What if context—patient beliefs, provider expectations, and the therapeutic relationship—drives a meaningful share of spinal manipulation outcomes? In this HANDS ON HANDS OFF episode, we break down a single-arm intervention study funded by the Paris Family Foundation via the Foundation for OMPT, why the current mechanisms model zeroes in on the “context zone,” and how to practically weave guidelines + shared decision-making into outpatient practice.
Top takeaways
- Outcomes vary—and context might be part of the mechanism
- Study design links individual providers ↔ individual patients for cleaner signals
- Implementation: use shared decision-making to operationalize guidelines
- Career notes: pick mentors early, build long-term collaborators, include patient partners
00:00:03 --> 00:00:04 Well, hi, everybody.
00:00:04 --> 00:00:06 I'm Dr. Skip Gill,
00:00:06 --> 00:00:07 and I'm one of the trustees
00:00:07 --> 00:00:09 on the Foundation for OMPT.
00:00:10 --> 00:00:11 And today I have the
00:00:11 --> 00:00:12 pleasure to introduce our guest,
00:00:12 --> 00:00:15 Dr. Jason Benecek.
00:00:15 --> 00:00:16 Jason is a research
00:00:16 --> 00:00:18 associate professor at the
00:00:18 --> 00:00:19 Doctor of Physical Therapy
00:00:19 --> 00:00:22 program at the University of Florida,
00:00:22 --> 00:00:23 and also a clinical
00:00:23 --> 00:00:25 research scientist at
00:00:25 --> 00:00:26 Brooks Rehabilitation.
00:00:27 --> 00:00:28 He's been supported by the
00:00:28 --> 00:00:30 National Institutes of Health,
00:00:30 --> 00:00:31 the Patient-Centered
00:00:31 --> 00:00:33 Outcome Research Institute,
00:00:34 --> 00:00:35 the Center for Health
00:00:35 --> 00:00:36 Services Training and Research,
00:00:37 --> 00:00:38 and the Foundation for
00:00:38 --> 00:00:39 Physical Therapy Research.
00:00:40 --> 00:00:42 His research interests focus
00:00:42 --> 00:00:43 on musculoskeletal pain,
00:00:44 --> 00:00:46 psychologically informed physical therapy,
00:00:47 --> 00:00:48 implementation science,
00:00:48 --> 00:00:50 and health services research.
00:00:50 --> 00:00:51 He currently teaches
00:00:51 --> 00:00:53 evidence-based practice in
00:00:53 --> 00:00:53 the Doctor of Physical
00:00:54 --> 00:00:55 Therapy program at the
00:00:55 --> 00:00:56 University of Florida.
00:00:57 --> 00:00:58 He also serves as an
00:00:58 --> 00:00:59 associate editor for
00:00:59 --> 00:01:01 physical therapy and an
00:01:01 --> 00:01:03 editorial review board
00:01:03 --> 00:01:04 member for the Journal of
00:01:04 --> 00:01:06 Orthopedic and Sports Physical Therapy.
00:01:07 --> 00:01:09 Dr. Benachek was also the
00:01:09 --> 00:01:10 recipient of the Eugene
00:01:10 --> 00:01:12 Michaels New Investigator
00:01:12 --> 00:01:13 Award by the American
00:01:13 --> 00:01:14 Physical Therapy
00:01:14 --> 00:01:16 Association in twenty twenty one.
00:01:17 --> 00:01:18 Jason, welcome.
00:01:18 --> 00:01:20 And it's great to have you on the show.
00:01:21 --> 00:01:21 Hi, Skip.
00:01:22 --> 00:01:23 And thanks for the opportunity.
00:01:23 --> 00:01:26 I always enjoy these podcasts,
00:01:26 --> 00:01:27 so I'm looking forward to it.
00:01:28 --> 00:01:29 OK, awesome.
00:01:29 --> 00:01:30 Well, you know,
00:01:31 --> 00:01:32 you're very well known in
00:01:32 --> 00:01:34 this area of mechanistic research,
00:01:34 --> 00:01:35 amongst other endeavors.
00:01:36 --> 00:01:37 But I wanted to hear a
00:01:37 --> 00:01:39 little bit about what your
00:01:39 --> 00:01:40 clinical and your research
00:01:40 --> 00:01:43 pathway was that led you to
00:01:43 --> 00:01:45 develop your expertise in this area.
00:01:46 --> 00:01:47 What was it that sort of
00:01:47 --> 00:01:48 sparked your interest?
00:01:49 --> 00:01:49 Yeah,
00:01:49 --> 00:01:50 I'm always kind of surprised when
00:01:50 --> 00:01:52 people say that I'm quote
00:01:52 --> 00:01:54 unquote known in the area
00:01:54 --> 00:01:55 of mechanistic research for
00:01:55 --> 00:01:56 manual therapy.
00:01:57 --> 00:01:58 But I guess that's where it
00:01:58 --> 00:01:59 kind of all started, right?
00:02:00 --> 00:02:01 And I think the group that I
00:02:01 --> 00:02:02 worked with at the
00:02:02 --> 00:02:03 University of Florida
00:02:03 --> 00:02:04 during my PhD training
00:02:06 --> 00:02:08 We did some pretty, I guess, novel,
00:02:08 --> 00:02:09 innovative studies
00:02:10 --> 00:02:12 back then.
00:02:12 --> 00:02:14 So that's where I think it
00:02:14 --> 00:02:15 probably all started.
