Announcement

Collapse
No announcement yet.

Evidence based PT a crisis in movement

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #61
    For someone who seems so tin-eared when it comes to politics, Kerry certainly seems to have no trouble exploiting a political position to increase his profile while at the same time criticizing others for doing the same thing. Neither clever or amusing in my opinion.
    I have only met him once and talked to him briefly, I found him courteous and modest. I don't think he needs to exploit a political position in order to increase his profile, he's doing fine. Imo he was irritated and wrote about it much as we do here and it has created ripples. Job done.

    Jo, who are "they" that you're referring to?
    They know who they are and if I ever meet any of them again, I'll have my £22 back.
    Last edited by Jo Bowyer; 02-10-2014, 05:40 PM.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

    Comment


    • #62
      Jo,
      I think anytime that there's a push for change in an entire profession that opportunists will glom on in order to raise their profile and improve their cash flow. This is inevitable. But I don't think it's fair to broad brush the effort to advance PTs' understanding of the neurophysiology relevant to the pain experience as "guruism".

      I think Evanthis poses a good question when he asks people to define what they mean by "pain science". It seems there are those who equate this effort with simply screening for yellow flags and then having a nice talk with patients. Sheld's case example of the guy with the undiagnosed spinal fracture where the interview reached the point where it was discovered that he was having relationship problems with his girlfriend is a striking example of how a superficial understanding of the biopsychosocial model can lead to misadventure in the clinic.

      As proud mentioned earlier- learning this stuff is hard. It takes a lot of time and study. Not only that, much of what was learned in school needs to be unlearned. This is no small task and creates a lot of cognitive dissonance that is very uncomfortable and difficult to overcome.

      Smart people can experience cognitive dissonance, too. Maybe this rant by Kerry is an example of that.
      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

      Comment


      • #63
        I am trying to convey better what I didn't like about the piece. See to me, he mixed up too many things and ended up dedicating the largest paragraph poo poo'ing pain science as if it represents an actual treatment approach.

        Kind of like how the McKenzie folks don't do PIVM's and PAIVMs and the black belt ortho folks don't look for directional preference patterns.

        It isn't that.

        All science should be is a foundation from which to build our treatment approaches. In other words, start with the most accurate principles and measure our approaches against it.

        As things stand now, we work backwards. We develop crazy ideas and then try to validate them in any way possible (see TDN for our mots recent example).

        I just got the sense he doesn't understand that and his message definately conveyed that to me (particularily when he oddly shoved in the missed aortic aneurysm within the pain science paragraph).

        Comment


        • #64
          Originally posted by John W View Post
          Jo,
          I think anytime that there's a push for change in an entire profession that opportunists will glom on in order to raise their profile and improve their cash flow. This is inevitable. But I don't think it's fair to broad brush the effort to advance PTs' understanding of the neurophysiology relevant to the pain experience as "guruism".

          I think Evanthis poses a good question when he asks people to define what they mean by "pain science". It seems there are those who equate this effort with simply screening for yellow flags and then having a nice talk with patients. Sheld's case example of the guy with the undiagnosed spinal fracture where the interview reached the point where it was discovered that he was having relationship problems with his girlfriend is a striking example of how a superficial understanding of the biopsychosocial model can lead to misadventure in the clinic.

          As proud mentioned earlier- learning this stuff is hard. It takes a lot of time and study. Not only that, much of what was learned in school needs to be unlearned. This is no small task and creates a lot of cognitive dissonance that is very uncomfortable and difficult to overcome.

          Smart people can experience cognitive dissonance, too. Maybe this rant by Kerry is an example of that.
          Literally just had this exact discussion with a co-worker. We were discussing the role of a chiro in caring for the painful patient when the argument was that they are great at re-aligning patients with vertebrae out of place. My response was "why does that need to be fixed in the first place?" Who can know that the problem is the vertebral body and not sixty other contributing factors? I think there is some progress in the movement of incorporating pain science, but at this pace I feel like it will be 15 years before the neuromatrix is even mentioned in PT school. And even longer before other practitioners embrace the idea in their practice. This stuff is hard to learn, but so damn easy to implement. And I don't feel like I am lying to myself and my patients.
          Michael Heinrich DPT.

          My opinions and statements on this site are not a reflection of the Department of Veterans Affairs or the Federal government.

