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500 Word Letter to the Editor? $31.50…

…real scientific and professional discussion? Priceless.*

*And free

In a previous post, Publishing in Science: Are Industry Standards Serving Researchers, Clinicians, and Science?, @JasonSilvernail and I discussed some of the problems with the current publishing industry paradigm as well as our personal frustrations with the process. These insights stemmed from writing a letter to the editor of Manual Therapy, which is currently e-published ahead of print (in press, corrected proof). A link can be found here: Innominate 3D motion modeling: Biomechanically interesting, but clinically irrelevant.

Well, unfortunately for you, reading that letter will cost you $31.50 unless you have a subscription to Manual Therapy, or are affiliated with an institution with accessing rights. For those of you doing mental math at home, that equates to 6.3 cents per WORD (references included at no extra charge!!) Of course, no abstracts accompany letters to the editor, but they do provide a 29 word preview (essentially 1.5 sentences). My question is: does anyone EVER buy a single letter to the editor? I sure hope not. Logically, I can’t imagine publishing companies profit significantly off 500 word letters to the editor, because I can’t imagine anyone buying them.

Now, if you would like to read our longer, better version that was denied prior to review check out this post:        SI Joint Mechanics in Manual Therapy: Relevance, Please? It even includes links to 2 other blog posts that have healthy discussions happening in the comments section. The references section contains links directly to abstracts.

  • Don’t agree? Have other insight? Want to comment? Click the comments section and fire away.
  • Want to share? Tweet, link back, Facebook, Google+, e-mail, and re-distribute the link freely.

Putting a 500 word letter to the editor behind a pay wall seems to accomplish nothing for science, discussion, clinicians, or even the publishing companies. We think it’s time for a change...

@JasonSilvernail   &   Dr_Ridge_DPT

 

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Publishing in Science: Are Industry Standards Serving Researchers, Clinicians, and Science?

Recently, @JasonSilvernail and I wrote a letter to the editor of the journal Manual Therapy entitled Innominate 3D Motion Modeling: Biomechanically Interesting, but Clinically Irrelevant. The article is currently in press [Reference: Ridgeway K, Silvernail J. Innominate 3D motion modeling: Biomechanically interesting, but clinically irrelevant. Manual Therapy (2012). doi: 10.1016/j.math.2012.02.017]. The letter was a response to a recently published article on the non-invasive 3-D modeling of SI joint and pelvic motion, which in our humble opinions lacked any clinical utility or relevance.

Our submission was denied prior to review 2 separate times because of word length. The (we feel arbitrary) word length for an editorial or letter to the editor is 500 words. Despite multiple e-mails explaining why our piece should be considered in it’s entirety, the editor (through the Journal manager) insisted on a 500 word maximum before being considered for review. The original submission was just over 1,100 words.

We were faced with some decisions. Increasing the scope of the piece to a different manuscript type such as a “masterclass” or “professional issue” was discussed. But, these pieces are usually 3 to 4,000 words and are beyond the scope of what we were trying to convey. We also debated about submitting to another journal, such as the Journal of Manual and Manipulative Therapy. In the end, we decided to cut the length to 500 words, publish our original piece (in it’s entirety) HERE on PT Think Tank, and start a discussion regarding the original topic as well as our current peer review and publishing system. We thought it was an ideal time to explore whether the current journal peer review system is working for clinicians and scientists and what, if anything, we should do about it.

The original piece can be found in it’s own blog post HERE. An excerpt is at the end of this post. Feel free to comment and distribute freely. We would love discussion surrounding the actual issues the letter raises, and some of our criticisms of the research.

In the end, our goal was to express our interpretation of the study Inter-tester Reliability of Non-invasive Technique for Innominate Motion by Adhia et al, including it’s relevance in the context of the current scientific research on the topic and modern clinical practice. We hoped to facilitate scientific discussion and discourse surrounding the topic. Yet, arbitrary word lengths and overly specific categorization of manuscript types actually hindered REAL discussion. For this, we are disappointed. We were not requesting 4,000 words in the journal for an unsolicited narrative review of an area not relevant to the readership. We were seeking consideration for an 1,100 word response letter to an article Manual Therapy had published. A response that in our minds was well written (you be the judge!!) and presented some key issues beyond the study itself that would be of interest to the readership.

We think it is likely that Manual Therapy and it’s editorial staff are forced into industry-standard practices that currently define the for-profit publishing industry.  We have every confidence that the clinicians and scientists on the editorial staff of Manual Therapy are as interested in professional discourse as we are, but are hindered by the system. We do not doubt their scholarly curiosity or suggest any bias against us personally or our perspectives. In many ways they are as hindered by the system as we were. In fact, perhaps more so.

Many people feel the current medical publishing industry does not support clinicians and scientists, but in many ways is primarily about making money for publishing conglomerates. There are many well educated, well published scientists who have raised these concerns, including the people at Body In Mind. A group of scientists the New York Times featured is actually boycotting the publisher Elsevier. Interestingly, Elsevier publishes Manual Therapy. As again highlighted by the New York Times, the Office of Science and Technology Policy is currently debating the issue of access to publications, research, and data that are federally funded.

So, what are the problems?

Access. Most clinicians do not have access to the plethora of articles from countless journals across disciplines that could affect their practice. Thus, how are they supposed (or even expected) to provide evidence or science based treatment? Secondly, how are they to intelligently discuss the literature with other colleagues or scientists? At BEST, they are left to skim abstracts. Chad Cook, the editor of the Journal of Manual and Manipulative Therapy, discusses some of the biases and problems within the PT literature regardless of some these publication issues in his piece Don’t Always Believe what you read… on Joe Brence’s Blog Forward Thinking PT. How do you think research and readership biases are compounded when many (most?) clinicians have limited, if any access, to full text publications? Especially, when abstracts can drastically misrepresent not only the results, but clinical implications of a study. We highlight this issue in our letter regarding Adhia’s et al’s piece; the abstract and conclusions far outstep the data and study design.

Time. From submission to review to dissemination is a LONG process, especially for larger studies. Originally, we began work on our letter in the beginning of DECEMBER. Our first 2 submission were February 14th and 15th, with the final submission on February 24th. Our piece as accepted February 29th (yay leap year!!). Manual Therapy provided proofs  for review March 14th. We are still unsure of when the letter will be electronically published. And, this is just for a 500 word letter to the editor!

