In this research recap, I continue the conversations surrounding individualized care and movement optimism. I tackle the myth that running is bad for your knees while also challenging my own biases on MRIs. No topic should ever be written off. There is always more to learn.

Applying the evidence to your clinical practice:

1. How do you determine an appropriate dosage of running for a patient? What if they have OA? What if they are experiencing knee pain?
2. How do you discuss MRI findings with a patient? How do findings influence your prognosis?
3. How can you improve hip flexor strength?
4. What are the differences between relative and absolute risk? How do they influence your education about treatment risk?

Links to the studies:
PMID: 33279802
PMID: 34269758
PMID: 34375940
PMID: 34287630

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This session explores patient values, goals, and expectations. We explore four types. of expectations that help shape a plane of care:

• Predicted – What they believe will occur
• Ideal – What they hope will occur
• Normative – What should occur
• Unknown – Unaware, unwilling, or unable

Understanding a patient's values, goals, and expectations are vital to treatment and plan of care development.

Research discussed:
Expectations
Values

Find out more about the PT Solutions Orthopaedic Residency Program here.

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Let's kick off this episode with a hot take: having a PT degree does not make you a movement expert.

In this episode, I discuss movement expertise and exercise prescription. How good are PTs at prescribing exercise for outcomes other than pain and functional outcome score improvement?

I also discuss the use of manual therapy in PT. 

Applying the evidence to your clinical practice:

1. How do you determine the dosage of exercise intensity for aerobic training? How do you determine the dosage for a patient's home exercise program?
2. How confident are you in prescribing exercise for strength, power, hypertrophy, and endurance? How can you improve your confidence level?
3. How do you decide what manual therapy techniques to use and when to use them? What are your measures of success?
4. How do you carry yourself in the clinic? How do your attitude and appearance change during the day?

Links to the studies:
PMID: 34822354
PMID: 33662892
Demonization of Manual Therapy
PMID: 34126294

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How do physical therapists show value? How does that value proposition change when interacting with patients, legislators, or payors? In this episode, I discuss how to show value and where physical therapists and the profession are missing the mark. I also use statistics to show why individualized care is so important. Research should provide the foundation for treatment, but research alone never provides the full answer. All treatment and assessments are a blend of art and science.

Harwood 2022 Study (PMID 35606781)

Hear more takeaways in my Residency Recap reel. My recent reel on this residency session discussed how frequently patients should be treated within a plan of care.

Find out more about the PT Solutions Orthopaedic Residency Program here.

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This episode was recorded in 2020 but unfortunately never aired. It's a shame because it is a great conversation and very relevant to the current landscape of physical therapy.

Telehealth took center stage in physiotherapy across the world in 2020 due to the COVID-19 pandemic. Additionally, digital PT has exploded in popularity, leading to concerns that brick-and-mortar PT may become obsolete.

Rather than approaching these care models as 'ether/or' we should be exploring and refining hybrid models.

Tom and Lindsay share their experiences with hybrid care and the data outcome they have collected at CBI Health. The research that has been published since this conversation supports their conclusions. The hybrid model supports continuity of care, improves patient outcomes and satisfaction, and expands access to clinical experts.


Bios:
Tom Carter is the National Director of Clinical Excellence at CBI Health, a national provider of rehabilitation services, and he completed his MSc at the University of Toronto in the Graduate Department of Rehabilitation Sciences. His research interests involve the interdisciplinary management of injuries and the field of health services. He has held the appointment of Adjunct Lecturer in the School of Physiotherapy, Faculty of Medicine at the University of Toronto. For over 20 years Tom has provided leadership expertise developing interdisciplinary healthcare teams providing community-based services, managing outpatient rehabilitation clinic operations and training programs at the clinic, provincial and national levels.

Lindsay Benoit graduated from the University of Alberta in 2004 and has worked in an interdisciplinary brain injury team treating concussions, traumatic brain injury, and stroke since graduation. Throughout her work with this population, she has taken several courses related specifically to vestibular rehabilitation including the Herdman Course out of Atlanta Georgia. Lindsay was a key person in developing the protocols in CBI as they relate to concussion treatment as well as for traumatic brain injury and stroke. Lindsay teaches a vestibular course and a concussion course to assist in using best practice across CBI. She is also one of the subject matter experts for CBI in concussion and vestibular care.

CBI Health

APTA Consumer Awareness Research Report

APTA's stance on digital health

Digital health resources

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One of our residents asked, "what is failed conservative care." This question was unpacked in our third residency session and I cover it in this episode of Residency Roundup.  I also discuss the importance of patient limitation, locus of control, and patient satisfaction.

Hear more takeaways in my Residency Recap reel. My recent reel on this residency session discussed why there are no optimal movement patterns.

Find out more about the PT Solutions Orthopaedic Residency Program here.

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What is a Clinical Specialist? Better yet, what does it mean to specialize in PT Practice?

I explore the answers to these questions in this podcast episode. I talk about obtaining clinical specialization certifications and developing clinical expertise and how they differ. I also look at the relationship between expertise and experience. I provide four key strategies every student and clinician can employ to develop expertise.

This talk was originally given at the 2022 GA Student Conclave.
APTA Georgia Student FIN Instagram Page

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This episode covers two main topics discussed in our second residency session: labels and good physical therapy vs. bad physical therapy.

The labels we use have profound effects on our patients and the ways we interact with them. If we label patients by a body region or diagnosis, it’s easy to home-in on that specific label and miss key characteristics of the individual, causing us to develop and implement an incomplete plan of care. It’s important to understand the patient’s primary complaint, but we don’t want to limit their experience or define them strictly with that complaint.

Is bad PT better than no PT? This argument can parallel the discussion of some exercise is better than no exercise, but we need to consider the long-term implications for the patient and the profession. How does the outcome and experience of PT influence public perception, reimbursement, and direct access laws? I discuss this in greater detail in the episode.

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Applying the evidence to your clinical practice:

• When are painful exercise interventions ok? How do you minimize anxiety and catastrophizing with painful exercise?
• Do you purposefully use painful manual therapy? If so, what is the communication to the patient? 
• How do educate a patient that experiences an increase in pain after exercise? Does it influence future exercise considerations?
• How do you structure plans of care when hypertrophy is the goal? What variables do you consider? How do you increase patient buy-in? How do you integrate an effective HEP?

Links to the studies:
https://pubmed.ncbi.nlm.nih.gov/33887445/
https://pubmed.ncbi.nlm.nih.gov/34391267/
https://pubmed.ncbi.nlm.nih.gov/33400333/
https://pubmed.ncbi.nlm.nih.gov/34658936/

Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!

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In this Residency Roundup, I cover the first session of the 2023 PT Solutions Orthopedic Residency Class. Today’s session focused on communication and relationships. Here are a few key reflection questions from the session:
 
How do you measure clinical quality?
How does the patient define success in PT?
What does the patient need from you?
 
A necessary attribute to be a clinical expert is curiosity. We all need a willingness to adapt, understanding no tool is undroppable.
 
Much of the residency will be focused on fostering curiosity. We also will work on refining, even shrinking the clinical toolbox. Rather than trying to add a bunch of shiny tools, we will focus on perfecting the foundational tools necessary for great patient care: relationship building, communication, and exercise.

Find out more about the PT Solutions Orthopaedic Residency Program here.

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