Panel Discussion: What evaluations, assessments, and tests do you use on a regular basis?
Many assessments have received heavy scrutiny due to new research examining their reliability and validity. How does this affect your evaluation process? What does the modern evaluation look like?
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This discussion started on my personal Facebook page –https://www.facebook.com/brent.brookbush on January 17th, 2015
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Brent Brookbush Example: Do you use special tests, goniometry, muscle length tests, MMT, postural assessment, Cyriax/Maitland style joint exam, soft tissue evaluation, neurodynamic testing, outcome measures, etc?
Feel free to get more specific, if you like certain goniometric assessments and not others list them (ex. shoulder external rotation but not shoulder extension).
Leon Chaitow Postural assessment - based on the Janda model; also Janda and Lewit's functional assessments such as hip extension, hip abduction; scapulo-humeral rhythm, active SLR, gait analysis; balance assessment; breathing function assessment - including a mix of questionnaires, biomechanical and capnometry tests; soft tissue evaluation including skin/fascia/muscle/joint using osteopathic TARTT assessments (tissue texture, asymmetry, range of motion, tenderness, temperature features); diet and lifestyle evaluation - with possible lab tests as follow-up. …Not all are used for everyone, and I've probably left a few out….not sure if they are all 'validated' but a combination of evidence from these tends to point me in clinical directions that achieve modest success . January 17 at 11:40am
Brent Brookbush Leon Chaitow - So no special tests, goniometry or MMT's? I certainly need to read more of the Lewit texts. January 17 at 11:44am
Leon Chaitow Brent - I leave 'specifics' to those who are immersed in the biomechanical detail of dysfunction. My approach is more broad-brush, whole person….I am interested in the person rather than the specific range of motion. January 17 at 11:45am
Brent Brookbush Leon Chaitow - Does insurance reimbursement play a role in any of the tests you choose? - for example, in the United States certain 3rd party payers may expect to see the results of particular special tests, or see improvements based on a specific outcome measure (questionnaire). January 17 at 11:47am
Maurice D. Williams I'm basic. OH Squat, OH Single leg Squat, Push Up, Upper Extremity & Treadmill Gait. Will add goniometry once I feel comfortable with it. January 17 at 11:55am
…oh, I forgot, in assessment, one of the most important factors is the individual's belief system - what they understand about their condition. In answer to your insurance query - some patients claim reimbursement and I am registered as a clinical expert by some companies…none of these has ever asked for details such as you mention. Most patients are self-funding apart from those I used to see in National Health Service settings, where the patient paid nothing and I was paid a salary. We conducted a detailed audit of the outcomes of some years of the provision of what was then called 'Complementary' treatment (acupuncture, osteopathy etc etc)…and found that we saved the service a great deal of money in medication prescription. This was published in 2001 by Elsevier: http://www.amazon.com/Integra…/dp/0443063451/ref=sr_1_5…
Integrating Complementary Therapies in Primary Care: A Practical Guide for Health…
AMAZON.COM
Brent Brookbush Goniometry just takes a little practice, and a good background knowledge of the restricting structures. I should have all of the basic goniometry videos up in the next couple of months Maurice D. Williams - January 17 at 11:59am
Brent Brookbush Interesting info Leon Chaitow ,
I know there are a couple studies out of Australia that show the huge cost-savings of physical therapists having direct access. We certainly need to see some major changes in our medical system - and a small yet meaningful shift from everything being driven by the physician to appropriate use of human movement professionals for orthopedic complaints. Hopefully this does not come with more "Insurance Dictated Evaluation". - January 17 at 12:08pm
Steve Middleton Contrary to what my education has taught me, I try to simplify everything:
Subjective/historyPosture
Fascial Movement Patterning
Then, I'm ready to start treating:
Gua sha the tight regions previously noted
Stretch the tissue: note end-feels and address as needed (joint adhesions, tight capsule, etc), note neural tensions, etc
Address any joint restrictions
For insurance, after the FMP, I will goniometers the muscles the screen seems tight then MMT their antagonists. Record joint and neural findings, etc. - January 17 at 12:59pm
Brent Brookbush Can you go a little more into detail on the Fascial Movement Patterning Steve Middleton ? - January 17 at 1:01pm
Schmid Etienne I am currently using ROM and muscle testing as part of my evaluate my client
Schmid Etienne i think that is much more effective than many other assessment
Schmid Etienne Leon you mentioned that you are interested in the person but the person is compose of the individual parts. Those part will give you more information about the WHOLE if assess properly. and ROM is the best way to assess that. - January 17 at 1:05pm