Now, we fully understand the time required for adequate peer review in order to ensure proper scholarship and science in large scale trials that involve the presentation of large data sets and sophisticated statistical analyses. But, is there a better way? Does the current system allow for broad access, discussion, and connection? And, really, who benefits?

So, what needs to change?

(Un)fortunately, more people will likely read, access, share, and comment on our original, longer piece published via this blog than the published letter to the editor in Manual Therapy. So, it appears the system is changing right before our eyes. The strength of Web2.0 is that discussion can happen right now. The process is dynamic as knowledge grows over time or people understand differently. I conceptualize this as real time peer review. Researchers, clinicians, students, and even those from other disciplines around the world can access and comment. This creates a vibrant, robust, and expert community of minds that are not limited by word count, publishing rules, or location.

A discussion on “Trigger Point Dry Needling” on @MikeReinoldBlog is an interesting case example. The post has generated 217 comments to date, some of them well researched, articulate, and publishable in our opinions! Imagine that type of discussion playing out in the literature of the current publishing system and paradigm? Unfortunately, the current literature at times is not as robust as these real time, remote, technologically driven interactions.

Fortunately, technology has afforded us the ability to highlight some of the pitfalls of the current publishing system, highlight our frustrations with our experience, and disseminate our original piece. Hopefully, this spawns discourse on scientific research and publishing, including open source and open access issues. Also, we would desire further discussion regarding the actual content of the research article as brought up in our response.

Interestingly, this entire project came about because of Web 2.0. Dr. Ridgeway stumbled across the abstract in his RSS feeder. It was e-published ahead of print. The article seemed out of step with the research evidence, and the author’s conclusions were in our opinion not supported by their study design and the current state of the literature regarding SIJ mechanics, treatment interventions, and lastly (but certainly not least) pain neurophysiology. So, @Dr_Ridge_DPT pushed a link of the abstract to both Twitter and Facebook. Dr. Jason Silvernail commented over social media and suggested a letter to the editor. The rest, as they say, is history. And oddly, despite their collegial nature Kyle and Jason have never met face to face! In total, 10 separate versions were created. The 10th version is the one that will be published in Manual Therapy at a mere 500 words. The 8th version, our best, can be read, in part, below:

We would like to thank Adhia and colleagues for their contribution to the literature regarding the non-invasive modeling of Sacro-Iliac joint (SIJ) motion. This study is interesting from a biomechanical perspective of the inter- and intra-rater reliability of measuring innominate motion via non-invasive palpation based measurements. However, in our opinion, this study has limited relevance to practicing clinicians and to the overall science and practice of manual therapy. The authors conclude “The results support clinical and research utility of this technique for non-invasive kinematic evaluation of SIJ motion for this population. Further research on the use of this palpation digitization technique in symptomatic population is warranted.” This seems to be a rather large logical leap given the results of their investigation and other data in the literature on the manual therapy assessment and treatment of the SIJ and pelvis region. We feel the clinical utility of SIJ palpatory movement testing has not been demonstrated by other research and we struggle to understand how such an assessment tool assists in evaluation, clinical assessment, or treatment with manual or physical therapy…CLICK HERE TO CONTINUE READING…

We thank you for reading, and urge you to comment with your views of the current publishing standard. In addition, what is your interpretation of the original Adhia et al article, and our reply?

@Dr_Ridge_DPT      Kyle J. Ridgeway, DPT

@JasonSilvernail      Jason Silvernail, DPT, DSc, FAAOMPT

 

Resources

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SI Joint Mechanics in Manual Therapy: Relevance, Please?

In a separate post Publishing in Science: Are Industry Standards Serving Researchers, Clinicians and Science? Jason Silvernail and I outline some of the perceived cons of the current publishing paradigm. We describe our experience writing a letter to the editor of Manual Therapy. In the end, our goal was, and is, to express our interpretation of the study Inter-tester Reliability of Non-invasive Technique for Innominate Motion by Adhia et al, including it’s relevance to the context of the current scientific research on the sacroilliac/pelvic region, pain, manual therapy, and modern clinical practice. We hoped, and continue to hope, to facilitate scientific discussion and discourse surrounding the topic.

Recently, others in the blogsphere have written about the assessment and treatment of the SI joint including Mike Reinold Assessing the SI Joint: The Best Tests. John Childs from Evidence in Motion, in the piece A blast from the past highlights how some continue to cling to old views of pain and “SI dysfunction.”

We feel our original, longer piece (which was denied prior to review) summarizes the issues of assessment and treatment of the SI/pelvis region quite well, while connecting various scientific and clinical issues. We cannot share the piece that is currently in press for Manual Therapy [Ridgeway K, Silvernail J. Innominate 3D motion modeling: Biomechanically interesting, but clinically irrelevant. Manual Therapy (2012). doi: 10.1016/j.math.2012.02.017] as they own the copyright. Although, we will provide the link when it is electronically published. Yet, we can share a completely different version of our letter that we were working on before we modified it for length. To be clear the version below is not the letter that is currently in press.

Here is our best reply, in full, to Adhia et al:

We would like to thank Adhia and colleagues for their contribution to the literature regarding the non-invasive modeling of Sacro-Iliac joint (SIJ) motion. This study is interesting from a biomechanical perspective of the inter- and intra-rater reliability of measuring innominate motion via non-invasive palpation based measurements. However, in our opinion, this study has limited relevance to practicing clinicians and to the overall science and practice of manual therapy. The authors conclude “The results support clinical and research utility of this technique for non-invasive kinematic evaluation of SIJ motion for this population. Further research on the use of this palpation digitization technique in symptomatic population is warranted.” This seems to be a rather large logical leap given the results of their investigation and other data in the literature on the manual therapy assessment and treatment of the SIJ and pelvis region. We feel the clinical utility of SIJ palpatory movement testing has not been demonstrated by other research and we struggle to understand how such an assessment tool assists in evaluation, clinical assessment, or treatment with manual or physical therapy.

