We break down a high-profile industry report making bold claims about the effectiveness of virtual musculoskeletal (MSK) care. Is the science solid—or is it strategic marketing masked as research?
Joining host Derek Clewley are two powerhouse PTs and researchers who aren't afraid to challenge the narrative: Dr. Megan Donaldson and Dr. Jake Magel. Together, they peel back the layers of bias, examine the limitations of observational studies, and explain why clinicians and patients should be cautious about AI- and app-based MSK care models.
00:00:02 --> 00:00:03 All right, so yeah, welcome to the show.
00:00:03 --> 00:00:06 We have Megan Donaldson and Jake Magel.
00:00:06 --> 00:00:07 I am really excited about
00:00:07 --> 00:00:09 this session today.
00:00:10 --> 00:00:12 I think it's a topic that is
00:00:12 --> 00:00:14 going to be of interest to
00:00:14 --> 00:00:15 a lot of our PT colleagues,
00:00:16 --> 00:00:17 and I couldn't imagine two
00:00:17 --> 00:00:19 better people to really go
00:00:19 --> 00:00:20 through this presentation
00:00:21 --> 00:00:23 this information with us
00:00:23 --> 00:00:25 today and so again welcome
00:00:25 --> 00:00:27 Megan welcome Jake to the
00:00:27 --> 00:00:29 podcast here Megan you're
00:00:29 --> 00:00:30 not a stranger to this
00:00:30 --> 00:00:30 podcast actually
00:00:30 --> 00:00:31 interesting because you're
00:00:31 --> 00:00:33 a you're actually a host
00:00:33 --> 00:00:34 and now I'm hosting a host
00:00:35 --> 00:00:36 so this seems a little bit
00:00:36 --> 00:00:38 awkward and weird but uh
00:00:38 --> 00:00:39 I'll see if I can do my job
00:00:39 --> 00:00:40 the way that I'm supposed
00:00:40 --> 00:00:41 to do my job but um
00:00:41 --> 00:00:43 certainly happy to have you on
00:00:43 --> 00:00:44 And Jake,
00:00:44 --> 00:00:45 I know that you've probably been on many,
00:00:45 --> 00:00:46 many podcasts,
00:00:46 --> 00:00:48 maybe not as exciting as this one,
00:00:48 --> 00:00:49 but I'm sure that you've
00:00:49 --> 00:00:50 been on many podcasts,
00:00:50 --> 00:00:53 so you know exactly what to expect,
00:00:53 --> 00:00:54 I suppose, here as well.
00:00:54 --> 00:00:56 Not as exciting, that's right.
00:00:56 --> 00:00:57 That's right.
00:00:58 --> 00:00:58 All right.
00:00:58 --> 00:00:59 So, you know,
00:00:59 --> 00:01:00 I wanted to get into a little
00:01:00 --> 00:01:02 bit of this conversation
00:01:02 --> 00:01:05 specifically around the
00:01:05 --> 00:01:07 report that was recently published.
00:01:07 --> 00:01:08 And, you know,
00:01:08 --> 00:01:10 I think it's probably worth
00:01:10 --> 00:01:12 noting that many of us
00:01:12 --> 00:01:14 probably have no idea what
00:01:14 --> 00:01:15 this report is.
00:01:15 --> 00:01:17 And I guess the first
00:01:17 --> 00:01:18 question that I have right
00:01:18 --> 00:01:20 off the top here is, and Megan,
00:01:20 --> 00:01:21 maybe this is the question
00:01:21 --> 00:01:22 best addressed to you.
00:01:23 --> 00:01:23 What
00:01:23 --> 00:01:24 What is this report?
00:01:24 --> 00:01:25 What is it all about?
00:01:25 --> 00:01:25 I mean,
00:01:25 --> 00:01:27 I know that I haven't I wouldn't
00:01:27 --> 00:01:29 have seen this report, especially without,
00:01:29 --> 00:01:29 you know,
00:01:29 --> 00:01:32 your bringing it to some of our
00:01:32 --> 00:01:33 attention and such.
00:01:33 --> 00:01:34 But so if you can give a
00:01:34 --> 00:01:36 little bit of background to our listeners,
00:01:36 --> 00:01:38 that would be fantastic.
00:01:38 --> 00:01:38 Yeah.
00:01:38 --> 00:01:38 So
00:01:40 --> 00:01:42 oftentimes what you find is
00:01:42 --> 00:01:43 this is a report that falls
00:01:43 --> 00:01:45 under like market research,
00:01:45 --> 00:01:49 which aims to inform market decisions,
00:01:49 --> 00:01:51 funding, even healthcare policy.
00:01:51 --> 00:01:54 I mean, this can have some broad reaches.
00:01:55 --> 00:01:57 So the fact that this came out, you know,
00:01:57 --> 00:02:00 I would say probably early
00:02:00 --> 00:02:02 summer and a lot of people
00:02:02 --> 00:02:03 didn't hear about it or
00:02:03 --> 00:02:04 talk about it because they
00:02:04 --> 00:02:05 were just kind of, you know,
00:02:05 --> 00:02:07 it was kind of more hearsay.
00:02:07 --> 00:02:08 Many of us are in the
00:02:08 --> 00:02:12 funding areas of virtual MSKs,
00:02:12 --> 00:02:13 which we'll talk about the
00:02:13 --> 00:02:15 digital health technologies.
00:02:15 --> 00:02:17 But there is actually a
00:02:17 --> 00:02:18 group called the Peterson
00:02:18 --> 00:02:20 Health Technology Institute,
00:02:21 --> 00:02:23 which evaluates these
00:02:23 --> 00:02:24 digital health technologies
00:02:24 --> 00:02:25 and the commercial interest
00:02:25 --> 00:02:27 and funding interest behind them.
00:02:27 --> 00:02:30 So that's really what started this project,
00:02:30 --> 00:02:32 which is it's a market research project.
00:02:32 --> 00:02:33 They want to know,
00:02:33 --> 00:02:35 is there resources here
00:02:35 --> 00:02:37 that people should invest in?
00:02:37 --> 00:02:38 And what could those
00:02:38 --> 00:02:39 investments look like?
00:02:39 --> 00:02:41 Could it save money?
00:02:42 --> 00:02:43 Is there an economic value?
00:02:43 --> 00:02:45 Is there an access value?
00:02:45 --> 00:02:46 and then how can that shape
00:02:46 --> 00:02:47 healthcare going forward so
00:02:48 --> 00:02:50 it could impact policy and
00:02:50 --> 00:02:51 that's where some of these
00:02:52 --> 00:02:53 groups have been out there
00:02:53 --> 00:02:54 for a while doing this in
00:02:54 --> 00:02:55 various pieces but this
00:02:55 --> 00:02:57 one's specific to us in
00:02:58 --> 00:03:02 virtual msk no that's great
00:03:02 --> 00:03:04 to hear and I think any
00:03:04 --> 00:03:05 time that we start talking
00:03:05 --> 00:03:09 about ai and virtual health
00:03:10 --> 00:03:11 things that probably matter
00:03:11 --> 00:03:15 to us a lot as physical therapists.
00:03:15 --> 00:03:16 Most of us are probably, well,
00:03:16 --> 00:03:18 all of us are native more
00:03:18 --> 00:03:20 to the setting where we are
00:03:20 --> 00:03:22 actually working in the
00:03:22 --> 00:03:23 environment with the patient.
00:03:24 --> 00:03:25 I would imagine that some of it is,
00:03:25 --> 00:03:26 it's obviously exciting.
00:03:26 --> 00:03:27 I think we're on a new
00:03:27 --> 00:03:28 frontier and there's things
00:03:28 --> 00:03:30 that we can look forward to,
00:03:30 --> 00:03:32 especially as we progress and such.
00:03:32 --> 00:03:34 But I guess another question
00:03:34 --> 00:03:36 that I have for you is why is this
00:03:37 --> 00:03:39 report really essential for
00:03:39 --> 00:03:40 us to talk about today
00:03:40 --> 00:03:41 especially as I just
00:03:41 --> 00:03:43 mentioned manual therapists
00:03:43 --> 00:03:43 obviously a lot of our
00:03:43 --> 00:03:44 listeners are probably
00:03:44 --> 00:03:45 manual therapy listeners
00:03:45 --> 00:03:46 and if they're manual
00:03:46 --> 00:03:47 therapy listeners they're
00:03:47 --> 00:03:49 orthopedic pts who you know
00:03:49 --> 00:03:50 we put our hands on
00:03:50 --> 00:03:51 patients and we do these
00:03:51 --> 00:03:53 sorts of things so why is
00:03:53 --> 00:03:55 this so important for us to discuss today
00:03:56 --> 00:03:57 Yeah,
00:03:57 --> 00:03:59 so the report is super interesting to
00:03:59 --> 00:03:59 read.
00:03:59 --> 00:04:00 So I'll state that first,
00:04:00 --> 00:04:03 which you should read the report.
00:04:03 --> 00:04:04 I think it gives you insight
00:04:05 --> 00:04:06 into the way people
00:04:06 --> 00:04:07 perceive our profession.
00:04:08 --> 00:04:09 And I'll be candid.
00:04:10 --> 00:04:11 I think some of this starts
00:04:11 --> 00:04:11 in the research.
00:04:11 --> 00:04:14 I think some of it is what is PT?
00:04:14 --> 00:04:15 What is typical PT?
00:04:16 --> 00:04:18 And what we see is that
00:04:19 --> 00:04:19 people believe that
00:04:20 --> 00:04:21 exercise can be done more efficiently.
00:04:22 --> 00:04:24 And so they started to look
00:04:24 --> 00:04:26 at these MSK reports.
00:04:26 --> 00:04:29 And some of this was, I would say,
00:04:29 --> 00:04:31 couched as an access piece.
00:04:32 --> 00:04:33 If you read the report,
00:04:33 --> 00:04:34 there's some limitations of
00:04:34 --> 00:04:34 our profession, right?
00:04:35 --> 00:04:37 They did identify that there would be some
00:04:39 --> 00:04:40 workforce demands around
00:04:40 --> 00:04:42 seventeen percent in deficit,
00:04:42 --> 00:04:43 like that we definitely
00:04:43 --> 00:04:45 needed to have more PTs in the workforce.
