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RE: ACL rehab
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RE: ACL rehab - March 5, 2008 10:22:14 AM
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proud
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quote:
ORIGINAL: orthotherapist
Bob,
Those do not sound like outcomes but strictly stats. Does it let you track objective improvements etc that occur within those number of visits?
A crappy therapist may show 3 visits on average for low back pain - but actually patients stopped coming after an average of three visits because they were not getting any benefit from the therapy.
If the data does not show pre and post fucntional status the numbers really do not mean anything.
Just my opinion
Yep. Now we have someone who understands outcome data.
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RE: ACL rehab - March 5, 2008 12:31:02 PM
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bobmfrptx
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yes , you set parameters which you wish to track , Interventions, increased objective findings and the like can all be included. Its not just a blind number count of Diagnosis and visits.
Bob
added after reading post from my buddy proud....
there are 6 catagories you set up to track based on what you wish to compare...functional improvements dependent on how soon seen after injury for example... pt group 1 seen 2 to 10 days post injury compared to pt group 2 seen 2 wks to 1 month post injury . Sooner seen group increased function with less visits = better outcome than patient who was seen 1 months post injury been thru medical machine finally referred to PT and needed more visits to obtain less function than pt. 1....very good to show to MD's and insurance carriers.
< Message edited by bobmfrptx -- March 5, 2008 12:42:58 PM >
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RE: ACL rehab - March 5, 2008 1:00:05 PM
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SJBird55
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PTOS is more of a business/scheduling product that also includes documentation capability or integration with documentation software. In my opinion, from what I saw at their website, it tracks utilization and cost by diagnostic code. I did not see any mention of data being collected for true outcome tracking... for example pain, level of function determined by a valid and reliable tool, return to work. If it tracks that goals were met, that's nice, but that kind of tracking isn't very standardized so you have no idea what level of goals were set to be met (which means technically you could low ball your goals so everyone always meets all their goals). At the moment, there has only been one study that integrated electronic outcomes with an electronic health record and that was in PT Feb 08. Of course Hart was involved with his FOTO baby and the implementation occurred in Isreal of all places. The products that are currently out there, such as PTOS, are not truly outcome oriented from a clinical viewpoint. They do not provide enough information to inform clinical decision-making, in my opinion.
Bob, the data from Virginia Mason Medical Center is out there and highly suggests that putting physical therapists first is very cost-effective.
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RE: ACL rehab - March 5, 2008 1:00:23 PM
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proud
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quote:
ORIGINAL: bobmfrptx
yes , you set parameters which you wish to track , Interventions, increased objective findings and the like can all be included. Its not just a blind number count of Diagnosis and visits.
Bob
added after reading post from my buddy proud....
there are 6 catagories you set up to track based on what you wish to compare...functional improvements dependent on how soon seen after injury for example... pt group 1 seen 2 to 10 days post injury compared to pt group 2 seen 2 wks to 1 month post injury . Sooner seen group increased function with less visits = better outcome than patient who was seen 1 months post injury been thru medical machine finally referred to PT and needed more visits to obtain less function than pt. 1....very good to show to MD's and insurance carriers.
Well Bob. I am from Canada so this tracking system is one I am not familiar with. But now I am curious. It sounds like an okay idea but here are the questions I would ask:
1. Who scores the "functional improvements". Is it blinded independantly from the treating clinician? In other words, is there any opportunity for "YOU" let's say to in any way bias the results?
2. You state these are good numbers to show MD's and insurance carriers correct? Then if the above is not controlled for in some manner, there is a built in problem with capturing the data in this manner.
3. Seeing a patient more acutely will naturally result in better outcomes and fewer visits. When you take on a patient latter on, all the variables associated with persistent pain tend to skew the outcomes. It's really comparing apples to oranges. Outcomes comparing similair injuries with similair timeframes for accessing PT services between two providers would be interesting. Can that be done?
4. Even if two providers could be compared....if there is no system to control "how" the data is captured....it means nothing.
I look forward to the response on this one as I have always felt third party payors could easily establish a way to capture some of this information in a controlled manner thus establishing who the true experts are in treating NMSK issues( I think the Virginia Mason situation is an example of that?).
Up front cost to third party payors would be large but the overall cost savings of eliminating payment for massueurs, chiro's, or even some non compliant PT's would be enormous. And I think clearly outcomes would be much much better as well...
< Message edited by proud -- March 5, 2008 1:06:17 PM >
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RE: ACL rehab - March 5, 2008 1:31:31 PM
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SJBird55
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With low back pain, proud, Virginia Mason Medical Center does prove that having physical therapists first in line substantially reduces cost.
