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Student in need of help.
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Student in need of help. - August 18, 2000 12:40:00 PM
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pschwarz
Posts: 7
Joined: June 14, 2000
From: Ft. Lauderdale, FL, USA
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Hi, I'm a Physical Therapy student. Can anyone share possible therapeutic excercises to give a patient 10 days post-op knee and hip surgery? How about modalities?
Sincerely,
Patricia Schwarz, SPT
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Re: Student in need of help. - August 18, 2000 9:54:00 PM
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nicaragua
Posts: 28
Joined: July 10, 2000
From: Australia
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TKA and THA????
[QUOTE]Originally posted by pschwarz:
Hi, I'm a Physical Therapy student. Can anyone share possible therapeutic excercises to give a patient 10 days post-op knee and hip surgery? How about modalities?
Sincerely,
Patricia Schwarz, SPT[/QUOTE]
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Re: Student in need of help. - August 19, 2000 4:11:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
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Dear Student,
Welcome to the forum, I hope that you and your classmates find RehabEdge a rewarding and innovative way to discuss topics relevant to physical therapy practice. Let’s try to act a little bit more like professionals than technicians though okay?
What did your MEDLINE search reveal? There was no information in any of your textbooks? In today’s age of evidence-based practice, it is INAPPROPRIATE for a student to ask this kind of question without first examining the literature. It speaks very poorly of the emerging “new breed” of physical therapists. In most cases, the answers (as well as the rationale for them) will present themselves if you put a little effort into finding the evidence, rather than asking for answers via the “tradition of physical therapy.” I understand when “experienced” clinicians react and respond to clinical questions this way because they were not trained in evidence-based practice. I (and most other faculty) hold students, the future of the profession, to a MUCH higher standard. For a physical therapy student, expected to achieve a higher level of competence for what defines today’s entry-level skills than was the case 20 years ago (especially when many are evolving toward DPT), to ask this kind of question without taking the time to do a 30 second sweep of the literature at MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed/) is unprofessional and inexcusable.
A more appropriate question would have been, for example, “I’m currently examining studies on the subject of post-op THR exercises. In the McNally study, very clear benefits were demonstrated in the use of ankle pumps, ankle circle, and ankle alphabet exercises in terms of venous flow, are clinicians routinely using this exercise in the management of their patients s/p THR? Anyone have any studies that specifically show a decrease in DVT’s when a specific protocol for ankle exercises is employed?”
Hopefully, someone on the forum would bring up the Sochart study and the professional discussion would continue.
Over the past 18 months, I’ve acted as something of a RehabEdge librarian when these kind of situations arise, and I’m getting a little tired of it folks. We’ve got to get out of the technician’s mindset and start acting like professionals . . . otherwise we don’t deserve to be described as a profession, and certainly should never hold ourselves up as clinical doctors. It is unfair to utilize others in this respect if you’re not willing to put in an equal amount of scientific effort. Physical Therapy is a SCIENTIFIC art, and you CAN’T have the art without the science. I expect more of my students and colleagues, especially ones from a school as strong, progressive and forward-thinking as Nova, and expect that the positive trend toward scientific professional discussions will continue on this forum.
That said, I’ve put together a few references for your review.
Andrew M. Ball, MS, MBA, PT
Certified Infant Toddler and Family Specialist
REFERENCES:
Beanland D. An exercise program for total hip replacement. ONA J 1978 Feb;5(2):36.
Beber CA, Convery FR. Management of patients with total hip replacement. Phys Ther 1972 Aug;52(8):823-8
Enloe LJ, Shields RK, Smith K, Leo K, Miller B. Total hip and knee replacement treatment programs: a report using consensus. J Orthop Sports Phys Ther 1996 Jan;23(1):3-11.
McNally MA, Cooke EA, and Mollan RA. The effect of active movement of the foot on venous blood flow after total hip replacement. J Bone Joint Surg Am 1997 Aug;79(8):1198-201.
Sochart DH, Hardinge K. The relationship of foot and ankle movements to venous return in the lower limb. J Bone Joint Surg Br 1999 Jul;81(4):700-4.
[This message has been edited by Andrew M. Ball, MS, PT (edited August 19, 2000).]
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Re: Student in need of help. - August 19, 2000 11:38:00 AM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
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pschawartz
Your question is important, however, misdirected. Most interns that I work with are very focused on treatment options before considering treatment appropriateness. I think that presenting paper patients in school is partly to blame because you are asked to list all possible treatment options reguardless of whether they should be performed or not.
