PT Elevated

Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM Align Conference this August 26-28 in Dallas, Texas.  On our third episode of season 3, guest Mark Jones, BSc (Psyc), PT, M App Sc, who is an Adjunct Senior Lecturer in the University of South Australia with 35 years’ experience teaching undergraduate and postgraduate physiotherapy joins us. Mark graduated from the University of Florida with a B.S. in Psychology and then completed his Physical Therapy studies at the University of Iowa. Having developed an interest in manual therapy Mark travelled to Australia to study Manipulative Physiotherapy and after completing his Graduate Diploma in 1985 under Geoff Maitland he completed his master’s degree by Research in 1989. The title of his thesis was “Facilitating Students’ Clinical Reasoning in Physiotherapy Education”. Mark has a special interest in biopsychosocial health care and the teaching and assessment of clinical reasoning in physiotherapy. He has conducted and supervised research in the areas of clinical reasoning and musculoskeletal physiotherapy with over 90 publications including three editions of the text “Clinical Reasoning in the Health Professions” and the text “Clinical Reasoning for Manual Therapists”. His latest text “Clinical Reasoning in Musculoskeletal Practice” was published in 2019. Mark has presented 30 Keynote Conference presentations and has taught professional development courses in clinical reasoning and musculoskeletal physiotherapy across 26 countries. They focus their discussion on the conversation of clinical decision making and reasoning that is the focus of Mark’s Align Conference discussion. Mark has dove deep into the technique of clinical reasoning to grow and develop it. Here are some of the highlights: Mark gave a little insight on how he got interested in clinical reasoning - In 1985 when Mark said he was studying clinical reasoning it was not considered as much as it is now in physical therapy programs. He studied with Robert S. Maitland in Australia and was very intrigued by the thought process he taught without it being overt. Robert didn’t have students think about their thinking, he gave them principles to follow. Mark came across the work Arthur S. Elstein, who wrote what probably still is considered the seminal study and paper in clinical reasoning in medicine, he immediately saw that applicably to physiotherapy. Everything that Arthur said about that process that people go through and how important your knowledge is to the success of that process, the concept of patterns, Mark connected that to what physical therapist did. He did his master’s degree surrounded around that. Looking at educational strategies to strategize reasoning. I began to theorize what this would look like in physiotherapy - “I found out that good clinicians have always reasoned. It would be arrogant to suggest that it was not always here. The beginning of Physios, there was reasoning always inherent in what they did. We didn’t think about our reasoning back then, it wasn’t explicit. Maybe that was what I with others contributed to the process. I started theorizing and writing about it suggesting things as to what this would look like in physiotherapy. In our program we started thinking about what it should be because every program that teaches then must start making decisions on the process you want to facilitate and judgements you think are important.” Mark’s Align Session Preview: “Physios are noisy.” Mark shares that he will share a podcast and a book at the conference in his lecturer that expands on this quote above. Mark’s Clinical Pearl – “My Favorite definition of an expert is somebody who has a lot of experience, they know a lot, they do what they do well, and they can communicate their reasoning well. But they also know what they don’t know. They do not have to have a supervisor look at them anymore, they can be on their own and recognize if they didn’t understand information or know what a medicine was. They have that mediative congeniality and that is why they have become an expert; they have become aware of their limitations, and they act on it. Ongoing learning cliché is very true, to all of us and our students but it is also being honest. They call it intellectual humility to recognize what you don’t know.” Helpful research and training: “Clinical Reasoning for Manual Therapists” “Clinical Reasoning in Musculoskeletal Practice “Clinical Reasoning in the Health Professionals”   Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout.  You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials:@ZimneyKJ on Twitter @PMintkenDPT on Twitter Mark Jones Align Conference Website Align Conference 2022, Website    

Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM Align Conference this August 26-28 in Dallas, Texas.  On our second episode of season 3 we welcome Dr. Keith Smart, DSc (Hons), Physio, MSc, PhD, who is a keynote speaker at our Align Conference happening this August! Keith is a physiotherapist who worked clinically as a physiotherapist in several hospitals in the United Kingdom and Ireland. He specialized in the field of ‘musculoskeletal physiotherapy.’ He completed his research master’s degree in 2004 and a PhD in 2010, during which he was the primary investigator on a number of research projects that investigated physiotherapists clinical reasoning of pain, and mechanisms-based classifications of low back pain. He has since acted as a co-supervisor to a number PhD candidates as well as undergraduate and masters-level physiotherapy students. He has also undertaken several systematic reviews related to pain. He is now a full-time academic physiotherapist at University College Dublin but maintains a small clinical caseload as a Clinical Specialist Physiotherapist within the field of musculoskeletal physiotherapy and orthopaedic triage at St Vincent’s University Hospital, Dublin. He has ongoing research interests related to pain and advanced practice physiotherapy. They focus their discussion on the conversation of pain mechanisms that is also Keith’s speaker topic of discussion at the Align Conference, and he expands on what his speaker discussion will also cover at the conference and more!   Here are some of the highlights: Keith published a series of 3 influential papers about 10 years ago on mechanisms of pain and broke them down to how we might be able to categorize where our patients fit in those categories. They discuss how he got interested in pain science initially and what about his findings surprised him. On a broadscale Keith tells how he used questionnaires, clinically when assessing pain and why. Listen in to hear more surrounding the topic of pain mechanisms. Keith’s Align Session Preview – Keith will be presenting virtually in August at the Align Conference; he is looking forward to it! He will be presenting on the broad topic of pain mechanisms, keeping it clinical. He hopes to be able to explain to the attendees what some of the limitations and shortcomings of mechanisms-based patients of pain are. Also, what that looks like in clinical practice, how we might begin to distinguish between different types of mechanistic categories of pain and how we might tell them apart in our patients. What implications that might have for our assessment treatment and prognosis of patient’s pain. Keith’s Clinical Pearl – “Embrace the complexity, but don’t be intimidated by it. Anyone who tells you that they know everything is almost certainly lying. Being a physical therapist and treating patients in pain is a challenge but it is also a privilege. Embrace the complexity and do your best.”     Helpful research and training: Management of Upper Extremity Disorders Management of Lower Extremity Disorders Management of Lumbopelvic Disorders Graded Motor Imagery Manual Physical Therapy Certification Mechanisms-based classifications of musculoskeletal pain: Part 1 of 3: Symptoms and signs of central sensitisation in patients with low back (+/- leg) pain Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (+/- leg) pain Mechanisms-based classifications of musculoskeletal pain: Part 3 of 3: Symptoms and signs of nociceptive pain in patients with low back (+/- leg) pain Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout.  You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials:@ZimneyKJ on Twitter @PMintkenDPT on Twitter @KeithMSmart on Twitter Keith Smart, Align Conference Website Align Conference 2022, Website

Welcome back to a NEW season of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. This season we will have some of our speakers as guests who will be live in-person at the EIM Align Conference this August 26-28 in Dallas, Texas.  Our first episode of season 3 welcomes Dr. Julia Treleaven who is a keynote speaker at our Align Conference this August. Julia is a senior lecturer and researcher at the University of Queensland in Australia and a part of the head and neck research unit. She has been researching whiplash and neck pain since 2000 and in 2004 completed her PhD focusing on the neck’s influence on sensorimotor control. She has continued her research in this area and now is also looking at the role of neck dysfunction in those with headache, dizziness and post-concussion due to concomitant whiplash-type injury. She has over 100 publications in this area, written several book chapters and is an author of the recent book “Management of neck disorders- an evidenced based approach.” Julia works part-time as a physiotherapist in a private practice managing patients such as those with, whiplash, cervicogenic dizziness and post-concussion syndrome.  They focus their discussion on sensorimotor control and what Julia's speaker discussion will be focusing on at the Align Conference and more! Here are some of the highlights:Julia discusses how important it is to understand why sensorimotor control is important in the head and neck.  She discusses the different tests that can be used to find and diagnose a problem and find out where it may be coming from and if the neck or head is involved or not.  Julia says today, "We are understanding more how to assess patients to decide whether the head or neck is involved or not." She talks about how to handle joint restrictions and more!  Julia's Align Session Preview – She will be going over the Clinical Assessment of Sensory Motor Control in the neck and tests that she thinks might be useful clinically to help differentiate if it is coming from the neck or the vestibular system. Then some ideas of how to integrate that into training for patients as well.  Julia's Clinical Pearl – “Really think about your examination: what you are feeling, what you are seeing? Try not to rely so much on pain, then try to put it together, does it make sense? If it is not making sense then you probably have missed something or you need to assess if there is anything else you can look at. If it is making sense, then fantastic! Really just focusing on what you are feeling and seeing and if it is making sense."   Helpful research and training: Management of Upper Extremity Disorders Management of Lower Extremity Disorders Management of Lumbopelvic Disorders Manual Physical Therapy Certification Orthopaedic Physical Therapy Residency Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Save 5% on registration as a PT Elevated Podcast listener. Visit alignconference.com and use the promo code PTELEVATED at checkout.  You can find the promo code and a link to the website in the show notes. We can’t wait to see you! Connect with us on socials:@ZimneyKJ on Twitter @PMintkenDPT on Twitter Julia Treleaven, Align Conference Website Align Conference 2022, Website

