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  • Ref Physical Therapy and non-specific effects.

    Let's get serious about this. A very nice breadcrumb trail exists, right in our own profession, and I want to fan it.

    Check out the following:

    1. Amanda M. Hall*, Paulo H. Ferreira, Christopher G. Maher, Jane Latimer and Manuela L. Ferreira; The Influence of the Therapist-Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Physical Therapy August 2010 vol. 90 no. 8 1099-1110 Full access.

    2. Maxi Miciak BScPT (PhD Student)**, Douglas P. Gross PhD (Associate Professor), Anthony Joyce PhD (Professor); A review of the psychotherapeutic ‘common factors’ model and its application in physical therapy: the need to consider general effects in physical therapy practice. Scandinavian Journal of Caring Sciences Volume 26, Issue 2, pages 394–403, June 2012
    This article explores the common factors model of psychotherapeutic intervention and discusses its relevance for physical therapy practice. The model provides an explanation for why the effects associated with specific technical approaches only minimally explain successful psychotherapy clinical outcomes. It postulates that factors common across diverse interventions (i.e. ‘nonspecific’ mechanisms) are responsible for a larger component of treatment efficacy. We outline the applicability of the common factors model to physical therapy and provide supportive evidence from evaluation and prognostic research on interventions for conditions seen in musculoskeletal physical therapy practice. The relevancy and consequences of applying the common factors model to physical therapy practice and research are discussed. The continued advance and evolution of the physical therapy profession requires creative and comprehensive analysis of all factors impacting clinical effectiveness. Additional research is needed to more clearly delineate the common factors that are operational in physical therapy practice and to measure their relative impact on clinical outcomes.
    3. Gebhard B, Relevance of Common Factors in Physical Therapy: A Qualitative Analysis, a poster presentation.

    References from the poster presentation:
    Frank J D, Frank J B. Persuasion and healing: A comparative study of psychotherapy. Baltimore, MD: Johns Hopkins
    University; 1991 (3rd ed.).
    Gibbs G R. Analyzing qualitative Data. Sage Publications, London, UK, 2007 (1st ed.).
    Grencavage L, Norcross J C. Where Are the Commonalities Among the Therapeutic Common Factors? Professional Psychology: Research and Practice 1990; 21: 372-378.
    *Hall A M, Ferreira P H, Maher C G, Latimer J, Ferreira M L. The Influence of the Therapist-Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Physical Therapy 2010; 90: 1099-1110.
    Mayring P. Qualitative Inhaltsanalyse, Beltz, Weinheim, 2010 (11st ed.).
    **Miciak M, Gross D P, Joyce A A. Review of the psychotherapeutic ‘common factors’ model and its application in physical
    therapy: the need to consider general effects in physical therapy practice. Scan J Caring Sci 2011; doi: 10.1111/j.1471-
    6712.2011.00923.x.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
    HumanAntiGravitySuit blog
    Neurotonics PT Teamblog
    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
    Canadian Physiotherapy Association Pain Science Division Facebook page
    @PainPhysiosCan
    WCPT PhysiotherapyPainNetwork on Facebook
    @WCPTPTPN
    Neuroscience and Pain Science for Manual PTs Facebook page

    @dfjpt
    SomaSimple on Facebook
    @somasimple

    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

  • #2
    I blogged about Miciak, recently: Deep versus shallow models of treatment
    She saw the post and came by to make a comment.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
    HumanAntiGravitySuit blog
    Neurotonics PT Teamblog
    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
    Canadian Physiotherapy Association Pain Science Division Facebook page
    @PainPhysiosCan
    WCPT PhysiotherapyPainNetwork on Facebook
    @WCPTPTPN
    Neuroscience and Pain Science for Manual PTs Facebook page

    @dfjpt
    SomaSimple on Facebook
    @somasimple

    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

    Comment


    • #3
      Diane,

      The longer I practice (15 years of uninterupted clinical care ONLY...as in no administrative side bars), the more patients I see (average 15 per day)...the more convinced I am that the profession is going to have to wrap it's head around these issues.

      We have to work within these realities not avoid them.

      Frankly, I think it's the way forward and I feel good quality Phyiotherapy care (better than the current out-dated biomechanical model) exists within these realities.

      Comment


      • #4
        I agree, proud. It's what happens anyway. All the science points right at this. All the inconclusive, poor inter-rater reliability testing, all the pain science, everything. I would like the profession to catch up to the reality, reframe itself just a bit. To itself, at least. To the students that enter it. "We help people. We help their nervous systems. Here's how."
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

        Comment


        • #5
          Here is a nice little news item about exercise and knee osteoarthritis. Factors impacting benefit of exercise in knee OA identified.

          It discusses this paper: Associations for change in physical and psychological factors and treatment response following exercise in knee osteoarthritis: An exploratory study

          The researchers found that, after adjustment, the only two factors that were significantly associated with treatment response were
          1. change in self-reported knee instability
          2. fear of physical activity
          :thumbs_up
          Diane
          www.dermoneuromodulation.com
          SensibleSolutionsPhysiotherapy
          HumanAntiGravitySuit blog
          Neurotonics PT Teamblog
          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
          Canadian Physiotherapy Association Pain Science Division Facebook page
          @PainPhysiosCan
          WCPT PhysiotherapyPainNetwork on Facebook
          @WCPTPTPN
          Neuroscience and Pain Science for Manual PTs Facebook page

          @dfjpt
          SomaSimple on Facebook
          @somasimple

          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

          Comment


          • #6
            I like the weekends. I come here. I see new papers. I go to work on Monday with a little skip in my step. Thank you :thumbs_up
            "Whereof one cannot speak, thereof one must be silent." ("Wovon man nicht sprechen kann, darüber muss man schweigen.“) Tractatus Logico-Philosophicus Ludwig Wittgenstein
            Question your tea spoons. Georges Perec

            Comment


            • #7
              Me too. Thumbs up!