Third party payors do not have outcome data. A huge obstacle for that issue is simply what tools should be used? I personally do not want some third party payor dictating to me the tool to use for subscribers (nor do I want my APTA telling me what to use - I don't like their "optimal" product because it definitely isn't "optimal."). Another issue... my claims are electronically sent M, W, F of every week. I use outcome tools but I don't use them on every single visit. Currently claims do not have a box for outcome data to be incorporated into the claim. There should be a rule of sorts that valid and reliable tools (not some made up tool) be used. The only way to really have third party payors receive valuable outcome information would be to 1) identify the tool 2) identify the best score on the tool 3) identify the worst score on the tool 4) identify the score and 5) identify the minimal clinically important difference. Allowing for this extreme of reporting would allow for clinicians to be the experts on determining the appropriate tool for the patient. Clinicians shouldn't be required to provide that data on every claim though... I'd expect at bare minimum at the initiation of services, in 30 day intervals and a discharge. I honestly really don't think anyone truly cares about outcomes because nothing has really been done in this area and there has been talk on P4P for quite a few years now.
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RE: ACL rehab - March 5, 2008 1:55:01 PM
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proud
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quote:
ORIGINAL: SJBird55
With low back pain, proud, Virginia Mason Medical Center does prove that having physical therapists first in line substantially reduces cost.
Third party payors do not have outcome data. A huge obstacle for that issue is simply what tools should be used? I personally do not want some third party payor dictating to me the tool to use for subscribers (nor do I want my APTA telling me what to use - I don't like their "optimal" product because it definitely isn't "optimal."). Another issue... my claims are electronically sent M, W, F of every week. I use outcome tools but I don't use them on every single visit. Currently claims do not have a box for outcome data to be incorporated into the claim. There should be a rule of sorts that valid and reliable tools (not some made up tool) be used. The only way to really have third party payors receive valuable outcome information would be to 1) identify the tool 2) identify the best score on the tool 3) identify the worst score on the tool 4) identify the score and 5) identify the minimal clinically important difference. Allowing for this extreme of reporting would allow for clinicians to be the experts on determining the appropriate tool for the patient. Clinicians shouldn't be required to provide that data on every claim though... I'd expect at bare minimum at the initiation of services, in 30 day intervals and a discharge. I honestly really don't think anyone truly cares about outcomes because nothing has really been done in this area and there has been talk on P4P for quite a few years now.
Wait a second( said with a confused look).
1. Identifying the tools should not be difficult should it? Plenty of valid and relaible instuments like the RMQ, DASH, LEFS, and even the patient specific functional scale for cervical radiculopathy was recently validated.
2. Best and worst scores are already established right?
3. the MDC is already established on these correct?
I think intake scores could be taken( in a blinded fashion). And after say 6 sessions re-taken. So on so forth...?
Am I confused SJ or are you suggesting this type of tracking is a bad idea and not one you would go along with?
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RE: ACL rehab - March 5, 2008 2:42:27 PM
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SJBird55
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Well, proud... what if I have a patient with balance deficits? None of those tools are appropriate. What if the person has an amputation like Lanzinger over in the Medical Complexity portion of the forum? Because physical therapists treat such a diversity of patients, no single tool is going to be the answer. Also, with research... I use a tool called the Spinal Functional Index. An Australian created it... I was part of a team that put it head to head with the PF-10 or the ODI or NDI. It outperforms the ODI and the NDI. (He's still writing up that paper and focusing on submitting it.) What about FOTO - that is a CAT. I'm not a huge fan of it, but at the same time that should be an option for clinicians if they choose to use it. At the same time, if new tools are designed and are better than we now have, we don't want to put ourselves into a box and be limited in ou ability to choose the appropriate tool. What if I decide that the FABQ is the best tool to use because the score is horrible and I think if I can reduce it that things will improve?
I'm not sure if the CAT has best and worst scores. The reason that best and worst scores need to be reported is because it is highly, highly unlikely that someone working for a third party payor making reimbursement decisions will take the time to truly understand the outcome scores and the results of using the tools. It would be better to provide that information up front to reduce the likelihood of a misinterpretation of plain laziness on behalf of third party payor employees.
CAT does not have a MCID to my knowledge. Does anyone remember the MCID at all times? It is very easy to look at a score and see how it changed and see if that change is greater than the MCID. Actually.. one other aspect to include would be the (+) or (-) change in score. Keep it easy for someone with a 12th grade education to understand.
