gdp's Comments

http://www.physicaltherapydiagnosis.blogspot.com/ : British Physical Therapists Begin to Prescribe Medications

Tue, 31 Jul 2012 22:03:15 +0000

Tim, What do you think would happen with our liability if we gained these same rights? I don't mind the low premium rates I currently pay, but I would expect if I began prescribing, these rights would rise significantly. I doubt our professions current subpar reimbursements and pay could substantiate these rises.

My Physical Therapy Space : Translating Evidence and Restructuring Clinical Implementation

Wed, 11 Jul 2012 02:06:21 +0000

Great reply Frank!!! Thumbs up. Make your way over to www.forwardthinkingpt.com and www.somasimple.com . We are trying to do this....

My Physical Therapy Space : Translating Evidence and Restructuring Clinical Implementation

Tue, 10 Jul 2012 01:12:03 +0000

I like how you're thinkin Selena...

My Physical Therapy Space : What Does Direct Access Mean?

Fri, 27 Apr 2012 14:25:53 +0000

Great response Chris. In this statement, I believe it is vital that we must differentiate that we are not replacing the primary care physician (the chiros have taken this route http://www.sciencebasedmedicine.org/index.php/chi... ). We simply need to identify ourselves to the public that we are the practitioner of choice for direct consultation for suspected neuromusculoskeletal conditions. We need to deliver a direct message to the public identifying us as more than an ancillary interventialist. Research has indicated that we do a good job of medical screening, recognizing a musculoskeletal diagnosis and treating that condition in a reasonable amount of time. We simply need to have a push to spread the word. I hope that #solvept will be a start for this movement.

My Physical Therapy Space : The Future of Physical Therapists is Bright

Tue, 17 Apr 2012 21:17:24 +0000

My concern is that a medical professional has provided an intervention on national television TWICE without any mention of a formal examination or assessment. I am not sure what the standards of practice are before one performs an adjustment, but I do know that physical therapists are expected to perform an examination and assessment, rule out red flags, etc. before we perform a thrust (if necessary). The same procedure before a medical doctor prescribes a medication. I am not aware, but did this chiropractor perform within the normative standards of chiropractic practice?

My Physical Therapy Space : The Future of Physical Therapists is Bright

Tue, 17 Apr 2012 01:02:00 +0000

JS, Please watch the video and tell me the timeframe at which he said he said this. I would slam an MD the same way if he gave a patient medications on the air without at least acknowledging they were formally assessed. I would slam a PT the same way if they performed mobilizations, a thrust or any potentially harmful interventions without assessment. This intervention was provided without any support.

My Physical Therapy Space : The Future of Physical Therapists is Bright

Mon, 16 Apr 2012 23:41:04 +0000

Ed, The video is linked in this thread...The patient was selected out of the audience and there was no mention of examination by Oz or the chiro. This was not stated anywhere in this video, or a prior tv appearance by the duo a month earlier in which they presented in the same fashion. You can watch on my site: www.forwardthinkingpt.com If you still believe that there was a mention of examination or assessment, please let me know and I will stand corrected.

My Physical Therapy Space : The Future of Physical Therapists is Bright

Sun, 15 Apr 2012 19:20:47 +0000

John, I also posted this garbage on my page ( http://forwardthinkingpt.com/2012/04/13/dr-oz-is-... ) There are actually 2 different videos in which the all and powerful "Oz" and this chiro perform adjustments without any formal examination or assessment. I find this quite alarming and quite negligent (especially in an individual with self reports of a history of back pain). On my website, I made the comment that what if Dr. Oz gave this individual prescribed medications without any formal exam or assessment. Would the AMA condone this behavior? Would this be safe? At minimum, there are red flags which must be screened before a manip is performed. This chiro also makes the statement, "Chiropractic looks for the root of the problem." I personally did not see him looking at anything prior to providing this intervention. I believe a formal retraction by Oz is appropriate and the ACA needs to have a talk with this chiro who is publicly manipulating without assessment (Im coining this as MWA) on national television.

