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RE: Does reading my posts make you stupid?
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RE: Does reading my posts make you stupid? - July 28, 2008 7:06:42 AM
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SJBird55
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From: Michigan
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In the PT world, I highly doubt that data is replacing reasoning. There continues to be too much variability in practice. Suboptimal care exists at a fairly high rate. The day we see less ultrasound, hot packs, laser, electrical stimulation is when change is occurring. Will the change be led by third party payors and lack of reimbursement for those codes OR will EBM create a change in behavior?
EBM makes us think deeper... most of us do not have our own "evidence" of practice. Since most of us do not know our own practice outcomes, our "expertise" or our "clinical experience" is left at the level of memory. Our memories won't accurately serve us. We also have testimonials and observations - those won't accurately serve us either. EBM has 3 parts... the research/literature aspect, the patient aspect AND the clinical experience/expertise aspect. As a whole, we are going to be working on inaccurate information of our clinical experience/expertise because we have no concrete data. Our brains do not have the capability to accurately inform us.
Exciting times are ahead of us... I can't wait to see the results of a study that focuses on a subgroup of patients that meet the clinical prediction rule for manipulation and compares manual techniques. For me, the research published in the last 5-7 years has really been clinically applicable and has assisted me in being more efficient and effective with the care I provide for certain subgroups of patients. I actually have concrete data on my performance and it is exciting to see that data evolve as I evolve with the literature that is out there.
Over on SS there was an example of a student who refused to provide some intervention that would reduce pain because of lack of evidence. The end result of that post was that "data is replacing reasoning." There was no mention of what intervention the student refused to perform nor was there a discussion of the alternative option the student suggested. Because thoughts within the SS forum are controlled and perspectives are common, the therapist posting didn't have any questions for clarification about the example. Instead, an immediate resulting thought that "data is replacing reasoning" occurred. And here the thought is again.
Data can't be replacing reasoning because as a whole EBM isn't occurring in physical therapy at a very high rate.
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RE: Does reading my posts make you stupid? - July 28, 2008 7:31:38 AM
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Sebastian Asselbergs
Posts: 1105
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From: Barrie, Canada
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First of all: you are right: there is still pathetic little reasoning in the world of PT.
Second, I disagree with this:
quote:
EBM makes us think deeper... most of us do not have our own "evidence" of practice. Since most of us do not know our own practice outcomes, our "expertise" or our "clinical experience" is left at the level of memory. Our memories won't accurately serve us.
Most PTs have access to the latest evidence - yet fail to consider it (still doing CST, MFR, US) - it obviously did NOTHING to make them think deeper.
EBM is just a term. It refers to the use of evidence in clinical practice. It is a part of the decision making process; a process that includes (and always will include) clinical experience, a profound understanding of the human we are dealing with, available research, and outcome studies. Very useful is the application of reasoning to explain why and how: the theoretical model of a particular practice.
You are firmly bonded to the prediction/outcome issue - likely a product of your work environment: insurance dictated practice. But this excludes a whole segment of EBM.
I'd love to see outcome studies done on everything. I have 14 persistent pain patients right now - with absolutely nothing in common other than their persistent pain (from 3 years to 33 years duration) and me as their PT; I have 3 TKAs - all 3 of them have very complex health histories and issues; another 3 have whiplash - one is simple (so far), the others have complicating issues (ankylosing spondy, previous 3 whiplashes etc). My practice has become one where I get the "tough" referrals from docs and family and friends. I get results with most, but none of it is based on any published outcome study, and none of my approaches are generalizable since every darn one is so different.
I can do what I do, based on an understanding of their common neurophysiology, brain issues, my skill in education and my clinical experience. This is my EBM. And this is acceptable in any description of EBM in our country.
_____________________________
Mundi vult decipi
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RE: Does reading my posts make you stupid? - July 28, 2008 7:46:17 AM
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SJBird55
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From: Michigan
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Bas, the therapists continuing to practice as you mention are not practicing EBM. They probably have no real clue what EBM is. Hence, as I said, EBM will be more prevalent as we see less modalities billed.
