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The Clinical Gap Podcast
30 minutes | Oct 6, 2022
Residency Roundup #4 - Showing Value, Individualized Care, and Understanding Statistics
How do physical therapists show value? How does that value proposition change when interacting with patients, legislators, or payors? In this episode, I discuss how to show value and where physical therapists and the profession are missing the mark. I also use statistics to show why individualized care is so important. Research should provide the foundation for treatment, but research alone never provides the full answer. All treatment and assessments are a blend of art and science.Harwood 2022 Study (PMID 35606781)Hear more takeaways in my Residency Recap reel. My recent reel on this residency session discussed how frequently patients should be treated within a plan of care.Find out more about the PT Solutions Orthopaedic Residency Program here.
41 minutes | Oct 4, 2022
Telehealth and Hybrid Care Models with Tom Carter and Lindsay Benoit
This episode was recorded in 2020 but unfortunately never aired. It's a shame because it is a great conversation and very relevant to the current landscape of physical therapy.Telehealth took center stage in physiotherapy across the world in 2020 due to the COVID-19 pandemic. Additionally, digital PT has exploded in popularity, leading to concerns that brick-and-mortar PT may become obsolete.Rather than approaching these care models as 'ether/or' we should be exploring and refining hybrid models.Tom and Lindsay share their experiences with hybrid care and the data outcome they have collected at CBI Health. The research that has been published since this conversation supports their conclusions. The hybrid model supports continuity of care, improves patient outcomes and satisfaction, and expands access to clinical experts.Bios:Tom Carter is the National Director of Clinical Excellence at CBI Health, a national provider of rehabilitation services, and he completed his MSc at the University of Toronto in the Graduate Department of Rehabilitation Sciences. His research interests involve the interdisciplinary management of injuries and the field of health services. He has held the appointment of Adjunct Lecturer in the School of Physiotherapy, Faculty of Medicine at the University of Toronto. For over 20 years Tom has provided leadership expertise developing interdisciplinary healthcare teams providing community-based services, managing outpatient rehabilitation clinic operations and training programs at the clinic, provincial and national levels. Lindsay Benoit graduated from the University of Alberta in 2004 and has worked in an interdisciplinary brain injury team treating concussions, traumatic brain injury, and stroke since graduation. Throughout her work with this population, she has taken several courses related specifically to vestibular rehabilitation including the Herdman Course out of Atlanta Georgia. Lindsay was a key person in developing the protocols in CBI as they relate to concussion treatment as well as for traumatic brain injury and stroke. Lindsay teaches a vestibular course and a concussion course to assist in using best practice across CBI. She is also one of the subject matter experts for CBI in concussion and vestibular care. CBI HealthAPTA Consumer Awareness Research ReportAPTA's stance on digital healthDigital health resources
19 minutes | Sep 29, 2022
Residency Roundup #3 - What is Failed Conservative Care?
One of our residents asked, "what is failed conservative care." This question was unpacked in our third residency session and I cover it in this episode of Residency Roundup. I also discuss the importance of patient limitation, locus of control, and patient satisfaction.Hear more takeaways in my Residency Recap reel. My recent reel on this residency session discussed why there are no optimal movement patterns.Find out more about the PT Solutions Orthopaedic Residency Program here.
33 minutes | Sep 27, 2022
Specializing in PT Practice
What is a Clinical Specialist? Better yet, what does it mean to specialize in PT Practice?I explore the answers to these questions in this podcast episode. I talk about obtaining clinical specialization certifications and developing clinical expertise and how they differ. I also look at the relationship between expertise and experience. I provide four key strategies every student and clinician can employ to develop expertise.This talk was originally given at the 2022 GA Student Conclave.APTA Georgia Student FIN Instagram Page
13 minutes | Sep 22, 2022
Residency Roundup #2 - Bad PT vs. No PT
This episode covers two main topics discussed in our second residency session: labels and good physical therapy vs. bad physical therapy.The labels we use have profound effects on our patients and the ways we interact with them. If we label patients by a body region or diagnosis, it’s easy to home-in on that specific label and miss key characteristics of the individual, causing us to develop and implement an incomplete plan of care. It’s important to understand the patient’s primary complaint, but we don’t want to limit their experience or define them strictly with that complaint.Is bad PT better than no PT? This argument can parallel the discussion of some exercise is better than no exercise, but we need to consider the long-term implications for the patient and the profession. How does the outcome and experience of PT influence public perception, reimbursement, and direct access laws? I discuss this in greater detail in the episode.
27 minutes | Sep 20, 2022
Research Recap #4 - Painful exercise, painful manual therapy, training volume for older individuals
Applying the evidence to your clinical practice: When are painful exercise interventions ok? How do you minimize anxiety and catastrophizing with painful exercise? Do you purposefully use painful manual therapy? If so, what is the communication to the patient? How do educate a patient that experiences an increase in pain after exercise? Does it influence future exercise considerations? How do you structure plans of care when hypertrophy is the goal? What variables do you consider? How do you increase patient buy-in? How do you integrate an effective HEP? Links to the studies:https://pubmed.ncbi.nlm.nih.gov/33887445/https://pubmed.ncbi.nlm.nih.gov/34391267/https://pubmed.ncbi.nlm.nih.gov/33400333/https://pubmed.ncbi.nlm.nih.gov/34658936/ Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!
