WEBVTT 00:00:00.009 --> 00:00:04.530 play one of these little graphic things, 00:00:04.551 --> 00:00:05.190 and then we'll kick it off. 00:00:05.751 --> 00:00:06.171 Sounds good. 00:00:06.671 --> 00:00:07.410 All right, let's do this thing. 00:00:07.972 --> 00:00:08.371 All right. 00:00:08.391 --> 00:00:14.814 All right, welcome to Orthostatic, 00:00:14.853 --> 00:00:16.153 a podcast created by the 00:00:16.193 --> 00:00:17.855 Academy of Orthopedic Physical Therapy. 00:00:18.614 --> 00:00:19.775 Keelan Ensky is on the show today. 00:00:19.815 --> 00:00:20.696 Keelan, welcome to the program. 00:00:21.265 --> 00:00:21.507 Thanks. 00:00:21.527 --> 00:00:21.946 Appreciate it. 00:00:21.966 --> 00:00:22.548 Thanks for having me. 00:00:22.888 --> 00:00:23.591 What's your background? 00:00:23.631 --> 00:00:24.792 You've done a bunch of 00:00:24.812 --> 00:00:25.714 different things in your career. 00:00:25.734 --> 00:00:27.518 What do you get to do? 00:00:27.557 --> 00:00:28.158 I'm not going to say what do 00:00:28.178 --> 00:00:28.679 you have to do. 00:00:28.699 --> 00:00:29.361 I'm going to say what do you 00:00:29.442 --> 00:00:31.184 get to do now in your PT career? 00:00:31.823 --> 00:00:32.283 Yeah. 00:00:32.302 --> 00:00:32.523 Yeah. 00:00:32.603 --> 00:00:33.963 It's kind of a mixed role that, uh, 00:00:34.225 --> 00:00:35.585 kind of has evolved over time. 00:00:35.604 --> 00:00:36.886 Uh, first and foremost, 00:00:36.926 --> 00:00:38.067 I still get to treat patients, 00:00:38.106 --> 00:00:38.927 which is great. 00:00:38.948 --> 00:00:39.628 It's something I would never 00:00:39.667 --> 00:00:41.168 want to fully leave behind. 00:00:41.228 --> 00:00:43.109 It may not be as much as I used to, but, 00:00:43.210 --> 00:00:43.771 uh, I, 00:00:43.930 --> 00:00:45.911 I still see patients almost not 00:00:45.951 --> 00:00:46.633 exclusively, 00:00:46.692 --> 00:00:47.993 but probably 90% with hip 00:00:48.033 --> 00:00:49.954 related pathologies of different types, 00:00:50.115 --> 00:00:51.415 non-surgical post-surgical. 00:00:51.956 --> 00:00:52.756 Um, I administrate, 00:00:53.036 --> 00:00:54.017 I'm an administrator for 00:00:54.137 --> 00:00:54.997 our residency programs. 00:00:55.018 --> 00:00:56.499 We have five within UPMC and 00:00:56.838 --> 00:00:57.899 day-to-day I'm in charge of 00:00:57.920 --> 00:00:59.040 the orthopedic program. 00:00:59.121 --> 00:00:59.640 And, uh, um, 00:01:00.213 --> 00:01:00.713 I have a little bit of a 00:01:00.732 --> 00:01:01.973 role with our clinical innovation, 00:01:02.033 --> 00:01:02.914 which is anything from 00:01:02.933 --> 00:01:03.933 telehealth to some of the 00:01:03.954 --> 00:01:04.914 things that are coming down the pipe, 00:01:04.933 --> 00:01:05.834 particularly in orthopedics 00:01:05.875 --> 00:01:07.795 and sports medicine, physical therapy. 00:01:08.355 --> 00:01:09.835 And then also a role, 00:01:09.855 --> 00:01:10.975 I still am an adjunct 00:01:11.016 --> 00:01:12.075 faculty at the University of Pittsburgh. 00:01:12.096 --> 00:01:12.917 And for the most part, 00:01:13.296 --> 00:01:15.096 for the residential DPT program, 00:01:15.477 --> 00:01:17.138 I teach most of the hip-related content. 00:01:18.052 --> 00:01:18.311 All right. 00:01:18.331 --> 00:01:18.912 So you're the guy. 00:01:18.951 --> 00:01:19.632 You're the guy for this. 00:01:19.673 --> 00:01:21.192 This is right down the road. 00:01:21.352 --> 00:01:23.394 We're talking about 00:01:23.493 --> 00:01:26.314 navigating orthopedic surgery recovery, 00:01:26.436 --> 00:01:27.896 something you're clearly familiar with. 00:01:27.915 --> 00:01:29.057 I wanted the audience to know that. 00:01:29.096 --> 00:01:30.816 So let's talk about big 00:01:30.956 --> 00:01:33.197 picture key factors in 00:01:33.337 --> 00:01:35.039 successful post-surgical 00:01:35.099 --> 00:01:37.099 recovery in orthopedics. 00:01:37.120 --> 00:01:38.000 And this can be anything 00:01:38.040 --> 00:01:39.600 from clinical to education 00:01:39.661 --> 00:01:40.421 to communication. 00:01:41.061 --> 00:01:41.882 If someone were to say, 00:01:41.921 --> 00:01:43.242 what are these key factors? 00:01:44.423 --> 00:01:45.022 How would you answer? 00:01:45.784 --> 00:01:46.403 You said one of them. 00:01:46.990 --> 00:01:47.751 Communication. 00:01:47.951 --> 00:01:48.873 And that's communication 00:01:49.572 --> 00:01:50.453 with the therapist, 00:01:50.474 --> 00:01:52.296 the physical therapist, the surgeon, 00:01:52.335 --> 00:01:53.677 the patient care team members. 00:01:53.697 --> 00:01:55.799 It's just crucial to understand, uh, 00:01:55.838 --> 00:01:56.060 you know, 00:01:56.219 --> 00:01:57.320 on our side from the therapist 00:01:57.340 --> 00:01:57.801 perspective, 00:01:58.001 --> 00:01:59.162 what procedure is performed 00:01:59.182 --> 00:01:59.742 because not all the 00:01:59.763 --> 00:02:00.664 procedures are the same. 00:02:00.703 --> 00:02:03.206 They're categorically maybe similar, 00:02:03.305 --> 00:02:04.466 but there are variations 00:02:04.486 --> 00:02:05.308 that could greatly affect 00:02:05.347 --> 00:02:06.289 the rehabilitation. 00:02:06.308 --> 00:02:06.349 Um, 00:02:07.739 --> 00:02:09.419 communication between us, the patient. 00:02:09.681 --> 00:02:11.823 It's crucial we monitor their response, 00:02:11.862 --> 00:02:12.543 not only for things that 00:02:12.582 --> 00:02:14.084 maybe are signs of things 00:02:14.125 --> 00:02:14.944 not going the right way, 00:02:15.265 --> 00:02:16.325 but also we use that 00:02:16.385 --> 00:02:17.187 response to some of our 00:02:17.227 --> 00:02:18.587 criteria to progress people 00:02:18.647 --> 00:02:20.370 through the rehabilitation protocols. 