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Evidence-Based Practice in Medicine: What Does it Mean? Part 1

 

Stethoscope and data

Prior to the COVID19 outbreak, the average person may have never heard the term “evidence-based” but this term has been utilized in the medical field for decades.  When we say that our clinical practice in physical therapy is evidence-based, we mean that the treatments, techniques, and clinical decisions we make are based on the best research and clinical experience available.  The same applies to MDs prescribing specific drugs and vaccines to combat illness, surgeons choosing specific surgical procedures, dentists applying topical treatments to prevent cavities, nurses wearing special protective gear to prevent infection, and so on.   

So where does the “evidence” come from?  First, let’s consider the alternative. Non-evidence-based medicine might use intuition, tradition, inconsistent anecdotes, personal histories, unsystematic clinical experience, etc. to inform diagnosis and treatment decisions.  Prior to the discovery of the scientific method, these were the tools healers had to work with. If something worked once, perhaps it would work again and over time, they developed a list of “cures” for various ailments. Some legitimately helped, many did not.  Sometimes the cures were worse than the original illness or injury.  For example, during the 1918 Spanish Flu pandemic, aspirin was found to help with feverHowever some patients died from aspirin toxicity when given large doses because we knew so little about that new drug 

We’ve come a long way in medicine since the days of bloodletting, non-antiseptic surgery, and lobotomies. This is because most medical practice today is based on research using the scientific method.  So what is this method? (Adapted from Live Science.) 

The steps of the scientific method go something like this: 

  • Make an observation or observations. 
  • Ask questions about the observations and gather information. 
  • Form a hypothesis — a tentative description of what’s been observed and make predictions based on that hypothesis. 
  • Test the hypothesis and predictions in an experiment that can be reproduced. 
  • Analyze the data and draw conclusions; accept or reject the hypothesis or modify the hypothesis if necessary. 
  • Reproduce the experiment until there are no discrepancies between observations and theory. The reproducibility of published experiments is the foundation of science. No reproducibility – no science and therefore no evidence. 

Some key underpinnings to the scientific method: 

  • The hypothesis must be testable and falsifiable. Falsifiable means that there must be a possible negative answer to the hypothesis. 
  • Research must involve deductive reasoning and inductive reasoning. Deductive reasoning is the process of using true premises to reach a logical true conclusion while inductive reasoning takes the opposite approach. 
  • An experiment should include a dependent variable (which does not change) and an independent variable (which does change). 
  • An experiment should include an experimental group and a control group. The control group is what the experimental group is compared against. 

Here is a visual way to think of the scientific method:

flowchart of scientific method

 

As you can see, the process repeats as we gather more and more data regarding a particular question Additional research helps us to reach conclusions we can apply to activities in the everyday world.  For example, years ago in physical therapy we used to administer ultrasound massage to patients with low back pain. The patients may have felt better after having some warm gel massaged into their low back muscles, but was the treatment affecting the cause of their pain? After many research studies, we now believe that ultrasound likely has no significant effect in the overall cure of low back pain. So nowadays, we rarely apply ultrasound because we have other more effective treatments.  Does that mean that ultrasound never helps? No, but it may not be the best use of our limited time with patients. Deciding whether to use something like ultrasound is part of our clinical reasoning, an important part of our treatment choices; but that’s a topic for another time. 

Through the scientific method, we hope to weed out what doesn’t work, and focus on what does.  We then build on the most effective treatments and as science advances our understanding, we are able to cure illnesses and heal injuries that were untreatable in the past. Whether it’s wiping out smallpox with vaccines or reversing heart disease with changes in diet and exercise, the scientific method helps to improve our health and save our lives.  However, like everything human-made, it’s not perfect. In the next installment of this series, we will look at Levels of Evidence to learn more about why some research studies are flawed or skewed, as well as other ways in which the scientific method fails to fullanswer our questions.  

If you’d like to experience the difference evidence-based, hour-long, physical therapy sessions can make resolving your pain or healing from injury, call OrthoSport Hawaii at 808.373.3555 for more information on scheduling a free online or in-person consult.

Meet Our Staff – Personal Trainer Travis!

Now that our Medical Fitness program has re-opened during our COVID19 restrictions, we can return to highlighting our amazing employees. The folks who work at OrthoSport Hawaii come from many different backgrounds, have a wealth of experience and knowledge to share, and love staying active while helping others improve their health and fitness. To schedule an appointment or get more information please call (808) 373.1114.

