Entering Chaos

[nickmPT]

I haven't even worked for a paycheck yet (not that that it is all about) and you are telling me my profession is going the way of the dodo.

What do I and the other young therapists need to do (besides treating our patients on the premises of the latest neurosciences)? Petition the APTA? Perform in-services for our fellow colleagues? Let us come up with solutions.

I understand the need for angst and venting, it can be very therapeutic. But let us channel it towards a productive form of action. Or is this all a pipe dream?

[Barrett Dorko]

I think it's a pipe dream because I've yet to actually work with a therapist willing to study here.

Maybe there's already a split - and the chasm is in between. What we need, I guess, is a real incentive to cross it.

So far, I can't think of one that might interest those on the other side.

[caro]

This belongs here. Fantastic.

[Barrett Dorko]

Carol Lynn,

I wrote a comment on the blog this AM. Wonderful discussion, including the song lyric at the end and Joe's interpretation of the comment by Eric.

[Randy Dixon]

Simply that CPRs were invented to predict even further that which couldn't be predicted in the first place.

The problems inherent to prediction in a chaotic system is what's being denied.

I read a book once (no, that does not mean I've only read one book) which I think is called "Chaos", in it the author talks about weather prediction, and how even if we were to place 1-cubic. inch sensors in every cubic foot of land on air that would be 1727 cu. inches that we would not have any data on, and there is no computer on earth that could model even 1 mile of the data that is provided. In other words, complex systems are by the nature of their complexity, unpredictable. The more precise the prediction attempts to be, the less accurate it it must be. Humans are pretty complex.

[caro]

Indeed Barrett. I posted the talk and your essay to my FB wall.

Hats off to Joe for making this possible.

[Barrett Dorko]

You're right Randy. The computers themselves have predicted that prediction of some things is impossible.

At least, for now.

[zimney3pt]

Great time for this thread considering it is during March Madness...my bracket already shows that some things are impossible to predict - Go Harvard!!!!!!!!!!!

[joebrence9]

So when I do PTTV discussions, my objective is keep a discussion going amongst practitioners, but not to inject too much of my own personal beliefs or understanding.

Here is my beef with the prescriptive CPRs:
1. Little to no follow up studies or validation of the rules.
2. Some lack face validity (IMHO). For example, the lumbar stabilization CPR includes the prone instability test (which at face, tells me very little. It has not been validated as an individual test and it relys on the belief that instability results in pain---its a provocation test at best) and "abarrent movement". Every patient with LBP has some form of abarrent movement (is this a valid measure of instability?)
3. The CPRs are only as good as the outcome tools which are used to determine a "successful outcome". For example, the CPR for lumbar manipulation is designed to predict a 1 week, 50% improvement on an Oswestry. Most manual therapists can recite the criteria for this CPR, but can any of them tell us what it predicts (do you guys know)? This is concept is often "lost". So remember this: the lumbar manipulation CPR predicts, that when the variables in the rule are present, an individual has a 95% chance of getting a 1 week, 50% improvement on an Oswestry. We are not talking about a long term improvement in low back "pain". We are talking about a perception of "disability". Important distinction.
4. They ignore the "patient response". Lets think about this. It is an operational mode of practicing. You fit the rule and "Im going to do this to you...".

This stated, I am very grateful that Eric and Kyle both added to this discussion. I plan to continue with these and am really excited about next months talk. Will disclose soon as we get folks on board.

[Barrett Dorko]

As I predicted (I'm being ironic here), the CPRs grew from the notion, perhaps a preference, that the body's reaction to method is linear and predictable. At least to some percent.

Eric Robertson's assertion is that we become "safer" when we follow the rules in response to careful exam. I think we become safer when we practice conservatively, that is to say, in a potentially harmless manner. This isn't always easy, and it has little to do with the use of CPRs.

I also heard Eric use the word cause.

Big mistake.

[nickmPT]

Again, I think we need to become more 'therapist' than 'physical.'

Would a talk therapist tell a patient, "I am going to do this to you to help alleviate the mental problems you have." I don't think so.

So should we as Physical Therapists say the same thing to a patient?

[zimney3pt]

Just to stick with the March Madness idea there is this article.

FRIDAY, March 22 (HealthDay News) -- Many sports gamblers consider their extensive betting experience and insight into college basketball a slam-dunk for success during the three-week U.S. championship dubbed "March Madness." But that sense of control over their wagers is an illusion, according to a new study.

"Sports gamblers seem to believe themselves the cleverest of all gamblers," Professor Pinhas Dannon, of Tel Aviv University in Israel, said in a university news release. "They think that with experience and knowledge -- such as players' statistics, managers' habits, weather conditions and stadium capacity -- they can predict the outcome of a game better than the average person."

Dannon and a colleague found, however, that these gamblers have no advantage.

Let reword it a little and see if sounds familiar:

FRIDAY, March 22 (HealthDay News) -- Many therapist consider their extensive patient experience and insight into the human body a slam-dunk for success during the treatment intervention dubbed "March Madness." But that sense of control over their treatment is an illusion, according to a new study.

"Biomechanical therapist seem to believe themselves the cleverest of all therapists," Professor Pinhas Dannon, of Tel Aviv University in Israel, said in a university news release. "They think that with experience and knowledge -- such as biomechanics, fascia, posture and muscle imbalances -- they can predict the outcome of a treatment better than the average person."

Dannon and a colleague found, however, that these therapist have no advantage.

[nickmPT]

I always found my uncertainty with telling a patient why they are having said pain and the excuses I gave them troubling. Oh your shoulder hurts? That is because your rotator cuff is weak, your scapular stabilizers are weak, your joint capsule is tight. I wish I had stumbled across this website and the neuromatrix sooner, I would have embraced this uncertainty far sooner and I believe my patients would have benefited far better.

[zimney3pt]

I always found my uncertainty with telling a patient why they are having said pain and the excuses I gave them troubling. Oh your shoulder hurts? That is because your rotator cuff is weak, your scapular stabilizers are weak, your joint capsule is tight. I wish I had stumbled across this website and the neuromatrix sooner, I would have embraced this uncertainty far sooner and I believe my patients would have benefited far better.

The good thing is that you have found this website and understanding of the neuromatrix (which puts you ahead of 99% of your colleagues) and your patients in the future will benefit far better.

Welcome to being a deadman.

[nickmPT]

My buddy in the PT program (who shared a lot of the skepticism I had) always joked he was going to PA school after all of this.

He was only half kidding.