January/February 2008 The Official Publication of the American Academy of Orthopaedic Manual Physical Therapists INSIDE THIS ISSUE... Message from the AAOMPT President Tim Flynn, PT, PhD Do you have an identity crisis? Vol. 14, No. 1 I Reports from the Executive Board.. 3 Credentialed Fellowship Programs . 4 Committee Reports ..... 5 Practice Affairs Corner 9 Conference Highlights 11 Clinical Pearl .............. 15 Research Pearl ........... 16 AAOMPT Membership Benefits .................. 18 AAOMPT Membership Application .............. 20 am Tim Flynn, PT. I am a Physi- cal Therapist. I am board certified in Orthopaedic Physical Therapy and fellowship trained in Orthopaedic Manual Physical Therapy. I am a Physical Therapist period. I used to place a lot of initials behind my name; at least I did before our Treasurer John Child’s insecurity ruined it for all of us. I remember this event very clearly, it happened when his initials overflowed onto two lines when using 10 point font on standard 8.5 X 11” paper. I guess we might want to actually thank him for saving us from what was rapidly becoming a complete loss of the branding of physical therapy. As members of the Academy we need to take the lead in our profession. We are Physi- cal Therapists. We are members of the best profession in Medicine. However, the average patient/client in our country does not have any idea of what a physical therapist does nor are they aware of the large volume of evidence that now supports manual physical therapy interventions for a wide range of musculosk- eletal disorders. We, as physical therapists, are largely responsible for this identity crisis. It is not unusual to see a wide array of alphabet soup behind our names (for example- Cert. MDT, CHT, CMP, COMT, CSCS, DPT, FACSM, FAAOMPT, FAPTA, FCAMT, FFCFMT, MTC, MPT, OCS, OMT, SCS). This dilutes who we are. Personally, I would fail an examination if I had to spell out what all of those initials mean. Try a little test with the next 10 patients you see by asking them if they know what these initials represent. Our professional colleagues are recognized by their professional title designator (MD, DO) and their specialized training is described to the consumer (i.e. board certified Orthopaedic Surgeon; fellow- ship trained in Foot & Ankle). The patient/cli- ent in our culture understands this; they do not understand all of the initials that we put with our names. Medical professionals in academia may have their terminal academic degree behind their name (i.e. MPH, PhD, etc). However, they are still identified by their professional designator and medical training. We are not defined by our techniques or our numerous certifications; rather we are defined by our unique body of knowledge and our perspective on managing the musculosk- eletal system. I believe clarity in our identity will come with less initials and more description. I would urge all Academy members to take the lead and clearly brand yourself as a Physical Therapist and describe clearly your board certification and fellowship training. Let’s lead the charge and get our identity back. Tim Flynn, PT, PhD Board Certified in Orthopaedic Physical Therapy Fellowship Trained in Orthopaedic Manual Physical Therapy MARK YOUR CALENDAR! AAOMPT Annual Conference Oct. 29 - Nov. 2 Seattle, WA
Transcript
January/February 2008
The Official Publication of the American Academy of Orthopaedic Manual Physical Therapists
InsIde ThIs Issue...
Message from the AAOMPT PresidentTim Flynn, PT, PhD
Do you have an identity crisis?
Vol. 14, No. 1
I
Reports from
the Executive Board.. 3
Credentialed
Fellowship Programs . 4
Committee Reports ..... 5
Practice Affairs Corner 9
Conference Highlights 11
Clinical Pearl .............. 15
Research Pearl ........... 16
AAOMPT Membership
Benefits .................. 18
AAOMPT Membership
Application .............. 20
am Tim Flynn, PT. I am a Physi-cal Therapist. I am board certified
in Orthopaedic Physical Therapy and fellowship trained in Orthopaedic Manual
Physical Therapy. I am a Physical Therapist period. I used to place a lot of initials behind my name; at least I did before our Treasurer John Child’s insecurity ruined it for all of us. I remember this event very clearly, it happened when his initials overflowed onto two lines when using 10 point font on standard 8.5 X 11” paper. I guess we might want to actually thank him for saving us from what was rapidly becoming a complete loss of the branding of physical therapy.
As members of the Academy we need to take the lead in our profession. We are Physi-cal Therapists. We are members of the best profession in Medicine. However, the average patient/client in our country does not have any idea of what a physical therapist does nor are they aware of the large volume of evidence that now supports manual physical therapy interventions for a wide range of musculosk-eletal disorders. We, as physical therapists, are largely responsible for this identity crisis. It is not unusual to see a wide array of alphabet soup behind our names (for example- Cert. MDT, CHT, CMP, COMT, CSCS, DPT, FACSM, FAAOMPT, FAPTA, FCAMT, FFCFMT, MTC, MPT, OCS, OMT, SCS). This dilutes who we are. Personally, I would fail an examination if I had to spell out what all of those initials mean. Try a little test with the next 10 patients you see by asking them if they know what these initials represent. Our professional colleagues are recognized by their
professional title designator (MD, DO) and their specialized training is described to the consumer (i.e. board certified Orthopaedic Surgeon; fellow-ship trained in Foot & Ankle). The patient/cli-ent in our culture understands this; they do not understand all of the initials that we put with our names. Medical professionals in academia may have their terminal academic degree behind their name (i.e. MPH, PhD, etc). However, they are still identified by their professional designator and medical training. We are not defined by our techniques or our numerous certifications; rather we are defined by our unique body of knowledge and our perspective on managing the musculosk-eletal system. I believe clarity in our identity will come with less initials and more description. I would urge all Academy members to take the lead and clearly brand yourself as a Physical Therapist and describe clearly your board certification and fellowship training. Let’s lead the charge and get our identity back.
