Common Clinical Findings with Uncommon Links of the Lower Extremity: Evidence,Evaluation and Intervention
The Orthopaedic Manual Therapist is uniquely qualified to act as a primary screener and interventionist for a majority of non-traumatic lower extremity impairments. This will be an interactive course focusing on the manual therapists' assessment and treatment of the lower extremity from the lumbo-pelvic region through the foot and ankle. Participants will implement clinical decision making skills in order to link kinetic chain relationships to tissue specific impairments. Interventions will include manual therapy techniques as well as supportive neuromuscular treatments. This session will detail clinically relevant relationships for diverse patient populations, including athletes, based on an organized examination and decision making process.
Presenters: Catherine Patla/Erin Conrad/Amanda Grant Roys
Evaluation and Treatment of Patients with Post-Concussive Syndrome The Physical Therapists Role
This one-day course will include 40% lecture and 60% lab. The content will focus on incorporating evidence based manual therapy and sensorimotor rehabilitation into the management of patients following concussion, particularly those with post-concussive syndrome. The morning classroom will discuss theory and evidence for evaluation and management of patients post concussion and will present a framework for examination, treatment, and collaborative management of these complex patients. The afternoon lab will be hands-on demonstration and practice of manual techniques as well as evaluation and treatment of the presenting sensorimotor components. The afternoon session will also provide discussion and practice of exercise prescription targeted toward impairments and reinforcement of clinical treatment. Clinicians completing this session will develop a clinical framework providing for the immediate integration into clinical practice.
Presenters: Amy Garrigues/Bara Alsalaheen
Foot Orthoses in the Management of Anterior Knee Pain: An Evidence Informed Pragmatic Clinical Approach
If you see clients who have overuse injuries such as patellofemoral pain and you are not too confident about the examination of the foot, its role in these conditions and prescribing foot orthoses, then this course is for you. It provides a simple yet effective means of understanding foot function and its role in the treatment of lower limb overuse injuries. More importantly it teaches Vicenzino’s new and efficient way to make a clinical decision on the appropriateness of orthoses in treating overuse injuries. Orthotic prescription is demonstrated and practised. Importantly, integrating the use of foot orthoses with exercises, manual therapy and other physical therapy management (i.e., integration into an overall physical therapy management plan) is covered during the 2-day workshop. Bill is a Prof in Sports Physiotherapy at the University of Queensland (Australia) and leads a productive research team that has a track record in this area with numerous publications and competitive research grants underpinning the workshops and presentations.
Presenter: Bill Vicenzino
Manipulations Around the World
Join Dr. Flynn and a team of his colleagues in an intensive laboratory session focused on thrust manipulation to the spine and extremities. Refine your skills in a fun and informative manner. Learn modifications to make your manipulation procedures extremely comfortable for patients and safe for your body. Participate in lively discussions on moving manual therapy forward.
Presenter: Tim Flynn
The California Challenge: How to Transition out of the POPTS Practice Environment
This course will describe the mechanical and logistical processes for the recent legislative events that have taken place in California related to the physician ownership of physical therapy practices and provide an update on the legal status of POPTS. There will be discussion regarding professionalism as it relates to the POPTS practice environment as well as the mechanisms to assist PT’s transition out of the POPTS environment.
A Pragmatic Evidence Informed Approach to Chronic Lateral Elbow Tendinopathy with Lessons for Other Sites
For too long injections have been used as a first line medical treatment for chronic tendon problems. Recent evidence indicates that steroid injections contribute to poorer long term outcomes and high recurrence rates. This presentation will highlight the evidence underpinning this statement and provide evidence informed approaches to optimising management of chronic tendon problems.
Presenter: Bill Vicenzino
Stop the Madness: Physical Therapists Solution to Chronic Spinal Pain
Spinal pain management in the United States is inconsistent, costly, frequently ineffective and associated with significant risks to the population. In 2005 alone total U.S. healthcare expenditures for low back pain were estimated at $85 billion. A huge driver of this cost is due to overutilization of magnetic resonance imaging (MRI) and the resultant "medicalization" of low back pain due to its visually exquisite depiction of pathoanatomy. This keynote will present data and patient examples of the alarming and escalating harms caused by inappropriate imaging and spine surgery along with the new roles of the manual physical therapist in terms of patient advocate, patient counselor, society educator, and primary care manager of spinal pain disorders.
