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Anyone have this study?
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RE: Anyone have this study? - September 2, 2008 12:44:15 PM
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rwillcott
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Less reliance on PT assistant equals superior care in the treatment of LBP. Who would have thought that spending more time with the PT would equal better care for the patient
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RE: Anyone have this study? - September 2, 2008 1:15:44 PM
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Diane
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quote:
Less reliance on PT assistant equals superior care in the treatment of LBP. Who would have thought that spending more time with the PT would equal better care for the patient
"Better" by factors of 6x, all the way up to to 12, at first read...
I wonder what this part means:
quote:
Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group.
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RE: Anyone have this study? - September 2, 2008 5:56:53 PM
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proud
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Anyone?
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RE: Anyone have this study? - September 2, 2008 7:14:54 PM
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SJBird55
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Diane... Resnik analyzed clinics. Apparently clinics that have a high volume of patients with low back pain syndromes are not considered in the best overall performance category but instead are generally rated as middle or lowest overall performance category.
Proud... I do have the full text article. There is a discussion occurring around the findings of this article over on EIM blog.
< Message edited by SJBird55 -- September 2, 2008 7:19:24 PM >
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RE: Anyone have this study? - September 2, 2008 8:10:46 PM
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TexasOrtho
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The p values aren't blowing my skirt up...I need to look more closely at those numbers before I'd make a dramatic conclusion.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Anyone have this study? - September 3, 2008 5:30:00 AM
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SJBird55
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Actually, I'm wrong... clinics that had a high proportion of patients with low back pain demonstrate low utilization of services - meaning those clinics were more efficient in providing services in less visits compared to the high utilization of services clinics. That being said, the clinics that had a high proportion of patients with low back pain were not found to be highly effective nor were those clinics found to be in the best overall performance group.
I tend to believe the study was reasonable. The p-values were <.05 for those results. The questions for me aren't around the p-values as much as the definitions of the "new" definition of high, middle and low groups. The determination of use of PTA was by memory alone and I know memory is never accurate. And, Hart manipulates numbers - the whole paper is based upon the results of manipulated numbers. Take all those factors away and then the study leads to more intense questions dealing with the processes involved with the use of PTAs. Is it the use of the PTA that leads to poorer outcomes OR is the process involved with PTA usage the problem? Until the processes are analyzed, I don't believe any solid conclusion can be made. That's just my opinion though.
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RE: Anyone have this study? - September 3, 2008 6:00:39 AM
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Sebastian Asselbergs
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Good points, SJ.
Either way, as soon as the use of a PTA becomes an aspect of therapy in any study - a rather significant number of variables gets added.
Makes the study a bit more challenging, and also makes it harder for the individual clinic to be consistent in its care/approach. I still think that involving a PTA in the therapy session adds a complicating aspect, rather than a simplifying one.
I am NOT slamming PTAs - I am expressing MY preference to be 100% responsible for the therapist's side of the therapeutic interaction - at all times. And not having an extra human in the mix makes that easier.... And, as rwillcott states so succinctly, that may well affect quality.
_____________________________
Mundi vult decipi
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RE: Anyone have this study? - September 3, 2008 4:45:03 PM
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rwillcott
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I have worked in clinic where aids are used. I think it's fine when the main duty is to clean the room, get modalities ready etc. My biggest rule when working with an aid is to not provide any advice or info to the patient. At any time! Especially with back pain. A comment such as "my uncle had back pain and he's still having pain" can cause a major set back for a patient.
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RE: Anyone have this study? - September 7, 2008 8:47:12 AM
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ptim
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SJBird55
'Hart manipulates numbers - the whole paper is based upon the results of manipulated numbers'
how?
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RE: Anyone have this study? - September 7, 2008 10:20:42 AM
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SJBird55
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FOTO collects health related quality of life (HRQL) information and somehow creates a FOTO overall health status (OHS) measure. Patients provide HRQL information at initiation of services and at discharge which is used to determine the FOTO OHS. Then, raw ordinal scores are transformed into interval scores between 0 - 100 for each question, with a higher score indicating better health. Let's stop at this point and compare the process with say the Lower Extremity Functional Scale - that's just a total... what about the process with the Neck Disability Index or the Oswestery - add up to get the raw score and multiply by 2 to put it into the disability score.
Now, Hart then takes the OHS scores and puts them through some risk-adjusting process which I have no comprehension of, no matter how many times I read his work. From this risk-adjusting process, somehow a predicted score (that's what I'd call it) can be calculated as to what the final score at the discharge from services should be. Again, don't ask me how this is known. This particular paper used a "residual score" which was the difference between the final outcome score and the predicted score. The residual score is what was used to determine the classification of patients into 1 of 3 outcome categories. So, my thinking is that there should be some caution with hinging outcome results on this "predicted" score because... what if the "predicted score" isn't right? The "predicted score" seems to be the foundation for the determination of outcome and that particular score is based on the manipulation of scores.
That's just my opinion of it though.
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RE: Anyone have this study? - September 7, 2008 12:32:44 PM
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ptim
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I think the 'predicted score' is the average outcome of all the FOTO data for that particular OHS measure. Don't quote me on that though!
In this particular study though, all scores/outcomes are calculated the same, comparing oranges to oranges, in which case I think its a good study.
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RE: Anyone have this study? - September 7, 2008 3:01:11 PM
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SJBird55
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I honestly don't know, ptim. Their description in this study is weak. It also references their own previous work. Yes, there is consistency in what occurred with all patients.
If you are doing a comparison and you assume that your foundation for comparison is a square, but you are wrong and reality is that the real foundation is a sphere, you've got issues. They provide the initial OHS score mean and standard deviation... they provide the discharge OHS score mean and standard deviation, but they don't provide the predicted score mean and standard deviation or the residual score mean and standard deviation. In my mind, kind of an important number since that is the number that determined the classification of the clinic.
They are also using scores without any interpretation of how much change is clinically relevant. I haven't seen anywhere any inference to MCID for the OHS. It's just a number that can change. They again used their own work to determine there was an effect size of .83 for low back pain syndromes and the OHS is responsive and could differentiate expert from average therapists. Effect size (using Cohen's d) is basically the differences of the means divided by standard deviation. The OHS is responsive enough to determine change in score; what is missing is how much of a change in score is considered clinically relevant?
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