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Monday, February 11, 2008
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.
