Thursday, March 31, 2011

Keeping up with Research

I think we can all agree that RESEARCH ROCKS . . . but how do we keep up with it all?!?! As a physical therapy student, I vowed to myself that I would “always” keep up with the latest research once I entered the working world. Journals, continuing education, conferences . . . I was going to do it all. Once classes, exams, papers and group projects were done, I thought I would have plenty of time to keep up with the research world. How could I possibly be busier than I was as a physical therapy student?!?!

After five years of working as a physical therapist, these thoughts make me laugh :-). I have come to realize that staying up-to-date with the latest research findings is a very personal and challenging journey for each of us. Finding a balance between family, friends, recreational activities and work can be demanding. With so many people, responsibilities, and activities filling each day, finding time to stay in touch with the research world can be difficult. It has taken me a few years of trial and error to figure out what works best for me. Here’s what I do:

· Skimming journal cover pages (JOSPT for example) as soon as I get them and highlighting the articles that are most relevant to the patients I am seeing currently. This helps me prioritize me reading/learning.

· Reading journal articles two days a week during lunch . . . often while riding a recumbent stationary bike. Starting to do this really helped me keep up with my journal reading.

· Attending continuing education courses and PT conferences as regularly as I can given time and $ constraints.

o Looking up journal articles cited by presenters at courses and conferences

o “Open Door” which is available to all APTA members is a great resource for finding journal articles in publications that you don't already receive

· Journal club – I work as one of two physical therapists at a university student health center. Putting together a journal club took some extra planning because our “Sports Medicine” journal club includes physical therapists, an athletic trainer, and primary care physicians. We meet once a month to discuss new articles and to work on our overall system of patient care.

· Talking “shop” with PT friends . . . sharing what we have learned

So fellow NPs, how do you do it? How do you keep up with the latest research while balancing family, friend, work, etc? I'd love some new ideas!

Monday, March 7, 2011

Exploring Our Future

Something is always lost in translation when you summarize a summary.  But I intend to try.  On Saturday I had the honor of attending and presenting in Emory University's "Exploring the Future of Physical Therapy Symposium."  We set out to bridge and contextualize two seminal APTA events, the Physical Therapy and Society Summit(PASS) and the Vitalizing Practice Through Research and Research Through Practice(VRTP) Conference.  The symposium though not officially sanctioned by APTA was certainly peopled with many of its luminaries.  Similarly to PASS, at which I was the youngest PT in attendance, I was surrounded by NIH grantees, journal editors, and progressive thinkers from academia and the clinic.

Emory's event built upon and went beyond past efforts.  PASS imagined the future.  VRTP established strategic goals.  On Saturday, with the help of an APTA lobbyist straight from D.C. and with the Chief Disability and Health Officer from the CDC, we began to compare the current state of affairs with our goals as a profession.  To borrow from Capitol Hill, this was a big "frickin" deal... ahem.  (Not bad for what was initially a simple Alumni weekend and Foundation Fundraiser.)

Exploring the Future was about initiating change in the PT world.  Ivory towers, silos, bloated curricula, exorbitant debt, disconnected scientists, and disinterested clinicians were all on the chopping block.  The audience was engaged and asked to reflect on how change can happen and where change is needed.  Topics ranged from ACOs to regenerative medicine to innovative co-pay incentivization schema.  Comments ranged from "Translational clinicians need to be honored within APTA." to "If you don't donate to the Political Action Committee, at least marry a congress person."  

The seemingly obligatory product of Symposiums these days is the White Paper.  While such a paper is in fact forthcoming, there was a strong call throughout the event to take action beyond the keyboard.  Hopefully bloggers are granted free license in this regard.  No blog of any readable length could do this day long event justice.  So I want to share a personal perspective that grew out of PASS and was strengthened over the weekend.

Physical therapists must come to lead community initiatives.  Our skill set has expanded in many helpful areas but the need for our skill set has exponentially out accelerated that growth.  Patient demographics have become population statistics.  As clinicians, researchers, and just professionals, our reach needs to extend further now than ever.  My personal mission, having attended PASS and presented in Exploring the Future as young leader, is to promote a skill acquisition model for leadership development within APTA.  The sooner we identify the societal needs of 2020 and beyond, the better we will be able to "skate to where the puck will be" by preparing our clinicians and leaders to meet those challenges.  Where do you think the puck is going?


Tuesday, March 1, 2011

Clinical practice is Research (and Research is Practice)

Research is the March theme on ~Move It~

Once upon a time, a time long, long ago, when I was only contemplating sitting for my NCS and not counting down the days until I would take the most expensive and difficult test of my life, I registered for a preconference course at the Combined Sections Meeting. The course was entitled "Laying the Foundation for Expert Practice in Neurological PT". A prominent theme of this course was differentiating between "intuitive" and "systematic" processing. We were taught that experts were able to synthesize information intuitively without investing cognitive resources in differentiating between plausible and implausible hypotheses. This ability was thought to improve efficiency and allow an expert to focus on an individual's complaints.

I'll be honest. I found this distinction frustrating in its over simplicity. Experts will inevitably be more efficient in processing information gathered from their patients. (If they weren't, we'd have a problem.) But in the world of Physical Therapy, everything is data collection, every touch, every question. Saying that something is intuitive makes light of the empirical process going on beneath the surface. New grads think in terms of T-tests, whereas experts conduct ANOVA.

So granted, there is a difference in the way information is processed.  But whether it's an expert clinician performing an evaluation or an NP assessing gait, hypothesis testing is the bread and butter of physical therapy.  Anything that obscures this fact contributes to the unfortunate divide between research and practice in our field.

Researchers assess whether or not a particular practice works.  They are "practicing" to see if it works.  Clinicians test hypotheses with every modification to a treatment plan.  Why, then, is there such an inexplicable divide between clinicians and researchers?  My hypothesis: the methodological family tree split too long ago.  The clinical language is different because there hasn't been an IRB looming in the background.  Standardization wasn't required.  But in the context of the emerging health care paradigm, in which comparative effectiveness and clinician scorecards will evolve, a common bench/bedside language will be indispensable.  Our branches must re-form a central trunk.

Where do you see the Clinic and Lab colliding?  And for the future, if we don't strengthen those connections, how will we survive?