Tuesday, November 25, 2008

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

Friday, November 21, 2008

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

Friday, November 14, 2008

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

Monday, November 10, 2008

Blogging on Peer-Reviewed Research

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