Evidence Based Rehab

The American Academy of Orthopaedic Surgeons (AAOS) recently released their Guidline on the Treatment of Osteoarthritis of the Knee. AAOS' guidlines join those made by the Osteoarthritis Research Society International (OARSI) guidlines released in February of this year. AAOS makes recommendations on topics ranging from lifestyle modifications to, of course, surgical interventions. However, there were a couple of recommendations/statements that stood out to me.

The first was they recommend AGAINST the prescribing of Glucosamine, Chondroitin, or hydrochloride. I would have to say that my observation in the clinic that greater than 50% of my patients over the age of 50 are taking one or all of these. I haven't read any studies that show a strong benefit from any of these. However, they are marketed hard. Will like to know if there are any side effects from long term use of these.

The last issue I wold like to discuss is AAOS', in my opinion, obvious choice to avoid the term/word "PHYSICAL THERAPY". This is in stark contrast to OARSI's recommendation which specifically recommends physical therapy. AAOS recommends many treatments used by physical therapists and education routinely provided by physical therapists. However, at no time does the 265 page document use the terms "physical therapy "or "physical therapist" in reference to it's recommendations. The did have 2 PT's on the review board (one the president of the orthopaedic section of the APTA) and get the nod of acceptance from the APTA. However, I feel this is just a continuation of, specifically, orthopaedic surgeons refusal to aknowldedge the importance of our profession instead of something the own and direct as just a small aspect of their patient's recovery.

Besides the hypocrisy of direct access for PT's (may go to a massage therapist with a certificate for back pain w/o MD ok but not a PT with a doctoral degree), this concerted effort by orthopaedic surgeons in general to make sure PT's stay subservient gives me the most angst in my professional life. In the end, our working together and respecting each others discrete knowledge for orthopaedic patients should be paramount. Instead, it's unilateraly ignored and buried.

Good recommendations and good information for us all to read. Hope future editions of these recommendations can include the recommendation skirted through out - the referral to a physical therapist.

Jason Harris

Labels: AAOS, evidence based medicine, knee, OA, OARSI

New Study Shows Manual Physical Therapy and Exercise ProducesSignificant Improvements in Neck Pain

ALEXANDRIA, VA, December 12, 2008 — The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one-third of American adults and nearly 12 percent of children use alternative medicine - with back and neck pain being the top reasons for treatment. Results of the 2007 survey of more than 32,000 Americans were released December 11 by the National Institutes of Health's National Center for Complementary and Alternative Medicine.

According to APTA, physical therapy offers an evidence-based, time-tested solution to these common conditions in comparison to alternative treatments.
For neck pain, for example, a recent study published in the medical journal Spine found that when patients received up to six treatments of manual physical therapy and exercise, they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.

"This study, demonstrating the efficacy of physical therapy for a condition as widespread as neck pain, is particularly relevant in today's challenging economic environment," according to the study's lead researcher and APTA spokesman Michael Walker, PT, DSc, OCS, CSCS, FAAOMPT. "The Kaiser Foundation, for instance, recently found that more than half of all Americans are not taking prescribed medication and postponing needed medical care in an effort to save money. It is important for consumers to know that there are effective, conservative solutions such as physical therapy available.1"

Walker's study compared the effectiveness of a three-week program of manual physical therapy and exercise to a minimal intervention treatment approach for patients with neck pain.
Study participants consisted of 94 patients with a primary complaint of neck pain, 58 (62%) of whom also had radiating arm pain. Patients randomized to the manual physical therapy and exercise group received joint and soft-tissue mobilizations and manipulations to restore motion and decrease pain, followed by a standard home exercise program of chin tucks, neck strengthening, and range-of-motion exercises. Patients in the minimal intervention group received treatment consistent with the current guidelines of advice, range-of-motion exercise, and any medication use prescribed by their general practitioner. Patients did not have to complete all six visits if their symptoms were fully resolved.
Sample exercises to relieve neck pain can be found on the APTA Web site, www.apta.org/consumer.

Results show that manual physical therapy and exercise was significantly more effective in reducing mechanical neck pain and disability and increasing patient-perceived improvements during short- and long-term follow-ups. These results are comparable with previous studies that found manual physical therapy and exercise provided greater treatment effectiveness (Hoving et al, 2002)2 and cost effectiveness (Kothals-de Bos et al, 2003)3 than general practitioner care.
"Physical therapist intervention can be an effective, high-value, conservative solution for treatment of musculoskeletal pain," said Walker.

"Physical therapists can help individuals improve mobility and quality of life without expensive surgery or the side effects of pain medication. We give patients the tools they need, such as the home program we used in the study, to help them prevent or manage a condition in order to achieve long-term health benefits."

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility — without expensive surgery or the side effects of medications. APTA represents more than 70,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice. Learn more about conditions physical therapists can treat at www.apta.org/consumer, and find a physical therapist in your area at www.findapt.us.

1 http://www.kff.org/kaiserpolls/h08_posr102108pkg.cfm
2 Hoving JL, Koes BW, de Vet HC, van der Windt DA, et al. Manual Therapy, Physical Therapy, Or Continued Care by a General Practitioner for Patients with Neck Pain. Ann Intern Med 2002;136 (10):713-722
3 Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 2003;326 (7395):911

Labels: APTA, evidence based medicine, manipulation, Mobilization, neck pain

The folks over at Evidence In Motion have announce the winners of their "30 Second Elevator Pitch Contest" asking participants to answer the question:

- Why physical therapy is the best first choice in musculoskeletal care.

The grand prize winner was the entry submitted by BJ Lehecka from Wichita State University. You can see BJ's winning entry below. To see the full list of winners and other information, please go to EIM's blog found here.

Labels: Direct access, media, physical therapy, public relations

Looking back on my first year of blogging, I noticed I liked a few posts that likely did not get much viewing exposure back then. Therefore, I plan to occasionally repost a few of these select posts from that first year. Here is the first offering.

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After many question from my patients and the general public regarding "alternative" treatments (e.g. magnets, craniosacral, dietary supplements, etc) I decided to sit down and write up an educational handout to summarize how to approach evaluating treatment options. This includes treatments in so called "Alternative Medicine" and main-stream medicine alike.

I am very concerned that many alternative treatments are blatant attempts to take advantage of persons in desperate situations. Such as end-stage cancer and progressive disease processes like arthritis.

Below are some ideas on how to approach decisions about "new" therapies to allow you to maximize your potential gains and to protect your money from those offering up only a big handful of woo.