In a busy clinic, "blinded" may or may not happen. For example... when I was using the ODI, I hated it. I had too many patients requiring assistance in interpreting what the tool was asking. I did my best to answer their questions, but obviously if a patient is asking for assistance, the scores may not have been blinded. Also.. I always score and review the tools myself. I need that information. I use it clinically. I don't want to be blinded from it. I usually do hand it to the patient, explain it to the patient and then walk away for it to be completed without me standing over... but there are times that the elderly in particular can't see well enough to read it and my office manager is on the phone working, so, of course, I accommodate their visual needs and read and complete it based on the oral answer. Sometimes you gotta do what you gotta do. Was that the best no, but for the resources I had and the time I had, it was all I could do. Life happens.
I am definitely for outcome data and I believe it is necessary. Your comment seemed somewhat flippant: quote:
I look forward to the response on this one as I have always felt third party payors could easily establish a way to capture some of this information in a controlled manner thus establishing who the true experts are in treating NMSK issues( I think the Virginia Mason situation is an example of that?).
Proud, it isn't going to be as easy as you think. There should be a lot of thought put into the process so that reasonable information is gained. Third party payors are doing all they can to pay less and less..... if outcome data begins being provided, the writing on the wall is that computers will be making payment decisions potentially at times based on the outcome data. If not based on outcome data, then at least screened and then providers required to provide documentation to support services. If we don't provide enough information for if/then types of statements, then we just might have a lot of rejections OR waste a lot of time providing documentation. With whatever is implemented, we need to take steps to ensure that we are protecting ourselves. That's all I was saying... it's bad enough right now with computers making denial decisons based on codes and modifiers... I can only imagine the world with outcome data IF time isn't taken to provide explanatory mechanisms to reduce more time dealing with capturing reimbursement.
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RE: ACL rehab - March 5, 2008 2:49:26 PM
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SJBird55
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Oh... and one other factor that I really do agree with Hart on.... risk-adjusted data. I think we do need to have explanatory mechanisms in place to establish that the rate of improvement may be slower than expected OR faster than expected. Risk-adjusting seems very logical and Hart has done some good work in that area. The risk-adjustment is important for the utilization data, I think. How do you explain 6 visits for a 25 year old female with back pain versus 15 visits for a 65 year old female post-menopausal with chronic back pain and osteopenia? The functional outcomes are going to be different and obviously the number of visits are different. Somehow, it would be good to have claim forms be able to capture those relevant factors that impact the provision of physical therapy services.
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RE: ACL rehab - March 5, 2008 3:05:44 PM
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proud
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Awsome posting SJ. And it's not that I think it would be easy. The main point here was to indicate to "bob" that although he thinks he is providing outcome data....in actuality I don't think he is or understands the concept very well.
Now. I do understand that a great deal of what we do has not really had any valid outcome measures established. However, I think acute LBP has quite a number of established outcome measures. Same for acute ankle sprains.
I think for certain conditions, we can track that data between clinics. And I'm willing to bet that the clinics that utilize classification based treatments for acute LBP will have superior outcomes than a rub down, IFC, or the manipulation for all things spinal clinics....
From that I'm willing to bet this would point toward a trend for better outcomes for almost all NMSK conditions from that clinic. It follows that a clinic that remains abreast of the current literature will have better outcomes throughout the NMSK spectrum.
SJ...something needs to be done. We cannot have the skyrocketing associative costs of NMSK problems continue as they are. I recognize it's not ideal to be restrictive however I look at it this way. I am again willing to bet that when all is said and done, PT's on average come out with superior outcomes than all other providers. From that, third party payors can establish one and only one authorized NMSK provider. Then....third party payors can work closely with the PT profession and improve the loop holes so to speak. And in the end....PT's who remain current benefit from a financial perspective because they become the provider of choice.
Not ideal but neither is the current free for all system we have with a plethora of nitwit PT's, Chiro's, etc milking the system dry to the point that insurance premuims become unattainable for millions.
< Message edited by proud -- March 5, 2008 3:10:30 PM >
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RE: ACL rehab - March 5, 2008 4:36:30 PM
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SJBird55
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Proud... I'm willing to bet that the majority of physical therapists exhibit apathy and have no idea what a classification based treatment approach would be.
