PT Inquest

Brought to you by CSMi If you have listened to more than one episode of PT Inquest you will know that Erik thinks that quadriceps dysfunction is a major problem after ACLR. Assuming that you agree with that, are there interventions to address that issue? Do they work? What about just waiting? How would we know what works? Progressive strength training restores quadriceps and hamstring muscle stren...

Brought to you by CSMi Providing accurate information on back pain seems to build confidence in the provider but doesn't seem to have a huge effect on outcomes. Is this really an improvement? In this episode, Erik and JW explore the role of the provider is these difficult cases. The Fear Reduction Exercised Early (FREE) approach to management of low back pain in general practice: A pragmatic clust...

Brought to you by CSMi Patients have unique personalities, values, and circumstances but what about providers? Can the specific personality traits of the provider have an effect on outcomes? Is that a good thing? Or a bad thing? And what should we do about it? Do therapist effects determine outcome in patients with shoulder pain in a primary care physiotherapy setting? Kooijman MK, Buininga EM, Sw...

Brought to you by CSMi We can prevent ACL injuries!!! Or are we just reducing risk? Or both? How do these programs work? Does it matter what you do or do you just need to do something ? A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster-Randomized Controlled Trials With Meta-analysis. Hua...

Brought to you by CSMi We are all aware of financial conflicts of interest. Their mechanisms for incentivizing towards inaccurate beliefs are known but can still be easy to fall for. But what about intellectual conflicts of interest? What if you job, or even worse your profession, depends on it? Conflict of Interest Wojtys EM. Sports Health . 2019 Aug 26;11(5):395-396. doi: 10.2106/JBJS.18.01160....

Brought to you by CSMi Is more better? Would additional tests improve outcomes? How often do we look for things that may not actually make a difference? We explore these questions as we review this non-inferiority study on managing wrist fractures. Omitting Routine Radiography of Traumatic Distal Radial Fractures After Initial 2-Week Follow-up Does Not Affect Outcomes. van Gerven P, El Moumni M, Z...

Brought to you by CSMi You have an athlete with want appears to be FAIS and you want to know if they would be able to return to full sport after surgery. How would you know? Are there predictors before surgery? Are predictors for failure after surgery also just predictors of failure in general? Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthros...

Brought to you by CSMi When you look at someone with a torn meniscus and some osteoarthritis, can you tell who would benefit from arthroscopy and who wouldn't? What about whether or not they would benefit from rehab? Would you be better than a coin flip? Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey...

Brought to you by CSMi After acute hamstrings injury is it ok to push into pain during rehab? Would you actually get better results? If you didn't, why not? If you did, what would that mean? Join us as we look at loading up injured hamstrings with special guest Jack Hickey ! Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. Hicke...

Brought to you by CSMi What is evidence without interpretation? For that matter, what exactly is evidence? Or interpretation? Can you make an evidence-based statement without a robust evidence base? Evidence vs Consensus in Clinical Practice Guidelines. Djulbegovic B, Guyatt G. JAMA . 2019 Jul 19. doi: 10.1001/jama.2019.9751. [Epub ahead of print] Due to copyright laws, unless the article is open...

Brought to you by CSMi A study shows that those with FAI who get surgery earlier do better than those who get surgery later. Does that mean patients should rush to surgery? Or is the reality more nuanced? Early Hip Arthroscopy for Femoroacetabular Impingement Syndrome Provides Superior Outcomes When Compared With Delaying Surgical Treatment Beyond 6 Months. Kunze KN, Beck EC, Nwachukwu BU, Ahn J,...

Brought to you by CSMi "How do you feel now compared to how you felt before surgery?" is a common question asked of patients? But how well do they remember? Are they accurate or do they overestimate or do they underestimate? What effects can perception of pretreatment symptoms have on perception of progress? Patients Undergoing Shoulder Stabilization Procedures Do Not Accurately Recall Their Preop...

