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Posts Tagged ‘readings’

Readings and Musings 8.31.12

Another collection of random things that have caught my attention.  In the future, I will try to put out this list of things a little more frequently.

The Best Argument in Favor of Open Access Science is All Of Them @Kevbonham  I shouldn’t have to explain why this matters.  More information here: Open Access Publishing

Develop a Web Presence – tips and ideas for boosting your web presence, from social networking to blogging.  I’m still on google.  Maybe I should make a switch to boost my street cred. @adachis

Ridgeway & Silvernail 2012.  Innominate 3d Modeling: Biomechanically interesting, but clinically irrelevent.  @Dr_Ridge_DPT

Dr. Ridgeway was kind enough to supply with the full unedited prior to submission full text here.  Thanks!! 


Patients understand that they are in pain. Health care professionals like to try to explain why patients are in pain. But it’s a spinning plate trick – to tell them what we know about pain without invalidating what they KNOW about how they feel, and how they believe it impacts them. I like the article What predicts outcome in non-operative treatments of chronic low back pain? A systematic review (Wessels et al. 2006) for this reason. Changes in cognitive and behavioral measures may be more predictive for treatment outcomes of chronic low back pain than physical measures. But more research needs to be done (click me). What I like about this review, and it ties back into other articles (like Mannion 2001), is that we shoud do more to address patients’ beliefs about pain, fear avoidance, coping, and mood. I don’t think these questions can be addressed without LISTENING to how patients feel, and what they understand about their pain. 

These info graphics are so cool:  Mobile Healthcare or validation for my interest in developing software.
More digital information: HIPAA Devices: 2 Myths Debunked, 1 Proven True from @WebPT.  Ipads are HIPAA compliant.  Cloud storage is safer than hiding money in your mattress.  Digital storatge is safer than paper storage. 

Forward Thinking PT Posts by @joebrence9.  The latest post is about the neuromatrix model of pain developed by Dr. Ronald Melzack.  The brain uses a vast integrative network of systems to interpet threats to the system contextually as pain. Cool stuff.  One of my major interests as a #physicaltherapist (when I get a license).

Thinking about Thinking

When I started PT school, I knew this is where it would take me.

Bad joke.  Let me explain.

Spent my whole life ignoring things like metacognition, because I preferred more discrete sciences. Love answers. Real answers.  But have, slowly, become enamored with social science and why we think and do the silly things we think and do, and how behaviors and thinking change over time.  Like a playground for my brain!  Errors in thinking… I make a great many errors.

What caught me about this, and why I decided to join the conversation on soma, is a book I’ve been reading about cognitive errors in the assumptions we create constructs of ourselves and the world around us.  The chapters on Hindsight bias and Confirmation bias have taken a lot of my brain power lately.  The book is “You are Not So Smart.”

I suspect that some errors in clinical decision making come from the minds innate need to make sense of the world quickly to move on to the next stimulus.

Clinicians are trained (I just finished school, but hope never to finish training) to rely on “clinical decision making.”  Human make decisions, which are subject to every kind of bias I’ve ever heard of.  Confirmation bias and hindsight bias (narrow spectrum, I know) work together to affirm our mistakes in thinking.  A perfect storm for error!  Hindsight works like this: an event/result/outcome happens.  In reflection, certain events stand out leading up to the incident.  You, being the reflective practitioner you were trained to be, try to construct patterns from randomness.  This is where it falls apart. Hindsight bias is “I knew it all along”.  It’s ignoring how you were wrong previously – taking from coincidence facts and ignoring other data to convince yourself you expected the outcome.   Confirmation bias is “I bought a honda, now all I see is hondas!  I must have bought a great car!”

The worst errors are of oversimplification (for the intent to do good!) of complex models to simpler ones.  This allows them to “see more” and explain more, and rationalize their own clinical decision making. To say “I knew that you would respond to ____” all along.  And a strong bias from then on to find evidence to SUPPORT instead of refute their newly constructed world view.  Confirmation bias is the reason my dad woke up every morning at 5AM to listen to Rush with his morning news before work (politics aside).  People look seek out things that agree with their world view to validate what they are already thinking.  Couple that with a strong hindsight bias and you have the recipe for a guru.  I will explain.  A guru isn’t believable because they are good liars.  They whole heartedly believe that what they are telling you about piezoelectric effect when, in reality, most of what they are saying sounds very plausible because of a very plausible sounding model of electricity.  Or biomechanical models of spine pain. Or justification for ultrasound.  Craniosacral therapy.   I digress.

