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First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
June, 2011, Vol. 11, Issue 06
Models and Evidence-Bases
By Keith Eric Grant, PhD, NCTMB
The techniques we use as massage therapists are increasingly coming under scrutiny and review. To an extent, this is part of a general movement in health care to review both the effectiveness of interventions and to compare what is actually done in practice with what accumulated evidence suggests would be the "best course".Two reports from the Institute of Medicine out this year underline this review: "Clinical Practice Guidelines We Can Trust" and "Finding What Works in Health Care: Standards for Systematic Reviews". The motivation from this introspection was noted by Joseph Padula in his blog "Managed Care Matters" — even many medical guidelines have had little or no solid evidence behind them, often resulting in less than optimal treatment.
In part also, the scrutiny of massage techniques and conceptual models behind the techniques stems from a cohort of massage educators looking to frame a more sound basis for massage therapy as a component of health care and to bring what's being taught into agreement with modern knowledge of anatomy and physiology. This has turned into an ongoing, international discussion across multiple social media: Facebook, Twitter, and ABMP's "Massage Professionals" forums, in particular.
Looking at evidence requires asking two types of questions; questions that I believe are separable. First, are there specific conditions for which we have evidence that massage techniques provide an effective treatment or co-treatment? If so, what can we say about the reliability of the evidence? Is it supported by research in addition to anecdotal (narrative) observations? In the best of possible worlds, we would like research and anecdote to reinforce each other and add to our insights. Enkin and Jadad provide a context for this delicate process of integrating experience and research.
Those who really follow the principles of evidence-based health care, "the conscientious and judicious use of current best evidence from clinical care research to guide health care decisions," understand that conscientious and judicious use does not mean blind adherence. They are making efforts to integrate research evidence with other types of information, values, preferences, resources and circumstances. Enkin and Jadad also caution about the interplay of belief with anecdotal "evidence," especially when anecdotes and research disagree, leaving the clinical practitioner to face a paradox.
Despite its low ranking in the evidence hierarchy, anecdotal information exerts a disproportionately powerful influence on clinical thinking and behavior. The paradox was well described by William Asher: "If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, your patients are much better, and your income is much better too... It is an almost insoluble problem, and the majority of worth-while doctors are driven to a compromise in which they muster enough genuine belief in their treatment to keep their patients happy and maintain their own respect, while preserving enough doubt to admit their inadequacy during transient bouts of uncomfortable honesty."
It's in trying to resolve the interplay between research and clinical anecdotes that we find the second kind of question. Do we have an explanation for the effectiveness of our techniques that doesn't violate laws of physics and is in accord with modern knowledge of anatomy, physiology and neurology? I explicitly add neurology because our body is not just physical. Our brain does an amazing computational feat in taking the myriad of sensory signals as input and providing us with a body sense as output. This second type of question brings us into the realm of conceptual models or maps for the actions of our techniques. Any such model is an approximation of reality. We can further subdivide questions about such a map into: "Is it useful?" and "Is it a correct approximation?"
Gregory Bateson, in "Form, Substance and Difference," from Steps to an Ecology of Mind (1972), elucidates the essential impossibility of knowing what the territory is, as any understanding of it is based on some representation: "We say the map is different from the territory. But what is the territory? Operationally, somebody went out with a retina or a measuring stick and made representations which were then put on paper. What is on the paper map is a representation of what was in the retinal representation of the man who made the map; and as you push the question back, what you find is an infinite regress, an infinite series of maps. The territory never gets in at all. [...] Always, the process of representation will filter it out so that the mental world is only maps of maps, ad infinitum."
Elsewhere in that same volume, Bateson points out that the usefulness of a map (a representation of reality) is not necessarily a matter of its literal truthfulness, but its having a structure analogous, for the purpose at hand, to the territory. Bateson argues this case at some length in the essay "The Theology of Alcoholics Anonymous."
To paraphrase Bateson's argument, a culture that believes that common colds are transmitted by evil spirits, that those spirits fly out of you when you sneeze, can pass from one person to another when they are inhaled or when both handle the same objects, etc., could have just as effective a "map" for public health as one that substituted microbes for spirits. While treatments of the individual would differ between the two models, actions such as isolation and quarantining would not.
Our challenge as a health care profession in the modern world comes in the way we address these questions, identifying areas needing research, filtering out disproved myths and ensuring the transfer of knowledge into practice.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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