After performing an evaluation I will ask the intern what treatment they CAN do and I get 10 to 20 options. Then I ask what treatment they SHOULD do for this specific patient and WHY-- ummm, welllll, maybe... It is this critical step which separates you (a professional with clinical judgement) from a technition who follows a protocol.
I propose you already know the answers you are requesting. Ask yourself what are this persons problems, impairments, functional limitations,... (pain, swelling, muscle inhibition) What interventions do you know are appropriate to address these issues (movement, ice, muscle contraction) You get the idea.
Use your knowledge of the healing process (10 days post-op What stage of healing?), anatomy (what tissues are stressed in which postions), physicis, physiology, biomechanics, and everything else you learned up until now to guide your decisions. Protocols and studies generally refer to the most common problems seen in the clinical setting. What happens when no studies show up in the medline search and there is no protocol to be found? You are stuck having to think.
That having been said- what type of operation? Arthroscopic debridment, meniscal repair, Open reduction internal fixation, ligament reconstruction, joint replacement...
I would love to share my experience with you after I know the type of injury and surgery we are dealing with and after you have thought about it and come up with your own options first.
Please continue with this thread as we will all learn from helping you.
Erik
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Re: Student in need of help. - October 7, 2000 6:20:00 PM
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Shawn Murphy
Posts: 7
Joined: October 6, 2000
From: Cedar Falls IA USA
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Dear Mr. Bell,
I think people like yourself is more damaging to our profession then Mrs. Schwarz. I would like to be known as a profession who helps others (like Erik)then one that belittles people (like Yourself).
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Re: Student in need of help. - October 8, 2000 5:58:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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Shawn,
Enough with the personal attacks folks. My posting had a point. A method to the madness . . .
I AM helping her Shawn. No doubt Erik's comments helped her too, but scientific fact should always take priority in the inquiry process BEOFORE clinical opinion and impressions about application are invoked. There is a place for both, but the process that students and clinicians alike use to problem solve and ask clinical questions is a little wacky, and makes us look like idiots to most true medical professions.
It's helpful for a student to get a small taste of that here among friends, before being laughed at when asking a question like this of a physician without having the background facts to support the question or to engaged in professional debate/discussion. We're supposed to be the experts in neuromusculoskeletal care right? Dismissing the responsibility for reviewing the literature before asking others how they apply it clinically is VERY damaging to the profession. We look like idiots.
There is a difference between belittling a student and dispensing "tough love". I'd expect any true evidence-based clinical scientist to know the difference. After privately e-mailing this student and one of her classmates, I'm sure she understands the difference.
Perhaps you feel that physical therapy should be practiced as an art form. That's your right to have that opinion, but to pass that philosophy on to a student, well it rapes the student of the tools that they need in order to survive in today's healthcare environment. I won't allow that to happen. I have too much passion for the profession.
PT's constantly bitch and complain about respect within the healthcare environment. We have to EARN that respect. That's what I'm trying to teach these kids. What are you trying to teach them?
Drew
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Re: Student in need of help. - October 9, 2000 3:29:00 PM
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pschwarz
Posts: 7
Joined: June 14, 2000
From: Ft. Lauderdale, FL, USA
Status: offline
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Thanks Drew for the "tough love", you're 100% right! I learn by my mistakes and I appreciate your feedback. Like you mentioned, I'd rather get laughed at now that I'm still a student and learning, than later, which could be a lot more damaging to myself and to my career. GOD bless!
[QUOTE]Originally posted by Andrew M. Ball, MS, PT:
Shawn,
Enough with the personal attacks folks. My posting had a point. A method to the madness . . .
I AM helping her Shawn. No doubt Erik's comments helped her too, but scientific fact should always take priority in the inquiry process BEOFORE clinical opinion and impressions about application are invoked. There is a place for both, but the process that students and clinicians alike use to problem solve and ask clinical questions is a little wacky, and makes us look like idiots to most true medical professions.
It's helpful for a student to get a small taste of that here among friends, before being laughed at when asking a question like this of a physician without having the background facts to support the question or to engaged in professional debate/discussion. We're supposed to be the experts in neuromusculoskeletal care right? Dismissing the responsibility for reviewing the literature before asking others how they apply it clinically is VERY damaging to the profession. We look like idiots.
There is a difference between belittling a student and dispensing "tough love". I'd expect any true evidence-based clinical scientist to know the difference. After privately e-mailing this student and one of her classmates, I'm sure she understands the difference.