00:02:22.412 --> 00:02:23.733 Along with that, compliance. 00:02:24.753 --> 00:02:24.973 I think 00:02:25.389 --> 00:02:26.270 I think we all know that. 00:02:26.330 --> 00:02:26.610 Right. 00:02:26.669 --> 00:02:28.591 And, and, but when we say compliance, 00:02:28.651 --> 00:02:29.790 it's not just consistency 00:02:29.811 --> 00:02:30.592 that they're doing things, 00:02:30.632 --> 00:02:31.611 but the quality of which 00:02:31.651 --> 00:02:33.051 they're doing things as well. 00:02:33.472 --> 00:02:34.992 Not always time that is part of it, 00:02:35.032 --> 00:02:36.272 but it's also, you know, 00:02:36.532 --> 00:02:38.193 are they doing things correctly, 00:02:38.253 --> 00:02:39.554 the right order, et cetera. 00:02:39.933 --> 00:02:40.534 And we're, 00:02:40.634 --> 00:02:41.775 we're the primary drivers of 00:02:41.814 --> 00:02:43.336 that other than the patient themselves. 00:02:43.895 --> 00:02:44.096 Sure. 00:02:44.915 --> 00:02:45.836 And is there a third that 00:02:45.855 --> 00:02:46.556 you might throw in there on 00:02:46.576 --> 00:02:47.896 top of communication and compliance? 00:02:48.498 --> 00:02:48.758 Yeah, 00:02:49.098 --> 00:02:50.280 and they probably fall within that 00:02:51.020 --> 00:02:52.121 kind of subdomains of it, 00:02:52.140 --> 00:02:52.860 but it's constant 00:02:52.881 --> 00:02:54.961 reevaluation and review of goals. 00:02:55.021 --> 00:02:55.921 So reevaluation, 00:02:55.981 --> 00:02:57.223 how are they doing objectively? 00:02:57.962 --> 00:02:59.963 Are they following the expected trajectory, 00:02:59.984 --> 00:03:01.544 which there's another variation there, 00:03:02.205 --> 00:03:03.506 but also review of goals. 00:03:04.165 --> 00:03:04.825 Are we meeting that 00:03:04.866 --> 00:03:06.787 patient's goals within what 00:03:06.847 --> 00:03:08.147 is expected at that point? 00:03:08.168 --> 00:03:09.108 And sometimes that's reeling 00:03:09.127 --> 00:03:09.949 them back in and then let 00:03:09.989 --> 00:03:11.468 them know what your goal is great, 00:03:11.649 --> 00:03:12.729 but is it realistic for 00:03:12.810 --> 00:03:13.349 where you are in the 00:03:13.370 --> 00:03:14.450 rehabilitation process? 00:03:14.471 --> 00:03:14.991 And that can be a 00:03:15.531 --> 00:03:17.032 challenging conversation at times. 00:03:17.489 --> 00:03:17.688 Right, 00:03:17.788 --> 00:03:19.110 but a conversation that should be 00:03:19.150 --> 00:03:20.871 had in the earlier I imagine you have it, 00:03:21.231 --> 00:03:21.891 the better that 00:03:22.012 --> 00:03:23.312 understanding has a chance 00:03:23.353 --> 00:03:24.394 of being achieved. 00:03:24.835 --> 00:03:25.635 Earlier and often. 00:03:25.836 --> 00:03:26.096 Correct. 00:03:26.477 --> 00:03:26.736 All right. 00:03:27.276 --> 00:03:28.979 So your very first C, 00:03:29.019 --> 00:03:30.039 and I don't think we even planned on that, 00:03:30.060 --> 00:03:31.781 but that was three Cs, right? 00:03:31.800 --> 00:03:33.842 We had compliance. 00:03:35.003 --> 00:03:38.046 So how do PTs collaborate with surgeons? 00:03:38.067 --> 00:03:38.627 Because now you're 00:03:38.646 --> 00:03:40.068 mentioning in terms of communication, 00:03:40.168 --> 00:03:41.269 all the different people in 00:03:41.329 --> 00:03:43.812 our neighborhood or on the rehab team, 00:03:43.872 --> 00:03:44.051 right? 00:03:44.592 --> 00:03:45.693 How do PTs collaborate or 00:03:45.712 --> 00:03:46.373 how do you suggest they 00:03:46.394 --> 00:03:47.514 collaborate well with 00:03:47.594 --> 00:03:49.757 surgeons to ensure optimal 00:03:49.796 --> 00:03:50.877 recovery outcomes? 00:03:51.481 --> 00:03:51.681 Yeah. 00:03:51.701 --> 00:03:52.201 And that, and you know, 00:03:52.222 --> 00:03:53.082 and that can be a challenge. 00:03:53.182 --> 00:03:54.362 I'm fortunate in our system. 00:03:54.402 --> 00:03:54.582 You know, 00:03:54.603 --> 00:03:55.704 we're an academic medical system. 00:03:55.723 --> 00:03:56.604 A lot of the surgeons that I 00:03:56.644 --> 00:03:57.764 work with are down the hall 00:03:57.884 --> 00:03:59.145 or I happen to know them. 00:03:59.165 --> 00:04:00.366 I've been doing this for a while, 00:04:00.765 --> 00:04:02.287 but irregardless, you know, 00:04:02.306 --> 00:04:03.026 that open line of 00:04:03.086 --> 00:04:05.207 communication and really I look at us, 00:04:05.929 --> 00:04:07.068 our role is so valuable in 00:04:07.169 --> 00:04:08.229 communication because we 00:04:08.270 --> 00:04:09.631 are the primary and most 00:04:09.911 --> 00:04:10.931 frequent touch points for 00:04:10.991 --> 00:04:12.312 the patient for us to 00:04:12.412 --> 00:04:13.391 advocate what is going on 00:04:13.412 --> 00:04:14.532 with the patient to the surgeon. 00:04:15.092 --> 00:04:16.793 Uh, so frequent communication. 00:04:17.622 --> 00:04:18.983 You do have to get to the point at times. 00:04:19.002 --> 00:04:19.843 They're very busy. 00:04:19.963 --> 00:04:21.382 So you have to speak their language, 00:04:21.802 --> 00:04:23.283 give it to them in summary fashion, 00:04:24.204 --> 00:04:24.843 kind of really put an 00:04:24.884 --> 00:04:25.985 emphasis on the important 00:04:26.045 --> 00:04:27.745 points of what is going on. 00:04:27.865 --> 00:04:30.925 So the other part of that is we over time, 00:04:31.446 --> 00:04:32.226 particularly as we've been 00:04:32.266 --> 00:04:35.348 kind of shifting to an 00:04:35.387 --> 00:04:38.048 emphasis on milestones in rehabilitation, 00:04:38.348 --> 00:04:39.728 we help develop those milestones. 00:04:39.749 --> 00:04:40.848 I mean, that's what we do. 00:04:40.889 --> 00:04:42.050 We look at how an individual 00:04:42.069 --> 00:04:42.750 is moving forward. 