Update: Be patient with the Samahope.org site as they roll out over the next few days… 

Welcome to PT Think Tank’s new website design and Happy Mother’s Day to all the mom’s out there!

Today, we’re going to jump right in and get real on Mother’s Day. So real, in fact, that we’re going to talk about fistulas. Obstetric fistulas, to be specific. The kind that form mostly in impoverished countries after childbirth, we’re birth trauma causes tissue death and connects parts of the mother’s pelvic anatomy that should never, ever be connected.  Women suffering with obstetric fistulae are ostracized by husbands and communities and suffer from infections, poor quality of life, and even death.

According to The Fistula Foundation, the occurence of new obstetric fistulae number about 50,000-100,000 annually, while the global capacity to treat this condition is only around 20,000. While this condition is extremely rare in developed countries, the World Health Organization estimates that between 2 to 3 million mothers in poor countries struggle with it. While the cause of obstetric fistulae are complex,  with as little as $450-$1000, the condition can be effectively repaired surgically.

My very compassionate and talented fried, Michelle Greer let me know about Samahope. Samahope.org is attempting to tackle this problem. This new venture is working to crowd-fund this procedure for women who can’t afford it. In an elegant interplay between philanthropy and technology, Samahope.org allows donors to select the individuals you want to help, donate simply using PayPal, and even track the outcomes for the surgeries they helped fund. Samahope.org is a project of Samasource.org, a non-profit based out of Silicon Valley who is working to reduce poverty through creating jobs via the innovate idea of mircrowork, connecting people with jobs over the internet. Leila Janah, the founder of Samasource, spoke recently at a TED event in Brussels:

Get involved and for this Mother’s Day, in addition to that nice pot of flowers and brunch we all like to confer upon our maternals, give the gift of life. Samahope.org is beginning their rollout today. In fact, they have but one tweet. It says, “How can you help change a life with only $20? Easy… I just did.“

Donate Now

Recently, the physical therapist social media world has been a buzz with #SolvePT. I added my thoughts on this in a separate post. This movement made me reflect on a Ted Video I watched and enjoyed recently. It got me thinking and it spawned this week’s thought.

Inspired by the video below by Brene Brown, we need vulnerability to connect. I believe the recent #SolvePT is a nice illustration of connection, albeit virtual, happening within the physical therapy profession. Now, taking the leap to join social media, and then leaping into the conversation means putting yourself out there in a virtual, but very real sense. It means expressing thoughts, views, and ideas. Ideas the world and other PT’s can read (and critique!). It is social media vulnerability, but we need it to truly connect.

Connect!

Now, what about in real life; what about the patients we serve? Many, if not all, come to us in vulnerable circumstances. Sharing their stories, their illness narratives, they are vulnerable. Are we, individually and collectively, creating an environment that welcomes and nurtures vulnerability in order to facilitate connection, understanding, and transformation?

You need vulnerability to connect. What can we do better in our personal and professional lives? Individually and collectively? What can we do better in education of our students and patients?

Thoughts? @Dr_Ridge_DPT

Recently, a new hash tag has emerged in the physical therapy twittersphere: #SolvePT. Selena, via the Evidence in Motion Blog, shared her thoughts in a post The Pulse of Physical Therapy. Dr. E of the Manual Therapist also briefly highlighted this new hash tag in a post.

#SolvePT

Initially, discussions focused on financial issues of physician owned physical therapy services (POPTS), student loans, payment, and educational costs. But, today involvement and content was rich with various contributors and topics. Physical Therapist Twitter regulars such as myself (@Dr_Ridge_DPT), Larry Benz (@PhysicalTherapy) and @SnippetPhysTher were present. @PTThinkTank even tweeted a few insights. Other tweeps included:

• Physical therapists from various states and practice settings
• Professional Organizations: @AAOMPT  @APTACO
• Sections of APTA: @SPTSAPTA (Sports)  @AcuteCarePT
• Physical Therapy Students: @APTASA (Student Assembly) @MattDeBole
• Physical Therapy Programs: @PacificDPTweet

Web 2.0 principles allow us to crowd source and brainstorm with a much wider audience; geographically, practice setting, and expertise. This hashtag will allow for the recording and analysis of a wide range of view points and ideas. We can follow the evolution of topics over time. This stream and  medium could be leveraged by larger, more formal organizations (are you listening APTA?) for idea generation  to guide future task forces and initiatives. In fact, some of the issues, solutions, and thoughts for future direction are solid. #SolvePT is already evolving into a task force.

My Insights and Thoughts

There was a lot of focus on “best practices” in physical therapy. Defining, measuring, communicating, and then teaching best practices is extremely challenging. Todd Davenport of @PacificDPTweet, made the observation that “best practice” is a moving target given the evolution of research, science, and understanding. I agree. Further, who defines best practice? I think we must look beyond a specific patient and episode of care when defining, analyzing, and teaching best practice. In addition, we must look at multi-level outcomes. For example, for an outpatient perspective we can not just look at the patient specific outcome of that episode of care, the time/number of visits, and it’s cost. That is a too narrowly focused frame of reference. We should broaden our lens, and our potential for impact. We need to also need to consider (and target?) recurrence, future health care costs, risk reduction for other medical conditions, and overall health/fitness. Cardiopulmonary fitness is maybe the most dramatic modifiable factor to prevent disease, morbidity, and mortality.

