy’s podcast Healthy, Wealthy, and Smart. He stressed it’s conciseness, applicability to educating consumers, and it’s ability to be a unifying theme across practice settings. Dr. Power’s asserts the profession of physical therapy needs an identity, a central theme, and something that applies across patient populations and settings. He describes the human movement system as a system comprised of many systems. “We treat the entire movement system, and in order to do that you have to be an expert in all of the subsystems.”

Matt Sremba, PT, DPT, OCS Paul Mitalski, MS, and myself are interviewed by Adam Van Cleave on the Conatus Athletics’ Podcast regarding the Human Movement System and Role of the Physical Therapist. We think there are issues in regards to the definition and it’s implications. All of us agree with Dr Powers that there are problems within the field of physical therapy spanning education, research, and clinical practice. But, we do not see the creation of a “human movement system” nor the definition as assisting in either solving nor identifying any significant problems.

It’s over ambitious and under precise…this definition allows for a misinterpretation of the physical therapy profession…The first example I’ll give is the word components and how it’s used. In this instance the word is too broad….The word movement is too narrow…do they really mean ALL components of all anatomical systems involved in movement? Because that is what they say. In fact, what system wouldn’t be involved? What system or component of human anatomy doesn’t directly or indirectly contribute to movement? This is too broad. Didn’t narrow the scope…

When you propose a definition that has no bounds you end up not defining anything. And definitions have to be precise. So, this is a lack of precision. On the other hand, the word movement also has a lack of precision, but it’s opposite. The word movement, to me, is too constraining. It’s inconsistent with what the physical therapist does and it limits what the physical therapists does. PTs should have a medical role…for the human whether or not the human is moving. The therapist should be involved in non-movement aspects of the human. -Paul Mitalski, CEO of Conatus Athletics

Sure, this may appear like nit picking, minutia, and nothing but semantics. Is the human movement system really a system? Is this our professional identity? Do we want to create something else that no one knows about? If the physical therapy profession senses there are issues communicating our knowledge and roles to various stakeholders any proposed solution must be clear. Precision in language is needed.

The problems have not been specifically identified or labeled meaningfully. Is the definition for marketing and branding only? One liners and advocacy for physical therapy are not bad. In fact, rallying generally around PTs helping people move is a likely a meaningful cause. And of course, PTs deal in human movement quite frequently. But, we remain skeptical that attempts to create a human movement system will contribute meaningfully to education, research, clinical practice, or advocacy efforts. Further, this definition will not contribute meaningfully to communication. We think creating new systems with broad definitions that demand assumptions may only complicate an already cloudy communication problem.

Are the problems properly identified? And, does the creation of the human movement system and it’s definition address them? Some of the issues we identify (and will discuss further in future podcasts) are leadership, collaboration, and education modifications.

Listen to The Human Movement System with Dr. Chris Powers on Healthy, Wealthy, and Smart as well as our reply The Human Movement System and the Role of the Physical Therapist on The Conatus Athletics’ Podcast. Our goal is to open a dialogue on this topic.

So, what do you think?

Resources
The Human Movement System with Dr. Chris Powers on Healthy, Wealthy, and Smart
The Human Movement System and the Role of the Physical Therapist on The Conatus Athletics’ Podcast
Human Movement System information on APTA website
Rothstein Roundtable Debates Implementation of Human Movement System
Rothstein Debate: Putting All our Eggs in One Basket: Human Movement System on PTJ Podcast
Discussion: The Human Movement System on PTJ Podcast
Shirley Sahrmann explains why PT’s are THE Movement System Specialists on PTPintCast
‘Movement System’ Is Our Professional Identity
The human movement system: our professional identity by Shirley Sarhmann
On “The human movement system: our professional identity…”

Keep Your Hands

Image Courtesy: https://www.flickr.com/photos/xlordashx/
Image Courtesy: https://www.flickr.com/photos/xlordashx/

A Hand Raised in Concern

At the 2014 APTA Combined Sections Meeting in Las Vegas, during the Orthopaedic Section membership meeting, Dr. Catherine Patla stood up and expressed a notion to the Section’s Board of Directors. She was concerned physical therapists were giving away their hands (she also expressed a similar concern to the AAOMPT Executive at AAOMPT 2014). After over a year of consideration and contemplation, I have to agree. We are in the midst of a silent crisis of physical therapy scope of practice!