00:04:45 --> 00:04:46 And then the other areas of
00:04:46 --> 00:04:47 that is actually in the
00:04:48 --> 00:04:49 rural health areas is some
00:04:49 --> 00:04:50 of that access and
00:04:51 --> 00:04:52 workforce needs are much greater.
00:04:53 --> 00:04:54 And so they kind of couched
00:04:54 --> 00:04:57 it as an access workforce support.
00:04:58 --> 00:04:59 for virtual MSK.
00:04:59 --> 00:04:59 Again,
00:04:59 --> 00:05:01 knowing that PT sometimes takes a
00:05:01 --> 00:05:03 little bit of time to get into.
00:05:04 --> 00:05:06 So having this as a easier
00:05:06 --> 00:05:08 access point was one of the
00:05:08 --> 00:05:11 pitches as why these may be
00:05:11 --> 00:05:13 viable solutions for healthcare support.
00:05:14 --> 00:05:15 So I think you have to
00:05:15 --> 00:05:18 appreciate that was some of their gap.
00:05:18 --> 00:05:20 That's what they see that these tools,
00:05:20 --> 00:05:21 the virtual health tools,
00:05:22 --> 00:05:23 would support and they
00:05:23 --> 00:05:24 identify it as being like
00:05:24 --> 00:05:25 for patients who have
00:05:25 --> 00:05:26 mobility limitations,
00:05:26 --> 00:05:28 work commitment limitations,
00:05:29 --> 00:05:30 or geographical barriers
00:05:30 --> 00:05:31 such as living in rural
00:05:31 --> 00:05:33 areas with low access to
00:05:33 --> 00:05:35 getting to in-person PT
00:05:35 --> 00:05:36 sessions each week.
00:05:36 --> 00:05:37 I think that's what we have
00:05:38 --> 00:05:39 to understand the context to that.
00:05:40 --> 00:05:41 But when we actually
00:05:41 --> 00:05:43 appreciate that virtual technology,
00:05:43 --> 00:05:45 so Derek, when you say like AI,
00:05:46 --> 00:05:47 AI may be different than
00:05:48 --> 00:05:49 these virtual technologies and I think
00:05:50 --> 00:05:52 We don't even talk about AI
00:05:52 --> 00:05:53 generated per se in this.
00:05:53 --> 00:05:54 I mean,
00:05:54 --> 00:05:55 there's going to be specific things
00:05:55 --> 00:05:56 that we say that are
00:05:56 --> 00:05:57 included in this study.
00:05:58 --> 00:06:00 But there's a big reach that's happening.
00:06:00 --> 00:06:02 And I think we have to
00:06:02 --> 00:06:03 really inform ourselves.
00:06:04 --> 00:06:05 What is this?
00:06:05 --> 00:06:07 How does this have impact to
00:06:07 --> 00:06:09 our practitioners on the daily?
00:06:09 --> 00:06:10 And some of it is
00:06:10 --> 00:06:14 understanding how our profession is seen.
00:06:14 --> 00:06:16 What's the value of PT and
00:06:17 --> 00:06:17 what is it they need to
00:06:17 --> 00:06:19 come to a provider for
00:06:19 --> 00:06:20 versus what can they get
00:06:20 --> 00:06:21 through this interaction,
00:06:22 --> 00:06:23 which has maybe little or
00:06:23 --> 00:06:25 no human interaction at all?
00:06:25 --> 00:06:26 with a PT.
00:06:27 --> 00:06:28 So I think this is a key piece.
00:06:29 --> 00:06:31 It's also an advocacy piece.
00:06:32 --> 00:06:33 This report actually so
00:06:33 --> 00:06:35 interestingly kind of puts
00:06:35 --> 00:06:39 into question the value of PT campaign.
00:06:40 --> 00:06:40 I would actually say the
00:06:40 --> 00:06:42 economic value of PT.
00:06:42 --> 00:06:45 We show in the APTA's document,
00:06:45 --> 00:06:47 which I so value that piece too,
00:06:47 --> 00:06:49 is that we are a value,
00:06:50 --> 00:06:51 economic value for a lot of
00:06:51 --> 00:06:52 MSK conditions.
00:06:52 --> 00:06:54 That includes low back pain,
00:06:54 --> 00:06:57 carpal tunnel, knee osteoarthritis,
00:06:58 --> 00:06:58 lateral epicondylase.
00:06:58 --> 00:06:59 I think they called it
00:06:59 --> 00:07:01 lateral epicondylitis in the studies,
00:07:01 --> 00:07:02 but that we actually have
00:07:03 --> 00:07:04 value in those areas and
00:07:04 --> 00:07:06 that we are a low cost option.
00:07:07 --> 00:07:09 And so interestingly to me
00:07:09 --> 00:07:12 is that in this virtual health report,
00:07:12 --> 00:07:13 They did look at knee,
00:07:13 --> 00:07:16 they looked at low back and
00:07:16 --> 00:07:17 still trying to make it
00:07:17 --> 00:07:19 more economically feasible.
00:07:20 --> 00:07:21 So again, just kind of looking at,
00:07:21 --> 00:07:23 we are already a low cost option.
00:07:24 --> 00:07:26 So making us even more low cost,
00:07:26 --> 00:07:28 I would question some of the gain there.
00:07:29 --> 00:07:30 And then just the other
00:07:30 --> 00:07:31 parts of that is that we
00:07:31 --> 00:07:33 have to appreciate what you
00:07:33 --> 00:07:33 had said before,
00:07:33 --> 00:07:37 which is virtual health may be PT,
00:07:37 --> 00:07:40 but it may be coaches not trained as PTs.
00:07:41 --> 00:07:42 It may be AI.
00:07:42 --> 00:07:44 And I just think we have to
00:07:44 --> 00:07:45 appreciate that we're not
00:07:45 --> 00:07:48 seeing this virtual MSK
00:07:48 --> 00:07:50 happening on other professions,
00:07:50 --> 00:07:51 like chiropractic,
00:07:52 --> 00:07:53 where there's more hands-on focus.
00:07:53 --> 00:07:55 So I just think we also have
00:07:55 --> 00:07:56 to advocate that, like,
00:07:56 --> 00:07:59 PTs do more than just exercise, right?
00:07:59 --> 00:08:00 And I think we have to learn
00:08:00 --> 00:08:02 to advocate for that as well.
00:08:03 --> 00:08:04 Yeah, I appreciate that.
00:08:04 --> 00:08:07 And actually, I glanced at the report too,
00:08:07 --> 00:08:08 just full disclosure.
00:08:08 --> 00:08:11 And so definitely there's a
00:08:11 --> 00:08:12 discussion around that, obviously,
00:08:12 --> 00:08:12 around the...
00:08:14 --> 00:08:15 physical therapists or
00:08:15 --> 00:08:16 clinicians or whatever it
00:08:16 --> 00:08:17 might be that could be
00:08:17 --> 00:08:19 providing some of these services.
00:08:19 --> 00:08:20 So I think that last piece
00:08:20 --> 00:08:21 that you brought up there
00:08:21 --> 00:08:22 and the value of what we do
00:08:22 --> 00:08:23 and what we distinguish
00:08:23 --> 00:08:24 ourselves as is certainly
00:08:24 --> 00:08:26 an important piece of this
00:08:26 --> 00:08:29 equation as it looks there.
00:08:29 --> 00:08:32 It's interesting too that you bring up,
00:08:32 --> 00:08:33 obviously if you look at
00:08:33 --> 00:08:34 the report and you sort of
00:08:34 --> 00:08:35 brief over the report,
00:08:35 --> 00:08:36 it could be viewed as
00:08:36 --> 00:08:38 something that seems relatively positive,
00:08:38 --> 00:08:38 right?
00:08:38 --> 00:08:40 I mean, obviously we get a lot of our
00:08:42 --> 00:08:43 information and some of us
00:08:43 --> 00:08:45 actually probably use app
00:08:45 --> 00:08:46 technology to help us with
00:08:47 --> 00:08:48 various aspects that we
00:08:48 --> 00:08:49 have in our life but
00:08:50 --> 00:08:51 understanding our role and
00:08:51 --> 00:08:52 our importance I think is
00:08:52 --> 00:08:54 really key there so I
00:08:54 --> 00:08:56 appreciate that answer there
00:08:57 --> 00:08:58 So Jake,
00:08:58 --> 00:08:59 you're going to get on the
00:08:59 --> 00:09:00 question board here pretty soon,
00:09:00 --> 00:09:01 but Megan, I've got another one for you.
00:09:02 --> 00:09:05 So could you kind of, you know,
00:09:05 --> 00:09:06 we've been talking about
00:09:06 --> 00:09:07 this report and I think a
00:09:07 --> 00:09:09 lot of our listeners are probably like,
00:09:09 --> 00:09:09 wait, wait,
00:09:09 --> 00:09:10 tell me a little bit more
00:09:10 --> 00:09:10 about this report.
00:09:10 --> 00:09:11 What are you talking about
00:09:11 --> 00:09:12 with this report?
00:09:12 --> 00:09:12 So
00:09:13 --> 00:09:16 A little bit of the cart in
00:09:16 --> 00:09:17 front of the horse there, Sam.
00:09:17 --> 00:09:17 But tell us,
00:09:18 --> 00:09:19 give us an overview of this report.
00:09:20 --> 00:09:21 And if you can,
00:09:21 --> 00:09:22 can you outline some of
00:09:22 --> 00:09:24 those options that they
00:09:24 --> 00:09:26 highlighted in this report
00:09:26 --> 00:09:27 for treatments and such?
00:09:27 --> 00:09:29 Yeah, that's a great question.
00:09:29 --> 00:09:31 So what I would first say is
00:09:31 --> 00:09:32 that you have to appreciate
00:09:32 --> 00:09:33 they kind of categorized
00:09:34 --> 00:09:35 the types of digital health
00:09:36 --> 00:09:36 technologies that they
00:09:36 --> 00:09:37 wanted to focus on.
00:09:38 --> 00:09:40 So the technologies that
00:09:40 --> 00:09:41 they put three different categories,
00:09:42 --> 00:09:44 so PT guided solutions,
00:09:44 --> 00:09:46 app-based exercise solutions,
00:09:46 --> 00:09:48 and then remote monitoring.
