Adabelle Recarte Fajardo

Thank you all for a very thoughtful discussion! I enjoyed getting to see you all implement the things we've learned in our classes #PT582 #ARF

@DrSethPT More so when a pt seeks modality based/passive tx and they don't believe in the value of therex so when you aren't doing e-stim or massage they don't want to come back to PT (happens regularly in developing countries) #PT582 #ARF

@RecarteAdabelle As in when a pt wants a non-recommended tx? I don’t think that’s too big an issue as far as financial incentives. DCing lots of pts w just reassurance is something that does conflict w financial incentives though.

I am looking forward to what you all bring to tonight's discussion. Last Twitter Thursday here we go! #PT582 #ARF

@BiesemeyerEllie You brought up a great point Ellie! How can we be even more proactive about this problem as it can be often correlated to the expectation to meet a productivity percentages? #PT582 #ARF

@RecarteAdabelle 2/2 So mindfulness training and adequate mental health resources could help curb this trend, especially as the COVID pandemic has significantly increased the work environment pressures. #ARB #PT582 pubmed.ncbi.nlm.nih.gov/30929705/

@SterrettCarolyn fascinating! Do you think there is a mental component that could play a role in these results? #PT582 #ARF

#PT582 #ARF this article showed that there were no statistical differences between outcomes of a manual therapy group and a therapeutic exercise group, but MT lead to more pain reduction and exercise reduced disability scores more. trialsjournal.biomedcentral.com/articles/10.11…

@DrSethPT Thank you so much for these insights! I am curious about how could we encourage adherence to guidelines if pts stop coming because they aren't getting the type of treatment they want? Does this place a financial burden on PTs and clinics? #PT582 #ARF

@RecarteAdabelle But I’ll add that while each ind thing may not sway outcomes hugely, adhering to guidelines overall does. Research backs this up, fellows also are more likely to adhere to guidelines and they’re outcomes appear to be better #d=gs_qabs&u=%23p%3DkL_QyUjWwtcJ" target="_blank" rel="nofollow noopener">scholar.google.com/scholar?q=guid…

@_Erin_Peterson @MichChristian5 This is such a great point Erin and often pts won't even do their HEPs. How would you explain the progression involved in loading our bodies to create the appropriate type and amount of stress to a pt? #PT582 #ARF

#PT582 #ARF (2/2) even though changes in pain and disability is what we need to document, it is still important that our pts have a positive experience, so educating pts that although manual t. does have its benefits, the ex. t. will be beneficial for their long-term outcomes

@AnnaReiserSPT Great point Anna! How can we be advocates for these changes so we can better serve our patients? #PT582 #ARF

I think these changes could only come from reducing the for-profit nature of the healthcare industry. Sometimes insurance won't cover newer evidence-based treatments, so PTs have to result to using older methods that may not be as effective #ARF #PT582

@TsaiJames_ Yes James, pt autonomy is so important and valuable! Making sure you are listening to your pt as a human being and not just as another diagnosis to treat will make you stand out in the health care field! #PT582 #ARF

@RecarteAdabelle The Pt is always in control of their body. If appropriate, I would still use a small amount of passive tx if still beneficial, b/c I want to care for the entire person. Most importantly, I will empower my Pts & show them how far they have come & do all on their own! #PT582 #ARF

@McCarthyShealey Nice! We can often get caught in the science behind what we know and why we do what we do, so it is important to find ways to transfer our knowledge to pts so they can make life long changes to improve their quality of life #PT582 #ARF

@RecarteAdabelle #PT582 #ARF case studies are always a good idea, and showing them real life examples of how the new treatments can work for actual patients instead of an abstract concept!

#PT582 #ARF I think this is a good ex. of why cont ed programs are so important in our field. What is now considered sub-par may have been mainstream years ago, and maybe this PT is stuck in their old ways. Education on why new modalities > old should be accessible everywhere!

@kdavidnau This a fantastic way to think outside of the box! What outcome tools would you use to help pts you see via telehealth see their progress, so they realize that modalities are not always necessary? #PT582 #ARF

@TsaiJames_ We definitely have to make sure we are taking into account long-term function. If your pt whole-heartedly believes in passive tx but your professional opinion says it is not the best approach what would you do if they complain about no longer getting passive tx? #PT582 #ARF

@RecarteAdabelle (2/2) ask ourselves if what we are doing is in the best interest of the patient. Yes, we must do all we can for our Pts, which includes passive treatments, but it must never replace the tools we give them for a life of functioning how they desire. #PT582 #ARF

@JessicaTeply Thank you for sharing this article! How would you then transfer the evidence based knowledge you have to pt friendly language to try to dismantle beliefs about physical therapy that have been engrained in our field for years? #PT582 #ARF

This review of EBM in pt. care had great tips: Seek out pre-appraised evidence (systematic reviews/meta-analyses) & integrate w/ clinical experience + considerations specific to the pt. To empower informed pt. choice: establish trust & educate. #PT582 #ARF bmcmededuc.biomedcentral.com/articles/10.11…

@Dmbrockman It is definitely tricky when you have to find a way to keep your doors open. Do you have any ideas about how to go on about educating pts, earning their trust and also giving them the best tx plan? #PT582 #ARF

and pays the bills. I am assuming the PTs know this is not the most effective treatment the pts need to be educated about how exercise and active therapy can provide lasting changes and be more beneficial in the long run. #PT582 #ARF

Unfortunately, making changes in a problem like this is going to take some time. Its tough because pts like passive treatments because they feel good and it would seem like PTs provide the treatments because it continues to bring the pts in... #ARF #PT582

@rainataylorrr That is a really neat article, thank you. For pts that seek modality heavy tx, how would you go on about explaining that passive tx is meant to be a supplement to active tx? #PT582 #ARF

#PT582 #ARF This article talks about how passive modalities should be used to facilitate participation in an active treatment program- as active tx keeps the pt functional in the long term. Pain education should also be included. ncbi.nlm.nih.gov/pmc/articles/P…

@EmilySelby_SPT You brought up a great point about some passive treatments allowing us to achieve goals that active tx might not. What are other outcomes from using passive tx that might not be as attainable with active tx? #PT582 #ARF

@RecarteAdabelle ... are often deemed "movement experts" so I definitely support movement as the bulk of our interventions. At quick glance of a few articles the outcomes for passive vs. active were better in active groups, especially long term. rb.gy/jpucgt rb.gy/47mawp

@BiesemeyerEllie this website dsaw.org/blog/equinethe… about how the anatomy of a horse can mimic human pelvic girdle anatomy&gait pattern so I wonder if there's a way to use hippotherapy to stimulate the central pattern generator in pts. with spinal cord injuries or gait ataxia #PT582 #EB

@RecarteAdabelle I'm glad we will have so many options to treat unique patients in ways that work for them! Can you think of any other conditions/ kinds of pts that would benefit from receiving hippotherapy? #PT582 #EB

#PT582 #EB Professional Association of Horsemanship certified programs are equipped to be able to work w/pts with DS. It can be safely used with proper certification&training,and has been proven to be beneficial for many other aspects of DS such as the social&behavioral aspects.