Presenter: Tim Flynn
The Architecture of a New Healthcare Civilization
The rules of engagement in healthcare have changed. The future of patient interaction is one built upon participation, personalization and portability. The potential for new web and mobile technologies to radically transform the physical therapy profession is real, and we, as leaders and practitioners, must be ready. This keynote will review trends associated with the integration of new technologies into healthcare and physical therapy, framed against basic human communication. The results of the AAOMPT Web Advocacy Task force will be outlined. We will also discuss the challenges and opportunities of this new paradigm, including information management, electronic health records, patient interaction and advocacy. As one key technologist once said, "When a new technology rolls over you, if you’re not part of the steamroller, you’re part of the road."
Presenter: Eric Robertson
Research Day Keynote
The Revolution in Health Care Delivery
The purpose of the presentation is to consider how resources related to healthcare and specifically the delivery of physical therapy can suffer the tragedy of the commons, and to consider the potential to manage physical therapy resources effectively through collective action that will result in defining our value.
Presenter: Gerard Brennan, PT, PhD
Break Out Sessions
Behavior Modification Strategies for Patient Adherence to Exercise and Wellness
Prescribing and promoting exercise, and educating patients on the importance and value of exercise are key responsibilities of the physical therapist. Prescribing and promoting exercise and educating patients on the importance and value of exercise are key responsibilities of the physical therapist. However, there is limited information on the degree to which benefits are sustained after participating in a physical therapy program. Some studies have shown that benefits of exercise gained during physical therapy often are not maintained after discharge. Lack of sustained benefits from physical therapy may be the result of poor adherence to a prescribed home exercise program (HEP) that is designed to promote the maintenance of improved function following discharge. No research has examined if cognitive behavioral strategies help patients overcome their barriers and increase adherence to a HEP or participation in additional physical activity programs. The two-way relationship between cognition and behavior is interactive. The cognitive processes can influence behavior, and behavioral change can influence cognitions. We have seen this in chronic pain patient management with mixed success. Clinical trials have demonstrated a trend for the study outcomes to revert toward the mean between the intervention/placebo or back toward baseline over time after discharge. This may lead researchers to examine behavioral change methodologies that empower the patient to perform tasks/exercises and to overcome their barriers to maintain their health or functional outcomes. Because cognition and behavior are so closely linked, the clinician can opt to intervene at either the cognitive or the behavioral level, using practical methods of interrupting the cycle and encouraging more adaptive responses. Techniques and strategies will be discussed and demonstrated through video to utilize with outpatient orthopaedic populations to address adherence to home exercise and overall wellness.
Presenters: Megan Donaldson / Ken Learman
Evidence-Based Practice Revised: Integrating Technology and Modern Learning Styles into Your Hunt for Evidence
The foundational principles of evidence-based practice were laid out well before the Internet was commonplace in our lives. The manner in which we know find information has evolved as our ability to access data has exponentially increased. To this end, this session will explore the ways in which we can find evidence, or make evidence find us. This session will propose a new process for evidence-based practice, which builds on the classically accepted steps of EBP, and offers a new path to maximize the ability of the clinician to integrate evidence into daily practice. If information overload has ever been a problem for you, this session will break down how to filter a vast sea of information using social tools, modern web technologies, and a thoughtful approach to evidence-based practice.
Presenter: Eric Robertson
Go Mobile! Extending Physical Therapy Practice Through Portable Technology
The mobile platform has been described as the great socio-economic equalizer for access to health information around the globe. This movement can seem more intuitive for some forms of health information, but can pose a conceptual struggle for practitioners of a trade defined by the hands-on approach. This session will showcase and describe strategies to extend orthopaedic manual physical therapy practice through social media and mobile platforms. Distance based care will be debated and controversial topics related to the concept of portable healthcare will be debated.