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EVALUATING INTERNET MEDICAL ADVICE

Jason Harris, PT, DPT

Our modern internet has opened the door to a vast arena of medical advice and information. With this information, it is important to critically evaluate the information and the author’s credibility. How does one pick between credible and worthless? It can be hard, but I will outline a few rules for judging the value of the information you are reading.

I suggest you look for "Red Flags" while researching medical information on the internet. In medicine "Red Flags" are signs and/or symptoms that warrant immediate attention as they indicate a potential life threatening situation. I will use the term to indicate immediate problems with information that is being evaluated.

"RED FLAGS":

1. Any site that use the terms "alternative", "holistic", "integrative", "natural", and/or "miraculous" (Barrett). The vast majority of websites using these terms should replace them with “unproven” and/or “ineffective”. They also tend to push Herbs, vitamins and supplements. Do not trust a salesman to tell you the whole and complete truth. Their job is to sell you the product.

2. Claim large effect on symptoms with out side-effects. Causing a large change in body function (or dysfunction) has a cascading effect that leads to known side-effects and occasionally adverse reactions. No side effect most often indicates such low doses as to have no real effect.

3. Claim that a treatment can cure multiple problems/pathologies. Nothing can, or ever will, cure your shoulder pain and skin melanoma.

4. Claim that everyone will experience the same positive results. Humans are not all the same. Disease processes are complex and include multiple organ systems to varying degrees. Due to this, you cannot expect all to respond the same way or to the same degree. This is why well run clinical trials are essential. Which brings us to the next point…

5. The use of testimonials as sole proof that treatment works. A positive experience one person has cannot be generalized to anyone else. This is a complex topic as we rely on recommendations and advice from our neighbors to function efficiently in society and these salesmen attempt to take advantage of this.

6. Person is touted as a “Guru” with many impressive sounding “credentials”. Often claims are made that your problems can only be cured by the seller. Often it is because of some procedure or test named after them that only they can do. In the end, only they can do it because there has been no published research to support or refute it’s ability to do what it is purported to do. Also watch for the use of “Dr.” when referring to this guru and/or unusual credentials (e.g. not common known credentials such as MD, DO, PhD). The use of the doctor title is an attempt to make the person appear more authoritative then they are.

7. Must buy to see results. Any reputable treatment/product should have peer-reviewed published literature that shows it can do what it claims. You should never have to first buy something to know or experience how it works.

Medical information from the internet must be reviewed wisely and used as a supplement to the advice a trusted healthcare professional has given you. When in doubt, bring the information you have found to your MD, DO, or PT and discuss it with them. These “red flags” are a good start to filtering out the majority of bad from the good.

Works Cited Barrett, M.D., Stephen. " How to Spot a "Quacky" Web Site." 06 September 2006. Quackwatch. 7 July 2007 .

Jason Harris

Labels: alternative medicine, evidence based medicine, repost, woo

Just wanted to share:

"Either it is true that a medicine works or it isn't.
It cannot be false in the ordinary sense but true in some 'alternative' sense."

-Prof. Richard Dawkins, Oxford, April 2001

Great stuff. I'm a true believer that if a treatment is shown to be beneficial it's medicine. There is no "alternative" to it; as the alternative is a treatment that is not beneficial.

Jason Harris

Labels: alternative medicine, evidence based medicine

Stumbled upon a nice article written about physical therapy from a patient's perspective. Nice view as it starts out with the patient expressing his hesitation in trying treatment from a PT and his desire for a quick fix.

Oh great!" I remember thinking. "Voodoo medicine! Why can't they just give me a pill to make this go away?

Nice to see a physical therapist was able to get one of our countries finest back up and running! You can read the rest of the article by clicking HERE.

Jason L. Harris

Labels: physical therapist, physical therapy, treatment

Iwas shocked to stumble upon a letter apperently written by president elect Barack Obama professing support for the chiropractic profession. Now, my intent for this blog is not to go out of my way to bash other professionals just to bash them. However, Obama's words concern me as they appear to indicate he is ignorance in regards to evidence based medicine and the problems with our healthcare system (over-utilization, excessive imaging, dogma and personal beliefs dictating treatment). From the letter posted on Chiroeco.com:

We need to knock down unreasonable barriers of access and discriminatory insurance coverage so Americans in need of quality chiropractic care can access it without difficulty. We need to expand the range of chiropractic services covered by Medicare, facilitate integration of doctors of chiropractic into the health care systems of the Department of Veterans Affairs and Department of Defense, and allow commission of doctors of chiropractic as officers in the Commissioned Corps of the U.S. Public Health Service.

I am absolutely for the right for people to choose chiropractic care for their conservative musculoskeletal care. However, I draw the line at the government using my tax dollars to pay for "subluxation" treatments and excessive imaging. The biggest problem is that an evidence based chiropractor is called a Doctor of Physical Therapy.

Secondly, Obama's comment on "integrating" chiropractic is almost laughable. The very tennant of chiropractic is it's drive to SEPERATE itself from mainstream medicine. No comment on whether this is right or wrong, just stating a fact. They push anti-vacination, subluxation theory for health, pedicatric health through manipulation, and a wide variety of nutritional supplements. Is this what we want to spend our money on?

We are all looking and hoping for health care system reform. I just hope the reforms are well researched and done with the least amount of ingnorance possible.

Jason L. Harris

Labels: Chiropractic, evidence based medicine, health care, Obama

Archives of Physical Medicine and Rehabilitation recently published a study on the benefits of physical therapy for lower extremity trauma. The abstract is as follows:

OBJECTIVE: To examine the effect of physical therapy (PT) use on a range of measures of physical impairment in a cohort of patients with lower-extremity trauma.

DESIGN: Longitudinal, observational study of patients with severe lower-extremity trauma. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission and at 3, 6, 12, and 24 months postdischarge.

SETTING: Eight level I trauma centers.

PARTICIPANTS: Patients (N=382) whose legs were salvaged after limb-threatening trauma to the lower limb.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Unmet need for PT was assessed from 2 perspectives: an orthopedic surgeon and a physical therapist independently evaluated each patient and were asked whether the patient would benefit from PT. Patients classified by these health professionals as needing PT services over a given period and who reported receiving no PT at the end of that period were classified as having unmet need as evaluated by the orthopedic surgeon or physical therapist for that follow-up period. Multiple variable regression techniques were used to compare improvement in 5 measures of physical impairment and functional limitation between the met and unmet need groups over the periods of 3 to 6, 6 to 12, and 12 to 24 months: percentage of impairment in knee and ankle range of motion (ROM), reciprocal stair climbing pattern, gait deviations when walking, self-selected walking speed greater than 1.2 m/s (4 ft/s), and the mobility subscores of the FIM instrument.