00:02:15 --> 00:02:18 And my interest in mechanisms,
00:02:18 --> 00:02:19 manual therapy specifically,
00:02:19 --> 00:02:20 I think really stemmed back
00:02:20 --> 00:02:22 to my clinical practice.
00:02:23 --> 00:02:24 My clinical practice,
00:02:24 --> 00:02:25 and then obviously as I
00:02:25 --> 00:02:26 kind of transitioned back
00:02:26 --> 00:02:28 into a fellowship program,
00:02:29 --> 00:02:30 that's really where I
00:02:30 --> 00:02:32 started having questions about,
00:02:33 --> 00:02:34 we're seeing good outcomes
00:02:34 --> 00:02:36 with some of these patients, we're seeing
00:02:37 --> 00:02:39 so-so outcomes with other patients.
00:02:40 --> 00:02:42 What are the potential mechanisms?
00:02:42 --> 00:02:43 Why some people do better
00:02:43 --> 00:02:44 than others and vice versa?
00:02:46 --> 00:02:47 I think that's really where
00:02:47 --> 00:02:48 it all started.
00:02:48 --> 00:02:50 If you go back to my PhD training,
00:02:51 --> 00:02:52 My first project really
00:02:52 --> 00:02:53 focused on manual therapy
00:02:53 --> 00:02:55 mechanisms where we looked
00:02:55 --> 00:02:56 at mechanisms associated
00:02:56 --> 00:02:58 with neuromobilization techniques.
00:02:59 --> 00:03:01 So we used different
00:03:01 --> 00:03:02 assessment tools like
00:03:02 --> 00:03:03 quantitative sensory
00:03:03 --> 00:03:06 testing and to kind of fill
00:03:06 --> 00:03:08 in some of the gaps for one
00:03:08 --> 00:03:09 specific type of manual
00:03:09 --> 00:03:12 therapy technique.
00:03:12 --> 00:03:16 I think one thing that was, I think,
00:03:17 --> 00:03:18 kind of an important
00:03:18 --> 00:03:19 transition in my journey
00:03:19 --> 00:03:21 along the way was the shift
00:03:21 --> 00:03:23 that happened in my research direction.
00:03:24 --> 00:03:24 And, you know,
00:03:25 --> 00:03:26 I think going back to even
00:03:26 --> 00:03:29 when I said I wanted to do a PhD,
00:03:30 --> 00:03:31 and I think everybody
00:03:31 --> 00:03:31 probably goes through this
00:03:32 --> 00:03:32 before they get started,
00:03:33 --> 00:03:34 like they already
00:03:34 --> 00:03:35 think they know what their
00:03:35 --> 00:03:38 dissertation project's going to involve.
00:03:38 --> 00:03:40 And I honestly always
00:03:40 --> 00:03:41 thought my dissertation
00:03:41 --> 00:03:43 project would focus on slump testing,
00:03:44 --> 00:03:45 slump stretching, I'm sorry,
00:03:45 --> 00:03:46 because that was like a
00:03:46 --> 00:03:47 real interest of mine in
00:03:47 --> 00:03:48 clinical practice.
00:03:48 --> 00:03:50 And that shift in research
00:03:50 --> 00:03:51 really happened probably
00:03:51 --> 00:03:53 after the first two years.
00:03:53 --> 00:03:54 And at first it was a little,
00:03:55 --> 00:03:55 I was a little worried,
00:03:56 --> 00:03:58 but I think ultimately in the end,
00:03:58 --> 00:03:59 it was a really good
00:03:59 --> 00:04:00 decision that my mentor
00:04:00 --> 00:04:01 kind of put on the table
00:04:01 --> 00:04:02 for me to think about.
00:04:04 --> 00:04:05 Now a lot of my work is
00:04:05 --> 00:04:08 really focusing on contextual factors,
00:04:08 --> 00:04:09 which could,
00:04:09 --> 00:04:10 and we might get into this
00:04:10 --> 00:04:11 discussion in a little bit,
00:04:11 --> 00:04:13 could be mechanisms in and of themselves.
00:04:13 --> 00:04:15 So long-winded answer,
00:04:16 --> 00:04:17 but I think an important question.
00:04:17 --> 00:04:19 Yeah, yeah, thank you.
00:04:19 --> 00:04:22 So I wanted to talk about
00:04:22 --> 00:04:24 some of your ongoing research.
00:04:24 --> 00:04:26 So you received the Clinical
00:04:26 --> 00:04:28 Science and Manual Therapy
00:04:28 --> 00:04:31 Grant Award in twenty twenty three.
00:04:32 --> 00:04:33 And that's a new grant
00:04:33 --> 00:04:34 that's offered by the Paris
00:04:35 --> 00:04:37 Family Foundation through our foundation,
00:04:37 --> 00:04:39 the Foundation for OMPT.
00:04:40 --> 00:04:41 I wonder if you could give
00:04:41 --> 00:04:42 us a little overview of
00:04:42 --> 00:04:44 maybe the study's aims and
00:04:45 --> 00:04:46 the gaps you were looking
00:04:46 --> 00:04:49 to fill with this ongoing study.
00:04:49 --> 00:04:50 Sure.
00:04:50 --> 00:04:50 Yeah,
00:04:50 --> 00:04:53 so the title of the study is Patient
00:04:53 --> 00:04:54 and Physical Therapist
00:04:54 --> 00:04:56 Perspectives on Spinal
00:04:56 --> 00:04:57 Manipulative Therapy
00:04:58 --> 00:04:59 for low back pain and
00:04:59 --> 00:05:00 associated clinical outcomes.
