WEBVTT 00:00:02.079 --> 00:00:03.821 All right, so yeah, welcome to the show. 00:00:03.861 --> 00:00:06.323 We have Megan Donaldson and Jake Magel. 00:00:06.543 --> 00:00:07.684 I am really excited about 00:00:07.903 --> 00:00:09.646 this session today. 00:00:10.486 --> 00:00:12.147 I think it's a topic that is 00:00:12.208 --> 00:00:14.130 going to be of interest to 00:00:14.169 --> 00:00:15.990 a lot of our PT colleagues, 00:00:16.291 --> 00:00:17.913 and I couldn't imagine two 00:00:17.952 --> 00:00:19.754 better people to really go 00:00:19.795 --> 00:00:20.855 through this presentation 00:00:21.675 --> 00:00:23.077 this information with us 00:00:23.117 --> 00:00:25.359 today and so again welcome 00:00:25.519 --> 00:00:27.222 Megan welcome Jake to the 00:00:27.341 --> 00:00:29.083 podcast here Megan you're 00:00:29.103 --> 00:00:30.164 not a stranger to this 00:00:30.204 --> 00:00:30.946 podcast actually 00:00:30.966 --> 00:00:31.766 interesting because you're 00:00:31.786 --> 00:00:33.307 a you're actually a host 00:00:33.649 --> 00:00:34.950 and now I'm hosting a host 00:00:35.229 --> 00:00:36.170 so this seems a little bit 00:00:36.591 --> 00:00:38.194 awkward and weird but uh 00:00:38.533 --> 00:00:39.615 I'll see if I can do my job 00:00:39.655 --> 00:00:40.276 the way that I'm supposed 00:00:40.295 --> 00:00:41.936 to do my job but um 00:00:41.976 --> 00:00:43.378 certainly happy to have you on 00:00:43.999 --> 00:00:44.359 And Jake, 00:00:44.399 --> 00:00:45.640 I know that you've probably been on many, 00:00:45.679 --> 00:00:46.539 many podcasts, 00:00:46.560 --> 00:00:48.441 maybe not as exciting as this one, 00:00:48.500 --> 00:00:49.640 but I'm sure that you've 00:00:49.661 --> 00:00:50.601 been on many podcasts, 00:00:50.621 --> 00:00:53.343 so you know exactly what to expect, 00:00:53.423 --> 00:00:54.902 I suppose, here as well. 00:00:54.923 --> 00:00:56.064 Not as exciting, that's right. 00:00:56.630 --> 00:00:57.610 That's right. 00:00:58.110 --> 00:00:58.392 All right. 00:00:58.451 --> 00:00:59.051 So, you know, 00:00:59.131 --> 00:01:00.412 I wanted to get into a little 00:01:00.432 --> 00:01:02.494 bit of this conversation 00:01:02.615 --> 00:01:05.177 specifically around the 00:01:05.218 --> 00:01:07.358 report that was recently published. 00:01:07.620 --> 00:01:08.801 And, you know, 00:01:08.861 --> 00:01:10.421 I think it's probably worth 00:01:10.542 --> 00:01:12.603 noting that many of us 00:01:12.644 --> 00:01:14.144 probably have no idea what 00:01:14.185 --> 00:01:15.447 this report is. 00:01:15.986 --> 00:01:17.688 And I guess the first 00:01:17.709 --> 00:01:18.588 question that I have right 00:01:18.629 --> 00:01:20.531 off the top here is, and Megan, 00:01:20.551 --> 00:01:21.311 maybe this is the question 00:01:21.331 --> 00:01:22.433 best addressed to you. 00:01:23.072 --> 00:01:23.233 What 00:01:23.914 --> 00:01:24.855 What is this report? 00:01:24.875 --> 00:01:25.694 What is it all about? 00:01:25.754 --> 00:01:25.915 I mean, 00:01:25.974 --> 00:01:27.956 I know that I haven't I wouldn't 00:01:27.975 --> 00:01:29.397 have seen this report, especially without, 00:01:29.736 --> 00:01:29.956 you know, 00:01:29.996 --> 00:01:32.478 your bringing it to some of our 00:01:32.519 --> 00:01:33.358 attention and such. 00:01:33.418 --> 00:01:34.400 But so if you can give a 00:01:34.819 --> 00:01:36.460 little bit of background to our listeners, 00:01:36.480 --> 00:01:38.102 that would be fantastic. 