Wednesday, November 10, 2010

The Clinical Importance of Patient Reported Outcome Measures

Measurement tools, such as patient reported outcome (PRO) measurement questionnaires, are essential in enabling stake holders to assess and determine if a patient’s problem is changing or not. For therapists, medical practitioners, and surgeons it is important to see that the intervention provided has enabled the individual to show improvement. You can’t just say or ask the patient, ”are you better?” They often reply, “yes” just to keep the treater happy. By recording change using PROs, it allows the practitioner to determine how the patient/client is doing both accurately and quantitatively. This is important for all parties (insurance, patients, therapists, and researchers). They can determine if different types of treatments are being effective or as effective as others. Without accurate measurement, the effectiveness of treatment and interventions cannot be established therefore, justification of treatment provision becomes ‘opinion based’.

By contrast, for patients with progressively degrading conditions such as degenerative discs, arthritis, and some oncology patients, these tools can help determine how they are doing in terms of their ability to maintain themselves and minimise their inevitable rate of regression. Outcome measures in this context enable action oriented decision supports to help decide when the step to the next stage of management should occur. It can confirm regression or worsening of symptoms and the need for change in management of their condition, be it medical, physical, or considering moving to the surgical approach. With each new stage of management the outcome measurement process is able to justify this decision and determine the effectiveness of the new strategy. Two simple examples of this can be seen within the case examples of Low Back Pain and post op shoulder management here.

Here is a great list of hundreds of PROs for you to utilize in your clinics.

If you have any questions please email me.

Philip Gabel

World Congress on Low Back and Pelvic Pain - We are Here!

PT Project contributor Luke Bongiorno is attending the 7th annual World Congress on Low Back and Pelvic Pain in Los Angeles. We are looking forward to an information packed next couple of days. If you would like to meet Luke, discuss The PT Project’s future, or are interested in becoming a member of our team please email me.

Ryan Orser

Mobile Technology and Physical Therapy - Ne'er the Twain Shall Meet

An interesting thing happens when you perform a Google search for mobile technology and physical therapy: You get one result – an advertisement for a physical therapy position in Mobile, Alabama!

Physical rehabilitation starts in the clinic and continues at home, in the office, at the gym – mobile technology is the perfect solution for this multi-location experience. Why then has the PT industry as a whole not embraced this exciting opportunity? Shouldn’t we capitalize on the prevalence of Internet connectivity and smart phone use to stay connected to our patients? Wouldn’t a patient’s mobile device be the perfect rehab aid? Our patients seem to think so. A February 2010 mobile metrics report revealed that smart phone usage had increased 193% in the last twelve months.
As a community we are resistant to change, especially when it comes to technology. Having spent most of our professional lives interacting face to face with patients and not sitting behind a computer, we aren’t particularly tech savvy. We are a sector stuck in the dark ages of information technology and somewhat intimidated by it.

The time has come to change that. With mounting pressure from insurance companies to reduce our length of stay as they cut our reimbursement, we are left with little choice but to innovate. Technology offers real and immediate solutions that could save us time, create alternative revenue streams and improve delivery of patient care.

Technology adoption in the physical therapy space is inevitable; we just have to accelerate the process from within because who understands our needs better than we do?

Bronwyn Spira

Top 10 Pieces of Advice to New PT Graduates

Top10 | Chris Johnson PT
This post goes out to all you new physical therapy graduates. I hope this advice will help guide you on your professional journey. I have been incredibly fortunate when it comes to my experiences and mentors over the years so this is a simple way to give back. Below is a list, in no particular order, of what has helped me and I am confident will help you reach your goals in the wonderful world of physical therapy. Drum roll please…

1. KNOW THY PATIENT – Arguably the most important factor when it comes to helping patients in the clinic is how well you know the person you are providing care for. Collecting a thorough and accurate history as well as knowing what each individual patient exposes their body to on a daily basis is critical. I’m talking about everything ranging from vocational demands to exercise habits to donning a tshirt to drinking a glass of water to picking one’s nose to sexual positions.

2. SPEND TIME WITH A MASTER CLINICIAN – Before I even started physical therapy school, I worked in Dr. Lynn Snyder-Mackler’s lab at the University of Delaware and gained exposure to how she conducted her clinical examinations and research data collections. Let’s just say that I was spoiled. After completing PT school, I then had the good fortune of working at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), where I fell under the tutelage of Dr. Malachy McHugh and the NISMAT staff. I am forever indebted to these indviduals as they have shaped me as a clinician and researcher and I hope you have the same opportunities.

3. DEVELOP YOUR MANUAL SKILLS – Nowadays, there is a huge emphasis on good manual skills and this should come as no surprise. All of the top notch clinicians that I know and respect possess exceptional manual skills. In particular, I would encourage you to become an expert in treating myofascial trigger points as well as owning joint mobilization and spinal manipulation. Once you become savvy in these areas, watch the referrals roll in. If you are looking to learn spinal manipulation and live in the NYC area, feel free to reach out to me as well. You can also attend a seminar that Luke Bongiorno and I teach that will get you competent in resolving trigger points and performing sound mobilization/manipulation.

4. STAY CURRENT WITH THE RESEARCH – Everything in medicine comes with a date. Let’s not forget that we used to cast people after ACL reconstruction and the arthroscope was considered the “tool of the devil.” Staying up to date with the medical literature is therefore critical and has never been easier. If you don’t have the financial means to subscribe to medical journals, at least follow various PT websites and blogs. For example, Mike Reinold runs a great blog that serves to provide the reader with current information and allows you to interact with other PTs and allied health professionals. Bruce Wilk also has some great articles on his website that I would encourage you to read, especially if you take care of endurance athletes. I try to give people free information on my personal website too that I hope you take the time to check out. Let’s not forget about The PT Project too people!

