ChadCookPT
@chadcookpt
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Professor, Duke University, United States. @DukeCEMMT @DukeMSK @ForceNET5 . Tweets are my own.
Chapel Hill, Seven Devils, NC
Joined February 2014
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Telehealth is hot, thus, this is worth a resend. Simulated telehealth FAI exam was more accurate than clinical exam. FYI, we just finished a comparable shoulder exam telehealth study with MRI as reference standard. We will post results soon. What do you think the outcome is?
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Time to request a moratorium on negative comments about LBP treatment. Let's spend our energy on finding processes/treatments that work and let's support those who are looking for improvements. It's 2 easy to criticize. Clinicians need answers, not to be told nothing works.
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IT'S OUT. "Early physical therapy appears to be associated with subsequent
reductions in longer-term opioid use and lower-intensity opioid use for all of the musculoskeletal pain regions examined". Open access link.
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👍Our telehealth shoulder accuracy paper is out. We calculated "accuracy" (diagnostic effectiveness) and found no difference between TH and clinical testing (p=0.96). Shoulder tests weren't accurate for RCTs in any location!🤪
@DukeMSK
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Interested in a comprehensive "one stop" paper for elbow tests and measures? I'd recommend this one. from
@BJSM_BMJ
Nice work, more tests than we report in our book.
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It's out. Save insurance costs by going to PT First. Ahead of print alert with
@JOSPT
.
@chuckthigpen
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Does SPINAL MANIPULATION cure death. According to this paper is does. Since it is PUBLISHED it must be legitimate. Right? Consequences of PREDATORY publishing.
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IT'S OUT! Sticks and stones and the role of language and pain. GREAT! viewpoint
@JOSPT
@JeremyLewisPT
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As manual therapy changes to reflect evolving evidence it's important to recognize those who have contributed. Freddy Kaltenborn just passed away. He was the right person at the right time. RIP
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Our suggestions for value based care for physiotherapists.
@chuckthigpen
@JeremyLewisPT
@InaDiener
and Tom Denninger
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IT'S OUT! How useless is the active compression (O'Brien's) test? Pretty useless. Max of 10 percentage points change on post-test probability with + or - finding. Meta-analysis of 18 papers. 18!!! Don't use it.
@ale_garciaPT
@codyeff
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Another study showing early change in pain is prognostic for good outcome in subjects who received manual therapy. ~8 similar studies now
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Extremely well done SR on Social Determinants of Health and LBP. Open Access.
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🤦♀️BAD day for journals today. 1 rejected our paper with 1 reviewer's comments (no editors comments) that were wrong. Another had paper n review for 6 months only to say they can't find an editor. That journal made 31.6 million in 2019. PAY YOUR HELP!!! Peer review is broken. 😣🤦♀️
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👍👍Super useful and practical advice for prescribing exercise for low back pain here: Solid authorship group.
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I am troubled by false claims about any exam or Rx approach. It has been claimed that manual therapy has no clinical effect. I spent 35 minutes in PubMed this AM and have found the following SRs and MAs. This effort is only to fact check the claim that MT has no clinical effect.
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Popping with manipulation thought to be vertebral repositioning by 49% of participants/pts receiving it. Must exorcise these silly thoughts
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Nice paper addressing exercise induced hypoalgesia in chronic pain (and normals). It's variable, but exercise may elicit hyperalgesia in those with chronic pain. How to manage that is key
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What a terrific read. The next generation of evidence-based medicine.
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I had a wonderful time speaking to SSFK and WVVK about recommending a new evidence-based pyramid. Here is my recommendation....🤪
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👍🧐Discussion comes out this week. Worth a listen, regardless of your view on MT.
@JaredPowell12
@AdamMeakins
Happy to provide reference links to my side of the discussion
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Mars and Venus will be discussing manual therapy with our friend (and interpreter)
@jaredpowell12
Is there any common ground?