I am intrigued by the capacity of the brain to justify just about everything.  Including writing this post.

It’s worth noting that I have not even passed my board exam yet.   Turns out I know a lot about neuro, musculoskeletal, and “other systems.”  But less about the foundational sciences of the cardio/pulm system and next to nothing about modalities.  3 of those things are interesting to me.  2 of them bore me to tears.  One of them, as a category of intervention, is mostly crap (so far as my education is concerned, but more independent research on my part should be done). Care to guess which one it is?

Also, I could use a good recommendation for a “review cardio for the NPTE” book, if anyone has anything. Thanks.

-d

Readings and Musings 8/6/12

Who’s driving this thing?!

I get most of my news from twitter and google reader.  I LOVE taking in information from all over and trying to synthesize it into one coherent thought.  I’ve decided to start gathering these readings, tweeters, and resources on a more regular basis and share with you the things I thought were interesting.  Many will have to do with physical therapy.  Some will definitely not!  You’ve been warned.  Without further adieu, my first ever “Readings and Musings.”   Love to hear your thoughts (if I haven’t already).

Appledorn et al. 2012. A Randomized Controlled Trial on the Effectiveness of a Classification-Based System for Subacute and Chronic Low Back Pain  Current treatment based classification schemes do not improve outcomes in patients with subacute or chronic low back pain.

An Essay for Physical Therapists: Lets Move Forward…  An inspiration to move forward, and some issues that are very relevent to physical therapy right now.  There are some great discussion points about manual therapy, and the abuse of modalities.  Comments at the end of the article are worth reading too!

Mannion 2001.  Increase in strength after active therapy in chronic low back pain (CLBP) patients: muscular adaptations and clinical relevance.  Three treatment groups, 1 outcome.  Strength changes through training for chronic low back pain did not appear improve outcomes.

One Word that Defines a Great Brand  Jeff Haden from Inc.com interviews Julia Allison about personal branding.  The interview and picture Julia paints of “personal branding” is organic.  You sell WHO you are, not just what you do.  It’s about representing yourself through your values and connecting with clients.  As physical therapists, we seldom ask a patient “may I help you?”  We ask about their kids, grand kids, their dogs, grades at school, favorite sports teams, or the last book they read.  This article couldn’t be more relevant to PT. 
Natural Cures?  “What medications are you taking?”  “I don’t take any medications.”  We might consider asking about supplements in addition, as I suspect (and I don’t have a lot of evidence for this that isn’t anecdotal, sorry) many patients don’t consider the gingko they are taking to help their memory might also impact their balance (dizziness is a known side effect).  AMA strategies for health literacy.
Build Systems Not Overhead  Rhetorical talk about reducing overhead while improving quality.  Just some food for thought, I guess.
The Right Tools for Negotiating Your Salary – Part One: Your Value.   Part of a 3 part (so far?) blog roll about how to negotiate salaries if you’re a new PT.  Interesting stat of the evening: this year, 12,738 new PT/PTAs will hit the streets looking for jobs. And we alllll want MONEY MONEY MONEY!  
Homework for the week:  Confirmation Bias and Hindsight Bias
People to follow:   @JayS_Tan, @MerylKevans, @Jerry_DurhamPT (unless you’re a Giants fan). 

Seth’s Blog

Brilliant and poignant commentary on balance, work life, and innovation. Really digging Seth’s blog. http://ping.fm/NnBIY

Freakonomics Repost…

Freakonomics is one of my favorite blogs.  This is a post about the new Danish fat tax and just how misguided policy makers were in creating this legislation…  This fat tax, as pointed out in the article by Steve Sexton, disadvantages the poor for being too poor to make healthy eating decisions.

This kind of legislation has proven marginally effective in the past with smoking cessation.  As a sin tax, smoking cessation is completely that unhealthy eating.  EVERYBODY HAS TO EAT.  And we can’t all afford $5.00 – $9.00 for a red pepper at the Community No-Op.

Anyway, great article.  The answer isn’t always just “live more like us healthy people!” Give it a read:

The Orwellian Efficiency of a “Being Fat” Tax

-d