Evidence Based Rehab

Rich-Mar announces the first FDA approved combination Laser/TENS unit. Because if separately one is questionable in it's effectiveness, together they must be able to cure the blind.

Somewhere Chiropractors are lining up to buy these units by the dozen.

From the release:

One of the biggest challenges physical therapists and chiropractors faced, up until now, is the fact that laser treatments were not reimbursable by health insurance,” said Douglas Johnson, ATC, EES, CLS, and medical consultant to Multi Radiance Medical. “These professionals knew that therapeutic lasers worked, but struggled with both the initial purchase of the unit and determining what to charge patients for the treatment without reimbursement. The LaserStim accessory and its unique design changes all of that. Time spent administering light therapy with LaserStim is now being reimbursed by insurance. Most physical therapists and chiropractors will see the unit pay for itself in less than one month of treatments.”

Ahh, the truth comes out. Insurance companies (rightfully, for now) won't reimburse for Laser treatment, but they do for E-stim. Well, hell, strap a couple of electrodes to the laser and call it "LaserStim" and you can now charge for it!

Labels: EBM, evidence based medicine, Fraud, Low Level laser therapy, woo

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 .

Labels: alternative medicine, Chiropractic, education, Fraud, Low back pain, physical therapy

Reading one of my favorite medical blogs - Respectful Insolence - Orac posted on a Homeopath in Arizona that had a patient die after performing liposuction on her. To make this even more interesting, the assisting physician had already had 2 patients die after lipo and his lisence had been put on probation.

This got me thinking, do people really know what homeopathy is? Or do they just blindly believe what these pseudo doctors are telling them?

Here is a great video of James Randi explaining Homeopathy and the "4 rules of homeopathy":



My favorite line when referring to a homeopathic medicine:

Has no side effects. That's true. My question is 'does it have any other effects'?

Absurdity, this is. I believe people should be able to choose how to treat their ailments. However, homeopathy is duping the desperate, fearful, and needy. Educate those who ask about the quackery that homeopathy medical treatment is.

Labels: EBM, education, Evidence, Fraud

Our friends over at Evidence in Motion posted in their blog about a gentleman that swears he has invented a machine that automates physical therapy. Called the HYDROT-pt5™, this machine:

..delivers automated alternating Hot, Neutral Zone, Cold, Intermittent Compression, and Directional Massage… back to back, through a single pad automatically.

Wow, isn't that how PT was practiced in 1980 before we realized all it did was make the patient feel better for 1 hour? Here's the machine itself:

The "inventor's" website is totally devoid, obviously, of any literature to back up his claims from a Cleburne Times-Review article that the machine is:

...capable of speeding up healing and reducing pain in less than a third of the time it normally takes...

The website does have a "Peer Review" link. However, this presents us only with testimonials. A few have "Dr." before their names, so this must warrant the "Peer" aspect of Peer Review.

As Physical Therapists, we must watch our backyards for snake oil salesman like this and educate the public and the medical community as to what real physical therapy is, and maybe more important, what it is not.

Labels: Fraud, physical therapy, treatment