5. MOVEMENT, POSTURE, & STRUCTURE – This quote by Thomas Meyers says it all… “Movement becomes habit, which becomes posture, which becomes structure.”

6. PERFORM THE EXERCISES YOU PRESCRIBE – One of the biggest pitfalls that I see in our profession is that PTs often fail to perform the exercises that they prescribe. By performing the exercises, you will become more acquainted with the details associated with each exercise as well as common mistakes that can be made. It will also help you provide a better model of performance and allow you to more clearly explain the exercise.

7. INTERACT WITH FOLKS OUTSIDE OF THE PT WORLD – I have spent time with massage therapists, chiropractors, strength and conditioning coaches, skateboarders, yogis, break dancers, martial artists, etc. I must admit that I have learned just as much if not more from these individuals about movement and performance than I would have ever thought possible.

8. KEEP A PT JOURNAL – Keeping a PT journal is one of the most important things I do in an attempt to sharpen my clinical thoughts and reasoning. Some examples of the things I jot down in this journal are patterns that I observe in various patient populations, mistakes that I have made, or exercise progressions that come to mind. Reflecting on your time in the clinic is critical!

9. CALL YOUR PATIENTS – “People don’t care how much you know until they know how much you care.” Nothing will compliment your work in the clinic more than a simple phone call to your patients. I have never had a patient get upset by me calling them. In most cases, they were thrilled (maybe that’s pushing it) to hear my voice when they were having a stressful day. It will also serve to remind them to stay consistent with their work/home exercise program outside of the clinic.

10. SHADOW AN ORTHOPEDIC SURGEON – I had the amazing experience of spending nearly 10,000 hours shadowing Dr. Michael J. Axe of First State Orthopedics as part of a graduate assistantship that I was awarded during PT school. This experience was beyond awesome. It specifically helped me understand the patient perspective and also served to bridge communication between patient, doctor, and therapist. This was particularly valuable in the case of post surgical rehabilitation. And don’t let orthopedic surgeons intimidate you because after all, we are all human!

Wishing you a career of good fortune and longevity.
Chris Johnson

Thursday, November 4, 2010

Some People Are Just Born to Run

The NY Times Online published the story of Christopher McDougall, a former retired, new back-to-running marathoner. He explains why he stopped running at first as 9 out of 10 runners have some sort of injury when training for these long distance runs. Why would anyone continue a sport that had only 10 percent chance of not injuring themselves?

After meeting with gringo protégé, “The White Horse,” (of the Tarahumara Indians of Mexico’s Copper Canyons) and Daniel Lieberman, Harvard’s “Barefoot Professor,” Christopher spend 9 months completely retraining his running style (physically, mentally, and spiritually). According to his book Born to Run, McDougall “discovered that injury-free legs aren’t such a miracle after all.”

To read the rest of the article click here. I would be interested in hearing what your best injury free running method is. . .

Ryan Orser

Why I Am Running the Marathon Against Orders

adam banks staten islandCheck out my article on why I am choosing to run the NYC Marathon despite what PTs are advising me to do.

I explore the reasons why people “must” do some things, even if it is the wrong decision or the decision that goes against medical advice. I think this is an important topic to explore – people will “do their own thing”.

For me I didn’t want to hear “don’t run the marathon” – as people were telling me that, in the back of my mind I knew that I was going to run it anyway. What I wanted from my PTs was to say, “don’t run the marathon, but if you do, here is the best way to do it to minimize further injury”.

Check out the full article on

Adam Banks

Five Key Exercises

I recently wrote an article on my blog about five key exercises that are appropriate for most people, while taking into consideration the following factors: safety, simplicity, and efficacy.

The post generated a lot of interest, and I am working on posting videos for them – I thought it worth sharing on The PT Project.

 My Five Key Exercises are:

  • Stand with feet shoulder width apart and equal weight between both legs.
  • Maintain a slight bend in the knees.
  • Gently tighten the abdominal wall.
  • Rotate the arms so the palms are facing forward and the arms are parallel with the torso.
  • Slide the shoulder blades back and down.
  • Look straight ahead and gently retract the chin.
  • Hold for 30 seconds and repeat at least once every waking hour.

  • Position the foot so it is pointing straight ahead or just slightly toed out.
  • Maintain a slight bend in the knee.
  • Gently tighten the abdominal wall and keep the pelvis squared off and level.
  • Perform three, one minute holds on each side every day.
3. SEATED ROW (requires resistance tubing with handles)

  •  Secure the resistance tubing around an immovable object or in a door jam so it is just below chest level.
  •  Ensure that your feet are shoulder width, knees neutral, and that you are sitting upright.
  •  Grasp the handles with a neutral grip (palms facing each other) and draw them back so the arms are parallel with your torso and not breaking the plane of you body.
  •  Once your arms are in position, gently slide the shoulder blades down and back and look straight ahead. 
  •  Complete five, thirty second holds.
  •  Afford a rest period of 45 seconds between each repetition.
4. SEATED HIP RAISES(requires velcro ankle weights)

  •  Start by sitting on a kitchen countertop or table so the feet are off the floor.
  •  Secure an ankle weight around each foot (not the ankle).
  •  While holding on to the front of the table to avoid leaning back, raise the thigh off the table about six to eight inches while keeping the foot level.
  •  Complete two sets of 25 repetitions.
  •  Afford a one minute rest between each set.
  • Assume the starting position of a standard push but with the back level.
  • Ensure the head is in line with the spine and that the elbows are slightly bent.
  • Keep the knees straight and gently tighten the abdominal wall.
  • Start with five, 30 second holds.
I am confident that you will find this group of exercises to be a game-changer when it comes to improving your strength, stability, balance, and endurance. And remember to please consult a physical therapist or fitness expert before starting this program.
Christopher Johnson