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Leveraging Technology III: Selection of Content

In the first two posts of this series I discussed the concepts of RSS and Web 2.0 as well as detailing the set up of Google Reader.

  1. The Basics: Web 2.0 and RSS
  2. Google Reader

This post will discuss which journals we should be following and reading as physical therapists. Obviously, there is Physical Therapy Journal as well as population and practice area specific physical therapy journals published by the sections of the American Physical Therapy Association:

Click on the picture to visit the Acute Care Section’s Website!

Definitely subscribe to some (or all!) of those journals via RSS. Remember, if the journal website does not have an RSS icon or url, you can create an RSS  for a PubMed search for that specific journal. I outlined how to do this in my previous post.

Following physical therapy specific journals seems quite obvious. But, an interesting article published in Physical Therapy Journal detailed some specifics regarding journals that publish physical therapy and rehabilitation specific trials. The article, Core Journals that Publish Clinical Trials of Physical Therapy Interventions, analyzed journals that published clinical trials of physical therapy interventions. The journals were then ranked by

  1. Total Number of Trials
  2. Quality of Trials ranked via PEDro Score
  3. Impact Factor

Most Trials of Physical Therapy Interventions

  1. Archives of Physical Medicine and Rehabilitation
  2. Clinical Rehabilitation
  3. Spine
  4. British Medical Journal
  5. Chest

Highest Quality Trials Based on PEDro Score

  1. Journal of Physiotherapy
  2. Journal of American Medical Association
  3. Stroke
  4. Spine
  5. Clinical Rehabilitation

Highest Quality Trials from 2000-2009

  1. Journal of Physiotherapy
  2. Journal of American Medical Association
  3. Lancet
  4. British Medical Journal
  5. Pain

Highest Impact Factor: 2008

  1. Journal of America Medical Association
  2. Lancet
  3. British Medical Journal
  4. American Journal of Respiratory and Critical Care Medicine
  5. Thorax

The authors conclusions:

  • Physical therapists must read more broadly than physical therapy specific journals
  • High quality trials are not necessarily published in journals with the highest impact factor

Surprised? The only physical therapy specific journal is the Journal of Physiotherapy, which is published by the Australian Physiotherapy Association.

NOTE: Take into account the data is only in regards to Randomized Control Trials (RCT’s) of interventions. It does not include information regarding articles on basic sciences, physiology, or neuroscience. Further, it does not include case reports, clinical perspectives, and other manuscript types. Regardless, it provides us with guiding information on where we should be looking for research to guide our practice and understanding. In addition, I believe it reiterates the point that we need to continually look to other areas of research to deepen our mechanistic understanding of physiology especially neuroscience. I think it is absolutely imperative we stay up to date on basic science research especially as it relates to neuroscience, the physiology of pain, and exercise science.

For example, in October of 2009 Critical Care Medicine devoted an ENTIRE supplemental issue to Intensive Care Unit Acquired Weakness (ICU-AW) including clinical and physiologic studies examining neuromuscualr impairments, clinical examination, and clinical treatment. In all, there were 20 articles, reviews, and manuscripts in this supplement. That sounds like something a physical therapist practicing in acute care should follow!!

Now, although Physical Therapy Journal failed to make the Top 5 in any of the categories above a recent investigation in Journal Citation Reports gave PTJ high marks: #1 Among physical therapy specific journals. #3 Among ALL rehabilitation journals. #7 of 61 Among orthopaedic journals. Please visit this post via PT in Motion: News Now for a summary. Paul Ingraham, a massage therapist and writer covering science based pain care over at Save Yourself, compiled his own Top 10 List based on the results of the PTJ study. His list is very similar to the ones above.

Below you will see journals that I think are applicable to clinical practice and scientific understanding. I organized them by a few practice areas and topics. I also provide the RSS link next to the journal name. I did not include any of the physical therapy specific publications, but the links to those journals are earlier in the post. In the instances where the journal does not have an RSS, I have included an RSS for the PubMed search for that particular journal. If you want to follow any of the journals below all you have to do is copy and paste the RSS url into the ‘Add Subscription’ box of google reader! I have also hyperlinked to the journal websites, so please also visit the journal websites to explore other potential RSS options on content including online ahead of print and podcasts.

