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Using Evidence to Change Practice Paradigms

Posted Sep 14 2008 3:59pm

Last night, the Midlands District of the South Carolina APTA was treated to a nice lecture from Stacy Fritz, PT, PhD, a professor at University of South Carolina, during our biannual meeting.

Her topic was something she calls Intensive Mobility Training (IMT). It describes a type of Physical Therapy intervention in which individuals with chronic neurological impairments are given intense (as the name suggests!) therapy utilizing some very interesting principles. The therapy essentially pairs components of two unique neurological interventions, Locomotor Training (LT) and Constraint-Induced Movement Therapy ( CIMT ).

Among the principles that this therapy is based on, one captured my imagination: the concept of massed practice. Essentially, this motor learning theory groups the learning for a task into one small period of time with an enormous amount of repetition during that time. An example would be 2 weeks of 3-6 hours of therapy daily, in which the majority of time spent was performing the desried task repetitvely, i.e., walking. This is in contrast to more traditional rehab schedules, such as 3 times a week for 60 minutes over 8 weeks.

While I was listening to the talk, I had a difficult time wrapping my brain around the possible scenario in which an insurer would ever pay for such time periods of therapy, which sometimes includes multiple therapists working on one patient. Well, research like this may help to answer a question that is just so obvious as to be often neglected:

"What evidence supports how much therapy a patient requires?"

Perhaps research like this might one day pave the way for a "revolution" in how Physical Therapy services are provided with respect to time and dosage. I know one thing for sure: without evidence like this, insurance companies will be all too eager to keep us locked into the current time-based payment scale!

Aside from her informative lecture on IMT, I learned two things I was not expecting to:

1. South Carolina leads the nation in incidence of stroke.

2. The incidence of Spinal Cord Injury in SC is 20% higher than the national average.

Labels: physical therapy, Research

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