Motivated by Dr. Patla’s observations and concerns, I began keeping unofficial (and admittedly unscientific score) of students in my musculoskeletal programs and how their clinicals handled, well, the hand. Conservatively, about 50% of the students reports that they were expressly forbidden by clinic policy to treat hands, elbows, and to a lesser degree, shoulders. Concernedly, the distal upper extremity appears to be the land of the OT.

This is a complicated situation.

A Handsomely Negative Impact

From a profession-wide perspective, there’s not much that can easily be done to counteract clinic-level policies. Certainly, both Occupational Therapy and Physical Therapy are qualified to perform rehabilitation to distal upper extremity injuries. Furthermore, I think the ultimate care pathway, for many injuries common to the area, involves both professions. I’ve not actually met a member of either profession who thinks differently (or at least admitted as such), yet the policies exist.

This trend has potential long-term, and wide implications. From my perspective as Director of the Kaiser Hayward Physical Therapy Fellowship in Advanced Manual Therapy, this increases the challenge to train fellows, who by decree, must have experience treating and managing patients with distal upper extremity diagnoses. Outside of residency/fellowship training, new professionals may exist without ever getting to see a hand patient in some clinics/regions! Over time, the collective knowledge of physical therapists will be diluted and will atrophy. Soon no one will be left to TEACH the hand. At my previous University, it was common practice for the senior orthopaedic PT faculty to contract an OT to come in and teach the hand to DPT students. This was a constant and disappointing source of stress for me. What message does this send! We could literally be voluntarily cleaving off an important scope of our practice! The irony is, it’s the body region most important to how we treat! It’s decidedly more difficult to be a PT if you don’t have hands.

The Hand Rehabilitation Section

I don’t know any more than a couple people in the Hand Rehab Section of the APTA. Perhaps that’s my issue. Perhaps it’s because the Section itself is a bit of an anomaly. Of the 18 Sections within the APTA, it’s the only one designated by an anatomical focus. The other sections are delineated by practice areas like Orthopaedic or Neurologic, settings like Home Health, Acute Care, or Aquatics, or related professional activities like Research, Education, and Federal Advocacy. Arguably, the Women’s Health section is anatomically focused, but in fact it’s not, since Women’s Health is more broad than a pelvic floor and I think “The Vagina Section” would offer some terribly difficult search engine optimization challenges! I do not know the history of how the Hand was excised from the rest of the Orthopaedic Section and would love to learn.

All that criticism on name/organization aspects aside, you have to also argue that the Hand Section is doing the best it can with the membership audience it has (~472 members and 36 Facebook likes). It offered an outstanding selection of programming at this years CSM Meeting in Indianapolis. Everything from a high-profile lecture including ESPN’s Stephania Bell, to a comprehensive clinical reasoning model for TFCC management by Brenda Boucher and Pieter Kroon was offered. Notably, the Hand Rehab Section also offered two pre-conference courses and presented the results for projects for 3 different clinical practice guidelines: carpal tunnel, distal radius fractures, and lateral epicondyalgia. Yet, while all this is taking place, other PT’s seem more than happy to give up the hand and let someone else manage it. Let some other PROFESSION manage it.

Hands are for Holding

To me, this boils down to a grassroots effort, and is an issue of personal responsibility as a professional. You cannot in good conscious, let your clinic enforce and carry out a policy that prohibits, or through practice, eliminates the opportunity to treat any body region, especially the hand. We all know the outcry when outside professions claim a technique is only their purview, and attempts are made to remove that from our practice. Physical therapists rise up in a collaborative rage and claim it back. Yet, I see malaise and laziness, and an acceptance of insufficient knowledge as a behavior pattern among physical therapists in these clinics. That may seem harsh, but I can’t see it any other way.