The only value in using outcomes is to actually capture data prior to the initiation of services and then again at discharge. Studies have horrible completion rates. Hart's current paper indicates one value... but when I calculate the figures, it appears to me that only 37.82% of the time the data was complete (using Fig 1 to for calculations). (Total of 15,494 cases and 5,860 with discharge functional measure... that's a very small completion rate. 62.18% of the time, discharge functional data wasn't collected... AND this was with a CAT - all computerized!) My data using paper and pencil tools is always in the 78-83% completion range. With numbers like mine, I could argue that I'm not "cherry-picking." With completion rates as Hart is showing, the patients could be "cherry picked." Meaning... the therapist choosed who completes the discharge tools - the ones responding and progressing nicely would always complete the tools.
There has also been quite a bit of research on low back pain, but that only represents 30% of my patient population. We are diverse... my age group breakdown has about 35-40% of aged coming to my clinic.
My feeling is that yes, we need to do something, but at the same time watch our backs. Those that have the knowledge and can forsee issues should be a part of the process. That data could be used against us if not implemented appropriately. Look where we are at with the CPT codes... why the heck anyone ever agreed to one-on-one timed codes beats me - stupidly limited our business opportunity.
There is data already out there to substantiate we can be the experts... Virginia Mason Medical Center... the studies on differential diagnosis comparing PT, OCS and PT and family physician and surgeon. We're up there. There is also data substantiating that liability risks do not increase with physical therapists in direct access. It's all there... the pieces are already in place. No one is doing anything about it. I got into a heated discussion with Rick Gawenda - the Health Policy and Administration section president. He doesn't see things my way. What do you do? I'm moderated on that section listserve because I have voiced my opinions. The delegate here in MI doesn't want to pursue my suggestions... Those in leading positions in our wonderful APTA - the delegates... they are apathetic too. If no one cares and no one wants to fight the fight, nothing will change.
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RE: ACL rehab - March 5, 2008 8:10:09 PM
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proud
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SJ. I am so happy with have people such as yourself within this profession. Apathy...it's a sad commentary that we have PT's actually treating the lumbar spine unawares of classifiaction based treatment. But here is the question: How can that happen? It would be like a Physician treating chest pain and not being familiar with appropriate differential diagnosis skills.
I'll tell you why. No one is holding them accountable.
Apathy.....yep. You nailed it there. We have the research to substantiate PT's as THE expert in NMSK management. It's there for the willing to utilize.
All those articles you pointed are tremendous spring boards for the PT profession. You mention the APTA. Well the same applies to our CPA in Canada. While we have a plethora of literature to propel things foward, our CPA is busy taliking about such foolish things as S.M.A.R.T:
http://www.physiotherapy.ca/PublicUploads/222460SMARTGardening.pdf
I honestly ask myself who these PT goofballs are making these things up.
Almost as bad as the APTA's exercise program for the couch potato( I think that was it).
Anyway, thanks SJ for letting me know that we do in fact have passionate PT's around. Now back to treating all those right legs that are longer...eh Bob....
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RE: ACL rehab - March 5, 2008 9:58:28 PM
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SJBird55
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Proud, how can it happen that therapists are not aware of treatment based classification systems? Easy... as you said - accountability. Employers and therapists themselves do little more than use memory, self-reflection (IF that) and satisfaction surveys along with their "performance" evaluations (which are based on productivity and completing documentation forms correctly in appropriate timeframes) to determine their performance (which includes attending work on time, dressing appropriately, getting along with others crap). In the physical therapy industry, physical therapists are held to very, very low expectations. Of course, over time the tendency is going to be for apathy.... very, very low expectations require little effort to surpass nor much motivation to meet. And then, there is always the discussion of "professionalism." LOL It's kind of like raising kids - if parents expect the bare minimum from their kids, that's what they're going to get.... I do believe that is why our profession is apathetic.
Bob is able to do what he does because there probably isn't any peer-review process of discussing patients or reviewing documentation to determine if his practice interventions are within published peer-reviewed literature. Of course, there can be all sorts of "new" concepts out there, so maybe Bob is correct (with the correct system in place, it's okay to experiment, in my mind), but if nothing is in place to compare what he is doing to what literature suggests, then Bob really has no idea that he is effective. And sad to say, Bob is okay "thinking" he's effective. I was listening to Mike and Mike this morning while doing some training for a triathlon and the Mikes were talking about Favre and his announcement of retiring. They were attempting a commentary to compare Marino to Favre. Anyways, one of them said something to the effect that with time, he believed our memories altered the truth. He's right.... I don't think we intentionally alter the truth, but it happens over time. Bob does believe that right leg being longer is true and does believe by addressing it he has an effect wherever he said. Does every patient actually respond to the intervention directed toward the right leg - of course not... but does he remember those that fail? Maybe not.