@AdamMeakins
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Selfie with 2300 of my colleagues at
#congresJFK2019
Great conference and wonderful hospitality
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Another great reason to look at psychological distress when addressing shoulder RTC tears. Our latest paper
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A study reminding us that clinician traits can influence report of symptoms. It's not just about the treatment; the interaction is meaningful as well.
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For my lecture today I'll discuss if manual therapy has been studied for the following pain modulator mechanisms. As a reminder, presence of a mechanism does not assure a clinical effect. We will discuss that too.
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Humbled to think that this publication with
@danrhon
and
@JoshClelandPT
is my 250th peer reviewed scientific manuscript published. I am beholden to the geniuses of my past collaborators
@ehegedus44
@PTLexie
@Weimrunner
@JeremyLewisPT
@DukeMSK
@ale_garciaPT
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Social Media viewpoint coming in January in
@JOSPT
Authors include
@JeremyLewisPT
@DrTobyHall
, Steven George, Mark Hancock and others. Great insight on pros and cons of using social media for evidence assimilation
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The majority of papers that found benefits with opioids included authors who were employed by Big Pharma
Hof off the press 🔥🔥🔥
Harms and benefits of opioids for management of non-surgical acute and chronic low back pain: a systematic review
@chadcookpt
and colleagues
👍👇👇👇
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🙏I am honored to be the 2023 recipient of the APTA Helen Hislop award. Huge thanks to Bob Rowe
@rrowe62
and Steven George
@DukeMSK
for their support letters. I'm proud to be part of
@Duke_DPT
and
@DukeOrtho
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To paraphrase from this 2018 paper: In SoMe, a credible voice is often ignored and/or infrequently heard, whereas the incredible voice is well represented. This is important since cascade size is highly dependent on the initial source of the information.
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Smart paper showing that MSK disorders are related to risk of chronic disease. Strong link between OA and heart disease.
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Just finished analysis with
@chuckthigpen
and found that PTfirst 4 neck-back pn leads 2 cost reductions of $1,660 per patient! N=603
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🤔"We conclude that in general, clinical LBP guidelines
do not provide clinicians with clear instructions about
how to incorporate psychosocial factors in LBP care".
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The cat is out of the bag. Thanks
@DukeHOD10
. I'm very honored, and humbled. What an amazing profession we serve.
Congratulations to our very own
@chadcookpt
for being recognized as a Catherine Worthingham Fellow of the APTA! We are so thankful to have you to as a program director, professor and role model in our field!
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🧐 JUST PUBLISHED!! Our study shows that mobility mediates the long-term relationship between pain and disability and QOL outcomes after spine surgery. Get your patients moving.👍 The "boss" first author
@ale_garciaPT
@OGdukeneurosurg
@APTAtweets
@DukeMSK
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?? Do you use Dry Needling as a physio?? Are you considering using a patient consent form (you probably should be). Take a look at this paper as it gives parameters on what to include in the consent
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1) Make bold statements about papers one has never read
2) Make bold statements about a keynote presentation one hasn't actually watched
3) Make definitive, conclusive statements about someone because they disagree with our narrative
4) Typical day on Twitter🥴🤦♂️
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EASILY, one of the top JOSPT viewpoints we've solicited. Unbiased FACTS about addressing biological factors and psychological factors associated with pain and disability in chronic WAD from people who've done the research. Consider ALL options.
@JOSPT
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🙃The Cook household is unbalanced. My 19 yr old son is a freshman at UNC; my 24 yr old son was accepted to med school at UNC 2 weeks ago. My wife was just offered a PT job at UNC yesterday.
I have been asked to watch the game in the garage....😵💫
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@JOSPT
Thanks
@JOSPT
. IMO (respectfully), it is potentially damaging to create diagnoses that are designed to support our philosophies or our identities. It's a recipe for medicalization. This is why I have concerns about this call to action paper from October 2020 PTJ
@PTJournal
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It's OUT! Here is the editorial that describes our experience with a Predatory journal. Thanks
@JOSPT
for giving us the platform.