00:04:43.029 --> 00:04:44.031 and the quality of their 00:04:44.071 --> 00:04:45.312 movement and where they are 00:04:45.331 --> 00:04:45.752 in these goals. 00:04:45.771 --> 00:04:47.033 And we're the experts there. 00:04:47.454 --> 00:04:49.875 So taking that and being 00:04:49.935 --> 00:04:52.297 able to communicate with the surgeon, 00:04:52.357 --> 00:04:53.358 how we can integrate that 00:04:53.658 --> 00:04:55.740 into the protocols for progression, 00:04:56.480 --> 00:04:57.161 we play a valuable, 00:04:57.201 --> 00:04:58.622 we are the primary drivers 00:04:59.163 --> 00:05:00.723 of that part of the process. 00:05:00.824 --> 00:05:02.324 And again, I think, you know, 00:05:02.404 --> 00:05:04.466 consistency of, you know, 00:05:04.526 --> 00:05:05.387 when we communicate with 00:05:05.447 --> 00:05:06.728 our surgeons and speaking 00:05:06.769 --> 00:05:08.310 their language is invaluable. 00:05:09.826 --> 00:05:10.007 Yeah. 00:05:10.187 --> 00:05:11.007 Understand those things. 00:05:11.487 --> 00:05:13.767 So let's talk about things that are common, 00:05:13.827 --> 00:05:14.088 right? 00:05:14.247 --> 00:05:15.947 Frequently asked questions is one thing, 00:05:15.968 --> 00:05:16.367 but how about, 00:05:16.908 --> 00:05:17.689 what about common 00:05:17.829 --> 00:05:19.468 challenges that you see 00:05:19.528 --> 00:05:21.410 patients facing after an 00:05:21.490 --> 00:05:22.470 orthopedic surgery? 00:05:22.509 --> 00:05:23.290 Doesn't really matter what 00:05:23.310 --> 00:05:24.129 it necessarily is, 00:05:24.189 --> 00:05:25.471 but what comes to top of 00:05:25.550 --> 00:05:26.451 mind when we talk about 00:05:26.471 --> 00:05:27.230 common challenges? 00:05:28.130 --> 00:05:28.211 Yeah. 00:05:28.271 --> 00:05:28.891 And it actually, 00:05:28.971 --> 00:05:29.651 there are two things where 00:05:29.670 --> 00:05:30.271 we talked about that kind 00:05:30.312 --> 00:05:31.112 of fall in there and then, 00:05:31.232 --> 00:05:32.492 and then they're part of a 00:05:32.531 --> 00:05:33.451 kind of bigger picture. 00:05:33.471 --> 00:05:34.211 And when we talk about 00:05:34.232 --> 00:05:36.512 compliance and goal management, 00:05:37.259 --> 00:05:39.721 Sometimes the long game is the challenge, 00:05:39.802 --> 00:05:40.021 right? 00:05:40.283 --> 00:05:41.302 Because some of these surgeries, 00:05:41.583 --> 00:05:42.363 most of these surgeries 00:05:42.403 --> 00:05:44.004 have some component of time 00:05:44.326 --> 00:05:44.805 that is involved, 00:05:45.286 --> 00:05:45.887 even if they're doing 00:05:46.107 --> 00:05:47.747 perfectly fine and they're 00:05:47.807 --> 00:05:49.889 the textbook case that you want to see. 00:05:51.158 --> 00:05:52.278 The challenges often are 00:05:52.298 --> 00:05:53.158 getting the patient to 00:05:53.218 --> 00:05:55.238 invest in their own success. 00:05:55.478 --> 00:05:55.699 Right. 00:05:55.798 --> 00:05:57.339 And not trying to rush the process, 00:05:57.360 --> 00:05:58.279 but also not giving up at 00:05:58.319 --> 00:05:59.100 some point and saying, hey, 00:05:59.120 --> 00:05:59.920 this is where I'm at. 00:06:00.360 --> 00:06:01.281 You want to be realistic. 00:06:01.701 --> 00:06:03.661 But at the same time, you know, 00:06:03.682 --> 00:06:04.882 the constant reinforcement 00:06:04.961 --> 00:06:05.762 of where they are, 00:06:05.781 --> 00:06:07.903 bringing reality and having 00:06:07.942 --> 00:06:09.103 those discussions very 00:06:09.202 --> 00:06:10.083 often because it is our 00:06:10.142 --> 00:06:11.204 patients either check out 00:06:11.283 --> 00:06:11.983 or they'll just jump ahead 00:06:12.004 --> 00:06:12.663 of you at times. 00:06:12.723 --> 00:06:13.884 And both of those kind of 00:06:13.923 --> 00:06:14.605 fall under compliance and 00:06:14.625 --> 00:06:15.625 gold management as well. 00:06:16.107 --> 00:06:17.627 Yeah. 00:06:18.028 --> 00:06:19.348 We want things to be personalized. 00:06:19.387 --> 00:06:20.728 You mentioned not skipping ahead, 00:06:21.009 --> 00:06:22.108 not lagging behind or 00:06:22.170 --> 00:06:23.170 checking out completely. 00:06:23.709 --> 00:06:24.831 What are some tips or 00:06:24.891 --> 00:06:26.130 suggestions you give to 00:06:26.211 --> 00:06:27.391 colleagues or students if 00:06:27.432 --> 00:06:28.112 you're interacting with 00:06:28.132 --> 00:06:30.173 them in terms of having 00:06:30.192 --> 00:06:32.074 that recovery protocol developed, 00:06:32.113 --> 00:06:34.153 but also personalized for this person? 00:06:34.173 --> 00:06:35.634 So when we say personalized, 00:06:35.935 --> 00:06:37.196 we might have similar surgeries, 00:06:37.216 --> 00:06:38.216 but not everything is the same. 00:06:38.235 --> 00:06:39.757 And we're similar humans, 00:06:39.797 --> 00:06:40.596 but not everything's the same. 00:06:40.617 --> 00:06:41.617 So what are suggestions to 00:06:41.658 --> 00:06:42.658 really develop a protocol 00:06:42.697 --> 00:06:44.178 and personalize it to that 00:06:44.259 --> 00:06:45.158 person's recovery? 00:06:45.759 --> 00:06:45.879 Yeah, 00:06:45.899 --> 00:06:46.680 that's true because you're always 00:06:46.720 --> 00:06:47.841 trying to, which can be somewhat, 00:06:49.062 --> 00:06:50.043 it is clinical and feel 00:06:50.062 --> 00:06:51.624 very clinical when you look 00:06:51.663 --> 00:06:55.007 at best practices, hierarchy of evidence, 00:06:55.026 --> 00:06:55.608 all the things that we 00:06:55.648 --> 00:06:56.528 consider that must be 00:06:56.569 --> 00:06:57.589 considered with a 00:06:57.769 --> 00:06:58.790 rehabilitation protocol. 