Critical observations of health, science, and the physical therapy profession.
Hey NPA Think Tank readers: I’m back from my blogging hiatus and ready to roll. My apologies for the unexpected lapse in my postings…
Here’s some video entertainment fresh from Texas State University. As you enjoy it, consider Evidence in Motion’s hint of a "Best of" video contest. Could be scary!
I got the chance to spend this past weekend at the annual conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). The event was excellent and my hat is off the the planners from AAOMPT who put together a seamless conference packed with incredibly useful programming, leaders in the field, pleasant receptions, and some awesome research platforms.
One of the more interesting moments occurred during the business meeting when a motion pass a position statement against referral-for-profit arrangements was passed without so much as a quip of debate. This, from a group who then proceeded to debate the appropriate use of the word "Evidence" vs. "Research" for more than 20 minutes! To me, this speaks to the ethical and rigorous standards the AAOMPT and its members are known to hold itself to.
This year’s conference marked the addition of a Student Association into the AAOMPT family (AAOMPT-SA). The
students who attended were well received and played a very significant role in the conference. Congratulations to them and to those students interested…join up! The networking and career growth that can occur from a conference like this is great.
Next year, we’re off to Seattle, Oct 29 – Nov 2. Convention center and all, it will be big time!
Images from Liz Sonnenberg
Some days it seems I need to search high and low for good blog fodder. On other days, the story seems to write itself.
Yesterday became one of those days when I clicked on the NEJM RSS feed in my reader. An article about the care and treatment of hip OA by Dr. Nancy Lane, was one of the new articles in this month’s issue of the New England Journal of Medicine. The editors obviously thought highly of the piece, because they attached continuing education credits for reading it if you were to take the following quiz. I was excited to see the medical community take a step toward reconciling their lack of musculoskeletal competence, however small, with this article.
The piece started off normally, with examination and interpretation of findings, but as the article progressed to treatment I found something sorely lacking. The physician writing the piece kind of skipped right over any details about a physical therapy intervention for this patient. Recommended were meds, an education program, and an aquatic exercise program. It wasn’t until the final conclusions that the term "physical therapy" actually makes an appearance and the term "joint mobilizations" was absent altogether. Dr. Lane did include acupuncture and "periodic telephone-support interventions by lay personnel" as treatments with supportive evidence, however.
A recent editorial in JOSPT (Journal of Orthopaedic and Sports Physical Therapy) thinks quite differently about how to treat an arthritic hip. In "First-Line Interventions for Hip Pain: Is It Surgery, Drugs, or Us?" Wainner and Whitman discuss exactly the patient population which the NEJM article presents. Their editorial outlines a variety of compelling evidence about the under-utilized, yet effective role physical therapists play with this patient population.
I’m not surprised that the Dr. Lane presumably had not read their editorial. After all, what motivation does a physician have to keep up with PT literature? Especially when they are so busy working as a consultant:
"Dr. Lane reports receiving consulting and lecture fees from Eli Lilly,
Merck, Procter & Gamble, Wyeth, and Roche and grant support from
Procter & Gamble, Amgen, and Rinat Neuroscience."
Which is another story in itself!
Hey, everyone’s got to make a living right? Regardless of who pays who and for what, the bottom line is that there is a standing lack of respect for Physical Therapy literature. Perhaps we speak "gibberish" to the docs, perhaps they don’t have the construct to understand manual therapy interventions, perhaps it is more of an institutionalized opinion among physicians that contributes to this oversight. Whatever the cause, I can only presume that more good evidence, from our group to theirs, can only help our cause.
Until then, I’m thinking of sending Dr. Lane an e-mail to let her know about how effective physical therapists can be with this patient population.
ERIC
Last night I got to work late and complete my required continuing education course in ethics and law for my Georgia PT license. I always enjoy working through case scenarios in classes like this and the debate that goes with.
We did not, however, deal with this situation, in which a therapist was allegedly stealing prescriptions from patients, and got caught on tape in a sting operation! Scott Ward aptly considered the case as "…certainly is grounds for investigation," when he was quoted in the article found at former of these links.
Nor did we consider if there is a different set of ethics and morals in play for big business, like orthopaedic implant manufacturers, for instance. What’s curious about this situation is that after these companies got caught in a kickback scheme, "Shares of all four public companies rose after the settlement announcement." So…kickback, get caught, enjoy increased market capitalization????
We also did not examine our role and legal duties if a patient shows up for their appointment right after being SHOT!
Well, at least I’m straight on how many continuing education hours I need to renew my license! Sandy, thanks for the fun class, by the way!
ERIC
If your wondering how effective spreading a message is on YouTube, just ask the Numa Numa Dance Guy who, like it or not, is at 5,856,401 views and counting. We know he’s good at that dance!
Well, some enterprising students at Regis University are hoping the same fame will befall them, and the clinical prediction rule (CPR) for patients with low back pain who respond to a spinal manipulation.
