So, you’ve got some back pain and are headed to your first appointment with your physical therapist. You’re expecting the therapist to start cracking joints, but what you get instead is something more akin to a gentle kneading. It’s not, needless to say, what you expected.
How a patient’s expectations for treatment match up to the actual treatment is the focus of new research by Ken Learman, associate professor of Physical Therapy, published in the Journal of Manipulative and Physiological Therapeutics.
“What we were really concerned about was whether or not it mattered if patients got the treatment they expected, or if they got what they felt would be better for them,” he said. “If people get what they really like or think will work best, do they wind up doing better than if they don’t?”
The simple answer is, no.
The study, conducted by Learman and four other physical therapy researchers, is titled “The Role of Patients’ Expectation of Appropriate Initial Manual Therapy Treatment in Outcomes for Patients with Low Back Pain” and involved a secondary data analysis of 149 patients under the care of 17 physical therapists in 16 clinics nationwide.
There are generally two main types of manual therapy treatment: mobilization and manipulation. Mobilization is gentler – oscillating the joint and surrounding tissues in their normal range of movement. Manipulation is more aggressive and performed at the end of the joint’s range – the joint-cracking that is commonly associated with therapy. In the study, each patient was told of the two types of treatment, and then randomly assigned to a type, not necessarily the one they would prefer. The outcome, says Learman, was that each patient improved whether or not they received the type of treatment they preferred.
The study is part of Learman’s ongoing research focusing on the effects of orthopedic manual therapy. Learman, formerly a physical therapist at Hillside Rehabilitation Hospital in Warren and director of Physical Therapy at St. Elizabeth Health Center in Youngstown, joined the YSU full-time faculty in 2003.
Learman said many aspects of healthcare are psychological, as well as physical.
“One of the overlying principles of all care are the psychosocial components, and how they interplay with a person’s eventual outcomes,” he said.
“Telling the patient that everything will be alright and reassuring them of a favorable outcome, when appropriate, is one of our most important treatments,” he added. In fact, physical therapists often play the role of lifestyle advisor as well, which benefits the patient further. “I routinely counsel patients on diet and weight loss, address stress, relaxation and any other concerns that may arise,” he said. “I do that with patients all the time. You need to treat the whole person.”
Unlike a visit to a physician which tends to be shorter and less frequent, physical therapy can take an hour per session, two or three times a week, meaning that there are far more chances to discover other factors affecting a patient’s health or their perceived health.
Learman explained that abnormalities at any given joint transfer forces inappropriately to joints either up or down the kinetic chain so, for example, knee pain may be partially caused in either the ankle or the hip. This will in turn place additional stresses on the spine as well.
“We are now seeing the interdependence of one body region to another,” he said. “Anywhere from the lumbar spine to the foot can impact how the knee moves, so you’ve got to examine the person as a whole, how they move, and make adjustments within that person’s anatomy to the way they move.”
While the healthcare industry is going through a period of uncertainty, Learman said he thinks the outlook is good for physical therapy. “The baby boomers are getting older, and they’re going to require care,” he said. “As research comes out suggesting that conservative care produces as good of outcomes over the long term as do more aggressive surgical intervention, and at a fraction of the price, they’re still going to need us.”
Story by Harry Evans