Movement of the SIJ appears to be very small, highly variable, and difficult to measure. Although undoubtedly complex, movement and translation of the SIJ is estimated to be small and variable between individuals (Harrison 1997, Goode 2008) while variation in anatomy exists even within individuals (Cohen 2005). Historically, SIJ dysfunction and pain has been “diagnosed” clinically via palpation-based tests aimed to identify hypo/hypermobility as well as asymmetry in anatomical landmarks. (Arab 2009)  From a basic anatomical and biomechanical plausibility perspective, measuring this motion and connecting it to a diagnostic process may be futile given the small amount of motion that occurs at the SIJ relative to other joints and the anatomical variation between and within individuals.

The evidence from diagnostic and therapeutic studies of the SIJ and pelvis area doesn’t suggest a clinically useful role for SIJ diagnosis via palpatory movement. A growing body of research indicates that positional palpation based testing in the spine and pelvis region, including the sacroiliac joints, is unreliable within and between examiners (Goode 2008, Laslett 2008). Investigations that do find some measure of reliability for testing have wide confidence intervals for their measurements, calling into question their applicability (Robinson 2007, Arab 2009). Such testing may not assist clinicians with the clinical reasoning process. Symptom provocation testing, rather than positional palpation, appears to have greater literature support, and in fact is the criteria used in guidelines produced by the International Association for the Study of Pain (IASP) (Szadek 2009). After investigating the reliability of individual provocation testing maneuvers (Laslett 1994), Laslett et al. went on to perform a high-quality double injection study (Laslett 2003) for diagnosis of SIJ related pain. This study examined the validity of provocation and movement testing in the diagnosis of a painful SIJ. In 2 separate investigations, they found that physical testing, specifically a composite of tests, aimed at provocation of symptoms was more useful in identifying individuals likely to respond to diagnostic injection, currently the most commonly-accepted “gold standard” (Laslett 2003, Laslett 2005, Laslett 2008). However, even the use of provocation testing and double injection validation according to criteria used by the International Association for the Study of Pain (IASP) does not conclusively diagnose SIJ related pain. The review by Szadek et al. illustrates some remaining issues and concerns when discussing the complexity inherent in making the diagnosis of SIJ related pain (Szadek 2009).

On the subject of clinical utility, in a developed (Flynn 2002) and subsequently validated (Childs 2004) clinical prediction rule aimed to identify a sub-group of patients who responded to an “SIJ region” thrust manipulation, no palpation based testing of the SIJ were included in the final rule. This rule was constructed via regression analysis and many palpation and movement based tests of the pelvis, lumbar spine, and SIJ region were examined, including techniques and landmarks similar to those used by Adhia et al. The final predictors of response to treatment did not include any SIJ palpatory assessments.  Certainly the failure of these investigations (both double injection diagnosis studies and manipulative treatment studies) to find positional or movement assessment of the SIJ of any clinical value raises serious issues about the validity of such assessments. Yet, it is palpatory assessment which Adhia et al investigate in their paper. Despite rigorous testing in different clinical environments, palpatory movement tests have failed to demonstrate their usefulness in helping clinicians diagnose SIJ related pain or treat pain in the SIJ and lumbo-pelvic area. We stress that overall manual palpatory examination seems to have a valid role in manual therapy in this region, but the current evidence seems to indicate that this validity is related to symptom provocation and mechanical testing (Laslett 2005, Laslett 2008) and/or an impairment-based clinical reasoning approach (Whitman 2006). Such a patient-response, impairment-based approach is quite different from the positional and movement diagnostic process advocated by Adhia et al.

Lastly, this paper seems to further perpetuate an overly biomechanical focus in the assessment, treatment, management, and understanding of pain. Moseley stated “equating pain to activity in nociceptors is seductive” (Moseley 2012), and so too is a strict biomechanically focused clinical frame of reference. This biomechanical model of pain, dysfunction, manual therapy application “target,” and treatment effect appears to have little empirical support in the current literature (including clinical trials) investigating mechanisms of action of and predictors of success with manual therapy treatment (Bialosky 2009). In light of our improved understanding of the multifactorial neurophysiology of the pain experience (Bialosky 2009, Moseley 2012 and Melzack 2001), 3D modeling of small and variable joint motion via classically unreliable, and likely invalid constructs lacks meaningful clinical utility. When taken into account with clinical trial evidence and pain neurophysiology, we do not advocate its use clinically regardless of the precision of any associated biomechanical measurements.

We are not stating that this research is flawed, or even that it is unimportant. Indeed, Adhia and colleagues should be commended on the rigor of their methods. The investigation holds immediate relevance to the non-invasive modeling and measurement of the SIJ, and there may be biomechanical studies of some value that could take advantage of this process.  However, we disagree with author’s conclusion that the investigation results are clinically applicable and we urge the readership to consider the study results in context of the current evidence – which calls into question the reliability, validity, and clinical relevance of palpatory SIJ testing and diagnosis. We are confused as to how we as clinicians could utilize the author’s technique effectively in day to clinical practice, and why, given the current state of the literature, the authors propose we should.

Kyle J. Ridgeway, DPT

  • Physical Therapist, University of Colorado Hospital, Aurora, CO
  • Physical Therapist, Panther Physical Therapy, Littleton, CO
  • Consultant, University of Colorado Anschutz Medical Campus: Physical Therapy Program, Aurora, CO

 

Jason Silvernail, DPT, DSc, FAAOMPT

  • Physical Therapist, US Army, El Paso TX
  • Adjunct Faculty, Army-Baylor Doctoral Fellowship in Orthopedic Manual Therapy, San Antonio TX

The authors of this letter have no financial interest to disclose. The views expressed are those of the authors alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

References

Adhia DB, Bussey MD, Mani R, Jayakaran P, Aldabe D, Milosavljevic S. Inter-tester reliability of non-invasive technique for measurement of innomiate motion. Man Ther 2012;(17):71-76

Arab HM, Abdollahi I, Joghataei MT, Golafshani Z, Kazemnejad A. Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for the sacroiliac joint. Man Ther 2009;14(2): 213-21

Childs JD, Fritz JM, Flyn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med 2004;141(12):920-8

