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Re: frequently asked questions
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Re: frequently asked questions - April 26, 2000 1:40:00 AM
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chrisPT
Posts: 19
Joined: April 8, 2000
From: hong kong, china
Status: offline
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Agree with u , Rose ^_^
this is a share corner
not a place for judging or what
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Re: frequently asked questions - April 26, 2000 3:34:00 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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Forum,
I'm not arguing folks, and I'm not yelling, but I am a bit disappointed in some of you, and by extension, the profession as a whole. I'm sorry that some of you see that as unprofessional yelling, but after months of "professional abuse" of FACT FINDING deferment by some of the more supernatural-based practitioners, some one has got to stand up and promote a greater sense of individual responsibility within the profession. I'm sorry if that is difficult for some of you to swallow.
I tried the honey approach, and as is per usual with physical therapists, that didn't work as pleas were largely ignored. No one wants to admit that ANY part of their professional being is degrading toward incompetence.
Either that or I simply have a higher standard of what it means to share clinical information.
Why continue to pass information that is potentially, and usually incorrect? That's usually what happens when "expert clinical opinion" is solicited.
What value does that serve for the profession? I agree that PT's should share clinical information, but the basis of that sharing should be in the suggestions of how to apply scientific fact (e.g. research) to clinical problems (hence sharing). To do otherwise promotes the status quo of using the "shotgun-approach" that doctors, chiropractors, and ex-patients, and local politicians frequently complain about at dinner parties. They may be right.
I constantly hear PT's say that we need to respect individual patient differences, and that's true, but human beings are in general much more alike than different. It's distressing the way that so many supernatural-based practitioners hide behind "individual-differences" in their avoidance and resistance of scientific fact. (e.g. "Craniosacral therapy works for some and not others because we're all different" That may be true, but a near -1.00 inter-rater reliability for craniosacral pulse??? I don't know, sounds like a load of crap defended by a PT who's doesn't want his or her ego bruised by the realization that they spent so much time and money to learn a clinically useless technique - - - and "individual differences" is a convenient way to save face).
To those of you who say that I could do a MEDLINE search but (insert your favorite excuse here). I would like to point out that Banks are pretty fickle in that they insist not only that you have the ability to pay . . . but that you will actually pay them back. The same is true of relying on fact through MEDLINE . . . it's not just important that you know how to search . . .
The level and quality of our clinical sharing on RehabEdge, as well as the respectability of our profession within the general healthcare environment, will greatly benefit as a result.
Very Respectfully Submitted,
Drew
------------------
Andrew M. Ball, MS, PT
MBA/PhD Candidate
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Re: frequently asked questions - April 26, 2000 6:18:00 AM
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gerry
Posts: 236
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
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Bobcat - some of your best work ever! My abdominals are sore from laughing. Next time I'll wear my weight-lifting belt before reading. The link was useful, and I'd have to agree with the authors conclusion that knuckle cracking has not been shown to cause arthritis, but should be eliminated because it is an annoying habit.
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Re: frequently asked questions - April 26, 2000 7:03:00 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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I agree with Gerry.
This brings me to another question though.
Bobcat, you always seem to find e-resources that I overlook with a MEDLINE or internet search engine (I usually use Yahoo). What search techniqe are you using to identify your sources? Do you use a different search engine? (e.g. Go, MSN, Lycos, etc.)?
I've been very impressed over the past year or so with your ability to identify not only research articles, but articles about RESEARCH IN PROGRESS. I have not been able to figure out how you're doing that. Would you mind opening another thread and sharing with the forum how you do this???
Drewfus
P.S. Your point about force-feeding PT's PWB-GT information is well taken. I'm excited to find something so clearly and more effective and efficient than anything else in the PT tookit when it comes to gait training in cases neurologic injury short of complete SCI.
I will in the futue, try to keep that enthusiasm in check, considering that some PT's have a severe ego defense reaction to learning that they may not be treating patients in the most efficient and effective manner possible.
As shown in either the Visinin or Hobkins study (I can't remember which off the top of my head) the traditional practice of working on stability (e.g. static standing balance) before mobility may actually INCREASE the likelyhood of the patient developing gait abnormality versus not only PWB-GT . . . but doing nothing at all. (Creepy huh???) I'd think PT's would want to know these kind of things. (For those of you who care, traditional therapy is far more likely to produce a "dorsum drag" and roll over in mid-swing phase --- that can't be corrected once it's there --- than no therapy at all) In cats (and yes I know cats arent' people), those trained with static standing and balance training, were LESS LIKELY to walk than those that got nothing at all. Human studies in progress suggest that the same may hold true for humans. The PWBTT group of cats, of course, had the best outcome (Hobkins).
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Andrew M. Ball, MS, PT
MBA/PhD Candidate
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Re: frequently asked questions - April 26, 2000 7:06:00 AM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
Status: offline
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Janet Reno is very tough and I, for one, will stay IN town later because of her.
Belts for wt. lifting are very different from the elastic belt you buy at Wal-Mart.
Sorry Shannon, but I would like to alter your question a little and ask whether one should use the belt in the first place? If the purpose of wt lifting is to get stronger not just to perform lifts, but also to function in the world, then I question the use of the belts. If a person feels their back is at risk performing a lift they need to consider that the wt may be too much or thier technique is off.