General Clinical Practice and Basic Sciences

Medical Journals

Acute Care

Neurologic

Orthopaedics: General

Manual Therapy

Sports

Now, this is not an exhaustive list. Depending on your practice area and the populations you work with other journals may be more applicable. For example, if you work at a rehabilitation hospital that specializes in the treatment of spinal cord injury Spinal Cord and Journal of Spinal Cord Medicine are obviously more applicable journals. Also, I did not include lists for Pediatric, Geriatric, or Women’s Health practice areas. But, if you practice in these areas or have suggestions please provide us some information by leaving a comment!

Hopefully, the information and journals listed were helpful. Spend some time over the next week analyzing which journals you subscribe to, follow, and read. Ask yourself “WHY?”

  • What journals do you read?
  • What would you add to the above lists?
  • What did I miss?

In the next post, I will provide a brief overview and evaluation of some of the blogs I follow. Do you have favorite blogs that you read? Please comment and let us know. Stay tuned!

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Leveraging Technology II: Google Reader

In the last post, I introduced the basics regarding RSS and Web2.0. In this post I will go over how to set up and utilize Google Reader, a specific RSS reader. Watch the video below for a an explanation and visual demonstration of Google Reader:
Google Reader in Plain English by Google

Before you can use Google Reader, you must have a google account. If you have a gmail e-mail address or use any of the other products from the google suite including calendar or documents then you already have a google account. Once you are logged into your google account find the link to “Reader.” This link lives either on the top menu or under the “More” drop down menu.

Click the “Add a Subscription” button!

The ‘Add a Subscription‘ box of of Google Reader is where you paste RSS feed urls. Once added, the RSS feed delivers new content from the website directly to your Google Reader: Your Internet Inbox! (FYI > click on any of the images in the post and bigger version will appear in a new window)

Now, adding RSS Feeds from your favorite websites, blogs, and journals is very easy. There are 2 ways to add feeds.

  1. Click on the RSS Icon of a website
  2. Search for RSS Feeds in the ‘Add a Subscription’ box

Most websites, including blogs and major journals, will have an RSS icon. Click this icon to access the url for the website’s RSS feed url. Some websites, such as Physical Therapy Journal, have multiple RSS options.

Physical Therapy Journal has multiple RSS options. You can subscribe to current issue, ahead of print e-publication, case studies, commentaries, etc.

When you click the RSS icon it may take you to a page that looks like code and/or a preview of the RSS feed. If this is the case, copy and paste the url. Or, it may have a bunch of buttons, one of which says ‘Add to Google Homepage’ or ‘Add to Google Reader.’ If that is the case, then click the ‘Add to Google Reader’ button.

Click the Add to Google Reader button!

Clicking the button will either add the feed to your google reader and/or open the RSS feed in google reader (as if you had found it through the add a subscription search box). Do not forget to click ‘add a subscription’ button! The ‘Add a Subscription’ box doubles as a search. You can type in keywords to search for RSS feeds of websites that match your topic, and easily add them to your Google Reader line up.

Unfortunately, not all journals have RSS feeds (what?!). For example, the International Journal of Sports Physical Therapy does not have an RSS feed for new content, issues, or articles. Luckily, there is an easy fix to this. You can turn any PubMed search into an RSS feed.

Turn any PubMed Search into an RSS feed including topic specific, author, or journal. Have new results automatically pushed to Google Reader!

To construct a specific search for journal click the advanced link which will take you to a new window. Under the heading search builder there is a drop down containing such search options as author, journal, title, or abstract. Select the journal option and then type the journal name in the search box. Once the search is complete click on the RSS link, which conveniently has the orange RSS symbol to the left. This will pop out a box with some options for the RSS feed including what you want to name. Click “Create RSS” once your have picked your settings. An orange box labeled “XML” will now appear. Click on this to obtain the url for your new RSS feed. Then copy and paste this url into the add subscription box of Google Reader. Now, you the results of a PubMed search delivered right to you. Remember, you can create an RSS feed for any search including author, journal, or topic!