My one caveat, and an important one at that, is that some hand injuries do require a very experienced hand specialist. Hand tendon surgical repairs quickly surpass entry-level practice. There is an insufficient numbers of physical therapists trained Certified Hand Therapists. In fact, I have only encountered one PT who holds the dual acclaim of Fellow of the Academy of Orthopaedic Manual Physical Therapists AND is a Certified Hand Therapist: the aforementioned, Dr. Boucher, who hails from Texas State University and teaches as part of the Manual Therapy Institute’s manual therapy fellowship program.

There are pathways, and opportunities that can happen, and I’ll outline my suggestions in just a moment, but this boils down to each and every physical therapy professional deciding to hold onto hands. It’s up to YOU!

Getting a Grip on this Problem

By all means, this is just a suggestion, but we need to start somewhere and why not now? Please comment, edit, innovate, or ACT on this:

  • Hand Rehab education should be led by physical therapists as often as possible in DPT programs.
  • Individual PT’s in clinics with hand-prohibitive policies should challenge these, and reach out to professional advocates like those in the Hand Rehab Section for assistance if needed.
  • Consideration of upper extremity policies in DPT Clinical Education should occur.
  • Joint clinical practice guidelines should be developed by OT’s and PT’s collaborating as authors.
  • Increased visibility and ultimately membership in the Hand Rehab Section. 36 Facebook likes is not going to cut it. 472 members is difficult to defend.
  • Development of post-professional pathways for Hand/Wrist/Elbow instruction including residencies, fellowships, and some stake in the Certified Hand Therapist credential.
  • Consideration of how the Hand Section can further collaborate with the Orthopaedic Section (absorbed by the Ortho Section?) and AAOMPT to further their collective mission.
  • Wide APTA support for these endeavors, including resources for training training, pathways for expertise, research, and advocacy.

Thanks for listening. Thanks for thinking. Thanks in advance for taking the challenge to not let this problem get any worse!

 

 

 

#PTDirectAccess as a Mindset through the Continuum of Care #APTAcsm

Direct Access is a hot topic for outpatient physical therapists. Many may feel pursuing the ability to practice to their full potential within a direct access environment is fundamentally a private practice outpatient issue. But, do we need to take a broader view of what the term direct access represents? Physical therapists in all settings need to have a stake in pursuing direct access for our profession. And, not just the legislative logistics of direct access, but also the mindset. Direct access is more than legislative semantics and private practice marketing. The education, knowledge, training, mindset, and approach to direct access patient care is not specific to private practice nor the outpatient setting.

While many states have some form of direct access, Allan Besselink states “you either have it or you don’t.” Assessing direct access laws by state illustrates that only 18 allow true unrestricted direct access. Allan comments:

It is time for physical therapists to simply say NO to accepting anything less than true direct access. We should not just accept the scraps as they fall from the table. In accepting anything less, we do a disservice to our profession by viewing ourselves as deserving of and accepting of a subservient role in the health care arena. Worse yet, we do a disservice to our patients who look to us as advocates for cost-effective and quality conservative care.

Direct access is something a patient either has – or doesn’t. There is no in-between. Physical therapists should not play in-between either.

In absence of profound legislative change from state to state what actions can each individual therapist, educator, and student perform tomorrow to advocate for and illustrate the value of direct access? Can we adopt a direct access mindset. Join Karen Litzy, PT, DPT, Kyle Ridgeway, PT, DPT, and Ann Wendel, PT, ATC, CMTPT at #APTAcsm to discuss not the logistics, but the professional mindset of #PTDirectAccess through the continuum of care from acute care to home health to outpatient orthopedics.Follow and utilize the #PTDirectAccess hashtag during #APTAcsm to ask questions, tweet about the session, and share resources on direct access.

Learn how to be an effective part of the medical team to address the needs of today’s patient, healthcare consumer, and other professionals. A direct access mindset contains the potential to add much value to all settings of care.

Recognize benefits of adopting a Direct Access Mindset across all physical therapy settings

Identify the key benefits of experience in the acute care setting as preparation for spotting red flag incidents, differential diagnosis, understanding medical treatment, and the team based approach in all other practice settings.
Describe ways that physical therapists can form partnerships with other medical professionals who see the value, and necessity of direct access to physical therapy.