00:09:48 --> 00:09:49 And so
00:09:49 --> 00:09:50 Each one has, I would say,
00:09:50 --> 00:09:53 different levels of PT interaction.
00:09:53 --> 00:09:54 And so, again, when you read that,
00:09:54 --> 00:09:55 I think that's a really
00:09:55 --> 00:09:56 important piece because
00:09:56 --> 00:09:58 they do some direct comparisons.
00:09:58 --> 00:10:00 And maybe even I would say
00:10:00 --> 00:10:02 this will dive into some of
00:10:02 --> 00:10:03 Jake's conversation pieces, but about,
00:10:04 --> 00:10:04 you know,
00:10:05 --> 00:10:06 what the findings actually mean
00:10:06 --> 00:10:08 from a clinical practice perspective.
00:10:09 --> 00:10:10 But PT-guided solutions may
00:10:10 --> 00:10:11 have moderate level
00:10:11 --> 00:10:13 involvement from a PT.
00:10:14 --> 00:10:16 So again, definitely they are, I would say,
00:10:16 --> 00:10:18 a little bit more simulated
00:10:18 --> 00:10:20 or similar to in-person PT.
00:10:20 --> 00:10:21 And so they did a lot of
00:10:21 --> 00:10:24 comparisons to in-person PT
00:10:24 --> 00:10:25 with these PT-guided solutions.
00:10:27 --> 00:10:29 The app-based therapy
00:10:29 --> 00:10:33 solutions used some app monitoring,
00:10:33 --> 00:10:34 some ACT
00:10:34 --> 00:10:36 some activity engagement,
00:10:36 --> 00:10:37 such as adherence tracking.
00:10:38 --> 00:10:40 But typically the PT set up
00:10:40 --> 00:10:41 the treatment plan.
00:10:42 --> 00:10:43 But then after that,
00:10:43 --> 00:10:44 it was like a little bit more hands off.
00:10:45 --> 00:10:45 So again,
00:10:46 --> 00:10:47 I think you can appreciate that
00:10:47 --> 00:10:48 the app base may not have
00:10:48 --> 00:10:49 as much interaction.
00:10:50 --> 00:10:52 It would typically set them
00:10:52 --> 00:10:55 up and then kind of go to minimal to no.
00:10:55 --> 00:10:56 interaction at all.
00:10:56 --> 00:10:58 And then remote monitoring
00:10:58 --> 00:10:59 were actually
00:10:59 --> 00:11:01 supplementations used in
00:11:02 --> 00:11:03 addition to in-person PT.
00:11:04 --> 00:11:05 And this one is what would
00:11:05 --> 00:11:08 they use is billing codes, is RTM,
00:11:08 --> 00:11:10 so remote therapeutic monitoring.
00:11:10 --> 00:11:12 So that would be in addition
00:11:12 --> 00:11:14 to in-person PT,
00:11:14 --> 00:11:15 this would be the augmented piece.
00:11:15 --> 00:11:16 This would be some
00:11:16 --> 00:11:17 additional things that they were doing.
00:11:18 --> 00:11:19 So those are the three
00:11:19 --> 00:11:21 categories that this report
00:11:21 --> 00:11:24 generated around those types.
00:11:25 --> 00:11:25 Um,
00:11:25 --> 00:11:27 they did talk a little bit about rural
00:11:27 --> 00:11:28 health as being one of the aims,
00:11:29 --> 00:11:30 but really their studies
00:11:30 --> 00:11:32 didn't focus on rural health access.
00:11:32 --> 00:11:33 So remember those who live
00:11:33 --> 00:11:34 in rural health may not
00:11:34 --> 00:11:36 actually have great wifi.
00:11:36 --> 00:11:37 And so some of these
00:11:37 --> 00:11:39 technologies and barriers
00:11:39 --> 00:11:39 and challenges weren't
00:11:39 --> 00:11:41 really detailed out.
00:11:41 --> 00:11:41 So I think we have to
00:11:41 --> 00:11:43 appreciate that report piece.
00:11:44 --> 00:11:45 But then the last thing I
00:11:45 --> 00:11:46 feel like you want to know
00:11:46 --> 00:11:47 just before we get into the
00:11:47 --> 00:11:49 studies more is that they
00:11:50 --> 00:11:52 prioritize some assessment pieces,
00:11:52 --> 00:11:53 which if you think about it,
00:11:53 --> 00:11:55 there were two pieces that
00:11:55 --> 00:11:55 they looked at.
00:11:55 --> 00:11:57 They looked at in-person PT
00:11:58 --> 00:11:59 and usual care.
00:11:59 --> 00:12:02 And so heterogeneity is
00:12:02 --> 00:12:03 pretty large when you think
00:12:03 --> 00:12:05 about in-person PT and all
00:12:05 --> 00:12:06 of these conditions and diagnoses.
00:12:07 --> 00:12:08 But really with that,
00:12:08 --> 00:12:09 it didn't prioritize it.
00:12:09 --> 00:12:10 It had to be hands-on.
00:12:11 --> 00:12:12 It didn't prioritize what
00:12:12 --> 00:12:14 those interventions specifically were.
00:12:14 --> 00:12:15 And again,
00:12:15 --> 00:12:16 I think we have to appreciate
00:12:17 --> 00:12:18 in-person PT,
00:12:18 --> 00:12:21 a lot of range of interventions.
00:12:22 --> 00:12:25 The usual care is actually
00:12:25 --> 00:12:26 what we would see in some
00:12:26 --> 00:12:28 other studies is, again,
00:12:29 --> 00:12:30 where it's not PT,
00:12:31 --> 00:12:33 that actually usual care is medications,
00:12:33 --> 00:12:34 which is over the counter,
00:12:35 --> 00:12:36 application of ice.
00:12:36 --> 00:12:38 They may actually get some education,
00:12:39 --> 00:12:41 but most of it was like PT
00:12:41 --> 00:12:43 visits or no care at all.
00:12:43 --> 00:12:44 So, again,
00:12:44 --> 00:12:45 each individual study kind of
00:12:45 --> 00:12:47 reset their own standard.
00:12:47 --> 00:12:49 And this study that was
00:12:49 --> 00:12:50 included in the virtual
00:12:50 --> 00:12:51 health kind of categorized those.
00:12:52 --> 00:12:55 are those in-person PT
00:12:55 --> 00:12:57 interventions or are those
00:12:57 --> 00:12:58 usual care interventions?
00:12:58 --> 00:12:59 And that's kind of how they
00:12:59 --> 00:13:00 dichotomize them,
00:13:00 --> 00:13:03 but a ton of heterogeneity
00:13:03 --> 00:13:05 within each of those studies.
00:13:05 --> 00:13:06 So again,
00:13:06 --> 00:13:07 just to kind of give you a high
00:13:07 --> 00:13:08 level overview of the way
00:13:08 --> 00:13:09 it was organized.
00:13:10 --> 00:13:10 Yeah.
00:13:10 --> 00:13:11 So basically comparing
00:13:11 --> 00:13:12 something highly variable
00:13:12 --> 00:13:14 to something that's highly variable.
00:13:15 --> 00:13:16 We know where that can go, right?
00:13:17 --> 00:13:18 And so, all right.
00:13:19 --> 00:13:19 Good to hear.
00:13:20 --> 00:13:21 Jake, you've been quiet here now.
00:13:21 --> 00:13:23 We've got to get you,
00:13:23 --> 00:13:25 I feel like you're ready to
00:13:25 --> 00:13:26 roll into this as well too.
00:13:26 --> 00:13:28 But I wanted to get,
00:13:29 --> 00:13:30 obviously as a background
00:13:30 --> 00:13:32 and research and
00:13:32 --> 00:13:35 NIH funding and somebody who
00:13:35 --> 00:13:38 has contributed a lot to our profession.
00:13:39 --> 00:13:40 I remember you've been on a
00:13:40 --> 00:13:40 lot of studies that
00:13:40 --> 00:13:42 actually probably do compare usual care,
00:13:42 --> 00:13:43 PT,
00:13:43 --> 00:13:45 those kinds of things in the infancy
00:13:45 --> 00:13:46 of when we were looking at
00:13:46 --> 00:13:47 those kinds of questions,
00:13:47 --> 00:13:49 specifically with hands-on care.
00:13:49 --> 00:13:50 So I think having you on
00:13:50 --> 00:13:52 here as a guest is really,
00:13:52 --> 00:13:54 really key and important.
00:13:54 --> 00:13:55 I think it really validates
00:13:55 --> 00:13:56 some of this conversation
00:13:56 --> 00:13:57 that we're going to have here.
00:13:57 --> 00:13:59 So appreciate you being on here.
00:13:59 --> 00:14:00 So we're going to go in a
00:14:00 --> 00:14:01 little bit into this
00:14:01 --> 00:14:03 because this is sort of a yes, it is a
00:14:05 --> 00:14:07 sort of a marketing kind of a thing,
00:14:07 --> 00:14:08 but it's also set up to
00:14:08 --> 00:14:11 look like it was a research being done.
00:14:11 --> 00:14:12 And so I think it needs to
00:14:12 --> 00:14:13 have some of that criticism there.
00:14:14 --> 00:14:15 So I wanted to ask you,
00:14:15 --> 00:14:17 why is it important to then
00:14:17 --> 00:14:19 critique this document?
00:14:20 --> 00:14:21 And especially that it's not
00:14:21 --> 00:14:24 a peer reviewed paper and
00:14:24 --> 00:14:25 it's not necessarily maybe
00:14:25 --> 00:14:27 intended to be a peer reviewed paper,
00:14:27 --> 00:14:29 but I think it warrants that critique.
00:14:29 --> 00:14:31 So why is that important?
00:14:31 --> 00:14:34 Yeah, great question, Derek.
00:14:34 --> 00:14:34 Thanks.
00:14:35 --> 00:14:38 And I think it's important
00:14:38 --> 00:14:40 just to retouch on the fact that, yes,
00:14:40 --> 00:14:43 this is really a report to
00:14:43 --> 00:14:44 industry and investors.
00:14:45 --> 00:14:46 And as a part of this report,
00:14:47 --> 00:14:48 kind of the foundation of
00:14:48 --> 00:14:49 it was a systematic review.
