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Re: Look at this validation study guys, worth reading!
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Re: Look at this validation study guys, worth reading! - January 19, 2005 3:32:00 AM
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childsjd
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The ROM exercise in the manip group was essentially a pelvic tilt, nothing fancy, just instructed to rock their pelvis back and forth in a pain-free ROM.
Diane, thanks for the clarification on the links.
John
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Re: Look at this validation study guys, worth reading! - January 19, 2005 4:04:00 AM
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Jon Newman
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Hi John,
You'll see from one of my first posts that I think the inclusion of liklihood ratios and NNT information was quite valuable. But obviously my interest isn't just how I can use this study to improve my pratice. The study already speaks to that. Most of my questioning has been geared at understanding as much of the why and how as possible. Hopefully this isn't viewed as a crime and people may actually learn something from it. I was interested in regression coefficients and beta weights so I can have a more complete appreciation of those variables' observed relationships.
Thanks,
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Look at this validation study guys, worth reading! - January 19, 2005 8:49:00 AM
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Randy Dixon
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John,
In an earlier post you advocated using manipulation in cases of 3/5 with the CPR, to simplify I would say it follows the rule of "it won't hurt and it might help". So wouldn't it also be advisable for 2/5 or even 1/5? In fact, if a person is comfortable that it is safe, wouldn't it be worth trying in all cases of LBP except those for whom you believe it is contraindicated? If it helps only 10% of the 1/5 group, rather than the 92% of the 4/5 group and it takes about two minutes to do, shouldn't it still be attempted? If so, perhaps what is more useful is identifying those who react negatively to manipulation.
Is their a risk/benefit ratio or some other reason not to manipulate?
I think this is the likely reasoning for the pro manipulation group, would you say it is valid?
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Re: Look at this validation study guys, worth reading! - January 19, 2005 11:03:00 AM
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childsjd
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Randy:
Others have certainly made similar arguments, and there is an entire profession that operates on this notion, correct? And they their patients tend to be generally quite satisfied with their care. I would suggest that we can do better than random manipulation, even given essentially negligible risks. Thus with folks meeting less than 3 criteria, I'm usually considering something else. Having said that, the argument you make is much more sensible than those who have expressed in this forum a refusal to manipulate any patient with back pain.
John
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Re: Look at this validation study guys, worth reading! - January 19, 2005 11:38:00 AM
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childsjd
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Jon:
I know what you're after and understand the rationale for asking. It's really an analysis in and of itself and would take some time to put together.
John
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Re: Look at this validation study guys, worth reading! - January 19, 2005 1:27:00 PM
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Andrew M. Ball PT PhD
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John,
Any backlash from chiropractors yet?
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Look at this validation study guys, worth reading! - January 19, 2005 4:01:00 PM
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Synergy
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I'm actually in the office with two open-minded chiropractors. I let them each have a copy of John's article this afternoon. It will be interesting to see how they interpret the article in regards to their alleged practice of 'random manipulation'. BTW John, I enjoyed the article quite a bit as well as reading everyone's opinions about it. Well done!
_____________________________
Chris Adams, PT, MPT
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Re: Look at this validation study guys, worth reading! - January 20, 2005 3:29:00 AM
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bravocosta
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Before pursuing any type of manipulation, check the laws/ordinances in your state as the open-minded chiro lobby has restricted manipulation in several states to individuals with 400 hrs.of supervised manipulation and 800 hrs of instruction. (Tennessee and New Jersey for example-there may be others).
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Re: Look at this validation study guys, worth reading! - January 20, 2005 4:43:00 AM
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Alex Brenner PT MPT OCS
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Drew, I dont think Chiros read any of our research. It would be interesting to post this over on Chiroweb and see how much negativity towards PTs comes out.
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Alex Brenner, PT, MPT, OCS
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Re: Look at this validation study guys, worth reading! - January 20, 2005 4:53:00 AM
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Bournephysio
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Army: If you look at chiroweb they have a dutch manual therapy study and claim that it supports what they do. I've seen that study used by both chiros and massage therapists.
This study can be very pro or anti chiro. first it shows that manipulation can be very effective but it also shows that you probably don't need tons of training. The manipulation group also received stability exercises over the next couple of weeks and I don't know many chiros that do anything but manip. Of course most of the chiro patients I see aren't happy and want to try something else so its a biased sample. Maybe chiroortho can coment.
I suspect that in states where PTs can't manip chiros will push for recognition for this study and probably not in states where PTs can manip.
Doug
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Re: Look at this validation study guys, worth reading! - January 20, 2005 6:19:00 AM
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childsjd
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Drew:
No backlash from the chiropractors yet (and I have nothing against chiros by the way), but it will likely come any day now. For some reason, the American Chiropractic Association (ACA) has a hard time letting an opportunity to respond to something like this pass them in deference to the fact that it might just go away if they would leave it alone. I anticipate a letter any day about some potential criticism, which will of course only keep the study in the forefront of everyone's mind longer than if they would just ignore it. We'll see if they can resist the urge to back off on their letter writing campaign here. I doubt it, but time will tell.
John
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Re: Look at this validation study guys, worth reading! - January 20, 2005 6:23:00 AM
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childsjd
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If you live in a state whose PT practice acts limits scope of practice with respect to manipulation (either prohibited or with restrictions), you should be beating down the doors of your legislature to demand it be changed. Plain and simple. This is about politics at the expense of some patients you see who would otherwise benefit from this care. Unfortunately, politics rarely has the best interests of the patient as a top priority, if it is a priority at all. It truly saddens me.