Brent Brookbush When you say "muscle testing" Schmid Etienne , are you speaking of the Kendall Manual Muscle Tests (traditional), or muscle testing more akin to MAT, FMS and National Academy of Sports Medicine (NASM) in which a score is - weak, strong, with compensation, or pain? - January 17 at 1:06pm
Schmid Etienne MAT - January 17 at 1:06pm
Schmid Etienne Brent Brookbush i have enjoyed your discussions and info since we met in Chicago. Thank you for helping me realized theres more to training/fitness - January 17 at 1:11pm
Brent Brookbush Just one more thing I want you to realize Schmid Etienne - if you hit "shift + enter"You can start a new paragraph without having to start a new post
Thank you for posting January 17 at 1:35pm
Leon Chaitow Schmid Etienne I think we see the situation differently - but maybe we are looking for different answers so are asking different questions. ROM is a small part of a big picture and may be compromised for many reasons. Reduced ROM tells you 'what' - but it doesn't tell you why. - January 17 at 1:58pm
Jamie Lowy In home health, we are reimbursed more for functional gains versus specific measures for ROM or MMT. I use TUG, Berg, dynamic gait, functional reach, 2 and 6 minute walk test paired with Borg's rate of perceived exertion, just to name a few that I'll look to use on my initial assessment. January 17 at 2:47pm
Schmid Etienne Leon Chaitow Reduce ROM tells you a lot about the state of the individual. I understand this: Our bones do not pass load to one another. Forces transfer through our muscles and facial structures to avoid compression of the bones. As long as all of the tension mechanism stay intact, the joints and bones stay separated. Therefore reduction of ROM that is not symmetrical is a big problem. that problem can effect nervous system, cause inflammation and many more. Leon Chaitow - January 17 at 3:46pm
Melinda Reiner There's a lot to be said for watching clients/patients in their "preferred" actitivities. What you see functionally, especially when a client is fatigued says lots in regard to dysfunction and what needs to be addressed. I do use the overhead squat assessment as my baseline and proceed from there. Functional for different sports are quite different, and these are folks from some of these sports that I've treated: track & field (sprints, middle distance, distance, pole vault, hammer throw, discus, javelin, long/triple jump), basketball, football, lacrosse, softball, fencing, wrestling, volleyball, field hockey/ice hockey, ultramarathoning, etc. I had an Olympic fencing coach, who could not coach past 2 hours (and was at risk of losing his job), and no one had ever considered assessing him by putting him through the mechanics of fencing….are you kidding me?! After simulating fencing him in the hallway, it was clear what to address from an exercise standpoint and also, from an orthosis standpoint. Very grateful to say that one month later, he was 90% better and coaching 6-8 hours per day--huge, considering he was at risk for losing his job and now, his athletes are on the podium consistently at major competitions (including 2 Olympic gold medalists!). Emphasizing the need to assess in the specific activity, and there are many ways to do that. January 17 at 4:07pm
Nicole Castillo I do the overhead squat assessment, 3 minute step test, posture assessment and push up test. Also do the tape measure starting point then every 5 weeks redo all of them to see progress. My one senior client do ROM assessment, step and overhead squat as she is on beta blockers. January 17 at 5:02pm
Tony Susnjara Yoga is my primary modality and the yoga postures tell you so much of what you need to know. I regress the postures, (this is after brief case history and questionnaire about injuries, health issues medication and so on) and most of the imbalances sho…See More
January 17 at 5:05pm · Like · 3
Brent Brookbush I see a ton of movement assessment which is great (Melinda Reiner , Nicole Castillo and Tony Susnjara ). What do you do after assessing an issue to differentiate potential variations between individuals? January 17 at 8:34pm
Melinda Reiner I think history plays a key component. And, also, changing things up based on what I see and feedback from the client over time. - January 17 at 8:35pm
Brent Brookbush After initial evaluation, treatment should be considered an important component of assessment Melinda Reiner - January 17 at 8:54pm
Melinda Reiner Let me clarify the second part of what I said earlier…I like to combine what I see and feedback from the client in continuing to tailor treatment programs. Some issues can be truly cookie cutter, but every human being is different/unique in their anatomy, injury/surgical impacts, health and work issues, etc. - January 17 at 8:56pm
Tony Susnjara If I could sum it up in one word it would be balance. If you have a tensegrity structure where some of the tensional elements are too tight and some are too loose, you tweak them like you would a set of guitar strings and of course there is stability and all of the other elements.