00:06:58.810 --> 00:06:59.692 But at the same time, 00:07:00.372 --> 00:07:01.372 that matters to the patient, 00:07:01.392 --> 00:07:02.613 but what really matters are their goals. 00:07:02.634 --> 00:07:04.536 So really keeping this 00:07:04.576 --> 00:07:06.478 somewhat clinical approach, 00:07:06.557 --> 00:07:07.478 very clinical approach, 00:07:07.778 --> 00:07:09.399 delivered in a patient-centered fashion. 00:07:09.459 --> 00:07:11.521 So what I attempt to do, 00:07:12.141 --> 00:07:13.723 and there's challenges with this at times, 00:07:13.783 --> 00:07:14.663 is to anything that we're 00:07:14.704 --> 00:07:15.644 recommending and bringing 00:07:15.685 --> 00:07:16.685 back to a goal that they have. 00:07:16.725 --> 00:07:17.446 Maybe it's a short-term 00:07:17.466 --> 00:07:18.567 objective to get them to 00:07:18.627 --> 00:07:19.887 where they want to be tomorrow, 00:07:20.228 --> 00:07:20.968 reducing pain, 00:07:21.309 --> 00:07:22.369 allowing more range of motion, 00:07:22.588 --> 00:07:24.031 or bringing that back to 00:07:24.091 --> 00:07:25.851 the long-term goals of, let's say, 00:07:25.872 --> 00:07:27.153 return to sport or return 00:07:27.213 --> 00:07:28.874 to just any daily activity, 00:07:29.153 --> 00:07:30.074 playing with their grandchildren, 00:07:30.095 --> 00:07:30.915 anything like that. 00:07:31.235 --> 00:07:32.136 Anytime we can bring back 00:07:32.175 --> 00:07:33.036 what we're delivering in a 00:07:33.096 --> 00:07:34.697 clinical fashion and is appropriate to 00:07:34.990 --> 00:07:36.211 who in a patient centered 00:07:36.232 --> 00:07:37.252 fashion to address a goal 00:07:37.273 --> 00:07:38.014 or an objective. 00:07:38.975 --> 00:07:39.795 I think that's how we keep 00:07:39.855 --> 00:07:40.536 it personalized. 00:07:40.596 --> 00:07:41.557 And we had sometimes those 00:07:41.598 --> 00:07:42.579 goals change for the patient. 00:07:42.619 --> 00:07:43.360 And if that changes, 00:07:43.720 --> 00:07:44.521 we have to incorporate that 00:07:44.560 --> 00:07:46.122 into our plan of care when 00:07:46.163 --> 00:07:47.483 we're looking at, again, that long game. 00:07:47.504 --> 00:07:48.125 Yep. 00:07:48.680 --> 00:07:48.800 Well, 00:07:48.819 --> 00:07:50.259 let me ask you this follow up to that 00:07:50.319 --> 00:07:50.660 question. 00:07:50.680 --> 00:07:52.100 And I struggled with this a 00:07:52.240 --> 00:07:54.081 lot as a student and going 00:07:54.100 --> 00:07:55.161 into my clinical rotations, 00:07:55.221 --> 00:07:57.161 which was how do I figure 00:07:57.281 --> 00:07:59.682 out how deep to go in terms of education? 00:07:59.802 --> 00:08:01.382 Some people want to know nothing. 00:08:01.543 --> 00:08:02.583 Just tell me what to do. 00:08:02.603 --> 00:08:03.403 I show up and do it. 00:08:03.822 --> 00:08:04.564 Some people want to know 00:08:04.684 --> 00:08:07.004 every single anatomic detail. 00:08:07.744 --> 00:08:08.384 What do you typically 00:08:08.423 --> 00:08:09.785 suggest for new graduates 00:08:09.824 --> 00:08:10.685 or students on how to 00:08:10.904 --> 00:08:13.646 figure out how much information is good, 00:08:13.685 --> 00:08:14.565 how much is overload and 00:08:14.586 --> 00:08:15.446 how much is not enough? 00:08:16.055 --> 00:08:17.456 Yeah, and it is very different. 00:08:19.257 --> 00:08:20.016 I'll get my high school 00:08:20.057 --> 00:08:21.718 athlete in here who may be 00:08:21.757 --> 00:08:24.399 interested in the anatomy and such, 00:08:24.459 --> 00:08:25.581 or maybe their interest is, hey, 00:08:25.600 --> 00:08:26.600 I want to get back to activity, 00:08:26.982 --> 00:08:28.802 or maybe I'm treating one 00:08:28.822 --> 00:08:30.283 of our surgeons post-operatively. 00:08:30.704 --> 00:08:32.164 They probably want much more detail. 00:08:32.184 --> 00:08:33.024 They probably already know more. 00:08:33.065 --> 00:08:34.046 They want more information. 00:08:34.466 --> 00:08:36.327 And really in that initial conversation, 00:08:36.347 --> 00:08:37.148 you know, 00:08:37.168 --> 00:08:38.009 some people say if there's a 00:08:38.028 --> 00:08:39.009 prehabilitation component, 00:08:39.049 --> 00:08:39.850 that's a perfect time to 00:08:39.890 --> 00:08:40.711 have this discussion. 00:08:40.971 --> 00:08:42.312 Or within that first session, 00:08:43.173 --> 00:08:44.394 through that initial conversation, 00:08:44.453 --> 00:08:45.695 you can directly ask them, hey, 00:08:45.715 --> 00:08:47.216 how much detail do you want about this? 00:08:47.277 --> 00:08:48.317 If it's too much, let me know. 00:08:48.738 --> 00:08:51.080 Or sometimes you just get a feel for it. 00:08:51.100 --> 00:08:53.782 There are some soft skills in that regard. 00:08:54.244 --> 00:08:55.583 But I would, if anything, 00:08:55.644 --> 00:08:57.304 recommend that you get a feel for that. 00:08:57.945 --> 00:08:59.046 Because if you give them too 00:08:59.086 --> 00:08:59.946 much information, again, 00:08:59.985 --> 00:09:01.025 they may check out on you. 00:09:01.046 --> 00:09:02.767 You don't give them nothing. 00:09:02.787 --> 00:09:03.667 Could be insulted, right? 00:09:03.687 --> 00:09:04.947 You're not telling me enough here. 00:09:05.246 --> 00:09:06.707 Sometimes see that on press gaming scores. 00:09:07.427 --> 00:09:08.989 So that is really on you to 00:09:09.048 --> 00:09:10.629 get a sense and early on 00:09:10.688 --> 00:09:11.649 just how much information 00:09:11.690 --> 00:09:12.789 that individual wants and 00:09:12.830 --> 00:09:14.250 look for cues of you're 00:09:14.269 --> 00:09:14.951 giving me too much. 00:09:14.971 --> 00:09:15.990 I'm going to check out on you. 00:09:16.551 --> 00:09:17.751 Or I need to know more. 00:09:17.971 --> 00:09:18.711 Yeah. 00:09:19.032 --> 00:09:19.412 And again, 00:09:19.471 --> 00:09:20.472 try to do that early because 00:09:20.493 --> 00:09:21.373 then it's going to set that 00:09:21.393 --> 00:09:22.133 relationship up. 00:09:22.214 --> 00:09:22.833 It's probably gonna be a 00:09:22.874 --> 00:09:23.933 fairly long relationship 00:09:24.193 --> 00:09:25.654 during the rehabilitation process. 