00:01:38.221 --> 00:01:38.581 Yeah. 00:01:38.641 --> 00:01:38.781 So 00:01:40.489 --> 00:01:42.111 oftentimes what you find is 00:01:42.650 --> 00:01:43.751 this is a report that falls 00:01:43.811 --> 00:01:45.852 under like market research, 00:01:45.933 --> 00:01:49.394 which aims to inform market decisions, 00:01:49.454 --> 00:01:51.775 funding, even healthcare policy. 00:01:51.816 --> 00:01:54.376 I mean, this can have some broad reaches. 00:01:55.106 --> 00:01:57.609 So the fact that this came out, you know, 00:01:57.670 --> 00:02:00.153 I would say probably early 00:02:00.253 --> 00:02:02.135 summer and a lot of people 00:02:02.155 --> 00:02:03.316 didn't hear about it or 00:02:03.355 --> 00:02:04.757 talk about it because they 00:02:04.777 --> 00:02:05.757 were just kind of, you know, 00:02:05.817 --> 00:02:07.040 it was kind of more hearsay. 00:02:07.519 --> 00:02:08.661 Many of us are in the 00:02:08.760 --> 00:02:12.825 funding areas of virtual MSKs, 00:02:12.866 --> 00:02:13.766 which we'll talk about the 00:02:13.806 --> 00:02:15.068 digital health technologies. 00:02:15.526 --> 00:02:17.007 But there is actually a 00:02:17.086 --> 00:02:18.828 group called the Peterson 00:02:18.867 --> 00:02:20.810 Health Technology Institute, 00:02:21.590 --> 00:02:23.091 which evaluates these 00:02:23.151 --> 00:02:24.372 digital health technologies 00:02:24.451 --> 00:02:25.832 and the commercial interest 00:02:25.893 --> 00:02:27.133 and funding interest behind them. 00:02:27.193 --> 00:02:30.735 So that's really what started this project, 00:02:30.816 --> 00:02:32.858 which is it's a market research project. 00:02:32.877 --> 00:02:33.457 They want to know, 00:02:33.978 --> 00:02:35.819 is there resources here 00:02:35.879 --> 00:02:37.480 that people should invest in? 00:02:37.881 --> 00:02:38.882 And what could those 00:02:38.921 --> 00:02:39.921 investments look like? 00:02:39.961 --> 00:02:41.502 Could it save money? 00:02:42.424 --> 00:02:43.865 Is there an economic value? 00:02:43.884 --> 00:02:45.246 Is there an access value? 00:02:45.686 --> 00:02:46.766 and then how can that shape 00:02:46.787 --> 00:02:47.987 healthcare going forward so 00:02:48.068 --> 00:02:50.610 it could impact policy and 00:02:50.629 --> 00:02:51.810 that's where some of these 00:02:52.330 --> 00:02:53.350 groups have been out there 00:02:53.371 --> 00:02:54.451 for a while doing this in 00:02:54.491 --> 00:02:55.652 various pieces but this 00:02:55.733 --> 00:02:57.995 one's specific to us in 00:02:58.034 --> 00:03:02.518 virtual msk no that's great 00:03:02.538 --> 00:03:04.359 to hear and I think any 00:03:04.419 --> 00:03:05.939 time that we start talking 00:03:05.979 --> 00:03:09.543 about ai and virtual health 00:03:10.492 --> 00:03:11.893 things that probably matter 00:03:11.954 --> 00:03:15.213 to us a lot as physical therapists. 00:03:15.253 --> 00:03:16.875 Most of us are probably, well, 00:03:16.935 --> 00:03:18.395 all of us are native more 00:03:18.435 --> 00:03:20.096 to the setting where we are 00:03:20.156 --> 00:03:22.056 actually working in the 00:03:22.097 --> 00:03:23.776 environment with the patient. 