Cohen SP. Sacroilliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment. Anesthesia & Analgesia 2005;101(5):1440-53

Flynn T, Fritz J, Witman J, Wainner R, Magel J, Rendeiro D, Butler B, Garber M, Allison S. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine 2002;27(24):2835-43

Goode A, Hegedus E, Sizer P, Brismee J, Linberg A, Cook C. Three-dimensional movements of the sacroiliac joint: A systematic review of the literature and assessment of clinical utility. J Man Manip Ther 2008;16:25–38

Harrison DE, Harrison DD, Troyanovich SJ. The sacroiliac joint: a review of anatomy and biomechanics with clinical implications. J Manipulative Physiol Ther 1997;20:607–17

Huijbregts PA. Evidence-Based Diagnosis and Treatment of the Painful Sacroilliac Joint. J Man Manip Ther 2008;16(3):153-154

Laslett. M, Williams, M. The Reliability of Selected Pain Provocation Tests for Sacoiliac Joint Pathology. Spine 1994;19(11):1243-1249

Laslett M. Aprill CN, McDonald B, Young SB. Sacroilliac Joint Pain: Validity of individual provocation tests and composites of tests. Man Ther 2005;10:207-218

Laslett M, Young SB, Aprill CN, McDonald B. Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Australian Journal of Physiotherapy 2003;49:89-97

Laslett M. Evidence-based Diagnosis and Treatment of the Painful Sacroiliac Joint. J Man Manip Ther 2008;16:142-152

Melzack R. Pain and the Neuromatrix in the Brain. Journal of Dental Education 2001;65(12):1378-82

Moseley LG. Teaching people about pain: why do we keep beating around the bush? Pain Management 2012;2(1):1-3

Robinson HS, Brox JI, Robinson R, Bjelland E, Solem,S.,Telje, T. The reliability of selected motion- and pain provocation tests for the sacroiliac joint. Man Ther 2007;12(1):72-79

Szadek KM, van der Wuff P, van Tulder MW, Zuurmond WW, Perez RSGM. Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of Pain 2009; 10(4): 354-68

Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, Garber MB, Bennet AC, Fritz JM. A Comparison Between Two Physical Therapy Treatment Programs for Patients With Lumbar Spinal Stenosis. Spine 2006;31(22):2541-2549

And, in the end “Enough is Enough”

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Leveraging Technology VI: Case Example: ACL Injury “Prevention”

Recently, I stumbled upon a website post via Twitter:

Original Tweet

 

I absolutely love the basis and intent of the tweet! Female athletes exhibit increased incidence of non-contact anterior cruciate ligament injuries, so we need to work to reduce their risk of injury through specific training, performance, and post-surgical rehabilitation programs. ACL injury, reconstructive surgery, co-morbidities, rehabilitation, return to sport, and prevention all are hot topics currently. Studies have investigated risk factors for ACL injury, sport specific rehabilitation and return to play, accelerated vs. standard rehabilitation timeframes, as well as predictors of osteoarthritis following reconstruction. Some investigations attempt to identify individuals who can cope without an ACL vs. those who require surgical intervention. And unfortunately, as ACL injuries occur in younger and younger athletes physical therapists must consider the proper management of ACL injuries in skeletally immature individuals. I posted about fear of re-injury and return to sport following ACL reconstruction.

The link in the tweet is a Santa Monica Sports Medicine Foundation website page that explains the Prevent Injury and Enhance Performance (PEP) Program. But, I had 2 discussion points:

  • The PEP may not be the best program
  • Prevention may not be the best wording



Based upon my understanding of the literature on the topic, Sportsmetrics seems a superior choice for both injury risk reduction and performance. Second, I do not think we can truly and absolutely prevent injuries. Injury is an inherent risk of sport. Even non-contact ACL injuries are not totally preventable. Now, injury risk reduction is possible and feasible. I believe that the using the term prevention is the wrong nomenclature. It conveys an inaccurate message. Every attempt is made to reduce the relative risk of injury. But, make no mistake, there is no way to totally abolish injury risk. Maybe I am being too fussy…

In a strike of happy coincidence I read the abstract of a systematic review from the journal Sports Health: A Multi-disciplinary Approach the day before through Google Reader. The title of the article is Anterior Cruciate Ligament Injury Prevention Training In Female Athletes: A Systematic Review of Injury Reduction and Results of Athletic Performance Tests. The review analyzed the results of other studies in an attempt to ascertain which training programs decreased ACL injury risk and in conjunction what measures of performance were improved. The conclusion:

Sportsmetrics produced significant increases in lower extremity and abdominal strength, vertical jump height, estimated maximal aerobic power, speed, and agility. Prevent Injury and Enhance Performance (PEP) significantly improved isokinetic knee flexion strength but did not improve vertical jump height, speed, or agility. The other 3 programs (Myklebust, the “11,” and Knee Ligament Injury Prevention) did not improve both ACL injury rates and athletic performance tests.

My initial response
And nomenclature thoughts
A little bit of info from the review
Responses
Other tweets

 

@PacificTigerDPT brought up some excellent points in our exchange. The importance of marketing to patients and clients to maximize accessing the most effective care was something I did not think about. I really enjoyed conversing, discussing, and learning via Twitter.

Now, I am bias, because my practice location utilizes the Sportsmetrics program. I am most comfortable and familiar with administering Sportsmetrics. But, given the data in the above systematic review, I think Sportsmetrics is overall a superior program. Obviously, you want your injury risk reduction program to reduce the risk of injury! That is priority number one. But, improving performance measures such as power, aerobic capacity, strength, and agility is always at the forefront of any training, recovering, or rehabilitating athlete’s mind. In this regard, the data seems to suggest that Sportsmetrics outperforms Prevent Injury and Enhance Performance (PEP) Program. I would argue the Enhance Performance part of the name should be taken out, given the data shows that it only improves isokinetic knee flexion strength, but no measures of athletic performance.

The interactions on this topic I had through twitter as well as this resulting blog post are a real illustration of how to leverage Twitter, tweet replies, RSS feeds, and blog posts to engage in the analysis of literature, discussion of clinical practice, and comparison of research. I think this is the future of professional discussion, and potentially continuing education.