Presenter: Eric Robertson
Grassroots Research in Manual Therapy: The Use of Crowdsourcing
The interactive discussion is designed to provide interaction and potential collaboration between clinicians and clinical researchers. Each clinical researcher will have materials, a study idea, IRB information, and what responsibilities a clinician would have at their location and clinicians will "visit" each location every 5-7 minutes, ala a "speed dating" format. This informal interaction will hopefully lead to collaboration between clinicians and researchers that will be mutually beneficial for both parties.
The Manual Therapy Clinical Research Consortium
Sponsored by: The Executive of the American Academy of Orthopedic Manual Physical Therapists
Facilitator: Chad Cook
Investigating Effectiveness and Efficiency for Patients with Lumbar Impairment Managed by a Patient-Response Classification Method During Routine Practice: A Practiced-Based Evidence Research Model
A sequential series of three inter-related topics will be presented. The first presentation will describe predictors of physical therapy clinician performance identified using Evidence-Based Practice (EBP) research design. PBE methods allow development of comparative effectiveness research (CER) models using advanced risk-adjustment to statistically control for confounders and diverse patient case-mix. The identification and evidence supporting risk adjustment to develop robust CER models will be discussed. CER results will demonstrate how data can be used to improve our understanding of clinical performance, assess which treatments are associated with better outcomes for which patients, and describe how to apply clinically meaningful interpretations to patient outcomes and clinician performance. The next segment of the breakout session will describe the steps required to develop a foundation for a PBE designed study conducted by full time clinicians during primary care clinical practice to ultimately determine which treatments are associated with better outcomes for which patients with spinal impairments. The final segment of the presentation will report actual data and initial results of a multi-clinic PBE study investigating a large sample of patients (N > 1000) referred to rehabilitation with low back pain and managed by clinicians trained in patient response MDT method, treatment processes (i.e., exercise, manual, educational, functional, cognitive behavioral techniques) and outcomes related to pain and functional status
Presenters: Mark Werneke / Dennis Hart
Managing Psychological Factors in Patients with Musculoskeletal Disorders
This session will enable participants to improve their effectiveness with physical therapy management of patients who have mental disorders coexisting with their physical disorders. The focus of instruction will be to assist the participants to integrate basic principles of psychotherapy into physical therapy clinical practice. A primary goal of this session will be to equip physical therapists with the ability to 1) identify patients at risk for becoming disabled with neck and back pain, and 2) implement intervention strategies targeted to address the cognitive-behavioral disorders that coexist with the physical impairments associated with spinal pain. Physical therapists are the practitioners best equipped to be the leaders is preventing disability associated with neck and low back pain. The focus of this presentation is to introduce and train PTs in the evaluation and treatment skills to take this lead.
Presenter: Joe Godges
Mechanisms of Action of Manipulative Therapy
Manual therapy is widely used in management of musculoskeletal problems and has an evolving evidence base, particularly for its efficacy. Practitioners frequently observe efficacious effects clinically, which stimulate the question: "How does the manual therapy work?" Bill Vicenzino, Head of Physiotherapy at the University of Queensland (Australia) and Professor in Sports Physiotherapy, has researched this question over the past 15 years, and will lead this session in addressing this question. So if you have ever thought about this question, then this session is for you.
Presenter: Bill Vicenzino
Mobile Computing in Physical Therapy: Leveraging Technology to Improve Clinical Practice
By the year 2015, 1.4 billion people will own smartphones, and 500 million of those people will be using applications related to healthcare. By 2010, over 100,000 physicians were utilizing iphones in their clinical practice. Where do you stand in your understanding and use of mobile technology in your practice? This session will answer the why, what and howquestions of mobile computing in Physical Therapy. Why would incorporating mobile technology into my practice be beneficial? What specific devices or software applications will improve my efficiency and effectiveness as a clinician or manager? How will I implement mobile computing solutions in a busy and tightly budgeted practice? This session will address these and other important issues surrounding mobile technology in Physical Therapy.