Click the Create RSS button, and an orange box labeled XML will appear. This is the url for the RSS feed of your PubMed search.

That’s the basics for Google Reader. Be sure to play around with the different options. You can create folders, edit feed names, and share items with people who follow you on Google. Check out the videos below for more in depth demonstrations and explanations of Google Reader. In our next post, I will discuss which Journals we should be following and why. Some of the recommendations may surprise you…

In the video below, our very own Mike Pascoe demonstrates using Google Reader including how to make an RSS feed for a specific PubMed search.

Monitoring Physical Therapy Research Using Google Reader from Mike Pascoe on Vimeo.

For a very detailed explanation of how to set up and start using Google Reader, watch the 10 minute video below.
Google Reader: Getting Started by Capture the Conversation

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Leveraging Technology I: The Basics: Web 2.0 and RSS

Via The Power of Media Blog. Click image to visit.

Last week, I gave a 30 minute demonstration and lecture to students illustrating how to utilize RSS and RSS Readers, specifically Google Reader, in accessing research, information, and discussion specific to physical therapy students and clinicians. The next series of posts will explain:

  1. Basic concepts of RSS and Google Reader
  2. Selection of content: Which journals we should be reading and WHY
  3. Review and critique some of blogs that I follow
  4. Finally, discuss the use of social media and Web 2.o principles, including Twitter, to not merely access information, but engage in critique, debate, and discussion.

Web 1.0 to Web 2.0

In the beginning, Al Gore created the internet. And, that internet was very much like navigating our highway system. You merged on, with or without a map, and started exploring. You searched, found, and read relatively stagnant content published by others. If there was a website you enjoyed you added it to your bookmarks folder. Then you had to visit the website regularly to check for updated content. That is Web 1.0. With the rise of blogs, Facebook, and now Twitter, users are not just recipients of content. Now, users can edit content (i.e. commenting on a blog or news article) and create content (i.e. Facebook and Twitter). This is Web 2.0: User generated content. Engaging, critiquing, editing, adding, and publishing content in real time!

What is RSS?

RSS stands for Real Simple Syndication. RSS is a specialized URL (usually ends in .xml) that feeds information from a website to an RSS Reader. It is a way to receive information from a website without actually visiting that website. For example, a podcast is a type of RSS feed that has an audio file at the center of each new post. Research journals and blogs all usually have RSS feeds.

What is an RSS Reader?

An RSS Reader, or Aggregator, is a software program that collects and displays information pushed from RSS links/feeds. A reader is similar to an e-mail inbox, except this is an inbox for the internet! No more bookmarking or remembering [forgetting] to visit different websites, journals, blogs, and online resources. The RSS Feed pushes new information to your RSS Reader allowing YOU to stay automatically updated on any new content from a blog, research journal, website, or even a PubMed search. Journals, blogs, websites (like ESPN), and most online resources now have RSS feeds.

There are browser-based readers and desktop based readers. Many readers also feature mobile apps, allowing you to access your RSS Reader Information on your smartphone. I utilize Google Reader, but of course there are other options.

Why RSS?

RSS Feeds and Readers save time and energy by pushing information directly to you. You then decide what to skim, what to skip, what to read later, and what to read now. There is absolutely no way you could access the same amount of information by surfing the net and bookmarking. RSS allows you to organize an inbox for the internet which broadens not only the volume, but the perspective of information you engage, share, and participate in. The scope of information pushed to you is limited only by your imagination. Plus, you only have to add an RSS to your reader once!

That is the basics regarding RSS. Hopefully, if you are not already utilizing RSS this outlined some of the advantages. The next post in the series will detail how to set up Google Reader.

Resources

  1. What is RSS? on ProBlogger.net
  2. Information to YOU! RSS and RSS Readers on AAOMPT Student Special Interest Group Blog
  3. RSS Info Detailed website dedicated to RSS information and history
  4. RSS Feeds for Physiotherapy by Rachael Lowe

Videos

  1. RSS In Plain English
  2. Getting Started with Google Reader
  3. Monitoring Research using Google Reader by Mike Pascoe [includes how to make a pubmed search into an RSS feed]
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Slide Design in Physical Therapy: A Case Study

A recent survey shows that most of us view at least 25 slide presentations per year. This is most certainly true for physical therapists, whether it is an in-service at the clinic or sessions at annual conferences.

