Entering Chaos

[Kyle Ridgeway]

Great points Joe and everyone else. Definitely an intriguing concept. I felt off of my game last night, so I hope I was somewhat clear in my explanations. I think we definitely need to consider nominal vs. essential diagnoses, the actual content of the interventions we are studying (from the assessment to the "intervention"), mechanisms, expectation, and pain in general. Joe brings up some very specific methodological and interpretation issues.

In reflection my closing thought or 30,000 foot view take is this...

If CPR's and thus the TBC are taught and implemented without an eye towards mechanisms, we build an attachment to an intervention(s) on the assumption of effectiveness of the intervention itself (manipulation, "stabilization"). Personally and professionally, this poses a challenge to modifying our understanding and treatment over time. It breeds confirmation bias, where we assume an intervention works based on the proposed theory, or an assumed theory, or a name (stabilization!). And, if a study shows it "works" and it appears to work. Voila, we know have a confirmation in our mind that will be difficult to break (I introduce you to manipulation….)

Our interventions for pain always contain boatloads of non-specific effects, and rarely do we truly understand their range of mechanisms. Yet, our explanatory model and thus our clinical reasoning for utilization can be grossly wrong. But, the appearance of effectiveness may remain. Further, why would we ever think a single intervention product studied in isolation would prove to be robustly powerful in the long term clinical treatment of an individualized pain experience? That is not at all how pain nor even clinical practice works (as we currently understand it). Yes, CPR's have a place (especially predictive and diagnostic), but prescriptive? Unless that CPR is helping validate a process of care....I am skeptical.
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That's what I was trying to communicate. Emphasis on trying. Don't think my point was presented clearly enough in the moment. Trying to refine and write some more....stay tuned...

I enjoyed the discussion and it definitely has spawned some further thinking and analysis. Definitely some interesting implications and concepts on this topic.

[Kyle Ridgeway]

Eric Robertson's assertion is that we become "safer" when we follow the rules in response to careful exam.

When he said that, I am pretty sure he was referring to the CPR's to assess the need for imaging in pseudo-trauma situations to rule out occult fractures in the ankle, knee, and cervical spine. I would have to check the video though.

[Barrett Dorko]

Kyle, You're probably right.

What of his attention to cause?

Why doesn't he ever talk to us?

[advantage1]

Kory, I love your March Madness analogy. Now we have Florida Gulf Coast to add to the uncertainty.

[Barrett Dorko]

For the record, my son Alex tells me that his son, Michael, chose FGC in his bracket because "eagle" starts with an "E".

Sounds like perfectly appropriate reasoning to me, and it worked out.

Michael is not yet three.

[smith]

Wasn't sure where to put this. Yesterday, at a ceu conf. in a hospital where I live, a MD gave a talk on electrodiagonstic EMG's in sports med. I live in north Jersey. He started with a power point reading - 1% of all sport injurys are neurogic. I believe he meant structural. He then did a good talk.

At the end, I finished the Q/A part with the statement, "since all ankle injurys will have peroneal involvment, how do you differntiate it from the tendon?" None of the MD's, PT's, ATC's or chiros challenged the statement. I think the MD giving the talk liked the statement. After all, that's what he does.