#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, APRIL 17, 2013: RESEARCH IN THE PT FIELD

We have all heard the term ‘Evidence Based Practice’. It makes sense that we base the majority of PT treatments around modalities or interventions that have been studied and show beneficial results for the patient. Evidence is constantly being updated and we are moving forward as a profession due to the individuals and teams who are passionate about research and performing studies.

But how are those studies funded? Why should we as students care? The Foundation for Physical Therapy makes it possible for PTs to obtain funding for their studies. In fact, the National Institute of Health (NIH) only accepts about 5% of all research proposals! If it were not for the Foundation for PT, many research projects within our field may not have been possible. Many of my professors have been funded by the Foundation.

LogNBlog for PT, and the Marquette Challenge, are ways that students can get involved and help the Foundation and all money raised goes directly towards helping research in the PT feild. Research is the heart of our profession- with out it we have little to advocate for and the public may not believe in us or our profession. As students, and the future of the profession, part of our job is to make sure that quality research continues.

Let’s talk about it! We will discuss why research is important, how we can get involved (it’s not ALL about the money!), and more about what the Foundation for PT does.

CHAT UPDATE

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Critical Thinking Vs Clinical Reasoning

During #DPTstudent chats, there has been many great conversations and debates. However, it seems that some of the debates end with phrases along the lines of, “that’s where clinical reasoning comes in,” or “that’s where we use critical thinking.”  What are these vague terms and what is a #DPTstudent supposed to do when that’s the final, definitive statement of an interactive discussion?!

Often, it seemed the terms clinical reasoning and critical thinking were being used interchangeably. So, I began to wonder what these terms meant, how they are different, and how they are the same. Is this some sort of common denominator for all PT-speak? Or, are people just applying these terms willy-nilly? I decided to investigate.

According to: The Foundation for Critical Thinking, critical thinking is:

1) A set of information, belief generating and processing skills

2) The habit, based on intellectual commitment, of using those skills to guide behavior.

And more importantly, is Not:

1) The mere acquisition and retention of information alone, because it involves a particular way in which information is sought and treated;

2) The mere possession of a set of skills, because it involves the continual use of them

3) The mere use of those skills (“as an exercise”) without acceptance of their results.

In other words, critical thinking is the process of constant evaluation and application of available information, including analyzing your results. To me, it sounds a lot like another oft-employed term: evidence-based practice.

In the article: Thinking and Reasoning in Medicine, (Vimla L. Patel, Jose F. Arocha, and Jiajie Zhang) describes three components of clinical decision making:

(a) Choice options and courses of actions

(b) The belief about objective states, processes, events, outcomes and means to achieve them

(c) Ideas of the consequences associated with the outcomes of each action-event combination.

The overlap, and thus breakdown, between clinical reasoning and clinical decision-making occurs with confirmation bias, or searching for evidence to confirm a preconceived hypothesis. Critical thinking is constantly required to recognize these biases we all possess, and continue to analyze and challenge them by considering other potential courses of action.

A classic example I have observed in my short time in the clinic is the SI joint confirmation bias conundrum. In school, we learned how poorly reliable, and questionably valid many SI joint tests are. We also learned how many manual therapy effects are not specific in terms of spinal level, or even side. However, when assessing SI joints, many therapists hold tenaciously to their belief that they can detect, and then treat specific biomechanical malpositions of this very firmly structured joint.  “Do you feel that? Yep, that’s an upslip on the right,” I would hear so many times. Follow-up questions would be posed in a format of confirmation rather than pure inquiry. Confirmation bias. Clinical reasoning fail.

In his famous book about diagnostic clinical reasoning, “How Doctors Think,” author Jerome Groopman cautions that a primary rule for becoming a great diagnostician is to not get boxed into one frame of thought. That sounds reasonable enough to me. Perhaps this is much more difficult in practice, especially considering the nuances to becoming a good clinical thinker.

Critical thinking and clinical decision making are difficult. It certainly isn’t for the faint of heart, when so often we’re forced to face honest assessments of how little we actually know.  So, next time your ideas and opinions are questioned and you feel cornered, don’t resort to the catch-phrases of critical thinking and clinical reasoning as a defense. They’re not a “get out of jail free” card. Recognize the opportunity to expand you understanding of other methods and models of thought that you’re perhaps less familiar with.

Don’t be afraid.

I’ll leave you with one of my favorite quotes:

“But, if thought is to become the possession of many, not the privilege of the few, we must have done with fear. It is fear that holds men back — fear lest their cherished beliefs should prove delusions, fear lest the institutions by which they live should prove harmful, fear lest they themselves should prove less worthy of respect than they have supposed themselves to be.”

~ Bertrand Russell (Principles of Social Reconstruction)

 

#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, APRIL 10, 2013: IS BEING A PART OF A PROFESSIONAL ORGANIZATION NECESSARY?

