The Journey

by: Andy Parsons, PT, DPT, OCS

No rest for the wicked. My 8:05 PM EST flight was delayed and my touch down in Texas was about 1230 EST but my head didn't touch down to the pillow until 2am. I woke from the dead at 5am ready to go. After all, this is #APTACSM folks. Go big or go home... everything is bigger in Texas... ***Please continue other random cliches in your head***

The Sessions

Integrating A “PT First” Approach in Emerging Healthcare Models

This session focused predominantly on an ATI group led by Charles Thigpen and Thomas Denninger in Greenville, SC that has changed the route of delivery for LBP and neck pain. 70% of the caseload was direct access the 1st year. They were able to show 45-60% reductions in disability and reduced costs for care routed through PT.

The take home: It's a slow process that has been ongoing for 6 years. Don't expect change overnight. Interdiscipline collaboration is needed.

Learning from each other: Sports and Neurology Sections Discuss Motor Learning

Remember sports/ortho PTs do more than strength and ROM. Everybody has a nervous system!
Motor learning = repetition matters...A LOT. intrinsic learning > extrinsic learner. Talk less, let the patient learn more.
"Talk less, listen more" get pt's input on success of the motor task to encourage intrinsic learning.

Talking Points: An Oxford-Style Debate on Dry Needling

This one was PACKED. Online presence? Yep… the #NeedleorNot hashtag was #1 in my tailored trends at one point.

@MarkMilligan @Kvenere @Dr_Ridge_DPT & Kali Aucoin, DPT had a cordial yet subtly heated debate about the merits or lack there of regarding dry needling. I have to admit, I learned something from both sides. The Women's Health section will be posting the video of the whole session. I recommend you watch and decide for yourself. I will post the link here when it goes live. Here are a couple #NeedleOrNot highlights.

Best Treatment Approach for Subacromial Impingement syndrome

The diagnosis itself is evolving and the simple definition by morphology of the hooked acromion process has lost ground. A multifactorial cause is a likely cause; intrinsic tendon pathology near the articular surface of the GH joint is one new suspect. Chad Cook reminded us that many of our special tests don't perform well in isolation. His biggest pet peeve test...

Chad also noted the path of delivery of care matters in terms of type of care delivered for SIS and many MSK disorders. Overall, conservative exercise management of SIS performed as well as surgery in this population.

Pain is pain: Treat the patient NOT the label

Adriaan Louw gave a spirited lecture about the state of pain and many chronic conditions. He postulated that these chronic conditions are the same variations of each other (I.e Fibromyalgia, chronic fatigue syndrome, complex regional pain syndrome, chronic lime disease, etc.) Regardless of label, persistent pain can be treated with the same 4 pillars:

paced neuroscience education of pain
aerobic exercise
sleep hygiene
patient goal setting.

(R)evolution: PTs in Prevention and Population Health

Innovations from @MikeEisenhart (Eisenstat for those of you in attendance...HA) @ChrisHinzePT @SunsOpeningBand

PTs absolutely have a role in population health. We are often stuck at the individual level of care, but if we think more broadly we can help so many more. Community design is one are we can have a voice. Contact your city planners and advocated for
In the end, do you want to constantly be saving people from drowning in the water, or do you want to be part of the solution, and put up a guardrail to keep people from falling into the water in the first place?

Innovations in Health Reform: Practice Redesign in a Health System

@EricRobertson and his colleagues presented a model for decreasing variability, improving outcomes, and optimizing rehab services at Kaiser Permanente. Ultimately, Eric pointed out the sub-optimal care costs the system more. Keys:

Rehab services needs to be the key drivers in managing change within the system not other physician groups.
Front line clinicians should be involved in task forces to drive clinical pathways and implementation of guidelines.
Our group has been working on a similar undertaking at ProMedica Total Rehab. Read the associated PT in Motion article click >>>>HERE<<<< (must be an APTA Member)