 

Travis smiling

Years of experience:  I’ve been a trainer at OrthoSport since 2018 and have been an ACE – certified personal trainer and group exercise instructor since 2014. Born and raised in Honolulu, Hawaii.
Specialization: Senior Fitness, Parkinson’s. I enjoy working with clients of all age ranges.
Interesting fact: Former high school football assistant coach.
Hobbies, interests: I enjoy exercising, hiking, and going to the beach. When I’m not doing any of these I am watching anything related to sports!
Travis Hiking a Ridge
What got you interested in your field/passions? I was actually a business major in college and ended up working in an office all day. I always enjoyed helping people and being more active so I made a career change that led me to the health and fitness field. I have been enjoying it ever since!

Returning to Exercise after a Layoff – What You Need to Know

There will always be times when you must take a break from your exercise routine. For many, the closure of gyms and cancellation of exercise classes during the COVID-19 pandemic has meant little ability to exercise in their normal routine.  Some of you may have started walking or cycling outdoors recently and are interested in continuing and building on that. Here are some tips to gradually return to or start an exercise program – post Stay At Home orders. 

  1. As always, if you have any injuries or health conditions, are new to exercise, or haven’t seen your primary healthcare provider in recent years, a quick check-up and go-ahead from a medical professional is always a good idea.  Many people ignore this step, but it’s extremely important. I’ve seen runners collapsed in cardiac arrest, joggers overcome by heat exhaustion nearly unconscious, and cyclists or swimmers blacking out during their workout.  These people all thought they were healthy but were in very real danger of losing their lives.
  2. START SLOWLY, START SLOWLY, START SLOWLY! You won’t be at the same fitness and ability level anymore.  It doesn’t matter what you used to do; your body is different now.  What does start slowly mean?  If you normally spent an hour exercising (even in a class) cut that time in half. Don’t push yourself to your limit.  In weightlifting, decrease your resistance and reps by half and work yourself back up gradually.  For endurance exercise, decrease your distance and intensity adding only 10% each workout.  During a fitness class, slack off for the second half of the hour or even step out to rest and stretch.
  3. Overuse injuries are your enemy. Avoid them! Your tendons and ligaments are no longer adapted to the forces you used to put on them. Whether it’s playing tennis or getting back to martial arts, your connective tissue needs a couple of weeks to re-build and return to its previous level of elasticity and load tolerance. Now is not the time to snap your achilles.
  4. Respect the messages from your body. If you feel overly fatigued or sick, don’t exercise or cut your workout short.  Especially during the pandemic, pay attention to feelings of fever, cough, and unusual shortness of breath.
  5. Now may be a good time to seek instruction or coaching in your favorite sport or activity.  Certified trainers and sports physical therapists can help you improve your weightlifting form, analyze your running gait, and teach you how to stretch correctly.
  6. If you wear a mask while exercising, rest if you feel light-headed. Don’t forget to stay hydrated. Signs of overheating include headache, dizziness, nausea, faintness, cramps, or palpitations.
  7. If you notice an ache or pain that doesn’t go away with rest for a day or two, seek medical attention from your MD or Physical Therapist.  Treating an injury in the earliest stages results in the best outcomes and less time required for full healing. 

At OrthoSport Hawaii, we offer a variety of services to help you return to your favorite sport or start a new exercise program.  Our certified personal trainers and PTs are available to help you avoid or recover from injury and optimize your performance.  Check out our RunFit running analysis program and our SportFit package for athletes looking to stay active in their favorite sport into their older years.  For information on our personal training, physical therapy, and massage therapy services, call 808.373.3555. 

Should You Wear a Face Mask during COVID-19?

Update 4/8/2020:

With new research affecting policy on a daily or weekly basis, it’s critical to stay on top of changing recommendations.  Cloth or home-made face covers are now recommended when out in public. Surgical and N95 masks are not recommended, as they should be reserved for health-care workers treating sick patients and are in short supply. According to the CDC website:

CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.

CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.  Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

 

Should you wear a face mask to your PT or other medical appointments? In the community? According to current guidelines from the CDC:

“Wear a facemask if YOU are sick.

If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. Learn what to do if you are sick.

If you are NOT sick: You do not need to wear a surgical or N95 facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.”

The N95 mask with face shield or goggles should be reserved for hospital workers actively engaged in the care of patients with COVID-19 and other contagious illnesses. These masks must be fitted to your face and require instruction on how to donn (put on) or doff (remove) with gloves and gown. If you have extra of these masks it is recommended you donate them to first responders and hospital staff. An N95 mask worn without eye protection and used incorrectly, is worthless and a waste of valuable resources.

The surgical mask is designed to protect others from YOU. So if you are sick you should wear a mask to avoid coughing or sneezing on others. They will NOT protect you from microscopic viruses (note how loosely they fit). However due to panic buying, even these masks are in short supply. If you have extras that you don’t need, you may want to donate those as well.