RESULTS: Patients with unmet need for PT as assessed by a physical therapist were statistically significantly less likely to improve in all 5 of the selected domains of physical impairment and functional limitation than patients whose PT need was met. These results remained constant after adjustment for patient sociodemographic, personality, and social resources, as well as injury and treatment characteristics, reported pain intensity, and impairment level at the beginning of the study period. Patients with unmet need for PT as evaluated by an orthopedic surgeon were significantly worse off than patients with met need in only 1 of the 5 selected measures (ROM).

CONCLUSIONS: The results are consistent with a beneficial effect of PT after lower-extremity trauma. The results point to a need for improved standards for the prescription of PT services, and highlight the importance of involving a PT professional in the prescribing process.

I think the conclusion is relatively strong worded in regards to not just the importance of physical therapy intervention, but that outcomes were affected by whether the PT was involved in the decision making for rehabilitation. While it would be a stretch to generalize these conclusion to other lower extremity conditions seen in PT (elective post-op, sprains/strains, neuromuscular) it's important that MD's (the gate keepers in the health care world) begin to shift their view of PT's as less of an adjunct of THEIR treatment to micromanage, and instead begin allowing themselves to work with PT's as health care professionals that bring a different body of knowledge to help in the conservative treatment of neuromusculoskeletal conditions.

Jason L. Harris

Article Reference

Labels: Direct access, evidence based medicine, lower extremity, physical therapist

Seattle, Washington, October 30, 2008- Physical therapists from around the world are converging on Seattle this week for the annual conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Pain: From Science to Solutions, the conference theme, speaks to the unique role physical therapists have in combating pain. Pain from musculoskeletal problems such as back and neck pain is a leading cause of healthcare utilization. Manual physical therapy techniques such as spinal manipulation play an important role in pain relief for patients throughout the United States. Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization designed to restore motion and reduce pain. AAOMPT members will be discussing emerging research suggesting that spinal manipulation has the ability to positively affect the brain’s processing of pain signals. Keynote speaker and distinguished researcher, Richard Deyo, MD, MPH, will open the conference. Dr. Deyo is the Kaiser-Permanente Endowed Professor in Evidence-Based Medicine, Oregon Health Science University Department of Family Medicine.

AAOMPT president, Tim Flynn, PT, PhD, said about the conference, “This is an exciting time for physical therapy and for health care. On one side, we have a tremendous amount of research emerging in support of manual physical therapy for pain relief, and on the other side we see the stars aligning for great change in the health care industry.” Flynn continued, “As a patient, your choices come down to drugs, surgery, or physical therapists. Physical therapists can offer a low-cost solution for patients with pain and high-quality research supports what we do.”

For more on the benefits physical therapists can provide in the management of back and neck problems, contact your nearest physical therapist or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org. AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research.

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Jason L. Harris

Labels: AAOMPT, evidence based medicine, manipulation, physical therapy

Seattle, Washington, October 29, 2008- Washington is one of only two states in the nation that prohibits physical therapists from performing spinal manipulation. Back and neck pain are two of the most common reasons patients seek medical care. The ability of physical therapists to perform spinal manipulation is supported by numerous high quality randomized clinical trials. This body of research, much of it developed by physical therapists, has demonstrated the proven efficacy of manual physical therapy interventions, to include mobilization AND manipulation, for patients with back and neck pain. Physical therapists have produced landmark research in the area of low back and neck pain which is recognized by national and international physician groups. This month’s issue of Spine, reports on the results of a randomized clinical trial, which demonstrated that patients with neck pain who received a physical therapy program of spinal manipulation and exercise had twice the improvement in symptoms compared to the current guideline group (Walker, 2008). Unfortunately, the current law prevents the citizens of the state of Washington from receiving physical therapy treatment that is evidence based, proven to be effective, and recommended in clinical practice guidelines.

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapists, expressed confidence that, "Given the overwhelming evidence of the benefits of physical therapy I would expect that this limitation will soon change. It is time to bring health care in Washington into the 21st century.” Flynn continues, “The American Medical Association, the Department of Defense, the American Physical Therapy Association’s Scope of Practice, as well as 48 other states in our nation recognizes physical therapists’ ability to perform spinal manipulation. Furthermore, the American College of Physicians and the American Pain Society (Chou, 2007) have published clinical practice guidelines recommending manipulation by physical therapists as the only proven treatment for patients suffering with acute low back pain.“

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It is my opinion that the chiropractic associations continue to push and agenda portraying "patient safety" as a reason to continue to prevent PT's in the state of Washington to manipulate. However, manipulation is taught to all PT's in our training, just as examination, evaluation, therapeutic exercise, and physical modalities skills are taught. "Safety" is a red herring covering-up for the real reason which is profits. Legislators in Washington need to hear from patients in particular about how this law is negatively affecting their health care potentially leading to chronic conditions and significantly increased costs.

Jason L. Harris

Labels: AAOMPT, evidence based medicine, legislation, physical therapy

Osteoarthritis (OA) is no doubt a growing cause of loss of function in our society. MSNBC's Health department recently reported on this growing epidemic related to total joint replacements. They are worth a watch. The first video found here discusses the financial impact on Medicare and the second seems more of a marketing clip for total joint replacements. What caught my ear was in the second video the surgeons comments on why total joints. To paraphrase he states total joints are done when "conservative" treatments don't help. He lists conservative treatments as "medications and drugs..". Wow, is it any surprise that these failed? Not many of us can manage chronic progressive pain with medications.

What is disappointing is the utter lack of mention of what literature shows helps and what is a first line recommendation for pain and dysfunction related to OA. That is Physical Therapy. PT is less expensive, can lead to independence in pain management, has good long term outcomes, and has little to no potential negative effects. These qualities are almost completely opposite of what pills and injections offer.

I've seen total joint replacements completely change a persons function, but if we truly want to decrease costs of conservative management of joint pain, we need to shift away from expensive drugs and injections, eliminate unnecessary imaging, and encourage the return of individuals control over their physical well being.

So, you've got drugs, you've got surgery, or you've got Physical Therapy. Let's let individuals know about their choices.