EBM has the 3 components that I mentioned. In the absence of evidence (no where did I state that "outcomes" are the only evidence), clinical expertise will trump evidence as long as it fits the patient's perspective. What I mentioned was the practical fact that as a whole, we have no knowledge of our individual clinical expertise. I'd say we think we know our clinical experience, but reality is we do not unless we have made an attempt to mathematically capture our performance. What we have are patterns of behavior and decisions and the belief that we achieve results. Without truly measuring, we really don't know.
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RE: Does reading my posts make you stupid? - July 28, 2008 7:53:53 AM
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Jon Newman
Posts: 1697
Joined: April 24, 2004
From: Amherst, WI
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Sj,
Watching too much Outer Limits lately?
Ginger, have you been banned from SomaSimple? Proud?
SomaSimple is developing like any discussion board will. A "just about anything goes" policy might be easier to maintain for discussion boards but I don't know because I haven't ever moderated on such a board. Trying to maintain a policy of no personal attacks is much harder than I had originally thought. Especially when people testing the policy view it as fun (while it lasts.) Still, I think it's worth trying.
When SomaSimple started much of the material being discussed/proposed (based on the evidence in peer-reviewed literature) was essentially dissenting opinion from currently popular PT opinion. Now we're the one's crushing dissent? I guess the times are changing.
As far as this moderator is concerned dissent is welcome but leave your personal attacks at home or do them in private. Some people, I'm becoming convinced, are simply incapable of doing this. Thankfully, there are other discussion boards for them because they might have opinions worth reading and simply need a different place to express them.
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RE: Does reading my posts make you stupid? - July 28, 2008 8:10:01 AM
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TexasOrtho
Posts: 423
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quote:
Thankfully, there are other discussion boards for them because they might have opinions worth reading and simply need a different place to express them.
Amen to that Jon. I think this was probably the founding principle of the other forum.
Bless your heart you are trying, but I do wish you could just have the cajones to call me out directly. The 'some people' references are a bit trite. As far as personal attacks go - please spare me of the high ground preachy attitude. The fun I had was interacting on some great threads, not telling the lady di to kiss my ass...That was not fun...just necessary. A bully never stops being a bully until he/she get's their nose bloodied.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Does reading my posts make you stupid? - July 28, 2008 8:15:53 AM
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PTupdate.com
Posts: 1433
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Rod, you told someone to "kiss my ass"? You vile, unprofessional, mean spirited and vulgar scumbag. While it happened on another forum, problem children like you should be routinely banned from ALL forums. In fact, I'm revoking your PTupdate.com membership right now, and petitioning the APTA to have your license suspended. I'd type more, but I have to go to confession just to purge myself of the evil that has occurred. And, on my way out the door, will wipe my feet on the US Constitution doormat (right over the "free speech" part)
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Does reading my posts make you stupid? - July 28, 2008 8:36:19 AM
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Jon Newman
Posts: 1697
Joined: April 24, 2004
From: Amherst, WI
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More people than you derive pleasure from testing and I think it's quite normal (I'm certain I do it.) I'll admit that is what I thought you were doing based on past conversations. You have my apology for misconstruing you.
I realize that much of what I have to say comes across as preachy. Disappointingly, I haven't figured out (yet) a more clever manner to convey information that falls into the potentially preacy category. One strategy I've considered is to avoid having those sorts of conversations but that doesn't seem helpful. All I can say is I'm quite aware that I'm not speaking from a "better than you" standpoint. I've made all the mistakes I talk about and sometimes I continue to make those mistakes.
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RE: Does reading my posts make you stupid? - July 28, 2008 9:32:35 AM
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proud
Posts: 873
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quote:
ORIGINAL: TexasOrtho
Proud's trying to carry the torch, but will likely end up bannished as SJ and myself.
In an effort to be consistent with the excellent point (I think) of this thread( that being gathering collective minds with perhaps differing viewpoints and allowing open discussion without knickers getting in a knot)....
Rod and myself have shared a few "moments" of dissenting opinion here on RE even... I think it's healthy. As direct as I am, I asked specfic questions about the terms "success" and "outcomes". I think the two things( theory and data) need to mesh along the way. That was not well recieved as I see that the issue has been hashed and re-hashed many times. I think people at SS are tired of that discussion. But getting called names for asking questions and for clarification is certainly uncalled for. That behavior does nothing to advance the profession.