Tim Flynn, PT, PhDBoard Certified in Orthopaedic Physical TherapyFellowship Trained in Orthopaedic Manual Physical Therapy
MARK YOUR CALENDAR!AAOMPT Annual
ConferenceOct. 29 - Nov. 2
Seattle, WA
3134 West Lewis Avenue, Suite 41 • Phoenix, AZ 85009
Public Relations:Britt Smith, PT Phone (970) 263-4079E-mail: [email protected]
AgendA
I. 4:45 pm Welcome and Rules of Order– Tim Flynn, AAOMPT PresidentII. Motion: Chris Showalter: Approval of minutes from 2006 business meeting A. Seconded: Bill BoissonnaultIII. Motion: Ken Learman: Approval of Agenda for 2007 business meetingIV. Seconded: Bill BoissonnaultV. Executive Committee Reports A. President – Tim Flynn 1. Highlighted top 8 accomplishments a. PR update b. Membership c. Adressed manipulation d. Website automation e. Conference update f. Entry level education update g. Advocacy h. Research report B. Vice-President – Robert Rowe 1. Thanked those individuals who have worked on the update of the DASP 2. Manual Therapy Language Taskforce continues its work 3. 18% of our members contribute to the PT PAC C. Secretary – Jake Magel 1. Report will come in form of the minutes printed in Articulations D. Member at Large – Stephania Bell 1. Excused absence. No report E. Treasurer – John Childs 1. See report 2. Practice Affairs Fund was promoted F. Reports 1. Committee Reports i. Standards – Catherine Patla A. See Report ii. USA MO IFOMPT review in 2011 iii. In process of revising present standards documents. iv. Working to improve fellow renewal process v. Establishing P and P template A. Credentialing update - Patty McCord i. 16 credentialed fellowship programs. Six applications in
review. ii. OMPT requirements are being revised. See website for info iii. Gail Deyle asked what is plan for individuals who do not
meet fellow renewal process. Tamara Little: Fellows will receive a letter on what is needed to complete the application
iv. At age 62 lifetime fellow status is granted v. Tim Flynn opened discussion on the need to separate the
credential of Fellow from the membership category. More discussion on this topic will occur in the future
B. Examination- Mike Puniello i. See report C. Practice Affairs – Bill Boissonnault i. See report
AAOMPT Business Meeting Minutes
October 20, 2007 • St Louis, MO
4 - Articulations - January/February 2008
Daemen College Orthopedic Manual Physical Therapy Fellowship4380 Main StreetAmherst, NY 14226Contact: Ron Schenk, PT, PhD, OCS, FAAOMPT, Cert. MDTPhone: 716/839-8360Fax: 716/839-8345E-mail: [email protected]
Institute of Orthopaedic Manual Therapy c/o Orthopaedics Plus101 CambridgeBurlington, MA 01803Contact: Martin Langaas, PT, OMTPhone: 781/932-8866Fax: 781/229-8374E-mail: [email protected]
Institute of Rehabilitation and Training Orthopedic Manual Therapy FellowshipHealthsouth Rehabilitation Center211 Sweet Briar LanePrattville, AL 36067Contact: C. Andy Gustafson,Phone: 334/221-1870Fax: 334/365-7724E-mail: [email protected]
International Academy of Orthopedic Medicine (IAOM) - US Fellowship in Orthopedic Manual TherapyPO Box 86177Tucson, AZ 85754(Sites in Alaska and Texas)Contact: Phil Sizer, Jr., PT, PhD, OCS, FAAOMPTPhone: 520/318-4266Fax: 520/318-0849E-mail: [email protected]
Kaiser Hayward Physical Therapy Fellowship in Advanced Orthopedic Manual Therapy 27400 Hesperian BlvdHayward, CA 94545Contact: Carol Jo Tichenor, PT, MAPhone: 510/675-4259Fax: 510/675-3241E-mail: [email protected]
Kaiser Permanente Los Angeles Orthopaedic Manual Therapy FellowshipKaiser Permanente Medical Center - Physical Medicine and Rehabilitation6041 Cadillac AveWest Los Angeles, CA 90034Contact: Joseph Godges, PT, DPT, MA, OCSPhone: 323/857-2422Fax: 310/215-0780E-mail: [email protected]
North American Institute of Orthopaedic Manual Therapy (NAIOMT), Inc. Clinical Fellowship1574 Coburg Rd, PMB 129Eugene, OR 97401-4802Contact: Ann Porter-Hoke, PT, OCS, FCAMT, FAAOMPTPhone: 800/706-5550Fax: 541/485-0016E-mail: [email protected]
Recognized Clinical Fellowships in OMPT by AAOMPT
List continued on page 6
ii. See state gov’t affairs website for info on mobilization/ manipulation and the MEM iii. Practice affairs update. Strategic plan update. Tennessee
practice act compromise. Better prepare selves to be advocates for our issues. White paper on manipulation
describing stance and background. Next hear will have legislation breakout session.
iv. 6-8 different states have chiropractic related issues each year. Oregon chiropractors are attempting referendum for ownership of manipulation
v. Do not to respond directly to chiropractors when challenged on manipulation instead go directly to state
chapter D. Membership – Cheri Hodges i. Committee is trying to increase general membership.
Members may order membership brochures on website. E. Education i. See report ii. Ken Olsen. Highlighted manipulation education courses.
