Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
An International Life: An Interview with Mary Elizabeth Wakefield
I met Mary Elizabeth Wakefield during her class last summer in Seneca Falls, New York at the Finger Lakes School of Chinese Medicine.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
March, 2012, Vol. 12, Issue 03
Trying to Get Something From Nothing
By Keith Eric Grant, PhD, NCTMB
"Sometimes nothing can be a real cool hand" – Paul Newman in the movie, "Cool Hand Luke."
You are going to be hearing more and more about evidence-based massage therapy (EBMT). Partly, this reflects a current trend in health care to re-evaluate treatment and to determine what has a sound basis for use and what doesn't. One example of this is the Institute of Medicine report, "Evidence-Based Medicine and the Changing Nature of Healthcare."
A second factor is the existence of the Massage Therapy Foundation (MTF), which has goals of making those in the profession aware of research, promoting research literacy and integrating research with practice. I would count the forthcoming book on such integration by Dryden and Moyer as among the efforts facilitated by the MTF.
A third factor is massage therapy now being regulated by the majority of states, combined with the legal presumption that such regulation is done for the protection of the public. If we consider that training is necessary for safe practice, the presumption of public protection can only be fulfilled when state-mandated training is based upon a solid foundation of objectively validated knowledge.
A final factor is the modern technology embodied in an interactive web. Communication without regard to physical proximity is facilitating extensive discussions among those both with a stake in massage therapy and with backgrounds in research and statistics. Alice Sanvito discusses evidence-based massage on her web site and provides a number of links there to additional resources. I like the definition she gives for EBMT.
Evidenced based massage therapy is massage therapy founded on ideas and principles supported by evidence. Many of the claims made and practices used by massage therapists are founded on tradition rather than evidence. Since there is not yet a large body of knowledge documenting the physiology of and effects of massage therapy, if we were only able to make statements strictly on the basis of scientific studies, we would be severely limited indeed. Some people prefer the term "evidence informed practice" as more accurate. An evidence informed practice takes into consideration scientific evidence, clinical experience and careful observation.
The concept of being evidence-based, however, necessitates having methods to collect such evidence. In this, we also need to be careful to distinguish between whether or not an intervention can be shown to work (beyond random chance) and the model that we believe is the mechanism underlying the intervention. It is fully possible, as with massage relieving muscle soreness and the lactic acid myth, for an intervention to be effective while the supposed mechanism is incorrect. The randomized controlled trial (RCT) is taken as the "gold standard" of clinical proof, but how does that work? We need three things: a study population, a methodology for the study and the ability to analyze the results for effectiveness.
For example, our study population might be those diagnosed with high blood pressure, over the age of 40, not having other medical complications and not knowing Morse code. The goal of our study might be to determine whether or not listening to relaxing messages keyed in Morse code by a live practitioner were effective in reducing blood pressure. A complicating factor for the study is that people respond to the presence of other people. As put by Ravensara Travillian recently, "As psychosocial beings, we respond psychologically and socially in ways that can be described as healing body and mind due to presence and caring attention from others." Thus, our study will need a means of differentiating the effects of the Morse code from those effects simply from the practitioner's presence and the setup of the trial itself.
After gaining a sufficient number of suitable participants, we would fulfill the "randomized" concept of the trial by randomly dividing them into three groups: control, sham Morse-code and Morse code. The intervention might be three-times per week for 12 weeks. Controls would come in, have their blood pressure (BP) measured, wait 30 minutes, and have their BP measured again. Those in the Morse-code group would, in the 30 minutes wait, listen to Morse-code keyed by one of several live practitioners. Those in the "sham-group" would listen to 30 minutes of keying, similar to Morse-code, but keyed by "practitioners" unfamiliar with Morse-code. With this protocol, we can look for short-term effects between sessions, beginning and session end, as well as for longer term effects over the length of the study. By taking follow-up measurements after the end of the 12 weeks, we can also look for persistence of any changes.
Now we get to the point of getting something from nothing. We assume the null hypothesis, that any differences between the groups is simply from random chance, and calculate the probability (p) that this assumption is true. We conclude that there is a statistically significant difference between groups only when the probability of our observations being due entirely to chance is less than 5% (p<0.05). We have three separate probabilities to check: whether the sham group is statistically different from the control group (psychosocial effect), whether the Morse code group is different from the control group (psychosocial plus Morse code), and whether the difference between the sham and code groups is significant (Morse code effect). In a recent paper, Bakker and Wicherts underscore the importance of doing the third test explicitly, even when the differences between the sham and control groups is not significant.
If there is no difference between the three groups, the study would conclude that, in the clinical trial as designed, neither psychosocial factors nor messages in Morse-code were effective. If the sham group differed statistically from the control, we would conclude that there was a psychosocial effect. Because the psychosocial effect would also be present in the code group, only if the code group was statistically different from the sham group could we conclude that there was an effect from Morse-code itself. Note that this code effect could be of either sign, adding to a psychosocial effect or negating it.
There you have the outline of a randomized control/clinical trial. Assuming initially that we get no difference, we end up with information. Sometimes "nothing can be a real cool hand."
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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