You can work on the balance over time while you are also working on progress which is overall strength, flexibility, endurance, motor control and so on.
If you consider the idea of a 'chain' with a series of links, I like to work on the links separately before working on the continuities so if someone has issues with flexion, the plantar fascia, calves, hamstrings can be stretched in isolation before performing say…a downward dog - that's one example among many. For back bends, it's typically about more thoracic mobility, more hip extension and limiting lumbar flexion.
In yoga, that is still the foundational work because when a certain level of competence is reached, you can work on the autonomic nervous system stimulating a sympathetic or parasympathetic response as required or desired. - January 17 at 9:14pm
Ken O'Neill Tensegrity is a general systems theory concept of utmost importance to whole systems' optimal self-organization as integrity. For those doing Chinese medicine, if you're learning it by learning to read original work in Chinese, you're ahead of the game since Chinese is a process language, Dao the original systems model of life/world. I recommend learning to read and write classical Chinese as a life long activity for sharpening holism understanding. - January 17 at 9:35pm
Jason Erickson Leon Chaitow said, "Reduced ROM tells you 'what' - but it doesn't tell you why"
Damn right. The same can be said of muscle testing. It gives you some ideas of where to look, but it's never going to tell you exactly what the cause is.
I would argue that the underlying cause of pain/dysfunction is, in many (most?) cases, never accurately identified. Despite this, the client often successfully recovers, or improves considerably.
The fact that a client improves following an intervention based on xyz conceptual model of assessment and treatment often leads us to erroneously assume that the xyz model was correct in identifying the cause and therefore how to treat it. This leads to confirmation bias.
Rather than a "cause", I tend to think in terms of "factors". A multitude of things can and do impact how the body responds to sickness/injury/stimulation/etcetera. While some factors have a more obvious impact than others (i.e. tear in glenoid labrum, spiral fracture of tibia), others can also have an important impact on long-term outcomes.
* What is the client's attitude towards their pain/dysfunction and to how it arose?
* Do they have a supportive social network?
* How patient are they?
* Are they self-motivated to follow through on self-care directives?
* Do they self-identify with the pain/dysfunction?
* Have they dissociated themselves from the area of pain/dysfunction?
* What sorts of compensation patterns do they have?
* Is their pain/dysfunction the primary issue, or is it the result of compensating for something else?
Those of you familiar with the biopsychosocial model of pain can see where I'm going with that.
The list can go on and on. Sometimes I really want to know a lot more about a client, but I am wary of getting caught in the "paralysis of analysis".
When my father had a stroke, he was admitted to St. Mary's Hospital in Rochester, Minnesota. Affiliated with the Mayo Clinic, St. Mary's is a world-class facility… but he received poor physical therapy. Why? Because every time he went to the PT center, he worked with someone that hadn't worked with him before. In an hour, they would spend most of the time doing assessments, then spend 10-15 minutes doing treatment, and then his time was up. In a half hour, he'd get maybe 5-10 minutes of treatment. As a result, he improved very little in the time he was there.
Because so much time was taken up by gathering information, very little real work was accomplished. If he'd had the same PT every time for the length of his inpatient treatment, he might have achieved a lot more by doing more work.
