“Ignorance: a limited understanding of all the relevant physical laws and conditions that apply to any given problem or circumstance”
I don’t think that this is much of a problem in the physical therapy profession for the basic concepts of the profession. The issue of ignorance comes into play when we start discussing current evidence. A new graduate’s primary responsibility is to pass the boards ( a national test in order to determine basic competency in order to practice as a PT). Unfortunately, the boards are based off the books used during the physical therapy program and the books are based from research that is at least 5 years old or older. This means that the students are being tested on material that is greater than 5 years old. Current published research may not make its way into an educational programs curriculum due to time constraints. In this fashion, the students may be ignorant to current research or niche research.
“Ineptitude: meaning that knowledge exists, but an individual or group fails to apply that knowledge correctly in a particular circumstance. “
This is common. We know that therapists are not staying current with published research. Time and access are two barriers to staying up to date on the research. Just a quick example. I dedicate 10 minutes per day to reading. Even 10 minutes per day is hard to fit in with all the other hats that I must wear such as: business partner (http://www.goodliferehab.com/) , father, husband, running a separate Facebook page that interviews influencers and performing community lectures. There is only so much time in the day and I can understand how some therapists will have a difficult time fitting learning into their day. Barriers to obtaining current research can be the cost of a subscription to get the journal articles. For instance, I pay over $1,000/year just to have access to research. This is a big chunk of money when you consider all the other life activities that aren’t free. Pair this with the fact that the “average” salary for PT is 80,000 ish and that students have well over $100,000 in debt.
, that $1,000/year over the lifetime of a career becomes expensive!
“For instance, through numerous scientific breakthroughs, there has been a repudiation of ‘folk’ treatments in our profession-such as hot packs or ultrasound for heat therapy-in favor of treatments based on scientific evidence.”
Going to PT should not resemble going to a spa! If you are going to PT and getting electrodes placed on you…getting hot packs placed on you…getting rubbed with gel while someone is moving a wand on your skin…or getting a rubdown…THAT IS NOT PHYSICAL THERAPY! On the flip side, PT should not resemble personal training! Going to your therapist and getting a list of exercises for you to perform independently while your therapist is chatting with others…IS NOT PHYSICAL THERAPY! The closes profession that I can equate therapy to is that of a teacher-student (and not always is the therapist the teacher!). This healthcare relationship should be a personal relationship that takes place in a private setting allowing for open communication between the therapist and patient. The patient should walk out of each session with more knowledge than they walked in with. The patient should understand why interventions are performed…or better yet why some aren’t performed. We need to get away from the tradition of PT and move towards what the evidence tells us.
“However, despite the excellent EBP (current evidence) resources now available, ineptitude remains a major 21st century challenge in medical and rehabilitation care”
I have a dare for all of you reading this. When you go see your next healthcare practitioner I want you to ask a simple question: “How much education do you get every 2 years?” In PT, we are required to get a minimal amount of continuing education to maintain our license. DO YOU WANT TO BE TREATED BY SOMEONE THAT IS ONLY GETTING THE MINIMAL AMOUNT OF EDUCATION OR SOMEONE THAT IS DEVOTING TIME TO FURTHER THEIR KNOWLEDGE OUTSIDE OF THE MINIMAL STANDARDS FROM EACH STATE!
“…3 types of influence that have been shown to relate to the rate of spread of an innovation: (1) perceptions of the innovation, (2) characteristics of those who adopt the innovation or fail to do so, and (3) contextual factors”
The following will discuss how these all relate.
“First, the perceived benefit of the proposed innovation relative to its cost is the most powerful influence.”
For instance, a hot pack may not give much benefit, but it is cheap and relatively safe. You will see this frequently in a PT clinic that sees a high volume of patients because of its relative ease of use and safety…assuming the therapist is asking you how you’re doing and checking a few things before, during and after.
Cold laser treatment is slower to take off in our profession because it is an out of pocket intervention…which means that your insurance company won’t pay for it regardless of whether it works. This intervention is slower to be used in the clinic because it may be cost prohibitive for some patients.
“Second, rapidity of change is directly related to how compatible the innovation is to values, beliefs, and history.”
There are some “treatments” that become popular during years of summer Olympics. In 2012, a specific brand of tape was seen on many of the “big name” volleyball players. The thought was that it “kept things more supported”. There is no research that conclusively states anything near this type of statement…but there is a lot of research that says the opposite. We still see it used in clinics today…which is okay, if the rationale for using it is what is intended from our current knowledge base. For instance, we know that it reduces pain and allows for increased ROM…sometimes. If the patients are educated in this regard and not that it “keeps things in place” …go for it. It seems like 2016 was the year of the octopus. If you looked at one of the “world’s most famous swimmers”, it looked like he wrestled with an octopus underwater. This technique has been around for centuries. Some therapists are starting to do it because patients are asking for it.
“Third, the complexity of an innovation affects the rate of its adoption, and, as expected, simple innovations spread faster than complicated ones.”
Ultrasound, electrical stimulation, and traction are all very easy to perform…since the machine does most, if not all, of the work. These were quickly adopted into our profession and are hard to convince some clinicians to stop using…regardless of what the evidence states.
More complicated interventions such as “critical thinking” are harder to adopt. For instance, when assessing a patient with back pain or vestibular issues, there is a plethora of research showing that if we can classify it that we have a better outcome. Classifying the problem requires (1) knowledge, (2) assessment, (3) application, which is a lot harder than just pushing a button on a machine.
Some of the personality types are as follows: 1. Innovators, 2. Early adopters, 3. Early majority 4. Late majority, 5. Laggards
A lot of these are self-explanatory, but it trends from those that jump onto something quickly to those that just hate change.
“Organizations that foster social exchange among its members are likely to see faster adoption of innovations as compared with institutions and organizations that foster habits of isolation and tradition.”
Essentially, workplaces that allow for communication will allow for change faster than workplaces that keep everyone separate. This has to do with changing a culture. A business that has a fluid culture (one that is easily adjusted), is more apt to change than one that has a strict culture.
“Publishing our work in journals is essential-but publication of research is not, by itself, sufficient if our goal is to change clinical practice. People follow the lead of other people they know and trust when they decide whether to take up an innovation and change the way they practice!”
This is huge! Any profession is a small world and PT is no different. To push the profession forward, we must depend on more than just published research. There are many influencers in our sphere such as Dr. Ben Fung, Dr. Jarod Hall, the team from PT on ICE, the team from Evidence in Motion, Dr. Richard Severin, and myself (I’m always trying to sneak my way into this group of titans). By seeing others lead the way, it is much easier to follow. Only the innovators and early adopters will feel comfortable at the front of the pack.
As a patient and therapist, you may want to assess your therapists/mentor and determine which of the 5 personality types he/she has.
Thanks for reading. Please leave a comment on my FB page letting me know what you think.
EXCERPTS TAKEN FROM:
Jette AM. Editorial: Overcoming Ignorance and Ineptitude in 21st Century Rehabilitation. Phys Ther. 2017;97:497-498.