The largest professional organization that represents Physical Therapists in the US is the American Physical Therapy Association (APTA). Currently, I am a student member and receive the monthly newsletter and emails almost daily. Students get away with a pretty cheap membership fee but once I graduate, if I keep the same selections of interest (general membership, Colorado chapter, and 2 specialized areas)  my fee is over $600! The APTA website outlines the benefits of being a member pretty clearly on their website and the benefits include connecting with other PTs, continuing education opportunities and access to many evidence based research articles. The APTAs biggest benefit is that they are the largest advocates of physical therapy.

What are your thoughts? Do you have to be a member of the APTA? Do your patients know (or care) if you are or are not a member? Is $600 a little too harsh on the wallet, especially with student loans? Let’s talk about it on Wednesday evening, April 10 2013 at 9pm EST!

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, APRIL 3, 2013: ADDITIONAL CERTIFICATIONS- NECESSARY OR SUFFOCATING?

After an intense, three year, non-stop DPT program we are prepared to play the role of physical therapist in almost any setting. After graduation many of us may feel so elated to finally have a Friday night that does not involve studying that we may not jump right into studying for additional certifications. However, this article on Monster.com says that PTs with specialized certifications are more desirable and are the first to get hired. Do you think that holds true for new grads? Do you think the more letters you have after your name the better (even if the patient has no idea what they mean)? Or do you think that becoming so specialized with certifications backs you into a tight corner and you are no longer able to be seen as a general physical therapist? Do you plan to obtain any extra certifications in school or closely following graduation? Let’s talk about it on Wednesday, April 3rd at 9pm EST! See ya on Twitter!

CHAT UPDATE

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How Do I Twitter Anyway? #DPTstudent

Twitter is an amazing place. I get smarter everyday by observing and connecting on the platform. However, I’m routinely astonished at the reluctance of the vast majority of the students I teach to engage. The #DPTstudent tweetchat has been a great conversation, but it’s only a droplet of the approximately 8000 of PT students currently in school.

One barrier to Twitter engagement is the requirement to spend time figuring it out. Twitter without filters and careful content curating is like trying to drink from a fire hose. It’s just not going to be a very comfortable event.

To that end, Mary Derrick (@Mary_PT2013), a Texas State DPT student who is mere weeks from graduating has crafted a handy and excellent user guide for those folks interested in playing along on the #DPTstudent chat. It’s also great for anyway who would like to figure this Twitter thing out! Enjoy!

(I suggest you expand this prezi to full screen size for optimal viewing.)

#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MARCH 27, 2013: THE COST OF THE DPT PROGRAM

Last week when I received the statement telling me the current amount of my student loans, I could have cried. To think that number will be double by the time I graduate with my DPT puts a serious pit in my stomach.

According to CNN, the average debt from undergrad is $27,000. According to the APTA the average cost of a 3 year DPT program (obviously this varies by public vs private school and other factors) is $86,204. That is a whopping $113,204 in student loans.

In the early 2000s the push was made for PT programs to be 3 year doctorate programs. With this came an increase in tuition cost, but no increase in salary. Is there anything we can do about it? Do we just have to suck it up and pay back student loans for the majority of our lives if we want to be physical therapists? Does the passion for the profession out weigh the cost? I have to admit that I almost didn’t leave my job as an accountant because of the cost of the DPT program.

What are your thoughts? Let’s talk about it this Wednesday at 9pm EST!

Tell us what you think about #DPTstudent, here

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MARCH 20, 2013: DIFFERING TREATMENTS FOR LOW BACK PAIN

If there’s one thing we all spend time learning about it’s low back pain. Physical therapists are highly skilled in the management of low back pain overall. However, individual physical therapists attack the treatment of low back pain with a stunning variety of approaches. From Treatment-based Classification, to McKenzie’s Mechanical Diagnosis and Therapy, to SIJ, to Movement System Impairment, it sometimes seems like there’s as many systems as there is schools of physical therapy. This week’s topic will discuss treatment variation in low back pain.

While physical therapy offers a wide range of approaches to managing low back pain, it is worth considering complementary options that can potentially enhance the effectiveness of treatment. As individuals seek comprehensive solutions for low back pain, exploring natural alternatives like Kratom can provide additional avenues for relief. With a commitment to providing high-quality Kratom products, Kratom Earth Canada offers a trusted source for those looking to supplement their treatment regimen with a natural botanical option. By embracing a holistic approach that combines physical therapy with complementary alternatives such as Kratom, individuals may find a more comprehensive and personalized approach to managing their low back pain.

What form of treatment rationale did you learn/are learning in your program? Have you struggled on clinicals to integrate what you learned in school to a particular approach seen in the clinic? What are the positives and negatives of this variation? Let’s talk about it! Tune in at 9pm EST this Wednesday, March 20th for the next #DPTstudent tweetchat!