Of the dozens of presentations, how many are memorable? What makes a presentation memorable? Aside from a story that resonates with your audience, engaging slide design is they key to sharing your message.

In this post I will illustrate what I mean by “engaging slide design” using a recent experience in which I was entrusted with a slide deck from a colleague who asked me to “jazz it up a little”. You see, I let this colleague in on my little secret – I am a presentation snob! Let’s get started…

Title Slide

Before

I did not like all of the logos on this slide. The “four corners” look really takes your eye away from the purpose of having this slide: to convey the TITLE of your talk and your name. Also presents too many font types and gives an eclectic feel to the slide. If you have a good introduction, which is not always the case, your audience will know where you’re from and who you represent. Presumably they also know that they are sitting in a chair at AAOMPT. I would also argue that only Johnny needs to be listed on the slide and to remove “Presenter:”. Mintken and Struessel can be moved to an acknowledgement slide. A black slide background is not a good choice, especially if your audience is going to attempt printing them out later.

After

One logo, one presenter name, no background color. Credentials are impressive but can take up more characters than your name and so I prefer to leave them off. I also convinced Dr. Mintken to finally join Twitter. You can learn more about Twitter use in physical therapy from this recorded lecture. Basically, by providing his Twitter user name “@PMintkenDPT” he is giving his audience a way to share content from his talk with others not in the room and providing a venue for discussions about his work long after the talk is over. It is 2011 and didn’t you know Twitter is the new Facebook?

Background Slides

Before

Time to build up your story by explaining why things are the way they are today, a.k.a. the background slide. This slide is typical of all slides in the “Before” deck, a title with bullet points, not one single image, redundant logos in the top corners, and a stock theme from PowerPoint.

After

In the first 60 seconds of your talk your audience is sizing you up and determining if they want to pay attention, you better grab them early! I suggest a full bleed, high-quality photo of a joint manipulation. The audience knows what they’re in for and they also have a better emotional response to a photo then a bunch of text. I confess that I did use bullet points here, but this is one of the only slides I used them. I felt that it was appropriate here because I am listing several items in the same class, terms for spinal manipulation.

Before

After #1

I really wanted an image to demonstrate how much research on the effectiveness of joint manipulation is out there – a stack of papers.

After #2

I used a photo of a classroom for the question – Are students receiving the education?

Before

Every talk with a research component needs to discuss what has been published previously. Here we see what is typical, a bulleted summary of the results.

After #1

It is also very common to put a screenshot of the title and author on your slide. I’ve been playing with a different way of showing the reference to the audience by capturing a screenshot of the top and sides of the paper and putting it into the slide with a shadow dropped behind it. The effect is that there is a physical paper out in front of you. Then I took a page from Garr Reynolds and built in the “56 %” in huge characters on top of the image of the article.

After #2

I also transformed the bulleted list of reasons why joint manipulation was not taught into a table.

Before

Here is another example of a slide that is covering the results of a previous study.

After

What I did here was magnify the bottom line of the study – 54% of clinical instructors reported not teaching joint manipulation. Again in a huge font, with an image of a PT clinic that reflects the fact that this lack of instruction on joint manipulation is happening in the clinic (where everyone in the audience also works).

Before

The presenter wanted to draw attention to the fact that some time had passed between when these studies above were published and when this talk was given. And did so with a text box.

After

I wanted to again use imagery to get a gut reaction for the audience. What happened in 2005 that really shows a large amount of time has passed? A pop culture image would surely connect with the audience. This is were Napoleon Dynamite can in to save the day. The presenter wanted to demonstrate that 5/6 years is a long time and I would argue that it feels like ages since since classic lines such as, “I told you! I spent the summer with my uncle in Alaska hunting wolverines!”

Methods

Before

People want to know how you did the research your presenting – the Methods. Here I saw another opportunity to transform bullet points into graphics.

After

The large blue circle represents the Program Directors and the small ones are the students that received the survey distributed from the Directors.