00:14:50 --> 00:14:52 And a systematic review is
00:14:52 --> 00:14:54 used to synthesize data and
00:14:54 --> 00:14:56 to help us understand a lot
00:14:56 --> 00:14:57 about a particular topic.
00:14:57 --> 00:14:58 And in this case,
00:14:58 --> 00:14:59 it was virtual musculoskeletal solutions.
00:15:00 --> 00:15:03 And when you do a systematic review,
00:15:03 --> 00:15:06 you register the review
00:15:06 --> 00:15:09 with an organization and
00:15:09 --> 00:15:12 which basically you
00:15:12 --> 00:15:13 basically tell an
00:15:13 --> 00:15:15 organization what it is
00:15:15 --> 00:15:16 that you're going to do in
00:15:16 --> 00:15:17 the systematic review so
00:15:17 --> 00:15:18 that people can come back
00:15:18 --> 00:15:20 and then and then check
00:15:20 --> 00:15:21 your work and make sure
00:15:21 --> 00:15:21 that you did what you said
00:15:21 --> 00:15:23 you were going to do in the
00:15:23 --> 00:15:23 systematic review.
00:15:23 --> 00:15:24 So they actually did that.
00:15:25 --> 00:15:27 But then, as you mentioned,
00:15:27 --> 00:15:28 it didn't the the actual
00:15:28 --> 00:15:30 systematic review itself
00:15:30 --> 00:15:31 and anything else in the
00:15:31 --> 00:15:33 report did not go through a
00:15:33 --> 00:15:35 normal peer review process,
00:15:35 --> 00:15:36 which would typically be
00:15:36 --> 00:15:37 which would be common and
00:15:37 --> 00:15:38 which would be standard
00:15:38 --> 00:15:40 practice if the report were
00:15:40 --> 00:15:41 to be published in the in
00:15:41 --> 00:15:42 the scientific journal.
00:15:43 --> 00:15:46 And so it really subverted
00:15:46 --> 00:15:47 might not be the right.
00:15:47 --> 00:15:48 term to use,
00:15:49 --> 00:15:50 but the fact that it did not
00:15:51 --> 00:15:52 go through a peer review
00:15:52 --> 00:15:54 process basically allows
00:15:54 --> 00:15:55 whoever's writing the
00:15:55 --> 00:15:57 report to frame the
00:15:58 --> 00:15:59 findings in whichever way
00:15:59 --> 00:16:00 that they feel like they
00:16:00 --> 00:16:01 want to frame them.
00:16:01 --> 00:16:05 And so some of the things
00:16:05 --> 00:16:07 that to me that were a bit concerning,
00:16:09 --> 00:16:09 well,
00:16:09 --> 00:16:10 let me just first say that the
00:16:10 --> 00:16:12 report included both
00:16:14 --> 00:16:15 randomized trials and
00:16:16 --> 00:16:17 observational studies.
00:16:17 --> 00:16:21 And the great majority of
00:16:21 --> 00:16:23 the studies in the
00:16:24 --> 00:16:25 systematic review were
00:16:25 --> 00:16:26 observational studies.
00:16:28 --> 00:16:30 It's important to know that
00:16:30 --> 00:16:31 kind of the gold standard
00:16:31 --> 00:16:34 for determining
00:16:34 --> 00:16:35 effectiveness of an
00:16:35 --> 00:16:37 intervention is a randomized trial.
00:16:38 --> 00:16:40 And observational studies
00:16:41 --> 00:16:42 are subject to lots of
00:16:42 --> 00:16:44 different types of bias
00:16:44 --> 00:16:49 that typically are not
00:16:49 --> 00:16:50 present or present in
00:16:51 --> 00:16:53 lesser amounts in randomized trials.
00:16:54 --> 00:16:56 And so it's just important
00:16:56 --> 00:16:57 to realize that when we're
00:16:57 --> 00:16:58 talking about making
00:16:58 --> 00:16:59 recommendations about the
00:16:59 --> 00:17:01 effectiveness of an intervention,
00:17:01 --> 00:17:03 when we have the great
00:17:03 --> 00:17:04 majority of studies in a
00:17:04 --> 00:17:06 systematic review are
00:17:06 --> 00:17:10 studies that are really subject to bias,
00:17:10 --> 00:17:12 then that should just give
00:17:12 --> 00:17:14 the reader some concern.
00:17:15 --> 00:17:20 And I think that in the report, they did,
00:17:21 --> 00:17:24 report the level of bias and
00:17:25 --> 00:17:29 they evaluated bias using
00:17:29 --> 00:17:33 standardized methods of evaluating bias,
00:17:33 --> 00:17:34 both for systematic reviews
00:17:35 --> 00:17:36 and for observational studies.
00:17:37 --> 00:17:39 And they found that about
00:17:39 --> 00:17:41 seventy five percent of the
00:17:41 --> 00:17:43 studies that were reported
00:17:43 --> 00:17:44 in the systematic review
00:17:44 --> 00:17:46 had high levels of bias,
00:17:46 --> 00:17:48 were rated as having high levels of bias.
00:17:49 --> 00:17:49 And so
00:17:52 --> 00:17:53 When you put that together
00:17:54 --> 00:17:57 with their strong
00:17:57 --> 00:17:59 recommendations for
00:17:59 --> 00:18:01 immediate adoptions of
00:18:03 --> 00:18:04 these musculoskeletal solutions,
00:18:05 --> 00:18:06 I think it should just give
00:18:06 --> 00:18:09 us pause to make that leap
00:18:10 --> 00:18:13 to immediate adoption of
00:18:13 --> 00:18:14 these solutions in the
00:18:14 --> 00:18:17 presence of high levels of bias.
00:18:18 --> 00:18:21 And I'm not sure that a peer
00:18:21 --> 00:18:23 reviewed manuscript of the
00:18:23 --> 00:18:24 same systematic review
00:18:24 --> 00:18:28 would allow such a strong recommendation.
00:18:29 --> 00:18:31 And so to me,
00:18:31 --> 00:18:33 I think that that's important
00:18:33 --> 00:18:34 to point out here.
00:18:35 --> 00:18:36 I appreciate that.
00:18:37 --> 00:18:37 As somebody that just
00:18:38 --> 00:18:39 published a systematic
00:18:39 --> 00:18:40 review and has had some
00:18:40 --> 00:18:41 history with publishing
00:18:41 --> 00:18:42 systematic reviews, yeah,
00:18:43 --> 00:18:44 I think one of the things
00:18:44 --> 00:18:45 that we're looking for, and maybe,
00:18:46 --> 00:18:47 you know, twenty years ago,
00:18:48 --> 00:18:49 we could just say, OK,
00:18:49 --> 00:18:50 the studies were bad,
00:18:50 --> 00:18:51 but here's the results and
00:18:52 --> 00:18:52 take with it what you may.
00:18:52 --> 00:18:54 But we're a little bit more
00:18:54 --> 00:18:56 of an advancing research profession now.
00:18:56 --> 00:18:57 And I've noticed that even
00:18:57 --> 00:19:00 when I've tried to, you know,
00:19:00 --> 00:19:02 get published systematic reviews,
00:19:02 --> 00:19:04 appropriately so, where we actually half
00:19:05 --> 00:19:07 to factor that bias into our
00:19:07 --> 00:19:08 recommendations,
00:19:08 --> 00:19:09 just not basically saying
00:19:09 --> 00:19:10 these studies were terrible
00:19:10 --> 00:19:12 and then here's our recommendations.
00:19:12 --> 00:19:13 And that would definitely go
00:19:13 --> 00:19:15 through that peer review process.
00:19:15 --> 00:19:18 And so appreciate that lens
00:19:18 --> 00:19:18 on looking at that,
00:19:18 --> 00:19:19 because I think a lot of
00:19:19 --> 00:19:20 times people don't
00:19:20 --> 00:19:22 understand how that can
00:19:22 --> 00:19:25 sometimes impact the
00:19:25 --> 00:19:26 results and the research
00:19:27 --> 00:19:28 and those sorts of things.
00:19:28 --> 00:19:29 And the peer review process
00:19:29 --> 00:19:30 certainly takes away some
00:19:31 --> 00:19:31 of that layering there.
00:19:31 --> 00:19:33 So, yeah, that's great.
00:19:34 --> 00:19:34 Well,
00:19:34 --> 00:19:35 if I could also point out something
00:19:35 --> 00:19:37 else is that there's
00:19:37 --> 00:19:39 something called the grade,
00:19:39 --> 00:19:44 which is a way of basically
00:19:44 --> 00:19:47 assessing risk of bias or, you know,
00:19:48 --> 00:19:49 I have to cut this out for
00:19:49 --> 00:19:50 a second because I want to
00:19:50 --> 00:19:51 figure out how I want to say this.
00:19:51 --> 00:19:58 It's not really, let's see.
00:20:07 --> 00:20:08 It's more determining the
00:20:08 --> 00:20:11 evaluation of the, yeah,
00:20:11 --> 00:20:13 it's used to be applicable.
00:20:13 --> 00:20:14 It's a quality rating,
00:20:14 --> 00:20:15 an overall quality rating.
00:20:16 --> 00:20:17 Yeah.
00:20:17 --> 00:20:18 But it's an evaluation piece.
00:20:18 --> 00:20:20 So you step back and do that.
00:20:20 --> 00:20:21 Yeah.
00:20:21 --> 00:20:22 Okay.
00:20:26 --> 00:20:28 Ready?
00:20:28 --> 00:20:29 I'd also like to point out
00:20:29 --> 00:20:32 that it's recommended that
00:20:32 --> 00:20:33 systematic reviews and
00:20:33 --> 00:20:35 other types of publications
00:20:35 --> 00:20:38 like guidelines use an
00:20:38 --> 00:20:39 overall evaluation for
00:20:40 --> 00:20:42 evaluating the quality of the evidence.
00:20:43 --> 00:20:44 And that is called,
00:20:45 --> 00:20:46 one thing that's recommended,
00:20:46 --> 00:20:48 one version of this is called the grade.
00:20:49 --> 00:20:51 And grade is a quality
00:20:51 --> 00:20:55 rating that can be applied
00:20:55 --> 00:20:56 to the evidence essentially.
