Redefining Orthopedic Manual Physical Therapy (OMPT)

[00:00:00] [SPEAKER_01]: I'm hopeful that other member organizations of I-Fawn from other countries and other people in the fellowship and residency training area, other people who are expert clinicians in OMPT can look at this definition and make a determination to whether they think it's time to upgrade I-Fawns again and I'm hopeful that the work that we did here could positively influence that and move that conversation forward because I think it's time.

[00:00:34] [SPEAKER_00]: So, it is my pleasure to have Dr. Jason Silvernail on our A-Ompt Hands On Hands Out Podcast and I'm Megan Donaldson.

[00:00:44] [SPEAKER_00]: I'm the president of A-Ompt and a real privilege to have this gentleman talk with us today and I'm so excited that you said yes but you're that kind of guy.

[00:00:55] [SPEAKER_00]: I thought this might be a topic you would like to talk about today.

[00:00:58] [SPEAKER_01]: In fact, it's one of my favorite topics, man.

[00:01:00] [SPEAKER_01]: I could not be more pleased to be here.

[00:01:03] [SPEAKER_00]: Well Jason, you know, I want to know a little bit more about how you and your group wanted to take on this project and look at OMPT and a re-frameing, a new modern definition.

[00:01:18] [SPEAKER_00]: What inspired you to take on that project?

[00:01:20] [SPEAKER_01]: Well, that's a great question. This has just been one of my favorite topics and something I'm just so proud and honored to be able to be involved with.

[00:01:28] [SPEAKER_01]: You know, I've been at physical therapists for many, many years.

[00:01:32] [SPEAKER_01]: I'm in the US Army where I'm currently a Colonel on active duty and so because I'm a Colonel in the Army Act today, everything I talk with you about today is my personal opinion commentary.

[00:01:40] [SPEAKER_01]: It does not reflect the official policy of position of the US Army Department of Defense with the United States government but it does reflect my personal opinion as Dr. Jason Silvernail.

[00:01:48] [SPEAKER_01]: And so I think that, like, I guess the story of how this started, I guess there's a long story in a short story.

[00:01:55] [SPEAKER_01]: And the long story is that the Board of Directors at A&T, which is the US Member Organization of I-Font, commissioned this definition.

[00:02:05] [SPEAKER_01]: So this isn't my definition and it's not my author's opinion.

[00:02:08] [SPEAKER_01]: This is A&T's commissioned definition of orthopedic manual physical therapy.

[00:02:13] [SPEAKER_01]: That's how this whole thing got started. That's the long story.

[00:02:16] [SPEAKER_01]: And the short story is, Gale Dile told me to do it or ask me to do it and I said yes because I don't say no to Gale just like I don't say no to A&T.

[00:02:24] [SPEAKER_01]: So I was just been, it's just an amazing honor to be able to, you know, sort of bring these, this group of like supremely talented and experienced authors who just,

[00:02:34] [SPEAKER_01]: who's experienced just sort of spam the spectrum, there's, we have educators. We've got researchers. We've got expert clinicians.

[00:02:42] [SPEAKER_01]: We've got people who are all three and we were able to pull all these folks together and sit down and say okay, here is I-Font's definition of what OMPT is, what is our updated definition for this.

[00:02:58] [SPEAKER_01]: And it was one of the things that I think of the most when I think about this project is I think about how different people trained in different ways who come from different like historical traditions of OMPT maybe we could say,

[00:03:14] [SPEAKER_01]: we all agreed on almost everything, almost right away and there was just all we had to do is pull all that agreement together and put it together in a way that people can understand.

[00:03:25] [SPEAKER_01]: And I think we did a pretty good job and I know that people at Physical Therapy Journal act tip to them to determine this job and the review process of helping us.

[00:03:33] [SPEAKER_01]: It turns out that the original I-Font definition we work for was actually excellent and we only sort of expanded that in a way that made it easier for people to appreciate and easier for people to recognize maybe when they see it out there.

[00:03:48] [SPEAKER_00]: Yeah, and I think again, I appreciate you talking about I-Font because right, Amt is this representative body to I-Font.