Jason L. Harris

Labels: Direct access, Medicare, Osteoarthritis, physical therapy

Tallahassee, Florida, October 20, 2008 – Neck pain is one of the top 10 reasons for a patient to visit a doctor. The lead article in the most recent issue Spine reports on the results of a randomized clinical trial which demonstrated that patients who received manual physical therapy and exercise had twice the improvement in symptoms compared to the current guideline group. The subjects in the study experienced both short and long term improvements in their neck pain. The study compared the use of manual therapy and exercise compared to the current guidelines of advice, rest, and range of motion. The results of this study are comparable to those reported by Hoving et al in 2002, which also demonstrated that manual physical therapy and exercise resulted in excellent clinical results in the treatment of neck pain while also providing a significant cost savings compared to usual physician care (Kothals-de Bos et al 2003). Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization, designed to restore motion and reduce pain. Hurwitz et al (2008) concluded in a systematic review on neck pain also in the journal Spine, “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.”

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, “This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain.” He continued, “Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain.” If you have neck or back pain or the aches and pains of musculoskeletal problems contact your local physical therapist today.

Jason L. Harris

Labels: AAOMPT, Direct access, evidence based medicine, manipulation, Mobilization

Web-based academic discussions could well be the way forward for cost-effective and tailored continuing education for health professionals. China’s interactive Orthochina.org wiki project for orthopaedic surgeons is an example of the potential of such internet training for continuing medical education. Zhen-Sheng Ma of the Fourth Military Medical University in Xi’an, China, and his colleagues thoroughly evaluated this online tool and will publish their results¹ in the October issue of Springer’s journal Clinical Orthopaedics and Related Research.

Until recently, the primary vehicle for continuing medical education has been the more traditional conferences and training courses. However, the content of these sorts of courses is not necessarily tailored to meet the individual or immediate needs of professionals and their cost-effectiveness has yet to be established. Created in 1998, Orthochina.org uses an interactive case-based format and is structured using the wiki concept, where the content of the website is created collaboratively by users through an Internet browser. Information in Chinese and English is posted, edited, deleted and updated by carefully screened participants and is academically monitored by its orthopaedic users. Ten years on, the site boasts nearly 34,000 users and counts over 6,000 visits and over 2,000 posts every month.

Real patient cases are submitted for discussion by orthopaedic surgeons. They include the patient’s complaint, findings from physical examinations and relevant images. Professional discussions between participants take place anywhere, anytime, giving suggestions for diagnosis and treatment. Multiple opinions can help the surgeon who has posted his complex case, and is seeking advice on how to treat it, to make an informed decision about his treatment plan.

The authors firmly believe that “surgeon-to-surgeon communication is the most important, the easiest, most closely related to clinical practice, and cost-effective method of patient-problem-orientated continuing medical education.” By using the Internet, orthopaedic surgeons from different backgrounds and geographic locations can work together to enhance their quality of care, something workshops and meetings cannot provide in such a tailored and timely manner.

As a profession that is hampered by practice variation and difficulty adapting (changing) to more evidence based treatemt, I feel physical therapy could really fourish with a similar approach. While we do have great sites to share ideas (EIM, Rehabedge, SomaSimple), often time the forum type format can be disonjointed and hard to follow or return to in the future.

Jason L. Harris

Labels: EBM, physical therapy, Wiki

A

LEXANDRIA, VA — The American Physical Therapy Association (APTA) is urging female athletes — particularly soccer players — to consider a new warm-up program to help lower their growing risk of anterior cruciate ligament (ACL) injuries. The announcement comes as APTA celebrates National Physical Therapy Month this October, an annual observance designed to educate the public about the important role physical therapists and physical therapist assistants play in the health care system.

Concurring with a new study published in the American Journal of Sports Medicine (August 2008), APTA says specialized stretching, strengthening, agility and jumping exercises could lower the overall ACL injury rate among female athletes.

The study evaluated outcomes of NCAA Division 1 female soccer players who performed the Prevent Injury, Enhance Performance (PEP) program, designed by physical therapists at Santa Monica (CA) Orthopedic and Sports Medicine Group. Those who performed the PEP program had an overall ACL injury rate 41 percent lower than a group of female athletes who did their regular warm-up. This was one of the largest studies conducted in the NCAA with 1,435 athletes participating.

The PEP program, one example of the many physical therapy-based programs that have demonstrated an equal ability to reduce ACL injuries among female athletes, consists of sport-specific agility exercises and addresses potential deficits in the strength and neuromuscular coordination of the stabilizing muscles around the knee joint. Physical therapist and APTA spokesperson Holly Silvers, MPT, who helped develop PEP, says, "The program was created to address the deficits that are seen in female athletes, particularly weakness in the lateral hip muscles, gluteal, and core muscles." These deficits can contribute to ACL injuries, notes Silvers.

According to physical therapist and APTA spokesperson Mark Paterno, PT, MS, MBA, SCS, ATC, coordinator of orthopedic and sports physical therapy at Cincinnati Children's Hospital Medical Center, recent research published in the British Journal of Sports Medicine found that ACL tears occur four times more frequently in females than in males involved in the same amount of sports participation. He says the difference in neuromuscular control, or the way our muscles contract and react, is one of four primary factors contributing to why women are more susceptible to knee injuries than men. Other discrepancies are anatomical (men and women are structurally differently), hormonal (women's hormonal makeup affects the integrity of the ligament, making it more lax), and bio-mechanical (the positions our knees get in during athletic activities).

Sample exercises athletes can perform to avoid ACL injuries can be found on the APTA Web site, www.apta.org/consumer.

"Women perform athletic tasks in a more upright position, putting added stress on parts of the knee such as the ACL, resulting in less controlled rotation of the joint," said Paterno. "While men use their hamstring muscles more often, women rely more on their quadriceps, which puts the knee at constant risk. To combat these natural tendencies, physical therapists may develop a treatment program to improve strength, flexibility, and coordination, as well as to counteract incorrect existing patterns of movement that may be damaging to joints," he added.

Silvers notes that physical therapist-designed programs can teach athletes how to avoid abnormal movement patterns and lessen stress on the knee, which may include exercises to strengthen hamstring and core muscles.

"Whether patients are athletes or not, physical therapist expertise includes not only rehabilitation and restoration of normal levels of function, but also education regarding how to prevent further injury," says Silvers.

