Letter to the Editor

Dear Editor:

I am writing comment on the article titled “The Best You Can Be,” which appeared in the January, 2015 edition of Impact.

The article is written by a Private Practice Section (PPS) board director and highlights his experience in receiving physical therapy treatment for a herniated disc. I have to say, I cannot recall a single article evoking so many different emotions in me.

The first question that came to mind is where is there any consideration for evidence-based practice? First, the author states they had a “herniated disc” in the low back. Now I do not know if they had any imaging studies, but given the diagnosis I assume so. If that is the case, why not self-refer to physical therapy first? Assuming imaging was done, it did nothing more than increase the cost for his episode of care as there is in fact evidence showing limited benefit in performing imaging studies routinely; unless of course there are severe, progressing neurologic deficits that were not mentioned. My other thoughts about evidence-based practice relate to the comments the author made that he went daily, each session lasted at a minimum of two hours and the longest three hours and that he “walked, stretched, suffered, strengthened, trained, laughed, was poked, pushed, and manipulated (physically, mentally, and emotionally), heated, iced, lasered and stimmed.” Wow, what happened to the kitchen sink, did they just forget to throw it in the mix? Where is the evidence to support all this time and stuff the author had done to him? I am glad he got better, but how long did it take? What really helped him and where is the evidence?

That is not what I am most disheartened about in this column, however. What concerned me, and upset me the most, is the authors comment that he wanted to remind us all of the incredible impact that more appointments and more interventions provided by a large team of providers can have on outcomes. We do not know what helped him get better, but because he got better he is advocating that more is the reason and advocating for us to take that approach. Do we really want that to be our message? It is for exactly this reason that our profession is where it is at today with all of the utilization management companies scrutinizing us. This is why we now have the Care Core’s, Orthonet’s and OptumHealth’s of the world limiting what we can do. Our profession and association have put in a tremendous amount of resources to provide us with evidence and to overcome this perception of physical therapy just wanting to do more and more. I fear this article has the potential to set us back decades.

The final concern I will address about the article is that it appears in a section called “Board Member Report.” So now the perception will not only be that this is what private practitioners’ are advocating, but it is what the section and PPS Board of Directors are advocating as well.

Sincerely,

Tom DiAngelis, PT, DPT