Digital Self Management Platforms: A Key Feature of Hybrid Rehabilitation
By: Chad E. Cook, PT, PhD, FAPTA Background: Musculoskeletal (MSK) disorders, such as low back pain, knee osteoarthritis, and shoulder injuries, are among the leading causes of disability worldwide [1]. They affect mobility, independence, and quality of life for millions of people. In two previous blogs, I discussed the emerging importance of a hybrid rehabilitation […]
The Art of Hybrid Rehabilitation Is Knowing When Presence Matters More Than Convenience
By: Chad E. Cook, PT, PhD, FAPTA A Model Born of Necessity, Now Here to Stay: Hybrid rehabilitation blends in‑person therapy with digitally delivered supported telehealth visits, remote monitoring, and app‑based exercise programs, to create a flexible, personalized model of care [1]. Once a niche experiment, it became a global necessity during the COVID‑19 pandemic. […]
Building Effective Hybrid Rehabilitation Programs: Clinical, Operational, and Technological Considerations
By: Chad E. Cook, PT, PhD, FAPTA Background: Over the past several years, I have served on Daniel Harvey’s PhD dissertation committee. His work centers on process variables in rehabilitation, defined as modifiable and measurable factors within a care pathway that, when altered, may lead to different operational or patient outcomes [1]. These variables encompass […]
Using MCID for Between‑Group Comparisons Is a Methodological Mistake
By: Chad E Cook, PT, PhD, FAPTA Background: In clinical research, especially in orthopedics, sports medicine, and rehabilitation, the minimally clinically important difference (MCID) has become a staple of outcome interpretation. By definition, an MCID is defined as the smallest change in an outcome that an individual patient perceives as beneficial. It’s patient-centered, intuitive, and […]
N-of-1 Trials. Are They Appropriate for Evaluating Physical Therapy Interventions?
By: Chad E. Cook, PT, PhD, FAPTA Background: On this Center of Excellence website, we’ve previously highlighted two key points: (1) individuals do not respond uniformly to otherwise effective interventions [1], and (2) randomized controlled trials (RCTs) estimate average treatment effects rather than individualized treatment effects, making it difficult to determine who benefits from a […]
Why Patients Rapidly Change After Initiating Treatment: What We Think We Know and What We Likely Don’t
By: Chad Cook, PT, PhD, FAPTA Background: The completion of our SS‑MECH trial [1] in the fall of 2025 marked the 20th clinical trial for which I had direct access to the data. Over the years, I have come to view data as a narrative, one that cannot be fully captured by summary statistics, tables, […]
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 […]
