I’ve already established my strong distaste of the term “non-specific effects.” Don’t even think of using those combined words with me!
After reading a recent JAMA abstract on the effects of physical therapy for hip osteoarthritis AND listening to the podcast interview with the lead investigator, I’m in favor of the term indirect effects.
When I see a title like, “Physical Therapy for Hip Osteoarthritis may not Lead to Significant Benefits” and we see a crappy photo of a group parachute activity, my immediate mode is attack mode. I mean, seriously, who the heck does that parachute thing for hip osteoarthritis?
Before getting defensive and raising the hackles over the abstract (I haven’t seen the full text) or even the stupid 2 Minute Medicine article, it’s interesting to instead take a step back and reflect.
No study is perfect. I truly believe the intent of the study was to determine the value of conservative treatment with physical therapy as a focus. I also believe thought was put into creating a standardized process to capture the effect. Is it difficult to hear that whether the subject spent time with a clinician providing reasonable care that seems on par with evidence OR whether the subject spent time with a clinician providing care that should not provide positive benefit both resulted in improvement in pain in function? You bet it is!
I don’t want to nitpick the study… instead, think of what this means… think of how this can alter your practice. I am not saying we should all begin doing sham ultrasounds or rubbing inert gel on hips (for those of you who know me, you know that would never be my advice).
We need to definitely accept indirect effects. We need to accept that what we code and bill and actually physically do with patients may not be the most relevant aspect of our role. We need to begin to standardize processes to capitalize on indirect effects.
If we don’t acknowledge and implement the science involved with indirect effects, we are no better than anyone who uses homeopathy. We need to banish the image of tossing our hands in the air and stating “non-specific effects.” We need to begin focusing on what triggers the indirect effect and understand specifically what happens, when it happens, how it happens & why it happens… we need to figure out how to measure it is actually happening… we need to figure out the maximal intensity or strength of positively skewed indirect effects… we also need to figure out what substantially reduces positively skewed indirect effects. The answers may not even lie in quantitative studies… the answers will probably be found in qualitative studies. Google Glass and video analysis… recording, measuring and analyzing behaviors (body language and verbal language) to then managing our own behaviors to improve the indirect effects. The answers may even already be out there in the realm of sociology and psychology…
Are we ready as professionals to accept a big piece of our value may not necessarily be tied to the evidence we use for the basis of our interventions?
Until next time,