00:09:25.754 --> 00:09:26.034 Yeah. 00:09:26.075 --> 00:09:26.254 Yeah. 00:09:26.294 --> 00:09:27.775 My experience was I just 00:09:27.836 --> 00:09:29.456 assumed I needed to know the answer. 00:09:29.496 --> 00:09:30.476 I needed to figure that out. 00:09:30.596 --> 00:09:31.957 And then when further on, I went, 00:09:32.018 --> 00:09:33.258 I realized it's okay for me 00:09:33.278 --> 00:09:34.158 to ask and say, Hey, 00:09:34.178 --> 00:09:35.198 is this too much information? 00:09:35.239 --> 00:09:35.938 Is this not enough? 00:09:36.158 --> 00:09:36.639 Yeah. 00:09:36.659 --> 00:09:37.500 And that actually helped me 00:09:37.539 --> 00:09:38.980 build sort of therapeutic alliance too. 00:09:39.041 --> 00:09:40.441 It showed I was worried 00:09:40.461 --> 00:09:41.902 about them having not enough or too much. 00:09:42.629 --> 00:09:43.350 I definitely made the 00:09:43.370 --> 00:09:44.230 mistake early on of 00:09:44.250 --> 00:09:46.131 sometimes providing what I 00:09:46.152 --> 00:09:48.673 would want to know, but I'm very curious. 00:09:48.693 --> 00:09:49.554 I mean, all of us are, you know, 00:09:49.575 --> 00:09:50.395 this is what we do. 00:09:50.515 --> 00:09:52.517 So maybe that's not as much 00:09:52.557 --> 00:09:53.018 as they want to know. 00:09:53.038 --> 00:09:53.518 Maybe they don't want to 00:09:53.538 --> 00:09:55.139 know every detail about the surgery or, 00:09:55.480 --> 00:09:55.740 you know, 00:09:56.600 --> 00:09:57.922 why you're doing every single 00:09:58.341 --> 00:09:59.102 thing that you're doing or 00:09:59.123 --> 00:10:00.004 that you're recommending. 00:10:00.043 --> 00:10:00.644 So it's really, 00:10:00.663 --> 00:10:01.644 you got to get that read 00:10:01.705 --> 00:10:05.368 early on and use that to make, you know, 00:10:05.408 --> 00:10:05.947 basically make that 00:10:05.989 --> 00:10:07.629 rehabilitation process most effective. 00:10:08.018 --> 00:10:08.197 Yeah, 00:10:08.278 --> 00:10:10.158 and you went and went with a nice 00:10:10.198 --> 00:10:12.778 little podcast segue as you 00:10:12.798 --> 00:10:14.460 talked about pre and before. 00:10:15.100 --> 00:10:17.100 So how would you describe or 00:10:17.139 --> 00:10:18.059 how would you explain or 00:10:18.159 --> 00:10:19.100 educate the role of 00:10:19.260 --> 00:10:21.500 pre-surgical physical therapy? 00:10:21.541 --> 00:10:22.701 Why is that so important? 00:10:22.721 --> 00:10:23.701 Why does that matter? 00:10:23.782 --> 00:10:25.182 And I think it's popped up 00:10:25.542 --> 00:10:26.841 or it's gained some 00:10:26.922 --> 00:10:28.442 notoriety in the last couple of years, 00:10:28.482 --> 00:10:29.702 this sort of pre-surgical 00:10:29.763 --> 00:10:31.724 preparation by the physical therapist. 00:10:32.203 --> 00:10:33.443 Yeah, it's a hot topic. 00:10:34.099 --> 00:10:35.480 you know, the term prehab. 00:10:36.061 --> 00:10:38.203 And, you know, it's interesting to, 00:10:38.543 --> 00:10:38.703 you know, 00:10:38.864 --> 00:10:40.666 it makes all the sense in the world that, 00:10:40.885 --> 00:10:42.128 and we tell people this, hey, 00:10:42.148 --> 00:10:43.649 the more information you have going in, 00:10:43.668 --> 00:10:44.450 the more you know about 00:10:44.490 --> 00:10:46.692 your rehabilitation process, 00:10:46.732 --> 00:10:47.974 the surgery itself, you know, 00:10:47.994 --> 00:10:48.575 you hope they're getting 00:10:48.595 --> 00:10:49.075 some of this from the 00:10:49.115 --> 00:10:49.875 surgical team as well. 00:10:49.895 --> 00:10:50.476 And that varies. 00:10:50.496 --> 00:10:51.538 You know, 00:10:51.557 --> 00:10:52.639 the easier it's going to be for you, 00:10:52.678 --> 00:10:54.020 the less stressful it's 00:10:54.041 --> 00:10:55.601 going to be for you after surgery. 00:10:56.102 --> 00:10:56.202 And, 00:10:56.602 --> 00:10:57.563 And perhaps we're 00:10:57.583 --> 00:10:59.186 recommending interventions 00:10:59.245 --> 00:11:00.486 that will set you up, 00:11:00.506 --> 00:11:01.467 whether it's strength, range of motion, 00:11:01.488 --> 00:11:02.208 whatever it may be, 00:11:02.850 --> 00:11:04.270 to do better or recover 00:11:04.291 --> 00:11:05.371 more quickly after surgery. 00:11:05.471 --> 00:11:07.274 And we do that with all good intentions. 00:11:07.615 --> 00:11:08.676 The studies are interesting. 00:11:08.956 --> 00:11:10.798 The overall trend is, yes, 00:11:11.077 --> 00:11:13.760 it is linked to outcomes that are better. 00:11:14.182 --> 00:11:14.701 It gets a little more 00:11:14.741 --> 00:11:15.503 challenging at times. 00:11:16.441 --> 00:11:17.322 There's a little more robust 00:11:17.341 --> 00:11:18.381 information out there for 00:11:18.481 --> 00:11:20.082 joint replacements, other surgeries, 00:11:20.102 --> 00:11:21.224 you know, I do hip arthroscopy, 00:11:21.543 --> 00:11:22.484 lower level of evidence. 00:11:22.844 --> 00:11:23.664 But part of this is just a 00:11:23.705 --> 00:11:24.565 challenge of what is 00:11:24.625 --> 00:11:25.605 prehabilitation or 00:11:25.686 --> 00:11:27.267 rehabilitation before surgery. 00:11:27.846 --> 00:11:28.667 What does that entail? 00:11:28.687 --> 00:11:29.988 It's not consistently defined. 00:11:30.008 --> 00:11:30.807 It's more education. 