[00:03:57] [SPEAKER_00]: So some people don't quite understand like okay well who is Amt and what's I-Font and how does that work with the A-BTA?

[00:04:03] [SPEAKER_00]: And so Jason we just signed our collaborative agreement with A-BTA who now again still recognizes as the body that refers and works with I-Font directly especially in the area of the OMPT practice.

[00:04:16] [SPEAKER_00]: So it makes sense that the board would say hey we need to make sure that this definition really fits what we're doing which was the charge.

[00:04:24] [SPEAKER_00]: And if you think about times right I mean you've been around for a while there's been this pendulum swing right.

[00:04:30] [SPEAKER_00]: What manual therapy is and what it's not and mostly what people think it is and so when you think about this article what you know and you think about your project what key changes are advancement in the field.

[00:04:45] [SPEAKER_00]: Do you think prompted us to do this charge or that you really felt inspired to take on this project?

[00:04:51] [SPEAKER_01]: Yeah I mean that really is I think the central question it's like why now and what changes did we make?

[00:04:58] [SPEAKER_01]: I think it gave us an opportunity to look again at that definition and really think about of all the ways in which we describe what we do.

[00:05:07] [SPEAKER_01]: How comprehensive is that is that definition and can we make that definition more comprehensive and more comprehensible to people?

[00:05:15] [SPEAKER_01]: We can it has to make sense to students it has to make sense to practitioners to instructors to our medical colleagues and other and in other professional groups to insurance payers.

[00:05:28] [SPEAKER_01]: And I think about a lot has changed since iPhones set that definition and one of the big changes has been really kind of a revolution in how we understand the mechanisms of me therapy where we really had thought you know for many many years maybe even you could make the argument hundreds of years.

[00:05:44] [SPEAKER_01]: We thought that manual therapy worked because some mechanical thing was moved or shifted in the body and you know we got more and more data

[00:05:52] [SPEAKER_01]: It said you know there's a lot more to it than that so I think that those sort of mechanisms were a big part of it and also we wanted to make sure that at the end of this definition.

[00:06:02] [SPEAKER_01]: We provided a way for you to identify it when you're still at.

[00:06:07] [SPEAKER_01]: So one of the things I like to talk about is that we didn't define manual therapy.

[00:06:11] [SPEAKER_01]: We defined orthopedic manual physical therapy and that's not the same as manual therapy, right?

[00:06:17] [SPEAKER_01]: There's a lot of people do manual therapy and you know and I think now I wish them all the best.

[00:06:21] [SPEAKER_01]: But what I do what we do is orthopedic manual physical therapy and we have a definition for that.

[00:06:27] [SPEAKER_01]: So we included a conceptual model which is the actions that people take when they practice OMPTP actions.

[00:06:35] [SPEAKER_01]: They take that's the conceptual model and then we also included distinguishing characteristics.

[00:06:40] [SPEAKER_01]: That means how can you recognize it when you see it?

[00:06:43] [SPEAKER_01]: So if you have that distinguishing characteristic list of front of you and you are say someone who's writing the clinical practice guideline,

[00:06:51] [SPEAKER_01]: you could pull up a randomized clinical trial and say, does this reflect OMPTP?

[00:06:58] [SPEAKER_01]: Or is this just an exercise trial by somebody who did some hands on care?

[00:07:03] [SPEAKER_01]: And you really will be able to tell the difference with that.

[00:07:06] [SPEAKER_01]: In addition, I gave us the opportunity to provide a patient case.

[00:07:10] [SPEAKER_01]: So one of the things that we sometimes run into is that people, especially practicing clinicians will say,

[00:07:15] [SPEAKER_01]: I feel like one of this stuff is just sort of, I don't know, maybe it's esoteric or it's hard to get my arms around.

[00:07:21] [SPEAKER_01]: How does this apply to me in the clinic day to day?

[00:07:26] [SPEAKER_01]: How do I apply this with a patient?

[00:07:28] [SPEAKER_01]: And the patient case allowed us to do that and the people at PTJ were so kind and allowed us not only the opportunity to create a great definition,

[00:07:37] [SPEAKER_01]: but to create a companion patient case that helps people understand that.

