RehabEdge Physical Therapy Forum

Forums  Register  Login  Forgot Login?
  My Profile 
My Subscription
  My Forums 
Search
  FAQ  Log Out
Follow @RehabEdge

RE: thoughts on manual therapy for scoliosis

 
Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Manual Therapy >> RE: thoughts on manual therapy for scoliosis Page: <<   < prev  1 [2] 3 4 5   next >   >>
Login
Message << Older Topic   Newer Topic >>
RE: thoughts on manual therapy for scoliosis - March 21, 2008 9:46:37 PM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
"The only difference between the therapy services this women recieved was the MFR...woo woo to you good buddy!!!"

So, now it has morphed into a comparison between one and more cases?!?  You are stretching the story more and more...
OK, let`s say I will swallow that for this moment: the only difference between the therapy services was MFR. Now, were the subjects all women.....  If so, were they the same age. Mothers. Had the same therapist. Same length of pain complaint. Same location.....


You see my point....
Before you spout on about the benefits of a very specific technique (without ANY credibility - see above posts - to which you have not commented), a lot more science needs to be done. Otherwise it will always be: ANECDOTAL!

_____________________________

Mundi vult decipi

(in reply to SJBird55)
Post #: 21
RE: thoughts on manual therapy for scoliosis - March 21, 2008 11:14:13 PM   
steve

 

Posts: 490
Joined: May 15, 2003
From: Canada
Status: offline
Bob:

Post-hoc ergo propter hoc This fallacy follows the basic format of: A preceded B, therefore A caused B, and therefore assumes cause and effect for two events just because they are temporally related (the latin translates to "after this, therefore because of this").

(in reply to Sebastian Asselbergs)
Post #: 22
RE: thoughts on manual therapy for scoliosis - March 22, 2008 1:53:44 AM   
bobmfrptx

 

Posts: 57
Joined: December 13, 2006
Status: offline
Yes it is all anecdotal....doesn't mean it didn't happen....If yopu look at my post I even say you can question the mechanism....Say a study was performed and it found tht 7 out of 10 did not have any measurable change of angle with treatment....Do you not treat and let the 3 out of 10 join the rest?  If you were hunting birds would you use the rifle, or shotgun? 
Bob

(in reply to steve)
Post #: 23
RE: thoughts on manual therapy for scoliosis - March 22, 2008 3:39:56 AM   
steve

 

Posts: 490
Joined: May 15, 2003
From: Canada
Status: offline
Bob,


I think you are referring to Number Needed to Treat when you suggest 3 would benefit out of the 10. Of course, you would actually have to do some research with a control group to determine this number rather than blindly suggest that those people had benefit from your MFR.

If I was hunting birds I'd rather shoot with my eyes open rather than shooting with a blinfold on, irrespective the size of the gun.

Steve

(in reply to bobmfrptx)
Post #: 24
RE: thoughts on manual therapy for scoliosis - March 22, 2008 3:44:19 AM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Bob, I am sorry to say that "it" may indeed not have happened as you perceive it.  The improvement may have been due to so many other factors that you did not seem to consider.  You just, all by yourself, decide that it is the MFR that "did it".  This  is not even anecdotal - this is a personal assumption.  Fine to have personal assumptions, but do not bring them forth as if it means anything more than that.

The rest of your post....Well, I think it illustrates the apparent significant lack of understanding you have of what evidence is all about - or what PT is all about for that matter.

And with regards to what gun I would use? Depends completely on what bird I would be hunting now, wouldn't it? 
But I am afraid that you would hunt everything with the same `weapon`and claim it the best....

_____________________________

Mundi vult decipi

(in reply to bobmfrptx)
Post #: 25
RE: thoughts on manual therapy for scoliosis - March 22, 2008 2:24:51 PM   
bobmfrptx

 

Posts: 57
Joined: December 13, 2006
Status: offline
quote:

ORIGINAL: Sebastian Asselbergs

....Well, I think it illustrates the apparent significant lack of understanding you have of what evidence is all about - or what PT is all about for that matter.



