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mcap -> Forum change (March 20, 2001 6:35:00 PM)
I would just like to let the adminstrators of this forum know that I am deeply dissapointed in their decision to change the format of the Rehab Edge for the following reasons: 1. How do you separate clinical discussions from evidence and research?? Do you think physicians would participate in a web forum, discuss medications and conditions without discussion of the relevant research? 2. The APTA has attempted to promote, in every way possible, evidence based practice 3. Now, more experienced members may feel more free to "mentor" and "advise" students or neophyte PTs without any support for what they do. 4. Why does everything have to be so friendly and nice? This is supposed to be SCIENCE. Debate and contention goes hand in hand with good science. 5. As a post-professional graduate student, when I present an idea or make a point to my faculty I can always count on them finding many holes in my reasoning (politely). This is what you expect as a scientist and a graduate student. If PTs are to be professionals, they should expect no less. 6. The inability to handle contention or spirited debate is a problem that plagues our profession....why continue the problem here? 7. Look at the allotment of forum reasources and space for evidence based practice compared to total site. I am afraid that this represents the relative value alloted to it within the profession. I realize the the forum wants to be inclusive and that at times, the tenor was somewhat unpleasant. But that is the cost of reasonable debate. Respectfully submitted, MCAP

David -> Re: Forum change (March 22, 2001 6:05:00 AM)
As perhaps one of the persons who indirectly "caused" this change in forum format to occur , I feel I should express how I feel about my experience with RehabEdge. To Bobcat....I appreciate your efforts to stimulate the need for logic and reason based on science and evidence. I appreciated the true meaning to some of your comments regarding my students inquiry. I truly learned more than something about ataxia, but about how to becaome a more effective educator. However, I did not appreciate your rude, sarcastic ways about which you attempted to get across the meaning. This only shadowed what real message my students and others might have gotten. I hope you can appreciate that. To both SJBird and Bobcat, Why is it that you want to be anonymous? I know this is an issue for some, and I am not so sure the pros and cons of hidden identity. Perhaps because I am identified, my fellow PTs can pass judgement on me and know who they are passing judgement on. This may lead to positive or negative experiences (credibility) in the future (i.e. future employment, invitations to speak, etc...) Even my students were somewhat worried about having their identity now known after the bashing they took. Yet, I think there is some honor in identifying one's self and being proud to stand by one's comments, take the falls, and the praise . Finally, I thank RehabEdge for addressing my students and the University. I would like for this forum to continue to be a learning tool for my students (and me). Whether or not we need to separate the evidence based from the word of mouth clinical advice is not my issue. I just feel we should all be considerate to our fellow forum participants.... David ------------------ David A. Lehman, MS,PT

Barrett -> Re: Forum change (March 22, 2001 12:22:00 PM)
David, I presume I wasn't alone in cringing when the responses to your student's questions were handled as they were. In the end, I feel that the change in the forum was appropriate, and I hope that you will be able to get your students to try again. I've recently reread Richard Di Fabio's excellent series of editorials in JOSPT, beginning in November of 1999 with "Myth of Evidence Based Practice." Others in the same vein include "What is Evidence" and "How Can We Assess Outcome Without Assessing Treatment?" All by Di Fabio. I'd recommend them and would be glad to send copies along to anyone who wants to see them. Richard makes the point that "Without clinical experience as a guide to the application of clinical research, we will suffer from either the dogma of personal preference when making clinical decisions or the paucity of published findings that are tied to our clinical reality." The divide between speculation, evidence and reality would not be so wide if we first asked the question, "Is my idea of what is happening or might happen in response to care biologically plausible?" and "Can I support my speculation with good evidence from reliable sources?" For me, this is essential, and when I question things in this fashion I usually make some progress as a clinician and advocate for the patient. This is a whole lot different than waiting for some outcome study to show up that proves that my efforts will make a difference. "Evidence-based" does not mean we know something works, but only that it makes sense to assume we're on the right track based upon the latest knowledge available. Constant vigilance is the price we all must pay for this. The trouble your students encountered is common, and I was sorry to see it happen. As far as the anonymity thing goes, I agree with you. This isn't a dating chat line, and I find it easy to ignore posts by people who feel it necessary to hide behind a nickname. [This message has been edited by Barrett (edited March 22, 2001).]