I think the process of assessment is important, but I haven't seen any particular assessment process that I strongly recommend over any others. My personal and practical preferences favor those methods that don't take much time.
Here are some of the questions I consider when assessing what seems to be a routine musculoskeletal injury:
* How do the client's signs and symptoms align with the proposed mechanism of injury?
* If already diagnosed, how does the diagnosis align with the signs, symptoms, and proposed mechanism of injury? (Is there reason to refer for a second opinion?)
* Should I attempt to work with this person, or refer them elsewhere?
* What are the patterns of discomfort that this person experiences?
* What are the patterns of dysfunction that this person experiences and/or displays?
There is no particular system of assessments that adequately explores all of these, so I must use a variety of methods. Some can be found in any orthopedic assessment manual, others are simple functional tests that I may create on the spot to see what they do and what they report during/afterwards.
To me, movement is more important than posture. I will look at posture, but movement tells me a lot more.January 17 at 11:55pm
Jim Horn After taking their history, I start by watching them walk, then the SFMA top tier. From there, I'll go to the more standard measurements that 3rd party payers seem to value (I think you make a good point about what the insurance companies like to see, Brent). - January 18 at 8:28am
Leon Chaitow I am returning to this discussion because reading various posts has led to a thought that I have found useful, particularly when confronted by complex symptoms: Almost all symptoms are evidence of failed or failing adaptation. One early task is therefore to evaluate/recognize what adaptive demands are operating….and to modify, minimise or remove these --- or find ways of helping the person or part to adapt more efficiently. Those 2 elements in the end define successful therapeutic intervention: Reduce adaptive load/enhance functionality…and 'assessment' - in all its forms - is only useful if it contributes to identification of those features of dysfunction. - January 18 at 9:09am
Brent Brookbush Hey Jason Erickson
I really appreciate your post, but I have to address your comment about "confirmations bias," and this horrifically offensive sentiment -"I would argue that the underlying cause of pain/dysfunction is, in many (most?) cases, never accurately identified. Despite this, the client often successfully recovers, or improves considerably."
The "confirmation bias" may hold true for an individual who saw 1 patient, but if the same evaluation and treatment methodology works for a larger more varied population with varied pathologies and dysfunctions than you can hardly assume that a "confirmation bias" is keeping us from the truth - in fact, the larger and more varied the population, the less the "confirmation bias" is likely to apply.
The reverse logic is almost always applied, in just about every argument I have ever seen for the BPS model… "Oh, your physical therapist failed you? It's because they didn't use the BPS model" - Now, it that is not bias, I don't know what is.
It is actually quite offensive to think that after nearly 10 decades of orthopedic evaluation and treatment (and more than enough research to back it up - look up Cyriax), that we, as medical professionals, cannot, under most circumstances, find the original insult which precipitated into a pain syndrome.
I am all for integrating the biopsychosocial model and really appreciate your last 6 questions… which should likely be added to a subjective evaluation (maybe an evaluation template)… but, to imply that without the BPS we are failed clinicians is crossing a line. I have been remarkably effective using an integrated movement impairment approach (NASM CES) well before I was a DPT - and now with a scope that includes differential diagnosis, assessment and manual therapy - I am more effective using an integrated movement impairment approach. I have a tremendous body of research backing what I do… and I have yet to see one study proving that the use of the BPS model by an orthopedic clinician was more effective than any model… well… actually, effectively used by a manual therapist in any setting at all.
Last, the BPS model has come under scrutiny lately… in actuality it is not a model that will aid with clinical decision making… it at no point implies an intervention for a particular dysfunction/pathology or diagnosis. The BPS model probably aids in roughly 10% of my cases, and even then, it may amount to 5% of treatment…
Keep doing what you are doing Jason Erickson , but don't forget where we came from. You were effective before BPS, and you will be long after this surge in popularity decreases and the BPS finds it rightful place - on an even keel with other successful methodologies. - January 18 at 9:36am
Brent Brookbush Thanks Leon Chaitow ,
You reinforce a point I have been teaching recently… If an evaluation/assessment/test does not either "clear" a patient for treatment, or have a direct effect on your intervention selection - get rid of it. - January 18 at 9:38am
Jason Erickson Brent Brookbush , I used some examples of questions that are consistent with consideration of BPS thinking, but at no point did I say that clinicians can't be effective (or accurate) if they don't think in a BPS model.