          Comment


          • #65
            I agree proud. This was poorly written and often misses the point.

            Saying the profession has things "backwards" is exactly how I see it. Diane's "looking through the wrong end of the telescope" is related here and Jan Dommerholt's objection to E.O. Wilson's ideas reported by me years ago is an exemplar of this thinking, such as it is.
            Barrett L. Dorko

            Comment


            • #66
              Originally posted by John W View Post

              As proud mentioned earlier- learning this stuff is hard. It takes a lot of time and study. Not only that, much of what was learned in school needs to be unlearned. This is no small task and creates a lot of cognitive dissonance that is very uncomfortable and difficult to overcome.

              Smart people can experience cognitive dissonance, too. Maybe this rant by Kerry is an example of that.
              It's fantastically hard, especially as what we are dealing with is someone else's 3D projection.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

              Comment


              • #67
                Just some thoughts:

                I think the broad, vague-ish brushstroke referring to "institutes" of pain science was a bit confusing - but I think I generally understand where he was coming from. I took it to mean that listening to someone talk about research and evidence is no replacement for actually taking the time to read it yourself and apply your own critical thinking to it. Nothing really new here, but a valid point regardless.

                Of course that's a problem in a profession that doesn't like to read, so it's likely that institutes and organizations of the most relevant science to what we do will continue to persist. And they should for that very reason.

                Sometimes I wonder if debates like this actually reflect a weakness in the BPS model itself. We still don't know how all the different domains interact with each other, we still don't have a reliably predictable way to determine how or when pain will emerge (although this is improving). We still tend to look at pain as a "thing", so these discussions tend to get caught up in each side arguing for others to pay more attention to whatever their favorite input domain into the neuromatrix is. I think that is the main problem with Kerry's point about abandoning a biomedical model - it doesn't actually advance the discussion or even touch on the main limitations of the BPS model. Instead it distracts from it by suggesting that "pain science" and "general theories of the world" have shifted the emphasis too far to the psychosocial side. Kerry is a smart guy, he has to know that the biomedical side of things is still important in a BPS model.

                It's like Quintner and Cohen said in that 2008 paper, the BPS model still fails to transcend bio-medical reductionism in this respect. I have read that paper several times now, it starting to make more sense to me. The problem with this point in Kerry's piece is that I don't think it addresses this.
                Ryan Appell DPT
                @Rappell_PT

                Comment


                • #68
                  Well worth the read and the article from which Roger drew inspiration.

                  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


                  • #69
                    Originally posted by Jo Bowyer View Post
                    Many here seem to think that Eyal Lederman is OK marketing the material he does.
                    point taken Jo ...

                    I think that Eyals writing and the approaches he takes are excellent but I dont agree with some of the other course running alongside this ..however this is what pays and all these courses fill up (the more integated ones not so much) ........I can't comment thats what seems to pay the bills ?
                    Like you I stay out of it all and I know your ethics are strong in the direction you want to practice --as a result you probably earn a great deal less than you could .........?
                    I agree with Ian that some of his stuff is of great value but much of the junk that he perpetuates via the CPDO website is just that - junk. It is not, in my opinion, to his credit whatsoever. I struggle to see how he squares his stance and his recent appearance at the ISPI conference with that.

                    Not that he would give a monkeys uncle about what I would think and he is a far cleverer man than I .



                    ANdy
                    Last edited by amacs; 02-10-2014, 09:20 PM.
                    "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


                    • #70
                      yes a great read ANdy …I sent it on to the boss and those responsible for the latest pathway developments …absolutely no interest as it challenges the logical algorithms based on mostly flawed RCT's …. which no one has any interest in challenging ?

                      Anyone care to offer credible RCT evidence to guide me how I should proceed with a man with kyphoscoliois /tense hypersensitive left sided paraspinal muscles who has ongoing but v low grade Rh , lives alone is isolated , finds it difficult to do his shirt buttons up has difficulty walking on occasion ? ( I massaged his back muscles in side lying , gave him a new stick that was more suitable , talked about his car /seating and helped him dress more easily….)