PT...the art of returning one from dysfunction to function with as little pain as possible and keeping costs to a minimum.  Fostering independence by educating in prevention of recurrence and wellness program designed to fit the individuals wants and goals.
My evidence...seeing is believing...
Spending time trying to classify things to come up with the best possible solution which is based on a group picked to be similiar is a waste of time in the real world of PT...each case is different each person is unique in their dysfunction and needs to be handled in the way they will respond the best.. not some statistic from a scientific double blind study.  Studies have some value in medicine since chemical reactions are likely to occur in a similiar fashion as long as the chemicals in the test tubes are the same or close. Bottom line, I FEEL very comfortable treating my clients with the techniques I have been using for the past 25 years.  They work well and my clients respond very well.  Until I find something which works better, cheaper and more quickly I will continue to treat in the manner I have become accustomed.  c'est la vie
Bob

(in reply to Sebastian Asselbergs)
Post #: 26
RE: thoughts on manual therapy for scoliosis - March 22, 2008 3:07:12 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
Bob... you have no idea if something works better or is cheaper.  You aren't collecting the appropriate type of data to assist you with clinical decision-making.  "Feeling" comfortable is a personal factor... KNOWING you are effective or just as effective as literature suggests is a higher road to take.

Classifying is a waste of time????  Bob, please tell me you didn't state that!  There IS current research out there that supports a treatment based classification system for low back pain.  MFR isn't one of the treatments advocated. 

Sadly enough, there is also research out that that suggests physicians with the most experience are the least effective and least likely to incorporate evidence into practice.  Those physicians are the WORST because they are using what they were taught years ago and not updating their approach as literature evolves.  If you've been practicing the same way for 25 years and not challenging your comfort level to incorporate new evidence, I'm going to tell you that I highly doubt that you are as effective as you feel or believe.

(in reply to bobmfrptx)
Post #: 27
RE: thoughts on manual therapy for scoliosis - March 22, 2008 4:26:35 PM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Bob, "seeing is believing"?!? OK, so you accept those stories of those who have seen aliens, UFOs, Mother Mary, have been to other planets for incubation, etc etc?
Bob, you really need to study the concepts of personal perceptions, as these are well-documented and found to be highly - HIGHLY - subject  to modification and change by personal factors. in other words, NOT representative of what really goes on or happened. Check with any police force - witness statements are well-known examples of this "seeing is believing" mud.

"Feeling" is nice. We all do that. But we do not all have our decisions guided by that.  We often use rational choices over feelings it would be a mess in the world if we did not.
And lastly - YOUR sense of comfort ("I feel very comfortable") is really not what should guide practice, is it?

_____________________________

Mundi vult decipi

(in reply to SJBird55)
Post #: 28
RE: thoughts on manual therapy for scoliosis - March 22, 2008 5:05:41 PM   
kamryn


Posts: 27
Joined: February 23, 2008
Status: offline
This is a very interesting discussion.  I think that Bob?s practice patterns are not uncommon amongst PTs and other medical providers.
 
For example, this paper published in the PT journal suggests that PTs don?t even recommend the simplest of evidence based interventions for pts w/LBP ? advice to stay active (only 3% of PTs recommended this for a pt with garden variety nonspecific LBP).  Manipulation was also not considered by PTs (3% again) in this paper.  So the 2 most evidence based interventions were not recommended by PTs ? this is very concerning.
 
http://www.ptjournal.org/cgi/reprint/85/11/1151
 
So how can we get recalcitrant PTs (or SJs elderly MDs) to get on board with evidence based practice?
 
Happy Easter!