[00:07:40] [SPEAKER_00]: And so I love that because I think that's so important so people can really understand maybe as previous conceptions or misconceptions, right?

[00:07:49] [SPEAKER_00]: And understand that OMPTP may look different and is maybe applied differently, right?

[00:07:55] [SPEAKER_00]: And so in terms of the patient case do you feel like some of the takeaway really was, did you outline differences?

[00:08:03] [SPEAKER_00]: And I'm mostly for the our listeners here.

[00:08:05] [SPEAKER_00]: Do you feel like that you could distinguish some of the differences?

[00:08:09] [SPEAKER_00]: What manual therapy is versus what OMPTP is so that they could really understand the key differences, maybe in their own reading next time that they see a case or a trial that they can understand those different things.

[00:08:20] [SPEAKER_01]: Absolutely.

[00:08:21] [SPEAKER_01]: I think that as you read the case, you'll see different callouts in the text that explain how what the practitioner is doing applies to the conceptual law or how it applies to the distinguishing characteristics.

[00:08:33] [SPEAKER_01]: So you can see it like almost like playing it back live, right?

[00:08:36] [SPEAKER_01]: It's almost like if you could think about playing the video tape of a clinical encounter with a PT and a patient.

[00:08:43] [SPEAKER_01]: And at the bottom there's those little captions that run across the screen.

[00:08:47] [SPEAKER_01]: And that's kind of what those callouts are doing.

[00:08:49] [SPEAKER_01]: They're pointing out to you how the model gets applied in real time.

[00:08:54] [SPEAKER_01]: And I think that that is going to be a big value for a lot of people in understanding what we mean when we define it with PT.

[00:09:01] [SPEAKER_00]: And in addition, you brought up some other things which is really thinking about exercise approach, right?

[00:09:07] [SPEAKER_00]: And so I'm going to take the time just to ask more questions about OMPTP because I think that there's that space that people are like, well, you know, me and I'll therapy or OMPTP, like, right?

[00:09:19] [SPEAKER_00]: You're doing that.

[00:09:20] [SPEAKER_00]: Well, that's, you don't do that in addition to exercise like me and I'll therapy alone or exercise alone.

[00:09:26] [SPEAKER_00]: But the combination is really what we see right in the literature.

[00:09:30] [SPEAKER_00]: So maybe you can talk a little bit about how OMPTP definition really is not just doing your hands on, but there's more to it than that, right?

[00:09:38] [SPEAKER_00]: So can you elaborate on why maybe these this misconception around that, you know, if you're orthopedic, you know, if you're a peedic man, if you're a peeduc,

[00:09:45] [SPEAKER_00]: or it does include, right, that progression and thinking about how you're playing hands on and then hands on.

[00:09:52] [SPEAKER_01]: Yeah, that's right.

[00:09:53] [SPEAKER_01]: I see what you did there.

[00:09:55] [SPEAKER_01]: Yeah, and I think that really, that's the core of a lot of the misconceptions I think they'll be getting.

[00:10:00] [SPEAKER_01]: And I think, you know, part of it is just a natural evolution of how people's practice gets adapted as they move along.

[00:10:09] [SPEAKER_01]: There are a lot of groups, different professional groups who do exercise therapy with people beyond just pees.

[00:10:16] [SPEAKER_01]: There are a lot of people who do hands on therapy of some kind and not just pees.

[00:10:20] [SPEAKER_01]: So there are plenty of people who really just do hands on or really just do exercise.

[00:10:27] [SPEAKER_01]: And there aren't a lot of folks who really combine the two well.

[00:10:31] [SPEAKER_01]: And I think there are some groups outside of PT that might dispute that and some of that is absolutely fair.

[00:10:36] [SPEAKER_01]: There are people out there doing that, but yeah, I think in physical therapy and in our tradition of care,

[00:10:42] [SPEAKER_01]: our hands on techniques have always been done with a long-term mindset towards exercise and activity.

[00:10:49] [SPEAKER_01]: I mean, that is just a key part of who we are in PT.

[00:10:53] [SPEAKER_01]: And so one of the things that we tried to lay out is sort of a conceptual model.

[00:10:57] [SPEAKER_01]: Here are the actions you take.

