Keynote Sessions
Evidence-based physiotherapy: challenges and reality
Presenter(s): Leonardo Costa
This presentation will cover the most comprehensive definition about evidence-based practise, why clinicians need to incorporate evidence into clinical practice, the challenges on this approach as well as the current status of evidence based practise in the field of physical therapy.
Should the Academy promote the advancement of its members’ Thrust Joint Manipulation Skills?
Presenter(s): Louie Puentedura
The Founding Fellows of AAOMPT are/were skilled practitioners of Thrust Joint Manipulation (TJM) and it was through their common interest in ‘advanced manual therapy in the United States’ that they founded in the Academy in Rochester, Michigan in the summer of 1991. Evidence-based medicine was still a year away from being formally introduced to the world, but once it spread to the allied health professions it forced manual therapists to pay more attention to evidence to inform their decision-making. Has the wealth of research conducted since then changed the way we practice? Does that research support the continued use of TJM in the management of spinal pain and dysfunction? This presentation will take a critical look at what the research tells us about the evidence for and against thrust joint manipulation in the management of spinal pain and dysfunction. It will make the case for manual therapists of today to return to the skilled application of TJM in clinical practice.
Post-Conference Sessions
Diagnostic Decisions in Orthopaedic Manual Physical Therapy
Presenter(s): Gail Deyle
This course will provide participants with a progressive look at diagnostic responsibility in past, current and future physical therapist practice. With an emphasis on diagnostic reasoning, Dr Deyle will provide innovative strategies and highlight a variety of clinical tools that help determine if the patient is suited for orthopaedic manual physical therapy (OMPT) treatment. Using a variety of personal and published case examples, Dr Deyle will guide course participants through key decision points made obvious through planned clinical reasoning that facilitate an accurate diagnosis and well-tolerated appropriate care. The course is designed to help the experienced physical therapist develop systematic clinical processes and use evidence-based strategies to differentially diagnose musculoskeletal problems and to recognize non-musculoskeletal problems as they present in current clinical practice.
Directional preference, load progression, and repeated movements for the management of lower quarter impairments.
Presenter(s): Joshua Kidd, Ronald Schenk
To date there is limited evidence in identifying prognostic indicators for painful lower quarter pathology. Traditional models include using pathoanatomical diagnostic labels. Despite the multitude of orthopedic tests and classifications, the pathophysiology of many lower quarter disorders is not well understood and may be treated without consideration of the spine as a source of pain. As a result, examination and interventions may be directed to the lower quarter inappropriately, resulting in a misuse of clinical resources, and more importantly, a misdirection in the treatment for the individual seeking care. Taking into consideration the shortcomings of conventionally used examination procedures, a growing body of opinion favors implementing a different approach than the pathoanatomical model in the assessment and diagnosis of musculoskeletal disorders. This session will introduce different models of movement-based classification systems as alternative methods that may fill the current care gap in the effective assessment and diagnosis of musculoskeletal disorders, leading practitioners toward better patient care. Several new peer-reviewed publications will be discussed that show the reliability and validity of movement-based classification systems, including a recent study demonstrating the prevalence of isolated lower quarter pain that emanates from the spine; recently published in the Journal of Manual and Manipulative Therapy. After laying foundational knowledge of movement-based classification systems the participants will be instructed in the use of repeated end range movements, load progression, and the identification of directional preference for the both spine and lower quarter to classify patients accordingly. This will include video demonstration and group interaction to highlight the diagnostic process and the subgroup classification system to treat lower quarter pain. At the conclusion of the session participants will understand movement-based classification including the use of repeated movements and load progression to classify lower quarter impairments. The course participant will gain immediate incite and tools to include in their current treatment methods that will be clinically applicable.
Panel Discussion
Lessons from 2020 - Challenges and Opportunities for OMPT
Presenter(s): Rob Tillman, Louie Puentedura, Jim Rivard, Maggie Henjum
The panelists will discuss the current environment and crucial conversation on topics of manual physical therapist's practice during COVID, addressing health disparities, telehealth experiences, and roles within primary care. Panelists will discuss other creative strategies for patient care or education when face to face was limited, etc. and the strategies in the future that may stay as a result, based on their professional opinions and experiences. The impact of COVID has also impacted the OMPT and physical therapy educational environment. Panelists weigh in on preparing students/residents/ fellows in training who are graduating and coming into this post-COVID health care environment.
