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Re: Mythbusters
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Re: Mythbusters - February 4, 2005 3:44:00 AM
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Yogi
Posts: 403
Joined: April 5, 2004
From: San Antonio, Tx., USA
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TK, well, I think Barrett has had this discussion also. We could review the ceteris paribus thread on the bullpit, from 8-5-04. See what you think TK. Yeah, I once thought case studies make research, but now i kind of think they're a waste of time unless they are rare unusual cases. Then of course they may help tv writers for their storylines. SJ, if one on one sets off a red flag, then the entire field of home health should set off a red flag. And maybe it ought to. Personally, I find it difficult to talk to or touch or visually monitor more than one person at once. Which is why I choose to work where I am not required to have four eyes and six hands and elastic arms.
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Re: Mythbusters - February 4, 2005 6:37:00 AM
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JLS_PT_OCS
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Joined: January 30, 2005
From: USA
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Good discussion...
TK, I would encourage you to publish a case study or two on your methods, or hopefully even a case series. It should be easy considering your reported numbers of patients treated/outcomes. That would at least introduce the research world to your methods and provide a classification system or paradigm with which to approach the issue in some patients.
I will agree that yes, we all see too many people, there's not enough time, etc, etc.
But at the end of the day, if we are to survive as a profession, this kind of research needs to happen. All excuses aside.
Not everyone has to be a researcher, but all of us need to evaluate and appraise research as well as use EBM.
You are truly fortunate both in your practice pattern and your level of skill, so please help by sharing that with the profession by providing some evidence. I am willing to bet it would seriously increase your revenue and enrollment at your courses also.
Army makes good points about having more time than you might think. Your research may provide the next great Clinical Decision Rule for patients with "SIJ pain".
Until then, sir, I will respect your opinion but view any claims of success with considerable skepticism.
Certainly we have proven that skill (palpatory, manual or otherwise) is not a factor in helping patients with nonspecific low back pain. It would not seem unreasonable that a similar finding could be expected in the case of the alleged SIJ dysfunction.
I think we can all find a good balance between operating a jam packed clinic full of "machines, hotfakes, and ultrascam" and one in which we spend an hour with each patient using what are essentially unproven and questionable methods. Again, not saying they don't work for some patients, just saying there's no evidence to support their use.
What do you think?
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Mythbusters - February 4, 2005 6:50:00 AM
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SJBird55
Posts: 2438
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From: Michigan
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Yogi, it wasn't the "one-one-one" that sets of a flag in my brain... it was the simple fact that every patient receives one hour of physical therapy. That isn't a patient-centered approach, in my mind. Does every single patient need/require one hour of physical therapy every visit?
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Re: Mythbusters - February 4, 2005 8:09:00 AM
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Yogi
Posts: 403
Joined: April 5, 2004
From: San Antonio, Tx., USA
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OK, yeah I couldn't see you having a problem with one-on-one, thanks for the clarification. I get it, now.
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Re: Mythbusters - February 12, 2005 6:44:00 AM
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Geert Jeuring
Posts: 92
Joined: June 26, 2002
From: Möhnesee, Germany
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Although I´m the ultimate sceptic or a critic rationalist (as in Karl Popper) on a whole load of myths in physiotherapy and medicine I have to agree with the osteopathic colleaques (which is generally rare) that most of the above mentioned Structures are palpable. The but is in the way we can palpate them. The psoasmuscle ist palpable in the medial triangle but only as a provocation test and there is no way we can differ from the bursa. The ventral Corpora are palpable, but what´s the use? The Piriformis is palpable, again as in provocation by palpating Origin and Insertion and drawing a line between them. In my opinion every assessment of quality is bogus or wishfull thinking.
Greetings from Germany
Geert Jeuring
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Re: Mythbusters - February 12, 2005 3:25:00 PM
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nari
Posts: 1568
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From: Australia
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jon
Thanks for the link you posted. At the end of reading it, I am still vaguely bothered by what is valid - many studies do not take into full account the placebo-controlled factor. Most aspects of alternative therapy, excluding chiropractic and osteopathy (at the cost of annoying quite a few posters on this forum) are based on the now well-established endogenous opioid-inducing effect of placebo.