00:03:24.317 --> 00:03:25.377 I would imagine that some of it is, 00:03:25.777 --> 00:03:26.798 it's obviously exciting. 00:03:26.877 --> 00:03:27.538 I think we're on a new 00:03:27.578 --> 00:03:28.657 frontier and there's things 00:03:28.698 --> 00:03:30.438 that we can look forward to, 00:03:30.519 --> 00:03:32.179 especially as we progress and such. 00:03:32.219 --> 00:03:34.539 But I guess another question 00:03:34.560 --> 00:03:36.661 that I have for you is why is this 00:03:37.381 --> 00:03:39.282 report really essential for 00:03:39.383 --> 00:03:40.743 us to talk about today 00:03:40.783 --> 00:03:41.544 especially as I just 00:03:41.585 --> 00:03:43.225 mentioned manual therapists 00:03:43.246 --> 00:03:43.947 obviously a lot of our 00:03:43.986 --> 00:03:44.608 listeners are probably 00:03:44.647 --> 00:03:45.588 manual therapy listeners 00:03:45.609 --> 00:03:46.549 and if they're manual 00:03:46.588 --> 00:03:47.629 therapy listeners they're 00:03:47.991 --> 00:03:49.792 orthopedic pts who you know 00:03:49.812 --> 00:03:50.693 we put our hands on 00:03:50.832 --> 00:03:51.834 patients and we do these 00:03:51.873 --> 00:03:53.436 sorts of things so why is 00:03:53.455 --> 00:03:55.758 this so important for us to discuss today 00:03:56.966 --> 00:03:57.246 Yeah, 00:03:57.265 --> 00:03:59.108 so the report is super interesting to 00:03:59.147 --> 00:03:59.367 read. 00:03:59.388 --> 00:04:00.748 So I'll state that first, 00:04:00.769 --> 00:04:03.290 which you should read the report. 00:04:03.411 --> 00:04:04.953 I think it gives you insight 00:04:05.032 --> 00:04:06.213 into the way people 00:04:06.294 --> 00:04:07.594 perceive our profession. 00:04:08.497 --> 00:04:09.997 And I'll be candid. 00:04:10.318 --> 00:04:11.217 I think some of this starts 00:04:11.258 --> 00:04:11.897 in the research. 00:04:11.957 --> 00:04:14.179 I think some of it is what is PT? 00:04:14.498 --> 00:04:15.699 What is typical PT? 00:04:16.519 --> 00:04:18.060 And what we see is that 00:04:19.100 --> 00:04:19.901 people believe that 00:04:20.000 --> 00:04:21.961 exercise can be done more efficiently. 00:04:22.502 --> 00:04:24.502 And so they started to look 00:04:24.541 --> 00:04:26.242 at these MSK reports. 00:04:26.262 --> 00:04:29.524 And some of this was, I would say, 00:04:29.584 --> 00:04:31.444 couched as an access piece. 00:04:32.125 --> 00:04:33.045 If you read the report, 00:04:33.084 --> 00:04:34.045 there's some limitations of 00:04:34.086 --> 00:04:34.966 our profession, right? 00:04:35.005 --> 00:04:37.826 They did identify that there would be some 00:04:39.526 --> 00:04:40.728 workforce demands around 00:04:40.807 --> 00:04:42.168 seventeen percent in deficit, 00:04:42.209 --> 00:04:43.009 like that we definitely 00:04:43.050 --> 00:04:45.031 needed to have more PTs in the workforce. 00:04:45.432 --> 00:04:46.434 And then the other areas of 00:04:46.473 --> 00:04:47.714 that is actually in the 00:04:48.036 --> 00:04:49.276 rural health areas is some 00:04:49.297 --> 00:04:50.999 of that access and 00:04:51.439 --> 00:04:52.821 workforce needs are much greater. 00:04:53.240 --> 00:04:54.442 And so they kind of couched 00:04:54.483 --> 00:04:57.365 it as an access workforce support. 