Breakout Sessions
A Breath of Fresh Air: Manual Therapy for Dyspnea
Track: Clinical Track
Presenter(s): Steven Kinney, Jeremy Houser
Most of the research on manual therapy has focused on the benefits for patients in pain. However, emerging research has also looked at manual therapy as an intervention for patients with difficulty breathing. The presenters will discuss how manual therapy can amplify the benefits of exercise therapy. This two part session will review the evidence for manual therapy when treating these conditions. Mechanisms of these benefits will also be discussed. In the second part of this session, participants will practice these techniques during a lab component. Clinical decision making when using these techniques will be discussed.
Are we at the table? Maximizing collaborations to impact the care of those with arthritis
Track: Professional Issues
Presenter(s): Emily Slaven
In this session, the impact that arthritis has on the American population will be considered. The complete data set from the Arthritis Foundation’s Live Yes Insights survey will be shared with attendees where the topics of pain, limited motion, and difficulty with walking are key themes of the first round of this data. Discussion of how we as orthopaedic manual therapists should be integral of the management of those individuals with arthritis will occur. Ideas for mechanisms for better collaboration with entities such as the Arthritis Foundation will be explored.
Bridging the Gap Between Pelvic Health and Orthopedic Physical Therapy
Track: Clinical Track
Presenter(s): Kimberly Durant, Ashlie Crew
As orthopedic manual therapists, can we really claim to be evaluating the whole musculoskeletal system if we are not including screening of the pelvic floor especially for patients with hip and low back pain? There is an established link between pelvic floor dysfunction and low back pain. A recent cross-sectional study (2,341 participants) found a higher prevalence of stress urinary incontinence in women with chronic low back pain compared to those not reporting low back pain (49% vs 35%). A Canadian Community Health Survey from 2017, analyzed 125,645 responses and found that both men and women diagnosed with urinary incontinence were twice as likely to also have a low back pain diagnosis. Another study of 200 females with low back pain found that 78% also suffered from urinary incontinence. Clearly, there is a link that we need to be addressing better. In this session, we will review relevant history questions, external examination and treatment techniques, and outcome measures that every orthopedic physical therapist should be using for patients with low back and hip pain. Types of underactivity dysfunctions including incontinence and prolapse will be reviewed. Also, we will discuss when it is appropriate to refer to a physical therapist with training in internal assessment and treatment. Let’s start evaluating the whole system and stop avoiding the pelvic floor!
Byproducts of Lumbar Disc Degeneration; Oscillatory Manual and Exercise Intervention
Track: Clinical
Presenter(s): Doug Creighton
This course will include the instruction and participant practice of initial, intermediate and advanced stabilization exercises for lumbar segmental hypermobility/instability secondary to early grade disc degeneration. In addition, numerous graded oscillatory angular and traction-based lumbar mobilizations will be instructed and practiced and will assist clinicians in enhancing his/her management of patients with disc degeneration resultant lumbar radiculitis, early grade lumbar disc degeneration and resultant segmental instability, advanced grade disc degeneration and resultant segmental motion loss (hypomobility) and lateral and central canal stenotic narrowing.
Chronic Spinal Pain: A Proposed Physical Therapy Model for Evaluation and Management
Track: Translational Knowledge
Presenter(s): Ronald Schenk, Joseph Lorenzetti
This interactive case-based breakout will describe and discuss physical therapy approaches designed to manage chronic musculoskeletal spinal pain. An analysis of the literature regarding the efficacy of the Mechanical Diagnosis and Therapy (MDT) and Pain Mechanism Classification System (PMCS) in managing people with psychosocial factors will be followed by case examples of patients examined and treated who fall into chronic pain subgroups. Preliminary data regarding the efficacy of integrating these approaches will be analyzed.