Labels: APTA, Direct access, evidence based medicine, exercise

The fine folks over at NursingDegree.net have worked to post a list of their thoughts on important websites and resources for Physical Therapists.   They have entitled it: "100 Essential Sites and Resources for Physical Therapists".  Check it out and leave a note on your thoughts on what was included and maybe what you think should be included that maybe wasn't.

Jason Harris

Labels: blogs, physical therapist, physical therapy

Physical Therapists in MainE are fighting for their livelihood against the ever-growing bravado in procuring profits by denying more on more services to subscribers and cutting reimbursements to providers. AFTER PT's in MainE signed on to be providers for Anthem BC/BS, Anthem UNILATERALLY cut reimbursement to those same PT's by 20%. Although that is bad in-of-itself, strong-arming providers into reimbursement agreements that are barely at a level (and sometimes below the level) allowing for a consistent profit margin, it is not new. There are two other developments from this action that I find interesting.

The first is what happened when Anthem forced this rate cut on the PT's in MainE. Unlike our long history of passivity, the PT's stiffened up and said "no!" and now have a lawsuit against Anthem that is moving through the courts. I see this as analogous to the terrorized finally pushing the bully back. We may get our asses kicked in the end, but it's finally a step towards standing up for ourselves and our profession.

The second event related to this is the response by our professional organization the APTA. It appears from my vantage point that the APTA is keeping to itself on this issue. In my opinion, this is the perfect opportunity for the APTA to help by flexing some muscle and stand up for what we know is right. It seems we are taking the stance that we don't want to "offend" anyone so we'll just make like Switzerland and play neutral.

We need to support our fellow PT's if not for anything but to avoid becoming bullied just as they are.

Jason Harris

Labels: Anthem, BC/BS, Healthcare, Lawsuit, Maine, physical therapist

Wow, it has been a while and I apologize for that. My family and I have moved across the country, sold our house, started new jobs, and have been looking for a new home just in the last month. On top of that, I have been without internet access until just this past week. Well, I am back, and hope to again barage you all with disconnected rants and musings.

I'll take this time to try to give a peek as to what I plan to post on in the near future:

• Medicare Cap
• Round 2 of NATA vs APTA
• Because I'm forced to...the Wii in rehab
• Reviews on interesting Journal articles that others may like too

Expect a new post early next week. Thanks to those still subscribed.

Jason Harris

Labels: evidence based medicine, physical therapy, welcome

Degenerative Disc Disease. For many of those that get an unnecessary MRI and get this diagnosis, it's often taken as a death sentence for a back instead of what it is - a normal process related to aging. Although pain can be associated with DDD, it is more often just a radiologic finding. Something that was most likely present before onset of spinal pain and will remain unchanged once the spinal pain recedes.

June's issue of the Journal of Orthopedic & Sports Physical Therapy (JOSPT) includes and excellent commentary on what we know and don't know regarding intervertebral disc degeneration. I would like to summarize some critical points I found in the article.

• Although environmental factors play a role in the incidence and progression of DDD, the strongest predictors are genetically related. It is estimated that 74% of what causes DDD appears related to genetics.
• Smoking and heavy labor have not been supported as etiologic factors in developing DDD. In fact, competitive weight lifters w/o trauma have a lower than expected rate of DDD.
• Primary factor in DDD is reduction of the Intervertebral Disc's (IVD) nutritional capacity.
• "...age-related changes that occur in the composition of the IVD are similar to those observed in articular cartilage and are not necessarily related to pain."
• Vertebral endplate disruptions are being shown to have a strong relationship with DDD.
• Although similar in appearance, there are measurable differences in the diffusion capacity at the vertebral endplate of those IVD's with age-related disc degeneration and symptomatic degnerative discs. This may suggest that aging and degeneration are 2 separate processes.
• "High-Intensity Zones" represented by high intensity T2 signals near the outer margins of the annulus are correlated to pain production with discography (IMO, discography is often painful regardless of pathology) but also commonly found in asymptomatic individuals. This leads to poor specificity and the authors suggest it should not be used in isolation to make clinical decisions.
• The body's attempt to heal annular tears may lead to increasing the area of the disc that is innervated which is further increased by inflammatory byproducts which can lower the threshold needed to trigger pain. The result could be increased sensitivity to otherwise innocuous stimuli. This includes those from just standing and/or walking.
• Even if MRI shows a dramatic disc bulge, this finding is very often not associated with symptoms.
• When nuclear material breaks free and migrates into the vertebral foramen, ipsilateral pain and parasthesia may occur. This results from the chemical response to the nuclear material touching the dorsal root ganglion and not from "pinching" the nerve.

The authors then make some comments on clinical relevance. Here are a few that will lead to a change in the way I treat on Monday:

• Patients with later stage DDD - decreased disc height and hydrostatic nucleus lost - care should be taken during loading progressions, avoiding sustained loading at end range trunk motions.
• Symptoms often occur several hours after trauma to the degenerated disc (DD). Thus, exercise in the gym may go well but in the morning the patient may be too painful to even get out of bed.
• Studies have found favorable outcome in treating DDD with lumbar stabilization exercises.
• It was found that patients with DD who avoided early morning lumbar flexion had significantly less pain and disability then did those who performed lumbar flexibility exercises early in the morning.
• Patients with DD should be encouraged to avoid prolonged flexed compressive forces such as sitting in flexed position.
• Hip ROM limitation can have large effects on loads acting on the lumbar spine.
• The authors make it a point to illustrate the important role the psychological effect that the diagnosis of "degenerative disc disease" has on the patient. they state:
• "...it is important that clinicians carefully communicate with patients to reassure them that DD is a normal aging process; while it certainly can be associated with episodes of pain, only in rare exceptions do these symptoms represent serious disease, and they should not, therefore, prevent one from performing reasonable activities."

It's important to remember the fact DD is related to normal aging. And, thus, it's main treatment should most likely be non-invasive conservative care. And, as I always say, PT's are the experts in this area and well positioned to give the more efficacious care.

Jason L. Harris

Labels: DDD, Degenerative Disc Disease, DRX 9000, evidence based medicine, Low back pain, physical therapy

Anew website has been published providing information and resources on fighting chronic diseases. As we all know, the biggest impact on quality of life and health care costs are the treatment of chronic diseases. The website called "Promising Practices" comments that:

America faces an important crossroads in health care. The Partnership to Fight Chronic Disease, a diverse, national coalition of more than 100 partner organizations, is committed to raising awareness of policies and practices that save lives and reduce health costs through more effective prevention and management of chronic disease. We share common concerns about the incredible burden that chronic diseases place on families, the health care system, and the economy overall.