[00:10:59] [SPEAKER_01]: So we have patient focused interviewing.

[00:11:01] [SPEAKER_01]: So I'm not asking you questions just to get my own diagnosis.

[00:11:04] [SPEAKER_01]: I'm my focus of the interview as on you as the patient.

[00:11:08] [SPEAKER_01]: But there's a planned and tailored physical exam, which means I don't just do the same exam to the same person.

[00:11:13] [SPEAKER_01]: What I choose to examine, and when I choose to examine it, and how vigorously my exam is conducted,

[00:11:19] [SPEAKER_01]: is based on my understanding of the problem that you have that came from that interview.

[00:11:24] [SPEAKER_01]: Right? There's a targeted exercise prescription that's again in action.

[00:11:28] [SPEAKER_01]: There's a hands-on skill therapy, and then there's activity in health coaching.

[00:11:32] [SPEAKER_01]: It's not like I heard once a personal trainer put it this way.

[00:11:35] [SPEAKER_01]: I don't care how much you can deadlift next week.

[00:11:38] [SPEAKER_01]: I care what your blood pressure is in 10 years.

[00:11:40] [SPEAKER_01]: And I think that's such a great encapsulation.

[00:11:44] [SPEAKER_01]: Because our charge for our patients is not just to get them feeling better right now.

[00:11:49] [SPEAKER_01]: For this problem they have here, but it's had a follow-up long to the rest of their life and keep them as healthy as possible for as long as possible.

[00:11:59] [SPEAKER_01]: And that's really the core of the conceptual model of the one PT.

[00:12:02] [SPEAKER_00]: Yeah, and I loved the distinguishing characteristics.

[00:12:07] [SPEAKER_00]: You know, as you just hit there, which is this patient-centered long-term mindset.

[00:12:11] [SPEAKER_00]: It's really not just in this one woman or episode of Care Right, it carries onward.

[00:12:16] [SPEAKER_00]: And then I really appreciate how you just spoke to the OMPTPs being really not just the examination,

[00:12:22] [SPEAKER_00]: but how that examination then drives the treatment.

[00:12:25] [SPEAKER_00]: And there is a progression right? Because if you're focusing on the judgment, you're reacting to how they're behaving,

[00:12:31] [SPEAKER_00]: whether it's, you know, if they're having more irritable types symptoms or if they're tolerant to the activity and you're able to progress,

[00:12:37] [SPEAKER_00]: but always thinking about kind of the end in mind.

[00:12:40] [SPEAKER_00]: And again, I just really appreciate the way, especially in the paper, right?

[00:12:44] [SPEAKER_00]: You have these models and you have great figures by the way.

[00:12:47] [SPEAKER_00]: Biggers and tables are my favorite.

[00:12:49] [SPEAKER_00]: But from a structured thinking standpoint, like it helps readers grab a few nuggets that can really appreciate.

[00:12:55] [SPEAKER_00]: And so I really appreciate it definitely the patient's centeredness of OMPTP.

[00:12:59] [SPEAKER_00]: And I think sometimes that gets lost in translation.

[00:13:04] [SPEAKER_00]: And so kind of as you're writing this, how did you end up landing in that space where a patient centered became one of those distinguishing characteristics?

[00:13:12] [SPEAKER_01]: Yeah, that's a great question.

[00:13:13] [SPEAKER_01]: I wonder, would you let me caveat again a little bit more on something we just talked about?

[00:13:18] [SPEAKER_01]: I think you did a really good job illustrating like how this sort of interaction between the patient and the practitioner is sort of iterative and systematic and continuous, right?

[00:13:28] [SPEAKER_01]: So I think that a big part of some of the discussion around hands on care, especially over the last several years, has been this idea that manual therapy or hands on therapy is passive care.

[00:13:39] [SPEAKER_01]: Meaning the patient just lays there and ideally just sort of disquiet, I suppose.

[00:13:44] [SPEAKER_01]: And the practitioner does some things to them and then after that something is supposedly different.

[00:13:49] [SPEAKER_01]: And you know if you're hearing this right now and you are an infysical therapy and you're practicing on a PT,

[00:13:55] [SPEAKER_01]: you know that that has nothing to do with what we do in the clinic and it doesn't sound like anything that you've ever been taught.