Season 2 of PT Elevated was amazing! In this season's final episode, we reflect on some of our clinical discussions we had throughout the season with our guests.  Join Kory, JJ & Paul as they talk through the expert guests' clinical perspectives that they thought were helpful for new clinicians.  Paul Mintken shares the take-home from season 2: You can't know it all you can't get everyone better It's all about relationships  Listening is so important  More Links:  Catch up on all the episodes  Host Kory Zimney on Twitter: @ZimneyKJ Host Paul Mintken on Twitter: @PMinktkenDPT Host JJ Thompas on Instagram: @primalphysicaltherapy

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day.   On a special tenth episode of season 2 of PT Elevated hosts Kory Zimney and Paul Mintken were LIVE at the American  Physical Therapy Associations 2022 Combined Sections Meeting in San Antonio, Texas interviewing students and presenters finding out what they learned to take back to their clinics.   Helpful research and training: EIM APTA Combined Sections Meeting Clinical Corner Schedule EIM Faculty Presenting at APTA CSM 2022   Ad Info: We are excited to be back in person and back to hands-on learning for the 2022 Align Conference. This year you can join an all-star lineup of speakers in Dallas, Texas, August 26 through the 28. The labs and lectures focus on sharpening the physical, hands-on treatments essential to patient care. Take advantage of Early Bird pricing now at alignconference.com. We can’t wait to see you in Dallas!   Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter American Physical Therapy Association

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day.   Our ninth episode of season 2 welcomes Dr. Bryan Guzski and Dr. Tim Reynolds who are the authors of the book Movers and Mentors. Bryan is a physical therapist who practices at the University of Rochester Orthopaedic Spine & Sports Center and recently just stepped down as the residency program director. He graduated from Ithaca College and then did a post orthopaedic residency and spice fellowship at Cayuga Medical Center. Tim is a physical therapist by trade who went to Ithaca College for his Doctorate. He then did a post orthopaedic residency and spine fellowship with Cayuga Medical Center as well. Currently he teaches anatomy and physiology at Ithaca College.    Here are some of the highlights:"This book is a compilation of stories, throughs, and advice from over 75 leaders  in the fields of physical therapy and movement science. From researchers and expert clinicians, to innovators and business owners, their answers to thought-provoking questions provide personal and professional guidance for the next generation of rehabilitation professionals."         Bryan and Tim started this book idea when they were going through residency together. They saw the same names recurring. They were also reading an interview style book called, "Tools of Titans," by Timothy Ferris and thought it would be great to have a book like that, centered around physical therapy. In 2018 they drafted a list of interviewees and a list of questions and fired off emails and one thing lead to the next and they published this past year.   Common Themes Bryan & Tim Recognized from interviewing leaders in our field for their book:  Failure The questions they asked were more human related about failure, good and bad advice and favorite interests and less focused on their interviewees treatment paradigm & focus.  "It was interesting to hear some of the big leaders in the profession discussing past failures, such as not getting into physical therapy school on the first try or failing clinicals."    Mentorship The importance of mentorship and the importance of investing in yourself. "Mentorship is an investment in yourself. If your are looking at who you want in your clinical mentorship circle, focus on who is practicing the way you want to be and how can you provide value to them so that they are able to provide value to you."  There were opinions on specializing right out of school via residency or becoming a generalist and seeing a lot of different things that several PTs they interviewed had different views on.    Tim's Clinical Pearl – “When I did my spine fellowship program it wasn’t the advancement in my manual skills or treatment paradigms or pattern recognition, it was Jason Cherry who is a professor at Ithaca College who introduced me to the concepts of motivational interviewing and that has been what my clinical focus the last two or three years has hovered around, the power of words. Being mindful of the power of word choice, being able to take advantage of that placebo effect, and being able to communicate more effectively with a patient. If I had the chance to go back and talk to myself coming out of school in 2014 my response would be, it is okay that you do not have these manual skills yet. Try to work on some of these “strong” skills, communication, and the power of words.”   