00:05:01 --> 00:05:01 Long title,
00:05:02 --> 00:05:03 but most of our studies do have
00:05:03 --> 00:05:04 fairly long titles.
00:05:05 --> 00:05:06 We also included in the
00:05:06 --> 00:05:08 title that this is a single
00:05:08 --> 00:05:09 arm intervention study,
00:05:09 --> 00:05:10 which is important.
00:05:10 --> 00:05:11 And I think we'll kind of
00:05:11 --> 00:05:13 maybe take a little deeper
00:05:13 --> 00:05:14 dive into kind of the
00:05:14 --> 00:05:17 limitations of such a design.
00:05:18 --> 00:05:23 But I think the precedence for this study,
00:05:23 --> 00:05:24 really when we kind of
00:05:25 --> 00:05:25 talked about even
00:05:25 --> 00:05:28 developing a grant for this mechanism,
00:05:29 --> 00:05:30 is that we're obviously,
00:05:31 --> 00:05:34 we know as practitioners, as clinicians,
00:05:34 --> 00:05:37 our clinical partners that we talk to,
00:05:38 --> 00:05:40 we know that the responses
00:05:40 --> 00:05:41 to spinal manipulative
00:05:41 --> 00:05:42 therapy are really
00:05:42 --> 00:05:43 influenced by a multitude
00:05:43 --> 00:05:45 of interactions between the
00:05:45 --> 00:05:46 patient and the provider.
00:05:48 --> 00:05:49 particularly related to
00:05:49 --> 00:05:51 these contextual factors,
00:05:52 --> 00:05:53 but it's not that easy.
00:05:53 --> 00:05:54 Those contextual factors
00:05:55 --> 00:05:56 could be specific to the patient.
00:05:57 --> 00:05:59 They could be specific to the provider,
00:05:59 --> 00:06:00 in this case, the physical therapist,
00:06:01 --> 00:06:02 or really the interaction
00:06:02 --> 00:06:03 between the patient and the
00:06:03 --> 00:06:05 provider's relationship.
00:06:05 --> 00:06:07 So that's what really kind of, you know,
00:06:08 --> 00:06:10 I think, you know,
00:06:10 --> 00:06:11 that was really our main
00:06:11 --> 00:06:12 interest in kind of going
00:06:12 --> 00:06:14 for this type of mechanism.
00:06:15 --> 00:06:16 And we also kind of,
00:06:17 --> 00:06:18 we use our prior model.
00:06:18 --> 00:06:21 So I think in the manual therapy world,
00:06:21 --> 00:06:22 most folks refer to this as
00:06:22 --> 00:06:24 the Biolosky model,
00:06:25 --> 00:06:26 mechanisms of manual therapy.
00:06:26 --> 00:06:28 And we first published that in, I think,
00:06:28 --> 00:06:29 two thousand nine.
00:06:29 --> 00:06:31 And we had an updated an
00:06:31 --> 00:06:33 updated model in two thousand eighteen.
00:06:34 --> 00:06:35 And that model was really
00:06:35 --> 00:06:37 important for us in terms
00:06:37 --> 00:06:39 of developing the idea for this study.
00:06:40 --> 00:06:41 So we can talk about that a
00:06:41 --> 00:06:42 little bit more too,
00:06:42 --> 00:06:43 if that's of interest.
00:06:43 --> 00:06:44 But overall,
00:06:44 --> 00:06:46 the goal is to really gain a
00:06:46 --> 00:06:48 deeper understanding about
00:06:48 --> 00:06:49 contextual factors
00:06:50 --> 00:06:51 associated with manual
00:06:51 --> 00:06:52 therapy utilization,
00:06:53 --> 00:06:54 the perception from both
00:06:54 --> 00:06:56 the provider and the patient perspectives,
00:06:57 --> 00:06:58 and then the clinical
00:06:58 --> 00:06:59 outcomes associated with
00:06:59 --> 00:07:00 patients after that
00:07:01 --> 00:07:02 experience with manual therapy,
00:07:02 --> 00:07:04 spinal manipulation specifically.
00:07:05 --> 00:07:06 Sure.
00:07:06 --> 00:07:07 I mean,
00:07:07 --> 00:07:08 it would be great if you wanted to
00:07:08 --> 00:07:09 give us just a quick
00:07:09 --> 00:07:10 overview of the model.
00:07:10 --> 00:07:14 And then I was just thinking,
00:07:15 --> 00:07:16 was there anything maybe
00:07:16 --> 00:07:17 within this study in terms
00:07:17 --> 00:07:19 of either the methodology
00:07:19 --> 00:07:22 or the design that was unique,
00:07:23 --> 00:07:24 allowing you to get at
00:07:24 --> 00:07:25 questions maybe you weren't
00:07:25 --> 00:07:27 able to answer before?
00:07:28 --> 00:07:28 Yeah,
00:07:28 --> 00:07:30 so I think the one thing that we're
00:07:30 --> 00:07:32 really excited about is that, you know,
00:07:32 --> 00:07:34 the conceptual model for this project,
00:07:34 --> 00:07:35 like I mentioned earlier,
00:07:36 --> 00:07:37 is based on our mechanistic model.
00:07:38 --> 00:07:40 And that model really
00:07:40 --> 00:07:41 describes potential
00:07:41 --> 00:07:42 mediators of manual therapy
00:07:43 --> 00:07:44 related pain inhibition.