(in reply to Sebastian Asselbergs)
Post #: 29
RE: thoughts on manual therapy for scoliosis - March 22, 2008 6:11:30 PM   
bobmfrptx

 

Posts: 57
Joined: December 13, 2006
Status: offline
This group is so easily triggered.....
That being said, I do keep up with the "classification systems" which I still feel are a waste of time.... recent evidence shows that non specific movement helps just as well as specific movement for nonspecific LBP...I add movement the first visit...I do not use near the manipulations that I did when I was younger...The lumbosacral decompression (LSD) works so much better in the majority of cases.   I believe in what I see...never have I seen a UFO, but my pancakes this AM resembled the topographical map of AREA 51......whats that mean?
You can't grow in your comfort zone is a statement that I am well aware of and if you feel dialoguing on this and others sites is comfortable , well?
Any way, this adventure has been fun...
May the renewal of the season be joyous for those who celebrate and may you all live with peace in your heart.
Bob
Medicus curat, natura sanat

< Message edited by bobmfrptx -- March 22, 2008 6:15:42 PM >

(in reply to kamryn)
Post #: 30
RE: thoughts on manual therapy for scoliosis - March 22, 2008 7:02:03 PM   
Sebastian Asselbergs

 

Posts: 2293
Joined: September 30, 1999
From: Barrie, Canada
Status: offline
Mens sana in corpero sano - I worry about you.

We can all use latin quotes: look at my "signature line"...
Applicable to many who espouse MFR.

I like the fact that you feel you are dialoguing here. It shows a great sense of humour. Dialoguing usually requires a common language. That seems to have become a real problem here, since we're apparently not in the same universe. 

``I believe in what I see...`` 

You would be a GREAT subject in a magic show: "No, really. trust me. He MADE THAT RABBIT DISAPPEAR!".  saw it with my own eyes....

_____________________________

Mundi vult decipi

(in reply to bobmfrptx)
Post #: 31
RE: thoughts on manual therapy for scoliosis - March 22, 2008 7:09:11 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
kamryn, not much anyone can do about the issue until our industry has a definition for quality combined with truly assessing the performance of physical therapists.  Sad to say, but the move toward this will probably occur with third party payors defining the standards because our profession as a whole doesn't have any standards.  When third party payors set standards, we can be assured the focus will be on their bottom line, not on patients nor on us as providers.  Since our profession doesn't have anything in place, there will be no way to negotiate those standards.  The fee schedule sucks and the timed one-on-one codes suck - both limit our ability to generate revenue, add in some "quality" standard defined by the third party payors and I can only imagine more limitations both professionally and financially.

(in reply to Sebastian Asselbergs)
Post #: 32
RE: thoughts on manual therapy for scoliosis - March 24, 2008 1:59:24 PM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
Bob,
I want to give you the opportunity to clarify your statement
quote:

.... recent evidence shows that non specific movement helps just as well as specific movement for nonspecific LBP
, and how this relates to the clssification scheme for LBP. It's certianly possible that I've missed some evidence along the way, but the last  research that I'm aware of that looked a specific directional exercise found that for patients who demonstrate directional preference, ROM exercises in that direction resulted in a better outcome than those patients who were treated with general ROM, or ROM that was not matched to their directional preference. Have you read evidence to the contrary? If so, would you mind providing a reference?
Also, I'm unfamiliar with the lumbosacral decompression technique  that you refer to. Could you describe it?
Additionally, I was hoping that you could expound upon the thought process you go through when you decide to use MFR over some other more "traditional" intervention. How do you make sure that the assesment you use is reliable and valid? Is it based on even theoretical evidence, or predominantly anecdotal?

Thanks

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to SJBird55)
Post #: 33
RE: thoughts on manual therapy for scoliosis - March 25, 2008 2:56:33 AM   
bobmfrptx

 

Posts: 57
Joined: December 13, 2006
Status: offline
Unloaded movement facilitation exercise compared to no exercise or alternative therapy on outcomes for people with nonspecific chronic low back pain: a systematic review.
Slade SC, Keating JL. J Manipulative Physiol Ther. 2007 May;30(4):301-11.