Will continue course. Contact Ken Olson or Rusty Smith for details
F. International Affairs a. Chris Showalter i. See report ii. Phil Sizer created and sent a survey of IFOMT member organizations questioning them regarding
referral patterns and practice issues. Will send results to the exec publish as technical paper then send on to IFOMT.
iii. IFOMT is June 8-15 Rotterdam. Nov 15, 2007 is deadline for abstracts
iv. David Lamb memorial award established for manual therapy research
v. Current bids for IFOMT 2012 are from Quebec Canada and London England
vi. IFOMT may change name from “International Federation of Orthopaedic Manipulative Therapists”
to “International Federation of Musculoskeletal Therapists”
vii. James Dunning: 1. Asked about reciprocity for foreign-trained physical
therapists to become AAOMPT Fellows. Discussion occurred regarding foreign-trained fellows still need to go through the AAOMPT Fellowship Examination process G. Public Relations - Britt Smith a. See report online b. Attempting to increase press releases to 1 per month. c. Breakout session next year on PR H. Newsletter - Dave Meiers. a. Thanks to Matt Garber for his participation with Articulations. Evan Petersen and Kevin Baker have joined
the committee as Assistant Co-Editors I. Nominating Committee - Alycia Markowski a. Call for nominations
Meeting Minutes (continued from page 3)
continued on page 6
January/February 2008 - Articulations - 5
Committee Reports
Research CommitteeH. James Phillips, PT, PhD, OCS,
FAAOMPT
At the annual awards luncheon, the Research Committee awarded Josh Cle-land, PT, DPT, PhD, OCS, FAAOMPT, et al, for the Cardon Research Award for their proposal entitled “Comparison of the ef-fectiveness of an impairment-based manual therapy and exercise approach versus tradi-tional treatment in the management of heel pain: A randomized clinical trial.” Receiv-ing the OPTP Research Grant were John Ruff May, SPT, et al, for their proposal entitled “An evidence-based paradigm: Student perceived barriers to learning and practicing spinal manipulation.”
This year’s Research Day keynote address was delivered by Dr. Linda Van Dillen from Washington University in St. Louis. Her topic was “LBP Classification: Are we all seeing the same things?”
The committee chose Carol Courtney, PT, PhD for the Dick Erhard Research Award for outstanding platform presenta-tion for her work entitled “Joint Mobiliza-tion and Volitional Contraction Modulate Flexor Withdrawal Responses in Subjects with Knee Osteoarthritis.”
Chosen for the Outstanding Poster Award was Paul Mintken, PT, DPT, OCS for his presentation entitled “Clinical Ex-amination of a Congenital Upper Cervical Instability in a Patient with Cervicogenic Headache.”
Examination Committee Michael S. Puniello, DPT, MS, OCS,
FAAOMPT
There will be a challenge examination on October 16, 2008. The examination is offered as a process for residency gradu-ates from IFOMT member countries to become Fellows in the AAOMPT. The deadline for the letter of intent for the
challenge examination is December 30, 2007. As of December 6, 2007 there is 1 graduate from an IFOMT member coun-try who submitted a letter. Candidates who failed a previous examination have one opportunity to re-take the exam. As of early December, 8 people have submitted letters to re-take the exam. I anticipate 5-8 more will apply before the deadline. In my next report I will have the final numbers of candidates.
There is no longer a challenge examination for candidates seeking Fel-lowship. The route to AAOMPT fellow-ship status is through an APTA approved and AAOMPT recognized fellowship program.
International Affairs Chris Showalter, Chair
eC AMeRICASEC Americas members, USA and
Canada, continue in their efforts to reach out to manual therapists interested in join-ing EC Americas. Membership is open to organizations that represent manual thera-pists in countries from Central and South America and the Caribbean. An “Introduc-tion to EC Americas” letter is available in English and Spanish.
If you know a manual therapist from the region, or think you know someone who may know one please email me at [email protected] and I would be happy to send you both letters.
ReSeARCH SURVeY Committee member Phil Sizer has
authored a survey to determine the simi-larities and differences in OMT around the world including patient accessibility to therapy, practice and reimbursement mod-els, significant competitors for patients, and what strategies OMT’s are using to protect their autonomy. The purpose of the survey is to evaluate the international
OMT environment and to potentially develop strategies to implement in the USA based upon others experiences. Upon completion the results will be shared with the AAOMPT and IFOMT Executives. The response was strong and results are currently being analyzed and will be given to the Academy Executive upon comple-tion.
IFOMT 2008 The 2008 IFOMT Congress and
Conference will be held in Rotterdam June 8-13, 2008.
