Whiplash: JOSPT Special Issues Highlight the Challenges Facing Clinicians, Patients

The Journal of Orthopedic and Sports Physical Therapy (JOSPT) recently released a special issue on the topic of whiplash-associated disorders (WAD). This July 2017 publication followed up on the October 2016 issue, both with guest editors Dr. James Elliot, an associate professor at Northwestern University, and Dr. Dave Walton, an associate professor at the University of Ontario. This rare opportunity to have outside editors underscores the challenge that not only clinicians are facing when treating WAD, but the imperative need that patients with WAD struggle with on a daily basis. From an overarching perspective, the special issues highlight that WAD is not simply an orthopedic condition, yet one that encapsulates the physical, social, and cognitive aspects of the patient at hand, which works to complicate the treatment approach further.

Whiplash-associated disorders are common neck injuries, most often seen in motor vehicle accidents. In Europe and North America, WAD is seen in 300 per 100,000 individuals in an emergency room setting.1 The annual cost of personal injury claims in the United States alone is estimated to be around $230 billion. You can click site and get personal injury lawyers. 1 In addition, consistent international data suggests that approximately 50% of those who sustain a whiplash injury will actually not recover and continue to report ongoing pain and associated disability one year after the injury.1 This low rate of improvement underscores the idea that whiplash has other psychosocial components. A 2014 article in the Journal of Physiotherapy discuss that of those who have sustained a whiplash injury, many concurrently are affected by mental health concerns, as well. 25% of those with WAD have post-traumatic stress disorder, 31% have a “major depressive episode,” and 20% have generalized anxiety disorder.1 This combined psychiatric involvement leads to poorer outcomes, secondary to the elevated levels of disability, chronic pain, and physical activity that these patients have.

Talus Media’s Eric Robertson had the opportunity to interview Elliot and Walton recently to discuss the special issues, as well as the current landscape of WAD in a physical therapy setting. The conversation discussed many components of WAD, including the approach that clinicians take when treating patients. Elliot stated that:

“Considering whiplash as a homogenous type condition and treating it as a homogenous condition is really at the crux of really why we haven’t seen fantastic results of management strategies.”

The two also argued that therapists should not be looking at whiplash from a biomechanical or tissue-focused perspective, “It might be more valuable to take an approach that moves away from the tissue at fault, because so far that has proven to be a fool’s game, and move more toward the question of ‘what is the likelihood the patient is going to get better.'” Elliot and Walton did, however, state that they do believe there may be the involvement of some specific tissues in the body. “We do have some fairly compelling evidence that it looks like in some discrete number of people with chronic problems that their white matter in their cord may have been damaged or certainly involved in some of these changes in muscle structure and function.”

The two JOSPT special issues are available online from both October 2016 and July 2017. In addition, the full interview with Dr. Elliot and Dr. Walton is available on Talus Media Talks. What is your experience in treating WAD? Do you feel as if there is something missing in the treatment of these patients? Let us know what you think on our Facebook page.

References:

  1. Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother. 2014; 60(1):5-12.

Photo by Vladlane Vadek

What’s the Cost of Quality? New ABPTRFE standards mean an uncertain future for Fellowships.

Back in February at the Combined Sections Meeting, the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) announced their new quality standards for post-graduate education. The release of the new standards marked ABPTRFE’s first step towards its initiative of revamping old policies and procedures. According to Tamara (Tammy) Burlis, Chair of ABPTRFE, the intent is to“ultimately enhance patient care and support overall goals of the physical therapy profession”. An external consultant company specializing in accreditation and compliance solutions for higher education helped with the development of the new standards. After a 6-month call for comments, the standards were finalized and are now slated to take effect on January 1, 2018. Residency and fellowship programs have until January 1, 2019 to comply. Physical therapy news outlet Talus Media News featured this story in their August 14th episode.

Behind the buzz of the shiny new standards, however, is the discontent expressed by some fellowship directors. The biggest concern regards the change in admission criteria into fellowship programs. Historically, there were three ways to be considered for admission into fellowship: (1) complete an accredited residency, (2) earn board certification in a related field, or (3) have adequate prior experience as judged by the program directors. The new standards have removed the third option, leaving residency training or board certification a mandatory requirement prior to applying for fellowship.

Pieter Kroon, program director and co-owner of The Manual Therapy Institute (MTI), a fellowship program started in 1994 for advanced manual therapy training, spoke up in an interview on Talus Media, “I understand where [ABPTRFE] wants to go with it but…there are some nasty consequences that come with that which threaten the viability of the physical therapy manual therapy fellowship programs…We have given input, but we always have the feeling it doesn’t get listened to a whole lot at the ABPTRFE level.” According to Pieter, fellowship directors don’t seem to have much of a voice in the decision-making process at ABPTRFE. The way in which program directors currently share their concerns is akin to a bad game of telephone. The manual therapy fellowship program directors share their thoughts in their Special Interest Group (SIG) meetings. SIG representatives then report to the Board of Directors at the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). After that, it is AAOMPT’s responsibility to talk to ABPTRFE and pass the messages along. It’s not hard to imagine why Pieter describes the communication between program directors and ABPTRFE “tenuous at best”. Of note, AAOMPT declined to comment on the potential impact of the new standards.