Though many understand the need for better ways to lower the risks of developing chronic illnesses and reduce the burden of illness on those already affected, they wonder how and where to begin. Innovators in schools, communities, workplaces, and the health care system are proving the value of addressing chronic disease in building a healthier America. Working together, we can develop innovative, common sense solutions to our current health care problems. We encourage you to use these resources to develop and support meaningful changes that will make a difference.

This appears to be a nice resource of patients and providers alike.

Jason L. Harris

Labels: education, Healthcare, Low back pain

A subject that has been eating at me for a while, but has been repressed due to it not having to do anything with PT, is "Spy Gate". Was it a shock how pervasive this taping was? Yes, but they were caught and punished. Should have been the end of it. Nope, not with our government.

We are struggling with ever decreasing reimbursement, $4 gallon gas, a war, and a slumping economy, yet Republican Arlen Specter feels this should all be ignored and the government get to the bottom of the Patriots video taping.

What a waste. I'll save the government some time. Just like stealing signs in baseball, taping-trying to get other tapes-spying-etc, is already done at every level in football. I only played at a small college, but I remember the whole team being sent running to scare off a car that seemed to be watching practice too intently; pretending to run a 3-4 defense during a walk-through at an away campus; coaches snickering at the tape they got from outside of a tape exchange agreement; and more.

I hope the good people of Pennsylvania see the light and get rid of this headline grabbing boob soon.

Jason L. Harris

Labels: Specter, spygate

More surgery, more drugs, and more injections are not what the doctor ordered.

Tallahassee, Florida, May 20, 2008 – When it comes to chronic back pain management patients should know that “less is more.” The American Pain Society at their annual meeting unveiled a current review on invasive procedures for the treatment of chronic low back. The scientific review concluded that most invasive interventions, including spinal joint injections, radiofrequency denervation, intradiscal electrothermal therapy demonstrated no evidence of effectiveness. Furthermore, surgical procedures for chronic low back pain demonstrated only small improvement in pain and disability but were accompanied by considerable risk.

"The expert panel reaffirms its previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou."

“The American Pain Society panel has acknowledged the central role of an active physical therapy program in managing low back pain patients,” noted Timothy W. Flynn PT, PhD, President of the American Academy of Orthopaedic Manual Physical Therapists. “The key in chronic low back pain is avoiding too much medicine. There is no magic bullet but a combination of hands on care and an active exercise approach is the best solution.”

Labels: AAOMPT, evidence based medicine, Healthcare, LBP, Low back pain, physical therapy, public relations

Iam following the lead of the bloggers over at Evidence in Motion and switching to using Disqus as my comments posting and administrative tool. I believe it will help the flow of comments and allow me more latitude in moderating the comments. Please let me know what you think - good, bad, indifferent, or other.

Jason L. Harris

Labels: comments

Google has released their online health information service. You can navigate to it by clicking here. While I fully support individuals taking positive steps in understanding and becoming a participant in their healthcare, I hope this service is just a step for the layman to organize their knowledge of their health and not a step turn over control of a patient record to the individual themselves.

The legal ramifications of how to practice when the individual has complete control of how and what is entered into their health record is frightening.

What is your opinion? Great step or bad road to go down?

Jason L. Harris

Labels: Direct access, google, Healthcare, Open Access

Isn't the internet great? Now you can receive consultations for sacroiliac pain over the phone. While I agree general advice can be delivered via telecommunications (especially with an established patient) it seems to be a stretch to do the same for low back/SI pain. As PT's our greatest tools are our hands and our minds. Seems this patient care approach is eliminating 1/2 of those tools. What do you think?

Labels: Healthcare, LBP, Low back pain

Labels: Direct access, evidence based medicine, Medicare, physical therapy

A press release from the American Association of Oral & Maxillofacial Surgeons discusses a bill that would allow them to refer patients to physical therapy. Currently only osteopathic (DO's) and allopathic (MD's) doctors may "oversee" (read: sign the ok for) physical therapy.

Oral & Maxillofacial surgeons and other dentist make the case that they routinely treat patients that would benefit from PT, therefore having the ability to do so would be beneficial:

As Congressmen Pascrell and Cantor noted in sponsoring the bill, because a dentist or OMS cannot directly refer patients for physical therapy, they must refer patients to an allopathic or osteopathic physician to establish a therapy plan. In his statement of introduction on the floor of the House of Representatives, Pascrell stated, Such consultation has proven to be inefficient, unnecessary and cumbersome, and it ultimately delays patient treatment and the continuum of care.

I agree. But I'll take it one step further. It is just as "inefficient, unnecessary and cumbersome" for patients to have to go to their MD, DO, DDS in the first place for neuromusculoskeletal rehab. True full direct access to physical therapist - the experts in neuromusculoskeletal conservative care - would greatly decrease time to recovery and the extraneous costs of medications and excessive imaging associated with going to multiple physicians before getting to see a physical therapist.

Jason L. Harris

Labels: Direct access, EBM, education, evidence based medicine, Medicare

I wanted to share a nice resource I recently found on the internet. It is an online publication of the book "Back Care Boot Camp" which covers many educational aspects for patients on low back pain. The online (free) version appears to leave nothing out in terms of what the book offers to the patient. You can also purchase an ebook version or have a patient purchase an individual section to print. Each section costs only $1.00 and the whole ebook in $4.95.

This appears to be a very nice resource to supplement you patient education and re-emphasize important topics covered in a patients clinic visit. Check it out and let me know what you think.

Jason L. Harris

Labels: Direct access, education, LBP, Low back pain

I thought I would share some resources on how to find a Physical Therapist in your area. The yellow pages is an Ok place to start. Asking a friend or you primary care provider whom they'd recommend is another option. For those that can't or don't want to use these options, there are a few tools on the internet that will help you:

• Find a Physical Therapist - A search engine provided by the American Physical Therapy Association (APTA). It lists physical therapists via a specific radius from a given zip code. You can also filter by specialty (orthopaedics, geriatrics, etc). Limited as only members of the APTA are listed - but...would you want a PT that doesn't participate in their professional organization anyways?
• Find a Orthopaedic Manual Physical Therapist - The American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) provides a tool to find physical therapists that have advanced training, via a fellowship, in orthopeadic manual therapy. While all PT's use manual therapy in some form, these PT's have demonstrated advanced skill and knowledge with it's use.