I was able to engage information from a tweet with replies. I read a website post on the PEP and compared it to the abstract I had read through RSS and Google Reader. Then, replied to the tweet with some of my analyses and a link to the systematic review. Lastly, I expanded upon my thoughts and analysis through this blog post. As illustrated, current technological and social media tool are not mutually exclusively. They can be leveraged together to facilitate networking, discussion, and professional growth.

Leveraging Technology Series

  1. RSS and Web2.0
  2. Google Reader
  3. Selection of Reader Content
  4. Blog Reviews
  5. Engagement
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Leveraging Technology V: Beyond RSS to Engagement

This is the 5th in a series of posts investigating how to leverage technology:

  1. RSS and Web2.0
  2. Google Reader
  3. Selection of Content
  4. Blog Reviews

In the previous blog posts I have outlined how information is pushed directly to you via RSS feeds and Web 2.0. I explained how to access information from journals and blogs without searching the net. I even discussed which journals and blogs you may want to follow and why. But, to truly engage, retain, critique, and apply this information to our clinical practices and research we must move beyond just reading. We need to discuss and analyze and integrate….but…

How do we do this when we are sitting by ourselves on a computer? There are a variety of built in tools that we can utilize to accomplish this within Google Reader, in the comments sections of blogs, via Twitter and Facebook. Most of the technology presented in this post series can be linked and utilized simultaneously. All of this from you office, laptop, tablet, or smart phone. In this post, I have bolded words, phrases, or concepts that I think are important throughout this post. This includes the concept of “pushing” information, modifying a tweet, micro-blogging, and discussion via blog comments.

The exact topic of blogs and the discussions stemming from them was recently written about on the CasesBlog: Medical and Health Blog. In the post, Blogging is good for you – and for most people who read blogs it is stated:

The back-and-forth between bloggers resembles the informal chats, in university hallways and coffee rooms, that have always stimulated economic research, argues Paul Krugman, a Nobel-prize winning economist who blogs at the New York Times. But moving the conversation online means that far more people can take part.

The post links to an article from the Economist Website titled Economic Blogs: A less dismal debate. Interestingly, they assert that papers that are blogged about and/or authors who blog may be considered more respected:

Academic papers cited by bloggers are far more likely to be downloaded. Blogging economists are regarded more highly than non-bloggers with the same publishing record.

I wonder if in the future, features such as track back or blog presence will be utilized to calculate a journal’s impact factor or rate researchers and academics.

TWITTER, with it’s 140 character limit for tweets and profile descriptions, is truly a micro-blogging medium. Everyone who is on Twitter is a micro-blogger. It forces succinct communication. Twitter offers a variety of opportunities and ways to access and discuss information. Obviously, you can read the tweets and go to the links that others post. You can reply to tweets to initiate a dialogue. RE-TWEET is when you tweet someone else’s tweet with RT before their twitter handle (name).

Here I re-tweeted @BodyinMind’s link about research and blogging. The link is the article I mention earlier in the post.

Now, you can also tweet a MODIFIED TWEET (MT). Essentially, with an MT you are changing or editing the content or message of a tweet. Below is an original tweet about manual therapy from @DenverDPT regarding manual therapy effects from the 2011 AAOMPT Annual Conference:

Original Tweet
My modifications

I then modified the phrasing and content to deliver a similar, but more specific message based on my understanding of manual therapy. I preceded the tweet with MT to communicate that I had modified an original tweet by Denver Lancaster.

I view FACEBOOK as a personal mini-blog. Links, videos, and articles can be posted with ease. Similar to a blog, friends can comment and discuss. Through pages, individuals can connect on a specific topic, cause, or organization. For example, the American Academy of Orthopaedic Manual Physical Therapists has a Facebook Page: AAOMPT Facebook Page. Beyond networking and professional connection, Facebook is an also a means to access, read, and talk about information.

It is not necessary to have your own BLOG to utilize the medium to discuss and learn. You can utilize BLOG COMMENTS to write your insights and questions. If you disagree with a conclusion you can formulate a more thorough, researched response. Often, I find myself more intrigued and challenged by the discussion that happens in the comments section of a blog post. Especially if you do not publish your own blog, posting well researched and thoughtful comments is essentially blogging! You can have online discussion with links to other blogs, research articles, and online resources with the blog’s author and commentors. Professionals, researchers, and students from across the world can have in-depth, passionate debates at their convenience. Want to stay plugged into a debate? Many blogs offer the option to SUBSCRIBE TO COMMENTS via e-mail or RSS. You will automatically be alerted when a new comment is posted.

After dabbling in blog engagement, you may even desire to publish your own blog. This process is actually quite simple. There are many free resources including Blogger and WordPress. Blogger is Google’s free blog hosting service. A very professional looking blog can be started in an afternoon utilizing free templates and helpful layout designs. As I have mentioned previously, I am disappointed in the lack of blogs surrounding neurologic and acute care physical therapist practice. I remain hopeful that this segment will grow.

PUSHING is an interesting concept in the current social media landscape. All of us has experienced pushing whether we realize it or not. E-mail is a pushing service. Information is pushed to our in-box, and we push information to others. As discussed in previous posts, we utilize Google Reader to have information pushed directly to one location (our RSS Reader). Further, information chosen specifically by our Facebook friends and the tweeps we follow on Twitter is pushed automatically to our news feeds. Conversely, we can push information between our social media accounts through certain applications or linkages. For example, I have a twitter application that allows me to push any tweet to my Facebook account by putting the hashtag (#) FB at the end of my tweet > #fb.

Some pushing and linking features are automatically available. You can “like” an item on Google Reader and then make comments. Then, individuals who follow you on Google Reader can see your comments. Information can be pushed or shared directly from Google Reader to Facebook and Twitter (via the “Send To” button). A post can also be made directly to Google+. There is even a button to e-mail the link!

Most journals are now publishing content and articles online before the print version of the journal is available. E-PUB AHEAD OF PRINT simply means that article was electronically published online ahead of the print version. Journals, including Physical Therapy Journal, even have RSS feeds for E-Pub content. Now, people can blog, comment, Tweet, and Facebook about articles before the print version is published. By the time someone who subscribes to a print journal reads an article, it has probably arlready been shared, critiqued, analyzed, and discussed for weeks to MONTHS.