The theme is “Connecting Science to Quality of Life” Featured speakers include: Bill Vicenzino, Jillianne Leigh Cook, Deborah Falla, Lorimer Mosley, Mark Jones, Karim Kahn, Paul Hodges and many more. Early bird registration ends March 1, 2008. More details can be found at www.ifomt2008.nl/
Membership Committee Respectfully submitted by Cheri Hodges,
DPT, MAppSc, OCS, FAAOMPT
Our committee met at our annual meeting this past October in St. Louis, MO. During that meeting, we established a strategic plan for the upcoming year to place emphasis on recruiting physical therapists for our general membership cat-egory. We strongly encourage all members of our organization to help in this effort by sharing the benefits and importance of our organization and recruiting member-ship with at least one of your colleagues. Jeff Giuletti and Michael Lucido from our committee have written a proposal for the development of a promotional DVD. This proposal is under consideration by the executive committee at this time. The purpose of the promotional DVD would be for membership recruitment at con-ferences, continuing education courses,
6 - Articulations - January/February 2008
Recognized Clinical Fellowships in OMPT by AAOMPT
Ola Grimsby Institute Orthopaedic Manual Therapy Fellowship4420 Hotel Circle Court, Suite 210San Diego, CA 92108Contact: Julia ChepakPhone: 800/646-6128Fax: 619/298-4225E-mail: [email protected]
Regis University Manual Therapy FellowshipDepartment of Physical Thereapy3333 Regis Blvd, G-4Denver, CO 80221-1099Contact: Timothy Flynn, PT, PhD, OCS, FAAOMPTPhone: 303-458-4344Fax: 303/964-5400E-mail: [email protected]
Sports Medicine of Atlanta Manual Therapy Fellowship2138 Scenic Highway, Suite BSnellville, GA 30078Contact: Robert E. DuVall, PT, DHSc, OCS, FAAOMPTPhone: 770/979-1400Fax: 770/978-3360E-mail: [email protected]
The Manual Therapy Institute2901 Livorno CoveCedar Park, TX 78613Contact: Pieter Kroon, PT, OCS, FAAOMPTPhone: 512/422-4258Fax: 512/467-7203E-mail: [email protected]
University of Illinois at Chicago Fellowship in Orthopedic Manual Physical Therapy1919 West Taylor Street, 4th FloorChicago, IL 60612Contact: Carol Courtney, PT, PhD, ATC, FAAOMPTPhone: 312/996-8381Fax: 312/996-4583E-mail: [email protected]
University of St. Augustine For Health Sciences Clinical Fellowship1 University BoulevardSt. Augustine, FL 32086 Contact: Catherine Patla, PT, DHSc, OCS, FAAOMPTPhone: 904/826-0084Fax: 904/826-0085 E-mail: [email protected]
U.S. Army - Baylor University Postprofessional Doctoral Program in Orthopaedic Manual Physical Therapy Brooke Army Medical Center3851 Roger Brooke DriveFort Sam Houston, TX 78234Contact: MAJ Norman “Skip” Gill, PT, DSc, OCS, Cert MDT, FAAOMPTPhone: 210/916-2651Fax: 210/916-4074E-mail: [email protected] For active US Military personnel only
Committee Reports (continued from page 5)
and schools. Student member Derek Dalton, represented our organization at the APTA National Student Conclave with our booth exhibit. Matt Lee is organizing our booth exhibit promoting membership at combined sections this year. Please contact Matt directly if you are able to help at the combined sections meeting in promoting membership for our organization at our booth in the exhibit hall. Matt’s email address is [email protected]. The membership committee has supported John Childs in the development of a blow card ad that will be coming out in upcoming JOSPT publications promoting the next annual conference and membership in AAOMPT.
J. Treasurer 1. Ken Olson nominated John Childs a. Accepted K. Member at Large 1. Andrew Bennett nominated Deydre Teyhen a. Accepted L. Nominating Committee 1. Catherine Patla nominated Toby Baldwin 2. Nominations open until November 1st. See website. Will continue with electronic ballots M. Student SIG a. No Report N. JMMT Update – Chad Cook and John Medeiros a. John Medeiros: Peter Huijbregts stepped down as
Editor-in-Chief but will stay on as associate editor. Chad Cook was appointed to position as Editor-in- Chief
b. Chad Cook: JMMT will still help young authors get published. Pursuing Medline publication and Pub med central indexing. Invited peer review
perspectives new section. Case studies. Quirks: more case reports at smaller size. Medline approval in 1-2 years. Start clinical research clearing house page where clinicians can contact each other
regarding researchVI. New Business A. MOTION 1: Lifelong Learning - Standards Committee 1. The American Academy of Orthopedic Manual Physical Therapy supports
the concepts of continued competence, lifelong learning, and ongoing professional development as identified in APTA Vision Statement for Physical
Therapy 2020 (Vision 2020), the Standards of Practice for Physical Therapy, and the Code of Ethics.
2. SUPPORT STATEMENT: This policy refers to the APTA PROFESSIONAL DEVELOPMENT, LIFELONG LEARNING, AND
Meeting Minutes (continued from page 4)
continued
January/February 2008 - Articulations - 7
CONTINUED COMPETENCE IN PHYSICAL THERAPY HOD P05-07-14-14 (Program 65) [Position]* This policy statement correlates with the Mission of AAOMPT and directly relates to the basis of the Fellow renewal process in AAOMPT. Adoption of this position statement would clearly inform members of the lifelong learning
philosophy developed within the renewal process for fellows. This position statement will guide the development of curricu-lum models and promote guidance in visionary developments in manual therapy education.