00:11:30.847 --> 00:11:31.948 Is it actual exercise? 00:11:32.249 --> 00:11:32.869 And what are the outcomes 00:11:32.889 --> 00:11:33.409 we're looking for? 00:11:33.429 --> 00:11:34.970 Is it their strength after surgery? 00:11:35.030 --> 00:11:36.650 Is it their patient report outcomes? 00:11:36.931 --> 00:11:38.192 Just the sense of them telling, you know, 00:11:38.211 --> 00:11:39.253 I felt more comfortable. 00:11:39.732 --> 00:11:42.433 So I'm all for it and we endorse it. 00:11:42.494 --> 00:11:43.315 And I think overall, 00:11:43.434 --> 00:11:44.134 all the literature that's 00:11:44.174 --> 00:11:45.755 available endorses it as well. 00:11:46.120 --> 00:11:47.282 We have a long way to go to kind of, 00:11:47.682 --> 00:11:48.442 for as much as we can, 00:11:48.461 --> 00:11:49.462 standardizing it and 00:11:49.582 --> 00:11:50.884 knowing really what we need 00:11:50.903 --> 00:11:52.384 to be really hitting in 00:11:52.424 --> 00:11:53.945 pre-surgical physical therapy. 00:11:53.965 --> 00:11:54.905 The only thing I will say is 00:11:54.966 --> 00:11:57.847 that we have payers that are endorsing it, 00:11:58.268 --> 00:11:59.528 and they're not going to 00:11:59.568 --> 00:12:01.149 most times if they don't see value in it. 00:12:01.229 --> 00:12:01.970 So if I think of our joint 00:12:02.009 --> 00:12:02.909 replacement surgeries, 00:12:03.610 --> 00:12:04.471 our insurance companies, 00:12:04.610 --> 00:12:06.852 many of them are covering a somewhat, 00:12:07.913 --> 00:12:11.034 a variably defined pre-surgical episode. 00:12:12.044 --> 00:12:12.905 And they wouldn't be doing that, 00:12:12.966 --> 00:12:13.466 as you mentioned, 00:12:13.505 --> 00:12:14.405 unless there was some 00:12:14.586 --> 00:12:15.687 research and some evidence 00:12:15.706 --> 00:12:16.368 that that was actually 00:12:16.388 --> 00:12:19.229 going to help recovery and ultimately, 00:12:19.349 --> 00:12:21.530 right, from their KPI is lower cost. 00:12:21.571 --> 00:12:22.770 And that's a great thing to do. 00:12:22.791 --> 00:12:24.773 But if it's helping the human first, 00:12:24.812 --> 00:12:25.673 that's where we're in. 00:12:25.753 --> 00:12:26.714 Yeah, you know, when you can cover, 00:12:26.933 --> 00:12:27.793 check both boxes, 00:12:27.835 --> 00:12:28.835 which doesn't always happen, 00:12:28.894 --> 00:12:30.076 it's always a wonderful thing. 00:12:30.561 --> 00:12:30.721 Yeah. 00:12:31.442 --> 00:12:31.662 All right. 00:12:31.682 --> 00:12:33.163 So you did mention other resources. 00:12:33.384 --> 00:12:34.865 Research is always fantastic. 00:12:35.307 --> 00:12:36.347 But is there if someone's 00:12:36.408 --> 00:12:37.448 nodding along and listening 00:12:37.469 --> 00:12:38.330 to this and saying, okay, 00:12:38.429 --> 00:12:39.572 I want to learn more about this. 00:12:40.131 --> 00:12:41.234 Are there other, you know, 00:12:41.313 --> 00:12:42.554 resources or places that 00:12:42.575 --> 00:12:43.897 you'd suggest physical 00:12:43.937 --> 00:12:45.138 therapists to go to maybe 00:12:45.177 --> 00:12:45.739 dig a little deeper? 00:12:46.620 --> 00:12:47.741 yeah you know and it's it's 00:12:47.782 --> 00:12:49.102 a great question oh and the 00:12:49.143 --> 00:12:50.163 timing is perfect because I 00:12:50.183 --> 00:12:51.845 just submitted uh myself 00:12:51.904 --> 00:12:53.346 and uh dave chorizers my 00:12:53.385 --> 00:12:54.246 co-authors just submitted 00:12:54.366 --> 00:12:55.967 our uh our manuscript for 00:12:56.028 --> 00:12:58.129 this uh one go-to you know 00:12:58.149 --> 00:12:58.910 because there is literature 00:12:58.931 --> 00:12:59.910 out the literature changes 00:13:00.491 --> 00:13:01.432 somewhat quickly for some 00:13:01.452 --> 00:13:02.774 of these fields uh or some 00:13:02.793 --> 00:13:03.933 of these subdomains of a 00:13:04.075 --> 00:13:04.715 post-operative 00:13:04.975 --> 00:13:06.076 rehabilitation and it can 00:13:06.115 --> 00:13:08.418 be somewhat daunting or intimidating 00:13:08.981 --> 00:13:10.423 And you can get some mixed messages. 00:13:10.943 --> 00:13:14.365 But one resource that the AOPT provides, 00:13:15.086 --> 00:13:15.746 and right now it is 00:13:15.807 --> 00:13:17.889 literally in the revision process, 00:13:18.389 --> 00:13:19.129 it's part of their 00:13:19.590 --> 00:13:20.890 independent study course series. 00:13:21.030 --> 00:13:21.932 And that is the 00:13:22.072 --> 00:13:22.792 Post-Arthro-Management 00:13:22.812 --> 00:13:23.673 Orthopedic Surgeries. 00:13:23.972 --> 00:13:24.813 you know now if you go into 00:13:24.833 --> 00:13:25.754 the website I believe it is 00:13:25.774 --> 00:13:26.615 listed under enrichment 00:13:26.715 --> 00:13:27.615 only because it is we're 00:13:27.635 --> 00:13:28.996 transitioning to a we will 00:13:29.037 --> 00:13:30.378 be or they will be 00:13:30.698 --> 00:13:31.820 publishing a new series and 00:13:31.860 --> 00:13:32.779 what they attempt to do is 00:13:32.799 --> 00:13:34.322 get authors and often it's 00:13:34.381 --> 00:13:35.423 a clinical team so you'll 00:13:35.462 --> 00:13:37.423 have a physical therapist a 00:13:37.464 --> 00:13:39.285 clinician uh you may have 00:13:39.306 --> 00:13:40.687 mixture of academic uh 00:13:40.787 --> 00:13:41.827 representation in there and 00:13:42.028 --> 00:13:43.708 often more often than not a 00:13:43.750 --> 00:13:46.611 surgeon representative co-writing these 00:13:47.092 --> 00:13:50.636 providing a summary in a reasonable amount, 00:13:50.697 --> 00:13:52.239 you know, a one-stop shop, if you will, 00:13:52.278 --> 00:13:53.961 at the time of the surgery, 00:13:54.341 --> 00:13:55.523 from what we look at, 00:13:55.562 --> 00:13:56.683 what they look at from the 00:13:56.724 --> 00:13:57.684 surgeon's perspective, 00:13:58.004 --> 00:13:58.946 the rehabilitation 00:13:59.267 --> 00:14:00.508 protocols associated with it, 00:14:00.668 --> 00:14:02.671 gaps in the literature kind 00:14:02.711 --> 00:14:03.171 of put together. 