Interestingly, as widgets and applications evolve the line between various forms of social media and Web2.0 principles becomes more blurred. For example, Twitter feeds and tweets can be seamlessly integrated on the sidebar of a blog. Applications allow for the automatic pushing of tweets to Facebook profiles. And with tools such as HootSuite you can control both from one dashboard. Many Twitter applications allow the scheduling of Tweets into the future, so you do not overload followers with 1,249 tweets in 5.9 seconds. Facebook also allows users to create a badge, or snapshot, to have the sidebar of blogs.

Imagine networks of students, researchers, and clinicians connecting through Google Reader, Twitter, Facebook, and blogs to diseminate and discuss research, blog posts, newspaper articles, and legislation. Imagine the proliferation of professional networking, learning, and discussion. The potential exists for clinicians to collaborate remotely on patient care and research projects. If you have not already, check out PHYSIOPEDIA. Physio-pedia is the model for the future fusion of technology with education, learning, and research.

All of these tools have the ability to elevate our individual knowledge base, care delivery, and research. On a grand scale, it gives us the opportunity to improve professional growth and patient care for all regardless of geographical location. I imagine technology integration and colloboration as the basis for the future of “continuing education” and professional learning…

I envision a future where professionals from across the globe are accessing, disseminating, discussing, critiquing, and even performing research and clinical practice.

In the next post, I will illustrate these principles from a real life scenario. As a preview, I responded to a Tweet that linked to a performance and injury risk reduction program aimed at decreasing ACL injury rate AND improving performance. In that interaction, I utilized and pushed an article via Google Reader to Twitter. I was able to engage in a virtual conversation with a handful of individuals regarding the topic. After I present the interaction, I will discuss and analyze the encounter and research evidence surrounding the specific topic of ACL injury risk reduction and performance improvement.

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Leveraging Technology IV: Blogs

So, this series has had a long, long hiatus between posts for which I apologize!! Time to start the new year off right. This is another dense post with a ton of resources and links. I hope you enjoy. In the previous post, I presented which research journals publish the most and highest quality clinical trials of interventions. I also discussed what research journals we should consider following. The preceding posts in this series were:

  1. Web 2.0 and RSS
  2. Google Reader
  3. Selection of Content

But, research journals are not the only way for us to engage information relating to clinical practice and scientific research. Blogs are another great online resource. With the advent of Web2.0 principles physical therapists, students, and researchers from around the world can critique research, discuss science, and debate clinical practice through the blog format (And, the micro-blog format such as Twitter, but more on that in the next post!). Disagree with a bloggers interpretation of the evidence? Comment on the post! If utilized civilly and with proper logic blogs (and social media like Facebook and Twitter) are a great platform for learning, discussing, and reviewing. And, as I have mentioned in previous posts with RSS feeds the information is pushed directly to you. Then you decide what to skip, what to skim, what to read, what to push forward through Twitter or Facebook and what to comment on!

There are many blogs relating to physical therapy, rehabilitation, training, science, exercise science, training, and research. I stumble upon new ones all the time. Some of them are great, some are bad, and some are just ugly. Below I am going to review some of the blogs that I follow.

I love the interactive nature of the blog format. You can participate in high level discussions regarding research and clinical practice from anywhere in the world. This type of crowd sourcing has the potential to elevate our knowledge dissemination, discussion, and growth. In fact, the proliferation of blogging and micro-blogging will (I believe) fundamentally change not only how information is disseminated, but how we learn, discuss, and collaborate on clinical care and research.

For each blog, I have included the title/subtitle hyperlinked to the actual blog as well as the author(s) twitter handle with a hyperlink to their twitter profile. Please comment on your thoughts of these blogs.

What blogs do you follow? Let us know in the comments section! Speaking of, follow @PTThinkTank as well as all the authors, including the creator @EricRobertson and humble contributors @MPascoe and @Dr_Ridge_DPT


I have to start off with some student blogs. As a student this is how I became exposed to and involved with leveraging technology!

AAOMPT sSIG: Blog of the Student Special Interest Group of AAOMPT

The AAOMPT sSIG Blog is where I got my start blogging about such issues as the doctor of physical therapy degree, direct access, physician owned physical therapy services, and grass roots political advocacy. The blog provides information on the happenings of the student special interest group. If you are a student, or know a student, send them to the blog for more information on getting involved in the sSIG. It is a great group of motivated, high energy students. Unfortunately, the AAOMPT sSIG is not on twitter, but you can e-mail the students directly with comments, suggestions, and questions: ssigaaompt@gmail.com

Colorado Student Physical Therapy Advocacy: Act now to protect the future of your profession

Author: @COSPTAdvocacy

I may biased since these students are from my Alma Matter, but these students are truly organized and accomplished. Not only did they WIN the APTA’s Student Advocacy Challenge they are leveraging technology through Blogger, Twitter, and Facebook to create a sustainable and visible student movement.

Below are some of the blogs that I regularly read and definitely have in my RSS Feed. Most of them deal directly with physical therapist practice, and are authored by physical therapists. Others are authored by other professionals, but still very applicable to physical therapy. Enjoy!

Better Movement: Learn to Move with More Skill and Less Pain

Author: @ToddHargrove

Todd is a Seattle based Feldenkrais Method movement instructor who used to be a lawyer. He writes about a neurocentric approach to movement, training, and pain. In Both Sides Now, he discusses research investigating the training, or treating, one side of the body and the effect on the contralateral side.

Body In Mind: Research into the role of the brain in chronic pain

Authors: @bodyinmind @NeilOConnell

This is the blog of Lorimer Mosely and crew out of Australia. They provide research summaries and discussions regarding the mechanisms of pain and the treatment of chronic. Probably one of the most robost blogs on the net regarding pain physiology and current research. Why Things Hurt is an outstanding Tedx video by Lorimer Moseley on the neurophysiology of pain. They even discuss if Chronic Pain is a Disease.

