PT Inquest

Many clinicians wonder is tests such as the quad index are good enough for returning an athlete to sport after ACLR. Turns out, clinicians aren't even doing that! In the episode we have special guests Allison Toole and Matt Ithurburn discussing their recent paper that looked at how athletes tested after they had already been cleared to return to play after ACLR. Spoiler - they didn't look very goo...

The scientific community has made some mistakes over the past couple decades, leading people to think many effects were much larger than they actually are, if they even existed at all! So what is the reason for this? How has the current process incentivized the publication of studies that may not be the best reflection of the truth? And what can we do about it? Turns out, there is a lot we can do...

Injecting tendinopathies is a popular practice; everything from PRP to steroids to saline to even sugar. But is there any efficacy? What exactly do these things do? Could there actually be a mechanical effect or is it chemical or just good ol' placebo? When is a sham not really a sham and how do we know? We explore all these questions and more with special guest, Peter Malliaras ! Effect of High-V...

Injuries to the hamstrings are more common than just about any other muscle injury in sport. And once you do it once, you are more likely to do it again. What is the problem here? Are some people just good at injuring that muscle and simple are destined to repeat it? Or are there deficits that just aren't fully rehabilitated prior to return to sport? Also, does anyone know how to pronounce Vodafon...

When it comes to using treatments which have effects that may be nothing more than placebo, the question that is often asked is "What's the harm?" Well, according to these authors, it could be more than you realize. If it works, who cares? Does it matter that you are accidentally treating a psychosocial issue with something claiming to be treating something else? THIS ARTICLE IS CURRENTLY OPEN ACC...

We all know that "correlation does not equal causation" but it is still counterintuitive. There are many questions in healthcare that just cannot be approached by the randomized controlled trial (RCT) requiring us to depend on observational data which is extremely susceptible to this confounding correlation problem. Are there any visual tools that we can use to help keep our thinking honest and no...

Being positive in life is usually seen as a good thing. Try to identify the silver lining and highlight it. But when it comes to research, that "spin" can have detrimental results for developing clinical guidelines and the scientific process as a whole. This is the final episode of this season - we'll see you all in a few months! 'Spin' in published biomedical literature: A methodological systemat...

The double bundle ACL reconstruction is better! Kinda. Sorta. Maybe. But maybe it's not for you. Or maybe it is! Does this squirrel look fat? Does anyone read these descriptions? Does anyone else smell toast? I smell toast... Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results. Järvelä S, Kiekara T, Suomalainen P, Järvel...

There is a lot that we can throw at musculoskeletal pain, but what actually has evidence behind it? We do we actually know and what directions should the research be headed? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Fo...

Medical research as a whole can be a mess of low quality studies. This has significant downstream effects of misinformation, confusion, and large variation of practice, not to mention the abundance of low value healthcare being provided. So how do we survive this mess? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! How to survive the medical misinformation mess. Ioannidis JPA, Stuart M...

QUICK! Cams in the hip: Good thing or bad thing?! Where do they come from? How do they develop? Does playing sports during adolescence cause them? How should you advise your patients? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Physical activity during adolescence and the development of cam morphology: a cross-sectional cohort study of 210 individuals. Palmer A, Fernquest S, Gimpel...

Why is there so much research waste? Why are there lots of redundancies and studies that show effects but don't actually move our understanding forward? Can anything be done to prevent this for happening before data collection even begins? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Preparing for what the reporting checklists will not tell you: the PREPARE Trial guide for planning c...

If all patients get formal rehab right after lumbar disc surgery that would result in better outcomes and reduced overall costs right? Well, that makes sense but it turns out that such a question is very difficult to answer objectively. Turns out that cost-effectiveness studies require a very particular design and a lot of forethought. Keep in mind that papers like this provide our profession hone...

Psychological interventions are becoming popular for treating pain but what is the evidence base for this? Can these interventions stand alone or are they just are part of a bigger picture? Is pain what should be measured as a benchmark for success? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! An umbrella review of the literature on the effectiveness of psychological interventions fo...

Is research like a language? The data being the words, studies being the sentences, and systematic reviews being paragraphs. But what gives all of this the required structure? You know, the grammar? Statistics! But how is all of this supposed to work? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Statistical science: a grammar for research. Cox DR. Eur J Epidemiol . 2017 Jul 29. doi:...

Back again (sorry). This time talking about PFP. A lot of people confuse the subtle differences of all the factors that underlie the heading "strength". Many are not interchangeable and should be thought about as separate constructs. This episode looks at how rate of force development may be a large factor in rehabilitation, specifically regarding PFP. Hip rate of force development and strength ar...

Sorry everyone. Erik has a bit too much going on these next couple weeks so we need to take a short 4 week break. We promise to resume with the next 10 episodes after that. If you want to catch Erik at his courses in Australia in early August or the small Portland course he is doing in September, go to http://thesciencept.com and click on the courses link. Music for PT Inquest: "The Science of Sel...

Can someone do poorly on static balance tests and NOT be an ACL injury risk? I mean, if they're having a hard time there they MUST be having issues during sport, right? Can poor coordination during one task predict poor coordination in another? What about more dynamic tests? IS JW ON DRUGS?! No association between static and dynamic postural control and ACL injury risk among female elite handball...

WE ARE BACK FROM BREAK and bringing with us some biologics! When talking biologics like PRP and "stem cells" sloppy research abounds. This reality isn't really fair to anyone trying to find a deeper understanding of what may or may not be going on here. Can we do better with this process? Can physical therapists apply some of these same reporting guidelines to their on research to provide a better...

We all love evidence-based medicine (EBM) with its three pillars and levels of evidence and science-sounding stuff. But why do we even have it? And does it mean what we think it means? 25 years later, have we really changed very much as a profession? Erik liked this article so much that he should marry it! Unfortunately marrying a document is not yet legal in the State of Oregon. See everyone in 3...

Meniscal repairs are notorious for having a mix of opinions regarding postoperative precautions. Should we be restricting weight bearing? Range of motion? Both? Neither? Does any of it matter? Why or why not? Wait for the drop! Rehabilitation Protocols After Isolated Meniscal Repair. O'Donnell K, Freedman KB, Tjoumakaris FP. Am J Sports Med . 2016 Oct 1:363546516667578. doi: 10.1177/03635465166675...

The prevalence of low-value healthcare is a huge burden on the global healthcare system. Sure, unnecessary care drives up costs and diverts scarce resources away from where they could provide more overall societal benefit, but are there other harms as well? Do physical therapists unknowingly make this problem worse, especially when it comes to treating diagnoses like low back pain? Are there broad...

One of the most dreaded perceived complications after shoulder surgery is the development of developing frozen shoulder. Can we spot those who are at increased risk? If we can, is there anything we can do about it? Can a study be more awkward than Erik? Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study. Koorevaar RC, Van't Riet E,...

I know my treatment doesn't work across a large population but what about subgroups?! Ah yes. Subgroups. Subgroups are absolutely a thing but how do we go about defining them? Do we just track everyone we treat then look back to see who responded and who didn't? Or is it more complicated than that? Find out on this dynamite episode of Nobel proportions! Evaluation of Evidence of Statistical Suppor...

The quad index (side to side strength comparison of the quadriceps) is one of the best known correlations to knee function, but can you test it accurately in the clinic? Do you need an expensive electromechanical dynamometer or can you get by with simpler tools? Also, are you going to CSM ? Diagnostic Accuracy of Handheld Dynamometry and 1-Repetition-Maximum Tests for Identifying Meaningful Quadri...