Good luck with your search!

Jason L. Harris

Labels: Direct access, how to find, physical therapist, physical therapy, search

I

received a nice email today from the president of the APTA, John Barnes. For outsiders, many of us in this profession feel we have an identity crisis in terms of how the public views us. We've had some off center PR campaigns such as "Blackberry thumb", "Couch Potato Exercises", and blah, blah. A grass roots effort has followed demanding more and better from our professional organization, and John Barnes seems to have stepped up to the plate. The most recent action is the hiring of a VP of communications for the APTA. Here is the email I received:

As a signatory of the public relations petition that was forwarded to APTA earlier this year, I thought you would be interested to hear about an exciting announcement.

I am pleased to let you know that we have hired Felicity Clancy as the new Vice President, Communications. Felicity starts at APTA on Monday, April 7.

Felicity is currently the Vice President of Communications and Marketing at the American Chiropractic Association. She has held that position since 2001 and has been with the ACA since 1990.

Before that Felicity worked for Express Newspapers in Gaithersburg, MD and at WJAC-TV News in Johnstown, PA.

Felicity is a graduate of Indiana University of Pennsylvania where she earned a BA in Journalism. She also holds a Master of Public Administration from George Mason University.

She is a member of the American Society of Association Executives and the Society of National Association Publications. She is also a member of the Metropolitan Chorus in Arlington, VA.

Felicity resides with her husband and two daughters in Falls Church, Virginia.

Please join me in welcoming Felicity to APTA!!!...

Her background working for the ACA could be a good thing. As long as we don't find ourselves pushing parents to bring in their children for health and wellness like so many DC's in my area.

At least they have direct access. Good luck Felicity.

Labels: APTA, evidence based medicine, legislation, public relations

Wow, I thought I'd found a candidate I could back. Not what am I going to do? I know this is not physical therapy related, but it is a prominent figure backing pseudoscience over evidence based medicine.

Here is McCain's statement from The Wall Street Journals Health Blog:

Going against the opinion of America’s top public health agencies, John McCain has suggested that autism may be linked to thimerosal, a preservative containing mercury that used to be common in children’s vaccines.

“It’s indisputable that autism is on the rise among children,” McCain (pictured) reportedly said while campaigning recently in Texas. “The question is, What’s causing it? And we go back and forth, and there’s strong evidence that indicates that it’s got to do with a preservative in vaccines.”

This despite every credible expert/scientist/clinical study that shows the opposite: NO LINK BETWEEN AUTISM AND THIMEROSAL

Jason L. Harris

Labels: Autism, EBM, evidence based medicine, Healthcare, McCain, Vaccine

A subject that is, again, seeing some light in PT world is Physician Owned PT clinics or POPTS as they are often referred to (acronyms are cool). This subject is also being discussed over at Evidence In Motion and Rehabedge (a rehabilitation forum).

Why are these a problem or concern to those outside the PT profession? This is an excellent question, because this situation does affect the general public as well as my profession.

I'll forgoing making any claims of the ethical nature of a physician owned clinic or those PT's that work for them. Suffice to say, it IS bad policy. While the mantra of these setups is that it is an attempt to provide convenient care with better oversight, in the end it is more about improving the revenue stream than patient care. An MD wanting to make money is not a bad thing. But, POPTS do present specific problems:

1. Inherent conflict of interest. The MD stands to profit from referring a patient to the clinic THEY OWN.
2. Doing so restricts a patient's CHOICE in regards to PT consultation.
3. When a patient can be used as an additional revenue source, the trust between that patient and the doctor is seriously compromised.
   
4. POPTS directly impact the autonomy of an individually licensed, regulated, and recognized profession. Doing so can affect the quality of care a patient seeking consultation with a physical therapist receives.
   

Additionally, a well known study done by Jean M. Mitchell, PhD, published in the Journal of the American Medical Association (JAMA) found the folowing in regards to POPTS:

• “Visits per patient were 39% to 45% higher in joint venture facilities.
• “Both gross and net revenue per patient were 30% to 40% higher in facilities owned by referring physicians.
• “Percent operating income and percent markup were significantly higher in joint venture physical therapy and rehabilitation facilities.
• “Licensed physical therapists and licensed therapist assistants employed in non-joint venture facilities spend about 60% more time per visit treating physical therapy patients than licensed therapists and licensed therapist assistants working in joint venture facilities.
• “Joint ventures also generate more of their revenues from patients with well-paying insurance.”

For those being referred to a physical therapist, ask you MD if they have financial interest in where they are sending you (seems as though they should tell you upfront, doesn't it?). If you are not comfortable with this situation, request that they refer you to a more convienient or non-physician owned PT clinic. You can also go HERE to do a search for local physical therapists and how to contact them directly.

Jason L. Harris

Labels: AMA, APTA, Direct access, education, kickbacks, physical therapist, physical therapy, physicians, POPTS, referral-for-profit

The APTA recently released an article on the benefits of seeing a Physical Therapist (PT) for back pain. They point out that despite a recent article in the Journal of the American Medical Association (JAMA) that even with rising costs associated with back pain there has been no improvements in care, PT's have an excellent track record with the public, and more importantly, in the literature showing our effectiveness in treating back pain with out surgery or drugs.

Consumers need to know that physical therapist management is a low-cost, high-value alternative to drugs and surgery to deal with musculoskeletal pain," said APTA President R Scott Ward, PT, PhD. "The judicious use of appropriate physical therapist treatment based on best evidence can improve the function of people who struggle with back and neck conditions." Ward added, "Because patients with chronic, disabling low back pain account for a disproportionate share of health care expenditures and workers' compensation costs, the potential cost savings of an early, effective intervention to prevent individuals from progressing to chronic disability may be considerable.

Here is the link to the press release.

Labels: AMA, APTA, evidence based medicine, LBP, Low back pain, manipulation, outcomes, physical therapist, physical therapy

Drugs, Surgery, or Physical Therapists

A great post over at Evidence in motion on good news coverage on the benefits of physical therapy. I usually don't like to make post on other posts, but this seems to scream to be an exception. Please click the link above to read.

Here is the link to the video on back pain and physical therapy.

Labels: Direct access, evidence based medicine, LBP, Low back pain, physical therapy

A committee formed by the Osteoarthritis Research Society International (OARSI) released a document on what they feel are evidence based recommendations for treatment of hip and knee Osteoarthritis (OA). The stated goal of this committee was:

To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world.