Bandanas, scarfs etc. These items worn covering the face may remind you not to touch your face. Along with hand washing or sanitizing this is one of the ways you can avoid infection from contaminated surfaces. Just remember that if you touch the outside of the scarf, you have possibly contaminated your hand and should wash or sanitize immediately.

The important thing to realize is that there are appropriate uses for various types of masks and face coverings. Wearing a mask incorrectly may give you a false sense of safety which could lead you to engage in risky behaviors, such as forgetting to wash your hands, getting into an elevator, or attending unnecessary activities in the community — all of which could INCREASE your risk of infection.

A Bit About the Biz – OrthoSport Hawai’i in the MIDWEEK

Treating And Preventing Injuries

MIDWEEK STAFF on March 4, 2020 at 10:54 am
www.midweek.com/treating-preventing-injuries

By THOMAS FASULO OrthoSport Hawai‘i Medical Fitness Director

In 2009, Dr. Michael Turner started OrthoSport Hawaii as an outgrowth of his own passion for leading an active, healthy lifestyle. While Turner’s original intention was to operate strictly as a physical therapy clinic, he began to see a glaring issue in the current medical model. This model does little to stop the revolving door of re-injury and largely ignores the need for prevention.

So, he developed the Medical Fitness Program, combining the best of both worlds — injury treatment, post-injury care and preventative wellness. Kinesiologists, athletic trainers, physical therapy assistants, postural specialists, medical massage therapists, and registered dietitians joined the physical therapy team to create a one-stop-shop for injury prevention and wellness needs.

Working closely alongside each other, we have created medical fitness programs such as a boxing class for Parkinson’s patients; the BrainFit workout, which combines physical and mental training to promote healthy brain function; and many other specialty group fitness classes. These classes, along with one-on-one rehab and training sessions, can make an active, healthy lifestyle an achievable reality for anyone, no matter their age or ability level.

Anne Davis, an Egoscue postural specialist, provides medical fitness training on The Shuttle.
Anne Davis, an Egoscue postural specialist, provides medical fitness training on The Shuttle.

In 2015, we expanded our services to the heart of downtown Honolulu. In addition to our Kaka‘ako location inside Queen’s Island Urgent Care on Keawe Street, we recently opened a 1,600-square-foot clinic on the lobby level of Topa Financial Center at Bishop Street and Ala Moana Boulevard.

Catering to professionals suffering from pain associated with desk work, the avid golf or tennis player, young athletes or simply downtown residents, the downtown and Kaka‘ako clinic teams are prepared to help you remain injury-free and return to the hobbies and activities you enjoy.

Standard medical, auto and workers compensation insurance generally covers physical therapy but may require a doctor’s referral. All other Medical Fitness services are not typically covered by insurance but remain one of the most effective and affordable ways to prevent health issues and maintain wellness.

OrthoSport Hawai‘i can be reached at 373-3555 for any questions or scheduling needs.

Meet Our Staff — Personal Trainer Sydney!

Every week or so, we hope to highlight one of our amazing employees. The folks who work at OrthoSport Hawaii come from many different backgrounds, have a wealth of experience and knowledge to share, and love staying active while helping others improve their health and fitness. To schedule an appointment or get more information please call (808) 373.1114.

“Aloha! My name is Sydney Thompson and I am excited to be working with you as a Medical Trainer at OrthoSport. I received my B.S. in Exercise Science at Eastern Washington University. My focus is on Therapeutic Exercise and Fall Prevention. I love my job because I get to help you feel better, as well as prevent injuries so that you can do all of the things that you love! In my free time I am usually playing volleyball or enjoying nature!”

Meet Our Staff – Medical Fitness Director Thomas!

Every week or so, we hope to highlight one of our amazing employees. The folks who work at OrthoSport Hawaii come from many different backgrounds, have a wealth of experience and knowledge to share, and love staying active while helping others improve their health and fitness. To schedule an appointment or get more information please call (808) 373.3555.

Thomas is the director of Medical Fitness in our Niu Valley and Downtown locations. He first came to Oahu in 2006 to attend the UH Kinesiology program and is also a licensed massage therapist and certified personal trainer.  He has experience working with youth as young as 8 years old, seniors as young as 94 years old, and everything in between. He believes the entire spectrum of wellness is important to consider and strives to make sessions as personalized as possible.

He utilizes soft tissue mobilization alongside strength training to ensure each client is treated as an individual with custom needs and goals. Outside of work, he enjoys traveling, boxing, and eating all the food in the world.

Alphabet Soup – What are all those initials after your names?