Editorial comment--
Weight lifting is a worthless, vain, self-glorifying, stuck-up, show-off, attempt at enlarging, vain exercise if one is doing it for the purpose of adding more wt to the bar. Fittness and health considers the function of the body as a unit, not overload and risk to one area to bulk others.
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Re: frequently asked questions - April 26, 2000 1:37:00 PM
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gerry
Posts: 236
Joined: July 6, 1999
From: Montgomery, AL, USA
Status: offline
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Editorial comment--
is not, is not, is not!
It can certainly be abused, as any other sport/recreational activity. But it can be a rewarding and function improving activity, too! Arnold does not get millions for his movies only because of his acting skills...
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Re: frequently asked questions - April 26, 2000 3:51:00 PM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
Status: offline
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Dear Drew,
I admire your intelligence, your insight, your knowledge, your command of semantics, your pride in your profession and your pride in yourself and your accomplishments and your abilities and your intelligence and your insight and your knowledge and your command of semantics. But I honestly feel that you are branding all but a minute few of your peers as dumber than snot and frankly you are giving me a headache. I have toiled long and hard for probably longer than you have been producing snot for my profession and have produced an outstanding number of functional individuals with blown apart spinal cords from Viet Nam to my newest CVA today. No, I do not run to MEdline and search it to answer my questions every time. It does not make me a lousy therapist nor does it destroy my profession. I DO enjoy the commaraderie of and bonding with my peers at work, at seminars and especially on this forum which is ALSO an integral part of this profession. Lose that and we lose it all. So there..... and by the way...is there a Freudian something or other to look at that you must always follow your name with your doctorate candidacy status ???? My grandfather had a saying to apply to that..... something about horns.....but I forget the wording......it's probably because of my headache.
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Re: frequently asked questions - April 26, 2000 5:35:00 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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Rose,
I must respectfully disagree with just about your entire post. If your statements and claims of clinical effectiveness, held true throughout the entire profession, then we would not be in such a state of chaos. Had today's "more experienced therapists" practiced the art of science, and not the art of physical therapy tradition, then we may not be in such a state of professional disarray.
The issue of the DPT feeds right into this basic difference of opinion. Experienced PT's can't understand the need for the evidence-based DPT, while new graduates (MPT or DPT), are generally disgusted with the state of the profession that we've left them by in general, not living up to that responsibility of practicing evidence-based science. I don't think that evidence-based practice is the entire answer to the problems we currently face as a profession . . . but the new graduates have a point.
I'm not saying that you, or Dana, or anyone else on this forum are lousy therapists. I've never thought that, quite frankly I never even considered it. The point is that no matter how good you, me, or any other PT is . . . we could be, we MUST be better. I believe that evidence-based practice is the most appropriate means to that end.
Case in point, you and I may have gotten some patients, or most patients or whatever very functional. We both claim to be excellent clinician and you appear to have an excellent grasp of clinical technique. I'm certainly in no position to argue the point of your clinical skills, and won't presume to. That's not at all the point.
The point is this, could a better, faster, cheaper way have been accomplished with an equally commanding grasp of the literature?
You bet.
For example, some new studies by Hobkins et al. suggest that traditional physical therapy gait training, may actually CREATE some of the gait abnormalities that we're claiming to correct and eliminate (specifically, working from the framework of the patient must have good balance before they can walk may actually create a greater number of people that walk by scraping the dorsum of their foot along the ground in mid-swing . . . than if NO THERAPY was provided at all). How about the Palmer study (randomized with a very large sample size) suggesting that traditional early intervention PT for kids with CP has no effect upon movement skills, movement quality the need for ortho equiptment, or ever the incidence of contractures? Such studies would strongly suggest that even the greatest therapist who thinks that major, major, improvements in their patients are achieved year in and year out . . . is simply somehow professionally kidding himself. Despite what the PT feels are functional gains, PT intervention may not have made a lick of difference in terms of natural history had nothing been done. There are other techniques that do in fact make a difference for such clients . . . but if the PT did not have a firm command of the literature . . . he wouldn't even be searching for the clinical alternative. He'd just practice day after day blissfully unaware that his patients may do just as well (less expensively) without him. The really sad thing is, that there are some things that we do as PT's that have been clearly demonstrated to work far better than the cornerstone traditional techniques.
Besides, I know a lot of PT's, and I've never heard a one of them describe themselves as an ineffective, outdated, awful clinician. Not everyone can be the most effective therapist to ever set foot in the clinic . . . and most people don't claim to be . . . but not everyone can be "about average, or maybe a little above average." It's not an attack, just a simple law of statistics.
COMIC RELIEF ADAPTED FROM JERRY SEINFELD:
Furthermore, no one has ever said to me that they have a bad physician, but I hear "Oh that PT sucked, he did some weird thing with his hands and it helped for an hour or so, but really didn't make much difference in the long run" all the time from discharged PT patients (friends, family, even other therapists). The general public seems to think that we’re a bunch of frauds. Why is that so? Managed care is part of it yes, negative PR comes from some but not the majority of MD’s DO’s and DC’s. Those are not the only reasons. Part of the problem is us, and how we have in general, not taken responsibility for what it means to be a physical therapy professional.