John
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Re: Look at this validation study guys, worth reading! - January 21, 2005 12:20:00 AM
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Andrew M. Ball PT PhD
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John,
I know what you mean about the ACA. I've had enough exeperiences with them to realize that they always seem to miss the opportunity to simply miss an opportunity. They're not yet a mature enough organization to understand that
1. They don't have to comment or take a stand on everything.
2. They lost the battle to own manipulation long ago.
3. There isn't a worldwide organization of "Men in black" comprised of MD's, DO's, and (D)PT's whose sole mission is to discredit them. There are enough within their ranks who discredit themselves as a profession.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Look at this validation study guys, worth reading! - January 21, 2005 2:52:00 AM
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childsjd
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Drew:
Well said. There are many legitmate chiropractors providing evidence-based care for their patients. Ironically, their professional association's tactics in my opinion will keep their profession being perceived as "alternative" by the medical establishment for many more years to come. Their continuing to hang on to some of the fanciful ideas about manipulation being a cure for presumably every ICD-9 code ever published also does not help the situation. The fringe practitioners in their profession (much like those in our profession) often contribute to substantial harm to their public credibility amongst both patients (who are increasingly more familiar with what constitutes evidence-based practice more than some practitioners!) and the medical establishment.
John
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Re: Look at this validation study guys, worth reading! - January 25, 2005 3:25:00 PM
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Andrew M. Ball PT PhD
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John,
Got copy of article from my wife (she downloaded and has been hording for the past few days) and will read over the next few days. I look foward to opening a thread in the evidence-based section. Having viewed the video on the APTA site, I can't help notice that the manipulation technique used seems to be the NMSE version. I've felt that I've always had more success with Cyriax, especially when it comes to thoracic mobs. Why did ya'll seem to use what appears to be the NMSE method for grade V mobilization?
Drew
By the way, my wife, a DPT grad from Duke, is the daughter of an Air Force Lt. Col. who flew T-38's for years. She was born on the very base in Schertz, TX where I'm guessing that you're stationed.
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Look at this validation study guys, worth reading! - January 31, 2005 9:30:00 AM
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JLS_PT_OCS
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What a great thread to read.
I am at once glad to see such great research being done in our profession, and saddened to see so many of our ilk who practice based on their personal approach and theory and not on evidence.
I think it takes a lot of guts to admit that you will not do something proven effective because you're not comfortable with it or it doesn't fit your paradigm. WHAT??
I hope my family physician doesn't practice like that:
"well, Jason, the evidence supports using an antibiotic for your condition, but I don't really think that's a good idea...given what we know about your nervous system, here's some Motrin instead..."
This criticism is not aimed at anyone in particular (let he who is without sin cast the first stone, right?) but at many people I have met in our profession who hold fast to theories of treatment and do not pay close attention to, and regularly modify, their practice based on evidence.
I admit, it is hard to abandon old concepts, especially since many of us have had them ingrained, but it is this willingness to reject personal feelings of "success" in the face of evidence that should be the mark of a scientist.
John C, (and all others like you) keep up the good work. Your research and your critical inquiry are desperately needed in this time of professional transition.
I read some things recently that made me think of this thread:
"New and stirring things are belittled because if they are not belittled, the humiliating question arises,'Why then are you not taking part in them?' " - H. G. Wells
"I have steadily endeavored to keep my mind free so as to give up any hypothesis, however much beloved, as soon as the facts are shown to be opposed to it."
- Charles Darwin
I have used this manipulation very frequently in my practice, and have seen similar results to those cited in the study. But that's really not a surprise, I just did what the evidence told me to.
In fact, of those low back patients in whom I use manipulation, I rarely have to use any other technique. It is simple and easy to learn.
Also, it seems that there is a name for Physical Therapists who do not use manipulation in their practice....Athletic Trainer.
If many physiatrists have their way, PT as a profession will die off, and all musculoskeletal problems will be managed by them while writing modality and exercise orders to ATCs.
!!!
This type of study helps define a separate, distinct practice area where we can provide better benefit than any other profession, and as such, it is great for all of us.
-Jason.
_____________________________
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: Look at this validation study guys, worth reading! - January 31, 2005 9:58:00 AM
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steve
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Jason,
Well put.
Steve
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Re: Look at this validation study guys, worth reading! - January 31, 2005 1:52:00 PM
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jma
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From: NY
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Hello all,
Its been a very long time since I first posted this topic in the beginning of this record setting topic. The amount of responses and dialogue that this has caused has truly impressed me.
Just think what would happen if we all posted one validation study, which I'm sure there a many, and see what it generates in this forum. They are out there and waiting to be discussed. Maybe not in JOSPT but in others that we rarely hear about or even read.
Keep the discussion going.
JMA
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Re: Look at this validation study guys, worth reading! - February 1, 2005 1:19:00 AM
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SJBird55
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JMA, maybe... but John is the person that really made the discussion occur in two ways - first by being a part of that study (then the work published) and secondly by taking time out of his schedule to respond to questions/comments here. How often do any of us get opportunities like that?
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Re: Look at this validation study guys, worth reading! - February 1, 2005 4:30:00 AM
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jma
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Yes SJ,
I agree 100%. I wish that those who were involved in many of the articles that we talked about, would take the time and clarify issues as John did. I may not be into reading articles on a daily basis but they can be contacted via email to this forum. We can discuss/debate all we want with all the members here. However, without the principle authors' involved, we are just adding more issues without resolving them. We need both sides of the coin.
JMA
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