                      A youngish guy with left sided back pain , vague arm pain who has been screened for cardiac , Rh, x ray and other things --real reason he sits all day all week at a job he doesn't like …again massage , advice about role of aerobic exercise to dissipate and manage his life stresses …

                      A pt with 20 pages of notes who was thinking of going for private golfers/elbow tendon releases who wanted computerised traction as she had it in another country amongst acu/chiro/physio etc etc …masses of intervention assessments telephone consultations with hospital ….real reason chronic hypersensivity +anxiety now living alone in a big house alone and a head full of nocebo information and prior 'treatments'….nil on exam other than usual staccato rapid speech pattern , coldness and rock hard trapezius muscles ….
                      Another guy frozen shoulders…. going through separation , angry ++ went to private physio tool scraping stuff on hypersensitive muscles in bed for a day after this …nil on exam other than co/contraction and minor avoidance behaviour …. simple mobilisation (harmonic technique to reduce co contraction of stabilising muscles- advice to swim and do aerobic stuff )… This selection was in a couple of hours this afternoon …….Only one person had any defined mechanism of injury and she was off needlessly from work for a month with poor coping (due to misinformation management after a serious lat ligament injury )……
                      We are trying to slot the above caseload into categories /compartments and approaches which make little to no sense and many of the approaches are iatrogenic ..probably mine too ! (but thats only an opinion!)

                      Comment


                      • #71
                        We are trying to slot the above caseload into categories /compartments and approaches which make little to no sense and many of the approaches are iatrogenic ..probably mine too ! (but thats only an opinion!)
                        I've come to the conclusion that there are exactly three and only three categories of patients with mechanical pain:
                        1. those whose mechanical pain will resolve on its own
                        2. those whose won't
                        3. those who started out in the first category, but medical people convinced them that they were in category two


                        We should obviously leave the people in category 1 alone. For category two, ian's approach sounds reasonable to me. I wouldn't be averse to a more formalized session of pain education as well, including drawing on stories that the patient can relate to and generally providing permission to move.
                        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

                        Comment


                        • #72
                          john your summary is about right ….for the 20 page note pt ….I endeavour to exactly that …set the scene (she has been advised to get explain pain from library as the council one has a few) i will double book an hour to really go over information and provide some relevant goals and assess her interest in pursuing pain management ….If at the end of this best attempt she wants computerised cerivcal traction and is not open to integrated GP/physio/poss psych if issues outside my remit (which i suspect ) arise ….I will not pursue much more and leave the door open . Many pts spiral round in circles and there are lots we can't help as the system and dominant models are often stacked against us !

                          Comment


                          • #73
                            When there is a plethora of practitioners all claiming to relieve pain and "increase function", what does a layperson do?

                            Try them all? Try a doctor's opinion on who is best? Take a friend's advice only? (Oh it worked soooo well for me..) Read online sites and in women's magazines and take a stab in the dark?

                            Not easy for those folk, and I understand their frustration when improvement does not happen or they get worse.

                            Nari

                            Comment


                            • #74
                              Evan,
                              Differences might be that Lee is Canadian and Kerry is British, or that Lee likes to have a blue background on her slides and Kerry prefers gray. I'm not talking about "differences", I'm talking about inconsistencies and apparent hypocrisy. I think we all agree that the thoracic ring stuff is a bunch of malarkey.

                              If in fact he has changed his mind recently, and this more recent piece is his attempt at a sort of "mea culpa", well then he should've acknowledged that he was taken in by the bright lights and big city of mesodoom. He didn't do that. He scolded the profession and directed us to change our behavior. Well, what about you, Roger?

                              He should lead by example. If he thinks he screwed up by hitching his wagon to the thoracic ring star, then he should have owned it.
                              I have to review the thoracic ring stuff, but based on my memory I think it fits the "complex and unnecessary classification and diagnostic systems" . What is Kerry's opinion about it? Is it clear from his blog posts and his publications/presentations? I can ask him in his blog but my comment from yesterday still awaits for moderation.
                              -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


                              • #75
                                Eric Meira wrote a great piece titled: 'Getting Rid of Something Positive' that addresses the above problems: http://ptpodcast.com/getting-rid-of-something-positive/

                                He broke patients down into 3 categories:

                                Category 1. Injuries that will heal on their own with time
                                Category 2. Injuries that require surgery to correct
                                Category 3. Injuries that result in a positive feedback loop
                                Rob Willcott Physiotherapist

                                Comment

                                Working...
                                X