Risk Stratification versus Risk Adjustment: Both are Important but They are Not the Same Thing
By: Chad E Cook, PT, PhD, FAPTA Background: In 2011, I was part of a team of researchers who looked at very large datasets and routinely used publicly available risk adjustment measures. We had access to the Nationwide Inpatient Sample, which is the largest publicly available all‑payer inpatient healthcare database in the United States and […]
What Really Happens When We Use Manual Therapy? A Fresh Look at the Mechanisms Behind Hands-On Approaches
Authors: Damian Keter DPT, PhD, Chad Cook PT, PhD, FAPTA Manual therapy (MT) has been part of musculoskeletal care for centuries, yet one question continues to challenge clinicians and researchers alike: How does it actually work? A new living review by Keter et al. [1], sponsored by ForceNET [2], offers the most comprehensive attempt yet […]
When the Numbers Don’t Move: Understanding Ceiling Effects, Floor Effects, and Limited Score Spread in MSK Patient‑Reported Outcomes
By: Chad Cook PT, PhD, FAPTA Introduction: I recently responded to a very supportive post on Linked-In that discussed a study we published two years ago on patient reported experience measures [1]. In the observational research study, we found that nearly all of the 50,000 plus physical or occupational therapy patients scored a near perfect […]
Why Individualized Treatment Effects Matter More Than Averages in Musculoskeletal Care
By: Chad Cook PT, PhD, FAPTA Introduction: Imagine being able to say: “Based on your profile, you’re likely to respond better to graded activity than manual therapy.” Or: “Patients like you tend to improve more with individual physiotherapy than group-based exercise.” This should be the future of MSK care. It isn’t yet. If you’ve spent […]
Spinal Manipulation: Lack of Precision Doesn’t Mean Lack of Skill
By: Mark Shepherd, PT, DPT, DSc Spinal thrust manipulation has been used for centuries, with evidence supporting its inclusion in neck and low back guidelines.1,2 Yet, how it’s taught and applied varies widely across and within professions, sparking debate among educators, clinicians, and researchers.3,4 Nim et al.’s recent systematic review5 and JOSPT blog6 challenge us […]
What is the Natural History of Low Back Pain? It Depends
By: Chad E Cook PT, PhD, FAPTA Definition: The natural history of a disease refers to the progression of a disease in an individual over time, from its onset (pathological or exposure to causal agents) to its resolution. It is generally considered “natural” when no interventions are used that could affect the resolution process [1,2]. […]
Advantages and Disadvantages of Research Metrics used to Evaluate a Researcher’s Impact or Influence
By: Chad E Cook PT, PhD, FAPTA Background: Each year, in Duke University’s Division of Physical Therapy, I teach a class on research methodology. One of the topics we discuss in class involves ways to measure research impact among physical therapists’ (and other professions’) researchers. The discussion is complimentary to those that occur during the […]
“It’s Not You, It’s Us…”: Heterogeneity of Treatment Effects as a Challenge to Effectiveness Trials.
By: Damian L Keter, PT, DPT, PhD Background: Comparative effectiveness studies are the cornerstone of medicine and health sciences research. They have a goal of finding ‘the best’ treatment for each associated condition. In comparative effectiveness studies, statistical models are able to provide ‘average’ treatment effects, which are often used to establish standardized mean difference […]
Is Myofascial Pain Syndrome a Legitimate Primary Diagnosis?
By: Chad E Cook, Damian Keter, Ken Learman Background: Myofascial Pain Syndrome (MPS) is hypothesized to be both a primary and/or a secondary chronic pain disorder that can refer symptoms to other parts of the body. MPS is relatively common, affecting millions of people worldwide, particularly those who have experienced muscle overuse, trauma, or stress […]
Risk of Bias Measures can be Biased
By: Chad E Cook, Damian Keter, Ken Learman Navigating the Literature: Navigating the ever-growing, healthcare literature can be challenging [1]. The sheer amount of new research, articles, and guidelines published regularly can be overwhelming. The number of biomedical publications has been steadily increasing over the years. As of 2022, there were approximately 3.3 million scientific […]