[00:14:04] [SPEAKER_01]: And that sort of continuous interaction is a big part of what makes this process of care not passive, it's active and interactive kind of at all times.

[00:14:16] [SPEAKER_01]: So thanks for letting me go back to hit that point.

[00:14:18] [SPEAKER_00]: No, absolutely. And I think it's a distinguishing feature of your profession.

[00:14:23] [SPEAKER_00]: Maybe versus other professions who maybe doing a similar type of an approach in terms of at least the hands on aspect.

[00:14:30] [SPEAKER_00]: It's the integration on patient interaction and patient response to that right that we really are using in our reasoning.

[00:14:36] [SPEAKER_00]: So I really appreciate you outlining that.

[00:14:38] [SPEAKER_00]: It's very helpful, very helpful.

[00:14:40] [SPEAKER_00]: And good to add how it's not just a passive approach. I think there's been some great papers on that too and you know certainly I think we have to highlight why that is essential understanding.

[00:14:52] [SPEAKER_00]: So, you know, as we think about the impact of a paper and you know Jason I can totally appreciate you had a rock star group in this group.

[00:15:00] [SPEAKER_00]: And there are so many of them and colleagues with many of them.

[00:15:04] [SPEAKER_00]: You know, I really think you didn't write it just to write the paper right you're hoping that there was an impact.

[00:15:10] [SPEAKER_00]: And what do you see is maybe the greatest impact that this paper could have.

[00:15:15] [SPEAKER_00]: And then maybe we can talk a little bit about where you see this maybe next step going.

[00:15:21] [SPEAKER_01]: Yeah, I really, I'm hopeful that this has a big impact across the profession in several different ways and I think here's a couple of them.

[00:15:29] [SPEAKER_01]: So one of the things I would like is to get to a point where physical therapy students start to understand that there's this thing called manual therapy which is really sort of general.

[00:15:39] [SPEAKER_01]: But then there is this approach called OMPT, which is the systematic and active clinical reasoning process.

[00:15:46] [SPEAKER_01]: And so when they see those distinguishing characteristics laid out of how to recognize the one PT and they see that conceptual model the actions that they take with the patient.

[00:15:55] [SPEAKER_01]: They can better understand when they're receiving education. Hey, is this person just teaching me some manual therapy or is this person teaching me the process of LMPT and those things are those things are very different and important.

[00:16:07] [SPEAKER_01]: So I'm hopeful that it makes a big difference for students.

[00:16:10] [SPEAKER_01]: I'm hopeful that it also makes a big difference for practitioners.

[00:16:12] [SPEAKER_01]: So people who are graduated already practicing DBT's who look around at the Columbia Cupia of options in the continuing medical education route area and say, you know, I if I'm going to choose and plan continuing education help make me better to make my patients better.

[00:16:33] [SPEAKER_01]: How can I choose wisely and how can I choose a recognized path that puts me on a pathway with the potential for fellowship training in the future.

[00:16:44] [SPEAKER_01]: But I think Gail dial put it this way like, OMPT gets trained at all levels of PT education. If you're in an entry level program they're going to give you OMPT skills.

[00:16:53] [SPEAKER_01]: If you are a graduate and you're out at a CME course, you might get a block of OMPT for a weekend or a week or something like that. You might get a OMPT in a residency or an fellowship.

[00:17:05] [SPEAKER_01]: And at each of those levels as we move up from entry level to CME to a residency to fellowship there is there is kind of a point estimate if you let me use this statistics expression for a moment.

[00:17:17] [SPEAKER_01]: I know that's really what people get excited about in the podcast. I hope it talks about this.

[00:17:21] [SPEAKER_01]: There's a point estimate for what kind of skill we are looking for in an entry level provider who learn to OMPT and then there's a confidence interval around that, right?

[00:17:32] [SPEAKER_01]: And ideally that might overla with a confidence interval and the point estimate for a graduate person who's pursuing a CME course.

[00:17:41] [SPEAKER_01]: And then a residency should have a higher point estimate with the confidence interval around it and so on for fellowship training.