Bryan's Clinical Pearl – “Don't underestimate the power of momentum. If you are interested or passionate about a particular area and find yourself wanting to know more and learn more about this one thing, dive into that and lean into that. That will lead to more momentum, where you have new conversations with new people and that is where doors start to open, and you can continue to grow from there. Learn into momentum and do not underestimate the power of it."     Helpful research and training: Online: Business Management Principles for the Rehab Therapist  Online: AmaZing! Customer Service Course for Individuals  Online: AmaZing! Customer Service Suite   Ad Info: Since you’re listening to this podcast, there’s a pretty good chance you’re the type of clinician who is always learning. One great way to learn more and earn CEUs is Evidence In Motion’s huge selection of courses. Choose from topics ranging from MSK management and pelvic health, to dry needling and pain science. Get back to hands-on learning by finding an in-person weekend intensive course near you. Or if you prefer online learning, opt for a virtual lab or online option. You can save 5% on courses as a PT Elevated Podcast listener. Just use the promo code PTELEVATED at checkout. You can find the promo code and a link to courses in the show notes.  PROMO CODE: PTELEVATED  Courses Link   Connect with us on socials:   @ZimneyKJ on Twitter @PMintkenDPT on Twitter @MoversMentors on Twitter @TimReynoldsDPT on Twitter  Moversandmentors.com 

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day.   Our eighth episode of season 2 welcomes Dr. Steve George who is in the department of Duke University’s Orthopaedic Surgery and a member of their Clinical Research Institute. His primary charge is research where his focused has been in musculoskeletal pain conditions, cohort studies, clinical trials with low back pain and more! This week he discusses acute and chronic lower back pain as it is related to recent changes to the newest clinical practice guidelines that were recently released. Here are some of the highlights:Clinical practice guidelines are guidelines provided to assist in clinical decision making, not to take the place of clinician judgment. The new Clinical Practice Guidelines for back pain are a revision to the 2012 release focused primarily on intervention updates. Things to remind your students and learners are these are guidelines they do not necessarily override the 2012 guidelines.   “I still think there is value in structuring your decision making around things and it’s great when there is a lot of evidence to support them, you just have to temper it to support them when there isn’t as much evidence. I think the exercise in structuring your thinking is still super valuable especially for those people just getting started in the area. Clinicians need to understand that you have to have flexibility in decision making because nothing in their findings were clearly superior and they know that happens with back pain studies. There isn’t a huge difference in results in exercise or manual therapy trials for back pain in some areas of medicine if they saw these small differences, they would wonder what we were studying but we live in small to moderate effects and that makes decision making a little bit more challenging.”    Steve shared the search Process for updating the Clinical Practice Guidelines: Process1. Research Questions  -They decided to keep the questions for the clinical practice guideline update broader because they are covering a lot of area.   2. Gathering search terms -They had the original search terms from the 2012 clinical practice guidelines and updated where needed.  -Focused on randomized trials -Only looked at studies with PEDro scores 6 or higher -Focused on trials where a PT was either delivering the treatment or they were in a PT environment.   3. First Draft -Put together and sent out for external reviews   4. Submit final version -Designed an Infographic and the summary of recommendations    Our hope is that people can use this as fuel to get an idea of what they want to do in their local health systems, in trying a new approach.   It was good to see some new themes popping up in this update like pain neuroscience education, cognitive functional therapy, and the prognostic risk stratification. A lot of this is moving away from the diagnostic model of treating back pain and moving into this management model that can be informed by prognosis.     Steve's Clinical Pearl – “I think remaining curious is so important. Asking good question and if you do not get good answers to your questions keep asking them. That is what drove me from moving from a clinical career to a research career. I was not the smartest person in the clinic. I was never voted most likely to do research, but I think when I got out and practiced, I think what bothered some of the people I worked with is just being curious and wondering why we were doing things one way. The focused curiosity. Secondly, I grew up in the non-patient centered era, but I learned so much from listening to my patients and viewing it as a bridge of my expertise with what their experiences were. Listening to your patients. Be curious not only about the patients that got better but the patients that did not.”   Helpful research and training: Management of Lumbopelvic Disorders   Management of Lower Extremity Disorders   PTA Orthopaedic Skills Weekend Intensive   Ad Info: If you want to keep learning past what you hear today, Evidence In Motion offers certifications that elevate your clinical decision making and take you to the next level of patient care and subject matter expertise. I encourage you to check out their website and explore your different options. What’s cool is that you can get 5% off by letting your enrollment advisor know you’re a PT Elevated Podcast listener. Details and links to find the certification for you are in the show notes. I encourage you to check it out.   Connect with us on socials:   @ZimneyKJ on Twitter @PMintkenDPT on Twitter Steve George, PT, PhD Duke University Bio

