PT Inquest

Available for CEU credit!!! Click here! The concepts of Envelope of Function and Physical Stress Theory are very useful in rehabilitation applications. We review these constructs and give ideas for use in the clinic. Reference List Dye SF. The Knee as a Biologic Transmission With an Envelope of Function: A Theory.  Clinical Orthopaedics and Related Research . 1996;325:10-18. doi:10.1097/00003086-1...

Available for CEU credit!!! Click here! Our understanding of the ACL, it's related pathophysiology, surgical strategies, and postoperative rehabilitation has an interesting history. We take a tour of the history and interview a couple guests who lived it. Reference List Chambat P, Guier C, Sonnery-Cottet B, Fayard JM, Thaunat M. The evolution of ACL reconstruction over the last fifty years. Int Or...

Brought to you by CSMi In this episode we review an article about causal fallacies but, more importantly, changes are coming in 2020 to PT Inquest! Tune in to hear all about it. Also, PATREON!!! Core stability and low-back pain: a causal fallacy. Open Science Collaboration. J Exerc Rehabil . 2019 Jun 30;15(3):493-495. doi: 10.12965/jer.1938198.099. eCollection 2019 Jun. Due to copyright laws, unle...

Brought to you by CSMi. In this episode we are joined by Dan Quintana from the Everything Hertz podcast to discuss reproducibility and improving science. We even talk a little about the "love hormone"! PSYCHOLOGY. Estimating the reproducibility of psychological science. Open Science Collaboration. Science . 2015 Aug 28;349(6251):aac4716. doi: 10.1126/science.aac4716. Due to copyright laws, unless...

Brought to you by CSMi So we're not the best with chronic nonspecific low back pain. We also tend to underload our patients in general. Maybe if we increased the intensity of our exercises, we would be more effective with chronic nonspecific low back pain. Well, at least we can test it! Exercise Intensity Matters in Chronic Nonspecific Low Back Pain Rehabilitation. Verbrugghe J, Agten A, Stevens S...

Brought to you by CSMi Clinical depression is a very real part of many of our patients' lives. As a matter of fact, our current understanding of many commonly treated PT diagnoses suggests that clinical depression may be a huge driver of symptoms. How do we identify it in our patients? Assuming we can do that, what do we do about it once we identify it? Using the 9-Item Patient Health Questionnair...

Brought to you by CSMi Everyone wants to succeed and no one wants to fail. Is failure so bad? Can we even have success without failure? How can we learn to embrace failure to get the greatest knowledge? A celebration of failure. Loscalzo J. Circulation . 2014 Mar 4;129(9):953-5. doi: 10.1161/CIRCULATIONAHA.114.009220. The other article that Erik mentioned: On the (f)utility of pain. Stonington SD....

Brought to you by CSMi One of the most important components of ethical healthcare is patient education. A fully informed patient makes everything easier later during the care. But that includes educated on the good and the bad. Sometimes "being hopeful" can actually be a disservice. "Doctor, What Happens After My Meniscectomy?" Smith JH, Houck DA, Kraeutler MJ, McCarty EC, Frank RM, Vidal AF. J Bo...

Brought to you by CSMi Cognitive Functional Therapy for the win! Or is it? Are these differences in effect sizes from a simple group program big enough to get excited about? What else could be at play here? Chronic low back pain is hard... Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled tria...

Brought to you by CSMi What does it mean to have self-efficacy? How does that differ from one's perceived locus of control? Are they situation dependent? Can we changed them or just measure them? How does this affect our patients. The Self-Efficacy for Home Exercise Programs Scale: Development and Psychometric Properties. Picha KJ, Lester M, Heebner NR, Abt JP, Usher EL, Capilouto G, Uhl TL. J Ort...

Brought to you by CSMi Physicians often will offer a corticosteroid injection for those with osteoarthritis. Patients feel better in the short term, but is there long term harm? If the joint is shot anyway, does it matter? Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. J Radiology ....

Brought to you by CSMi Shared decision making is the greatest thing! Ethical, honest, engaging. But do patients give a crap? Would they rather the provider just tell them what to do? Can we find a happy ground? Semistructured interviews regarding patients' perceptions of Choosing Wisely and shared decision-making: an Australian study. Allen J, King R, Goergen SK, Melder A, Neeman N, Hadley A, Hutc...

Brought to you by CMSi There has been some great work done regarding guidelines for many different musculoskeletal diagnoses, but do physical therapists follow them? How do they do compare to other medical professionals? We can always be better, but what stops us? Is it stubbornness, lack of knowledge, or might market forces and patient/professional cultures drive some of this? We discuss all of t...

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...