CHAT UPDATE

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Mentioned Readings

http://www.somasimple.com/forums/showthread.php?t=14868

http://www.craigliebenson.com/wp-content/uploads/2010/08/sdarticle.pdf

#DPTSTUDENT TOPIC FOR WEDNESDAY, MARCH 13, 2013: THE PT/ PTA RELATIONSHIP

The first PT clinic I ever experienced as a patient utilized PTAs to the max. In fact, I think I only saw the PT for 10 minutes at most each visit. The next PT clinic where I was a patient did not have PTAs at all because the clinic owner wanted the physical therapists to spend the maximum amount of time with each patient. I received great care at both clinics.

What are your thoughts on the relationship between PTAs and PTs? How much time should a PT spend with their patient versus the PTA? Do you think patients understand the difference between the PT and PTA? What are the big differences in what we do?

And lastly, let’s about the article that appeared in the December 2012/ January 2013 edition of Pt in Motion titled “The Joint Manipulation Debate” that discusses the APTA policy that only PTs can perform join manipulations.

Talk to you tomorrow evening at 9pm EST!

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, MARCH 6, 2013: PHYSICIAN OWNED PHYSICAL THERAPY SERVICES (POPTS)

Physician owned physical therapy services and referral for profit can be added to the laundry list of items that physical therapists are standing against. What is a POPTS? The name pretty much sums it up- it is a clinic which offers PT services that is owned by a physician. This means the physician gets a kick back of the profit for patients referred to the physical therapist.

I read about the bill and the legislation behind it, I read the cons that the APTA stated about POPTS, but it was not until I read Joe Black’s post on POPTS that I truly realized what it was, the impacts it had on PTs and patients. It was then that I also realized that in 2009 I was one of those patients getting mediocre care at a POPTS clinic. I took a pretty nasty fall why skiing, tearing my ACL, MCL, and medial and lateral meniscus. I went to the best Orthopedic surgeon that the DC area had to offer. After surgery he referred me to “his” PT clinic saying that I would get the best care there because “his” physical therapists know the ins and outs of the surgery I just had. I did not argue because I did not know any better. After 2 weeks of seeing a PT that asked me every time I saw her what my injury was, I decided to find attorney for birth injuries claims to help me financially for what I am about to do next. I went to small independently owned clinic and worked with the PT who pushed me beyond my limits, had me running in a few weeks, and came to cheer me on at the finish line of my first 10k. She is the reason why I became a triathlete, quit my job in accounting and am pursuing a career in PT but that is a different story for a different day.

Now looking back on it I also realize that the POPTS clinic charged me $25 each visit where as the independently owned clinic did not charge me anything because she told me my insurance covered it in full. Darn, I wish I would have not been so uninformed back then!

To play devil’s advocate- do you ever think a POPTS clinic model could be a wise investment for both the physician, the physical therapist AND the patient? Let’s talk about it!

For your reading pleasure here are several great reads on the topic:

Stop POPTS
Term and Title Protection for Physical Therapist and Physical Therapy
AB783 and the California Campaign to Stop POPTS
POPTS in California. The Anti POPTS Movement Goes Web 2.0
POPTS and Referral for Profit
APTA and POPTS-II

Talk to you Wednesday, March 6 at 9pm EST!

CHAT UPDATE

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#DPTSTUDENT CHAT TOPIC FOR WEDNESDAY, FEBRUARY 27, 2013: IS TAKING A HISTORY AND PERFORMING A PHYSICAL EXAM NECESSARY?

The other day this article was making its way around Twitter. It discusses the importance (or lack thereof) of performing a history and full physical exam on a patient.

While this article is not about PT specifically, it got me thinking. I am spending a great deal of time learning how to perform a PT exam- I even have a class this semester titled “Physical Therapy Examination”. Yet, I know that some PTs do not perform a comprehensive exam and even fewer take vital signs during a visit. There is a ton of valuable information that can be learned through vital signs and a full evaluation. What do you think about this? How do we balance efficiency while still being thorough and treating the whole person? Is a full evaluation necessary or a waste of precious time?

Let’s talk about it!

Current PTs are welcomed and encouraged to join in on this chat! All of us students would love your input!

 Chat Summary

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This chat also included a great list of recommended readings.

Maitland’s Vertebral Manipulation, 7th ed: http://t.co/tPQHxzanTm

  • Eric Robertson (@EricRobertson): “Also the Maitland texts have an excellent chapter on communication.”
  • Jerry Durham (@Jerry_DurhamPT): “Directed towards Maitland book which was very helpful”
  • Kyle Ridgeway (@Dr_Ridge_DPT)- “Read the Maitland Subjective Exam Chap about 1x every 4 months w/ experience it will make more sense”

 

Checklist Manifesto by @Atul_Gawande

  • Kyle Ridgeway (@Dr_Ridge_DPT) – “all #DPTStudent should read Checklist Manifesto by @Atul_Gawande #PTScience”

 

Reading list by @mikereinoldblog

  • Mark Kev SPT(@markymarkkev) – “@mikereinoldblog has a good reading list”

 

Illness Narratives by Arthur Kleinman

  • Kyle Ridgeway (@Dr_Ridge_DPT)– “All PTs should read the book Illness Narratives by Arthur Kleinman For us the subjective is VITAL”