Coaching, Mentoring and Sponsoring: Professional Development in Physical Therapy Practice & Education
Track: Teaching/Mentoring
Presenter(s): Bryan Pickens, Chris Allen, Jon Umlauf
An influncial mentor plays a crucial role in the professional development of physical therapists and other medical professionals. Recently, an effort to distill what the best mentors do has emerged as a question of particular interest. The abstract concept of a "mentor" is difficult to define, but usually contains elements of mentorship, coaching, and sponsorship. While the overall construct of mentorship is recognized to be extremely valuable in physical therapy education, mentors often must play the role of a coach or sponsor to best influence the mentee. While the importance of mentoring has long been understood, the specific function of coaching and sponsoring is rapidly gaining attention in the development and growth of medical professionals. Mentoring involves establishing a relationship between a more experienced individual and a less experienced individual. However, mentoring is typically directive, with the mentor intentionally transferring specific knowledge and skills and guiding the learner’s activities. Coaching, on the other hand, supports a developmental process through regular meetings over time with a coach to create goals, identify strategies to manage existing and potential challenges, improve performance, and further professional identity development toward reaching the individual’s highest potential. Coaches, after reviewing objective data on performance, help individuals gain insights into their own assumptions, clarify meaning about relevant outcomes, and help identify specific actions needed to achieve the desired result. Sponsorship, in addition to mentorship, is critical for successful professional development. Understanding sponsorship as a distinct professional relationship may help faculty and academic leaders make more informed decisions about using sponsorship as a deliberate professional development strategy. With sponsorship, a protégé is put forward by a sponsor for high-visibility, professional development opportunities. This may include a recommendation for a leadership role, award, or a high-profile speaking opportunity. This session will define each of these concepts in great depth. Attendees will gain a deeper understanding of these roles and determine how and when to use each of them to influence the professional development of other physical therapists.
Evaluating research is > p‐values alone: a clinician’s guide to interpreting statistical influence
Track: Translational Knowledge
Presenter(s): Bradley Myers
Remaining up-to-date with emerging evidence can be challenging for clinicians for many reasons. Obtaining access to journal articles and allocating time for reading can be burdensome. For most OMPT clinicians the difficulty does not end there as interpreting research findings in relation to clinical practice can be a daunting task for even the seasoned clinician. Unfortunately, the historical implementation of Null-Hypothesis Significance Testing and the p-value has been called into question by statistical experts. The evolution of statistical inference requires more critical evaluation than the basic cut-off value of p < .05. This session is intended to provide an update on statistical inference while reviewing and applying important concepts to recent evidence. Additionally a simple framework will be provided for busy clinicians to utilize when assessing clinical research in the future.
Implement Therapeutic Alliance Assessment to Redefine Your Patient’s Musculoskeletal Health
Track: Translational Knowledge
Presenter(s): Christina Myers, Lindsey Hughey, Glenn Thompson
This session will start with an overview of the background and significance of therapeutic alliance as it relates to the practice of physical therapy and then will move deeper into the use of assessment tools for therapeutic alliance including interactive assessment during the session. Learners will come away with tools to implement therapeutic alliance assessment for both their patients and themselves and will be able to immediately implement these assessment techniques into their daily practice.
Introduction to Motivational Interviewing in Physical Therapy
Track: Translational Knowledge
Presenter(s): John Seivert
This 1/2 to full day workshop will focus on understanding the basic concepts of motivational interviewing (MI). This session will focus on real life transcripts of patient and PT interactions demonstrating the effectiveness of MI in helping patients make positive changes. Upon completion of the session each participant will have new tools to use in helping patients make changes with ideas and plans that have come from the patient, not the PT trying to fix the problem.
Modern management of the stiff and painful shoulder
Track: Clinical Track
Presenter(s): Eric Chaconas, Mark Shepard
Shoulder mobility deficits are a common occurrence in painful shoulder conditions such as adhesive capsulitis and post-operative stiffness. High irritability of the painful shoulder is a contributing factor to persistent stiffness and poor outcomes. A body of evidence has recently emerged for the stiff and painful shoulder demonstrating effectiveness with modern interventions. In this 2 part session a shoulder irritability model of care will be discussed along with the current evidence for nervous system targeted progressions, manual therapy and exercise covering the spectrum of irritability levels. Lab activities in part one will include techniques that will cater to those patients with high irritability, such as tactile discrimination, graphesthesia and graded motor imagery. The lab in part two will include progressive manual therapy techniques from several patient positions along with exercise and loading programs to be used in varying levels of shoulder irritability.