It's merely my opinion that, regardless of the methods used, we are always at risk of confirmation bias, and that what we think the cause may be, may be an error. I don't think there are any exceptions to this.
After more than 10 decades of medical research and development, I agree that we've come a long way… and yet (to me) we still seem light years away from developing consistently reliable assessment and treatment methods.
Manual muscle testing is one example of a category of assessment that has exhibited low interrater reliability. There are many different schools of thought regarding manual muscle testing, and claims regarding reliability, efficacy, efficiency, etcetera, some of which have become marketable "modalities" with their own brand names, personalities/gurus, and protocols. Because of the personal investment of time, effort, and resources required to learn any of them, those practicing such modalities are effectively subscribing to a way of thinking that encourages confirmation bias.
The same principle can be extended to any/every "modality", particularly if it comes with a brand name/certification/"guru". Those in charge of the brand name have a market share to protect, and they do so. (I have no particular axe to grind against MMT, it was just the first example that came to mind.)
In short: The guy who sells hammers tends to encourage people to think that every nail sticking up should be hammered down, and that screws are simply nails that require a bigger hammer and/or a more sophisticated technique performed with the new, unique hammer he recently unveiled. The people buying the hammers look for reasons to use them as directed, often exploiting opportunities where they previously wouldn't have considered it necessary.
I was a marketing professional long before I became a massage therapist, and I know how someone good at marketing can put a bright, shiny polish on everything from excrement to diamonds. I take all marketing claims with a grain of salt, and I don't believe in elevating anyone to the position of "guru" or whatever. They are only people. They know some things and/or have had some experiences that have made it possible for them to charge money to share those things with other people.
Every method and conceptual model should be open to scrutiny. No exceptions.
"I would argue that the underlying cause of pain/dysfunction is, in many (most?) cases, never accurately identified. Despite this, the client often successfully recovers, or improves considerably."
Yes, I stand by this. I have to. It feels honest. Even when my clients improve dramatically, I must consider the possibility that I was mistaken about their situation, but that they recovered anyway. It's a perpetual confounding factor that can never be eliminated from my clinical practice. It took years for me to accept this, and it was painfully humbling, but that's okay.
The only people who truly have to live the results of therapy are those who come to us for help. I have to get my ego out of the way and recognize the limitations of myself and of those who have worked with them before me. That's when I do my best work. - January 19 at 12:29am
Brent Brookbush Hey Jason Erickson ,
I both agree and disagree with your statements. We are light years from understanding certain aspects of human movement, physiology, pathology and pain, but we have also come a long way.Not all tests are bad - although I do not know the research on MMT, (but will be doing a review soon) some goniometric assessments have an extremely high level of reliability, the same could be said about special tests, as well as, subjective criteria and outcome measures that help to guide clinical decision making. One of the first things I teach in my more advanced courses is - "Just because you don't know the research, does not mean it does not exist." Maybe you could do some research reviews on specific questions you have. I can assure you that "…and yet (to me) we still seem light years away from developing consistently reliable assessment and treatment methods." is not a true statement for all aspects of rehabilitation and performance enhancement intervention.
To this point:
"I would argue that the underlying cause of pain/dysfunction is, in many (most?) cases, never accurately identified. Despite this, the client often successfully recovers, or improves considerably."
Yes, I stand by this. I have to. It feels honest."
All I can say is… it's not honest, not in the slightest… in no way can you generalize the ineffectiveness of a particular treatment for a particular population to the whole of rehabilitation science. What do you say about the research that shows manipulation post acute lumbar spine injury successfully reduces pain, length of rehab, and improves function? So, we are supposed to believe that despite this effective intervention, targeted at facet joint dyskinesis, having a dramatic effect on pain… we do not know where much of the pain stems? What about injections? Have you ever read Travell and Simons - are they full of it? How about successful surgical outcomes… does that not tell us anything… How about anything that has every been correlated (by research) to be more effective than placebo in the medical field?
