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Evidence based PT a crisis in movement

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  • #16
    It's the fact that he spelled it out at all that I found refreshing.
    Yeah, that's it.
    Gloves off. Authentic saying it how he sees it.
    I saw that in Moseley's blogpost too.
    Great - keep it 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


    • #17
      I loved the line about "touching people who need touch is therapy and touching people who don't need touching is battery."

      I thought, there is something there about depth he should have mentioned. My brain was going,
      "Touching people in pain lightly and slowly, only as deeply as their nervous system wants you to, is therapy. Touching people who don't need to be dug into or their joint surfaces waggled to test ligaments or poked by needles, and still doing it, is battery."
      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


      • #18
        Anyone read the follow up articles? This one is a bit of an eye opener ...

        http://rogerkerry.wordpress.com/2013...ink-this-hard/
        Dan
        Tactile Raconteur

        Comment


        • #19
          Point being, the problem doesn't seem to be enhanced knowledge of pain, but rather poor vigilance on the part of the health care practitioner that leads to these problems.
          I agree, but I don't think that Roger Kerry argued otherwise. All he wrote is "Psycho-social dimensions are of critical importance to our reasoning and management. So is differentiating non-specific back pain from aortic aneurysm."
          -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
          The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

          Comment


          • #20
            It is possible that he is employed as an expert in fitness to practice and medicolegal cases and may have seen evidence of what does and does not happen first hand.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #21
              Originally posted by Evanthis Raftopoulos View Post
              I agree, but I don't think that Roger Kerry argued otherwise. All he wrote is "Psycho-social dimensions are of critical importance to our reasoning and management. So is differentiating non-specific back pain from aortic aneurysm."
              And obviously I agree with him on that point. Later in the essay though he would seem to suggest that our thinking has moved too far beyond the bio aspect of pain, so much that many of us have started ignoring the bio side - and that he has partly blamed the "pain scientists" (or, rather, our fawning over them) for that shift. Maybe I'm just reading into it too much, maybe Kerry works with a lot more clued up therapists than I do, but this wouldn't be the first time someone has made the suggestion that the "pendulum" has swung too far.

              I guess my eyes just tend to glaze over a bit anytime someone starts to suggest that we've moved to far away from the "bio" side of pain. I just haven't seen any evidence of that from where I'm standing.

              Side note - I don't think there is a more dualistic metaphor out there then that of a pendulum.
              Ryan Appell DPT
              @Rappell_PT

              Comment


              • #22
                Later in the essay though he would seem to suggest that our thinking has moved too far beyond the bio aspect of pain, so much that many of us have started ignoring the bio side - and that he has partly blamed the "pain scientists" (or, rather, our fawning over them) for that shift.
                I don't think so, he has shared a platform with them. It could be that he is a Brit speaking to Brits in some of his posts. He knows what is going on in our healthcare system.
                Last edited by Jo Bowyer; 01-10-2014, 09:03 AM. Reason: expansion of quote
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                Comment


                • #23
                  Originally posted by Jo Bowyer View Post
                  I don't think so, he has shared a platform with them. It could be that he is a Brit speaking to Brits in some of his posts. He knows what is going on in our healthcare system.
                  I wonder Jo,

                  I note his colleague and co-course lecturer on WAD had a fairly acerbic blog on pain science gurus.

                  It may reflect some attempt to try and keep a sense of balance and proportion and avoid an over emphasis on pain to the worse but I am not sure.

                  ANdy
                  "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

                  Comment


                  • #24
                    Arrhh, time. The average physiotherapist will, say, work an 8 hour day, seeing a patient on average every half-an-hour or so. That half-hour involves taking important information from the patient and undertaking the best physical tests (which are..?) and treatments (which are…?), then recording all of that (don’t forget the HPCP are on your back young man – a mate of a mate of someone I know got suspended last week for shoddy note-keeping. How would I pay the mortgage?). So when is that evidence read, synthesised, and applied? No worries, in-service training sessions at lunch-time will help (no lunch or toileting for me then). What about evenings and weekends – yes, lots of thinking does occur here (but what about the wife and kids). I know there is no training budget for physiotherapists, but you can do some extra on-call or private work to pay for those courses can’t you? (Yes. When?) You get annual leave don’t you? That’s another great opportunity to catch up on your thinking education (Cornwall will wait).
                    One could always read soma simple while toileting
                    Rob Willcott Physiotherapist

                    Comment


                    • #25
                      Originally posted by amacs View Post
                      I wonder Jo,

                      I note his colleague and co-course lecturer on WAD had a fairly acerbic blog on pain science gurus.