Categories: Pain Science, Chronic Pain, Neuroscience, Physiology, Research

Leaps and Bounds: Perspectives from a physical therapist

Author: @ForwardMotionPT

Corey provides unique insight into physical therapist practice, and is obviously a very deep thinker. He has produced many videos illustrating the use of novel movements of various body regions. Here is a great post about The Movement Diet.

HealthSkills: Skills for health living for health professionals working in chronic pain management

Author: @adiemusfree

Healthskills is a blog for health providers who want to read about research related to self managing chronic pain. Topics include chronic behavior therapy, measuring outcomes, patient education, and many other topics. The author was originally trained as an occupational therapist. In this post, she discusses what to do when a patient is “inconsistent” with their pain behavior or presentation.

Categories: Pain, Chronic Pain, Cognitive Behavior, Clinical Treatment of Pain

The Manual Therapist: Promoting the highest level of physical therapy practice

Author: @The_OMPT

Dr. E posts very regular providing links to other blogs (including this one, thank you!), videos on techniques he uses, clinical cases, and clinical reasoning. He has a very expansive background being both a fellow of AAOMPT and MDT diplomat. See the post What is the Mechanism Behind Rapid Change? for a discussion we had regarding mechanisms of manual therapy. (Here is the comments section)

Mike Reinold: Rehab | Sports Medicine | Performance

Author: @mikereinoldblog

The most up to date information related to evaluation and treatment of athletes, specifically overhead athletes. Good citation of clinical research for evaluation and exercise treatment. Lots of links to different courses/products. Mike is the head of athletic training for the Boston Red Sox, and is well published on issues regarding the shoulder and injuries in throwers. In the post Rotator Cuff Fatigue Increases Superior Humeral Head Migration, Mike discusses the importance of not training the cuff to fatigue.

Categories: Athletes, Shoulder, Knee, Sports, Orthopaedics

Move It: The New Professional’s Collaboration Blog

A group of young physical therapists (<5 years experience) discuss clinical practice, clinical development, and issues regarding being a new professional. It has been a while between posts, but they have some excellent content. Check out A Generation with Challenges, Vision, and Debt.

Categories: Young Professionals, Professional Development, Legislative Advocacy, Professional Issues

My Physical Therapy Space: Evidence in Motion Blog

Authors: @EIMTeam

The blog of the Evidence of Motion crew. Great information regarding private practice, legislative issues, and research pertaining to orthopaedics. Discussions regarding the overuse of imaging and surgery, as well as the how physical therapists can provide value to society and healthcare. In a Blast from the Past, John Childs illustrates how some clinicians and researchers cling to old models of pain and treatment despite evidence to the contrary. Tim Flynn discusses how access to early, cheap care (physical therapists!) for low back pain is Not Rocket Science, and could have HUGE implications for our society. Larry Benz deconstructs poor logic about Physician Owned Physical Therapy Services (POPTS) that appeared in Advance Magazine.

Categories: Professional Issues, Private Practice, Orthopaedics, Research, Professional Development

The Sports Physiotherapist: Resource for physiotherapists (or physical therapists) with a passion for assessing, diagnosing, and rehabilitating the sports injuries of the world’s athletes

Author: @TheSportsPT

Extremely well cited articles discussing the evaluation, assessment, and treatment of athletes including surgical approaches and their implications on rehabilitation. Their blog and website is maybe the most comprehensive sports physical therapy resource on the net. In this post, they review the diagnostic accuracy of tests used to identify Acetabular Labral Tears of the Hip.

Categories: Sports, Athletes, Research, Examination

Physical Therapy Diagnosis: Make Decisions Like Doctors

Author: @timrichpt

Private practice owner in Florida discusses clinical decision making as well as leveraging decision support tools/software. Lots of discussion of Medicare flaws, clinical decision making, and issues in private practice. Tim recently authored a book detailing bullet proof decision making processes to improve documentation and efficiency in outpatient practices. Tim presents The Art and Science of Physical Therapy by analyzing the Oxford Debate from the American Physical Therapy Association’s Annual Conference in 2011

Categories: Private Practice, Legislative Issues, Clinical Decision Making, Outpatient

Save Yourself: Science powered advice about your stubborn aches, pains, and injuries

Author: @painfultweets

A massage therapist by training who turned to science focused blogging regarding painful problems. Skeptical analysis of pain, pain syndromes, and treatment techniques. Great information for patients and practitioners alike. Although I very much respect Paul’s work and critiques, there is a very apparent bias towards trigger points as a significant pain complaint and treatment target. Paul talks about MRI Overuse and how MRI is too sensitive of a diagnostic tool. He also does a nice job of summarizing some of the Science Surrounding Stretching.

Categories: Pain, Chronic Pain, Manual Therapy, Science

SomaSimple: The so simple body. A place for physical & manual therapy.

@SomaSimple Contributors: @jasonsilvernail @dfjpt @BarrettDorko @wrtrohio @JohnWarePT @ForwardMotionPT among others

You will not find a more thorough or logical analysis of manual therapy, physical therapy, and their relation to people with painful problems anywhere. The folks over there are true skeptics in their thought process, and challenge all. Be ready to be challenged, even if all you do is read the forums! This site is such a density of information and discussion you could read for months. Whether you troll or join in on the discussion it will deepen your analysis and understanding of pain, pain physiology, and clinical practice. Enough is Enough is a well written piece by Jason Silvernail talking about how we need to stop looking for the magical technique or tissue and focus on deeper models of understanding pain. In Crossing the Chasm, he absolutely shines in his ability to tie current clinical research to a deeper, neurophysiologic understanding of pain as he describes his process of evaluation and treatment utilizing sub-grouping in low back pain.

Categories: Pain, Neuroscience, Discussion Board, Manual Therapy

The blogs above are more specific to physical therapy principles. But, it also useful to engage information from other disciplines or sources. For example, decision making, principles of science, behavior, and psychology are all integral parts of physical therapy practice. These topics relate to how we treat patients, but maybe more importantly how we make decisions and analyze/integrate literature.

Science Based Medicine: Exploring issues and controversies in the relationship between science and medicine

I believe this is a must read blog for all health care professionals. It discusses the application of scientific principles to improve evidence based practice. These principles include prior plausibility, physiologic plausibility, and an increased focus on the integration of basic science into the understanding and practice of medicine. Although, much of it is not related directly to physical therapy, the lessons and principles discussed are applicable to research interpretation and clinical practice of all health care professions. In fact, physical therapists receive a mention in the post Subluxation Theory: A Belief System that Continues to Define the Practice of Chiropractic.