@PMintkenDPT
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Really great review of cognitive biases that confound diagnosis in 2017 paper
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Welcomed SR looking at manual therapy's influence on pain catastrophizing, fear avoidance and kinesiophobia. It doesn't influence these constructs-positively or negatively. Not surprised, that's not its role. Thanks Sean Riley for sending it my way.
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Our editorial is out at
@BJSM_BMJ
Four good reasons for null trials: 1) poor fidelity, 2) the outcome measure used, 3) common factors, and 4) non-specific factors. With SZ George and Frank Keefe
@Mertonbike
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This paper intrigues me . How many use heavy resisted loading of the LB muscles during care? Seems to have fallen out of favor and I'm not fully sure why
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👇Paper is a reminder that people with similar problems respond differently to efficacious treatments. We have no silver bullets. Having time away from work is awesome!
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Great paper which identified six domains of social determinants of health: 1) stress/depression, 2) alcohol use, 3) education, 4) physical activity, 5) partner violence, 6) social connection/isolation. These influence health inequity and health outcomes
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My son and me at Machu Picchu. We had an amazing experience in Peru. No cuy was harmed on this trip
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Spine manipulation risk for serious adverse effects 1 in 20,000/200,000. Risk for opioid 💊misuse after prescription 3-4% (1 yr use).
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Found a whiskey store in Switzerland with over 1,000 types and free samples. This is not a typo
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RTC re-tear rates after sx increase with age. Why surgery for elderly if conservative care gives similar self-report of long-term results?
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Lovely surprise in the mail. Proud to contribute a chapter with
@ale_garciaPT
and
@JoshClelandPT
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Great viewpoint on why Patient Reported Experience Measures are necessary by
@ale_garciaPT
. If you are not familiar with these, this paper will help sort it.
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SUPER trial from good friends Griswald, Learman, O'Halloran, and Cleland. Trial found no differences in any outcomes between thrust and non-thrust manipulation for mechanical neck pain. Also measured clinician equipoise. Cool paper.
@JOSPT
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🎉🎉Just announced. Dan Rhon
@danrhon
has been selected as this year's APTA Eugene Michel's New Investigator Award.🎉🎉 ~15 million in funding. NEJM. Annals. So well deserved
@JoshClelandPT
@DukeMSK
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EARLY ACCESS TO PT and OPIOID use. Teaser from JAMA Network. Looking forward to this one. Comes out Friday!!
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Nice infographic explaining possible internal and external contextual effects of care.
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Our Active Compression test meta-analysis is now available open access. As a reminder, 1 study (O'Brien) has found good diagnostic value. 17 have not🤔 The test does not robustly rule in or rule out a SLAP lesion.
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✅👏👏It's official. Shefali Christopher DPT, is now Shefali Christopher DPT, PhD. What a wonderful journey this has been. Well done Shefali!! 🔥🔥
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Nice mediation paper about LBP , packed with smart people
@stevekamper1
Definitely worth the read.
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Remember the pain and disability wheel? This is the second publication that reflects ongoing efforts toward validating the model.
@YTL_PT
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It's out! Our updated SR/MA of clinical signs for myelopathy. Contributions from some of the top myelopathic researchers on the planet.
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Pt's decision to undergo shldr sx is influenced more by low expectations regarding physical therapy than by pt symptoms or anatomic features
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😵💫Just when I thought I've seen it all. This paper wins the creativity award. The Effectiveness of Leech Therapy in Chronic Low Back Pain.
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No differences in return to work at 5 years for SA decompression Vs. diagnostic arthroscopy Vs. Exercise.
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Really enjoyed this paper by Bjorn Hofmann. The concept of "disease" has markedly grown and continues to grow at a rapid pace. Normal is now a disease. Favorite quote "Disease is expanded by making more things count as disease". e.g., behaviors, feelings, emotions, sensations..
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TWO days, TWO posters and TWO first places for
@ale_garciaPT
and
@Duke_DPT
. She is a beast!!!
@DukeMSK
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It's now out. Central Sensitization Inventory displays good COSMIN properties in our systematic review.