00:04:58.004 --> 00:04:59.225 for virtual MSK. 00:04:59.326 --> 00:04:59.646 Again, 00:04:59.687 --> 00:05:01.689 knowing that PT sometimes takes a 00:05:01.749 --> 00:05:03.209 little bit of time to get into. 00:05:04.091 --> 00:05:06.333 So having this as a easier 00:05:06.492 --> 00:05:08.055 access point was one of the 00:05:08.115 --> 00:05:11.156 pitches as why these may be 00:05:11.338 --> 00:05:13.319 viable solutions for healthcare support. 00:05:14.040 --> 00:05:15.040 So I think you have to 00:05:15.081 --> 00:05:18.084 appreciate that was some of their gap. 00:05:18.103 --> 00:05:20.466 That's what they see that these tools, 00:05:20.485 --> 00:05:21.466 the virtual health tools, 00:05:22.213 --> 00:05:23.035 would support and they 00:05:23.115 --> 00:05:24.315 identify it as being like 00:05:24.536 --> 00:05:25.196 for patients who have 00:05:25.255 --> 00:05:26.536 mobility limitations, 00:05:26.617 --> 00:05:28.519 work commitment limitations, 00:05:29.079 --> 00:05:30.379 or geographical barriers 00:05:30.399 --> 00:05:31.461 such as living in rural 00:05:31.581 --> 00:05:33.422 areas with low access to 00:05:33.502 --> 00:05:35.023 getting to in-person PT 00:05:35.103 --> 00:05:36.524 sessions each week. 00:05:36.644 --> 00:05:37.985 I think that's what we have 00:05:38.004 --> 00:05:39.867 to understand the context to that. 00:05:40.307 --> 00:05:41.367 But when we actually 00:05:41.408 --> 00:05:43.249 appreciate that virtual technology, 00:05:43.288 --> 00:05:45.870 so Derek, when you say like AI, 00:05:46.310 --> 00:05:47.451 AI may be different than 00:05:48.173 --> 00:05:49.793 these virtual technologies and I think 00:05:50.314 --> 00:05:52.158 We don't even talk about AI 00:05:52.218 --> 00:05:53.519 generated per se in this. 00:05:53.540 --> 00:05:54.000 I mean, 00:05:54.021 --> 00:05:55.264 there's going to be specific things 00:05:55.283 --> 00:05:56.245 that we say that are 00:05:56.286 --> 00:05:57.427 included in this study. 00:05:58.512 --> 00:06:00.553 But there's a big reach that's happening. 00:06:00.793 --> 00:06:02.014 And I think we have to 00:06:02.175 --> 00:06:03.675 really inform ourselves. 00:06:04.735 --> 00:06:05.716 What is this? 00:06:05.776 --> 00:06:07.117 How does this have impact to 00:06:07.276 --> 00:06:09.257 our practitioners on the daily? 00:06:09.658 --> 00:06:10.499 And some of it is 00:06:10.678 --> 00:06:14.300 understanding how our profession is seen. 00:06:14.661 --> 00:06:16.982 What's the value of PT and 00:06:17.081 --> 00:06:17.942 what is it they need to 00:06:17.982 --> 00:06:19.002 come to a provider for 00:06:19.062 --> 00:06:20.103 versus what can they get 00:06:20.483 --> 00:06:21.863 through this interaction, 00:06:22.004 --> 00:06:23.564 which has maybe little or 00:06:23.805 --> 00:06:25.346 no human interaction at all? 00:06:25.747 --> 00:06:26.447 with a PT. 00:06:27.209 --> 00:06:28.910 So I think this is a key piece. 00:06:29.350 --> 00:06:31.211 It's also an advocacy piece. 00:06:32.250 --> 00:06:33.771 This report actually so 00:06:33.872 --> 00:06:35.773 interestingly kind of puts 00:06:35.833 --> 00:06:39.394 into question the value of PT campaign. 00:06:40.014 --> 00:06:40.894 I would actually say the 00:06:40.975 --> 00:06:42.336 economic value of PT. 00:06:42.815 --> 00:06:45.117 We show in the APTA's document, 00:06:45.156 --> 00:06:47.158 which I so value that piece too, 00:06:47.639 --> 00:06:49.899 is that we are a value, 00:06:50.019 --> 00:06:51.560 economic value for a lot of 00:06:51.680 --> 00:06:52.661 MSK conditions. 