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day.   On our seventh episode of season 2, Dr. Craig Wassenger, PT, PhD, who currently works in the Tuffs University School of Medicine hybrid DPT Boston program will be telling us about the pain manual that was published by the Pain Special Interest Group within the Academy of Orthopaedic Physical Therapy that he was instrumental in producing.   Here are some of the highlights: The pain manual Craig and his colleagues produced is an expansion of the International Association for the Study of Pain (IASP). The IASP has a curricular outline for teaching pain to physical therapists. It has a list of topics that should be included in physical therapist education. Around three years ago Craig and his colleagues led by Mark Shepherd were able to join and make something out of the IASP, the Pain Education Manual for Physical Therapist Professional Degree Programs.   “Collectively as healthcare professionals we have learned a ton about pain in the past two decades and I do not think that the content that has been included in physical therapists’ education has been able to keep pace with that. As we learn more through psychology and neuroimaging particularly of the brain, we can understand more from a basic science perspective then the application of that content to clinicians treating patients daily and it really has not been done, so this is an attempt to bring those things together as well as an understanding of educators and physical therapists on that topic.”   Although the pain manual focuses on education there is a role for clinicians to take content from it. “The way that I look at it from an educator’s perspective, is we had this guideline document which was the IASP outline, and it was just a list of stuff telling what you should be teaching. I think of that as if you have a recipe that being your ingredients list, but you didn’t really know what to do with it. We tried to take the list of ingredients and add the recipe to it. Here are some things that you can do, here is how you put it together, here are examples of how we have put it together to try to help educators pull that information. If you are an experienced cook for that recipe, like an experienced educator you can take what we offered and then mold it to fit your specific needs, just like the way that an experienced cook would do.”   “In addition to just having an extrapolation of the checklist of content from IASP we offer and provide examples of learning activities both active and lecture for educators to incorporate into their classes. The manual is also supported by asynchronous content, so we have partnered with the APTA and the APTA learning center, so the developers of the manual put together lectures to get faculty current on all topics. The document has supported material from an asynchronous learning site so they can see how we present the details as well as opportunities and examples of assignments that could be used within class as homework for students on the educator’s side of things.”   On pain Craig says, “I think the best way to do it is to have integrated pain content with an additional stand-alone course.” One of the challenges with pain both logistically within the association and from an educational perspective is that it crosses all clinical areas. The pain specialist group is housed within orthopaedics but the course is not only a orthopaedic thing, it is all clinical areas and when you don’t have a focus point around it, it gets diluted across a lot of different areas. That is why I think it needs to be integrated across lots of different courses. But have a place where it is centered and have the focus time to evaluate it and study it as a student. Also provide that opportunity to our post graduate students as well, primarily talking about DPTs.”   The pain education manual is housed on the Orthopaedic Academy website.   We’ve also partnered with APTA, and have prerecorded lectures for educators and people that are more audio or visual learners.   In teaching about pain Craig says, “Pain science is centered around patient education. I use a scaffolded approach to that because it is one of the key things that I cover within the course and one of the main assignments I have with all the universities that I teach this course at. First step is understanding the background information, the research, the content, to substantiate what the education should be centered around, and it comes down to the psychosocial contribution to pain as well as what we understand now around the nociplastic pain and the changes in the central nervous system that are not very well understood by many healthcare providers or the public. The students watch me delivering it to a patient and we watch the interactions and break down the interaction. They then have a practice session with each other.   Our training is improving, and this is one step to try to make it better and provide resources but there are still gaps that we recognize. I’m hopeful other healthcare providers do too. There is a role for us to contribute medical, nursing, and pharmacist education and all the other healthcare providers that we and our patients interact with to try to bolster this. I’m hoping there is a shift in the criteria that we are using for our accreditation and or licensure because unless a change is forced it is hard to make people change.   