                      It may reflect some attempt to try and keep a sense of balance and proportion and avoid an over emphasis on pain to the worse but I am not sure.

                      ANdy
                      From Roger Kerry's blog post at 9.40 this morning.

                      .... I suppose the point I was trying to make is why “Pain Science” (PS) should be privileged, in a EBP context.....

                      However, generally, I think we are at a time in our scientific progression when discrete institutes are not need per se. So, there was a time when clinicians would benefit from say. The McKenzie Institute. But in an EBP world, this shouldn’t need to be the case. We have developed skills which allow us to understand and interpret data and data-summaries ourselves, and allow us to contextualise that data with our patients. So why do we need an authoritative institute?

                      Specifically, it seems like PS institute behave somewhat differently to others. PS is an alluring patch of thought and data, but it seems like the ‘institutes’ built on this are presenting the notion as some sort of general theory, confirmed with data. And doing this in an aggressive way which stifles discourse and debate............

                      If there should be institutes at all, they should be developed around broad notions of reasoning, evidence, and practice, and serve to facilitate, not terminate, debate and progress.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

                      Comment


                      • #26
                        Thanks Ryan.
                        Later in the essay though he would seem to suggest that our thinking has moved too far beyond the bio aspect of pain, so much that many of us have started ignoring the bio side - and that he has partly blamed the "pain scientists" (or, rather, our fawning over them) for that shift.
                        I’m not sure that he actually suggested or implied that many of us have gone down that road. At least it’s not clear to me. Perhaps he can further clarify in his blog. Nevertheless, all I'm reading is his opinion on things in the context of what constitutes optimal practice. It does not necessarily mean that he is right or wrong. Like with any other blogger, some things that he is saying I find more attractive and thought provoking than others.
                        -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                        The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                        Comment


                        • #27
                          Originally posted by Jo Bowyer View Post
                          Anecdote and grapevine over the last six years or so. Pain science has caught on in the UK, lectures are well attended and there is a danger in my opinion that practitioners lacking mileage could dismiss patients' claims that there must be something wrong with them, because pathology is rare.

                          We don't routinely work up MSK cases to the extent that you do in the USA and the younger generations of UK physios have less exposure to ward and clinic based experience than previous generations.

                          There has been a documented problem with UK physios missing cases of cauda equina syndrome. The lack of red flag testing and failure to manage has led to litigation. The taking and documentation of adequate case history and asking relevant questions on subsequent visits gives a better chance of timely intervention.

                          The same goes for dizzy patients, I may have a working diagnosis of visual vertigo and/or BPPV but I'm still going to keep an eye out for CNS and CVS red flags.

                          There is a reluctance to talk to patients about pathology in case it is nociceptive, it needn't be and forewarned is forearmed.
                          Jo,

                          Thank you for this observation. I share the same concerns about younger practitioners missing/dismissing patients' complaints that may be of serious pathology. There are rabbit-holes and then there are sink-holes. A clinician should learn to avoid both.

                          In the US, I've had students rotate with me and they have dismissed patient complaints that warrant referral or cautious examination. I've had last-rotation DPT students who should be versed in basic differential dx and screening of UMN miss things, a first-year DPT student try to convince me that an end-range U/c rotational manip should be first-line without even attempting to screen UMN/LMN and CVS. I've seen outright dismissal of the potential for pathology in the name of pain science. They are getting this somewhere from someone, and it's concerning. I'm with Kerry; I see the "bio" getting missed and ignored a lot; this is not to say it's everything but it is something and it matters sometimes.
                          Always learning.

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                          • #28
                            Interesting

                            More interesting

                            I admit to struggling with that connection and endorsement particularly in the light of

                            Stop inventing complex and unnecessary classification and diagnostic systems. They are not needed. Sub-classification is important, so pay attention to high quality studies which allow us to learn which interventions suit which patients. But the best systems are the simplest
                            bemused

                            ANdy
                            "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

                            Comment


                            • #29
                              Sheld,
                              I've seen outright dismissal of the potential for pathology in the name of pain science.
                              What would such a scenario be like? I'm just curious.

                              @all
                              What do you guys define as “pain science”? It seems that many of us have different definitions.
                              -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                              The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                              Comment


                              • #30
                                So, let me get this straight- the guy who's telling us that complicated classification systems are not needed is doing lectures on EBP at international conferences with someone who has developed one of the most complicated classification systems this side of the Atlantic?

                                I'm with ANdy- bemused.
                                Last edited by John W; 01-10-2014, 11:13 PM.
                                John Ware, PT
                                Fellow of the American Academy of Orthopedic Manual Physical Therapists
                                "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                                “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                                be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

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