Perhaps you feel that physical therapy should be practiced as an art form. That's your right to have that opinion, but to pass that philosophy on to a student, well it rapes the student of the tools that they need in order to survive in today's healthcare environment. I won't allow that to happen. I have too much passion for the profession.
PT's constantly bitch and complain about respect within the healthcare environment. We have to EARN that respect. That's what I'm trying to teach these kids. What are you trying to teach them?
Drew[/QUOTE]
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Re: Student in need of help. - October 9, 2000 3:38:00 PM
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pschwarz
Posts: 7
Joined: June 14, 2000
From: Ft. Lauderdale, FL, USA
Status: offline
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Thanks Shawn! I did feel like Drew slapped me in the face with his response to my topic. But with his negative feedback he also gave me positive feedback. Of course, I was a little intimidated to continue with the forum, but I look at this experience as part of my learning process. Drew's actually a kind, helping person, why else would he be the "librarian" of the forum; I respect him giving me his two cents worth! Take care!
In Christ, Patricia.
[QUOTE]Originally posted by Shawn Murphy:
Dear Mr. Bell,
I think people like yourself is more damaging to our profession then Mrs. Schwarz. I would like to be known as a profession who helps others (like Erik)then one that belittles people (like Yourself).[/QUOTE]
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Re: Student in need of help. - October 9, 2000 4:23:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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Thank you Patricia. I didn't mean to slap you though. (Here, have some ice for that).
Anyway, How is your project coming along? Did you find the clinical opinions of practicing PT's to be in sync with, or on contrast to, the literature that you read??? I'd be very interested to know.
Respectfully,
Drew
Welcome back, I'm glad you decided to stick with us!
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Re: Student in need of help. - October 9, 2000 5:02:00 PM
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Shawn Murphy
Posts: 7
Joined: October 6, 2000
From: Cedar Falls IA USA
Status: offline
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Mr. Bell, I apologize, My responce should have been, statements like yours are damaging rather then people like you are damaging. You are very pasionate about our profession and without a doubt a benefit to it.
Patricia, thanks for your reply and best of luck in your future 8)
In my experience, the belittling of people has caused our profession to lose a lot of respect with other health care professionals. I have seen a lot of PT's belittle nurses in the same type of way that Mr. Bell did to Patricia. I have seen alot of PTs belittle physicians (not to there faces) in the same way. I feel that this is a much greater threat to our respect as a profession, then me having poor grammer in my documentation or students asking questions in a vague manner.
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Re: Student in need of help. - October 13, 2000 1:10:00 AM
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nicaragua
Posts: 28
Joined: July 10, 2000
From: Australia
Status: offline
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This forum sounds more like being at school. The member wanted only some information not a lecture about the lack of literature review done before asking a question in this forum.
If any one has a question about physio please email me at wernerspine@yahoo.com I promess I will not give you any lectures. search the literature [QUOTE]Originally posted by Shawn Murphy:
Mr. Bell, I apologize, My responce should have been, statements like yours are damaging rather then people like you are damaging. You are very pasionate about our profession and without a doubt a benefit to it.
Patricia, thanks for your reply and best of luck in your future 8)
In my experience, the belittling of people has caused our profession to lose a lot of respect with other health care professionals. I have seen a lot of PT's belittle nurses in the same type of way that Mr. Bell did to Patricia. I have seen alot of PTs belittle physicians (not to there faces) in the same way. I feel that this is a much greater threat to our respect as a profession, then me having poor grammer in my documentation or students asking questions in a vague manner. [/QUOTE]
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Re: Student in need of help. - October 13, 2000 2:49:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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Nicaragua,
I'm sure that students will appreciate your generosity, but you're also promising not to be of much help to anyone either. Students need to learn how to "fish for themselves" by searching the literature for answers to their questions instead of looking to clinicians to answer questions about physiology and treatent that are more often than not outdated and incorrect.
I'm harder on students because they are the future of the profession and I'll be ****ed to let the profession continue on as is has in the past. We MUST support our clinical profession with FACT not TESTIMONIAL. It would be nice if practicing clinicians would adopt this kind of approach to clinical practice, (tempered of course with sprinklings of clinical art), but I've pretty much written them off. Most people don't want to be enlightened and that's their right . . . but please don't pass along that poison to the next generation of PT's.