I do think there is a certain tone that comes from some over there. If a question get's asked, you might get a question back that certainly "feels" patronising to me. But I've been wacked for implying interpretation of tone at SS.... what can I say....it's what I feel.
I think that site, as well as the "is evidence based practice making us stupid" thread, are very useful. Excellent even. In reading there( I have for a while anyway), I recognize my own deficiencies with understanding pain( certainly at the level some have there). I think since we all deal with pain, it is incumbant upon us to understand it better. And understand what it is we are actually doing to our patients. Jason Silvernail's post Rod Linked was excellent I thought, I had read it back in May. Thus, if I have to avoid getting banned by...avoiding the tempation to ask a direct, perhaps intrusive question, I'll do that in favour of learning from the many knowledgable people there. I think I would learn more if I felt free to ask intrusive questions without getting called names etc.
But t'aint my site....t'aint my rules.
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RE: Does reading my posts make you stupid? - July 28, 2008 10:11:03 AM
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Sebastian Asselbergs
Posts: 1105
Joined: September 29, 1999
From: Barrie, Canada
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Ah, John Duffy: The "free speech" argument. The right to say whatever you damn well please.
News flash: The world is NOT made up of U.S. rules and law.
In fact, the "free speech" issue is rather fun: try to post something in favour of Osama - wonder how long it takes for Homeland Security to come knocking....
Rod, it is "cojones".....
_____________________________
Mundi vult decipi
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RE: Does reading my posts make you stupid? - July 28, 2008 10:21:06 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Bas, I am quite familiar with the "you can't yell FIRE in a crowded theater" point, and while it is their forum and their website (and they can permit/not permit anybody they want), they are still in the PT arena, and not sure if those banned had such a drastic act taken for the right reason(s) I am glad the EIM chose to provide a forum/battleground for the various parties to argue their viewpoints without banishment.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Does reading my posts make you stupid? - July 28, 2008 10:42:17 AM
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Sebastian Asselbergs
Posts: 1105
Joined: September 29, 1999
From: Barrie, Canada
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John, point taken.
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Mundi vult decipi
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RE: Does reading my posts make you stupid? - July 28, 2008 11:34:57 AM
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BB
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SS did not grow out of this site (as proposed by SJ), not that that would be anything bad. If it was a spin off at all it was from another no longer existing site.
What does all of this have to do with EBM discussion?
Cory
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RE: Does reading my posts make you stupid? - July 28, 2008 11:44:11 AM
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Jon Newman
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From: Amherst, WI
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John, you should consider aiming your constitutional outrage where it belongs, not at SomaSimple.
There is no banishment for arguing viewpoints unless those arguing can't refrain from personal attacks. As I pointed out before, maintaining such a policy is not easy especially when it takes two to tango and one of two that gets involved is a moderator.
Consider some of the MyPTSpace disscussions, the length of the threads and what was ultimately gleened. I think a less personally contentious discussion will bare bear fruit more quickly. I suppose not only do I think that mutliple sites should exist (everyone seems to agree with this) but also that those sites can have their own criteria for participation. I don't set the policy at SomaSimple but I give my input. I remain unconvinced that I should change my mind about this.
< Message edited by Jon Newman -- July 28, 2008 5:30:55 PM >
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RE: Does reading my posts make you stupid? - July 28, 2008 12:26:47 PM
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Sebastian Asselbergs
Posts: 1105
Joined: September 29, 1999
From: Barrie, Canada
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A small point while talking about Evidence: I remember distinctly that people have been banned from here as well....And for less than saying "kiss my *ss".
Just the facts, Dano.
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Mundi vult decipi
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RE: Does reading my posts make you stupid? - July 28, 2008 1:19:52 PM
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proud
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quote:
ORIGINAL: BB
What does all of this have to do with EBM discussion?
Cory
I think it's an effort to bring all the interpretations on the term EBM together. Oddly, I think everyone agrees with how to define it. And I doubt anyone would disagree with the notion: "first get the facts....then get the data". In an ideal world, this would be operational. Unfortunetly, despite the advances in our understanding, we are miles away from putting all the pieces of that puzzle together.