00:14:03.211 --> 00:14:03.871 It's an opportunity for 00:14:03.892 --> 00:14:04.952 continuing education as well, 00:14:04.972 --> 00:14:06.195 and many residency programs 00:14:06.235 --> 00:14:08.136 also use it in their curriculum. 00:14:08.655 --> 00:14:09.677 i think that's a I i would 00:14:09.716 --> 00:14:11.458 find and I'm not sure I did 00:14:11.639 --> 00:14:12.559 write one of the monographs 00:14:12.600 --> 00:14:13.620 but I use the monographs 00:14:13.640 --> 00:14:14.621 that other authors when I 00:14:14.642 --> 00:14:15.663 get outside of my comfort 00:14:15.682 --> 00:14:17.544 zone is references as well 00:14:17.625 --> 00:14:18.205 and they're great they're 00:14:18.225 --> 00:14:19.405 being updated I think for 00:14:19.525 --> 00:14:21.128 early next year I believe 00:14:21.168 --> 00:14:22.428 is is the target 00:14:22.469 --> 00:14:23.809 publication date that's a 00:14:23.909 --> 00:14:25.111 first stop recommendation I 00:14:25.131 --> 00:14:26.413 have for anybody at any level 00:14:27.355 --> 00:14:28.956 Talk about that interesting 00:14:29.037 --> 00:14:30.018 format for a second. 00:14:30.038 --> 00:14:30.918 I mean, you helped write this, 00:14:30.958 --> 00:14:32.059 so you got firsthand knowledge. 00:14:32.080 --> 00:14:33.321 You were paired with a 00:14:33.341 --> 00:14:34.402 physician colleague. 00:14:34.741 --> 00:14:35.743 That had to be fun. 00:14:35.783 --> 00:14:36.864 That's a different way of doing it, 00:14:36.923 --> 00:14:38.725 is making sure there was 00:14:38.806 --> 00:14:39.866 collaboration across 00:14:39.927 --> 00:14:42.048 professions when creating this resource, 00:14:42.109 --> 00:14:43.691 which is primarily directed at PTs. 00:14:44.260 --> 00:14:44.400 Yeah, 00:14:44.640 --> 00:14:48.804 it is a great opportunity to really 00:14:49.466 --> 00:14:50.265 see what they see. 00:14:50.326 --> 00:14:52.307 Sometimes I don't understand 00:14:52.508 --> 00:14:53.408 why they're telling... I'm 00:14:53.448 --> 00:14:54.250 not always in the office. 00:14:54.269 --> 00:14:54.910 I'm very rarely in the 00:14:54.951 --> 00:14:55.791 office when these 00:14:55.831 --> 00:14:57.373 discussions are being had with patients. 00:14:58.094 --> 00:14:59.414 And then collaborating with them, 00:14:59.514 --> 00:15:00.075 I can see it. 00:15:00.154 --> 00:15:01.716 I can see, this is what you do in surgery. 00:15:01.756 --> 00:15:02.778 These are the concerns. 00:15:03.879 --> 00:15:05.419 We know what they're doing, 00:15:05.700 --> 00:15:06.140 but we don't know 00:15:06.181 --> 00:15:07.581 everything that goes on around that. 00:15:09.003 --> 00:15:09.543 And at times... 00:15:10.389 --> 00:15:12.591 Getting a even just a 00:15:12.672 --> 00:15:13.893 glimmer of what they are 00:15:13.932 --> 00:15:14.614 looking at in their 00:15:14.653 --> 00:15:15.794 clinical decision making 00:15:15.835 --> 00:15:17.475 and why they make recommendations. 00:15:17.996 --> 00:15:19.378 And then also it just it 00:15:19.557 --> 00:15:21.039 evolves into good discussion. 00:15:21.100 --> 00:15:22.780 You get to share points of 00:15:22.821 --> 00:15:23.802 view and sometimes maybe 00:15:23.861 --> 00:15:24.543 they will change what 00:15:24.562 --> 00:15:25.182 they're doing based on what 00:15:25.202 --> 00:15:25.903 you're saying. 00:15:25.943 --> 00:15:26.684 That has definitely happened 00:15:26.705 --> 00:15:27.605 and vice versa. 00:15:27.625 --> 00:15:28.706 And it's just great to get 00:15:28.745 --> 00:15:29.427 that perspective. 00:15:29.447 --> 00:15:30.248 And it's often we just 00:15:30.488 --> 00:15:31.568 depending where you're practicing, 00:15:31.609 --> 00:15:32.269 you may not get that 00:15:32.309 --> 00:15:33.390 opportunity very often. 00:15:33.410 --> 00:15:33.610 Right. 00:15:33.971 --> 00:15:34.571 and you get to take 00:15:34.610 --> 00:15:35.711 advantage you know sort of 00:15:35.772 --> 00:15:37.173 highlighting the format for 00:15:37.212 --> 00:15:37.972 this independent study 00:15:38.014 --> 00:15:39.354 course you get to take 00:15:39.374 --> 00:15:39.914 advantage of that 00:15:39.955 --> 00:15:41.195 collaboration a lot of 00:15:41.235 --> 00:15:42.895 times uh they say you know 00:15:42.916 --> 00:15:44.037 the the biggest problem 00:15:44.057 --> 00:15:44.977 with communication is when 00:15:44.998 --> 00:15:46.818 we think it has occurred so 00:15:47.239 --> 00:15:48.480 why are they doing that 00:15:48.559 --> 00:15:49.660 they don't understand me 00:15:49.701 --> 00:15:50.760 it's like that when this 00:15:50.821 --> 00:15:52.701 comes together we're closer 00:15:52.741 --> 00:15:53.702 to achieving more 00:15:53.763 --> 00:15:54.503 understanding I think 00:15:54.523 --> 00:15:55.144 that's one of the main 00:15:55.203 --> 00:15:56.884 benefits of an independent 00:15:56.904 --> 00:15:57.865 study course like this is 00:15:57.884 --> 00:15:59.546 that it wasn't written just 00:15:59.986 --> 00:16:01.748 by a physical therapist it 00:16:01.768 --> 00:16:03.609 had cross professional collaboration 00:16:04.065 --> 00:16:05.206 And the editors were very 00:16:06.947 --> 00:16:07.466 particularly in the 00:16:07.706 --> 00:16:09.447 specifically in the upcoming edition. 