[00:17:49] [SPEAKER_01]: And so you can really see OMPT is a step stone approach, as you continually develop some of the key things that you need to be the most effective for your patients that you can be.

[00:18:01] [SPEAKER_01]: And one of our diagrams kind of shows that sort of stepwise thing. Thank you for calling out the diagrams. We were a TARDO that was a pleasure.

[00:18:08] [SPEAKER_00]: I love them. And I guess, you know, I think about myself is probably a good representation of many others that visual learning is a great way to learn.

[00:18:17] [SPEAKER_00]: Although I can read papers and do things that sometimes just have a visual aid. I think it's super helpful.

[00:18:23] [SPEAKER_00]: You know, Jason, you bring out something that I really appreciate which is the master adaptive learning model, right?

[00:18:28] [SPEAKER_00]: Which is that we're over time hopefully getting to a point or point where lifelong learning is just what we do and we continue to grow over fine and improve our practice great to expertise of care.

[00:18:38] [SPEAKER_00]: And so I think that this is a great frame. So people can understand that this is almost like with within itself, Odomain, right?

[00:18:49] [SPEAKER_00]: And in that right there is plenty of these, I would say, domains within that like reasoning and communication practices and other aspects.

[00:18:58] [SPEAKER_00]: And so some of that you have written out here, you know, very detailed. Do you see this paper is maybe being a space where as we're looking to maybe think about competency based education.

[00:19:09] [SPEAKER_00]: There's elements in this paper that could help to drive some of those thoughts forward.

[00:19:15] [SPEAKER_01]: Yeah, and I think one of the things that struck me the most about working with this absolute all-star author list that AOMs came up with for this is just how similarly we all have a lot of experience.

[00:19:28] [SPEAKER_01]: And how aligned we all were on the concept not only of lifelong learning, I think people talk about that. Like I'm a lifelong learner.

[00:19:37] [SPEAKER_01]: But we can demonstrate how a systematic reasoning process like OMPT facilitates lifelong learning by providing a step-wise competency ladder that you can climb.

[00:19:50] [SPEAKER_01]: And that has competencies that can be tested and are reproducible within each training, in between different trainees to find that point estimate.

[00:20:03] [SPEAKER_01]: And that confidence interval based on where you are on that level.

[00:20:06] [SPEAKER_00]: Yeah, and for our listeners, I mean, you have some impressive people on this group, right?

[00:20:12] [SPEAKER_00]: So Gail Dial is a rock star in his own right in OMPT and he's been long standing, especially Philly with the Arid Baylor program. And again, what do you make model they have?

[00:20:23] [SPEAKER_00]: Right? And that he has trained a ton of people and just excellent excellent resource.

[00:20:28] [SPEAKER_00]: You know, again, I see some of these other authors and quite impressive.

[00:20:31] [SPEAKER_00]: One of those super interesting is my colleague, Gail Denson, who is not an OMPT or fellow or really tied to that, but her passion is education.

[00:20:43] [SPEAKER_00]: And I really appreciate she's one who has really subscribed to the master adaptive learning model.

[00:20:48] [SPEAKER_00]: And I am just curious, you know, as you were thinking these things through. Did you find that again somebody who didn't have that same training could definitely align with the kind of the definition in the pathway that you guys were taking?

[00:21:02] [SPEAKER_01]: Yeah, I think Gail Genson clicked right in like a Lego. She fully understood what we were trying to do in terms of describing this pathway.

[00:21:11] [SPEAKER_01]: She fully, like she has a very deep understanding of learning models, practice models for expertise of the way in which we need to structure our systems to provide a long-term pathway for people.

[00:21:25] [SPEAKER_01]: A way that we can describe different levels of expertise and competency in different domains. And she brought all of that to help us with this paper, which is a great addition.

[00:21:34] [SPEAKER_00]: Yeah, well I really appreciate that insight because I think that we are just starting to really think about how we need to recognize maybe even the language differences.

[00:21:48] [SPEAKER_00]: Right? So people say me and I know therapy and that's oftentimes because it's identified as a CPT code.

[00:21:54] [SPEAKER_00]: And this is what students are introduced to right? And sometimes they forget me and I know therapy is really a whole process not just a technique.