Presenters: Daniel Rhon / Benjamin Hando
Not Every Acromioclavicular Joint Needs to be Cut Out — Orthopaedic Manual Physical Therapist Interventions for AC Joint Dysfunctions
This lecture and lab session is intended to give the orthopaedic manual physical therapist an evidence-based foundation for the evaluation and treatment of acromioclavicular (AC) joint dysfunction. We will examine how impairments at this location may affect the shoulder complex. The AC joint is generally underappreciated and is often overlooked in the examination and treatment of patients following shoulder injuries, or in patients with non-resolving or recalcitrant shoulder pain. The format will be a lecture and hands-on lab. The presentation will include a discussion on anatomy, biomechanics, imaging, diagnosis, proposed mechanisms of orthopaedic manual physical therapy (OMPT) intervention for the AC joint, manual therapy decision making using case examples, and an evidence review of current AC joint research. The lab portion of the program will consist of specific joint mobilization/manipulation and other treatment techniques directed at primary AC joint dysfunction.
Presenter: Kevin Harris / Dr. Gail Deyle
Palpatory Assessment and Mobilization of the Cervical Spine: Advancing from Conceptual Models to Clinical Practice
The content of the session would specifically focus on presenting the current evidence and sensorimotor skill of cervical spine passive movement palpation for assessment and mobilization. Common conceptual models of mechanical lesions of the cervical spine have been historically based on palpating the amount of movement and quality of end-feel. However, cumulative data does not support these models and challenges to reframe the manual physical therapists longstanding diagnostic criteria for cervical spine disorders. This session will offer the accumulated evidence (both published and in preparation for submittal for publication) to potentially modify the current paradigm of cervical spine passive movement examination and interpretation. The session will also offer a unique interactive lab session teaching cervical spine mobilization. Pairs of therapists will learn to palpate the cervical spine and perform mobilization, gaining immediate feedback on performance and consistency with the evidence by utilizing innovative computerized modeling.
Presenters: Charles Hazle / Matt Lee
Rationale Use of Manipulation in Cervical Spine Disorders
There is always risk associated with the management of patient with head and neck disorders. Frequently injury to the vertebral artery is mentioned as a complication of cervical manipulation. Controversy continues on the magnitude of that risk and often to the exclusion of potentially more common risks such as missed diagnosis. The purpose of this session is the to review the current literature and discuss a framework of best practice risk in context when managing individuals with head and neck complaints.
Presenter: Tim Flynn
Thrust Joint Manipulation for the Cervical Spine: New Thoughts on Benefits and Risks
There is good evidence to support manual therapy directed to the cervical spine in some patients with neck pain.2-4, 7, 10, 12 These manual therapy techniques include passive joint mobilization (non-thrust techniques) and thrust joint manipulation (TJM). Many physical therapists may be reluctant to utilize TJM to the cervical spine because of perceived risks associated with thrust techniques applied to this region.1, 5, 6, 9, 11. This educational session will provide an opportunity for participants to take a renewed, critical look at TJM to the cervical spine, and consider risks and benefits. We will present new research from recent studies that have been accepted for publication or are currently under review.13-15 The first is a randomized clinical trial comparing outcomes of patients with neck pain who met a clinical prediction rule for thoracic spine TJM8 and received TJM to their cervical spine instead of the thoracic spine. The results of this study13 demonstrated that patients with neck pain experienced greater improvements in pain and disability when the TJM was directed to their cervical spine. Furthermore, they reported fewer transient side effects that those that received TJM to their thoracic spine. No serious adverse events associated with cervical TJM were encountered. The second study was a review of documented case reports of serious adverse events (death, stroke) associated with TJM to the cervical spine to determine if the TJM was used appropriately and if events could have been prevented.14 One hundred and thirty-four cases reported in 93 articles published between 1950 and 2010 were reviewed. The TJM applied in each case was categorized as appropriate or inappropriate based upon whether or not the treatment technique was