Posted on

Broadcast your CPR!

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

Posted on

Does "Peer-Reviewed" make it True?

I wrote a post a couple days ago about epidemiology in which I quoted a line from a news article about wrong hypotheses.  The concept of wrong hypotheses seems to have previously gotten a leg of its own in the blogosphere.  Most notably, Alex Tabarrok at Marginal Revolution wrote a thorough post entitled, "Why Most Published Research Findings are False" mirroring the title on an article written by John P. A. Ioannidis in PLOS Medicine.

The WSJ has even gotten in on the mix commenting on Dr. Ioannidis’s article.  This is a nice editorial full of resources if you wish to read more on this topic.

Speaking of the WSJ, I was excited to hear that Mr. Murdoch is considering eliminating the payed subscription requirement for the online journal much like the New York Times recently did as well.  Hooray for free info!!!

Here is the diagram used by Tabarrok to explain the false findings argument:

Truehypo_3_2

Posted on

Examining Epidemiologic Research…

Spider_web

…or why you shouldn’t believe much of the health information coming to you from your local newscast.

The New York Times magazine has presented a wonderful article written by Gary Taubes, which describes the strengths, weaknesses and intricacies of epidemiological research studies.  It is lengthy, but contains more than its fair share of great quotes and good information.  It nicely concludes with some basic suggestions for how you or I, as individuals, should interpret what we hear from these type of investigations.

This is a great read for providing some good insight into complicated research in some nice, plain language.  The prescriber effect, healthy person effect, and the inability of observational cohort studies to conclude causality between variables are just a few of the topics discussed.  My favorite quote of the article: 

"There are, after all, an infinite number of wrong hypotheses for every
right one, and so the odds are always against any particular hypothesis
being true, no matter how obvious or vitally important it might seem."

Update:  The WSJ has checked in with another Hormone Replacement Therapy update at their blog this morning.  The title aptly mentions the words "clue" and "mystery."

ERIC

Posted on

The next big advance?

At one point in time, scientists did not know that germs caused disease.  The reason:  they were not able to see the germs.  Well, as optical technology improved, it became easy to study and examine the little buggers causing our body harm.  The knowledge now seems commonplace today.

One lasting barrier to all imaging is the ability to see inside living cells.  An MRI can image tissue well, but not at a cellular level. A study in the online journal, Nature Methods, discusses a technology that could change the way we think about how our bodies work.  Scientists have been able to construct an view of the inner workings of living cells in your body!

Tomographic Phase Microscopy.

Labels:

Posted on

How do you get your evidence?

I am employed by an academic institution with a fine health science library. I belong to several sections of the APTA as well as the AAOMPT. Through these affiliations I am able to get my hands on quite a few journals and read full text articles when I like.

I was thinking the other day, about how many allied health professionals do not have access to such a library of content. This would include those working in private practice, non-academic hospitals, rehab centers, local school systems, etc. How do these folks get their dose of evidence? How difficult is it to get access to an important new article?

There is PEDRO, and the Cochrane Database, and the APTA resources such as Open Door, but these are far reduced from what I use. They also suffer from lack of use among therapists. A scattering of journals offer free text, but usually there is a time delay or restriction with this. A service like InfoPOEMs is kind of expensive and not rehab focused even if it is useful in theory.

A colleague recently left the hospital system that I’m in and now works at a corporately owned outpatient clinic. She has no access to journals.

Barriers lead to inactivity. Inactivity leads to the failure of the principles surrounding Evidence-Based Practice. How much of a professional duty is it for health care providers to pay their own $$ for access to evidence? How much of that burden should fall on the employer?

I will assume that a majority of the Physical Therapy work force is in practice settings with limited access to rehab/ortho journals. Does this mean that the majority of the profession does not keep up with new evidence? Regardless of that being true or not, I think these barriers need to come down somehow.

Any thoughts on access to literature among Physical Therapists?

Image: Arnold Bernhard Library, Quinnipiac UniversityHamden, Connecticut

Labels: ,

Posted on

Oh Brother! "PT's Do Research?"

Teaser: Find out what one MD thinks of Physical Therapy! Please read the whole story: Kind of longish, but entertaining never-the-less.

Recently, my work environment has changed. I’m no longer in the traditional outpatient setting. I have been shifted to a clinic that exclusively treats military trainees. I’m still deciding if I enjoy it or not, but my new office mate has proven to be rather thought provoking.
I now share an office with a Physician. The simple fact that I share an office in this way speaks about how Physical Therapists are perceived differently in the Army vs. civilian life, where I would never be allowed to have a key to the proverbial "Physician’s Lounge." Anyway, this guy, an elder fellow who’s a Family Practice doc, has taken it upon himself to challenge my brain every few minutes. For some, this might be tortuous. For me: Game On!
We have each had our share of victories and defeats thus far. He usually sets me up for wrong answers, so I expect my winning % to increase once I recognize his lead-ins more quickly. Anyway, he loves to impress me with his medical knowledge base. Occasionally, I get to teach him something.
I was reading this very useful case series from the latest JMMT issue. The article is a good representation of how back pain is treated in the hands of expert Physical Therapists. Included is a nice chart about how certain symptoms lead to certain treatments and so forth. I explained this chart to my office mate and answered some of his questions about the research supporting it. His response was mostly quiet, which I have come to take as a sign of my victory in our virtual battle of wits. I sat back happy and gave myself a pat on the back. Unaware that his greatest and most vicious attack yet was pending.
Several hours later over lunch he states, "That article was pretty interesting."
Still I think I’m winning.
He continues, "You know, I never new Physical Therapists did that."
I smirk, "What, classify types of back impairments and treat accordingly with specific, focused treatments because they are backed by scientific evidence?"
"No. I didn’t think you guys did research."  He was being totally serious.
I walked away in stinging defeat. This story is sadly humorous, and of course, limited to this one doctor. But, how many more physicians have the same opinion as my witty office mate? 
Lesson Learned: Talk about the research you read. It not only shows others that you personally are well read, it impresses them about the entire field of Physical Therapy. And, as this points out, we need all the good PR we can get.