              Comment


              • #8
                Yup, it's like a gas station for the mind!
                Frédéric Wellens, pht
                «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                «
                Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                »
                Friedrich Nietzsche
                www.physioaxis.ca
                chroniquesdedouleur blog

                Comment


                • #9
                  Originally posted by Frédéric View Post
                  Yup, it's like a gas station for the mind!
                  I'd like to agree, but sometimes I feel like that gas station is further and further away!

                  Comment


                  • #10
                    Hi PCollinsDPT, welcome to SS. Check out the Welcome forum, start a thread there to introduce yourself. :angel:
                    Diane
                    www.dermoneuromodulation.com
                    SensibleSolutionsPhysiotherapy
                    HumanAntiGravitySuit blog
                    Neurotonics PT Teamblog
                    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                    Canadian Physiotherapy Association Pain Science Division Facebook page
                    @PainPhysiosCan
                    WCPT PhysiotherapyPainNetwork on Facebook
                    @WCPTPTPN
                    Neuroscience and Pain Science for Manual PTs Facebook page

                    @dfjpt
                    SomaSimple on Facebook
                    @somasimple

                    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                    Comment


                    • #11
                      The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain
                      Abstract

                      Background The impact of the relationship (therapeutic alliance) between patients and physical therapists on treatment outcome in the rehabilitation of chronic low back pain (LBP) has not been previously investigated.

                      Objective To investigate whether the therapeutic alliance between physical therapists and chronic LBP patients predicts clinical outcomes.

                      Design Retrospective observational study nested within a randomized controlled trial.

                      Methods 182 patients with chronic LBP who volunteered for a randomized controlled trial that compared the efficacy of exercises and spinal manipulative therapy rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session. The primary outcomes of function, global perceived effect of treatment, pain, and disability were assessed before and after 8 weeks of treatment. Linear regression models were used to investigate if the alliance was a predictor of outcome or moderated the effect of treatment.

                      Results The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome. The therapeutic alliance moderated the effect of treatment on global perceived effect for two of three treatment contrasts (general exercise vs motor control exercise, spinal manipulative therapy vs motor control exercise). There was no treatment effect modification when outcome was measured with function, pain and disability measures.

                      Limitations Therapeutic alliance was measured at the second treatment session and it is likely to bias the interaction during initial stages of treatment. Data analysis was restricted to primary outcomes at 8 weeks.

                      Conclusions Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP. Future research should investigate the factors explaining this relationship and the impact of training interventions aimed at optimizing the alliance.
                      LINK
                      Diane
                      www.dermoneuromodulation.com
                      SensibleSolutionsPhysiotherapy
                      HumanAntiGravitySuit blog
                      Neurotonics PT Teamblog
                      Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                      Canadian Physiotherapy Association Pain Science Division Facebook page
                      @PainPhysiosCan
                      WCPT PhysiotherapyPainNetwork on Facebook
                      @WCPTPTPN
                      Neuroscience and Pain Science for Manual PTs Facebook page

                      @dfjpt
                      SomaSimple on Facebook
                      @somasimple

                      "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                      “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                      “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                      "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                      "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                      Comment


                      • #12
                        Who would have known my deep-seeded love of psychology would help me as much as it does.

                        Honestly I didn't when I began to pursue this career path. I find there is a constant (but lessening) battle of my natural instincts and those "things" that we're pounded into my head for years.

                        I much rather perform instincts.

                        Comment


                        • #13
                          This maybe should go into a different thread, but, considering that PTs are going to be licensed to do injecting, maybe here is fine: Expensive Arthritis Treatment No Better Than Steroid Therapy

                          A randomized, double-blind clinical trial by researchers at Hospital for Special Surgery has revealed that corticosteroids are more effective than the more expensive treatment, hylan G-F 20 (Synvisc One, Genzyme Biosurgery), in providing pain relief to patients with thumb arthritis. The study also showed that both of these commonly used treatments provided clinically meaningful pain relief, but so did a placebo injection.
                          Diane
                          www.dermoneuromodulation.com
                          SensibleSolutionsPhysiotherapy
                          HumanAntiGravitySuit blog
                          Neurotonics PT Teamblog
                          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                          Canadian Physiotherapy Association Pain Science Division Facebook page
                          @PainPhysiosCan
                          WCPT PhysiotherapyPainNetwork on Facebook
                          @WCPTPTPN
                          Neuroscience and Pain Science for Manual PTs Facebook page

                          @dfjpt
                          SomaSimple on Facebook
                          @somasimple

                          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                          Comment


                          • #14
                            I'm putting this link to the video about sham knee surgery into this thread.
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                            Comment


                            • #15
                              Here is a write-up about the study.
                              Diane
                              www.dermoneuromodulation.com
                              SensibleSolutionsPhysiotherapy
                              HumanAntiGravitySuit blog
                              Neurotonics PT Teamblog
                              Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                              Canadian Physiotherapy Association Pain Science Division Facebook page
                              @PainPhysiosCan
                              WCPT PhysiotherapyPainNetwork on Facebook
                              @WCPTPTPN
                              Neuroscience and Pain Science for Manual PTs Facebook page

                              @dfjpt
                              SomaSimple on Facebook
                              @somasimple

                              "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                              “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                              “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                              "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                              "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                              Comment

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