Craig’s Clinical Pearl: “One thing I wish I knew when I started clinical practice was that I didn’t have to have all the answers. You come out of school you’ve spent so much time studying and learning all this content and you’ve had expert clinicians and educators telling you all this information and there is so much you must learn. You take your board exam, and you pass it and then you get a patient in front of you, and you don’t have the clinical instructor to lean on and you may or may not have a mentor and I just felt like I had to know it all. You certainly do not know it all. You’ll never know it all or have all the answers. But that is one thing to not worry about and this will tie back into the pain manual to show that there are resources available for you to help you. My strong recommendation even if it isn’t a formal process is to get a mentor and learn much as you can from them. Lastly, it certainly is not all about knowledge it is a whole lot about relationships, people, trust, caring and those other things that are hard to teach but are maybe more important than all the content we talk about in PT education.” Helpful research and training: Advance Therapeutic Neuroscience Education: Focus on Function Therapeutic Neuroscience Education Pain Education Manual for Physical Therapist Professional Degree Programs  Ad Info: How many of you are thinking about or preparing to sit for your board-certification exam? Achieving board certification can be a strenuous process, and the right prep course can mean the difference between a passing and failing exam score. PT Elevated sponsor, Evidence In Motion, offers test prep courses for OCS, SCS, and GCS, with over 95% pass rates! As a podcast listener, you can get 5% off a prep course now. Find the promo code and more info in the show notes. You got this!  Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter Craig Wassenger Tufts University Bio

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our sixth episode of season 2, Dr. Trevor Lentz, PT, PhD, MHA, who is in the department of Orthopedic surgery and in the Clinical Research Institute at Duke University, discusses yellow flags and fear in physical therapy.   Currently, his primary focus is in research, first on how to improve value of care in physical therapy and health policies and secondly in yellow flag screening, understanding physiological distress and the impact it has on things like returning to sports, getting back to work and function after orthopedic injury. Here are some of the highlights: Trevor and his colleagues developed the OSPRO yellow flag assessment tool. It was developed because the need for it in the clinics with the frustration they were facing. They knew there were a lot of different psychological characters that may be important to evaluate evaluate but the problem was evaluating efficiently. The OSPRO-YF assessment tool looks like a traditional psychological assessment tool but works very different and there are a couple different versions. The assessment calculates what patients would score on 11 different psychological questionnaires. The tool improves the efficiency of screening and allows clinicians to administer these tools in an efficient way. When developing the OSPRO-YF Trevor and his colleagues looked at 11 different questionnaires (130 different questions overall) that they had patients fill out. It enabled them to have a question pool that they could pull from. It also told them information about how a patient would score on those individual questions. It was a factor analysis, identifying which items told them the most information about some of these underlying constructs. It would allow them to estimate these scores most efficiently. The OSPRO-YF is designed as a screening to identify patients that may require additional psychological work up. Trever says they do not advocate making treatment decisions based on those numbers alone. It is recommended to take the information and use it to make conversation with the patient about how they are feeling, what they are thinking about pain or their condition and that will help make decisions. “To determine what treatments to provide patients we are actively conducting research to understand how exactly to interpret this.” “I think that the fear avoidance of beliefs, I’ve always conceptualized as a term that would encompass the term like kinesiophobia which is a more specific term that focuses on the fear of movement. I think that there are several different types of fear patients can display, fear of pain, movement, injury. All of those I conceptualize under fear avoidance beliefs and in my clinical experience I tended to see that you could have patients that were extremely afraid of reinjury but not necessarily afraid of pain.” Trevor Lentz Clinical Pearl: “The biggest thing I could recommend is the value in looking at recovery and rehabilitation from a biopsychosocial perspective. One of the things I found helpful both on the research and clinical side, is getting to know your providers outside of physical therapy. Developing relationships with the physiologists that are working in that field and your orthopedic surgeons and others to understand how they are portraying this information to patients. How they are talking with patients about their condition and their recovery. It is helpful to hear their perspective both ways and for you as a physical therapist to be able to inform them on the types of things you are encountering within clinical practice and how you feel they could be helpful within this whole rehab process. Making sure you are really listening to the patients. That was something that people coming out of school recognized as important and understanding goals and values and beliefs, but I truly didn’t recognize that until I got a little further out and started doing a lot more work around physiological distress that sometimes to get into those conversations with a patient about their physiological needs you really have to listen and dig a little bit. I think that is very important and falls within our scope of practice and something that I think we should be doing."   