Brought to you by CSMi This episode is less about exercise programs after total hip arthroplasty and more about meticulous study design prior to data collection. We look at essentially having the paper written before the study begins - all you have left to do is plug in the data and run the calculations! Pragmatic Home-Based Exercise after Total Hip Arthroplasty - Silkeborg: Protocol for a prospec...

Brought to you by CSMi Patient reported outcome measures (PROM) are commonly used to assess function in patients. But is that what they are actually measuring? Can we alter those scores in a meaningful way just through practicing the tasks mentioned in the questionnaire? Can the QuickDASH PROM be Altered by First Completing the Tasks on the Instrument? Shapiro LM, Harris AHS, Eppler SL, Kamal RN....

Brought to you by CSMi What do patients believe about knee osteoarthritis and nonsurgical interventions? Where do they get these beliefs? Can we change these beliefs? Even if we do will that make a difference? Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study. Bunzli S, O'Brien P, Ayton D, Dowsey M, Gunn J, Choong P, Manski-N...

Brought to you by CSMi Exercise works for pain..but why? Probably not for the reasons that we think. Does it matter? What a silly question... Musculoskeletal pain and exercise-challenging existing paradigms and introducing new. Smith BE, Hendrick P, Bateman M, Holden S, Littlewood C, Smith TO, Logan P. Br J Sports Med . 2018 Jun 20. pii: bjsports-2017-098983. doi: 10.1136/bjsports-2017-098983. [Ep...

Brought to you by CSMi What happens when you go onto the interwebs and search for information from the websites of reputable organizations (government, hospital, university, professional associations, etc)? Is it accurate? Who defines accurate? What is the purpose of these websites? Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review....

Brought to you by CSMi . Following an algorithm in medicine (and other high consequence professions) is shown to result in better outcomes. But isn't that just like following a cookbook? Or is it more about making sure that we don't miss things? Evidence-based algorithm to treat patients with proximal humerus fractures-a prospective study with early clinical and overall performance results. Spross...

Brought to you by CSMi Doing a manipulation on the thoracic spine may help people with cervical radiculopathy but there are a lot of questions to answer here. This paper has an odd presentation of the data and generates concerns when looking at the pretrial registration ( https://clinicaltrials.gov/ct2/show/NCT01495728?term=NCT01495728&rank=1 ). Immediate and Short-term Effects of Thoracic Spine M...

Brought to you by CSMi Is there a lack of diversity in orthopedics? Is improving diversity around gender the same challenge as improving diversity around race? Why are some areas of medicine improving while others are still having issues? In this episode we look at the specific issues around orthopedics and see if there are lessons that can be learned in the physical therapy profession. The Orthop...

Brought to you by CSMi Does the weight of an athlete matter when considering how much force they can handle? Is obesity the cause of disease or just something else that was caused by the cause of disease; whatever that actually is? Here we take a look at understanding predictors versus understanding causation and how this affects interventions for public health. Why causality, and not prediction,...

Brought to you by CSMi In previous episodes we have talked about many issues around biologics research. This article takes an honest look at PRP for patellar tendinopathy by including two different preparations AND a placebo group. How did it turn out? Not so well for PRP... Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Ve...

Brought to you by CSMi There is a lot of health misinformation out there from simple "wellness" advice to anti-vaccination zealots, but what do we as medical providers do about it? Is it time to wage war? How high are the stakes? How do we make a difference? Do medical journals play a role? Counteracting Health Misinformation: A Role for Medical Journals? Armstrong, PW, Naylor CD. JAMA . Published...

There are studies that show that a hip focused exercise program helps for PFP; there are others that show that a knee focused exercise program also works. Is one better than the other? What about just doing ANY kind of exercise? This study takes a look at answering those questions...kind of. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A...

"You hate on everything! What do you even do with your patients? Why so negative?" We've heard it all before, and so have the authors of this paper. This open source article explores and defends the position of being skeptic within the medical world. The Case for Being a Medical Conservative. Mandrola J, Cifu A, Prasad V, Foy A. Am J Med . 2019 Mar 6. pii: S0002-9343(19)30167-6. doi: 10.1016/j.amj...