3. Motion passed B. MOTION 2: Referral for Profit and Physical Therapy
Services – Practice Affairs 1. POSITION: The American Academy of Orthopaedic
Manual Physical Therapists opposes the ownership of Physical Therapy services by Physicians and any other referral for profit model that presents a conflict of interest for financial gain as a result of making the
referral. 2. SUPPORT STATEMENT: The Academy believes
that the consumer of Physical Therapy services is best served when they are able to access a Physical
Therapist who has the best skills for their condition based on clinical expertise and physical therapists can exercise their best clinical judgment when free of accepting referrals from referral sources with a potential conflict of interest or potential for financial gain as a result of making the referral. 3. Motion passed C. MOTION 3 Evidence Based Practice – Practice Affairs 1. To promote improved quality of care and patient client outcomes, the American Academy of Orthopaedic Manual Physical Therapists supports
and promotes the development and utilization of evidence-based practice
that includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient/client management, practice management, and health policy decision making. a. Discussion occurred on wording and nature of
evidence b. Phil Tygiel moved to amend the statement and
change the word research to evidence c. Vote on amendment failed d. Original motion passed D. MOTION 4 – IFOMT Name Change - Stanley Paris 1. AAOMPT MO USA will vote against a name change
for IFOMT other than adding in the word physical before therapist
2. Bill B Seconded 3. Motion PassedVII. Open Forum A. Members encouraged to attend IFOMT this year. USA
attendance has been low in the past. Tim Flynn will send membership information on a way to communicate with one another regarding travel to IFOMT. Discussion
occurred on sponsoring a student to travel to IFOMT however no formal plans were discussed
VIII. Announcements A. Study group 1. Perry Tallman – Encouraged interested members to start and or join a regional MT study group as way to practice and learn MT. IX. Motion to adjourn - Ken Simmons A. Seconded - Joe Farrell 1. Meeting adjourned 5:45 pm
Submitted by Jake Magel, PT, DScBoard certified in orthopaedic physical therapyFellow of the American Academy of Orthopaedic Manual Physical Therapists
Dear Program Directors,The editors of Articulations are seeking submissions of
Clinical Pearls and Research Pearls for publication. The Clinical Pearl is a manual therapy or exercise technique
that has been found to be useful in the clinic setting. These can be established techniques which have been modified to fit a specific patient population or therapist; or they can be novel methods created by the therapist to accomplish a desired patient outcome. The Research Pearl is similar to a Critically Appraised Topic (CAT) and serves as a method of formally analyzing a research article or topic and putting it in a format which com-municates the information efficiently.
Submissions should ideally examine articles and methods applicable to orthopedic and/or manual therapy clinical practice. We recommend reviewing articles published in well recognized journals. The co-editors will review submissions for appropri-ate quality and select a Clinical Pearl and Research Pearl for publication most appropriately matched to the theme of the edi-
tion. While Articulations is not a peer reviewed publication, we do want to establish and maintain a level of quality appropriate for our readership. Submissions not published in Articulations, but judged to be of appropriate quality will be posted on the AAOMPT website.
We invite you to encourage your students to submit their work which may already be a part of your curriculum. We also invite you and your colleagues to consider submitting either Research or Clinical Pearls both of which meet the standard for scholarly work required for fellowship renewal.
All documents should be in Word format and pictures in jpeg form. Examples of Clinical Pearls and Research Pearls can be found in previous editions of Articulations and on the AAOMPT Website. Send all submissions to Evan Petersen at the following email address: [email protected]. Thank you for your assistance in improving our organization and its official publication.
Sincerely, Dave Miers, Editor; Evan Petersen, Co-Editor; Kevin Baker Co-Editor
8 - Articulations - January/February 2008
Treasurer’s ReportSubmitted by John Childs with assistance
from Craig Crosby and Jamie Bellamy
Budget for 2007Income $362,813.33Expenses $357,316.54Difference $ 5,496.79
Income & Expenses for 2007 (January – November 28, 2007)Income $ 397,310.78Expense $ 377,458.33Difference $ 19,852.45
(PAF) Practice Affairs Fund (January – November 28, 2007)Income $ 26,005Expenses $ 15,000Difference $ 11,005
Assets as of november 28, 2007Operating Account $152,372.83Practice Affairs Fund (PAF) $ 93,594.23Reserve Fund $123,140.37 Total Assets $369,107.43
Member-at-Large Stephania Bell, PT, OCS, CSCS
As I transition off the Executive Committee, I want to take a moment to thank the entire membership for provid-ing me with the opportunity to serve the Academy in a formal capacity over the last three years. It has been an exciting time of tremendous growth and evolution for this special group. I have been particularly pleased to see the addition of our student Special Interest Group which represents the interests of one of our fastest growing member populations. Students are the next generation of practitioners whom we will rely on to carry the manual therapy
torch forward, so we welcome their pres-ence and voice.
I am exceptionally proud of the work done by the two committees for whom I have served as liaison over the last few years. The Standards Committee contin-ues to take on many of the large projects so integral to our core and our continu-ing relationship with IFOMT. In the last three years the manual therapy practice analysis was updated (no small task!), the recognition of Fellows and credentialed manual therapy fellowship programs has turned into a very special ceremony, and the process for fellowship renewal has been streamlined. Perhaps most importantly, we continue to maintain a very significant po-sition within the APTA credentialing pro-cess for clinical residencies and fellowships. We have strong representation on the com-mittee and provide multiple additional site reviewers. This helps ensure that the stan-dards that we set forth as an organization, which are critical to our member status within IFOMT, are recognized within the APTA process. I would like to thank Cath-erine Patla and Ann Porter Hoke for their role in chairing the Standards Committee, and Patty McCord for her tenure on the APTA Clinical Residency and Fellowship Credentialing Committee.
The Nominating and Awards Com-mittee has streamlined the awards process, both the solicitation of nominations and the selection process itself. Additionally, elections have moved to an electronic format which no doubt increases member participation and cuts costs substantially by eliminating paper ballots and mailers. I would like to thank Alycia Markowski for her contributions as Nominating and Awards Chair in 2007.
I would also like to recognize the contributions of the Executive office in advancing the work of these two commit-tees. The website elections, the updating of fellow databases, the formalization of the fellow recognition ceremony and the awards lunch program at annual conference – all are due in large part to the hard work of the Executive staff to move us forward.