clinically indicated (e.g. for neck pain, headache, or cervical radiculopathy). Adverse events reported were categorized as preventable, unpreventable or unknown based upon whether or not attention to contraindications or red flags should have otherwise stopped the care provider from performing the TJM to the cervical spine. Results of this study found that TJM to the cervical spine was performed appropriately in 80.6% of cases, indicating the potential to avoid adverse events in 1 out of every 5 cases. Furthermore, 44.8% of the cases were preventable (10.4% unpreventable) indicating that if all contraindications and red flags have been ruled out, there is potential for a clinician to prevent 44.8% of serious adverse events. The final study present results of a survey on educational opportunities in TJM for entry-level doctor of physical therapy students, and novice clinicians.15 The survey involved 435 students and 193 novice clinicians, and found that confidence amongst students and novice clinicians in utilizing TJM on patients was significantly associated with method of instruction. Students and novice clinicians who received laboratory (practical) instruction in the application of TJM were more confident in its use within the patient population, whereas students and novice clinicians who did not receive sufficient laboratory instruction were less confident and less likely to use TJM clinically. The information presented in this educational session should provide for a more thoughtful analysis on the use of TJM in the cervical spine.
Presenters: Emilio "Louie" Puentedura / Paul Mintken
The Challenge of Spine-Related Extremity Pain: Clinical Assessment and Strategies for Management
Pain that radiates distally at the extremities is clinically divided into radicular and pseudoradicular syndromes and is distinguished as neuropathic and non-neuropathic, respectively. Because of the underlying pathophysiology, optimal management strategies differ significantly, thus, accurate diagnosis is ideal. It is hypothesized that pain from spinal somatic tissues does not extend distally into the lower limb, while pain from disorders associated with nerve root compression often is felt in distal dermatomes below the knee (projected pain), However, recent evidence has questioned some of these previously held notions. Furthermore, many physical therapy treatment algorithms are based on the presentation of spine related extremity pain. In this presentation, the pathophysiology of radicular and pseudoradicular pain will be explored, and evidence-based clinical assessment and management strategies will be discussed.
Presenters: Carol Courtney / Allison Duncombe / Micheal O’Hearn
The Yin and Yang of Patient Outcomes Measures: Pros of Using Outcomes Measures for Assessment of Patient Improvement
In ancient theory, Yin and Yang represent both balance and disintegration. Measuring outcomes from patients provides a parallel; representing both useful and depredating traits. This first course in the two part presentation discusses the development, validation, use, and necessity of patient outcomes measures. The course assesses the trends and merits of item response theory, minimally clinically important change scores, and adoption of standardized measures.
Presenters: Chad Cook /Alexis (Lexie) Wright / Alicia Emerson Kavchak
The Yin and Yang of Patient Outcomes Measures: Cons of Using Outcomes Measures for Assessment of Patient Improvement
In ancient theory, Yin and Yang represent both balance and disintegration. Measuring outcomes from patients provides a parallel; representing both useful and depredating traits. This second course in the two part presentation discusses the weaknesses and potentially flawed aspects of patient report outcomes measures. The course discusses mode of administration bias, the fallacy of the minimally clinical important change score, the improper over-focus on tools with only one construct, and challenges of using outcomes measures as single measures of success in a pay for performance environment.
Presenters: Chad Cook /Alexis (Lexie) Wright / Alicia Emerson Kavchak
Student Sessions Part 1 and 2
Evidence Based Evaluation and Manipulation of the Lumbopelvic Spine
The objective of this breakout session is to provide the Physical Therapy Entry-Level student the opportunity to learn spinal anatomy and biomechanics, and apply these principles to a thorough examination process. Manipulation techniques supported by the AAOMPT Manipulation Education Manual will be instructed as a treatment for spinal dysfunctions determined by the evaluation process. Current research will be discussed to support the use of these techniques in clinical practice. All students are encouraged to attend this 2 session breakout session.
Presenters: Robert Boyles / Paul Mintken / Joshua Cleland