Check out these posts:

  1. About Science Based Medicine
  2. Announcing Science Based Medicine Blog
  3. Does Evidence Based Medicine Undervalue Basic Science and Overvalue Randomized Control Trials?
  4. Is it a Good Idea to test Highly Implausible Health Claims?

Eric Cressey: Performance and health on a whole new level

A personal trainer with a masters degrees in kinesiology with a highly successful persontal training facility targeted towards baseball players. Collaborates with Mike Reinold. Although targeted for personal trainers and fitness specialists, he provides amazing information on training athletes that is very applicable to physical therapists.

Very detailed information about the training of high level athletes especially baseball players. Eric exhibits in depth understanding of kinesiology, training, and anatomy specifically as it relates to baseball players and overhead athletes. Although, he does seem to have a poor understanding to mechanisms and effects of manual therapy and at times “plays doctor” in regards to client’s pain complaints. In How Much Rotator Cuff Work is Too Much? Eric discusses the implications of training the rotator cuff in throwing athletes both in season and during the off season. He highlights the fact that many throwers overuse their cuff musculature.

Categories: Sports Training, Baseball, Shoulder


  1. Do you read any of the blogs above? If so, what is your critique?
  2. Did we miss a good resource? Please comment and enlighten us!
  3. Do you have a blog? Comment with a link and a brief summary!

Unfortunately, there seems to be a lack of physical therapist focused blogs relating to in-patient acute care, neurologic physical therapy, and in-patient rehabilitation (hint, hint, any takers??). Most focus on outpatient, orthopaedics, sports, and private practice.

I hope you have enjoyed the leveraging technology series thus far! We have covered a ton of information as these posts are are very dense. The next post will discuss the use of social media tools including Twitter, Facebook, and Blog comments to move beyond RSS into active sharing, discussion, and engagement of information! Remember, we always value your feedback and comments.

@Dr_Ridge_DPT

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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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Medical Illustration: Entertainment and Education

One of my favorite activities in Augusta was/is to attend trivia at a local hang called, Helgas. Apart from the irony and inconvenience of the ultra smoke filled bar that’s frequented by graduate students at a medical college, it’s a solid game of trivia. It was always a treat for me to run into some of the medical illustration folks there. I admire the work and skill of medical illustrators, and one of my long-time favorite blogs is Street Anatomy. If you happen to be in Chicago next Friday, you can plan to attend Street Anatomy’s very first Gallery Show! Yes, I’m jealous if you do.

Medical illustrators are hard to come by, and there are only 4 accredited programs in the United States! Their work with animation and interactive learning images is priceless and plays an integral role in the education of all health professionals as well as the general public. I love to stumble across collections of medical illustrations, and so here’s one you can check out too: The 2009 Salon Award Winners from the Association of Medical Illustrators. Everyone should have a friend who’s a medical illustrator!

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The Stress – Pain Connection

Matrix
The WSJ Blog had a brief but important bit about the relationship between stress and pain this week. The gist: It's old school to think having pain that is "in your head" is the same thing as faking it or being crazy in any way. The truth of the matter is, all pain is in your head! More acurately, pain is an output from your head.

Scientists recognize now that older models of pain, which could only account for acute injuries, don't work for many of the ways that people experience discomfort. Even in those acute injuries, where a tissue may be damaged, the processing of pain still occurs in the brain. But, for those discomforts that don't seem to arise from any specific tissue damage, like chronic pain, newer models can help explain how such an unpleasant sensory experience is possible.

It seems the experience of pain is a very complex phenomenon, including connections to almost every part of our nervous system. Stress may not be any trigger by itself for pain, but can help enhance any pain we might be feeling. The same goes for fear about pain, or even memories of previous pain that we might connect with a specific activity or body part. In the clinic, I often can get dramatic improvements for patients with low back pain, by simply explaining what they're feeling and helping to reduce the anxiety and fear that occurs with low back pain. It's very cool. In effect, the brain, and its ability to learn and reason, becomes a very powerful pain analgesic. 

The NOI Group out of Australia is a leader in discussions about pain, and modern pain models like the neuromatrix model of pain. I found a neat application on their site called Recognise, which is a flash based program that helps with mental imagery. You see, it's easy for your own representation of a body part to become altered after an injury, and re-training your brain to percieve a normal, pain-free body part can help "re-wire" the altered hardware. 

Photo courtesy of marcos papapopolous via Flickr
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Patient-centered Marketing Beats Fringe

Hippotherapy

I have a Google News search feed (you can copy and paste this url into your reader, fyi) for "Physical Therapy" set up in my reader program to help me keep up with what's going on.  Sometimes there's some interesting items, sometimes not so much.  But sometimes, the thing that captures my interest lies not so much in the individual news items, but in the patterns of groups of news items.  

This was the case today as I scrolled through the various entries.  There were a few job postings, one or two clinic opening announcements, and a whole lot of articles devoted to Wiihab, hippotherapy, and physical therapy for pets.

Not once in any of the hundred or so entries that I read did I discover news about physical therapists doing anything related to the core of the profession: enabling function, reducing pain.  Sure, those things are briefly implied in the fringe type articles, but why doesn't good old fashioned physical therapist practice garner news headlines?

Perhaps because it's boring.  From a news perspective, there's nothing too exciting about going to physical therapy and getting a good treatment.  Just like it's boring to hear about someone going to a primary care doctor and getting a new prescription for pain relievers.  We don't see news items about that either.

News headlines are about things that touch our humanity.  Things that are new and different.  Human stories.  Perhaps the stories of our patients need to play a larger role in the profession's marketing efforts.  Perhaps then the story might be more about what we can do to help, what good physical therapy is, and less about the random fringe-type aspects of physical therapy.  I'm routinely fascinated by the stories of my patients and the efforts they put forth to improve their lives.  Now that's good news!

I propose Patient-centered Marketing, which by the way, will be ripe for social media efforts as well.

ERIC