00:07:45 --> 00:07:47 And if you refer back to the
00:07:47 --> 00:07:50 most recent edition of the
00:07:50 --> 00:07:52 model back in two thousand eighteen,
00:07:53 --> 00:07:54 it's a little different
00:07:54 --> 00:07:55 than the initial model in
00:07:55 --> 00:07:57 that we are really focusing
00:07:57 --> 00:07:59 on just one component of the model.
00:07:59 --> 00:08:00 And that's really,
00:08:01 --> 00:08:02 if you refer to the paper,
00:08:02 --> 00:08:04 it would be considered zone one.
00:08:05 --> 00:08:06 And that would be contextual
00:08:06 --> 00:08:08 factors related to both the
00:08:08 --> 00:08:09 patient and the provider.
00:08:10 --> 00:08:11 And one of the things that
00:08:11 --> 00:08:12 we really tried to
00:08:12 --> 00:08:13 incorporate in the design
00:08:13 --> 00:08:15 of this study is to collect data
00:08:16 --> 00:08:18 specific to the patient and
00:08:18 --> 00:08:19 specific to the provider,
00:08:20 --> 00:08:22 but specifically using
00:08:23 --> 00:08:24 measures that were very similar.
00:08:25 --> 00:08:26 So that in essence,
00:08:26 --> 00:08:27 it gives us the potential
00:08:27 --> 00:08:28 opportunity to really
00:08:28 --> 00:08:32 compare a provider's perspective about,
00:08:32 --> 00:08:32 let's say,
00:08:32 --> 00:08:35 expectations and beliefs to a
00:08:35 --> 00:08:36 patient's perspectives
00:08:36 --> 00:08:39 about pain beliefs and
00:08:39 --> 00:08:40 expectations as well.
00:08:41 --> 00:08:42 and also linking that
00:08:42 --> 00:08:44 specific provider to that
00:08:44 --> 00:08:45 specific patient,
00:08:45 --> 00:08:46 as opposed to looking at it
00:08:47 --> 00:08:49 on more of a group level, if you will.
00:08:49 --> 00:08:53 So, you know, I think very, very,
00:08:53 --> 00:08:55 very complex in terms of, you know,
00:08:55 --> 00:08:56 how we're going to collect
00:08:56 --> 00:08:58 this and match up patients
00:08:58 --> 00:08:59 with specific providers.
00:08:59 --> 00:09:01 And I will tell you up front,
00:09:01 --> 00:09:02 it took a lot of time to
00:09:02 --> 00:09:03 kind of set up the data
00:09:03 --> 00:09:05 collection system with this.
00:09:05 --> 00:09:05 But
00:09:06 --> 00:09:07 We're beyond that now,
00:09:07 --> 00:09:08 and that was a nice
00:09:08 --> 00:09:11 exercise in really making this work.
00:09:11 --> 00:09:14 So I think that's something
00:09:14 --> 00:09:16 that we're probably most excited about.
00:09:17 --> 00:09:17 Yeah,
00:09:17 --> 00:09:19 and I know you're kind of in the
00:09:19 --> 00:09:20 midst of it,
00:09:20 --> 00:09:21 so it would be kind of too
00:09:21 --> 00:09:24 early to probably talk about results,
00:09:24 --> 00:09:26 but in terms of kind of
00:09:26 --> 00:09:29 your recruiting and your data collection,
00:09:29 --> 00:09:31 can you give us an idea of
00:09:31 --> 00:09:32 maybe where you're at and
00:09:32 --> 00:09:33 then maybe what the
00:09:33 --> 00:09:35 timeline looks for
00:09:35 --> 00:09:36 finishing up this project?
00:09:37 --> 00:09:37 Sure.
00:09:38 --> 00:09:41 So at this point in late
00:09:41 --> 00:09:43 February of twenty twenty five,
00:09:43 --> 00:09:44 we have twelve physical
00:09:44 --> 00:09:45 therapists enrolled.
00:09:46 --> 00:09:49 We also wanted to we were
00:09:49 --> 00:09:51 intentional in that the
00:09:51 --> 00:09:52 physical therapist that we
00:09:52 --> 00:09:54 approached for this study,
00:09:54 --> 00:09:55 we wanted to have a fairly
00:09:57 --> 00:09:59 a fairly equal distribution
00:09:59 --> 00:10:00 amongst those who have
00:10:00 --> 00:10:02 received or experienced or
00:10:02 --> 00:10:02 went through a manual
00:10:02 --> 00:10:04 therapy fellowship program.
00:10:05 --> 00:10:06 and another group that
00:10:06 --> 00:10:08 haven't because that
00:10:08 --> 00:10:10 potential experience could
00:10:11 --> 00:10:12 influence the outcomes and
00:10:12 --> 00:10:13 it could influence a lot of
00:10:13 --> 00:10:14 the outcomes that we're
00:10:14 --> 00:10:16 looking for in this study particularly.
00:10:17 --> 00:10:18 So we have, like I said,
00:10:18 --> 00:10:19 twelve physical therapists involved.
00:10:20 --> 00:10:22 The goal, the plan, the expectations,
00:10:22 --> 00:10:23 if you will,
00:10:23 --> 00:10:24 is that each of those
00:10:24 --> 00:10:26 physical therapists recruit
00:10:26 --> 00:10:28 and enroll eight patients
00:10:29 --> 00:10:30 over the course of the study.