The video is pretty funny and does an excellent job getting the point across. If I was unaware of this CPR, I would be very curious to learn more after watching the video, which is the point I think. Often, you can’t tell which of your many efforts to communicate will stick with someone. Maybe this will be one of those times. I applaud the people who put together that video and hope to see more like it. I’m feeling a cult classic in the making if this came out as a series…
ERIC
I stumbled across this new blog at ESPN this morning and was very thrilled. Stephania Bell, MS, PT, OCS, CSCS, has a new fantasy blog hosted at ESPN where she provides injury analysis for all of the worrisome fantasy sport managers around the globe. This is a big time blog presence for a physical therapist.
This is some solid PR for PTs! This very excellent post on Greg Oden is just one example of the nice analysis Stephania is providing on ESPN. But, perhaps Stephania has even more marketing savy than she lets on. You see, when she posted that post about microfracture surgery, Google Hot Trends tells us that "microfracture surgery" was in the top 25 of all Google search queries. So, we have poignant information, very large broadcasting platform, and good writing all in one. Go Stephania!
The APTA has even gotten in the mix on this one and includes a link to the ESPN blog on their consumer page. I do consider this a solid upgrade over conversations about backpacks. As a fantasy football player, I appreciate the input and advice a therapist can bring to interpreting injuries. For example, I understood that Eli Manning and his AC joint sprain would probably play, but why another player with a meniscus injury might not. That type of information is gold to fantasy players and I can think of few others more qualified to offer it that a PT.
Welcome!
Thanks for joining me here at the new domain for NPA Think Tank. I do apologize if your feed e-mails have been a little weird lately, the transfer process wasn’t as smooth as I would have hoped. Anyway, here we are. I had a lot of help from Jessica King designing my site, so if you like the page and want one of your own, a link to Jessica can be found in the right sidebar. I should also point out, that Jessica is also quite the musician and can help you out if you’d like to hear some nice music from someone who can work wonders on an acoustic guitar!
Some Updates:
Since this post isn’t really about anything, I’ll continue in the same direction and provide some updates about me. Most of my readers are probably well aware of my new job by now, but to update, I’m now on the faculty at Medical College of Georgia teaching in the Physical Therapy department of course. I’ve been there for about a month so far and I’m really loving it! I hope to be able to explore some new twists in the field of evidence and technology as I go, so stay tuned. As far as upcoming content goes, I plan is to use my teaching content as a generator for posts thoughts. For example, if I’m teaching about Power Training, I might try to write a post on the same subject. That way, the MCG students at least will be able to find something else to think about and the rest of you can keep up with where my brain is.
I’ve run on for long enough! Make sure to re-subscribe to the new feed for this site if you did not subscribe to the Feedburner feed. Not sure if you need to resubscribe? Do it anyway…if you get two feeds, just delete the old one.
Thanks for Reading!
ERIC
Unless you’ve been living under a rock, pretty much everyone must be aware that Kevin Everett suffered a severe spinal cord injury this weekend in the Bills game. At first, the prognosis was expectedly grim after an estimated impact force of 2/3 of a ton to Everett’s spine. Now it seems a more positive outcome may be expected.
In listening to some of the interviews, a physician from the Miami Project made a statement that Everett benefited from the earliest application of moderate hypothermia after a spinal cord injury…ever. That is rather profound. From what I can gather as a very outside observer, doctors began lowering Everett’s body temperature in the ambulance and further reduced it once at the hospital by means of an IV catheter.
It is widely understood that cooling tissues reduces the damage cause by inflammation. It is practiced in neurosurgery, with neonates, after sprained ankles, and now with spinal cord injuries.
This image demonstrates the reduction in neural tissue possible with hypothermia treatment. The top two tissue samples were controls, and the bottom sample was cooled to 32 degrees C. The highlighted parts of the image shows areas of tissue death. Pretty amazing!
And, in a big example of "what comes around, goes around," it was reported that the Buffalo Bills owner is a large donor to the Miami Project.
One final note, the Miami Project doctor I cited earlier did upset me with the quote, "…will walk out of the hospital." This is far from a foregone conclusion and seemed a bit overzealous and self-promoting to say that on ESPN. Either way, I’m writing about him.
“Consumers have just become more comfortable eating films.”
That, from the New York Times.
This story about professional mountain biker Neven Steinmetz, caught my eye for sure. I have a special place in my heart for downhill mountain bikers, people who survive smashing into things, intellectual pursuits and stories about physical therapy. This one has it all! An inspiring tale of what a driven person can accomplish. I’m so inspired, I’m going to start commuting to work on my downhill bike!
Steinmetz has been nominated to represent the United States at the upcoming 2007 UCI Mountain Bike World Championships in Fort William, Scotland, Sept. 3-9. I will be watching her results for sure!
As an interesting note, this woman suffered a head injury that went undiagnosed, a very popular story in the media right now as it relates to injured troops.
Labels: current press, physical therapy, sports