00:20:56 --> 00:20:59 And really what it does is
00:21:00 --> 00:21:02 the researchers then use
00:21:02 --> 00:21:03 this grade to say that
00:21:03 --> 00:21:08 their level of certainty
00:21:09 --> 00:21:12 regarding the findings of
00:21:12 --> 00:21:13 the studies is very high or very low.
00:21:17 --> 00:21:18 Although this is recommended
00:21:18 --> 00:21:20 for systematic reviews to use the grade,
00:21:20 --> 00:21:21 it wasn't in this case.
00:21:21 --> 00:21:22 And so again,
00:21:22 --> 00:21:24 I think that we just need to
00:21:24 --> 00:21:25 be aware of these,
00:21:25 --> 00:21:26 what I feel like are
00:21:26 --> 00:21:28 shortcomings in the conduct
00:21:28 --> 00:21:29 of the systematic review.
00:21:30 --> 00:21:31 Yeah, no, great.
00:21:31 --> 00:21:32 Probably brought that up there.
00:21:32 --> 00:21:34 So you've kind of mentioned
00:21:34 --> 00:21:35 this a little bit,
00:21:35 --> 00:21:35 but can you tell us a
00:21:35 --> 00:21:37 little bit about the
00:21:37 --> 00:21:38 studies and why the
00:21:38 --> 00:21:41 listeners may need to read
00:21:41 --> 00:21:43 the report cautiously?
00:21:43 --> 00:21:44 You've mentioned a little bit of that,
00:21:44 --> 00:21:45 but maybe you can expand on
00:21:45 --> 00:21:46 that a little bit too.
00:21:48 --> 00:21:49 Okay, pause for a second.
00:21:49 --> 00:21:50 I'm not sure what I want to
00:21:50 --> 00:21:51 say here because I think that...
00:21:59 --> 00:21:59 I don't know.
00:22:00 --> 00:22:01 I mean, how should we frame this?
00:22:01 --> 00:22:03 Because I think that the, the main,
00:22:03 --> 00:22:05 the main issues there are
00:22:05 --> 00:22:06 the fact that it's
00:22:06 --> 00:22:07 observational studies and,
00:22:08 --> 00:22:09 and they're more subject to
00:22:09 --> 00:22:11 bias and randomized trials are,
00:22:11 --> 00:22:12 I think I've kind of said.
00:22:12 --> 00:22:12 Yeah.
00:22:13 --> 00:22:14 You might've said that when you,
00:22:14 --> 00:22:15 when I asked the question,
00:22:15 --> 00:22:16 it was in my list of questions to ask.
00:22:16 --> 00:22:17 So that's why I did it.
00:22:17 --> 00:22:19 But I would just,
00:22:19 --> 00:22:21 I would just restate like, so, I mean,
00:22:22 --> 00:22:23 in that study, right.
00:22:23 --> 00:22:23 I mean,
00:22:23 --> 00:22:25 and I've got to just pull it back up, but,
00:22:26 --> 00:22:26 um,
00:22:26 --> 00:22:29 majority of these were high risk of bias.
00:22:29 --> 00:22:29 I mean,
00:22:29 --> 00:22:31 and you could even state what that
00:22:31 --> 00:22:31 number.
00:22:31 --> 00:22:32 So just so we know,
00:22:32 --> 00:22:33 like there's twenty seven.
00:22:33 --> 00:22:34 I just have it right here.
00:22:34 --> 00:22:36 Exhibit seventeen or exhibit thirteen.
00:22:37 --> 00:22:38 So nine studies were
00:22:38 --> 00:22:40 moderate risk of bias and
00:22:40 --> 00:22:45 twenty seven were high risk of bias.
00:22:45 --> 00:22:46 And I think you just state
00:22:46 --> 00:22:47 that and then maybe what
00:22:47 --> 00:22:48 that means for people.
00:22:49 --> 00:22:50 You know, remember,
00:22:50 --> 00:22:51 clinicians don't always
00:22:51 --> 00:22:52 understand risk of bias.
00:22:52 --> 00:22:53 I would even say, like,
00:22:53 --> 00:22:55 what does that mean in the
00:22:55 --> 00:22:56 way that they should interpret it?
00:22:56 --> 00:22:57 Okay.
00:22:57 --> 00:22:59 Yeah, I think that's a great idea.
00:22:59 --> 00:22:59 Okay.
00:22:59 --> 00:23:01 Get ready.
00:23:01 --> 00:23:02 Let me mark.
00:23:02 --> 00:23:02 Yep.
00:23:02 --> 00:23:03 Go for it.
00:23:05 --> 00:23:07 So I think that just to
00:23:07 --> 00:23:10 reiterate that we had nine
00:23:11 --> 00:23:12 clinical trials,
00:23:12 --> 00:23:13 randomized clinical trials
00:23:13 --> 00:23:15 in this systematic review
00:23:16 --> 00:23:18 and twenty seven observational studies.
00:23:19 --> 00:23:22 And among the clinical trials,
00:23:24 --> 00:23:25 six of the nine were
00:23:25 --> 00:23:28 reported as having high risk for bias.
00:23:29 --> 00:23:32 And among the observational studies,
00:23:32 --> 00:23:33 twenty one of the twenty
00:23:33 --> 00:23:34 seven were reported to have
00:23:35 --> 00:23:35 high risk of bias.
00:23:36 --> 00:23:38 And so why we need to be
00:23:38 --> 00:23:39 concerned about this is
00:23:39 --> 00:23:40 when you have risk of bias
00:23:40 --> 00:23:42 in a clinical trial or
00:23:42 --> 00:23:43 observational study is that
00:23:44 --> 00:23:45 essentially it can impact
00:23:45 --> 00:23:46 the results and you can get
00:23:48 --> 00:23:50 potentially a misleading result.
00:23:50 --> 00:23:53 And so that's the big
00:23:53 --> 00:23:55 picture of why we need to
00:23:55 --> 00:23:56 be concerned about risk of
00:23:56 --> 00:23:58 bias and these high levels,
00:23:58 --> 00:24:00 particularly high levels of risk of bias.
00:24:00 --> 00:24:01 Remember, that's it.
00:24:01 --> 00:24:02 Seventy five percent of the
00:24:02 --> 00:24:03 studies in the systematic
00:24:03 --> 00:24:05 review had high risk of bias.
00:24:06 --> 00:24:08 yet the reports suggested
00:24:08 --> 00:24:09 that we ought to
00:24:09 --> 00:24:12 immediately adopt these
00:24:12 --> 00:24:13 musculoskeletal solutions
00:24:14 --> 00:24:15 when the risk for
00:24:15 --> 00:24:16 misleading results is high.
00:24:18 --> 00:24:19 You know,
00:24:19 --> 00:24:21 and I guess one of the things
00:24:21 --> 00:24:21 that I'm just thinking
00:24:21 --> 00:24:23 about here right now is, you know,
00:24:24 --> 00:24:24 I think a lot of our
00:24:24 --> 00:24:25 listeners might be looking
00:24:25 --> 00:24:26 at this and saying,
00:24:26 --> 00:24:27 especially if they look at
00:24:27 --> 00:24:28 the report and you just
00:24:28 --> 00:24:30 read it kind of quickly and
00:24:30 --> 00:24:31 you forget about some of
00:24:31 --> 00:24:32 the things that we talked about here,
00:24:32 --> 00:24:33 you might say, wow,
00:24:33 --> 00:24:34 this is pretty interesting,
00:24:35 --> 00:24:36 maybe even alarming, right?
00:24:36 --> 00:24:38 Like, wow, holy cow,
00:24:38 --> 00:24:40 we've got ways that we can
00:24:41 --> 00:24:42 or things that might even, you know,
00:24:43 --> 00:24:44 oh no,
00:24:44 --> 00:24:46 we could be replaced in a certain way,
00:24:46 --> 00:24:46 right?
00:24:46 --> 00:24:47 I think that that's some of
00:24:47 --> 00:24:48 the fears and the concerns
00:24:48 --> 00:24:49 that a lot of industries
00:24:49 --> 00:24:50 are going through.
00:24:50 --> 00:24:51 And maybe we've always felt
00:24:51 --> 00:24:52 a little bit protected
00:24:52 --> 00:24:53 around that in physical
00:24:53 --> 00:24:55 therapy because of that.
00:24:55 --> 00:24:55 But now we're seeing that
00:24:56 --> 00:24:58 infiltrate into what we are doing.
00:24:58 --> 00:25:00 And I think what I wanted to
00:25:00 --> 00:25:01 get at here was especially
00:25:01 --> 00:25:04 with the research aspect of this.
00:25:04 --> 00:25:05 So, you know,
00:25:05 --> 00:25:06 all three of us are a little
00:25:06 --> 00:25:08 bit nerdy in our research ways.
00:25:08 --> 00:25:12 And some of us more than others, Jake, we,
00:25:12 --> 00:25:12 you know,
00:25:13 --> 00:25:15 we look at things very differently,
00:25:15 --> 00:25:16 maybe than, say,
00:25:16 --> 00:25:17 clinicians might look at
00:25:18 --> 00:25:19 things or certainly the consumers.
00:25:20 --> 00:25:20 Right.
00:25:20 --> 00:25:21 I think that's actually
00:25:21 --> 00:25:22 probably even a bigger
00:25:22 --> 00:25:24 population that might see this and say,
00:25:24 --> 00:25:24 hey,
00:25:24 --> 00:25:26 this is this is fascinating and
00:25:26 --> 00:25:26 interesting.
00:25:26 --> 00:25:26 And actually,
00:25:26 --> 00:25:28 it was just today that I
00:25:28 --> 00:25:30 perused my social media and
00:25:30 --> 00:25:31 I'm on like these
00:25:32 --> 00:25:34 runner group pages, right?
00:25:34 --> 00:25:35 And on the runner group
00:25:35 --> 00:25:36 pages are always like,
00:25:37 --> 00:25:39 putting a picture of their leg and saying,
00:25:39 --> 00:25:39 I have pain here.
00:25:39 --> 00:25:40 What is this?
00:25:41 --> 00:25:42 And then you have a lot of
00:25:42 --> 00:25:45 people that provide input and, you know,
00:25:45 --> 00:25:46 opinions and, you know,
00:25:46 --> 00:25:47 we ourselves or other
00:25:47 --> 00:25:48 people are probably doing this.