Helpful research and training: Therapeutic Neuroscience Education Advance Therapeutic Neuroscience Education: Focus on Function Hurt People Hurt People Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions OrthoPT's OSPRO Scoring Tool Ad Info: How many of you are thinking about or preparing to sit for your board-certification exam? Achieving board certification can be a strenuous process, and the right prep course can mean the difference between a passing and failing exam score. PT Elevated sponsor, Evidence In Motion, offers test prep courses for OCS, SCS, and GCS, with over 95% pass rates! As a podcast listener, you can get 5% off a prep course now. Find the promo code and more info in the show notes. You got this!  Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter @TrevorLentzPT on Twitter

Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day. On our fifth episode of season 2, Dr. Louie Puentedura, a Professor in the Department of Physical Therapy at Baylor University and an EIM faculty member discusses the evolution of manual therapy.  Here are some of the highlights: Louie was trained and worked as a physical therapist in Australia until 1995 when he came to the United States primarily because of problems he could see in the field of manual therapy. He now is a full-time clinical professor at Baylor University. "Recently there was an update to the clinical practice guidelines for the treatment of acute and chronic lower back pain that recommended manual therapy and exercise. Not for manual therapy alone and not for exercise alone but for manual therapy and exercise combination." “I think that the take home message is that most patients will benefit if they are given a combination of education, manual therapy and exercise. Even patients experiencing chronic pain that you are attempting to convince that their pain is not because of a certain structure in their back, can benefit." "A lot of the research tends to suggest that manual therapy is not very effective but if you look at that research, they haven’t tested or done experiments on manual therapy. They have a hard time defining what manual therapy is. Is it thrust? Joint techniques? Or is it non-thrust mobilization? Many of the researchers lump it altogether and say it is all the same." Louie looks at Clinical Prediction Rules as a guide to determine if a patient needs a thrust manipulation versus a non-thrust. He says the style of treatment nowadays is much more about empowering the patient and making sure they achieve self-efficacy and self-care. Back in the 80s that was not what was being promoted. "It was all about; you have come to me because I can fix you. I might need several visits to fix you, but we will get you there." "In that process of trying to promote a safer way of trying to manipulate the neck – I hope I’ve made it less scary to manipulate the neck. But I also hope that therapist who do manipulation thoracic techniques to the neck they are learning how to do it appropriately and safely." Louie Puentedura Clinical Pearl: "One of the things that has stuck with me over the years is that early on I wanted to be just like my mentors. I had people like Jeff Maitland, Robert Mckenzie, Bob Elvey and all these people to look up to and I would watch them treat people. The first few years out in clinical practice I didn’t feel like I was making any progress. What I realize now that I’m much older is that the little bit of practice that I do every day, accumulates over the years. It's really only after many years that you start to feel very confident and skilled at what you do. It just takes time to practice. That is what we are supposed to do as PTs, keep learning, practicing, keep getting better. Once you stop doing that and stay where you are, you are not growing and maybe you shouldn’t be in that practice anymore."   Helpful research and training: Manual Physical Therapy Certification Management of Upper Extremity Disorders Management of Lumbopelvic Disorders Management of Lower Extremity Disorders Ad Info: Since you’re listening to this podcast, there’s a pretty good chance you’re the type of clinician who is always learning. One great way to learn more and earn CEUs is Evidence In Motion’s huge selection of courses. If you prefer to stay home and save on travel, they’ve got self-paced and faculty-led online courses and virtual labs. Or you can opt for a hybrid option with their in-person weekend intensives. Choose from topics ranging from MSK management and pelvic health, to dry needling and pain science. You can save 5% on courses as a PT Elevated Podcast listener. Just look for the promo code and links in the show notes. Connect with us on socials: @ZimneyKJ on Twitter @PMintkenDPT on Twitter @AussieLouie on Twitter @louiepuentedura on Instagram