00:10:30 --> 00:10:31 And right now,
00:10:31 --> 00:10:33 I think we have I think we
00:10:33 --> 00:10:34 have approximately eight
00:10:34 --> 00:10:35 patients that are enrolled
00:10:36 --> 00:10:37 across the twelve different
00:10:37 --> 00:10:38 physical therapists.
00:10:38 --> 00:10:41 So that's where we are right now.
00:10:41 --> 00:10:42 And I think it's too early
00:10:42 --> 00:10:43 to kind of do any
00:10:43 --> 00:10:44 preliminary analysis of anything.
00:10:45 --> 00:10:46 You know,
00:10:46 --> 00:10:47 that's really our main effort
00:10:47 --> 00:10:49 right now is to really
00:10:49 --> 00:10:50 focus on the recruitment
00:10:50 --> 00:10:52 and enrollment parts of the study.
00:10:52 --> 00:10:53 Yeah, that's great.
00:10:53 --> 00:10:54 And I mean,
00:10:54 --> 00:10:55 I like that you're looking at
00:10:55 --> 00:10:56 both angles of this.
00:10:57 --> 00:10:57 Do you,
00:10:58 --> 00:11:00 either from your own kind of
00:11:00 --> 00:11:01 research or clinical
00:11:01 --> 00:11:05 intuition or from other
00:11:05 --> 00:11:06 things maybe that are published,
00:11:06 --> 00:11:08 do you have a sense of,
00:11:09 --> 00:11:11 by parsing out maybe how much of this is
00:11:12 --> 00:11:13 How much of the effect might
00:11:13 --> 00:11:15 be related to the patient's
00:11:15 --> 00:11:17 contextual factors versus
00:11:17 --> 00:11:18 how much might be related
00:11:18 --> 00:11:19 to the clinician?
00:11:19 --> 00:11:19 I mean,
00:11:20 --> 00:11:21 are you thinking it might be a
00:11:22 --> 00:11:23 fifty fifty or do you think
00:11:23 --> 00:11:25 that maybe even like the
00:11:26 --> 00:11:28 provider's influence might
00:11:28 --> 00:11:29 be a lot higher than we thought?
00:11:29 --> 00:11:32 Yeah, so that's another great question,
00:11:32 --> 00:11:33 and that's something we
00:11:33 --> 00:11:34 considered when we kind of
00:11:34 --> 00:11:36 developed this grant.
00:11:36 --> 00:11:36 You know,
00:11:36 --> 00:11:37 if you look at the literature in
00:11:37 --> 00:11:38 this area,
00:11:38 --> 00:11:40 there's been quite a few
00:11:40 --> 00:11:42 studies that really focus
00:11:42 --> 00:11:43 on one or the other, right?
00:11:43 --> 00:11:45 The patient's perspective or
00:11:45 --> 00:11:46 the clinician's slash
00:11:46 --> 00:11:47 provider's perspective.
00:11:48 --> 00:11:49 And there's been a few
00:11:49 --> 00:11:50 studies that have actually
00:11:50 --> 00:11:52 looked at both and really
00:11:52 --> 00:11:54 looked at relationships
00:11:54 --> 00:11:56 amongst patients and providers.
00:11:57 --> 00:11:59 So that's kind of like our
00:11:59 --> 00:12:00 approach to this is that we
00:12:00 --> 00:12:03 wanted to look at both,
00:12:03 --> 00:12:04 but we also wanted to link
00:12:05 --> 00:12:07 specific patients with therapists,
00:12:08 --> 00:12:09 not as a therapist group as a whole.
00:12:10 --> 00:12:13 The question about what's my hypothesis,
00:12:13 --> 00:12:14 what do I think is stronger?
00:12:16 --> 00:12:18 I think in a perfect world,
00:12:18 --> 00:12:19 you might say that it's fifty-fifty,
00:12:20 --> 00:12:22 but I don't think that will be the case
00:12:24 --> 00:12:25 I think my gut instinct is
00:12:25 --> 00:12:27 probably telling me that a
00:12:28 --> 00:12:29 lot of this is probably
00:12:30 --> 00:12:33 more heavily driven by the provider.
00:12:34 --> 00:12:35 And again, I think, you know,
00:12:36 --> 00:12:37 a follow up question to
00:12:37 --> 00:12:39 this study would be, you know,
00:12:40 --> 00:12:41 wouldn't it be great if we
00:12:41 --> 00:12:42 had a better understanding
00:12:42 --> 00:12:44 of the influence of
00:12:44 --> 00:12:46 provider perspectives and
00:12:46 --> 00:12:47 how that can influence outcomes?
00:12:48 --> 00:12:49 And I had a really
00:12:49 --> 00:12:50 interesting talk with some
00:12:50 --> 00:12:51 of the leadership in our
00:12:51 --> 00:12:53 health system just to kind
00:12:53 --> 00:12:54 of get an idea like, you know,
00:12:55 --> 00:12:56 in a few years from now,
00:12:56 --> 00:12:57 would this be something
00:12:57 --> 00:12:59 that we would even consider?
00:12:59 --> 00:13:01 And the topic of really
00:13:01 --> 00:13:03 matching patients with
00:13:03 --> 00:13:06 providers that have similar attitudes,
00:13:06 --> 00:13:07 beliefs, what have you about,
00:13:07 --> 00:13:09 in this case, spinal manipulation.