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RE: ACL rehab - March 8, 2008 10:31:34 AM
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bobmfrptx
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Quite the twist on ACL recovery...
I do understand outcomes. I do agree that PTOS is limited to 6 parameters you can input to determine outcomes. It tracks by ICD9 numbers so that in itself is a limitation since we all know that the number does not define the individual case. I do "know about" classification systems which I don't follow to the extreme since most of my patients have multiple complaints and have been to the other guys at the OCS clinics and performed badly. My subgroup is 90% comprised of chronic pain patients, failed surgeries, failed rehab protocols etc. Of that group I allow over 85% to return to normal ADL's with 0-1/c/o pain . I do not use a myopic PT approach but treat the whole. I do not care that the studies do or do not validate my approach. My clients do not either.
I am a well trained PT and use my 26 years of experience daily. I went thru the Paris E1,S1 S2 in the 80's with Alan Grodin. I studied with Mckenzie who when he tried his extension principle on my knee tore my meniscus in front of 50 people..Ace Neame, Dick Erhard, Rocabado for over a month of study...he invited me to Chile! I'm not her to quibble over resumes. I am here to tell you there are things which can be done to shorten rehab which involve the gentle handling of the patient first. A good evaluation is essential. The doctor who sent me a patient with hip pain didn't need me to explain to him when I sent the patient back that further study is needed since he may have a neoplasm based on Cyriax's sign of the buttock. (Leg Length discrepancy didn't matter much in this case BTW) It does in most and I do remember those whom I am unable to correct more than the ones I do. I've used maybe 5 heel lifts in 25 years.
I do agree that recipe therapy and outcomes are dangerous to the profession. It will be extremely hard to get reimbursement beyond "the usual and customary response time for this ICD9". If they can find a way not to pay they will. My practice is 90% thrid party payor.
I do not have peers to review my charts. In fact over the years I have had to send my charts only twice in comp cases for review. I am one for two.
Anyway, I am glad that there are fighters of truth justice and the therapists ways out there, just be sure you do not create any collateral damages in your battles. Patient care should come first.
Edited secondary to reprimand...didn't read the rules sorry
bob
< Message edited by bobmfrptx -- March 8, 2008 12:49:37 PM >
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RE: ACL rehab - March 8, 2008 1:24:30 PM
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Crevidence
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quote:
ORIGINAL: bobmfrptx
Anyway, I am glad that there are fighters of truth justice and the therapists ways out there, just be sure you do not create any collateral damages in your battles. Patient care should come first.
Are you trying to imply something? Can you clarify what type of collateral damage these "fighters" may create? Are you trying to say that some of these "fighters" may not put pt. care first?
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RE: ACL rehab - March 8, 2008 3:00:46 PM
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bobmfrptx
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Crevidence
No implifications. Collateral damage, the cost of doing business therefore the cost of PT services went up when my state mandated that only Licensed PT Assists. were able to perform ultrasounds, set up and tear down FES etc in the PT dept. The PT tech who had 20 years in the navy and was working in the local hospital lost his position, had a reduction of benefits and salary due to that move. I bet the PTA's coming out of school hadn't the clinical knowledge that this man did. The local chiropractor can have a high school student set up and perform modalities in their office. Those are the type of damages. I am all for a well trained PTA, but their time can be better spent. Patient care is affected by increased out of pocket expense as one example. I'm not suggesting that patient care will be ignored by well intentioned folk.
look at this crazy Govt. bail out/refund give back.. Lets borrow money from the Chinese to give to our citizens who in turn can buy things (mostly made in China) to stimulate our economy. Who thought that thru!!!! oops politics and religion taboo......
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RE: ACL rehab - March 8, 2008 5:44:39 PM
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Crevidence
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Bob,
Thank you for the clarification.
< Message edited by Crevidence -- March 8, 2008 10:35:36 PM >
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RE: ACL rehab - March 8, 2008 10:22:53 PM
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proud
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Well Bob:
quote:
The local chiropractor can have a high school student set up and perform modalities in their office. Those are the type of damages.
I fail to see why PT's with a university degree in hand, from a reputable university (not simply an equivalent), feel we should on any level be competing with a Chiropractor. By and large, chiropractors are shysters (not all of course, it is possible to leverage the basic knowledge contained within the training into a legitimate, evidence based practice). However, PT's are ideally positioned to be "the" NSMK experts of choice...if we choose to use our built in advantages.
quote:
Patient care is affected by increased out of pocket expense as one example.