In closing, I want to thank my won-derful colleagues on the Executive Com-mittee, past and present, all of whom have made the past three years an experience for which I will be forever grateful. Your collective wisdom, energy and passion are unmatched and the Academy is lucky to have you all.
Thank you again to everyone for the gift of service. I look forward to seeing you all in Seattle next year. Best wishes in 2008 and beyond!!
In September, 1999 the APTA Ma-nipulation Task Force was formed and charged with developing a strategic
plan to confront the then-recent onslaught of Chiropractic legislative challenges. The plan included legislative, regulatory and educational strategies with the overall goal of putting “our house” in better order. Numerous positive changes were a result. In some ways we can thank the Chiroprac-tors for forcing our hand, as many of these changes probably should have happened years ago.
During the past 5 years the Chiroprac-tic challenges have not been near the level they were in the late 1990s, but their tactics have taken on a new level of desperation and antagonism. It became clear that our current strategic plan required a “fresh” look. In July a group met in Nashville to re-visit the strategic plan. In addition, we met with 2 Tennessee legislators to get their feedback regarding recent local PT legisla-tive efforts; “what could we have done differently”, being the discussion focus. It was clear from the legislators’ perspec-tives that evidence and facts supporting one’s position, although important, do not guarantee legislative success. Constituent name and face recognition are critical. One legislator stated he needed to see or hear from someone 5-6 times before that name stuck, and someone who made that kind of effort deserved strong consideration of their views. Part of the message being we cannot start our legislative “campaigns” too early.
Below represents a summary of the APTA Manipulation Task Force’s 2007 Strategic Plan. Please look at it closely and provide feedback-please! Thank you!
• PTSTudenTeducaTion w Produce and distribute to all PT
education programs a powerpoint presentation on spinal manipulation for inclusion into the PT curriculum.
w Connect AAOMPT Fellows with PT education program directors. Fel-lows would contact PT programs to
Practice Affairs Corner
Confronting the Chiropractic Legislative ChallengesWilliam Boissonnault
let them know they are a resource for them and assist programs in the devel-opment of their spinal manipulation curriculum.
w Investigate need of re-issuing of the Manipulation Education Manual (2
nd
edition) to all PT student education programs. MEM was first issued in 2004
w Investigate feasibility of forming state-based PT Manipulation Educa-tion Program Coalitions (California for example).
• PTMeMbereducaTion w Chapter Newsletters – draft and
submit one newsletter article each year on the issue of spinal manipulation (various aspects) for inclusion in the various APTA state chapter newslet-ters.
w Framing Scenario – draft a worst case scenario narrative that demon-strates what a day in the life would be like for the average PT should the chiropractors be successful in their legislative and PR efforts.
• PaTienTSandPublic relaTionS w APTA White Paper on Spinal Ma-
nipulation – similar to APTA White Paper on POPTS, this document will serve as a primary document in explaining this issue to patients, policy makers and the public. It would explain – in layman’s terms - what manipulation is, why PTs perform manipulation, history of PTs and manipulation, provide arguments and position on issue.
w Alert to APTA Public Relations Department – request input and strategies on better ways to communi-cate to the public and with patients on the issue of spinal manipulation and assistance on “messaging.”
w Provide patient access to APTA’s online grassroots system. Current system is member-protected but does have a stand-alone patient website for
just Medicare direct access-can use as a model.
• STaTeGovernMenTaffairS w Develop brochure aimed at state
legislators educating them on the performance of spinal manipulation by physical therapists. Brochure to in-clude patient quotes, education back-ground, history, visuals, and provide for inserts for state specific legislation.
w Better educate PT members on how to foster relationships with legislators.
w Re-format Indiana legislative video on spinal manipulation to online and DVD format, make available to chap-ters.
w Investigate setting up a stand alone webpage that would serve as a “legisla-tor education center on PTs & spinal manipulation” designed specifically for state legislators. Would include online version of brochure, Indiana video, White Paper, FAQs, etc.
w Identify AAOMPT fellows who are willing and able to provide expert testimony before legislative committee hearings at their state capitol.
w Work on getting chapter Executive Directors more involved with state legislation – waive registration costs for chapter execs for future State Gov-ernmental Affairs Meetings.
w Manual Therapists Practice Visit Initiative – identify manual therapists who are willing and able to host a practice visit initiative with their state legislator to educate and demonstrate the performance of spinal manipula-tion by PTs.
If you hear of any potential legisla-tive or legal challenge to PTs providing manipulative services please contact your APTA Chapter! They will then contact APTA, and then the Manipulation Task Force will be brought into the mix. Please feel to contact me as well as chair of the Task Force and AAOMPT’s Practice Com-mittee; [email protected]
10 - Articulations - January/February 2008
January/February 2008 - Articulations - 11
ConferenceHighlights
Jim Phillips and Tim Flynn present Josh Cleland (right) the Cardon Research grant award.
John May (right) recieves the OPTP research grant award.
Tobi Baldwin (left) receiving the RehabPro research grant award.
A large number of student members were well represented in St. Louis.
12 - Articulations - January/February 2008
ConferenceHighlights
Ken Olson (right) receiving the Menell Service Award.
Martin Langaas (center) receiving the Kaltenborn I Teach Award.
2007 New Fellows
Karol Jo Tichenor receiving an Honorary Fellowship from the Academy.