00:13:10 --> 00:13:11 and you know I've talked to
00:13:11 --> 00:13:12 others about that and you
00:13:12 --> 00:13:14 know well that sounds like
00:13:14 --> 00:13:15 a great idea but you know
00:13:15 --> 00:13:16 that's that's not going to
00:13:16 --> 00:13:18 happen you know leadership
00:13:18 --> 00:13:19 in my system said that
00:13:19 --> 00:13:21 would be great if we could
00:13:21 --> 00:13:22 do that and are we there
00:13:23 --> 00:13:24 are we to the position that
00:13:24 --> 00:13:25 we can do that right now
00:13:26 --> 00:13:27 No,
00:13:27 --> 00:13:28 but just to hear that there's
00:13:28 --> 00:13:30 enthusiasm and interest and
00:13:30 --> 00:13:31 excitement from leadership
00:13:31 --> 00:13:33 on our system that, you know,
00:13:33 --> 00:13:34 this is maybe something we
00:13:34 --> 00:13:35 could look at in the future.
00:13:35 --> 00:13:37 You know, to me, that was exciting.
00:13:37 --> 00:13:38 And that really kind of
00:13:38 --> 00:13:40 pushed me a little further to say,
00:13:40 --> 00:13:42 you know, hey, this study, this study,
00:13:42 --> 00:13:43 the outcomes of this study
00:13:43 --> 00:13:45 could have relevance from a
00:13:45 --> 00:13:46 clinical practice perspective as well.
00:13:47 --> 00:13:49 Yeah, yeah, definitely.
00:13:49 --> 00:13:50 I mean, I think that's great.
00:13:50 --> 00:13:51 I mean,
00:13:51 --> 00:13:53 maybe any other future research
00:13:53 --> 00:13:54 directions that you're
00:13:54 --> 00:13:55 thinking along these lines?
00:13:55 --> 00:13:58 I mean, I know like in this area,
00:13:58 --> 00:13:59 only everyone can take a
00:14:00 --> 00:14:02 small bite out of the bigger problem.
00:14:02 --> 00:14:04 So whether for your research
00:14:04 --> 00:14:07 team or other teams that are out there,
00:14:08 --> 00:14:10 any other maybe big ideas
00:14:10 --> 00:14:11 or big questions that
00:14:12 --> 00:14:14 everyone needs to dissect a bit?
00:14:15 --> 00:14:16 Yeah,
00:14:16 --> 00:14:16 so one of the co-principal
00:14:17 --> 00:14:18 investigators on this study
00:14:18 --> 00:14:19 is Dr. Joe Bialawski.
00:14:19 --> 00:14:21 He's one of my colleagues at
00:14:21 --> 00:14:22 the University of Florida
00:14:22 --> 00:14:23 and Brooks Rehabilitation.
00:14:23 --> 00:14:25 And we both have a really
00:14:25 --> 00:14:26 shared interest in shared
00:14:26 --> 00:14:27 decision making.
00:14:28 --> 00:14:28 You know,
00:14:28 --> 00:14:31 we recently completed a small
00:14:31 --> 00:14:33 pilot study looking at, you know,
00:14:34 --> 00:14:36 how we can incorporate or
00:14:36 --> 00:14:37 integrate clinical practice
00:14:38 --> 00:14:40 guidelines into clinical
00:14:40 --> 00:14:41 practice with our patients.
00:14:41 --> 00:14:43 Because our patient partners tell us,
00:14:44 --> 00:14:45 although they may be aware
00:14:45 --> 00:14:46 of the guidelines,
00:14:46 --> 00:14:47 one of the real struggles
00:14:47 --> 00:14:49 or barriers is still how to
00:14:49 --> 00:14:51 implement them in clinical practice.
00:14:52 --> 00:14:53 So one of the things that we
00:14:53 --> 00:14:54 kind of looked at and we
00:14:54 --> 00:14:56 were interested in is, you know,
00:14:56 --> 00:14:56 this could be an
00:14:56 --> 00:14:59 opportunity for shared decision making.
00:14:59 --> 00:15:01 And I say that because, you know,
00:15:02 --> 00:15:03 shared decision-making in
00:15:03 --> 00:15:04 the outpatient physical
00:15:04 --> 00:15:05 therapy arena is a lot
00:15:06 --> 00:15:07 different than shared decision-making,
00:15:07 --> 00:15:09 let's say in primary care,
00:15:09 --> 00:15:10 because let's face it,
00:15:10 --> 00:15:12 a lot of the options that
00:15:12 --> 00:15:13 we can provide from an
00:15:13 --> 00:15:14 intervention perspective,
00:15:15 --> 00:15:18 all have very similar levels of risk.
00:15:18 --> 00:15:21 And that risk is probably very low, right?
00:15:21 --> 00:15:23 So how do we make this work?
00:15:24 --> 00:15:25 So that's one thing that we
00:15:25 --> 00:15:27 are interested in is kind of, you know,
00:15:27 --> 00:15:29 how do we really take the
00:15:29 --> 00:15:30 preliminary results of that
00:15:30 --> 00:15:32 small pilot study and kind
00:15:32 --> 00:15:33 of what we're looking at here and,
00:15:34 --> 00:15:35 you know,
00:15:35 --> 00:15:37 maybe look a little further in
00:15:37 --> 00:15:38 terms of how we can really
00:15:38 --> 00:15:39 integrate our patient
00:15:39 --> 00:15:41 preferences and our
00:15:41 --> 00:15:44 clinicians' experience in
00:15:44 --> 00:15:45 terms of clinical
00:15:45 --> 00:15:47 decision-making for our patients.
00:15:47 --> 00:15:48 Yeah, I like that direction.