[00:22:01] [SPEAKER_00]: And some people are trying that it's a technique. And so, you know, as you're thinking about educators, so I know what you think about the student side and I know what you think about from the practitioner side.

[00:22:12] [SPEAKER_00]: How do you think this paper could be used in entry-level educational settings?

[00:22:17] [SPEAKER_01]: Well, what I'm hopeful of is I'm hopeful that our entry-level faculty, well first of all, you know, if they're faculty in a DPT program, they understand a lot about human education,

[00:22:30] [SPEAKER_01]: how people learn and all of these things. So I don't think there's anything here that's going to be like a surprise to a faculty member.

[00:22:36] [SPEAKER_01]: But what I'm hopeful is, is that they'll be able to see in this definition. They'll see in this description the kinds of progressive competencies that they already understand from other contexts and are able to apply that to OMPT.

[00:22:51] [SPEAKER_01]: Such that when they're teaching students, OMPT competencies, they don't just do one part of it. So let's look at the distinguishing characteristics for example.

[00:22:59] [SPEAKER_01]: That's how you can identify OMPT-25 advanced up specialty training, focus on clinical judgment, expertise in exam expertise and treatment, patients that are long term mindset.

[00:23:10] [SPEAKER_01]: So if they're teaching the expertise and treatment part, which is totally okay and I spent plenty of time learning all that from Yale and others, that wasn't it. That wasn't the only thing we did.

[00:23:21] [SPEAKER_01]: And so I'm hopeful that the educator will look at that and think, oh, I can't just teach them that.

[00:23:25] [SPEAKER_01]: I also need to include some of those other distinguishing characteristics if I'm going to call it OMPT.

[00:23:31] [SPEAKER_01]: And how do I choose what actions I want the student to be able to demonstrate? Well, here's our conceptual model that leads them to the right kind of actions to take.

[00:23:42] [SPEAKER_01]: And I'm hopeful that they can look at those things and read the paper and be able to see, I immediately see how I can take my block of instruction in manual or OMPT care for patients.

[00:23:54] [SPEAKER_01]: And I can structure it like that so that it makes sense for that definition.

[00:23:59] [SPEAKER_01]: And I'm hopeful that they find that that's a more complete way to teach and it's a way that more closely aligns with the tenets of OMPT.

[00:24:08] [SPEAKER_00]: That's a great segue to my next question, which is, what do you want next out of this paper in terms of opportunities to influence change?

[00:24:16] [SPEAKER_01]: Well, you know, one of the things that one of the areas I'm hopeful to get change in is in the areas of how we interpret and summarize evidence for recommendations and in systematic reviews.

[00:24:32] [SPEAKER_01]: And, you know, so like probably many people listening, you know, I've been on expert panels.

[00:24:37] [SPEAKER_01]: I've developed clinical practice guidelines. I've participated in systematic reviews and I can tell you, you know, behind some of those closed doors when you get people who aren't really closely understanding of OMPT.

[00:24:52] [SPEAKER_01]: You get a lot of folks who want to slice and dice things in different groups.

[00:24:56] [SPEAKER_01]: And I've been in a clinical practice guideline group, but they said, well, this study here, this had manual therapy. So we're going to put it in the manual therapy bucket.

[00:25:06] [SPEAKER_01]: Like, well, but it also had exercise. You're not going to put it in the exercise bucket. Well, now that had a hand, but it had hands on care though.

[00:25:12] [SPEAKER_01]: Like, wait, so why are we using that one thing to make the definition and to make that and to make that distinction?

[00:25:19] [SPEAKER_01]: You know, one of the things people have talked about in this area for some time is they said, oh, well you've got this definition paper. You know, you're people, but you know, you guys are all manual therapy people. So your your bias toward manual therapy.

[00:25:32] [SPEAKER_01]: Okay, let's talk about it. What do we mean when we say bias? Well, I think sort of a quick summary or blue collar of quick explanation of bias is that I'm treating one thing out of a list differently for no good reason.

[00:25:47] [SPEAKER_01]: So when we looked at our distinguishing characteristics, expertise and treatment is only one of the five. And we're treating that treatment. We are we are categorizing. We are describing it.