Lets make this a little personal - Are you saying that all of the individuals who are making a living in diagnostic medicine are fooling themselves?
I know you call this humility, but it does not sound like humility… it sounds like your essentially saying "everybody else is wrong".
P.S.
You may also do some research on confirmation bias… yes we can all be victim of confirmation bias, but I hold by my original statement. The more varied the input and consistent the outcomes, the less likely this is the case. - January 19 at 11:39am
Mark Jamantoc Thanks for tagging me on this nice discussion, Brent . A typical first visit with me includes a brief but thorough interview process of their history: oftentimes, they've been in another physical therapy clinic and was being seen with multiple patients that they have not gotten a chance to really speak with the therapist. This process takes about 10-15 minutes. I then perform my own ROM exam and the purpose for this is not mainly to measure the range but to see which motions hurt with active and/or passive and repetitive motions. I almost always include overpressure to stress the structure involved. If I was evaluating the lumbar spine, I check the Lumbar, thoracic and the hip and pelvic region to screen them. I do utilize palpation a lot to see if any structure responds and perhaps I can isolate the structure involved. I then perform muscle testing (I learned MMT in school) but experience has taught me that a fatiguable test helps me isolate the problem better and therefore produce a weakness that may be perhaps nervous in origin. I ALWAYS include treatment with my evaluation so I treat as I go. "Find it, fiddle with it, fix it. Then move on." With the time constraint in a busy facility, I always give the patient something to do at home to maintain what I did. It is rare that I give 20 exercises. I give perhaps 1-2 exercises to ensure I can assess next session the effectiveness of such and not be puzzled by 20 other stretches I gave the patient. In terms of SPECIAL TESTS: I utilize them, I use a book from Tim Flynn Guide to Musculoskeletal assessment or my good ol Magee book. I use clinical judgment on what to perform to either rule in or rule out a diagnosis that I am suspecting - especially if the patient walked in with no imaging at all. - January 19 at 11:59am
Brent Brookbush Thanks Mark Jamantoc ,
It sounds like you are using a Cyriax/Maitland style approach to evaluation with some additional "Jamantocisms". I have grown fond of the Cook Text for special tests - http://www.amazon.com/Orthopedic-Manual…/dp/0138021732
Cook covers the specificity, sensitivity and relative usefulness of most orthopedic tests and also examines clusters. It has been very helpful narrowing down my choice of tests with a new patient.
I think I might steel "Find it, fiddle with it, fix it" - that's hilarious and so true about so much of what we do.
Thanks for the response Mark Jamantoc
Orthopedic Manual Therapy (2nd Edition)
ORTHOPEDIC MANUAL THERAPY, 2/e is extensively updated and presents all modern foundations of…
AMAZON.COM - January 19 at 1:03pm
Mark Jamantoc I have this book as well Brent . I have the first edition.
January 19 at 1:31pm · Unlike · 1
Jason Erickson Brent , you seem offended by my perspective. That was not my intent, so I apologize for upsetting you.
You raise some good points that I will respond to:Brent: "Not all tests are bad - although I do not know the research on MMT, (but will be doing a review soon) some goniometric assessments have an extremely high level of reliability, the same could be said about special tests, as well as, subjective criteria and outcome measures that help to guide clinical decision making. One of the first things I teach in my more advanced courses is - "Just because you don't know the research, does not mean it does not exist.""
Reply: I completely agree.
Brent: "Maybe you could do some research reviews on specific questions you have."
Reply: This is something I would like to do.
Brent: "All I can say is… it's not honest, not in the slightest.."
Reply: I said that it feels honest to me. I didn't say that it is necessarily true. It happens to be my opinion at this time.