OBJECTIVE: The purpose of this study was to determine the effect of unloaded movement facilitation exercises on outcomes for people with nonspecific chronic low back pain (NSCLBP). METHODS: This systematic review was conducted according to Cochrane Back Review Group and Quality of Reporting of Meta-analyses (QUORUM) guidelines. Exercise effects were reported as standardized mean difference (SMD) with 95% confidence intervals (95% CI). RESULTS: Six high-quality randomized controlled trials were included. For NSCLBP effects favored McKenzie therapy over intensive trunk strengthening for pain: SMD: short-term: 0.35 (0.10, 0.59); long-term 0.36 (0.12, 0.61) and short-term function: SMD: 0.45 (0.20, 0.70) and were comparable for medium-term function: SMD: 0.15 (-0.90, 0.40). Effects of favored McKenzie therapy were comparable to specific spinal stabilization exercises for short-term pain: SMD: 0.63 (-0.11, 1.38) and function: SMD: 0.47 (-0.27, 1.20). Pooled effects favored McKenzie therapy over other exercises for short-term pain (pooled SMD: 0.38 (0.14, 0.61)) and were comparable for short-term function: SMD: 0.10 (-0.20, 0.40). Yoga compared to trunk strengthening produced comparable effects for pain: (SMD: short-term: 0.13 (-0.46, 0.71); medium-term 0.51 (-0.08, 1.11)) and function SMD: short-term: 0.51 (-0.08, 1.10); medium-term 0.38 (-0.22, 0.97)). Compared to education, effects of yoga were large for medium-term pain and function (pooled SMDs: 0.92 (0.47, 1.37); 0.95 (0.50, 1.40)). Effects favored unloaded movement facilitation exercises of McKenzie compared to other or no exercise and were comparable for yoga. CONCLUSIONS: For NSCLBP, there is strong evidence that unloaded movement facilitation exercise, compared to no exercise, improves pain and function. Compared to other types of exercise, including effort-intensive strengthening and time-intensive stabilization exercise, the effects are comparable. This challenges the role of strengthening for NSCLBP.
__________________
The LSD is explained in my post on coccydynia in the orthopedic forum.
More later
bob
I use a McKenzie approach to determine probable cause of LBP along with standard LB eval, SLR sitting,  supine. Kernig tests, loading tests in standing etc etc.....


< Message edited by bobmfrptx -- March 25, 2008 3:01:09 AM >

(in reply to jesspt)
Post #: 34
RE: thoughts on manual therapy for scoliosis - March 25, 2008 1:23:18 PM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
Bob,
The classification scheme that you're probably referring to is the Delitto treatment based classification (TBC). Am I correct? If so, the article you site has little relevance to the TBC - the TBC system is for acute and sub-acute LBP populaitons and the article you site is obviously for chronic pain. If you are stating that in patients with chronic pain the direction the exercise occcur in doesn't really matter, I'd aggree with you, but from you previous post (#30) it looks like you're comparing apples to oranges when you talk about the TBC and then use the review article to support your argument.

When you use the LSD, do you use the same criterion that is called for in the clincal prediction rule for manipulation. If not, I can't see how you can really compare the efficacy of the two.

You state, "...I believe what I see." I think you're treading on a slippery slope here, essentially abadoning any use of the scientific method in favor of anecdotal evidence at best. Do you think this is really the best way to approach caring for your patients?

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to bobmfrptx)
Post #: 35
RE: thoughts on manual therapy for scoliosis - March 25, 2008 1:28:57 PM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
Bob,
How is this,  "CONCLUSIONS: For NSCLBP, there is strong evidence that unloaded movement facilitation exercise, compared to no exercise, improves pain and function"  an indication for non-specific movement?  Once there are descriptors for the movements, the movements become specific, no?

Disclaimer.  I read only your abstract this AM, as I did not have time to look at the whole study.