Results

Before

The data could be conveyed more effectively by using graphics over bullet points. But how?

After #1


Because the data were based on geography, a map immediately came to mind. You tell your audience that 38 states participated in your survey and they are probably wondering “was my state one of them?” I downloaded a vector graphic of the USA from wikipedia and filled in the relavanet states in Adobe Illustrator.

After #2

What about percentages? A pie chart works well to quickly show proportions. Put yourself in your audience’s place: while you are talking do you really want your audience to need to read all of your bullets? The words coming out of your mouth are in direct competition with the text on your slide. Make it easier for your audience to digest!

Before

For the first bullet point, a sub bullet point is used to convey MUCH IMPROVEMENT.

After

Made the 95% larger, in green to suggest this is a good thing, and put a thumbs up graphic in place of CAPITALIZED TEXT

Before

Here was an opportunity to tell the audience WHY students were not performing the joint manipulations they were trained to do.

After


Great opportunity to add some video into the talk. It is one thing for Dr. Mintken to stand up front and read quotes from students. It is a much better thing for him to show video testimonials from the actual students themselves.

To conclude…

So, all of these changes were made to this slide deck. How did it go? The presenter (Dr. Mintken) was pleased with his delivery of the talk, which is a good thing. For the remainder of the four day conference, every time someone approached Dr. Mintken the first words our of their mouth were “that was a really great talk!”

Here are some great books that have influenced my approach to slide design – Presentation Zen by Garr Reynolds – slideology by Nancy Duarte

I would love to hear your thoughts on how the slides changed in the comments section below.

– Mike

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Manage the Evidence Like a Pro

The problem. You are trying to stay current with the literature because that’s a great way to ensure quality treatment of your patients OR your a student in a physical therapy school that has a strong evidence based practice curriculum AND you end up having a hard drive littered with PDFs, like this:

Image by mekentosj.com

The solution. Papers2 by software developer mekentosj. This app makes it dead simple to organize your PDFs. Think of it as iTunes for PDFs, where instead of double clicking a track to listen, you double click to open the PDF in your favorite PDF viewer. You can search for articles quickly, email them to a colleague, even takes notes, all within the app. There are so many neat features I just had to put together a brief screencast demo, which you can view below:

Managing Physical Therapy Articles Like a Pro from Mike Pascoe on Vimeo.

In this 5 minute screencast, I show off some of the key features of Papers2. This video is directed toward those with a physical therapy background.

Papers2 can be downloaded here:
http://www.mekentosj.com

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Smart Phone Use by Physical Therapists

A Physical Therapist using his cell phone today in clinic.

Houston, we have a problem!

Kyle’s post about smart phone use by physicians had a brief reference to some data attempting to describe smart phone use by PT’s. Well, we did some digging and discovered the real figures. This information is preliminary data obtained when PT Journal surveyed a representative sample of APTA member subscribers and was relayed to me by personal communication from the managing editor. The response rate was limited (~30%) which is why this is preliminary data, but I’m told the demographics of the responders matched the journal’s overall demographics. The numbers are concerning when the respondents were asked, “Do you use a smartphones to access professional content?”

Essentially, more than half (54%) of the respondents from this preliminary survey were not interested in using smart phones to access professional content, thus rendering the phones significantly less smart. We have no idea how many PT’s own smart phones, but to me it this question is more important that how many people own a smart phone. To compare, numbers for physician use of smart phones range from 72% to 80% depending on the survey. Yikes!

Why the disparity between two related professions? I’m just not sure. I am looking forward to more data of this sort. We need to figure this out. I’ll leave you with this quote from Stewart Brand:

“Once a new technology rolls over you, if you’re not part of the steamroller, you’re part of the road”

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Hi-Tech at CSM

As healthcare continues to integrate new web technologies, fittingly, there is an increase in the technology-based offerings at the APTA Combined Sections Meeting this year. This conference, the pinacle of the PT meetings each year in terms of attendence and scope of programming and exhibitors, will be in New Orleans.

