I was sitting in a training session today, sitting two rows from the back when a colleague says, “Do you ever consider the difference in personalities for those who sit in the front of the room versus the back?”
Perhaps there is a difference, as I observed during the day. Everyone up front is taking notes, asking questions, fully engaged.
Then my back row mind starts to wander… Back to college days, the front row students were always tuned in, hanging on the professor’s every word, and could, as a result, effortlessly translate research to evidenced-based therapy when it was time for clinical rounds and observations.
The further you moved to the back of the room, the more creative the interpretation of lectures became.
You get to the back row and while the lessons are appreciated, they are viewed with a jaded eye, “Yeah, but…”
I was always that student, until day one of research methods, final semester of grad school, and thanks to Dr. Deem’s simple words of wisdom.
“Ask why,” I recall her saying.
“Ask why?” I thought. After six years of us being asked to regurgitate anatomy and physiology and practice guidelines, and with the upcoming final exams you want us to “Ask why”?!
“When you enter the real-world,” she continued, “clinical practice will continually evolve, you will be presented with protocols, and challenges, new research, and opportunities to learn more. Always ASK WHY!”
Ok, I thought, finally a break in the rigidity. I can do this.
Fast forward 17 years and many, many patient sessions later. The need for understanding research methods supportive of evidenced-based therapy practice holds true.
All therapists out there quote it with me. We know it well. The standard we must adhere to for our services to be considered reasonable and necessary.
To be considered reasonable and necessary, each of the following conditions must be met:
The services shall be considered under accepted standards of medical practice to be a specific and effective treatment for the patient’s condition.
Acceptable therapy practices are found in:
- Medicare manuals (such as the Medicare Benefit Policy Manual Chapter 15 and Publications 100-03 and 100-04)
- Contractors Local Coverage Determinations (LCDs and NCDs are available on the Medicare Coverage Database), and
- Guidelines and literature of the professions of physical therapy, occupational therapy and speech-language pathology
“Yeah, but how do we practically apply this research into daily therapy practice?”
“What were the research methods used?”
One recently published JAMA Forum article titled “Association Between the Patient Driven Payment Model and Therapy Utilization and Patient Outcomes in US Skilled Nursing Facilities” is encouraging us all to ask these questions.
What can we learn from the work of this research team?
Experts quoted in this week’s McKnight’s Long-Term Care News article address key points that this is a start. However, we could benefit from seeing a broader patient population, more information across the entire course of care, and more granularity in functional outcomes across disciplines.
We can as an industry use their efforts to further refine and improve more specific research in the future.
My key takeaway from this piece is that we also need to be more diligent as therapists in understanding research methods, potential limitations, and at the end of the day, how the findings can influence further research and our day-to-day therapy practice.
Now is where I give you the resources to take this one step further and continue your lifelong learner journey.
As with many of my articles, I didn’t go at this alone. Thanks goes to the teams at AOTA, APTA and ASHA for guiding me to key resources when I came calling with… “Can you send me some materials that would be useful for the practicing clinician to better understand research?”
Interested in learning more about how external scientific research impacts evidenced based practice? Check out this ASHA resource.
Or maybe you are a PT looking for more information that bridges the gap between evidence and front-line, clinical practice. The evidence workshop is a great place to start!
And in the words of the AOTA, evidence-based practice (EBP) is based on integrating critically appraised research results with the practitioner’s clinical expertise, and the client’s preferences, beliefs and values. For more information consider their resources here.
Why ask why? Such a simple concept, yet imperative as the therapy industry continues to evolve and aim to better serve those we care for.
In closing, I would also encourage therapists to surround yourself with people who encourage you to ask why. In my career I have been fortunate to be surrounded by exactly those types of mentors, directors and colleagues. You all know who you are!
Go forth, ask more questions, and let’s aim to all do our part to improve therapy services, one piece of research at a time.
Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected]
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.