00:25:48 --> 00:25:49 It's like, okay,
00:25:49 --> 00:25:49 I'm not going to type anything.
00:25:49 --> 00:25:50 I'm not going to type
00:25:50 --> 00:25:52 anything because you just really can't,
00:25:52 --> 00:25:52 you know,
00:25:52 --> 00:25:53 but that's kind of what this is
00:25:54 --> 00:25:56 a little bit like, but like you said,
00:25:56 --> 00:25:59 this is such a big stakes thing, you know,
00:25:59 --> 00:26:00 where it's replacing
00:26:00 --> 00:26:03 something that is so important.
00:26:03 --> 00:26:04 Whereas in research,
00:26:05 --> 00:26:06 what I think is most
00:26:06 --> 00:26:07 alarming with this is that
00:26:08 --> 00:26:09 research we know takes what
00:26:09 --> 00:26:11 five to seven plus years
00:26:11 --> 00:26:12 for findings to then
00:26:13 --> 00:26:14 translate into clinical
00:26:14 --> 00:26:15 practice and that's
00:26:15 --> 00:26:16 research the unfortunate
00:26:16 --> 00:26:18 thing with this is that
00:26:18 --> 00:26:19 it's actually something
00:26:19 --> 00:26:21 that is put forth by
00:26:21 --> 00:26:23 industry that actually
00:26:23 --> 00:26:24 probably has a bigger
00:26:24 --> 00:26:26 engine in it than even our
00:26:26 --> 00:26:28 research bodies do and I
00:26:28 --> 00:26:29 think that's probably one of the more
00:26:30 --> 00:26:32 alarming features of this is that yes,
00:26:32 --> 00:26:33 while it didn't follow the
00:26:33 --> 00:26:35 research process, like we say it should,
00:26:36 --> 00:26:40 um, the outcome and the, uh, potential,
00:26:41 --> 00:26:41 uh,
00:26:41 --> 00:26:42 fallout from that is actually much
00:26:42 --> 00:26:44 greater than in the research.
00:26:44 --> 00:26:45 I really think that's really
00:26:45 --> 00:26:46 important and key for
00:26:46 --> 00:26:47 listeners to understand
00:26:47 --> 00:26:48 that process and that
00:26:48 --> 00:26:50 systematic methodology for
00:26:50 --> 00:26:51 being able to come up with
00:26:52 --> 00:26:53 answers and address those things.
00:26:53 --> 00:26:54 So appreciate that Jake a lot.
00:26:54 --> 00:26:55 Yeah.
00:26:55 --> 00:26:57 And if I can just kind of reiterate that,
00:26:57 --> 00:26:58 that, uh,
00:26:59 --> 00:27:00 You know, that this is, again,
00:27:01 --> 00:27:02 being a report to industry,
00:27:04 --> 00:27:05 the thing that we're really
00:27:06 --> 00:27:08 concerned here is that
00:27:08 --> 00:27:09 there was no peer review
00:27:09 --> 00:27:13 process for this product.
00:27:14 --> 00:27:15 And as such,
00:27:16 --> 00:27:19 there's no way to let potential consumers,
00:27:20 --> 00:27:22 being clinicians, policymakers, and so on,
00:27:24 --> 00:27:26 any concerns that we might have.
00:27:28 --> 00:27:29 And I, and I'll add, I mean,
00:27:29 --> 00:27:31 so it's interesting, right?
00:27:31 --> 00:27:32 Is when you read in the top, you know,
00:27:33 --> 00:27:34 the beginning of the document,
00:27:34 --> 00:27:36 it does have who contributed
00:27:36 --> 00:27:37 to the writing of this.
00:27:37 --> 00:27:41 And there was one PT, again, clinician.
00:27:41 --> 00:27:43 The rest of them were physician-based.
00:27:43 --> 00:27:44 And so again,
00:27:44 --> 00:27:47 that's who constructed the study.
00:27:47 --> 00:27:49 And when they looked at
00:27:49 --> 00:27:50 getting some additional
00:27:50 --> 00:27:52 stakeholder involvement,
00:27:52 --> 00:27:53 they actually looked at
00:27:53 --> 00:27:54 more of those that were in
00:27:54 --> 00:27:55 the virtual health side of
00:27:55 --> 00:27:58 things rather than the PT side of things.
00:27:58 --> 00:28:00 I think that's a gap that I
00:28:00 --> 00:28:01 just want to re-highlight.
00:28:01 --> 00:28:02 And then I want to gap
00:28:03 --> 00:28:07 that PTs, we're not a dime a dozen.
00:28:08 --> 00:28:10 There is a wide range of what we do.
00:28:11 --> 00:28:11 However,
00:28:11 --> 00:28:12 it's usually patient driven and
00:28:12 --> 00:28:14 they put a lot of different
00:28:14 --> 00:28:16 types of patients together.
00:28:16 --> 00:28:17 And then again,
00:28:17 --> 00:28:17 there's a lot of
00:28:17 --> 00:28:18 heterogeneity in the types
00:28:18 --> 00:28:20 of approaches that we use.
00:28:20 --> 00:28:21 And again,
00:28:21 --> 00:28:24 it just adds layers of what I
00:28:24 --> 00:28:25 would say variables that
00:28:25 --> 00:28:27 then muddy the waters into
00:28:27 --> 00:28:29 really the validity of what
00:28:29 --> 00:28:30 their findings were.
00:28:30 --> 00:28:31 So stepping back,
00:28:31 --> 00:28:32 saying maybe we didn't get
00:28:32 --> 00:28:33 the right input,
00:28:33 --> 00:28:35 maybe there was some risk of bias,
00:28:35 --> 00:28:36 it maybe overinflated some
00:28:36 --> 00:28:38 of the outcomes from those studies,
00:28:38 --> 00:28:40 but now we're putting it
00:28:40 --> 00:28:42 out as a marketing product
00:28:42 --> 00:28:43 without that layer of
00:28:43 --> 00:28:45 complexity to state.
00:28:45 --> 00:28:46 It simplifies it,
00:28:47 --> 00:28:48 like there is more value in
00:28:48 --> 00:28:52 this maybe than what really may be there.
00:28:52 --> 00:28:53 It may be an overestimate.
00:28:54 --> 00:28:56 Yeah, I would agree.
00:28:56 --> 00:28:58 I think hopefully a lot of
00:28:58 --> 00:29:00 our listeners do agree as well too,
00:29:00 --> 00:29:00 right?
00:29:00 --> 00:29:02 I mean, obviously our product,
00:29:02 --> 00:29:03 our bulk of our listeners
00:29:03 --> 00:29:04 are going to be listening
00:29:05 --> 00:29:06 into this and having some
00:29:06 --> 00:29:07 concerns and hopefully
00:29:07 --> 00:29:08 feeling proud about what
00:29:08 --> 00:29:10 they do from an actual
00:29:11 --> 00:29:11 physical therapy
00:29:11 --> 00:29:12 perspective and the
00:29:12 --> 00:29:13 training that they've
00:29:13 --> 00:29:14 received and what they
00:29:15 --> 00:29:16 bring to the table when it
00:29:16 --> 00:29:18 comes to managing these
00:29:18 --> 00:29:20 patients and individuals with
00:29:20 --> 00:29:21 you know, lots and lots of problems.
00:29:21 --> 00:29:22 And I think the impact that
00:29:22 --> 00:29:23 we can have on society,
00:29:23 --> 00:29:24 I think all those things
00:29:24 --> 00:29:25 should be things that we
00:29:25 --> 00:29:26 should be very proud about.
00:29:27 --> 00:29:28 So I guess for both of you,
00:29:30 --> 00:29:32 what can our said consumers,
00:29:32 --> 00:29:33 our physical therapists,
00:29:33 --> 00:29:34 especially those that
00:29:34 --> 00:29:35 really believe in what
00:29:35 --> 00:29:36 they're doing in terms of
00:29:37 --> 00:29:38 either hands-on or being present.
00:29:38 --> 00:29:39 So it doesn't have to always
00:29:39 --> 00:29:41 just be hands-on the care,
00:29:41 --> 00:29:43 but being present in the moment, right,
00:29:43 --> 00:29:44 is also important.
00:29:44 --> 00:29:45 What can our consumers do?
00:29:45 --> 00:29:46 And is there sort of any
00:29:47 --> 00:29:48 kind of call to action to our,
00:29:49 --> 00:29:51 especially musculoskeletal practitioners?
00:29:53 --> 00:29:53 Yeah,
00:29:53 --> 00:29:56 I'm going to step in a safe space and
00:29:56 --> 00:29:57 just say advocacy.
00:29:57 --> 00:29:59 But when I say advocacy,
00:29:59 --> 00:30:00 I'm actually being very specific.
00:30:01 --> 00:30:02 We need to actually
00:30:02 --> 00:30:03 understand the complexity
00:30:03 --> 00:30:04 around this problem.
00:30:05 --> 00:30:07 And part of this is just making yourself,
00:30:07 --> 00:30:08 first of all, a little bit more informed.
00:30:09 --> 00:30:10 Read this.
00:30:11 --> 00:30:12 The other part is that you
00:30:12 --> 00:30:14 also need to look at the landscape.
00:30:14 --> 00:30:16 I mean, so I need to say, and again, Derek,
00:30:16 --> 00:30:17 you brought it up in the
00:30:17 --> 00:30:18 beginning of the conversation,
00:30:18 --> 00:30:20 but AI is different than
00:30:20 --> 00:30:21 virtual health technologies
00:30:21 --> 00:30:22 that were grouped into this study.
00:30:23 --> 00:30:25 And the reality is AI is
00:30:25 --> 00:30:26 picking up even faster.
00:30:27 --> 00:30:28 We need to be prepared for
00:30:28 --> 00:30:29 that conversation.
00:30:30 --> 00:30:31 And I'm going to even say
00:30:31 --> 00:30:32 one of the major virtual
00:30:32 --> 00:30:34 MSK contributors was Sword
00:30:34 --> 00:30:36 Health that was in these studies.
00:30:36 --> 00:30:38 Again, not speaking bad about it,
00:30:38 --> 00:30:39 but I'm going to give you facts.
