Julie Fritz

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@DrSethPT @Retlouping There is a critical distinction between delivering a standardized protocol vs real-world clinical decision-making. The latter is where we would expect expertise to emerge. As I recall we had this distinciton in mind at the time, but likely would reflect differently on it now.

@Retlouping I love these authors but this was back in the day when you could run stats on 13 people and get it accepted in a good journal. There are quite a few studies showing benefits of specialization but clinical outcomes are tough…(1/2)

The Influence of Experience and Specialty Certifications on Clinical Outcomes for Patients With Low Back Pain Treated Within a Standardized Physical Therapy Management Program jospt.org/doi/pdf/10.251…

@MichaelTamePain @GregLehman @jasonsilvernail @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT Not that I am aware of

@jfritzPT @GregLehman @jasonsilvernail @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT Dr. Fritz are there plans for a pragmatic RCT for effectiveness? If so, planned comparators? Just curious.

Orthopaedic Manual Physical Therapy: A Modern Definition and Description All-star team of @jasonsilvernail @CarolACourtney1 @chadcookpt @jfritzPT @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT academic.oup.com/ptj/advance-ar…

@GregLehman @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT I would focus on the core components not a label. I will defer to my clinical colleagues but if Mulligan's framework has different components then that you could use it as a comparator to examine an OMPT framework

@jfritzPT @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT How would this framework be tested? Could you compare a group of PTs who incorporate exercise/advice and are also trained in the Mulligan concept with someone trained in your OMPT fellowship? Are both groups doing OMPT or only the ones trained with the specific label?

@GregLehman @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT That's true, but you could draw conclusions about the particular model you test, which can be quite valuable. But if the model is an ill-defined black box you learn little or nothing by trying to test it.

@jfritzPT @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT I'm not sure I follow. An analogy - It looks like you have come up with a framework to test "soup" (OMPT). There are lots of different ways to make soup. If one type of soup is effective we can't then say all types of soup are effective.

@GregLehman @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT That's the point, studies have to be designed to answer a discrete research question. A study investigating OMPT can't address individual components and v.v.

@jfritzPT @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT Yes, it will assess the components but that means you can't extrapolate what you find to other components that could make up an OMPT approach. That's all I'm saying. You can't evaluate OMPT and then make blanket statements about other OMPT approaches

@GregLehman @jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT As in all clinical studies the design has to match the question. A delivery model or framework can be evaluated relative to an alternative framework. This type of pragmatic effectiveness study benefits greatly from defining, then monitoring, the model's core components.

@jasonsilvernail @MichaelTamePain @nakedphysio @DerekGriffin86 @DrSethPT @CarolACourtney1 @chadcookpt @jfritzPT @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT This is a framework though. Since you can different types of manual therapy and different types of exercise a study would only let you make conclusions on those specific permutations. Not on whether OMPT is of value

@GregLehman @MichaelTamePain @jasonsilvernail @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT Precisely the rationale for defining OMPT from a research perspective. Defining its competencies, core components, etc. makes OMPT a testable delivery strategy and also allows for studies evaluating the model itself.

@MichaelTamePain @jasonsilvernail @DrSethPT @CarolACourtney1 @chadcookpt @jfritzPT @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT But we couldn’t just test “OMPT”. It’s potentially many different soups.

@GregLehman @jasonsilvernail @DrSethPT @CarolACourtney1 @chadcookpt @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT As researchers we test multi-modal interventions like PT often. Typically they are poorly defined and like a conceptual frame. Defining core competencies and training domains will benefit this type of research.

@jasonsilvernail @DrSethPT @CarolACourtney1 @chadcookpt @jfritzPT @JoshClelandPT @PMintkenDPT @LonnemannElaine @echaconas @PTJournal @AAOMPT I have trouble seeing how OMPT is a systematic approach like MDT is. It seems, like physical therapy, to be composed of many different treatment options. And like Physical Therapy, its not something we "do" and therefore not something you can test

Honored to have discussed barriers, opportunities, and future directions for telerehabilitation for chronic low back pain with @KevinMcLaughlin and @jfritzPT at @APTAcsm in Boston! @NASSspine @HopkinsOrtho

@sunsopeningband @DrSethPT An important consideration that applies broadly to interpretation of observational studies, but not a unique concern to TR.

@jfritzPT @DrSethPT Yes, absolutely. Lines up with my experience, as well. My concern, maybe better expressed in another thread, is that folks will pick up this study and use the data to support a narrower use of telerehab based on this subpopulation of “likely responders.”

This study is interesting bc we always used to think TR might be most beneficial in people with high psychosocial risk (dec. travel, has been used by psychologists for half century), yet it seemed to help most ppl you’d think would need less intervention academic.oup.com/ptj/advance-ar…

@sunsopeningband @DrSethPT This differs somewhat from our experience. TR can be as frequent and intense as is clinically appropriate. In my mind the group that may be best served by TR are those with chronic pain lacking access to evidence-based care with traditional in-person delivery often due to SDOH.

@DrSethPT We hear a lot about regression to the mean, etc, and I think telerehab is great for those folks who may likely improve anyway because of the low frequency and intensity of contact but still providing evidence-based assurance and advice in a mutually convenient way.

@USCArnoldSchool @Heyfritz @UofSCProvost Congratulations Dr. Fritz.

Congratulations to Stacy Fritz @Heyfritz on being selected as a Catherine Worthington Fellow! #ArnoldSchoolProud @UofSCProvost

@ChristineGoertz @Cyndy_Long_PCCR @DukeMSK What a great list to be on.

Am I the only one to notice that the top 3 authors with published articles on manual therapies for low back pain are women? There are no two LBP scientists I am more honored to follow than @Cyndy_Long_PCCR and @JFritzPT! #WomenInScience ⁦@DukeMSK⁩ dovepress.com/bibliometric-a…

@joshkj_dpt @Duke_DPT Congratulations Josh!

Some professional news: The faculty ⁦@Duke_DPT⁩ are clearly passionate about advancing #physicaltherapy science and practice. I’m excited to join them! medschool.duke.edu/blog/cleveland…

@JRayFalvey @JasT_PhD @BBurkeMD @nbcoe1 Congrats Jason

Excited to announce that an R01 submitted by @JasT_PhD and I is now funded! For 5 years, we will focus on if and how federal programs to bolster nursing home staffing improved health among residents living w/dementia, and if it was equitable in economically deprived areas

@danrhon If risk stratification "works" it likely requires a lot more PT training to change their practices.

@danrhon Hard to say as the trials aren't telling us much about fidelity and if risk stratified care actually differs from "usual care". You used visits for fidelity but the PT behavior changes needed to provide risk-stratified care is much more.

This is now 5th trial looking at use of risk-stratified care w STarTBack tool (Keele, MATCH, TARGET, Danish trial & V-START-MHS). 3 countries. 2 randomized at clinic level; 3 at individual level. Only 1 trial found tx effect. Is it the tool or the overall idea?

📌 This Friday, June 16, in PCT Grand Rounds: "BeatPain Utah Pragmatic Clinical Trial: Partnering With Community Health Centers Within a Socio-Technical Framework" with Julie Fritz @jfritzPT and Guilherme Del Fiol of @UofUMedicine 🔗 bit.ly/42HUxRK #pctGR