The E3 Rehab Podcast 190. How and Why Do Treatments Work? w/ Chad Cook
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Mar 4, 2025 Chad Cook, a tenured physical therapist and researcher at Duke University, dives into the intricacies of treatment mechanisms. He discusses the impact of non-specific effects and clinician biases on patient outcomes. The conversation takes a fascinating turn as they explore the SS-MEC trial comparing manual therapy and exercise for chronic neck pain. Cook emphasizes the need for personalization in treatment, addressing the role of motivation and therapeutic alliances. They also highlight the challenges of maintaining strong clinician-patient relationships in high-volume care settings.
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Specific vs Shared Mechanisms
- Specific mechanisms are unique physiological or psychological effects tied to an intervention's action.
- Shared mechanisms occur across multiple interventions leading to similar therapeutic outcomes.
Role of Natural History
- Natural history in musculoskeletal conditions often leads to favorable spontaneous recovery.
- Treatment benefits sometimes mix specific effects with natural healing over time.
Understanding Regression to Mean
- Regression to the mean is a statistical phenomenon where extreme initial outcomes tend to move toward average over time.
- It's distinct from natural history and impacts outcome measurement.