mcap -> Re: Forum change (March 23, 2001 5:28:00 AM)
Barrett: I would agree that evidence based practice needs direction and guidance from clinical experience but this cannot continue forever. I see many PTs using techniques and theories that have been around for years. There has been more than enough time for clinical observation now it is time to begin the research. The need for clinical observation does not preclude the need for validating research. Simply having the theory make sense to you is not enough. Your theories lack scientific validation and I am afraid you are using clinical observation as an excuse. Furthermore, when someone backs you into a corner during a debate you simply elevate the discussion to a level so vague that it cannot be continued or, worse, you simply ignore them. There are perfectly valid reasons for wanting to protect our anonymity here. You reply to some of our posts but not the ones that truly challenge you. So don't use identity as an excuse. As for evidence based medicine........let me reiterate my point. Use low back pain as an example. Year after year, groups or experts get together and make sweeping judgements and formulate guidelines based on the research. Their reviews are very, very heavily weighted towards randomized controlled trials. The lack of studies will eventually catch up with us. Some of the people involved in this process have informed me that insurance will take about ten years to come around. But they might, and if they do, they will be very reluctant to pay for PT for low back pain. So continue to justify your treatments only to yourself. COST is the driving factor in healthcare and will only become a more significant factor. Third parties will be willing to look at the evidence that we seem to be so willing to ignore! mcap

Barrett -> Re: Forum change (March 23, 2001 3:53:00 PM)
mcap, You write: "Your theories lack scientific validation..." Please tell me which of my theories you're talking about. ------------------

mcap -> Re: Forum change (March 23, 2001 8:03:00 PM)
Barrett: Well....for one...you don't seem to have an answer for SJ's questions. Lacks validation......where do we start. How about "nervous irritation" theory. Or...should we discuss your comparison of yellow flags to racial profiling?? The most respected and renouned experts in the field of low back pain get together and decide on what yellow flags might be. Why do they do this????? It is because these factors have been shown to be better predictors of disability than the physical factors that you and other PTs are so obsessed with. In racial profiling you are in effect assuming guilt based on a person's race. Where do you seen any comparison???????? No one is accusing these patients of anything. A yellow flag is not, in any way, a label and is not intended to be used as such. Depsite your continual claims to the contrary there are NO psychological defects or faults assumed on the part of the patient. It simply should tell you, as a clinician, that this patient is at risk for long term disability and may require additional measures such as more aggressive pain control, reactivation or multidisciplinary treatment. You don't appear to be familiar with the research at all. Your analogy is inappropriate and ridiculous.

David -> Re: Forum change (March 29, 2001 7:09:00 AM)
To SJ Bird: Thank you for your comments. I am interested in what type of clinical research you are interested in...not that I am in any position to help you, but I am interested in collaboration in the future. My research interest at this time is the gait of people with Parkinson's disease. I am doing my dissertation on the training effect of verbal instructional sets on the automaticity of gait. After this, I probably will need a few year vacation from research [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]....but, I will then have time to do collaborative research. I also thank you for your input (and you, too, Bobcat) about anonymity. Like I said, I do not really have a strong feeling about this one way or the other....BUT, since you know who I am, I hope that maybe in the future, either or both of you will introduce yourself to me at a conference. SJBird...about letters of recommendation for students and Kim's ataxia posting.....I think I would say Kim (and all of my students) have learned from this RehabEdge experience....and I would give her a letter of rec for the growth she has shown...I agree the original posting was done incorrectly, and perhaps there needs to be a lot more emphasis on inquiry and critical thinking! I am trying, but I am also having to work against the hardwiring that developed over the students' life long learning, which probably had a lot to do with how they think. Agreed? Oh, yes, Bobcat....I guess I also appreciate your defense of being tough on students to get a message across or to put them in a position thatfacilitates the critical thinking you demand. I am not so sure that I have to be mean, but, I can certainly use this forum and your comments as a way to prepare my students, by saying...I am not this mean, but, there are those out there! [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] Until next time..... David ------------------ David A. Lehman, MS,PT

Andrew M. Ball, MS, PT -> Re: Forum change (March 29, 2001 11:54:00 AM)
David, Agreed. I think that your students ended up learning far more than they bargained for in this thread. I hope they continue to use RehabEdge to facilitate their learning process. As for the four students that posted, I think that they demonstrated superior maturity and growth through the course of discussion, and I'd be happy to write any of them a letter of recommendation for their efforts here. That reminds me, I made a copy of the ataxia lecture that I talked about. I'm going to e-mail Trish Montgomery and see if she's okay with me forwarding down there to ya'll. What is your address??? Drew

Andrew M. Ball, MS, PT -> Re: Forum change (March 30, 2001 11:17:00 AM)
Terps

mcap -> Re: Forum change (March 31, 2001 5:48:00 AM)
TERRAPINS!!!!!!!!!!!!!!!!! TERRAPINS!!!!!!!!!!!!!!!!!! TERRAPINS!!!!!!!!!!!!!!!!!!

luizaperez -> Re: Forum change (April 12, 2001 9:30:00 PM)
I think students are not respected too much by my modern faculty. Students cant learn much when faculty force them to guess but dont give too many pointers.

David -> Re: Forum change (April 18, 2001 5:37:00 AM)
Luiz, Please clarify what you mean by your post. What do you mean, modern faculty. What do you mean by guess? David

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