My Physical Therapy Space : Physical Therapy Myths De-bunked – Part 2

Wed, 21 Mar 2012 10:28:22 +0000

Jay, Why do some patients continue to have pain following a total knee or hip replacement? The joint has been cut out and replaced...and the metal/plastic prosthesis has no neural innervation. There was an article in the Journal of Pain last year that examined this. The authors found that expectations of pain relief and pain catastrophic thoughts pre-surgically predicted 1-year post surgical outcomes. So, I would argue that if the patient "thinks" the surgery will be effective, it will be effective. If the patient has doubt or has psychological variables such as pain catastrophizing, kinesiophobia, etc. they are more prone to having prolonged symptoms. I do not disagree that osteoarthritis is a contributory variable. I do disagree that it is the only variable that needs to be treated. And it appears that most surgeons only focus on one variable.

My Physical Therapy Space : Physical Therapy Myths De-bunked – Part 2

Wed, 21 Mar 2012 03:23:58 +0000

Nice follow up, John. As a profession, I think it's important that we critically re-examine what we know to be true, what we think to be true, and what we wish was true. Unfortunately, some of the techniques we were taught have been invalidated. We may wish they were still truths, because we spent alot of time (and money) trying to learn and perfect them, but sometimes we must just let go. I can understand hesitancy and resistance, but when an overwhelming amount of well-designed studies tell us something, we cannot ignore it. I see alot of debate occuring in two major PT realms: Manual Therapy (the biomechanics vs. neurophysiology debate) and Education (the biomedical vs. biopsychosocial model debate). In this, we must understand that our brain is wired to disagree when presented with two sets of conflicting information. This is a natural response and the job of the anterior cingulate cortex, but we must all continue to work hard to attempt understand these new concepts because they will ultimately result in better practice patterns for our patients.

My Physical Therapy Space : Health Care Recruiter Spam

Sun, 11 Mar 2012 13:08:27 +0000

Maybe you could get some tips on how to respond to the phone calls from Jim Florentine: http://www.youtube.com/watch?v=2dy9lUJJGqI

My Physical Therapy Space : Conventional Wisdom Debunked

Thu, 23 Feb 2012 14:41:53 +0000

We look at what we do know to be true and restructure what we do to be evidence-based...Despite having alot of things which have little to no evidence to support, we have alot of things that have significant evidence to support...We simply quit "beating around the bush", accept our limitations, and this will strengthen our overall practice... We don't need alot of "tricks" to be effective clinicians...

My Physical Therapy Space : Conventional Wisdom Debunked

Mon, 20 Feb 2012 19:41:48 +0000

Myths: 1. Abnormal biomechanics = pain 2. Bad weather = pain 3. We can reliably differentiate which type of tissue is causing our patients pain 4. We can reliably (inter-) determine endfeels and hyper/hypo-mobility 5. Ultrasound does anything 6. Cold laser does anything 7. We can isolate segments with grade 5 thrust manipulations 8. We can reliably determine vertebral rotations or an abnormally positioned SIJ through palpation and movement testing 9. The VBI test tells us reliable information about the vertebral artery 10. No pain, no gain

My Physical Therapy Space : Expanding on the Idea of Quality

Mon, 20 Feb 2012 02:00:55 +0000

Thanks Selena but I did mean "no" in that reply. The biopsychosocial model takes into account anatomical, psychological and social variables....the biomechanical/biomedical model does not consider the ladder 2....So we should toss out the one model that excludes, and follow the one model that includes... Again, great article! If anyone is interested in reading more about this subject, Dr. Joel Bialosky out of the University of Florida studies placebo and the effects of expectations on outcomes...and he states we should always maximize expectations and placebo bc of the large effect they have on what we do (or what we think we do)

My Physical Therapy Space : Expanding on the Idea of Quality

Sun, 19 Feb 2012 20:08:56 +0000

"Don't you think it would be hazardous to toss out the biomechanical model?" - No. That stated, the biopsychosocial model still takes into consideration anatomy and biomechanics...but also attempts to tackle the psychological and social components which comes into play with all injuries...The biopsychosocial model incorporates what we already do with a greater appreciation for other variables which may confound or contribute to outcomes

My Physical Therapy Space : Spinal Fusion Rates Continue to Climb

Sat, 4 Feb 2012 19:03:58 +0000

" there is NO test available today that tests for MYOFASCIAL RESTRICTIONS, which a growing number of medical professionals today believe is the real cause of joint pain, including spinal joint pain" "The most effective treatment for back pain, or any other joint pain, that I have ever seen is JOHN BARNES' version of MYOFASCIAL RELEASE ("Barnes' MFR" for short), which can only be provided by a Barnes' trained Physical Therapist, or other 'licensed to touch' therapist" I am not one of these people and can confidently state there is NO available scientific evidence to support your claims...