This particular student understood the help that I was giving her, and subsequently thanked me for it. I don't suspect that she'd ever make that kind of mistake again . . . thusly, your offer to "help with physiology" if students so desire to contact you directly, will likely, and appropriately, go untapped.
Respectfully,
Drew
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Re: Student in need of help. - October 13, 2000 3:40:00 AM
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Bobcat
Posts: 493
Joined: July 13, 1999
Status: offline
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I vote "TKA and THA????" as the most clinically relevant response.
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Re: Student in need of help. - October 15, 2000 12:11:00 AM
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nicaragua
Posts: 28
Joined: July 10, 2000
From: Australia
Status: offline
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[QUOTE]Originally posted by Bobcat:
I vote "TKA and THA????" as the most clinically relevant response.[/QUOTE]
I wanted to know if he wanted information about TKA or THA two different things!
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Re: Student in need of help. - October 15, 2000 12:28:00 AM
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nicaragua
Posts: 28
Joined: July 10, 2000
From: Australia
Status: offline
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I try never to provide clinical information to students that is unfounded. I agree that clinical wisdom without research is just another point of view and subjective may be. Some students may not know how to fish? providing them with some clinical information that is based on evidence levels 1,2 3, or 4 to start I do not see a problem? I will not provide fish again if he does not make an effort.
We may have a different approach to teach. We may need to do an RCT to find out if your approach to teach is effective and better than other methods.
[QUOTE]Originally posted by Andrew M. Ball, MS, PT:
Nicaragua,
I'm sure that students will appreciate your generosity, but you're also promising not to be of much help to anyone either. Students need to learn how to "fish for themselves" by searching the literature for answers to their questions instead of looking to clinicians to answer questions about physiology and treatent that are more often than not outdated and incorrect.
I'm harder on students because they are the future of the profession and I'll be ****ed to let the profession continue on as is has in the past. We MUST support our clinical profession with FACT not TESTIMONIAL. It would be nice if practicing clinicians would adopt this kind of approach to clinical practice, (tempered of course with sprinklings of clinical art), but I've pretty much written them off. Most people don't want to be enlightened and that's their right . . . but please don't pass along that poison to the next generation of PT's.
This particular student understood the help that I was giving her, and subsequently thanked me for it. I don't suspect that she'd ever make that kind of mistake again . . . thusly, your offer to "help with physiology" if students so desire to contact you directly, will likely, and appropriately, go untapped.
Respectfully,
Drew[/QUOTE]
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Re: Student in need of help. - October 16, 2000 8:15:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
Status: offline
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LOL! Point taken Nicaragua! I can't say that I disagree with your comments. I think the difference is that I don't share your degree of conviction.
I think that the tides have changed a little too far toward the artistic side of practice. I also think that there is a little too much information passed down from "experienced mentors" to students and novice clinicians. Some of it is correct and useful, but a lot is incorrect.
Both modes of teaching are effective, but with daily breakthroughs in basic science, what is "correct neurophysiology" today may not be correct tomorrow. Just look at the clinical implications of central pattern generator research and the medullary locomotor region (I didn't realize that the walking center wasn't actually in the cortex until recently), whisker-barrel reflex research (this should change our view of neurodevelopment, neuroplasticity, and has implications upon sensory-integration therapy), or the embryological basis of autism research (Did you know that the neuroanatomy of an autistic child is different than the neuroanatomy of a typically developing child? Did you know that this may actually explain autistic behaviors? Did you know that this may define how children become autistic . . . or why it can be argued that sensory integration therapy should actually be contraindicated for these kids?) Don't feel bad if you don't. Most PT's have not kept up with any of this stuff. I was sure as hell shocked to learn that a some of what I was taught in school was outdated within a decade. That's why teaching things like physiology to new graduates, though well intentioned, may not be a good idea . . . 2 years out and you're likely outdated. Sucks don't it?
The point is, that I (like you) have learned quite a bit from experienced mentors in how to, for example, work with a child with autism. As the basic science research improves however, there are direct implications upon clinical practice that must be woven into the clinical art. Students need to be exposed to BOTH. If we give them the fish, rather than teach them to fish, then we have failed them. They will "starve".
Your point is well taken though, I we don't feed 'em a fish from time to time, then some won't ever "survive" to the point of learning to fish for themselves.
Good comments, and thanks for keeping my analytical, scientifically-based mind in check! Keep it up!
Drew
[This message has been edited by Andrew M. Ball, MS, PT (edited October 17, 2000).]
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