IntroductIon: Gaining and permanently retaining the last few degrees of terminal knee extension can sometimes be difficult and even harder to carryover into functional weight-bearing activities. We have seen a few patients that have had difficulty gaining and maintaining the last few degrees of terminal knee extension with standard mobilizations, making us believe that there may be a positional fault contributing to their impairment resulting in an abnormal rolling and gliding in the joint.
Mulligan states that “minor positional faults occur following injury or strain result-ing in movement restrictions and/or pain. These faults are not readily palpable or visible on x-ray. However, when a correctional mobilization (a repositioning) is sustained, pain-free function is restored and several repetitions will begin to bring lasting improvements.” True mobilizations with movement (MWM’s) require the force to be applied in a different direction of the movement glide taking place. However, this technique follows the arthro-kinematic convex-concave rules during closed chain movement. Similar to Mulligan’s “MWM’s”, when the desired movement is repeated several times, there is a resultant car-ryover of maintaining the new range. Because this mobilization is done in weight bearing, we have found the retention of maintaining the new motion for more restrictive joints to be better than with classical mobilizations. This may possibly be due to the additional forces associated with closed kinetic chain activities, the functional carryover, and the added proprioceptive patterning.
IndIcAtIon: Lack of full passive/active terminal knee extension.
PAtIEnt PosItIon: Preferably standing on a 15” box (or the floor if the patient is un-able to stand on the box), with the patient holding onto a stable surface for support. (Figure 1 & 2).
thErAPIst #1 PosItIon: The therapist stands behind the patient with a belt wrapped around her buttocks and the patient’s anterior distal femur. The therapist may use one hand to stabilize the patient’s pelvis. (Figure 1)
thErAPIst #2 PosItIon: The therapist stands in front of the patient with a belt wrapped around her buttocks and the patient’s posterior proximal tibia. The therapist may hold the belt in place around the anterior distal femur to prevent it from sliding during the technique. (Figure 1)
ProcEdurE: The patient performs a double leg mini-squat (Figure 3). As the patient returns back to the knee extended position, the two therapists facilitate the desired arthro-kinematic motion (posterior glide of the femur, anterior glide of the tibia) via the belts, providing a guided mobilization with movement. (Figure 4). This motion is repeated 10 times with a 2-3 second hold at the end range of knee extension.
ModIFIcAtIon: This technique can be changed from a double leg squat to a single leg squat as the patient’s strength and balance progress.
TIP: Towels may be placed between the skin and the belt to prevent discomfort to the patient.
TIP: It has been found to be more effective if therapist #1 provides a greater force than therapist #2 to prevent the patients from feeling like they are being pulled too far forward.
16 - Articulations - January/February 2008
REsEARCH PEARl
Screening for Rheumatoid Arthritis in Pregnant Patients
Appraised by: Dan Rhon, PT, DPTDate Appraised: Dec. 2007
Kill or update by: Dec. 2008
clInIcAl BottoM lInEs: 1. There is no validated screening process for rheumatoid
arthritis (RA).2. The American Rheumatology Association (ARA) has
provided a seven step clinical criterion classification system which has become a reference standard for ruling RA in/out (20 years old).
3. The scarce literature regarding pregnancy and RA has shown that symptoms tend to be suppressed during pregnancy
cItAtIons: 1. Arnett FC, Edworthy SM, Bloch DA, et al. The American
Rheumatism Association 1987 revised criteria for the clas-sification of rheumatoid arthritis. Arthritis & Rheumatism. 1988;31(3):315-324.
2. de Man YA, Hazes JM, van de Geijn FE, Krommenhoek C, Dolhain RJ. Measuring disease activity and functional-ity during pregnancy in patients with rheumatoid arthritis. Arthritis Rheum. Jun 15 2007; 57(5):716-722.
3. van Dijk MA, Reitsma JB, Fischer JC, Sanders GT. Indica-tion for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Clin Chem. Sept 2003; 49(9):1437-1444.
sEArch strAtEgy: A combination of Rheumatoid Arthritis, screening, pregnancy, proxi-mal interphalangeal joint swelling, pain, hypertrophy in Medline, Cinahl, Cochrane Reviews, PEDro, CEBM, Pub MED & Hooked on Evidence.
clInIcAl QuEstIon: What is the best way to screen for rheumatoid arthritis (RA) in a 28 y/o pregnant female with isolated PIP joint pain, inflammation, and hypertrophy?
thE studIEs:• TheARAguidelineslookedat524RAandnon-RA
patients (262 each). Patients had clinical diagnosis of RA not based on any specific criteria, and controls were patients with rheumatic diseases other than RA.
• Asystematicsearchofliteraturelookingforstudiesofpatients with systemic disease concurrent with carpal tunnel syndrome (CTS), revealed the high prevalence of 3 systemic diseases, including RA. The search (June 2002)
revealed 292 articles.• Sixtytwopatientswith
RA in categories of pregnant and non-pregnant were evaluated prospec-tively for change in self-reported quality of life measures at each trimester and post-partum.
thE EvIdEncE: • TheARAhasvalidateda
clinical presentation algorithm with 7 criteria. • RA=4ormoresymptoms(91-94Sens/89Spec) SENS/SPEC (%) +/- LR
(#’s 1-4 need to be present for at least 6 weeks) *Bilateral DIP, PIP, MCP, Wrist, Elbow, Knee, Ankle
• A systematic search of the literature for concurrent RA with CTS with a goal of identifying a laboratory screening test for RA in CTS patients did not reveal any signifi-cant positive predictive value for screening RA in CTS patients.