Labels: , ,

Posted on

The Solution for Elderly Driving Woes

Always up for noble research investigations, Yale University researchers have been studying elderly driving.  Elderly driving, of course, frightens me.  All too often a senior citizen finds themselves slamming on the brake, only to maroon their sedan halfway up a tree by hitting the gas instead!

The research sent elder drivers to a Physical Therapist who enacted a supervised physical fitness program.  Not surprisingly, the participants in the experimental group improved their driving skills.

 
 
The fit elders also had a reduced risk of falls. 
 

Labels: ,

Posted on

The Health Effects of a Forest, or Yoga, or Pilates…


Get to the point, originally uploaded by surfwax.

I happened across this unique investigation in the the Journal of Physiological Anthropology today. Sure, this might not be the most widely read journal, but I thought this little study worth some thought.

Shinrin-yoku or "Taking in the forest" was found to be correlated to reduced blood pressure and reduced salivary cortisol secretion (stress hormone). In other words, taking in the forest was relaxing. The study was proud of the fact that it was able to correlate subjective responses to the forest with measurable physiological changes.

I’m happy because I think this may provide all the scientific evidence I need to open a cardiac rehab unit in my local state forest! Not convinced? Well, go check out the multiple citations in Pub Med on the subject of Shinrin-yoku.

This type of thing also calls to mind the practice of Yoga Therapy. This has gotten some pretty solid press lately, in both the New York Times and elsewhere. In both instances, the subjects of the article were keen on selecting a yoga therapist who was also a Physical Therapist.

"I wonder what kind of evidence supports this yoga therapy?", I asked myself.

Well, here’s some evidence supporting yoga therapy for non-specific chronic low back pain (pdf) in a slightly more well-respected journal, Annals of Internal Medicine. Per the NY Times, the National Institutes of Health has allocated $1.2 million for a second study to see, in part, if the results can be replicated on a larger scale. In fact, there is quite a bit of evidence for Iyengar Yoga Therapy in general. I also found this systematic review.

So what’s my point? Evidence is evidence. Sometimes I’m tempted to shrug off research that speaks about walking in the forest. I know that hiking is relaxing without consulting a journal. But, perhaps it is in this "alternative" research where some basic and valuable lessons are learned. Is there enough evidence for me to integrate yoga therapy in my practice? Not sure, but I better keep a look out!

I leave you with a quote from the news article:

“Anybody can hang their shingle and say they are a yoga therapist,” said Julie Gudmestad, a physical therapist who also practices yoga therapy in Portland, Ore. “Buyer beware. I’ve seen some strange things done in the name of yoga therapy.”

Labels: ,

Posted on

Using Evidence to Change Practice Paradigms

Last night, the Midlands District of the South Carolina APTA was treated to a nice lecture from Stacy Fritz, PT, PhD, a professor at University of South Carolina, during our biannual meeting.

Her topic was something she calls Intensive Mobility Training (IMT). It describes a type of Physical Therapy intervention in which individuals with chronic neurological impairments are given intense (as the name suggests!) therapy utilizing some very interesting principles. The therapy essentially pairs components of two unique neurological interventions, Locomotor Training (LT) and Constraint-Induced Movement Therapy (CIMT).

Among the principles that this therapy is based on, one captured my imagination: the concept of massed practice. Essentially, this motor learning theory groups the learning for a task into one small period of time with an enormous amount of repetition during that time. An example would be 2 weeks of 3-6 hours of therapy daily, in which the majority of time spent was performing the desried task repetitvely, i.e., walking. This is in contrast to more traditional rehab schedules, such as 3 times a week for 60 minutes over 8 weeks.

While I was listening to the talk, I had a difficult time wrapping my brain around the possible scenario in which an insurer would ever pay for such time periods of therapy, which sometimes includes multiple therapists working on one patient. Well, research like this may help to answer a question that is just so obvious as to be often neglected:

“What evidence supports how much therapy a patient requires?”

Perhaps research like this might one day pave the way for a “revolution” in how Physical Therapy services are provided with respect to time and dosage. I know one thing for sure: without evidence like this, insurance companies will be all too eager to keep us locked into the current time-based payment scale!

Aside from her informative lecture on IMT, I learned two things I was not expecting to:

1. South Carolina leads the nation in incidence of stroke.

2. The incidence of Spinal Cord Injury in SC is 20% higher than the national average.