00:15:49 --> 00:15:51 And lots of work needs to be done, I guess,
00:15:51 --> 00:15:52 by lots of folks on that.
00:15:52 --> 00:15:53 Definitely.
00:15:55 --> 00:15:56 I wonder if you could just
00:15:56 --> 00:15:59 share for me a little bit about, you know,
00:15:59 --> 00:16:01 for folks maybe looking for
00:16:01 --> 00:16:02 the clinical science and
00:16:02 --> 00:16:04 manual therapy grant, you know,
00:16:04 --> 00:16:07 we're in the process right now of that.
00:16:07 --> 00:16:08 And this is an award that
00:16:08 --> 00:16:10 we'll be doing every year.
00:16:12 --> 00:16:14 And at least for the next couple of years.
00:16:14 --> 00:16:15 So I just wonder if you had
00:16:15 --> 00:16:18 any advice or maybe just
00:16:18 --> 00:16:19 you could share a few
00:16:19 --> 00:16:20 thoughts about the process
00:16:20 --> 00:16:22 of going through that particular process.
00:16:23 --> 00:16:28 grant application with our organization.
00:16:28 --> 00:16:28 Sure.
00:16:28 --> 00:16:28 Yeah.
00:16:29 --> 00:16:33 And I'd like to thank the
00:16:33 --> 00:16:35 Paris Family Foundation for
00:16:35 --> 00:16:36 the opportunity.
00:16:36 --> 00:16:39 It was very timely for our
00:16:39 --> 00:16:41 group to kind of move forward with this.
00:16:41 --> 00:16:43 And I think the process in general was
00:16:44 --> 00:16:47 DRI say it was a fairly easy
00:16:47 --> 00:16:49 process for us to kind of,
00:16:49 --> 00:16:51 communicating with folks
00:16:51 --> 00:16:54 along the way was a seamless process.
00:16:54 --> 00:16:55 So that's the first thing I
00:16:55 --> 00:16:56 wanted to talk about.
00:16:57 --> 00:16:59 I think in terms of suggestions is,
00:16:59 --> 00:17:00 and I think this probably
00:17:00 --> 00:17:01 applies for a lot of
00:17:01 --> 00:17:02 different grant opportunities,
00:17:02 --> 00:17:03 grant mechanisms,
00:17:03 --> 00:17:05 is make sure your project
00:17:06 --> 00:17:07 idea is consistent with the
00:17:08 --> 00:17:09 overall mission and goals
00:17:10 --> 00:17:11 of the grant application.
00:17:13 --> 00:17:15 Because even if
00:17:15 --> 00:17:16 investigators have ideas
00:17:16 --> 00:17:19 about a novel idea, an innovative idea,
00:17:19 --> 00:17:19 an interesting idea,
00:17:20 --> 00:17:21 it needs to be in line and
00:17:21 --> 00:17:22 consistent with the call
00:17:22 --> 00:17:24 for the grant itself.
00:17:24 --> 00:17:25 I think another thing that's
00:17:25 --> 00:17:27 really important is to
00:17:27 --> 00:17:28 really develop your team,
00:17:29 --> 00:17:30 a strong team ahead of time.
00:17:31 --> 00:17:33 And a really important part of that team,
00:17:33 --> 00:17:35 at least in our experiences,
00:17:35 --> 00:17:37 is the clinical partners.
00:17:38 --> 00:17:38 You know,
00:17:38 --> 00:17:39 we've communicated with and we
00:17:40 --> 00:17:41 engaged our clinical
00:17:41 --> 00:17:42 partners even during the
00:17:42 --> 00:17:44 grant development stages to
00:17:44 --> 00:17:44 really get their
00:17:44 --> 00:17:46 perspective about this idea
00:17:47 --> 00:17:49 and how might this look in
00:17:49 --> 00:17:50 clinical practice.
00:17:51 --> 00:17:52 Conducted the study in
00:17:52 --> 00:17:53 clinical practice because
00:17:54 --> 00:17:54 that's where this study is
00:17:54 --> 00:17:55 being conducted.
00:17:55 --> 00:17:56 It's not a laboratory setting.
00:17:56 --> 00:17:58 This is really being done
00:17:58 --> 00:17:59 during routine clinical practice.
00:17:59 --> 00:18:01 So I think those are
00:18:01 --> 00:18:02 probably the most important
00:18:02 --> 00:18:05 points and comments in
00:18:05 --> 00:18:07 terms of advice for folks
00:18:07 --> 00:18:07 that might be thinking
00:18:07 --> 00:18:08 about this in the future.
00:18:09 --> 00:18:09 Yeah.
00:18:09 --> 00:18:10 Okay.
00:18:10 --> 00:18:10 Yeah.
00:18:10 --> 00:18:10 Thank you.
00:18:11 --> 00:18:11 Um,
00:18:12 --> 00:18:14 so just wondering as we kind of finish up,
00:18:14 --> 00:18:14 if, uh,
00:18:15 --> 00:18:17 you have any kind of last thoughts or, uh,
00:18:17 --> 00:18:19 any little pieces of wisdom,
00:18:19 --> 00:18:20 maybe you'd like to share
00:18:20 --> 00:18:23 with our listeners, uh, about, you know,
00:18:23 --> 00:18:24 building a successful
00:18:25 --> 00:18:27 academic and research career, uh,
00:18:27 --> 00:18:28 like you've done.
00:18:28 --> 00:18:30 Yeah.