00:16:09.807 --> 00:16:10.229 They said, you know, 00:16:10.249 --> 00:16:11.970 can you include what 00:16:11.990 --> 00:16:13.450 physicians sometimes think 00:16:13.490 --> 00:16:14.390 about when they when they 00:16:14.410 --> 00:16:15.030 think about why? 00:16:15.071 --> 00:16:16.711 Why is the physical therapist doing this? 00:16:17.212 --> 00:16:17.773 I'm thinking this. 00:16:17.793 --> 00:16:18.113 But why? 00:16:18.432 --> 00:16:19.673 Why are they thinking this way? 00:16:20.114 --> 00:16:21.575 And it kind of they're not 00:16:21.595 --> 00:16:22.336 always clashing points. 00:16:22.375 --> 00:16:23.115 I think you're thinking alike. 00:16:23.135 --> 00:16:24.116 You're just communicating it 00:16:24.157 --> 00:16:24.937 in a different way. 00:16:25.758 --> 00:16:26.477 And there's some great kind 00:16:26.518 --> 00:16:27.398 of interaction there. 00:16:27.418 --> 00:16:27.519 Right. 00:16:28.619 --> 00:16:29.700 I think clinicians, 00:16:30.179 --> 00:16:31.201 physicians and PTs would 00:16:31.240 --> 00:16:33.101 find it useful to look at 00:16:33.142 --> 00:16:33.903 that and kind of get a 00:16:33.923 --> 00:16:35.923 sense of the viewpoints and 00:16:35.964 --> 00:16:37.164 why sometimes we see these 00:16:37.225 --> 00:16:38.326 recommendations or these 00:16:38.346 --> 00:16:39.285 points of conversation that 00:16:39.326 --> 00:16:40.106 we often have during the 00:16:40.147 --> 00:16:41.326 rehabilitation process. 00:16:41.447 --> 00:16:41.628 Yeah. 00:16:41.847 --> 00:16:42.508 The more we know, 00:16:42.607 --> 00:16:45.330 going back to that series on TV. 00:16:45.370 --> 00:16:47.150 Now we're going to put you on the spot, 00:16:47.191 --> 00:16:47.532 Keelan. 00:16:47.932 --> 00:16:48.631 We have a segment on the 00:16:49.013 --> 00:16:51.053 show called Words of Wisdom. 00:16:51.173 --> 00:16:51.433 Wow. 00:16:51.974 --> 00:16:52.695 What would you want to leave 00:16:52.735 --> 00:16:54.176 with the audience about this topic? 00:16:54.235 --> 00:16:56.517 Is there a parting piece of 00:16:56.638 --> 00:16:57.298 advice or wisdom? 00:16:58.361 --> 00:16:58.701 Yeah. 00:16:58.981 --> 00:17:02.004 You know, what I would tell anybody, 00:17:02.063 --> 00:17:03.144 wherever you are, you know, 00:17:03.164 --> 00:17:04.365 and I feel like this is 00:17:04.385 --> 00:17:05.465 what I tell myself every 00:17:05.506 --> 00:17:07.367 day is that you really have 00:17:07.428 --> 00:17:09.249 to expect that change is going to occur. 00:17:10.229 --> 00:17:10.529 You know, 00:17:10.849 --> 00:17:12.230 whatever is here today is going 00:17:12.250 --> 00:17:13.852 to change tomorrow, if not tomorrow, 00:17:13.932 --> 00:17:15.492 next week, next month or next year. 00:17:16.113 --> 00:17:17.314 Every time that I think I've 00:17:17.334 --> 00:17:18.954 had this great monograph we put out. 00:17:19.674 --> 00:17:19.775 Um, 00:17:20.035 --> 00:17:21.214 when it gets knocked down by the 00:17:21.255 --> 00:17:23.336 editorial process, uh, so, you know, 00:17:23.355 --> 00:17:24.635 we said the clinical practice guidelines. 00:17:24.675 --> 00:17:25.316 So you look at it like, 00:17:25.336 --> 00:17:26.557 these are great recommendations. 00:17:26.576 --> 00:17:28.136 I got the C level recommendation. 00:17:28.257 --> 00:17:29.136 That's actually better than we had. 00:17:29.156 --> 00:17:30.616 It was an F in 2014. 00:17:30.998 --> 00:17:32.518 Now it's a C maybe someday 00:17:32.557 --> 00:17:33.278 we'll get to an a, 00:17:33.577 --> 00:17:34.417 but what you have to really, 00:17:34.438 --> 00:17:35.558 you have to realize the 00:17:35.618 --> 00:17:36.959 evolving nature of this. 00:17:37.098 --> 00:17:38.179 And it's always going to change. 00:17:38.439 --> 00:17:39.659 Surgeries always change our 00:17:39.679 --> 00:17:40.680 rehabilitation associated 00:17:40.700 --> 00:17:41.460 with those surgeries. 00:17:41.579 --> 00:17:42.920 It's going to be an ongoing change. 00:17:43.319 --> 00:17:44.240 So you should be satisfied 00:17:44.279 --> 00:17:44.901 when you see that, 00:17:45.260 --> 00:17:46.381 if we want to call it an improvement, uh, 00:17:46.840 --> 00:17:48.241 or that evolving process, 00:17:48.281 --> 00:17:49.083 but just know it's going to 00:17:49.103 --> 00:17:50.183 evolve into something different, 00:17:50.203 --> 00:17:51.384 hopefully better tomorrow, 00:17:51.424 --> 00:17:52.425 or if not tomorrow, soon. 00:17:52.826 --> 00:17:54.827 Yeah, this is, I was taught in PT school, 00:17:55.588 --> 00:17:56.910 just add one word onto the 00:17:56.990 --> 00:17:58.530 end of what you're sharing. 00:17:58.550 --> 00:18:00.813 This is what I understand to be true now. 00:18:00.972 --> 00:18:02.694 That word right now, now says, 00:18:02.954 --> 00:18:03.855 so we understand now, 00:18:03.875 --> 00:18:05.217 and that leaves you sort of 00:18:05.356 --> 00:18:07.038 off the hook when and if 00:18:07.118 --> 00:18:09.520 and when information changes. 00:18:09.780 --> 00:18:10.481 It's your disclaimer. 00:18:11.742 --> 00:18:13.065 It is my lifelong disclaimer. 00:18:13.144 --> 00:18:14.666 So that's fantastic. 00:18:14.727 --> 00:18:14.967 Keelan, 00:18:15.007 --> 00:18:16.449 thanks for putting the time and the 00:18:16.528 --> 00:18:17.631 effort and the research 00:18:17.750 --> 00:18:18.731 into that independent study 00:18:18.771 --> 00:18:20.054 course that you mentioned 00:18:20.114 --> 00:18:22.497 coming out very soon from AOPT, 00:18:22.517 --> 00:18:24.499 available at orthopt.org. 00:18:24.519 --> 00:18:25.240 And thanks for taking the 00:18:25.279 --> 00:18:26.362 time to talk with us today 00:18:26.741 --> 00:18:27.423 on orthostatic. 00:18:28.203 --> 00:18:28.503 Thank you. 00:18:28.544 --> 00:18:29.144 Thank you for having me. 00:18:29.164 --> 00:18:29.705 I appreciate it.