My Physical Therapy Space : Spinal Fusion Rates Continue to Climb

Fri, 3 Feb 2012 20:25:53 +0000

I think that we agree to an extent (maybe because I am also in PA). Here are my thoughts: I believe it could be speculated that a combination of the thriving biomedical model as well as extensive reimbursements are driving these statistics. If pain was approached through a biopsychosocial model, the surgeon would not only take into account the abnormalities found on imaging, but also the social context in which the individual experiences pain, the patients level of kinesiophobia, pain catastrophizing, etc. and would likely opt for more conservative measures (PT, pain psychology, etc). The biomedical model teaches them that the mechanical/structural deficit needs to be fixed to inhibit pain---and despite literature leading us away from this approach, the current model of education in US medical institutions (as well as PT institutions) are leading them to continue to treat this way. There is a high degree of liability with spinal fusions, so when performed, I have no issue with the reimbursement being much more than mine. I also think the majority of spinal surgeons are ethical individuals but their understanding of why someone hurts is not current. I think that if medical students are instructed from a different model of care from the beginning of their education, these rates would most definately drop.

My Physical Therapy Space : Spinal Fusion Rates Continue to Climb

Thu, 2 Feb 2012 20:56:51 +0000

Do you think this increased rate could be associated with the lack of a current understanding of pain neuroscience by both the clinician and patient? I would suspect that the current biomedical model has a large influence over what the surgeon suspects are causing the symptoms, and the patient has low expectations for the effectiveness of non-surgical treatments because their "discs have degenerated"---this just sounds horrific and debilitating. Do you suppose if surgeons use Adrienne Loews pain education piece, these rates may drop? I myself would def. think the individual may think twice...

My Physical Therapy Space : The Pain Game

Tue, 24 Jan 2012 03:12:25 +0000

" I am not sure why you perceive that I am so different (and thus wrong) when compared to you?" The only thing that I questioned you about in your patient's care is dry needling and your reasoning to support dry needling. I feel this was a legitimate discussion due to the reliability issues regarding the detection of trigger points. Writing on an issue such as this makes you subject to questioning in regards to the literature and science behind it . Anytime I blog I also open myself up for the same level of criticism and critique. I am sure you are a fine clinician. I only questioned one intervention and the science behind it. I would argue that the benefit of "maturity, life experience, continuing education experience" makes you a better clinician. I appreciate that clinical experience can help you with inductive reasoning but I work with many clinicians with much more clinical experience than myself who treat every patient with ultrasound and hamstring stretching. I have also taken fourteen continuing education courses since my graduation and have been disappointed by the outdated and unscientific nature of some of the content in these courses (I would say the Maitland courses by MAPs have been the best). There are good and bad courses which can help mold a career. I also read 4-5 articles a day and am involved in several clinical research projects, but does this make me a better clinician than you because I do and you may not? No. We simply have different variables which lead to our ability to make sound clinical reasoning. It is vital that PTs discuss these topics and continue to question the science behind what we do. We are all on the same team, and because of this, we must continue to search for truth. I hope that we can all continue to work together to improve the PT profession's ability to understand why people hurt and how to make them not hurt. But we can't continue to beat around the bush--- We can start encouraging change by signing the petition below. It doesn't sign itself and we need all the support we can get to garner attention : http://www.change.org/petitions/capte-to-ensure-t...

My Physical Therapy Space : The Pain Game

Mon, 23 Jan 2012 21:35:43 +0000

This editorial by Moseley coincides well with this discussion... http://cdns.bodyinmind.org/wp-content/uploads/Mos...