I brought up the topic of physical therapists in hospital intensive care units. Johns Hopkins performed a quality improvement project where they staffed 1 physical therapist for a 16 bed medical ICU. Their estimation is that by decreasing ICU length of stay and increasing patient mobility/function the hospital, and thus the health care system, saved an estimated 5 million dollars over a 1 year period. The internal investigation lead to the hospital staffing 2.2 full time physical therapists solely in a 16 bed medical ICU. This is a dramatic change in practice focused not on productivity or reimbursement, but on VALUE, risk reduction, and other broader outcomes.

Unfortunately, in discussing best practice no attention was brought to the actual content of current PT programs. In my opinion, pain science/physiology, basic neuroscience, critical thinking, philosophy of science, cognitive biases, and metacognition are vastly lacking from our curriculums.

The teaching and study of pain should be integral in all PT education, both didactic and clinical. We have neuromuscular, musculoskeletal, cardiopulmonary, and or medicine tracks in our programs. Why do we not have a specific pain track? Or, at least a focus and integration of neuroscience and pain physiology into our other courses? Regardless of practice setting, the majority of our patients will have a primary or secondary complaint of pain. Joe Brence, who blogs at ForwardThinkingPT, started an online petition regarding this exact topic. I recommend you sign it HERE.

In order to be “evidence based” (or more accurately Science Based) we need extensive training in the philosophy of science and critical thinking including prior plausibility, research design, and article analyses. To assume that students entering PT programs received such instruction as undergraduates is, to put it nicely, a huge assumption. How are we to make appropriate clinical decisions if we do not understand our inherent cognitive traps and biases? How are we to correct them, if we can not even recognize them? The skill of appropriately analyzing a single article based on design, statistics, and results in the context of plausibility, basic science, and the state of other literature AND THEN applying that to everyday clinical practice is what being a master clinician-scientist is all about. And, that is what we need to strive for. The title of Tamara Little and Todd Davenport’s recent editorial in the Journal of Manual & Manipulative Therapy sums it up quite nicely: Should we be expert clinicians or scholars? The answer is yes.

How do we generate results from this passion and discussion?

1. How do you think we should #solvePT?
2. What are the most pressing issues in education, payment, practice, and our evolution?
3. How can we focus some of the general issues and proposed ideas into specific and concrete action; solutions!?

#SolvePT has been thought provoking. Hopefully, it will continue to grow. I foresee big potential in this type of interaction.

Our inaugural PT Think Tank Thought of the Week was BE YOU.  This week’s thought stems from a video that has been circulating over the past few months. Inspired by the video below, this weeks thought is:

MOVE

Slow movements, fast movements, weird movements, new movements!! Time to get moving. Obviously, this video discusses some of the health implications of not moving, and the benefits of daily activity. As physical therapists, we are always trying to assist our patients with movement. How can we best assist them to not only become themselves (per the previous thought of the week), but MOVE more to illicit potentially powerful health, wellness, and quality of life benefits? Your thoughts?

…real scientific and professional discussion? Priceless.*

*And free

In a previous post, Publishing in Science: Are Industry Standards Serving Researchers, Clinicians, and Science?, @JasonSilvernail and I discussed some of the problems with the current publishing industry paradigm as well as our personal frustrations with the process. These insights stemmed from writing a letter to the editor of Manual Therapy, which is currently e-published ahead of print (in press, corrected proof). A link can be found here: Innominate 3D motion modeling: Biomechanically interesting, but clinically irrelevant.

Well, unfortunately for you, reading that letter will cost you $31.50 unless you have a subscription to Manual Therapy, or are affiliated with an institution with accessing rights. For those of you doing mental math at home, that equates to 6.3 cents per WORD (references included at no extra charge!!) Of course, no abstracts accompany letters to the editor, but they do provide a 29 word preview (essentially 1.5 sentences). My question is: does anyone EVER buy a single letter to the editor? I sure hope not. Logically, I can’t imagine publishing companies profit significantly off 500 word letters to the editor, because I can’t imagine anyone buying them.

Now, if you would like to read our longer, better version that was denied prior to review check out this post:        SI Joint Mechanics in Manual Therapy: Relevance, Please? It even includes links to 2 other blog posts that have healthy discussions happening in the comments section. The references section contains links directly to abstracts.

• Don’t agree? Have other insight? Want to comment? Click the comments section and fire away.
• Want to share? Tweet, link back, Facebook, Google+, e-mail, and re-distribute the link freely.

Putting a 500 word letter to the editor behind a pay wall seems to accomplish nothing for science, discussion, clinicians, or even the publishing companies. We think it’s time for a change...

@JasonSilvernail   &   Dr_Ridge_DPT

We are starting a new, original feature on @PTThinkTank called Thought of the Week. Other blogs have weekly links, videos, songs, fun posts, and other various features. This will be ours. Since this is a Think Tank, we figured it should be a statement, a thought.

Thoughts may be funny, serious, analytical, and or insightful. Hopefully, they will provoke thought. Posts will likely include links, pictures, and videos that illustrate (or even inspired) the message.  As always, sharing, comments, and discussion are not only allowed, but highly encouraged.

Inspired by the video below (and credit to my graduate school neuroscience professor and faculty advisor @RGisbertDPT) the first PT Think Tank “Thought of the Week” is:

BE YOU.

Now, the thought could have been MOVE or DANCE or FREEDOM. But, in the end you can move, dance, and be free to become yourself. So, BE YOU. How can we assist our patients to be themselves? Or, more importantly have them change and move to become the selves they desire?

Your thoughts…?