Regards,
Steve

(in reply to bobmfrptx)
Post #: 36
RE: thoughts on manual therapy for scoliosis - March 27, 2008 12:19:01 PM   
bobmfrptx

 

Posts: 57
Joined: December 13, 2006
Status: offline
FYI
Another example that the CPR may not be so predictable:

May S, Rosedale R. J Manipulative Physiol Ther. 2007 Sep;30(7):539-42.

A case of a potential manipulation responder whose back pain resolved with flexion exercises.

OBJECTIVE: Researchers have begun to investigate the value of subgrouping patients with back pain to improve clinical outcomes; one method is the development of clinical prediction rules. To be of clinical value, it is important that subgroups identify distinct categories of patients with an associated optimal treatment. This case study raises the suggestion that subgroups identified in this way may not represent distinct categories. CLINICAL FEATURES: A patient with sudden-onset back pain, who had 4 of 5 criteria for a clinical prediction rule said to identify responders to manipulation, was successfully treated using repeated flexion in lying exercises. OUTCOMES: Pain numeric score and Roland-Morris Disability Questionnaire were used to measure changes in pain and function. Pain score changed from 9/10 to 0/10 and disability score from 19/24 to 0/24 after 1 week and at 1 and 6 months of follow-up. CONCLUSION: We have presented a case study that was positive for 4 of 5 items of the clinical prediction rule for manipulation responders, but this patient was successfully treated with flexion exercises. The clinical prediction rule may not represent a discrete subgroup but may include patients who can be effectively managed in other ways.

"There is more than one way to skin a cat."

(in reply to Shill)
Post #: 37
RE: thoughts on manual therapy for scoliosis - March 27, 2008 12:49:19 PM   
TexasOrtho


Posts: 1090
Joined: December 22, 2007
Status: offline
A couple of things Bob that pertain to interpreting research in general.  I believe the authors of the manipulation CPR would make no claims that the CPR applies to everyone - it is a guideline used to assist PT's in determining an intervention.  It is no more or less generalizable (that a word?) than that.

Secondly.  I think it's important to interpret the statistical power of a case study vs the CPR which looked at an N>>>1.


_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
Movement Science Podcast and Blog

(in reply to bobmfrptx)
Post #: 38
RE: thoughts on manual therapy for scoliosis - March 27, 2008 2:15:45 PM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
Bob,

I agree with Rod's earlier post. Disregarding the CPR due to one case study of a "flexion responder" is foolhardy at best, and shows a genuine lack of understanding in the interpretation of resarch.

Will write more later when I have time.

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to TexasOrtho)
Post #: 39
RE: thoughts on manual therapy for scoliosis - March 27, 2008 3:48:52 PM   
jesspt

 

Posts: 182
Joined: April 4, 2007
From: Illinois
Status: offline
Alright, I'm back. Bob, I'm sure you're thrilled.

The study you referenced in no way supports your statement:
quote:

Another example that the CPR may not be so predictable 


The CPR remains predictable. The study you cite in now way disproves that, nor does it even cast doubt on its predictability.The study the authors of the CPR completed shows that when a patient meets four out of the five criteria and a specific lumbopelvic manipulation technique is performed, followed by a ROM exercise for the lumbopelvic region, the patient has over a 90% chance of achieving a 50% (or greater) reduction in their ODI score (within two visits, I believe). The authors in no way state that there may not be other ways to effectively treat this subgroup of patients, although there have yet to be any studies that support this premise.

Obviously, the sample size of the CPR validation study was quite large, so the findings of that study carry far more "weight" for me than one case study.

I only have access to the abstract. Does someone have the actual article? If so, can they outline how the authors examined the patient to determine they were a flexion responder? My assumption would be that they used repeated moveement testing (which is part of the TBC system that utilizes the CPR for manipulation).

_____________________________

Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to jesspt)
Post #: 40
Page:   <<   < prev  1 [2] 3 4 5   next >   >>
All Forums >> [RehabEdge Forum] >> Manual Therapy >> RE: thoughts on manual therapy for scoliosis Page: <<   < prev  1 [2] 3 4 5   next >   >>
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.125