00:30:39 --> 00:30:40 The facts are is that Sword
00:30:41 --> 00:30:41 Health just laid off
00:30:41 --> 00:30:43 thirteen PTs in order to
00:30:43 --> 00:30:44 ramp up their AI
00:30:44 --> 00:30:46 technologies in their in
00:30:46 --> 00:30:48 their type of services.
00:30:48 --> 00:30:50 So, OK,
00:30:50 --> 00:30:51 so the PT is going to have oversight.
00:30:51 --> 00:30:53 Who's verifying?
00:30:53 --> 00:30:54 How do we know that this AI
00:30:55 --> 00:30:56 isn't taking over maybe into
00:30:56 --> 00:30:57 areas that are concerning
00:30:57 --> 00:30:58 I'm going to step into
00:30:58 --> 00:31:00 another space so united
00:31:00 --> 00:31:01 healthcare is now under a
00:31:01 --> 00:31:03 major class action lawsuit
00:31:03 --> 00:31:05 because they actually have
00:31:05 --> 00:31:06 algorithms that were used
00:31:06 --> 00:31:08 by ai to determine cutoff
00:31:08 --> 00:31:10 points of service and so
00:31:10 --> 00:31:11 now they've cut off
00:31:11 --> 00:31:12 essential rehab services
00:31:13 --> 00:31:14 for those individuals with
00:31:14 --> 00:31:15 injury or sickness and
00:31:16 --> 00:31:16 medicare advantage
00:31:16 --> 00:31:18 beneficiaries and there's
00:31:18 --> 00:31:19 actually a lawsuit on this so
00:31:20 --> 00:31:21 Advocacy.
00:31:22 --> 00:31:23 If you have patients who are
00:31:24 --> 00:31:25 seeking those technologies,
00:31:25 --> 00:31:26 they absolutely need to be
00:31:26 --> 00:31:27 aware that it may not be
00:31:27 --> 00:31:28 considered the same.
00:31:29 --> 00:31:30 If they're not getting the type of care,
00:31:31 --> 00:31:32 we have to think about how
00:31:32 --> 00:31:33 are our insurance companies
00:31:33 --> 00:31:34 now using AI and
00:31:34 --> 00:31:36 technologies to make
00:31:36 --> 00:31:37 decisions on how they're
00:31:37 --> 00:31:37 going to provide care
00:31:37 --> 00:31:40 benefit coverage to our patients.
00:31:40 --> 00:31:43 So this is really advocacy as in like,
00:31:44 --> 00:31:45 talk to your legislators,
00:31:45 --> 00:31:47 get active and talk about
00:31:47 --> 00:31:49 what these technologies do
00:31:49 --> 00:31:51 to the patients that we so care to serve,
00:31:51 --> 00:31:52 not just with our hands on,
00:31:52 --> 00:31:53 but with our brains that we
00:31:53 --> 00:31:55 ended up seeking so many years of,
00:31:56 --> 00:31:56 you know,
00:31:56 --> 00:31:58 degrees in education to best benefit.
00:31:59 --> 00:32:00 It's not the same as a coach.
00:32:00 --> 00:32:01 And I don't know that AI is
00:32:01 --> 00:32:03 going to do it in the same
00:32:03 --> 00:32:05 way with personalized care.
00:32:05 --> 00:32:06 I do think there's formulas,
00:32:07 --> 00:32:07 but I don't know that
00:32:07 --> 00:32:08 they're going to ever
00:32:08 --> 00:32:10 replace the human touch piece
00:32:10 --> 00:32:11 and the human conversation
00:32:11 --> 00:32:14 piece that is essential to what we do.
00:32:14 --> 00:32:16 I really appreciate that answer.
00:32:17 --> 00:32:17 And I think,
00:32:18 --> 00:32:18 especially those of us that
00:32:18 --> 00:32:20 are a little bit involved in advocacy,
00:32:20 --> 00:32:21 maybe we think about it this way,
00:32:21 --> 00:32:22 but maybe it's time for all
00:32:22 --> 00:32:23 of our PTs to start
00:32:23 --> 00:32:24 thinking about this way a
00:32:24 --> 00:32:25 little bit more so,
00:32:26 --> 00:32:27 is being proactive instead
00:32:27 --> 00:32:28 of being reactive.
00:32:29 --> 00:32:30 And a lot of things in the world,
00:32:30 --> 00:32:32 we can be a little bit
00:32:32 --> 00:32:34 reactive because the wheel
00:32:34 --> 00:32:35 moves a little slowly.
00:32:36 --> 00:32:37 But I think, as you said,
00:32:37 --> 00:32:39 the AI wheel moves a little
00:32:39 --> 00:32:40 faster in certain spaces
00:32:41 --> 00:32:42 than we can appreciate.
00:32:42 --> 00:32:44 So I think, you know,
00:32:44 --> 00:32:45 not waiting to be reactive
00:32:45 --> 00:32:46 because by that point,
00:32:46 --> 00:32:48 maybe far too late.
00:32:48 --> 00:32:50 We don't know, but very well could be.
00:32:50 --> 00:32:51 So I appreciate that
00:32:51 --> 00:32:54 proactive advocacy response.
00:32:54 --> 00:32:54 Jake, what do you think?
00:32:55 --> 00:32:55 Yeah,
00:32:55 --> 00:32:58 I just really agree with everything
00:32:58 --> 00:33:00 basically Megan said and that you said,
00:33:00 --> 00:33:03 and doing our best as
00:33:03 --> 00:33:04 physical therapists to find
00:33:04 --> 00:33:06 a seat at the table where
00:33:06 --> 00:33:07 decisions are being made
00:33:07 --> 00:33:09 about whether or not these
00:33:09 --> 00:33:10 types of solutions are
00:33:10 --> 00:33:13 going to be available for consumers.
00:33:14 --> 00:33:20 And that requires some work,
00:33:21 --> 00:33:23 but I think that we need to have that
00:33:27 --> 00:33:32 Cut that out.
00:33:32 --> 00:33:33 Leave that in.
00:33:33 --> 00:33:36 Especially the tongue.
00:33:36 --> 00:33:39 We are going to do outtakes at some point,
00:33:39 --> 00:33:39 but yeah.
00:33:41 --> 00:33:46 Love it.
00:33:46 --> 00:33:47 I think that most of what I
00:33:47 --> 00:33:50 said was good except the very end.
00:33:50 --> 00:33:50 Yes.
00:33:50 --> 00:33:51 It was all good.
00:33:51 --> 00:33:53 It was all good.
00:33:54 --> 00:33:56 Do I have to reshoot that or what?
00:33:56 --> 00:33:57 Because I don't even remember what I said.
00:33:59 --> 00:34:00 No, do you remember where you were at,
00:34:00 --> 00:34:01 like thought-wise?
00:34:02 --> 00:34:04 You were talking about seats at the table.
00:34:04 --> 00:34:08 Yeah, I think that it's just, yeah,
00:34:09 --> 00:34:11 if we can stop it at everybody needs to,
00:34:11 --> 00:34:14 we need to be making
00:34:14 --> 00:34:15 efforts to make sure that
00:34:15 --> 00:34:16 we have a seat at the table
00:34:16 --> 00:34:17 where these decisions are made.
00:34:18 --> 00:34:19 I'll find that somewhere.
00:34:19 --> 00:34:20 Okay.
00:34:20 --> 00:34:21 All right.
00:34:21 --> 00:34:23 And begin.
00:34:27 --> 00:34:28 Oh, you just want to stop it there.
00:34:28 --> 00:34:28 Oh, yeah.
00:34:28 --> 00:34:30 I think I don't really have anything else.
00:34:30 --> 00:34:31 I think that's good.
00:34:32 --> 00:34:33 Then I may fire a question
00:34:33 --> 00:34:34 back at you then.
00:34:34 --> 00:34:35 Yeah, fire another one.
00:34:36 --> 00:34:37 Yeah.
00:34:37 --> 00:34:37 Well, wait.
00:34:37 --> 00:34:38 I'm going to get us on the
00:34:38 --> 00:34:39 right timer here.
00:34:42 --> 00:34:42 So Jake,
00:34:42 --> 00:34:43 I think that's really interesting
00:34:43 --> 00:34:44 that you mentioned getting
00:34:44 --> 00:34:46 a seat at the table.
00:34:46 --> 00:34:48 I feel like in this space,
00:34:49 --> 00:34:50 especially with what we're doing in PT,
00:34:51 --> 00:34:53 there are a lot of tables in this.
00:34:53 --> 00:34:54 And I know that this is
00:34:54 --> 00:34:56 putting you a little bit on the spot,
00:34:56 --> 00:34:58 but have you any thoughts
00:34:58 --> 00:35:00 on what that might actually look like?
00:35:00 --> 00:35:02 Megan's brought up talking
00:35:02 --> 00:35:03 with your legislators and
00:35:03 --> 00:35:04 those kinds of things that
00:35:04 --> 00:35:06 can actually have impact on
00:35:06 --> 00:35:07 swift policy changes and
00:35:07 --> 00:35:08 that sort of thing.
00:35:09 --> 00:35:11 Any other thoughts on how that might look?
00:35:11 --> 00:35:12 I especially want your
00:35:12 --> 00:35:13 thoughts and your opinion
00:35:13 --> 00:35:13 because you've been
00:35:14 --> 00:35:14 involved in a lot of
00:35:14 --> 00:35:15 different things like the
00:35:16 --> 00:35:19 opioid misuse and different
00:35:19 --> 00:35:21 types of ventures and such.
00:35:21 --> 00:35:21 And I know that so you've
00:35:21 --> 00:35:23 had seats at the table.
00:35:23 --> 00:35:24 And I just would love our
00:35:24 --> 00:35:26 listeners to hear how you
00:35:26 --> 00:35:27 get those seats at the table,
00:35:27 --> 00:35:28 what you've done in the past.
00:35:29 --> 00:35:30 Well, I think that related to this,
00:35:30 --> 00:35:31 the seat of the table could
00:35:31 --> 00:35:34 be making sure that you
00:35:34 --> 00:35:35 have a good pipeline to
00:35:35 --> 00:35:38 your health system
00:35:38 --> 00:35:40 leadership when decisions
00:35:40 --> 00:35:42 are being made about what
00:35:42 --> 00:35:44 types of insurance options
00:35:44 --> 00:35:45 are being provided.
