The Case of Mr. SpoonerSome readers of this blog have posited that you should never, ever use the OPTIMAL scale because it is "crap" and not a useful tool for clinical decision-making.The shortcomimgs of the OPTIMAL have been previously discussed here and are well-known.OPTIMAL is a 'setting-specific' tool for activity limitations affecting the upper body, lower body and trunk.That is, OPTIMAL is Read this article: When should you use the OPTIMAL Scale?

Should physical therapists complete a full neurological screening for every patient with lower back pain?Over 12 years ago, Richard Deyo, MD, MPH asked the question... "Should the physician complete a full neurological examination of every patient - even those who present with no leg pain?"I almost always believe that, as specialists, physical therapists should 'step up to the plate' and screen See original here: Should orthopedic physical therapists always test for nerve root injuries?

In "Why 'Quality' Care is Dangerous" Jerome Groopman, MD complains the definition of 'quality' is too narrow, eg: only 'quality' that conforms to consensus standards set by Medicare experts is of sufficient 'quality'. Consensus means measurement of simple clinical procedures that fail to capture the complexity of medical decision-making, such as diabetic management.But 'quality' in P4P is meant Go here to read the rest: Why 'Quality' Care is Inevitable

Call me 'old school'... (some folks have called me that, and more).I still treat some impairments - it's how I was trained.There is a certain amount of satisfaction in measuring a stiff joint, fixing it with my 'old school' physical therapy techniques and getting the patient better.It makes sense.Today, however, physical therapists measure patient characteristics that predict the treatment the Read the rest here: The 'Old School' case for impairments

The X Prize foundation announced yesterday the creation of a $10 million prize for a "bold, measurable and scientific" proposal that "results in viable, creative and achievable health care system changes."Physical Therapists Take NoteThis is your skill set!The winning proposal will "improve care within communities and proactively assist individuals in optimizing their health in a way that reduces Excerpt from: X-prize for physical therapy: $10 million for autonomous practice

Anchoring, Availability and Attribution.One medical student calls these the "3-A Mistakes" so she wont forget how doctors make mistakes.In How Doctors Think Jerome Groopman, MD describes common cognitive errors that busy doctors make in diagnosing their patients.Do physical therapists make these same mistakes?Perhaps I should be more circumspect but I'll follow Dr. Link: Do Physical Therapists Make Decisions Like Doctors?

In updating my Facebook page I've rewritten the mission statement for the Physical Therapy Diagnosis blog.As my knowledge and commitment to my physical therapy patients and practice deepen and broaden through years of study so has my understanding of this blog: it's purpose and it's power to educate and inform go both ways.Many thanks to those of you who have chosen to respond and comment to my The rest is here: Physical Therapy Diagnosis Redefined

Rahm Emanuel, the current administration's Chief of Staff wasn't the first one to say... See original here: A crisis in Physical Therapy?

I treated a very sweet lady named Rosa today. See the original post: I saw Rosa today in PT...