00:18:30 --> 00:18:33 Um, so, you know, a few years ago,
00:18:33 --> 00:18:35 back in Cleveland at the, uh,
00:18:35 --> 00:18:36 annual conference,
00:18:36 --> 00:18:38 I was asked to give a talk on, um,
00:18:40 --> 00:18:40 on mentorship.
00:18:41 --> 00:18:43 And for the first time in
00:18:44 --> 00:18:45 probably fifteen years,
00:18:45 --> 00:18:46 it really forced me to sit
00:18:46 --> 00:18:49 down and think about my mentors.
00:18:49 --> 00:18:50 They're always on your mind,
00:18:50 --> 00:18:51 you know who they are,
00:18:51 --> 00:18:53 but to really talk about
00:18:54 --> 00:18:55 the influence of the mentors.
00:18:55 --> 00:18:57 So I think that's really,
00:18:57 --> 00:18:59 really important is for
00:18:59 --> 00:19:00 folks to identify strong
00:19:01 --> 00:19:03 personal and career mentors
00:19:04 --> 00:19:05 and do it early.
00:19:06 --> 00:19:07 And sometimes a single
00:19:07 --> 00:19:08 individual could kind of
00:19:08 --> 00:19:10 fill both of those, right?
00:19:10 --> 00:19:12 personal mentor and a career mentor.
00:19:13 --> 00:19:14 I think that's really important.
00:19:15 --> 00:19:16 I think developing your
00:19:16 --> 00:19:18 strong collaborator team
00:19:19 --> 00:19:20 And when I say collaborator team,
00:19:21 --> 00:19:22 I think it's important that
00:19:22 --> 00:19:23 folks think about real
00:19:24 --> 00:19:25 long-term collaborators and
00:19:25 --> 00:19:27 not just collaborators that
00:19:27 --> 00:19:28 want to be involved from a
00:19:28 --> 00:19:30 data collection perspective.
00:19:31 --> 00:19:32 The sooner you can develop
00:19:33 --> 00:19:34 and strengthen your team,
00:19:34 --> 00:19:37 I think it'll be a benefit to folks.
00:19:38 --> 00:19:39 I mentioned earlier about
00:19:39 --> 00:19:41 the collaboration with clinical partners.
00:19:42 --> 00:19:44 I think that's extremely important.
00:19:44 --> 00:19:47 And then the final piece of this,
00:19:47 --> 00:19:48 we did a little work
00:19:48 --> 00:19:50 several years ago in kind of
00:19:50 --> 00:19:51 developing partnerships
00:19:51 --> 00:19:52 with our patients.
00:19:53 --> 00:19:54 And that's a little bit more challenging.
00:19:54 --> 00:19:56 It's a little bit more difficult,
00:19:56 --> 00:19:58 especially sustaining those partnerships.
00:19:58 --> 00:20:00 But I think it was really
00:20:00 --> 00:20:02 valuable to me and it
00:20:02 --> 00:20:04 allowed us to kind of provide
00:20:04 --> 00:20:06 the patient's perspective in
00:20:06 --> 00:20:08 terms of ideas that we have
00:20:09 --> 00:20:10 for our future research projects.
00:20:11 --> 00:20:12 So I think those are
00:20:12 --> 00:20:14 probably the easiest things
00:20:14 --> 00:20:16 to think about in terms of my mind.
00:20:16 --> 00:20:19 And then finally, you know, reality,
00:20:20 --> 00:20:21 you know, it's not an easy journey.
00:20:22 --> 00:20:23 There will be times where
00:20:23 --> 00:20:25 you decide you want to
00:20:25 --> 00:20:27 switch your career or position again,
00:20:27 --> 00:20:28 maybe some folks.
00:20:29 --> 00:20:30 But I think you have to kind
00:20:30 --> 00:20:33 of keep the end picture in mind.
00:20:33 --> 00:20:35 And it's very rewarding,
00:20:35 --> 00:20:37 especially if your
00:20:37 --> 00:20:38 overarching goal is to
00:20:38 --> 00:20:40 improve clinical practice.
00:20:41 --> 00:20:42 Ultimately,
00:20:42 --> 00:20:43 it's going to benefit the
00:20:43 --> 00:20:44 patients that we serve.
00:20:45 --> 00:20:46 And I think something that
00:20:46 --> 00:20:47 can't be missed is it's
00:20:47 --> 00:20:48 also going to benefit the
00:20:48 --> 00:20:50 providers that care for those patients.
00:20:51 --> 00:20:53 So I think, you know,
00:20:53 --> 00:20:55 those are my pieces of wisdom,
00:20:55 --> 00:20:55 if you will.
00:20:57 --> 00:20:57 I think that's great.
00:20:58 --> 00:21:00 I've enjoyed this time with you, Jason.
00:21:01 --> 00:21:03 Thank you so much for taking
00:21:03 --> 00:21:05 some time out to talk to us
00:21:05 --> 00:21:07 about your current study,
00:21:07 --> 00:21:09 about the grant process,
00:21:09 --> 00:21:12 and just kind of future
00:21:12 --> 00:21:13 research directions and
00:21:14 --> 00:21:15 some great advice there.
00:21:16 --> 00:21:18 So we'll be looking forward
00:21:18 --> 00:21:19 to hearing more about your
00:21:19 --> 00:21:22 study and any future research endeavors.
00:21:23 --> 00:21:24 So again,
00:21:24 --> 00:21:26 Thank you and take care, Jason.
00:21:26 --> 00:21:27 Okay.
00:21:27 --> 00:21:27 Thank you, Skip.