The title to my blog is, “Physical Therapy Blog on Evidenced-Informed Orthopedics, Manual Therapy and Knowledge Translation from Academia to Clinical Practice” with a primary emphasis on the bolded phrase.  With the blog and intern teaching, I try to mingle all 3 aspects of EBP but especially giving a fairness to the two that most of us fight over presently, and more than likely until the end of time…which are “current literature and expertise“.

The separation of research and clinical practice was quite evident this past weekend at AAOMPT conference 2015.  If you haven’t been to a conference before (this was my first), this is the general set-up:

  • There are several presenters (researchers) who give lectures on their topic based on a common theme to the entire audience in one room.  Then, there is a roundtable discussion with hot questions aimed at them on their opinions of clinical practice, manual techniques, etc. with regards to current research.
  • The other aspect includes break-out sessions presented by clinicians based on a topic of choice.  These usually include some type of clinical reasoning, technique, and/or differential diagnosis on a topic related to OMT and orthopaedic practice.

To summarize briefly, the main lectures presented by researchers examined information on big data and how whole health services research will help in managing low back pain. Two main points came out of it:

1. Outcomes improve the earlier someone sees a PT.

2. The OMT technique doesn’t matter.

To summarize briefly, my experience listening to lectures in break-out sessions presented by clinicians:

1. Case studies / series showing results & outcomes of specific techniques / approaches when other general PT failed.

2. The OMT technique does matter.

But now this can’t be right.  Big data research shows technique doesn’t matter—get patients in, move them, and move on.  But clinicians presenting show specific techniques/approaches and wail that technique does matter…

If the national conference in OMT doesn’t agree, then how can I, in rural Virginia, extrapolate the information given to me by experts in the field?

How do I know what to turn to, research or expertise?  Which mainly drives my practice? In 2013, I asked readers of this blog a very similar question.  Here are the results.

Now granted the big data research topic involved low back pain, which we all know may not the most suitable subject for this talk….

We all want to balance being a clinician and researcher (clinical researcher), just like a collegian balances being a student and athlete (student athlete).

To paraphrase an expression from a good colleague of mine, Dr. Eric Jorde:

…just like student is first in a student-athlete, should clinician (expertise, gut feeling) be first in clinical-researcher?

Interesting reads from some of our own on this topic:

Should we move beyond the technique?

Should we move away from the product?

 

What are your thoughts?

 

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3 comments

  1. Big data doesn’t currently account for patient preference and PT equipoise. The reason the technique might matter on the individual level is likely more related to confidence and belief structures. Placebo, nocebo, expectation and equipoise data collection at the “big” level may bridge this gap in the future.

  2. A couple of the largest data points missing from most “big data” sets are PT equipoise and patient expectation. Research in beliefs and confidence in techniques will likely go a long way toward answering this question. The current trend in other health related fields indicate that these things matter on the individual level, a level that big data needs to figure out a way to measure on the larger scale.

  3. Harrison,
    You pose some interesting thoughts on your blog. When you look at the Big Data that was presented at the AAOMPT conference this yr–you should take that at face value. That is get PT first. The other message I got was that we don’t need to be seeing everybody becuase not every one maybe appropriate for PT. We just have to continue doing a better job finding those folks that will respond to PT and quit burdening the healthcare system on those folks that won’t respond to PT. What really bums me out is that this information constantly presented to the choir (aka PT’s/ PT conferences). We as a profession need to be presenting this information to MD’s and DO’s and at healthcare professionals conferences letting them know the value of PT. So don’t get too caught up with the Big Data presentation. It was more about getting folks to seeing a PT first rather than the current alternative that is taxing to the heatlhcare system. Big Data = finding the proper pt responder + PT first = lower HC cost–that is the equation.

    When you look at the break out sessions — there is a good show case of good clinical reasoning and maybe new techniques etc. Flynn et al wrote a editorial along time ago titled “Move it and move on.” There is more than one way to skin a cat. Remember experts do the basics extremely well. It’s having good sound clinical reasoning and always looking at perfecting your assessment skills and refining a handful manual techniques–it’s not about how many more can I learn but more about looking at ways to fine tune and improve your current skills.

    Great thoughts man!
    Dr Ron Masri

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