Drewfus (see, not every post is signed MBA/PhD Candidate – LOL!)
[This message has been edited by Andrew M. Ball, MS, PT (edited April 26, 2000).]
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Re: frequently asked questions - April 26, 2000 5:43:00 PM
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jeffmcv
Posts: 9
Joined: April 24, 2000
From: Richmond, VA
Status: offline
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Drew,
Unfortunately, typing is not speech and while you may think you are typing to Dana and are "saying" you need to be more evidence-based in both application to your practice and in your asking questions, it sure sounds like you are sniping from on high one step down from the PT Valhalla. In my program where I am second year student, we are beat over the head with evidence-based practice, and I agree that we should have justification for what we do. At the same time, there is a certain value for doing what works. We have recently been introduced to the article in NEJM (I believe) re: chiropractors vs. physical therapy vs. pamphlet (if you need the reference I can supply it--I'm too lazy to go looking for it). In many ways, this study contradicts physical therapy's effectiveness...so should we all quit our jobs knowing we aren't really doing anything? Evidence-based practice is reliant on an ABUNDANCE of evidence, because after all a single study on the effectiveness of physical therapy that claims that a pamphlet is just as effective (heck most people likely can't even READ the pamphlet let alone follow the directions!!) doesn't necessarily mean that PT is useless. Research requires volume in order to know that every possible difference or variable has been covered.
Hang in there Dana, I'm sure we can all be evidence-based as soon as we learn what the heck Medline is (J/k)
Jeff
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Re: frequently asked questions - April 26, 2000 6:05:00 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. I've actually got the article. We (Barrett, Mcap, Bobcat, and I) talked about it about a month ago here on RehabEdge before you joined us, but I'm having a hard time finding the thread at the moment. (A little help out there please).
I think that study, along with the others that we discussed showing rather clearly that Hx of smoking, followed by psychological factors play a far greater role than the PT intervention ever will in the rehab of the patient with chronic low back pain, are VERY damaging. What's worse is that unlike you, most experienced PT's are not even aware of the existence of these studies. That's frightening. That's a problem.
A healthcare administrator doesn't need much more than these few studies to cut reimbursement for all PT for the Rx of back pain right out of the insurance plan. That study has a lot of politics to it that cloud it's value for discussion here, except to say that PT's just point to it and like you say "It's not valid". Valid or not is not the point. Is anyone doing any replication study to counter this study???? Sadly, no.
Should all PT's leave the profession as a result of this study? No, of course not. But we should figure out how to cover out collective butts either by counter-studies or by researching the value of new techniques over traditional methods
.
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Re: frequently asked questions - April 27, 2000 6:08:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Dear Jeffmcv:
I am glad you posted as you bring up an interesting point.
I disagree though. PTs may think that volumes of research are necessary and indeed they are. But that is no reason to ignore the research until there are numerous studies are available.
Case in point is the article you mentioned. I am McKenzie certified and I have seen some wonderful results. But the study made me question whether the results were lasting, without hard science how do I know and eventually no one will pay me for this service. A review of the literature revealed that Richardson and Jull were getting good results (lasting!) with their program to retrain the transversis abdominus and multifidus. Two coworkers and I came up with a three phase program based on their work and the results, I think, have been more permanent.
Did I throw McKenzie out the window. No. I still use it. But evaluation of the research has changed my priorities and shaped my practice. With a thorough review of the literature and acknowledgement of the role of psychosocial factors I am careful in how I handle my patients. If you set up an expectation of a cure and make them dependant, you can actually make them worse in the long run.
So there you have it. Research is critical even if the picture is incomplete. Or else...how do you know you are really helping!!!!!!!! Don't forget that with some patients there is a tremendous potential for placebo especially if you lay hands on and seem to know what you are talking about. But as recent article in the New York Times magazine stated, you can never underestimate the placebo effect. In some cases, cure rates can reach 70%!!!!!!!!!!!!!!! But regardless of results....no one should pay your salary to deliver placebos.
Respectfully submitted,
Mcap
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Re: frequently asked questions - April 28, 2000 8:52:00 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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Forum,
For those of you who have been following the continuing saga between Dana and myself, I'm pleased to announce the following:
Dana and I have set aside our differences and are planning to work together on a collaborate summarization and review of the following article:
Schindl MR. et al. Treadmill Training with Partial Body Weight Support in Nonambulatory Patients with Cerebral Palsy. Arch Phys Med Rehabil. Vol 81. Issue 3 March 2000.
I think that our individual strenghts will be magnified and respective weakness and differences diminished if we collaborate in this manner. I'm very excited about it!
The article seems to show that GMFM scores stay the same over 6 weeks of traditional PT, and improve between 47% and 50% with 3 months of PWB-GT.
If anyone would like to follow along with us, please let me know we'll discuss how to get a copy of the article to you.
I don't have to tell anyone that working together will be a new experience for both Dana and I, and the process may take a little while. Please be patient, it should be well worth the wait!
Drew
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