The consequences Pieter referred to are a few in number, but of primary concern to fellowship programs is sustainability. Or, as Pieter more bluntly puts it: “we would be out of business”. To illustrate his point, 95% of the fellows that graduated from MTI in the past five years were admitted via review of prior experience, the route now deemed obsolete. Without such a large section of the cohort, his program would not have had enough overhead to be self-sustaining. Pieter shared off record that he runs his program because he loves teaching and helping clinicians become their best; the revenue the program generates is marginal. The new standards pose a big bottleneck to fellowship admissions, limits student accessibility, and places programs like his on a pathway to an uncertain future.

But what makes fellowship programs think they won’t get enough applicants?

Though there has been a paradigm shift in recent years where clinicians are looking towards residency training soon after entering the work force, there has yet to be an identifiable fiscal incentive for clinicians to become experts in the field given their low ceiling of professional compensation. Furthermore, time is of the essence. The American Board of Physical Therapy Specialties currently only offers certification exams once a year. So, not only are the additional certification exams expensive, it also requires foresight and planning to fit it into one’s professional and personal timelines. There is additionally a current lack of evidence that suggests being a resident-trained therapist and/or having board certification contributes to being a more prepared fellow. Though that’s not to say there won’t be evidence of this in the future, it does call into question how this new admission standard was arrived at. Did it consider any of the current evidence in post-graduate education? Or, was it developed with more philosophical underpinnings? To that end, it remains to be seen…

PT Think Tank community: the point of this piece isn’t to say that the new admission standards are “bad”. Rather, I hope it makes us consider how its proposal potentially overlooks the current reality of the residency/fellowship climate. What parameters are in place, if at all, to help address the worries of Pieter and other program directors? What will be in place to aid them during this period of transition?

I’ll end it here, but do think on this last part of ABPTRFE’s position on the new admissions criteria: “Our goal is to support residency and fellowship programs, while addressing and planning for the future…As a part of our own continuous improvement process, we will continue to monitor the data that occurs as a result of this revised change. We will go back to this concept if we find that it has been detrimental to fellowship programs.”

Pieter and Tammy’s full interviews are available on Talus Media Talks.

#DPTstudent chat August 20, 2014: Why should I be an APTA member?

It’s about that time where DPT programs across the country are beginning. Many programs require APTA membership but, if yours doesn’t, is there any value of being an APTA member as a first year #DPTstudent? Won’t everything be way over your head? Will you even be able to go to a conference and take advantage of the savings with all the work coming your way? What else can APTA membership as a first year do for you?

Join us on Wednesday, August 20 at 9PM EST to discuss! If you are a second or third year or practicing physical therapist, please join us to share what value APTA membership has brought to you!

-Jocelyn, Laura, & Tyler

#DPTstudent chat for Wednesday, June 18: Professionalism in a Digital Age

As a PTthinktank reader, you are likely aware that social media sites have made new information easier to share and access. Health professionals, fitness “experts” and the average Joe are now able to disseminate large amounts of information quickly and easily – with content that may or may not be credible.

Drs. Kendra Gagnon and Carla Sabus argue in a recent PT Journal article that physical therapy professionals have an “opportunity – and perhaps a professional obligation” to contribute in meaningful ways to the quality of health-related information on social media websites. In their article, they offer several opportunities and guidelines through which physical therapy professionals can use social media to connect with other providers, patients, and readers around the world.

For this week’s #DPTstudent chat, we’ll be interviewing Kendra and Carla via Google Hangout from 8pm-9pm CST. The live YouTube link will appear on this site on Wednesday evening immediately before the interview. We welcome your comments, questions and discussion on Twitter during the interview regarding social media use for physical therapists and DPT students.

Abstract and link to full-text for APTA members here

View the interview here: http://youtu.be/dQHgoj_kyDE

See you there!
@LauraLWebb

How to Survive Finals – #DPTstudent topic for Wednesday, December 5, 2012

Topic: How to Survive Finals!

It’s that time in the semester again where you can’t seem to drink enough coffee, you quiz yourself in your sleep, and you don’t think that there is any way for this much information to be absorbed in your brain. It’s finals time! This Wednesday we will be discussing how we make it through finals. What are your tricks to staying sane? What kind of study breaks do you take? Are you an up-all-night studier or early-bird studier?

Use this twitter chat as a nice study break to learn some new ideas from other DPT students on how to survive finals. Talk to you all this Wednesday at 9pm EST! #DPTStudent

User’s Guide to Twitter:

APTA’s Social Media team put this excellent quick guide to how to get the basics of Twitter down. Check it out!

CHAT UPDATE

Click here for this chat’s analytics and transcript.

 

About Lauren Riley:

Lauren is a first year DPT student at Regis University in Denver, CO. She’s helping to coordinate the #DPTstudent tweetchat with others, and is a new PTThink Tank contributor! She attended American University in Washington, DC for her undergraduate degree where she majored in accounting and statistics. After a severe knee injury and a change of heart, Lauren decided to change careers. Outside of PT school, Lauren enjoys whipping up new recipes, hiking and triathlons. You can find her on Twitter at @LaurenrSPT.