20 minutes | Sep 15, 2022
Residency Roundup #1 - Building Relationships and Fostering Curiosity
In this Residency Roundup, I cover the first session of the 2023 PT Solutions Orthopedic Residency Class. Today’s session focused on communication and relationships. Here are a few key reflection questions from the session: How do you measure clinical quality? How does the patient define success in PT?What does the patient need from you? A necessary attribute to be a clinical expert is curiosity. We all need a willingness to adapt, understanding no tool is undroppable. Much of the residency will be focused on fostering curiosity. We also will work on refining, even shrinking the clinical toolbox. Rather than trying to add a bunch of shiny tools, we will focus on perfecting the foundational tools necessary for great patient care: relationship building, communication, and exercise.Find out more about the PT Solutions Orthopaedic Residency Program here.
25 minutes | Sep 13, 2022
Research Recap #3 - Healthcare Utilization Prognosis, Knee Confidence, Stretching, Manual for Carpal Tunnel
Applying the evidence to your clinical practice: What prognostic factors do you focus on? How do they influence your POC development? Do you communicate the factors to the patient, referring provider, or your colleagues who may co-treat? How do you assess a patient’s confidence level with respect to the body region they primarily experience symptoms (e.g. confidence in their knee when they have knee OA) Is stretching part of your in-clinic or at-home programming? If so, how do you determine the dosage (duration, intensity, and number of sets) How do you assess the effectiveness of your manual therapy techniques? Links to the studies:https://pubmed.ncbi.nlm.nih.gov/35717179/https://pubmed.ncbi.nlm.nih.gov/35713515/https://pubmed.ncbi.nlm.nih.gov/35694390/https://pubmed.ncbi.nlm.nih.gov/35719196/ Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!
59 minutes | Sep 8, 2022
The Influence of Sleep Deprivation on Clinical Decision Making with Dale Whelehan
In this episode, physiotherapist, consultant, and researcher Dale Whelehan shares his research and thoughts on sleep and heuristics. We discuss how bias and heuristics can aid clinicians when used correctly. However, when sleep deprivation enters the equation, critical thinking Is heavily Influenced.Dale received his Ph.D. (after recording this episode) in Behaviour Science at Trinity College Dublin. He focused on surgical performance with respect to the objectivity of performance, the influence of sleep deprivation, clinical decision-making, and fatigue risk management approaches to enhance performance. He is now a Human Capital Management Consultant for Deloitte. *This episode was recorded in 2020 and originally aired on the first iteration of the Clinical Gap Podcast on September 1, 2020.Where to find Dale:Twitter, LinkedIn, Physioplus, Research Gate
24 minutes | Sep 6, 2022
Research Recap #2 - Movement-Associated Fear, Clinician Communication, Benefits and Harms of Surgery, Exercise for Older Adults
Applying the evidence to your clinical practice: What movements do your patients fear? How do you implement graded exposure for those movements? When and how should you hold conversations arguing for conservative care first in common surgical situations (ACL, Rotator Cuff Tear, Knee OA, etc.) How do you stage your education throughout a POC? Do you track physical activity guideline adherence? Should you? How would you? Links to the studies:https://pubmed.ncbi.nlm.nih.gov/35661387/https://pubmed.ncbi.nlm.nih.gov/35655691/https://pubmed.ncbi.nlm.nih.gov/35647883/https://pubmed.ncbi.nlm.nih.gov/34746955/ Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!
23 minutes | Sep 1, 2022
Research Recap #1 - Spinal Manipulation, HIIT, Adaptive Myelination, Self-Efficacy
The Clinical Gap Podcast is back! This is the first Research Recap episode (keep a look out for Residency Roundups starting in mid-September and past interviews). This Research Recap dives into many topics regarding plan of care development and appropriate exercise selection, taking into account neural health, self-efficacy, metabolic health, and training goals. Here are some practical questions to consider and help you apply the evidence to your clinical practice: How do you decide if spinal manipulative therapy is appropriate for your patient? How can you enhance exercise self-efficacy? What strategies do you use to enhance motor learning? How do you bias myelination vs. remyelination? How do you structure HIIT and MICT exercises? How do you involve patients in the decision-making process for exercise? Links to the studies:https://pubmed.ncbi.nlm.nih.gov/35633383/https://pubmed.ncbi.nlm.nih.gov/35622474/https://pubmed.ncbi.nlm.nih.gov/35635130/https://pubmed.ncbi.nlm.nih.gov/35399102/ Please leave a rating and review, share the podcast with fellow clinicians, and check out future episodes!
75 minutes | Sep 1, 2022
Critical Thinking and Applying Research to Clinical Practice with Lars Avemarie
In this episode, I speak with Lars Avemarie about critical thinking and translating research. We discuss the propensity of misinformation across mass and social media and how to remain accountable to the information we provide patients and fellow physical therapists. We also tackle the state of manual therapy research (in 2020). As with any good conversation, I am left with more questions than I started with. The points Lars made have led to a lot of personal reflection about my clinical practice and how I teach.*This episode was recorded in 2020 and aired on the first iteration of the Clinical Gap Podcast on September 1, 2020.Where to find Lars:Website, Twitter, Instagram
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