• Limitedstudieswithweakmethodologysuggestthatpreg-nant women with RA demonstrate increased activity and better health self-reports than pregnant women without RA.
January/February 2008 - Articulations - 17
ArE thE rEsults vAlId?
Did the clinicians face diagnostic uncertainty?The purpose of this research study was to examine the clinical
usefulness (Sensitivity, Specificity, Positive and Negative Predic-tive Values) of three special tests for the Acromioclavicular region. These tests included: Active Compression Test (O’Brien’s Test), Acromioclavicular Resisted Extension Test, and the Cross Body Ad-duction Stress Test. The patient population in this investigation was similar to those individuals that would be seen in an outpatient orthopedic physical therapy setting, with a primary complaint of shoulder and or upper quarter pain.
Was there a blind comparison between the test and an independent gold standard?
There was no blind comparison noted between the test and the diagnostic arthroscopy as the three clinical examinations being investigated and the diagnostic arthroscopy were all performed by the senior author.
Did the results of the test being evaluated influence the decision to perform the reference standard?
No. All participants in this study underwent diagnostic ar-throscopy. Definitive surgery followed.
WhAt ArE thE rEsults?
What likelihood ratios were associated with the range of possible test results? (See below)
hoW cAn I APPly thE rEsults to PAtIEnt cArE?
Will the reproducibility of the test result and its interpretation be satisfactory in my clinical setting?
The authors described all three tests and positive findings were included. Overall, it is felt that these three tests are easily performed and interpreted though the photo is needed to supplement the written description.
Are the results applicable to the patients in my practice? The authors comparison group did include patients with
conditions that would be seen routinely in a physical therapy clinic and have the potential to mimic AC joint disorders. A question to the applicability to patients in our practice was the use of an “amal-gamation of several previously published questionnaires”. This amalgamation questionnaire was used to gather information on demographics, subjective information and functional status prior to their procedure. This is the only mention of this information and the results of this questionnaire were not included. The impact on validity with this questionnaire and the impact to this study is not known. Only 315 participants, 16 in the AC lesion group and 299 in the non- AC lesion group, received all three of the studied tests. Diagnostic values were calculated for the combined tests and reported in table form. Given the fact that the subjects closely resemble those treated in the typical clinic and that the diagnostic values of the combined tests were included, we feel the results would be applicable to patients in our practice. One must use caution in the interpretation of subjective reports of signs and symptoms of the shoulder, as they can be nonspecific. These results of the physical examination need to be interpreted with a sound clinical reasoning framework as well as general caution.
Will the results change my management strategy?The results look at using a cluster of tests rather than depend-
ing on single tests to stand-alone. Walton et al (2004) described a prevalence rate of 74% with the use of a pain diagram, but 17% as a whole when actually looking at the population studied and calcu-lated from their 2x2 table2. With a pre-test probability of 17% and a positive likelihood ratio (+LR) of 8.3 (cluster of all three tests), a
posttest probability of 63% is achieved.
Will patients be better off as a result of the test?
The addition of this test battery along with pain diagrams would lead to more de-finitive diagnosis and the ability to correctly intervene with ACJ pathology. However, with a posttest probability of 63%, more test-ing may be required to reach a comfortable treatment threshold. With proper interven-tion, patient satisfaction and outcomes will be enhanced.
REsEARCH PEARl
Diagnostic Value of Physical Tests for Isolated Chronic Acromioclavicular Lesions
Kevin Jones, Kevin Baker, Michael LealChronopoulos, E, Kim TK, Park, HB, Ashenbrenner D, McFarland EG. Diagnostic Value of Physical Tests for Isolated Chronic Acromio-
clavicular Lesions. Am J Sports Med. 2004;32:655-660
TEST SN % SP % +LR -LR
Cross Body Adduction Stress test 77 79 3.7 0.29AC resisted extension test 72 85 4.8 0.33Active compression test 41 95 8.2 0.62
COMBINATION If all 3 are positive 25 97 8.3 0.77If at least 2 are positive 81 89 7.4 0.21
18 - Articulations - January/February 2008
MEMBER TYPE
AAOMPT MEMBER:Any physical therapist who is a current member or eligible for membership in the American Physical Therapy Asso-ciation.
AAOMPT FELLOW:A fellow is a physical therapist who has been recognized by their peers as having reached the standards of the Academy. There are several ways this can be achieved (ref: AAOMPT Bylaws and Constitution Updated August 2, 1996). A fellow is a full voting member of the Academy.
STUDENT MEMBER:Any full time student enrooled in a graduate or undergraduate physi-cal therapy program who is a current member or eligible for membership in the American Physical Therapy As-sociation. Student members will have a reduced membership fee to be set by the AAOMPT executive.
FOREIGN MEMBER:A physical therapist living and work-ing outside the United States who is interested in supporting the objectives of the Academy.
INSTITUTIONAL MEMBERS:Any educational, research or clinical institution with an interest in orthopae-dic manual physical therapy.
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• A subscription to Journal of Manual and Manipulative Therapy
• Discount for “Standards” document & DACP
• Discounts on Academy sponsored seminars and annual conference
• Eligible to serve on Executive Com-mittee
• May use the designation FAAOMPT after their name
• Receives the Academy newsletter - Articulations
• Discounts for Academy sponsored conference
• Receives the Academy newsletter - Articulations
• A subscription to Journal of Manual and Manipulative Therapy
• Receives the Academy newsletter - Articulations
• A subscription to Journal of Manual and Manipulative Therapy
• Free copy of “Standards” document• Discounts for “Standards” docu-
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