Author: Karen Simsen

By Seth Peterson, PT, DPT, OCS, FAAOMPT

“I don’t know how they can sleep at night.” I was getting chewed out in a hallway in my first year of residency training. My mentor was speaking in general terms, but it was painfully clear that “they” meant me. I had just seen an 11-year-old girl with an ankle sprain. I had given her a painful balance exercise in standing (because the evidence showed it was more effective) and we had talked about pain neurophysiology, which was cutting-edge at the time. Her problem with what she’d just witnessed was that, despite me applying “evidence-based care,” she hadn’t really seen me apply that care to the individual. She hadn’t seen me think.

Looking back, my lack of thinking about the interventions was made worse by the fact that I was doing so much thinking about the simple things. While my mentor was thinking about the words used to greet someone and deciding what mattered to that person on that day, I was focused on how to sequence an ankle examination. I was focused on the basics—and the basics were something they did unfailingly well. Using the conscious competence learning model, you could say I was at a stage of “conscious incompetence” while they were well into the “unconscious competence” stage. Another way to say it is they had “mastered” the basics, while I was just beginning to grasp them.

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by Chad E Cook PT, PhD, FAPTA

Randomized Controlled Trials

In clinical research, treatment efficacy (the extent to which a specific intervention, such as a drug or therapy, produces a beneficial result under ideal conditions) and effectiveness (the degree to which an intervention achieves its intended outcomes in real-world settings) are studied using randomized controlled trials. Randomized controlled trials compare the average treatment effects (ATEs) of outcomes between two or more interventions [1]. By definition, an ATE represents the average difference in outcomes between treatment groups (those who receive the treatment or treatments) and/or a control group (those who do not receive the treatment) across the entire population. Less commonly, researchers will include a secondary “responder analyses” that looks at proportions of individuals who meet a clinically meaningful threshold.

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by Chad E Cook PT, PhD, FAPTA

The “Facts” Please

Perhaps you’ve heard the following “facts”? The Great Wall of China is visible from space. If you touch a baby bird that is in its nest, the mother will abandon it. If you flush a toilet in the Southern Hemisphere, water rotates in the opposite direction through a process known as the Coriolis Effect. I’m uncertain when and where I’ve heard these, but I was surprised to have learned recently that each of these “facts” is actually false [1]. The Great Wall is not visible at low earth orbit without magnification and baby birds are not abandoned once touched. In fact, most birds have a poor sense of smell and won’t even detect that a human has been there. Lastly, toilet construction dictates how water rotates once flushed, not its position on the earth [1]. Each of these statements, which I’m certain you and I have heard numerous times, is an example of the “illusory truth effect” [2].

The illusory truth effect is a cognitive bias in which people tend to believe that a statement or claim is true if they have encountered it repeatedly, even if it is false or lacks evidence to support it [2]. This effect demonstrates the power of repetition and familiarity in shaping beliefs and perceptions. This form of cognitive bias is commonly employed by politicians, marketers, and left- and right-wing journalists to manipulate the truth. Unfortunately, in situations where the “truth” is complicated, the illusory truth effect is a very effective strategy that leads to unwarranted changes in thoughts and beliefs [3].

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