While this is true, I feel this is a short-sighted veiw of things. We have to elevate our practice expectations. The Viginia Mason experience should serve as flashing beacon's for third party payors on how to provide excellent care in a safe cost effective manner. From that, third party payors saving money can in turn increase their payments to the experts providing the care. We really need to move ourselves forward and we have a nice start on the literature to make that happen.
Without knowing the definition off hand that Sackett provided for EBM, I believe it included incorporating the best available evidence with patient expectations and clinical experience. I have been at this for 11 years and I do not discount my clinical experience. But for sure if there is evidence available, it trumps my anecdotal experiences until the evidence appears less effective.
We cannot have PT's stuck in the realm of "clinical experience". I'm sorry Bob but I gather from your posts that you feel your 26 years experience is a valid pivot point to tip the scales towards anecdotally driven practice. Continuing with that mindset is what will result in collateral damage. It is that very type of behavior by PT's that has resulted in our inability to leverage the plethora of PT driven research into becoming recognized by third party payors for it.....
Clinical experience is required Bob, but if your not using classifiaction based treatments, you are the person causing collateral damage. Perhaps I read your comment incorrectly? If you are saying that you have used it and get better outcomes with your right leg theory....I would be suprised but at least THAT would be consistent with Sackett's definition of EBM.
< Message edited by proud -- March 8, 2008 11:11:40 PM >
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RE: ACL rehab - March 8, 2008 10:48:41 PM
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Tom Reeves DPT ATC
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Proud,
I want to jump in here. you said:
"I fail to see why PT's with a university degree in hand, from a reputable university (not simply an equivalent), feel we should on any level be competing with a Chiropractor. By and large, chiropractors are shysters (not all of course, it is possible to leverage the basic knowledge contained within the training into a legitimate, evidence based practice). However, PT's are ideally positioned to be "the" NSMK experts of choice...if we choose to use our built in advantages."
I don't wish to compete with them. However, the general population of the town where I live has a choice in where they go for NMSK problems. They can go the traditional medicine route which includes a trip to their doctor, then hopefully a referral to me, OR they can go alternative and go to a chiro. That is competition just like you can choose Outback Steakhouse or Applebee's for supper. We do our best as professionals to put forth the notion, i.e. explain to our patients why our outcomes are better and more permanent, but ultimately it is up to the patient.
My town is unusual. 5300 people with 7 chiros,(they were here before me and I think that is why there are so many, because perhaps the "traditional" was not terribly effective) so I might be a little sensitive about that.
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RE: ACL rehab - March 8, 2008 10:57:21 PM
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proud
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Tom,
I agree that we currently are in competition. In fact, there will always be competition. It's healthy in that it sharpens the knife. I suspect that I would not mind a little healthy competition from Buddy( an apparent evidence based chiro from before on Rehabedge...).
However, when PT's start to compete in the "patient satisfaction" sense....that is when we shoot ourselves in the foot by offering VAX-d, CST, in depth patho-anatomical explanations to "convince" our patients of all that is wrong with them that only YOU can "fix"....we have lowered the standard.
That is what I meant by trying to compete with the town shyster.
I know, I know....it's difficult to avoid because we all have to earn a living. But I urge all PT's to stay the course. Remain evidence based. Educate the public. I still expect soon with healthcare dollars at a premuim, third party payors are going to be looking to shave some types of treatments out. Expect thermal scans, Vax-d, maintenance manipulations, manipulations for chronic LBP etc to be carved out.
If all PT's remain current with the literature, apply it...and avoid the pitfalls of trying to compete with shysters, things will work out really really well. The more PT's that do that....the sooner we will see the positives.
< Message edited by proud -- March 8, 2008 11:20:06 PM >
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RE: ACL rehab - March 11, 2008 1:31:36 PM
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pappawheelie
Posts: 40
Joined: September 19, 2007
From: Vermont
Status: offline
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Nice discussion, but what about my girl with the new ACL repair? Just kidding. Last time my car wouldn't work I took it to a mechanic. I didn't see any "alternative" mechanics, which to me tells me that they (mechanics) know what is going on. With so many 'alternatives' to healthcare, it implies nobody knows for sure what is going on. Not only that but too many of the studies I read have pretty low "N"s and almost all of them end with the suggestion that further research in the area is needed. I'm all for using the best available evidence, but when we ignore what people want, (and in some instances need) then we will be overlooked by people who are looking for more than prescripted exercise.
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Ted Lamb, MSPT
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