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A Day in the Life of a PT Student

The Importance of Research

Published October 14, 2008 4:04 PM by Veronica Haywood

As I progress in my program I realize just how important research is in our profession.  Research helps to guide what is taught in our classes, how we practice in clinics, and how we receive reimbursement.  Research is used in so many avenues of the PT profession, however, it has been brought to my attention that there is a significant lack in quality research.

Not only is there a lack of information available concerning the benefits of certain things that we use in practice, but in areas where there is research there is either no conclusive evidence asserting its benefits or the studies were poorly done. Then in some areas there is so much conflicting research that is hard to know what really works and how it works versus what we think works. For example, between the information that I learned while attending a MCW symposium in 2007, what I have learned in 2 different PT classes, and what I learned during the course "Stretching the Truth" at the WPTA Fall 2008 conference, I have received conflicting information regarding the benefits stretching. There is a multitude of research regarding this matter, but much of it conflicts each other.

So how does one come to a conclusion about what to do? To be honest I think some just base it off of whether they feel as though it works or not. Even in this area that has been frequently researched, there is no definitive answer on what should be done-partially because the quality of the research is compromised.  In this case more comprehensive research needs to be done that is of high quality (Randomized Control Trials or higher). This also needs to be done with most of the biophysical technologies (modalities) that are used. For example there is lacking quality research in the use of ultrasound to promote healing using non-thermal effects, yet it is often used and is also reimbursed by insurance companies. Interestingly, low laser therapy has quality research backing its use in RA, OA and chronic disorders to reduce pain, yet it is often not used or reimbursed. It baffles me as to why this is that in one area where there is actual sufficient evidence available its use is limited, but something that is not supported is used.

With all of this, I was just wondering for those reading, how do you determine what you will use in your treatment plans and do you keep yourself updated on the research related to the things that you use?

5 comments

Wow. That's amazing. I hadn't realized that so many sources were available on podcast. I will definately be taking a look at these. Thank you very much.

Veronica Haywood November 4, 2008 6:59 PM

Veronica, what a cool question.  When I was in PT school (20 years ago) a lot of what we learned was based on the experience of our professors.  There was a lot of bench science and animal studies but not much available for evidence based practice.  

Keeping up with current evidence and deciding if it is good evidence is a challenge but I think it is part of what makes our field so interesting and excited.  I can't count the number of times I read an article and it changed the way I though about a patient in the very same week or even day.

1.  I use free publication podcasts and listen to them while I walk the dog or fold linen in the clinic.   JAMA, New England Journal of Medicine, Lancet, Journal Junkie podcast, Orthopedic and neurology journal podcasts as well as PT Journal.

2. I also listen to classes on podcast.  Anatomy reviews or physiology reviews are great to listen to  (College of St. Scholastica PT program has great anatomy/physio lectures)

3. I also try to keep myself in the discipline of specifying to my patient why I'm doing certain things.  Sometimes I say, "I haven't seen any definitive research on this, but in my experience and that of colleagues I plan to take this approach."  Or I say, "Based on study that came out a couple of years ago I plan to take this approach."  (Of course I need to be able to back that up with the study if the patient asks.)  

4.  I tear abstracts out of PT journal or print them and file them to access later.  I have a file for each joint or condition and have three separate post it flags for Eval, Treatment and Home program info.  I stick the abstracts in the appropriate place so when I'm at a loss I can pull the folder out and flip through the stuff I saved.  As I do it I toss out stuff that no longer seems relevant.  (Why on earth did I save that irrelevant study?)

5. Medscape and Epocrates:  These two services are free and offer medical continuing ed and journal highlights.  I've taken a couple of great classes on diabetes and restless leg syndrome that aren't necessarily PT focused but do help me in my practice.

My final advice is what helps me the most.  I have friends that are as nerdy or even nerdier than I am and I call them often.

Good luck.  It is the best job in the world.  I wish you all the best.

Becky Roush, , PT Grand Traverse PT November 2, 2008 11:10 PM
Traverse City MI

P.S. I have to give "props" to Dr. Andy Starsky of Marquette University as some of the information was found in his lectures and talk at the WPTA fall conference "The Ethical Use of Modalities". Thanks Andy!!!

Veronica Haywood October 20, 2008 11:32 PM

Thank you very much for your informative comment. I will be sure to take all of that into consideration when practicing and hopefully others will too. Thank you!

Veronica Haywood October 15, 2008 7:45 PM

First Veronica,

Good for you for realizing this important issue so young in your career.  Let me tell you that it's just as frustrating for us "veterans."  Unfortunately, conflicting evidence is everywhere.  Trying to understand what makes a good study a "good" study can help you to sort out some of these issues.  Invariably, in two pieces of opposing research, there is one factor in one that makes it a "better" study.

Context and generalizability are also important.  Therefore, we need to first undestand who we should be treating.  Randomized controlled trials are the text book answer of a "good study," but I will content that we need to take a step back further from that and understand how to identify more homogenous populations first.  This has been the hot button topic in "low back pain care"...of course the outcomes are dismal when you include everyone and their brother as having "non-specific low back pain."

As an example, consider the hypothetical statement: "nitro is no more effective at treating chest pain than an antacid."  This could certainly be true if ALL cases of CP were included in the study.  However, if we could differentiate who is having GERD and who is having angina and we applied the treatment to those with angina, we would probably see a much different outcome.

We first need reliability and validity studies of how we group populations so we can deem they are the "same" before we perform randomized control trials.

Unfortunately, most PT RCTs that come up with equivocal responses can be found to be linked to poor assessment processes.  

To answer your last question, I keep myself updated on the literature by contniuing my education with certification and degree directed programs...being a PT with several years experience and being a student is an exciting experience.  

Christie October 14, 2008 10:06 PM
Streamwood IL

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