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On The Brink: A Physical Therapy Crisis

Table of Contents

Key Takeaways:
  • Getting a course approved for Physical Therapy continuing education credits is a little too easy.
  • Over half of the courses approved did not teach interventions supported by clinical practice guidelines or systematic reviews. 
  • Continuing education courses and Physical Therapists both need to get on board with utilizing supported and recommended interventions if we want the patient to receive the most benefit.

Over the last couple of years, Across The Continuum has regularly gotten its course approved by the Arizona and Florida state boards of physical therapy for continuing education credits. I used to think this was prestigious, being granted the power to aid in the further education of allied health care providers. 

I now recognize that con-ed seems to be the wild west. In my experience (and outlined in part in this paper)¹, you need only pay the money to the state board you want to be approved by, submit “evidence” for your course, and presto-approve-o, you are now allowed to mold the minds of healthcare providers in a majority of the states in the country.

The end product of this barrier to entry being so low is an onslaught of courses focused on things surely to be referred to by future researchers as hokum and gobbledygook. Now we aren’t just talking about a few courses slipping through the proverbial swiss cheese, but to the tune of over half of the courses approved focusing on management of musculoskeletal (MSK) disorders did not teach interventions supported by clinical practice guidelines (CPGs) or systematic reviews1

I know by now you must be standing up out of your chair had you been sitting prior to reading that statistic, but keep that chair close by so you can once again sit after reading some of the marketing material the baloney-filled-courses used to lure providers into their clutches. 

The marketing materials below were pulled directly from the advertisements for the unfortunate majority of courses that are selling fairy dust to the American medical system. See if you can connect the claim with the en vogue intervention:

  • “The fascial lines are used in conjunction with kinesiology taping techniques to support efficient human movement,” and “emphasis on taping fascial chains to improve movement and enhance function.”
  • Lastly, participants will learn to evaluate the presence of pelvic imbalances and how to bring them back into balanced alignment through advanced fascial release techniques muscle energy, and core strengthening exercises
  • For many therapists, treating low back pain is the number 1 issue for their patients. While there are likely to be a myriad of causes for this pain, the biggest factor may be the quadratus lumborum muscleheadaches, neck, and back pain can be resolved with myofascial release to the pelvic area
  • This advanced lecture and lab course is structured so that clinicians will gain an appreciation for the patterned respiration influences on: rib torsion, asymmetrical oblique strength, costal and crural function, habitual use of accessory respiratory musculature, and a positionally restricted diaphragm”

Were you able to guess them all? Did you recognize any personal treatment paradigms in there? If so, that’s ok and to be expected. Continuing education has the ability to influence a wide margin of the MSK community, considering that most folks find it difficult to find the time to read research on their own.

The paper cites keeping up with the ever-growing body of literature as one of the biggest challenges for busy clinicians. This is one of the primary factors that make enrolling in a course so enticing. It guarantees to provide a condensed overview of the latest research, usually in layman’s terms. I mean, that’s what we do with the over 65 peer reviewed papers included in our course, The 6 Week Clinical Coach Challenge

We do need to be careful where we spend our continuing education money though. Healthcare providers are the fingers attached to the brain we call education. They are the tips of the spear, the ones in the trenches that are communicating the clinical pearls, theories and frameworks taught in continuing education courses. Similar to a child learning to say curse words from their parents’ drunk sister (read cool aunt), there is a non zero risk of harm when continuing education goes unregulated. 

When we further consider the propensity of physical therapists to not use treatments based on research evidence2, the perfect storm seems to be upon us. What’s the recipe for a quickly deteriorating field of doctorate level educated healthcare providers?

Physical therapists who not only applied evidence-based recommendations for musculoskeletal (MSK) conditions in an underwhelming manner but also attended continuing education courses that similarly underutilize evidence-based recommendations for MSK conditions. To add insult to injury, the end user who gets stuck with the crap sandwich is always the vulnerable patient.


References:

  1. Peterson et al. Continuing Education Courses for Orthopedic and Sports Physical Therapists in the United States Often Lack Supporting Evidence: A Review of Available Intervention Courses, Physical Therapy, Volume 102, Issue 6, June 2022, pzac031, https://doi.org/10.1093/ptj/pzac031
  2. Zadro et al. Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review. BMJ Open 2019;9:e032329. doi:10.1136/ bmjopen-2019-032329