SS is a great fact finding site. Many on SS have developed treatments grounded in the science. People just want those treatments to be consistent with EBM...which does include some gathering of data....eventually. It's difficult to claim credibilty just by having a treatment theory based on the science. You could have all the facts before you about how to build a bridge....but until you do.....you've done nothing.
Theory.....crucial and should be primary. Data....crucial and required of any credible profession. All are calling for the two to mesh.
That is how this is relevent to EBM.
< Message edited by proud -- July 28, 2008 3:21:10 PM >
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RE: Does reading my posts make you stupid? - July 28, 2008 6:29:48 PM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
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Evidence can work in a backward way too... if you have data and you have outcomes, then you know where you are at and you know the general effect that occurs. You can then reflect and analyze what it is that you do, especially if the effect is generally consistent. And then, other studies can be done to assist in figuring out what is occurring. We need both qualitative and quantitative research. It's great to have a theory, but a theory alone, untested is pretty worthless.
Okay.. SS WAS created before many of the moderators went to that site a dead spinoff though. SS wasn't horribly popular until those that left here over differences of opinion went to SS. Dorko being invited to SS is what created the popularity of SS.
SS definitely has some good conversations and mentioned resources. The problem is that it is often wiser to read the actual resource/article being discussed individually versus taking the word of the moderators. The moderators aren't the greatest at keeping an open mind and only seem to focus on details that assist in perpetuating their "theory" - be it skin stretching or simple contact. And how they sometimes miss the boat with what they read is beyond me... LOL I sometimes wonder if we really are in the same profession and really are communicating in English.
LOL Jon... I don't have to watch the Outer Limits - I experienced the Outer Limits over at SS. It's actually quite hilarious that those that moderate SS don't even recognize that they do create an Outer Limits situation.
Proud, the only way you'll be kept around is if you stroke their egos, frame your questions in ways that they are your mentors, and never, ever think on your own anything that is different than what the moderators state, unless of course you positively sugar-coat your thoughts prior to taking a spin from the common thoughts. LOL It's all a game over on that site. One piece of advice - never, ever mention outcomes or the role of outcomes. Zip it on that thought. LOL I couldn't play their game. Life's too short to be constantly walking on eggshells around people that seem fragile.
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RE: Does reading my posts make you stupid? - July 28, 2008 7:01:51 PM
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Jon Newman
Posts: 1697
Joined: April 24, 2004
From: Amherst, WI
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Yawn.
Well everyone but the porn spammers have outlasted you SJ so it's not like you set a high bar or anything.
Dorko's writing attracks eyes that's for sure. Good writing is like that. But I learn things from the interaction and input from the users there that I don't get from simply reading essays.
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RE: Does reading my posts make you stupid? - July 28, 2008 7:09:49 PM
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TexasOrtho
Posts: 423
Joined: December 22, 2007
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quote:
Consider some of the MyPTSpace disscussions, the length of the threads and what was ultimately gleened. I think a less personally contentious discussion will bare bear fruit more quickly. I suppose not only do I think that mutliple sites should exist (everyone seems to agree with this) but also that those sites can have their own criteria for participation. I don't set the policy at SomaSimple but I give my input. I remain unconvinced that I should change my mind about this.
This is a bit selfish Jon, unless I miss your point. Some really great information and action arises out of the most contentious discussions. The fact it doesn't occur with the tenor or expediency you would prefer doesn't resonate with me. Often these discussions develop into thought exercises for those participating in the debate. The fact that I may not connect with what's being said doesn't make the debate less relevant.
We are all ostensibly looking for the same things in improving our clinical decision making. With an arguably unified goal, it makes me wonder why we must have multiple forums. It's not BAD or GOOD. Just interesting and at times dissapointing. The good news is that those with passion and energy to make this profession better won't stop regardless of how you or I feel about their efforts. The main thesis of my initial post was to illustrate another way we could be moving this profession forward through an integration of theory and evidnece. This as opposed to pitting them against each other as if they were oppositional.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Does reading my posts make you stupid? - July 28, 2008 7:42:53 PM
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TexasOrtho
Posts: 423
Joined: December 22, 2007
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quote:
ORIGINAL: Sebastian Asselbergs
Rod, it is "cojones".....
My deepest apologies. I was trying to find a more civil substitute for "balls". Also thanks for popping in and offering your insight into our Constitution. You are truly a jack of all trades...
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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