A very noble goal indeed. What I'm excited about is that the committee did not include a single physiotherapist/physical therapist, yet our profession figures very prominently in most of the "non-pharmacological" treatment recommendations. The paper goes on to state, specifically, that referral to PT for symptomatic knee and hip OA was "strongly supported" and recommended by "100% of the experts" on the panel.

Good news for us. Now if we can get this into the hands of the public, all would be even better.

Jason L. Harris, PT

Labels: Direct access, evidence based medicine, Healthcare, OA, Osteoarthritis, physical therapy, special test

As promised, I am presenting my response to James Scifers comment regarding the NATA's lawsuit against the APTA. I will attempt to address all of the, in my opinion, important positions James Scifers wrote in his comment to the "NATA Attacks Our Profession" post.

James Scifers said:

Finally, as a professor who holds each of these credentials and teaches both entry-level athletic training and entry-level physical therapy students, I can honestly state that in terms of their ability to perform an evaluation and differential diagnosis of both orthopedic and non-orthopedic dysfunction, I see absolutely no difference in abilities between graduates from the two programs in which I teach.

Furthermore, given the choice to be evaluated and treated for an orthopedic condition by either group of graduates, I would, without a second thought, select the entry-level athletic training professional. The depth of their knowledge regarding the evaluation, differential diagnosis, treatment and rehabilitation of orthopedic conditions is far superior to that of most physical therapists.

First, this is just one man's opinion. I think red heads are the best physical therapists, hands down. But, unfortunately, that is just an anecdotal claim. However, in terms of evaluation and diagnosis, we do know that:

Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists.

So, while my opinion is just that, research can help speak for a physical therapists skills in managing musculoskeletal conditions compared to a wide variety of other healthcare professionals.

James Scifers said:

Additionally, students in the entry-level athletic training program receive a far more extensive education in terms of therapeutic exercise, therapeutic modality selection and application, orthopedic assessment (including a full course of evaluation and treatment of the spine) and diagnostic imaging than the PT students at the same institution.

Don't know how to address this statement really. I know what my education was, but my alma mater did not have an ATC degree program for me to compare against. I did look into Seton Halls curriculum and course descriptions for the DPT and MATC programs. Things I do know:

1. Seton Hall DPT must be real new as board pass rates are not available

2. The clinical imaging class is the same for both the DPT and the Masters ATC

GMED 6017 Clinical Imaging
This course emphasizes imaging of musculoskeletal connective
tissue, central neural tissues, and peripheral vasculature. Survey
of current technology used in structural and functional imaging
of the body is discussed as well as interpretation, documentation,
and communication of clinical imaging information.
2 credits

3. Seton Hall MATC Therapeutic Ex vs Seton Hall DPT Therapeutic Ex

GMED 6022 (GMED 4022) Basic Rehabilitation Procedures
Provides the student with an introduction to the principles of
patient care. Topics include: Patient interviewing, documentation,
monitoring of vital signs, positioning, transfers and the
use of assistive equipment for ADL activities. Students will also
be introduced to physical examination skills including:
goniometry, range of motion, manual muscle testing, reflex
testing and sensory testing.
GMED 6018 Therapeutic Exercise
This course provides a foundation of knowledge and skills used
to manage the majority of musculoskeletal problems using
appropriate exercise principles and rehabilitative techniques.
Additionally, this course will examine current concepts in
strength and conditioning designed to assist individuals in
achieving maximal performance without incurring injury.

VS.

GDPT 6445 Therapeutic Exercise
Therapeutic exercise is one of the key tools that physical therapist
utilize to restore and improve a patient’s neuromusculoskeletal
well being. This course provides a foundation of
knowledge and skills used to manage the majority of neuromusculoskeletal
problems using appropriate exercise principles
and techniques. Using a problem-solving model, patient care
intervention for musculoskeletal dysfunction includes medical
screening, physical evaluation, and goal setting. Students will
develop skill in therapeutic exercise techniques and learn how
to integrate these techniques with other therapeutic modalities.
GDPT 6030/PTFY 4030 Clinical Skills I
This course will promote skills acquisition in basic elements of
patient services. Emphasis is placed on basic physical handling
skills, health care record information collection and documentation,
general screening for all systems, and essential of
patient-practitioner interaction.
GDPT 6031/PTFY 4031 Clinical Skills II
The course promotes skills acquisition in basic elements of
patient services. Emphasis is placed on basic handling skills,
health care record information collection and documentation,
general screening for all systems, and essentials of patient- practitioner
interaction. The course will prepare the student to
integrate elements from examination procedures into basic
treatment approaches.

4. Seton Hall Modalities MATC vs. Seton Hall Modality courses DPT. Wait...again, same course for both:

GMED 6013 (GMED 4013) Therapeutic Modalities
This course emphasizes the use of heat, cold, compression,
traction and electrotherapeutic techniques in the management
of patients with impairments and functional limitations due to
a variety of orthopedic, neurological and medical conditions.
This course will stress a problem solving approach for the selection
and application of appropriate procedures to manage pain,
edema, limitations in motion, muscle weakness and wound
healing.

So, from the information I can access, the statement that Seton Hall MATC students receive a greater amount of therapeutic exercise and modality education seem unfounded.

Finally, James Scifers says:

This is only one example from one University in the country, but I think it illustrates the need to allow each profession to practice according to their educational competencies and professional qualifications and not according to title alone.

and

Joint mobilization is not physical therapy.

Fair enough. I cannot argue with those statements.

I'm not convinced by any stretch of the imagination that the average MATC graduate tomorrow has the same, and definitely not superior, skill set of an average DPT graduate tomorrow in regards to patient evaluation and differential diagnosis. That doesn't mean they won't get as good results with joint mobilization (including the spine) that a PT would. Joint mobilization as a skill is not a magical tool at all. The skill is knowing when, and more importantly, when not to utilize it.

In the end, I guess, the profession that proves itself to the general public and healthcare policy makers, will ultimately be held as the first choice in treating neuromusculoskeletal conditions. No amount of blogging will change this.

It's unfortunate that a much needed and skilled profession such as Athletic Trainers (ATC's) feels the need to waste everyones time and money with an unfounded lawsuit. Instead, maybe spend the money on research on ATC manual skills and outcomes.

Labels: APTA, evidence based medicine, NATA, physical therapy