[00:25:59] [SPEAKER_01]: We're exposing it to scrutiny to the exact same level of scrutiny and attention that we have to a patient center long term mindset or advanced subspecialty training.

[00:26:09] [SPEAKER_01]: And when people are a little bit nervous or concerned about this definition, they never seem to call those things out. They never seem to raise their hand and say, you know, I've got a problem. I think your bias for a patient center long term mindset.

[00:26:21] [SPEAKER_01]: No one has ever said that to me, right? They've only focused on the hands-on part of it. So I guess the at the end of all that is what I'm saying is some people come to this definition biased, but it's not us because we're treating all of those those characteristics with the same level of rigor and care.

[00:26:38] [SPEAKER_01]: And I'm hopeful that when we get to the clinical practice guideline or systematic review stage, that people who are doing this kind of work will be able to look and recognize the difference between a trial of OMPT and a trial manual therapy.

[00:26:54] [SPEAKER_01]: Because I think, and I think you think in many of the people who are listening along, we believe that OMPT provides higher value in different care. And we already have quite a bit of evidence to demonstrate that and, oh by the way, we linked it with the paper.

[00:27:07] [SPEAKER_00]: Right? Well, I'm going to circle a one more question and then we'll wrap this up. So, you know, you started off by saying, I've bumped has the definition.

[00:27:17] [SPEAKER_00]: So, you've created one from that definition and you have a more comprehensive description associated with it. How do you think this paper could be used to maybe influence the practice of OMPT internationally?

[00:27:32] [SPEAKER_01]: Yeah, I'm hopeful that other member organizations of OMPT from other countries and other people in the fellowship and residency training area, other people who are expert clinicians in OMPT can look at this definition.

[00:27:48] [SPEAKER_01]: And make a determination is to whether they think it's time to upgrade iPhones again.

[00:27:52] [SPEAKER_01]: And I'm hopeful that the work that we did here could positively influence that and move that conversation forward because I think it's time.

[00:28:01] [SPEAKER_01]: One of the things that I thought about is I reviewed the older definition that I thought provided was just kind of how ahead of its time it was.

[00:28:09] [SPEAKER_01]: And how impressive and detailed that it was. And so the opportunity to add on to that and to bring that into bringing some new knowledge and new descriptions of practice to that was just an amazing opportunity.

[00:28:24] [SPEAKER_01]: And it was a great honor to be able to sit on that panel to have those conversations with that, you know,

[00:28:31] [SPEAKER_01]: most expert group and to be able to publish that paper which are really great experience.

[00:28:37] [SPEAKER_00]: Well Jason, thank you so much for, you know, first of all your work here and your dedication to the profession.

[00:28:43] [SPEAKER_00]: Thank you for your service always and all that you stand for and represent for our country so grateful to you.

[00:28:49] [SPEAKER_00]: And so grateful for just the conversation today, right, where we can have some kind of conversation about what was behind the screen is paper and some of the challenges and things you all had to work through.

[00:28:59] [SPEAKER_00]: And then to me really thinking about where's the influence and the opportunity for us to be a better version of where we are now five years from now in paper like this, right, that really helps to give some shape with some outline structure that helps multiple audience to from a student to practicing clinicians to educators.

[00:29:17] [SPEAKER_00]: And maybe even thinking about organizations that then structure themselves. So, AOMT is definitely one that's benefited from this so thank you for that.

[00:29:26] [SPEAKER_00]: And I hope that I, fondful also have an opportunity to consider if this is something that they would like to, you know, consider for adoption and or review.

[00:29:34] [SPEAKER_00]: We're sharing and so, you know, is that I found recently and they have some incredible people there and I'm certain that there will be opportunities for those collaborations.

[00:29:42] [SPEAKER_00]: Have a good four or two. Yep, well Jason, thank you so much for joining us on the AOMT hands-on hands-off podcast.

[00:29:49] [SPEAKER_00]: It's a newer podcast who are always looking to make sure we're getting some more listeners and opportunities to share awesome speakers and the work that they're doing.

[00:29:58] [SPEAKER_00]: So thank you for making that time tonight and I appreciate you.