"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

Showing posts with label "Placebo Effect". Show all posts
Showing posts with label "Placebo Effect". Show all posts

Monday, July 25, 2011

Lower Back Pain, the "The Doctor Effect" and Patient Self-Reported Outcomes

The Doctor Effect is also known as the Placebo Effect.

Except, as pointed out in JournalWatch's Clinical Conversations Podcast #126, Placebos and Medical Meaning, a placebo is an inert substance that has no effect on a patient.

The Placebo Effect was raised by an article in the July 14th, 2011 New England Journal of Medicine Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. The authors found that patients' self-reported breathing after sham acupucture improved while their Forced Expiratory Volume in 1 second (FEV-1) did not improve. The authors concluded that the self-report measures were therefore unreliable.

Dr. Daniel Moreman, author of Deconstructing the Placebo Effect and Finding the Meaning Response, argues that real, therapeutic effects can be measured in patients who take "inert" substances and that the patient experience (eg: feeling better) may be more important than "instrumental', or objective data, like the FEV-1.

At 11:38 min. in the podcast, Dr. Moreman (an anthropologist) directly speaks to the difficulty of lower back pain, patient self-report outcome measures and physician care.

Physical therapists should think about the Doctor Effect because of evidence that the Doctor Effect, or the process-of-care, may provide at least as large a therapeutic benefit as that provided by pharaceuticals with dangerous or deadly side effects.

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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"


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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.