Brent: "in no way can you generalize the ineffectiveness of a particular treatment for a particular population to the whole of rehabilitation science"
Reply: You are correct. However, you are interpreting my statement more specifically than what I actually said. I am including both "effective" and "ineffective" interventions, and I said "many", not "all". Due to the scopes of practice of those invited to participate in this discussion, I am referring to the domains of non-invasive interventions, particularly manual and movement therapies,
Brent: "What do you say about the research that shows manipulation post acute lumbar spine injury successfully reduces pain, length of rehab, and improves function? So, we are supposed to believe that despite this effective intervention, targeted at facet joint dyskinesis, having a dramatic effect on pain… we do not know where much of the pain stems?
Reply: I would like to see that research. With post acute lumbar surgery, we have a defined patient population and we are following up on a specific intervention. Within limited parameters, I would expect the development of more effective interventions. Can it be generalized to patients that do not fall within those parameters?
Brent: "What about injections?"
Reply: Which injections, and for what? Some, like insulin and epipens, clearly work quite well. Others, like corticosteroids, have a mixed track record.
Brent: "Have you ever read Travell and Simons - are they full of it?"
Reply: LOL, I have both editions, and that was the foundation of the therapeutic work I learned in massage school. I used to think that manual trigger point therapy was gospel. It is not, though it can be useful. Travell and Simons weren't "full of it", but their work left many questions unresolved and their explanations are, at best, incomplete. I still use their work as references, but I remain mindful of its limitations.
Brent: "How about successful surgical outcomes… does that not tell us anything… How about anything that has every been correlated (by research) to be more effective than placebo in the medical field?"
Reply: Sure, there's a lot of surgical stuff that has been shown to be effective, and that body of knowledge continues to increase.
Brent: "How about anything that has every been correlated (by research) to be more effective than placebo in the medical field?"
Reply: Anything? That sure throws the doors open. I'd rather confine this to manual and movement therapies, which I had assumed is the focus of this conversation. I hope we don't need to discuss "correlation is not causation" and the post hoc ergo propter hoc fallacy. - January 19 at 3:57pm
Brent Brookbush I think some of your statements were so general it was hard not to feel a little get a little combative Jason Erickson… rather than saying we "seem light years away" or pain is "never accurately identified"…you could replace those terms with a specific area that you feel needs more research within a specific population… or better yet, pose it as a question. - January 19 at 4:55pm
Jason Erickson This is why discussion is important. It helps refine the way we think and express those thoughts. - January 19 at 5:33pm
Jinny McGivern In addition to a mish mash of goniometry, manual muscle testing, special tests and functional movement testing (gait, squat, etc), I always use functional outcome measure questionnaires (DASH, LEFS, Neck Index, Back Index). While I have had a bit of a problem with ceiling effect, especially with the athletic populations I treat, generally speaking these assessments are a win-win. Insurance companies love them, they provide insight into how the patient feels they are able to function, are handy for providing a list of functional goals and usually include at least a few tasks that are meaningful to the patient. In the event that I have a patient who always tells me that their pain is always the same after several sessions of treatment, I ask them to complete a new questionnaire and see where they fall. This provides valuable information to me as the PT - have I made any gains? If I have, why does the patient not recognize changes in their day to day life? Is there a fear avoidance component to this pain? I am able to use this information to tailor my goals, interventions and conversations with the patient going forward. - January 19 at 5:34pm
Rick Daigle Kind of late to the party… My response is probably not going to be liked very much… "It depends" - January 19 at 5:45pm
Rick Richey ^BOO!! - January 19 at 6:54pm
Rick Daigle Ha Rick Richey - The question asked what tests, evaluations, assessments, etc do we use… And thats my honest answer - January 19 at 6:55pm
Rick Richey Lol, yeah man. I've been sitting back and observing this round. There are many options - I'm with you. January 19 at 6:57pm
Rob Fluegel I too have been sitting back and taking this all in. And I am for the most part in agreement with Rick in that it depends. I do have a standard thought process, but sometimes someone comes through the door and that goes out the window. I'll try to expand on this post tomorrow if I have a chance. - January 19 at 7:08pm