Multi‐modal Approach in the Treatment of the Hypermobile Patient
Track: Translational Knowledge
Presenter(s): Laura Fisher, David Johnson
Joint hypermobility syndrome (JHS) is a commonly misdiagnosed and mismanaged condition in the physical therapy setting. Individuals with JHS have demonstrated lower scores on quality of life measures across the lifespan, and present unique challenges to even the most skilled clinician. Generalized hypermobility has been linked to an increased risk of injury in contact sports; and hypermobile athletes have been shown to miss more training time, competitive games, and take longer to recover. In addition to the unique physical characteristics present in these patients, they have also been shown to present with increased risk of depression, anxiety, fear avoidance behaviors, and agoraphobia. There is a significant knowledge gap among physical therapists regarding appropriate evaluation and treatment of the hypermobile patient population. A large study among Physical Therapists showed that 38.8% were unfamiliar with JHS and 73.2% did not know the Beighton criteria for diagnosing JHS. Physical Therapy can be a valuable part of the management of these patients and could potentially reduce healthcare costs. This presentation is an opportunity to tremendously improve the quality of life of hypermobile physical therapy clients by reviewing recommendations on examination and diagnosis of hypermobility as well as providing a multimodal treatment plan.
Shared Decision Making: Opportunities for Enhancing Patient Engagement
Track: Translational Knowledge
Presenter(s): Laura Thornton, Jackson McNeal, Dominque Tull
Shared decision making, a process that focuses on achieving patient-centered healthcare, has been increasingly accepted in clinical medicine. The goal of shared decision making is to enhance and restore patients’ autonomous capacity by engaging them in collaborative deliberation on available treatment options. Clinicians help to clarify treatment options by informing on best available evidence and helping patients actively consider options before supporting an informed, well-considered, and confident decision. This process is specifically relevant when a decision requires specific behavior change and when there is more than one reasonable option for treatment. Evidence suggests consistent improvement in patients’ knowledge and more accurate perceptions of risk led to increased confidence in decisions in the medical realm. There is lack of guidance on how to accomplish this in the rehabilitation setting despite research supporting therapeutic alliance as a key component to successful outcomes. This session will detail examples of shared decision making in outpatient physical therapy to showcase the feasibility in the rehabilitation setting. A lecture format will be used with emphasis on case-based learning to provide attendees with a practical application of shared decision making in the outpatient setting with patients with musculoskeletal complaints. Each case will describe the process in which shared decision making was implemented and provide integration strategies for clinicians.
So, You’re Interested in Academia? A roadmap to prepare OMPTs in their transition
Track: Teaching/Mentoring
Presenter(s): Michael Bourassa, Jodi Young
The Orthopaedic manual physical therapist has a long history of excellence in research, clinical reasoning, practice management, and post-doctoral training. It is these values that have led OMPTs to become leaders in the profession and serve in a variety of academic roles. Within the last decade, the total number of physical therapy programs has grown dramatically. Doctor of Physical Therapy (DPT) programs grew by 50 and Residency/fellowships have increased from 50 to 296. The need for faculty members is high, however, the transition into academics is not an easy one for most clinicians. The Academic and Clinical Faculty Special Interest Group (ACF SIG), in collaboration with the Early Professional Special Interest Group (EP SIG), will focus on providing a framework to guide members into varying academic roles. The presentation will consist of multiple speakers, each with diverse academic experience. The aim of this session is to focus on the OMPT as an educator and discuss key points to consider during the transition into an academic role.
Systematic Clinical Reasoning: From Novice to Expert in No Time
Track: Teaching/Mentoring
Presenter(s): Evan Petersen, Stephanie Thurmond
The development of clinical reasoning needs to be seen as part of a learner continuum and grounded in explicit teaching and learning strategies. Due to the variability in clinical reasoning for students in entry-level and even advanced level physical therapy programs, a systematic approach to introducing effective strategies and instructional tools is needed to improve this essential skill. Clinical reasoning is essential to understanding a patient’s pain and in determining the appropriate vigor and extent of the physical exam and intervention. This pre-conference will highlight the use of several clinical reasoning strategies and tools that can facilitate the development of clinical decision-making. Attendees will learn to utilize these tools in the clinical and academic settings to improve clinical reasoning and effective decision-making. The pre-conference is targeted for first time AAOMPT conference attendees and fellows-in-training.