@ThomasScerbo
@PaininMotion
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🔥🔥It's out! Our protocol paper for our PEERC expectations restructuring trial for the shoulder. Solid collaborative group.
@DukeMSK
👇👇
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Brilliantly written VIEWPOINT from Rod Whitley
@RodWhiteley
on blood flow restriction training. His conclusion may surprise you and his onging "discussion" with himself throughout the paper is truly great writing.
#japanesewhiskey
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Small study (N=64) demonstrating between group differences in favor of MT and EX vs. usual physio care (that's what it was called) for chronic neck pain. Usual care received more visits. Global recovery better at 3 mo's not earlier. We found same previously for LBP. Interesting.
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First time speaking in Peru, with a wonderful group of physios. And Pisco sours.
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Is it correct to say MT has no clinical effect? In some areas yes, others no. Am I some MT zealot who is biased toward MT?🤪It's worth reading what I've written about MT in past papers & books. I don't like biased opinions & fake news about exam and RXs. Nor should anyone
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My grandmother will be celebrating her 99th birthday. Married at 15. Mom at 16. Widow in her 40s. The most incredible and frightening woman I've ever met
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For those of you who are struggling on how to engage individuals with platforms such as telehealth, this is one of my favorite reads that provides suggestions
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Congrats
@cooksimon02
(my son) for his acceptance to the University of North Carolina (like his big brother) So proud of you.
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Meta-analysis of Active Compression Test for SLAP lesions (N=18 studies). O'Brien's 1999 study included. 70% of clinicians use this test in practice to diagnosis SLAP
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🪣Bucket list🪣. Cycle up Mount Mitchell, highest point east of the Mississippi in the USA. Done✅ Thanks to my wonderful wife Amy (and birthday girl) for being my sag wagon🥃
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"....the central dilemma of evidence-based medicine, from the perspective of a practicing clinician: all our evidence comes from groups of patients, yet all our decisions really are made on individual patients"
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Perfect timing for this great paper from
@PMintkenDPT
and colleagues. Patient expectations influence outcomes. The time is right for an intervention to change patient expectations. Stay tuned
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Excellent editorial from
@JeremyLewisPT
in
@JOSPT
He's been talking about the demise of the concept of impingement for years. Great read.
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OUT TODAY! Our viewpoint on therapist drift. Drift occurs when a clinician provides the appropriate intervention initially, but fails to implement the intervention in the recommended way over time
@JBeneciuk
@DukeMSK
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Pardon the self-promotion, but if you like "thinking person" courses, this one might be of interest to you. We explore the "whys" of several critical topics.
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A "weighted" CPR to DX meniscus tear of knee. I'm jealous, this is a good idea. It does not assume all predictors have equal influence 4 DX
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These are super graphics. Very useful
International Framework for Red Flags for Potential Serious Spinal Pathologies
🔓👀👀👇👇
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💪Today, Duke University is flexing.
@zachrstearns
@TrevorLentzPT
Marissa Carvalho, and some guy from Florida
@JBeneciuk
win the
@JOSPT
G. Davies research award. For this gem of a paper.
@DukeMSK
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👇👇Does the use of manual therapy (e.g. spine manipulation) lead to RX escalation and addiction? Database study of 7951 patients found that starting with other RXs had higher relative risks of RX escalation for surgery, imaging, injections, ED etc)🤔
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Case series in which patients with frozen shoulder have increased range under anesthesia. I think we've all encountered this. Muscle guarding masquerades as capsular contracture.
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👏👏Recommendations (treatment options) for excessive criticism of science by individuals on social media: from two giants in research. Classy paper.
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We talk about shared mechanisms here My opinion is that many of the interventions used by multiple professions are not specific and that shared mechanisms are the norm vs the exception. Maybe troubling for cont. ed. providers 😃
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😊Pretty good day today. Two manuscript acceptances. One small grant funding notification. And a gift 👇👇in the mail from
@NZMPA1
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Patients with LBP and a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit. Baseline pain intensity, psychological profile and self-rated health DID NOT MODIFY the effect of expectation on outcome. But why?
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