So what may be taken as gospel truth may actually be no better than placebo; unless this factor is controlled.
Nari
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Re: Mythbusters - February 12, 2005 3:50:00 PM
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Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
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Hi Nari,
I agree. Placebo is one of the ties that bind the therapies together. When true believers both in receiving and in giving are paired up the outcomes are probably as best as it can be for that given therapy.
Placebo is not easily controlled for in certain situations and is one part of the whole Ceteris Paribus thing.
I think this is one of the reasons why theory is so important. From a scientific standpoint this is what should be tested if there is a way to measure what it is the theory purports to be happening. Clinically, this may not be interesting.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Mythbusters - February 12, 2005 7:17:00 PM
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steve
Posts: 470
Joined: May 14, 2003
From: Canada
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Jon or anyone,
Ever heard of any research on how to maximize placebo effect? It is obviously a powerful tool and if we were able to maximize it to improve our patients outcomes... Would that be unethical?
Just a thought.
Steve
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Re: Mythbusters - February 13, 2005 2:44:00 AM
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Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
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Hi Steve,
I've given much thought to that. My answer is a conditional no; it would not be unethical. If that placebo leaves the person with decreased self efficacy I would hesitate to use it however. For instance in pharmacology the medicines that go to market must be shown to have an effect greater than that of placebo. Why? Because the sub population taking the medicine can draw no other conclusion except that they biologically need the pill for their condition and subsequently are willing to pay for it. It would be unethical, in my opinion, (and apparently to those who write laws) to let that happen if there is no effect greater than placebo. Again, there is a caveat. If there is no alternative then there is no alternative. Many are familiar with the use of placebo morphine during the war when supplies were gone. And then there is the aspect of freedom to choose--always difficult. If someone knows "it works" for them and they are spending their own money then what's the harm? It depends. If they are foregoing an otherwise useful treatment for cancer then the harm could be seen as large. If it's just a matter of pushing money around then one has to weigh the benefits of a mislead culture with a successful economy.
Boy you asked a tough question. I alluded to this topic in a different thread.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Mythbusters - February 13, 2005 4:10:00 PM
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steve
Posts: 470
Joined: May 14, 2003
From: Canada
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Jon,
Actually I was referring to the placebo component of proven treatments, perhaps there is a way with which we speak or act with our patients that enhances their outcome. I agree, it would be completely unethical to offer a treatment with a placebo effect purely for profit but is there a way to enhance the placebo effect that must exist, in part, with a proven treatment? Hope that makes sense - It just seems that placebo is such a strong effect, why not add it to whatever treatment we give?
Steve
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Re: Mythbusters - February 13, 2005 4:50:00 PM
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TKOPT
Posts: 7
Joined: January 17, 2005
From: Willoughby Ohio
Status: offline
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Hi All,
Something is not right,
I posted a huge reply about 5 days ago and I even saw that it was sucessfully posted but it is not here now??
Am I crazier than I thought???
Any thoughts..Did it go to another topic???
HELP!!
_____________________________
Thomas K.Ockler P.T.
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Re: Mythbusters - February 13, 2005 5:00:00 PM
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Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
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Hi Steve,
I took a quick look and found this reference.
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15630827]link[/URL]
I understood your question. Unless a "proven therapy" has been compared to a placebo, we can't be sure what's been proven. In the absence of that information, people aren't just providing a placebo for money, they are providing it because it works. Physical therapy research, unlike the pharmaceutical research, isn't held to the placebo controlled standard. This is likely because controlling for placebo in therapy would be some degree more difficult than in drug testing. Or perhaps we would learn what we don't want to know.
But back to the point. If one is to maximize the effectiveness of their therapy, I think there are ways of being that help. Or maybe more accurately, there are way of being worth avoiding. I don't know if that would be classified as placebo. I think that any placebo that does not rob a patient of self efficacy is worth employing.
On the topic of placebo, here's a link that I was made aware of by the insightful Ian Stevens
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15533601]link 2[/URL]
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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