That's not my brand, is It? How to market your OMPT in 2020
Track: Professional Issues
Presenter(s): Matthew Daughtery
Currently, orthopaedic manual physical therapists (OMPTs) have professional and advocacy issues specific to our profession. More specifically, OMPTs have an identity crisis with the public, which causes OMPTs to miss out on career opportunities have difficulty sustaining their practices and ultimately serve less patients. Some of this identity crisis is due to OMPTs limited business training. We need focused efforts to correct this identity crisis through business training sessions with a focus on marketing to improve public awareness and perception. This may lead to improved opportunity within the health field and a foothold in prevention, wellness and rehabilitation in this metamorphosis of musculoskeletal health evolution. The implications of session may cause positive social change toward the OMPT’s direct and indirect patient marketing. This could lead to economic growth in the physical therapy practice market, as well as improved patient access to physical therapy services through a greater number of physical therapy practices. Description of session This evidenced based session will cover the topics of: brand awareness, relationship marketing, perceived quality, social media and online marketing, and word-of-mouth marketing to advance participants knowledge on these topics. Crowd interaction will be encouraged with the use of A/V aides, KahootIT quizzes and a Q and A session.
The Utility of Non‐Traditional Physical Therapy Interventions As A Means Of Holistic Management & Treatment Of Chronic Pain.
Track: Clinical Track
Presenter(s): Chase Edwards
The utilization of holistic or integrative based treatment approaches aim to address a patient a whole system versus isolated segments. The practice integrates conventional and alternative therapies to prevent and treat disease and, most important, to promote optimal health. The efficacy of holistic based treatment approaches within physical therapy practice employee traditional physical therapy interventions with nonconventional intervention strategies aimed at addressing all aspects of health and wellness. Physical Therapists are in a primes position to discuss this multimodal treatment approaching targeting: sleep hygene, evidence based nutritional recommendations within scope of practice, lifestyle and activity modifications, and restoring autonomy and internal locust of control to patients. One such case employing this holistic approach of physical therapy intervention for a patient suffering from chronic pain and opioid dependence. This case emphasized sleep hygiene promotion, pain neuroscience education techniques, evidence based nutritional recommendations targeting anti-inflammatory properties of daily nutrition, manual therapy interventions, progressive loading and gym based exercise plan, and traditional therapeutic exercise strategies.
What does the evidence suggest? Exercise therapy (ET) and targeted dosage in the management of individuals presenting with chronic NP
Track: Translational Knowledge
Presenter(s): Mark Wilhelm, Megan Donaldson, Josh Cleland, Ken Learman, David Griswold
Currently, there is a lack of evidence-based dosage recommendations for exercise therapy (ET) prescription for the management of NP-associated disorders. Clinicians are encouraged to use exercise in the management of neck pain but how do they select exercises and dosing in the variability of information. The presenters were authors on a published study which conducted an SR and MA on the optimal exercise dosage recommendations for treatment of chronic NP. The authors want to share the learned lessons and clinical implications from this study. Authors will discuss the studies that evaluating the type and dosage effect of ET on pain and disability in the management of individuals with chronic NP. Video and interactive polling will be used during this session.
What PT’s need to know about Regenerative Medicine and Orthobiologic Injections.
Track: Teaching/Mentoring
Presenter(s): Greg Johnson, Christopher Centeno
Some of the most exciting recent advances in musculoskeltal care has been achieved within Regenerative Medicine. Through the use of Orthobiologic Injections (platelet-rich plasma, stem cells, and other tissues) major progress has been achieved in helping heal degenerative and traumatic tissue changes. This presentation will illuminate how injections performed under exacting image-guidance can help patients avoid traditional orthopedic surgery. The medical literature and basic concepts will be discussed. In addition, how orthobiologics change physical therapy paradigms will be reviewed. In addition, the role of how Physical Therapy can be an important adjunct for the pre-injection preparation phase and the post-injection rehabilitation and care.