Quick Links! | Modern Manual Therapy Blog

Quick Links!


Today's Quick Links come from Ann Wendel via WebPT, KevinMD, and Dynamic Principles.

Ann Wendel recently blogged on WebPT's site. It has been a hotly discussed topic recently, on #solvePT and other sites. I am with the camp that the Severity-Intensity model is just as easily abused as other systems. From my experience working in Utilization Management, you would be absolutely shocked at the PTs out there with poor documentation, poor outcomes, with our current system. I am talking about 150 visits or more with S: No new complaints P: Continue PT... that's it. I am all for the PTBA's proposed system and I fit 90% of my treatments within 30-40 minutes on even the most "severe" patients. In fact, the better of a clinician you are, the more "severe" patients you get. It is just what took another clinician/practice 30 visits, may only take a better one, who is using evidence led practice, plus 1:1 time, 6-10 visits. Read The Road to a New Payment System for Physical Therapy.

Thanks to Dr Kyle Ridgeway for posting this on his Social Media. KevinMD posted recently about the effectiveness (or lack thereof) of CPR. I have not ever learned this anytime I went for CPR certification through any of the known programs. I don't know if I'd still rather opt out, maybe I would be in the small minority that made it past 30 days with good body and brain function? Scary!

Leonard Van Gelder shares his Self Eval and Treatment for Hip Extension Dysfunction. Makes sense, and it does not always have to be evidence based! Some of his points have been recently raised elsewhere and they make sense from a pain science approach. Do you tell your patients that their gluts are "shut off?" I have definitely said this over and over again. Charlie Weingroff had a tirade about this at his recent course. If you EMG a "shut off" muscle, it's not really shut off at all. While I believe I have not adversely affected anyone's outcomes by using words like "shut off" or "not working," the mind is a powerful thing and it is most likely more facilitating to use explanations such as muscles on one side of the joint are dominant and the ones on the other side are having trouble with quality movement. What do you think? Are we becoming too soft? Back on track, great post Leonard, my "shut off" right side definitely has a bit more trouble with 20 heel to the ground, knee driving forward SL bridges, and my left side has no difficulty! Time for some resets!


2 comments:

  1. Don't give up on CPR just yet!

    I don't think it was a study on the effectiveness of CPR. The article may have significant affects on the way epinephrine may be used for out-of-hospital cardiac arrest.

    The objective of the study as stated by the researchers was to "evaluate the effectiveness of epinephrine in CPR..."p 1161. Dr. Hagihara and colleges don't even breakout the OUTCOME data on those who received chest compressions, rescue breathes only and AED even though they have the data. They did find that, "that the use of (prehospital) epinephrine might be related to decreased 1-month survival." p. 1166.

    The editorial by Dr. Callaway provides an interesting explanation of why this may be the case that patients who receive epinephrine have end up with "iatrogenic squash rot." JAMA. 2012;307(11):1198-1200. doi:10.1001/jama.2012.313

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  2. Thanks for sharing my post!

    And, I agree with Charlie and Leonard's viewpoint - if I hear one more patient come in telling me that their trainer/PT/MD has told them that their glute on one side "isn't firing at all" I'm gonna scream! Patients believe this and then fixate on it. I try to explain that if they can stand up from a chair and walk without major deviation, their glute is not "completely shut off." It may be weaker than the other side, it may need some neuro re-ed to work properly, it may have trigger points, their hip flexors may put them in a position which makes it harder to extend the hip, etc, etc. I think that tweaking our language on these things can make a big difference.

    Thanks again!

    Ann

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