To conceptualize and discuss these ideas

Define role of PT as part of the medical team & global health care system: acute care to home health to outpatient clinics
Outline key points of a direct access mindset
Examples of other providers who already value consulting and referring to physical therapists across the continuum

Discuss and illustrate the potential value of physical therapists

Across a variety of diagnoses as well as in risk reduction in both pathologic and healthy populations
Via ideal acute care practice
By connecting acute care to a direct access mindset
In potential direct access in various settings
How does acute care facilitate, reinforce, and contribute to direct access?

Direct Access Through the Continuum of Care
Thursday, February 5, 2015
11:00 AM – 1:00 PM
Room 205 Indiana Convention Center

Your state, setting, patient population, title, or practice act do not dictate your mindset. Listen to Ann, Karen, and Kyle discuss why it’s time to approach all of practice with a direct access mindset.

Physical therapists, it’s time to own it.

Science, Technology, Engineering, and Math (STEM). The Future of Sports Medicine? #APTAcsm #sportsPT

What is the future of sports medicine? How do we get there? Whether considering APTA’s original Vision 2020, discussing the current state of affairs during a break at work, or participating in discussions on Twitter, the future direction of our profession is constantly debated. The past 20 years have contained tremendous growth and the profession of physical therapy continues to mature, however, the question for the future is: how do we continue to evolve in meaningful ways? Who do we need to discuss our clinical challenges with to improve collaboration within research, education, and clinical practice?

A panel discussion at Combined Sections Meeting on Saturday February 7th at 8am will discuss these topics and propose one path for the future of sports medicine. STEM is an acronym for Science, Technology, Engineering, and Mathematics and experts from each of these disciplines will present on how a greater understanding and application of concepts contained within these fields hold the potential to evolve physical therapist education, research, and clinical practice. Future collaboration amongst these disciplines can assist clinicians in hopefully making better clinical decisions and improving patient outcomes. What is the new vision and role for physical therapists in athlete management? Join us at CSM to discuss…

Integration of STEM with Physical Therapy: The Future of Sports of Medicine

Saturday, February 7, 2015
8:00 AM – 10:00 AM
Indiana Convention Center Sagamore Ballroom 5

Panel Members
David Logerstedt, PT, PhD, MA, SCS
Paul Mitalski, MS
Eric Nauman, PhD
Christopher Powers, PT, PhD
Matthew Sremba, DPT
Moderator: Kyle Ridgeway, DPT

To hear a preview of the panel and more about the topic listen to Karen Litzy discus and interview Paul Mitalski, Matt Sremba, and Kyle Ridgeway on her podcast Healthy, Wealthy, and Smart.

The Right Call. APTA Public Relations Removes Questionable Podcast

A few days ago Move Forward, the APTA’s consumer targeted website, posted a podcast. The premise was inaccurate, and the conclusions appeared potentially damaging for patients and the general public. I posted a link to the original Facebook post with a brief statement of my disagreement. Via Twitter and Facebook other physical therapists expressed their disappointment with podcast.

@SandyHiltonPT expresses her disagreement
@SandyHiltonPT expresses her disagreement

 

Historically, Move Forward has published accurate and useful information for patients and consumers including a podcast with Joe Brence and John Ware on Understanding Pain, a post 9 Things You Should Know About Pain, and publicity regarding Choosing Wisely: 5 Things PT’s and Patients Should Question. Yesterday afternoon, Jason Bellamy APTA’s director of web and new media, removed the podcast from the Move Forward website as well as deleted all related Facebook posts.

 

APTA_Remove

I commend the decisive action by Jason and the APTA. I agree with decision. And further, I’m encouraged by their ability to respond to informal feedback via the conversations occurring on social media. Personally, I participated in a panel at #CSM2014 The Value of Using Twitter for Branding Yourself and the Profession, and was highly impressed with Jason’s commitment to engagement. Jason stressed that he and others at the APTA are “listening” to the conversations, discussions, and informal feedback ocurring in the realm of social medical (even if just lurking). But, he also encouraged members to actively contact the APTA with suggestions, feedback, and insight. They want to hear from concerned members. And, apparently, they are willing to act on those intentions.

The APTA listens, so speak up. Becoming a member is a start. Using your voice is next. What do you have to say?

Feedback? E-mail consumer@apta.org
Feedback? E-mail consumer@apta.org