I found this handy way to read down some of the HPA Technology SIG programming via a Google Group. You might notice one tech session is Connecting the Classroom and Clinic: Use of an International Collaborative Classroom Wiki. I’m particularly excited about this session, as Rachael Lowe, Elaine Lonnemann and myself will be presenting Physiopedia! Hope to see you there!

Of course you can always check out all the programming on the APTA’s event page.

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iPad: PT’s New Best Friend?

By Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS

The iPad is quickly transforming the way business is conducted in the media, entertainment and education sectors. But what about health care? What are the specific benefits of the iPad for physical therapists and what should you be cautious about? As a clinic that has actively been using the iPad for about 6 months now, we have found a number of tangible benefits. Documentation is much faster and happens in real time with each visit. We can track and log the time of each modality, which is especially useful for insurance billing. The small, flat screen is less obtrusive than a laptop – We always felt the screen created a physical and potentially emotional barrier between my patients and myself. We also like that the ipad can be easily handed to the patient for demonstration of a video exercise or other visual aids.

A couple of notes of caution – the iPad doesn’t have a USB port or printer connection so document management is challenging. Current battery life is shorter than the 12-hour workday and common flash-based applications don’t work.

The other issues we face when evaluating the iPad as a medical tool are fragility (it will break if dropped) and hygiene since it cannot be sterilized. The latter is probably less of an issue for physical therapists than other medical professionals, but certainly bears mentioning.

The true future of iPad use within physical therapy clinics will depend on the availability of medical apps for clinicians. It seems inevitable that as our world becomes more and more technology focused we will have to start thinking about how to maneuver our own clinical landscape.

—

Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS authored this guest post. They can be found at Force Therapeutics or Twitter.com/ForceTherEx.

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Medieval Therapy Techniques?

Graston ToolsDo PTs today practice medieval therapy techniques? An ABC affiliate in San Francisco seems to think we use medieval tools, anyway. The technique reported on is the Graston Technique,® an aggressive form of soft tissue mobilization aimed at breaking up adhesions between fascia and muscle fibers using specialized tools. In theory, this treatment is essentially the same as aggressive STM; the difference lies in the use of the specialized tools.

So do the tools really make the technique more effective than traditional STM? The literature results are extremely limited. Only one study directly compared STM and the Graston Technique ®:

Burke et al. compared Graston Techniques ® to regular STM provided by the therapist’s hands for the treatment of Carpal Tunnel Syndrome. They resulted no clinical differences between the two groups, but did substantiate the clinical efficacy of conservative treatment for mild to moderate CTS.

Perhaps the effectiveness of the Graston Technique ® occurs from the ability to detect adhesions better than manual palpation alone. Users report feeling vibrations or hearing clicks as they move the tools over adhesions that were not detected by palpation. There are a few case studies that report solely on the effectiveness of the Graston technique.

Hammer reports on the ability of the Graston Technique ® user to both feel and target treatment on areas of degenerated tissues in three cases involving plantar fasciitis, Achilles tendonosis, and supraspinatus tendonosis.

Aspergren et al. effectively used thoracic (HVLAT) manipulation and the Graston Technique ® to treat a collegiate volleyball player with acute costochondritis. Although the authors did not compare to thoracic manipulation plus manual STM, pain and functional levels improved.

Other foreseeable benefits include the ability to really dig-in during STM and saving your own joints as a PT, benefits that may also be found in simple massage tools. The side effects include being too painful for many patients and causing bruising in some patients. In all, more research needs to be performed comparing the technique to regular STM by independent examiners.

Bottom line: for now, trust in your hands – they have been around since before medieval times, and are the most powerful tool a PT possesses.

1. Burke J, Buchberger DJ, Carey-Loghmani MT, et al. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007;30(1):50-61.

2. Hammer WI. The effect of mechanical load on degenerated soft tissue. J Bodyw Mov Ther. 2008;12(3):246-256.

3. Aspegren D, Hyde T, Miller M. Conservative treatment of a female collegiate volleyball player with costochondritis. J Manipulative Physiol Ther. 2007;30(4):321-325.

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Earth’s Central Nervous System

Yes, this is an IBM advertisement. But, I just had to post a video about the evolution of the internet which suggests that Earth has “grown a central nervous system!” Hello, semantic internet.