If you look at the OrthoSport Hawaii website under About Us/Staff  you will see quite a wide variety of initials after the names of our team members. These initials represent extensive education and training on medical and fitness topics which is why we have some of the most experienced physical therapists and medical fitness trainers in the state. In addition, most of these certifications require yearly continuing education. We are always updating our treatments and protocols to match the current evidence-based science in our fields. 

PT  – Licensed Physical Therapist – all Physical Therapy school graduates must pass a rigorous licensing exam after completing their clinical rotations in various medical settings.

DPT – Doctor of Physical Therapy – All PT graduate programs are now doctorate level and include courses on pharmacology, differential diagnosis, radiography/imaging, psychology, wound care, as well as the expected musculo-skeletal, cardiopulmonary, and nervous systems education.

MPT – Master of Physical Therapy

MPH – Master of Public Health

MEd – Master of Education

OCS – Orthopedic Clinical Specialist – a PT who completed a residency or OCS coursework and passed their exam to become board-certified in Orthopedics.

MTC – Manual Therapy Certified – a PT who completed a post-graduate training program in osteopathic manual therapy.

FAAOMPT – Whoo! This one means a PT is a Fellow of the American Academy of Orthopedic Manual Physical Therapists. A “Fellow” is a physical therapist who has demonstrated advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal orthopedic disorders and is internationally recognized for their competence and expertise in the practice of manual physical therapy.

LMT – Licensed Massage Therapist – in the state of Hawai’i massage therapy students complete 500 hours of study and hands-on training then sit for their state license exam.

ATRIC – Aquatic Therapy and Rehab Institute Certification indicates someone has specialized training and has passed an exam to become a certified Aquatic Therapist.

CSCS – Certified Strength and Conditioning Specialist – Fitness professionals with at least a Bachelor’s degree must pass a certification exam through the National Conditioning and Strength Association. They apply scientific knowledge to train athletes for the primary goal of improving athletic performance. The CSCS is one of the most respected strength coaching certifications.

CPT – Certified Personal Trainer – our staff are certified through a variety of recognized organizations including the American Council on Exercise, the Athletic Certification Training Commission, and the National Academy of Sports Medicine.

CPT – also stands for Certified Pilates Teacher via the STOTT Pilates method which requires months or years of training and apprenticeship as well as written and practical exams. 

CES – Corrective Exercise Specialist – a designation in the NASM for those who have taken special training to address movement and postural imbalances.

ATC – Certified Athletic Trainer – requires Bachelor’s or Master’s degree from an accredited athletic training program and passing a comprehensive licensing exam. 

CWHC – Certified Wellness Health Coach through nutritional supplement and weight loss company, Optavia.

PN – Precision Nutrition Certification.

RD – Registered Dietician –  requires a Bachelor’s degree, internship, and national license exam.

 

Whether you are looking to decrease pain and stiffness, improve performance, lose weight, or recover from an injury, we have the professionals to get you to your goal. Call 808.373.3555 for more information.

 

Meet Our Staff – Athletic Trainer Haj Takeshime!

Every week or so, we hope to highlight one of our amazing employees. The folks who work at OrthoSport Hawaii come from many different backgrounds, have a wealth of experience and knowledge to share, and love staying active while helping others improve their health and fitness. To schedule an appointment or get more information please call (808) 373.3555.

Haj Takashime was born and raised in Tokyo, Japan. He has been an athletic trainer for college athletics for 10+ years. He joined the Medical Fitness Program after returning from China for a Major League Baseball academy stint. He is fluent in Japanese and Chinese Mandarin for your exercise pep talk. He loves to work with young athletes and anyone looking to improve their sports performance. Call 808.373.1114 to schedule a session with Haj!

Meet Our Staff – STOTT Pilates Certified Personal Trainer Cassandra!

Every week or so, we hope to highlight one of our amazing employees. The folks who work at OrthoSport Hawaii come from many different backgrounds, have a wealth of experience and knowledge to share, and love staying active while helping others improve their health and fitness. To schedule an appointment or get more information please call (808) 373.3555.

CassandraCassandra started participating in Pilates with her mom when she was 10 years old, and fell in love with Pilates at age 16. After taking an Anatomy and Physiology class her senior year of high school, Cassandra knew she wanted to have a career where she could help others improve their physical health and move without pain. Cassandra has a BS in Health and Wellness and an AA in Kinesiology. She is continuing her education with the goal of becoming a Physical Therapist. Cassandra moved to Oahu in September 2018 and has fallen in love with its beauty. In her free time Cassandra loves to be active outdoors hiking, swimming, kayaking, and walking her two dogs. If you’d like to get fit through Pilates, call 808.373.1114 to learn more about personal training sessions with Cassandra!

Cassandra teaser

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