"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Sunday, April 3, 2011

Livin' with Indecision

"I understand about indecision
But I don't care if I get behind
People livin in competition
All I want is to have my peace of mind.

Evaluation of a Treatment-Based Classification Algorithm for Low Back Pain: A Cross-Sectional Study published in the April 2011 Physical Therapy Journal helps quantify where algorithmic decision making tools leave off in physical therapists' practice.

Algorithms are new in physical therapy - Australian physical therapists have an average of only 1.2 years of experience with algorithms while American physical therapists have 7.6 years of experience with algorithms.

What did we use before we had algorithms? Intuition.

This study clarifies where algorithms leave blanks that physical therapists need to fill in with intuition.

The treatment based classification algorithms explained the majority of the patients studied. Forty nine percent (49%) belonged to one sub-group and twenty five (25%) belonged to more than one treatment group. Twenty five percent (25%) of the 250 study subjects did not belong to any treatment group (eg: manipulation, traction, etc).

Is is possible that every physical therapy patient will belong to one and only one treatment group? Have we described all of the groups? If not, how much our our practice is left to intuition?

Algorithms are important because they allow physical therapists to create sub-categories of patient that respond well to our interventions. These sub-categories can be analyzed for long-term outcomes.

High quality outcome studies based on well-defined sub-categories will surely show larger treatment effects than current studies. Better outcomes will prove physical therapists' worth in the reformed, more competitive healthcare system.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.