00:35:46 --> 00:35:48 And that could be,
00:35:50 --> 00:35:50 and it could also be
00:35:51 --> 00:35:53 actually banding together
00:35:53 --> 00:35:55 as local clinics,
00:35:56 --> 00:35:58 more mom and pop clinics
00:35:58 --> 00:36:00 banding together to figure
00:36:00 --> 00:36:00 out how you're going to
00:36:00 --> 00:36:02 respond to some of these
00:36:03 --> 00:36:04 potentially virtual
00:36:04 --> 00:36:05 solutions that might be
00:36:06 --> 00:36:09 pushed upon us rather than
00:36:12 --> 00:36:13 being given really an option
00:36:13 --> 00:36:16 of whether or not to adopt it.
00:36:17 --> 00:36:19 And so being able to have
00:36:20 --> 00:36:22 kind of a critical mass in
00:36:22 --> 00:36:25 order to go to health
00:36:25 --> 00:36:27 system leadership and
00:36:27 --> 00:36:29 insurance companies to have
00:36:29 --> 00:36:30 these conversations and
00:36:31 --> 00:36:32 advocate for our profession,
00:36:33 --> 00:36:35 I think will be critical in
00:36:35 --> 00:36:35 the coming years,
00:36:36 --> 00:36:38 particularly as Megan mentioned,
00:36:38 --> 00:36:39 related to AI,
00:36:39 --> 00:36:41 because that's not going away,
00:36:41 --> 00:36:42 it's only going to accelerate.
00:36:43 --> 00:36:44 Yeah,
00:36:44 --> 00:36:45 the competition changes a little bit
00:36:45 --> 00:36:46 there instead of being
00:36:46 --> 00:36:47 competing with the
00:36:47 --> 00:36:48 clinician down the street,
00:36:48 --> 00:36:49 we're competing against
00:36:49 --> 00:36:50 something very different,
00:36:50 --> 00:36:51 very interesting perspective.
00:36:51 --> 00:36:52 Yeah.
00:36:52 --> 00:36:54 And it's going to be couched as access.
00:36:54 --> 00:36:54 I mean,
00:36:54 --> 00:36:55 so I think we really need to
00:36:55 --> 00:36:57 appreciate that it's couched as access.
00:36:58 --> 00:37:00 I live in North Carolina or North Canton,
00:37:00 --> 00:37:00 Ohio.
00:37:01 --> 00:37:01 Right.
00:37:01 --> 00:37:02 And so when we think about, you know,
00:37:02 --> 00:37:03 where you live, Derek,
00:37:03 --> 00:37:04 and where Jake lives,
00:37:04 --> 00:37:06 I would say we're not in
00:37:06 --> 00:37:08 rural areas for the most part.
00:37:08 --> 00:37:10 I received a solicitation
00:37:10 --> 00:37:11 from the insurance provider
00:37:11 --> 00:37:13 of a local hospital systems
00:37:13 --> 00:37:15 around here that they're
00:37:15 --> 00:37:18 now offering sword health PT services.
00:37:19 --> 00:37:20 And I'm thinking about all
00:37:20 --> 00:37:22 of the access of PT local to him.
00:37:22 --> 00:37:23 Like there's a ton.
00:37:24 --> 00:37:24 I was solicited.
00:37:25 --> 00:37:27 I don't live in rural health areas.
00:37:27 --> 00:37:29 Access is pretty easy.
00:37:29 --> 00:37:31 And so is it going to be one
00:37:31 --> 00:37:32 of these solutions?
00:37:32 --> 00:37:33 And again,
00:37:33 --> 00:37:34 it was through sword health and
00:37:34 --> 00:37:36 now I'm actually more anxious.
00:37:36 --> 00:37:37 Is it AI generated?
00:37:37 --> 00:37:38 And so,
00:37:39 --> 00:37:40 Here's another advocacy tool.
00:37:40 --> 00:37:41 Go through it yourself.
00:37:42 --> 00:37:43 That's what I'm going to do.
00:37:43 --> 00:37:44 I'm actually going to sign
00:37:44 --> 00:37:46 up for Sword Health PT,
00:37:47 --> 00:37:48 and I'm going to evaluate it.
00:37:48 --> 00:37:49 And then I'm going to write
00:37:49 --> 00:37:50 to the hospital system and
00:37:50 --> 00:37:52 the insurers if I see
00:37:52 --> 00:37:52 something that would be a
00:37:53 --> 00:37:54 high variation of typical practice.
00:37:55 --> 00:37:56 So start small.
00:37:57 --> 00:37:58 You can go big,
00:37:58 --> 00:38:00 you can have big conversations,
00:38:00 --> 00:38:01 but we can't put our head
00:38:02 --> 00:38:02 in the sand and pretend
00:38:02 --> 00:38:04 like this isn't existing in
00:38:05 --> 00:38:06 a current concern.
00:38:06 --> 00:38:08 We have to engage in the conversation.
00:38:09 --> 00:38:10 My bigger concern is how are
00:38:10 --> 00:38:11 these algorithms going to
00:38:11 --> 00:38:13 then decide who gets coverage,
00:38:13 --> 00:38:14 who doesn't get coverage,
00:38:14 --> 00:38:16 or when does coverage get cut off?
00:38:16 --> 00:38:18 These are conversations that
00:38:18 --> 00:38:19 we have to start to
00:38:19 --> 00:38:20 appreciate in our science.
00:38:21 --> 00:38:22 We've come a long way.
00:38:23 --> 00:38:24 But we're not all the way
00:38:24 --> 00:38:25 where we need to be even
00:38:25 --> 00:38:27 about dosage in all of the
00:38:27 --> 00:38:28 research areas that we
00:38:28 --> 00:38:29 still need to explore what
00:38:30 --> 00:38:32 is best practice in the various areas.
00:38:32 --> 00:38:33 So I would continue to
00:38:33 --> 00:38:35 encourage clinicians in the
00:38:35 --> 00:38:36 listening areas to make
00:38:36 --> 00:38:38 sure that they're doing best practice,
00:38:38 --> 00:38:39 such as the guideline-based cares.
00:38:39 --> 00:38:40 I mean,
00:38:40 --> 00:38:42 we really do need to be at the top
00:38:42 --> 00:38:44 of our game for us all to unite together.
00:38:44 --> 00:38:46 so that we don't have a low
00:38:46 --> 00:38:47 variation in our practice
00:38:48 --> 00:38:49 and that that's who gets
00:38:49 --> 00:38:50 picked on and then it
00:38:50 --> 00:38:51 changes the practice
00:38:51 --> 00:38:53 profession for all of those
00:38:53 --> 00:38:54 who truly do believe in the
00:38:54 --> 00:38:55 best hands on care,
00:38:55 --> 00:38:58 the best solutions for our patients.
00:38:59 --> 00:39:00 We definitely need to step
00:39:00 --> 00:39:02 up our game as practitioners, too.
00:39:02 --> 00:39:03 So there's there's a lot of
00:39:03 --> 00:39:04 low levels of hanging fruit
00:39:04 --> 00:39:05 that we can do.
00:39:05 --> 00:39:06 There's some higher,
00:39:06 --> 00:39:07 bigger things that we need to target.
00:39:08 --> 00:39:10 But I think the biggest
00:39:10 --> 00:39:11 thing I can say is engagement.
00:39:12 --> 00:39:13 and advocacy.
00:39:13 --> 00:39:14 Those are the things we have
00:39:14 --> 00:39:15 to start to believe that we
00:39:15 --> 00:39:16 can make a difference and
00:39:17 --> 00:39:18 we have to start somewhere.
00:39:19 --> 00:39:20 I appreciate that.
00:39:20 --> 00:39:21 Really good advice.
00:39:21 --> 00:39:22 This has been great.
00:39:23 --> 00:39:24 I really do hope that our
00:39:24 --> 00:39:26 listeners have enjoyed some
00:39:26 --> 00:39:28 of this conversation, this dialogue.
00:39:28 --> 00:39:31 It's not doom and gloom, by all means.
00:39:31 --> 00:39:32 We're a wonderful profession.
00:39:32 --> 00:39:32 I think that we should all
00:39:32 --> 00:39:33 be excited about it.
00:39:33 --> 00:39:34 And that's how we should
00:39:34 --> 00:39:35 actually walk away from
00:39:35 --> 00:39:37 this podcast is who we are
00:39:37 --> 00:39:39 and what we do and what our identity is.
00:39:39 --> 00:39:41 But realize that there are
00:39:42 --> 00:39:43 people that are always
00:39:43 --> 00:39:44 wanting to have a little
00:39:44 --> 00:39:45 bit more say in this space.
00:39:45 --> 00:39:47 And we need to just make sure that we are
00:39:48 --> 00:39:49 for society and for the
00:39:49 --> 00:39:50 individuals that we serve
00:39:50 --> 00:39:51 protecting that space.
00:39:51 --> 00:39:52 So appreciate.
00:39:52 --> 00:39:54 We're already an economic value.
00:39:54 --> 00:39:55 We're an economic value.
00:39:55 --> 00:39:56 I don't need to be cheaper
00:39:56 --> 00:39:57 to just be cheaper.
00:39:57 --> 00:40:00 We need to be cheaper with high quality.
00:40:00 --> 00:40:01 And I think that's the piece
00:40:01 --> 00:40:02 we just can't lose sight of.
00:40:02 --> 00:40:04 We are already a great value.
00:40:04 --> 00:40:06 So we just need to keep the
00:40:06 --> 00:40:07 message consistent.
00:40:07 --> 00:40:08 Yeah, there we go.
00:40:08 --> 00:40:10 Great words to leave on.
00:40:10 --> 00:40:11 Thank you, Megan.
00:40:11 --> 00:40:12 Thank you, Jake,
00:40:12 --> 00:40:13 so much for being on the show.
00:40:13 --> 00:40:14 Pleasure being here.
00:40:14 --> 00:40:14 Thanks, Derek.
00:40:15 --> 00:40:16 Thanks, Derek.
00:40:16 --> 00:40:16 Bye, Jake.
00:40:17 --> 00:40:18 Bye Megan.