00:06:52.901 --> 00:06:54.341 That includes low back pain, 00:06:54.824 --> 00:06:57.526 carpal tunnel, knee osteoarthritis, 00:06:58.028 --> 00:06:58.848 lateral epicondylase. 00:06:58.889 --> 00:06:59.629 I think they called it 00:06:59.670 --> 00:07:01.372 lateral epicondylitis in the studies, 00:07:01.812 --> 00:07:02.973 but that we actually have 00:07:03.014 --> 00:07:04.495 value in those areas and 00:07:04.516 --> 00:07:06.858 that we are a low cost option. 00:07:07.519 --> 00:07:09.541 And so interestingly to me 00:07:09.583 --> 00:07:12.266 is that in this virtual health report, 00:07:12.639 --> 00:07:13.620 They did look at knee, 00:07:13.819 --> 00:07:16.322 they looked at low back and 00:07:16.362 --> 00:07:17.322 still trying to make it 00:07:17.682 --> 00:07:19.803 more economically feasible. 00:07:20.163 --> 00:07:21.925 So again, just kind of looking at, 00:07:21.966 --> 00:07:23.706 we are already a low cost option. 00:07:24.067 --> 00:07:26.129 So making us even more low cost, 00:07:26.668 --> 00:07:28.769 I would question some of the gain there. 00:07:29.310 --> 00:07:30.190 And then just the other 00:07:30.230 --> 00:07:31.211 parts of that is that we 00:07:31.252 --> 00:07:33.173 have to appreciate what you 00:07:33.194 --> 00:07:33.874 had said before, 00:07:33.913 --> 00:07:37.637 which is virtual health may be PT, 00:07:37.776 --> 00:07:40.798 but it may be coaches not trained as PTs. 00:07:41.177 --> 00:07:42.218 It may be AI. 00:07:42.999 --> 00:07:44.100 And I just think we have to 00:07:44.139 --> 00:07:45.800 appreciate that we're not 00:07:45.841 --> 00:07:48.663 seeing this virtual MSK 00:07:48.923 --> 00:07:50.725 happening on other professions, 00:07:50.745 --> 00:07:51.706 like chiropractic, 00:07:52.045 --> 00:07:53.846 where there's more hands-on focus. 00:07:53.867 --> 00:07:55.569 So I just think we also have 00:07:55.588 --> 00:07:56.468 to advocate that, like, 00:07:56.790 --> 00:07:59.151 PTs do more than just exercise, right? 00:07:59.230 --> 00:08:00.391 And I think we have to learn 00:08:00.411 --> 00:08:02.593 to advocate for that as well. 00:08:03.800 --> 00:08:04.521 Yeah, I appreciate that. 00:08:04.540 --> 00:08:07.343 And actually, I glanced at the report too, 00:08:07.403 --> 00:08:08.384 just full disclosure. 00:08:08.824 --> 00:08:11.067 And so definitely there's a 00:08:11.086 --> 00:08:12.447 discussion around that, obviously, 00:08:12.487 --> 00:08:12.908 around the... 00:08:14.437 --> 00:08:15.459 physical therapists or 00:08:15.519 --> 00:08:16.680 clinicians or whatever it 00:08:16.720 --> 00:08:17.880 might be that could be 00:08:17.920 --> 00:08:19.262 providing some of these services. 00:08:19.281 --> 00:08:20.322 So I think that last piece 00:08:20.341 --> 00:08:21.062 that you brought up there 00:08:21.083 --> 00:08:22.144 and the value of what we do 00:08:22.184 --> 00:08:23.004 and what we distinguish 00:08:23.024 --> 00:08:24.826 ourselves as is certainly 00:08:24.846 --> 00:08:26.487 an important piece of this 00:08:26.786 --> 00:08:29.309 equation as it looks there. 00:08:29.689 --> 00:08:32.030 It's interesting too that you bring up, 00:08:32.071 --> 00:08:33.032 obviously if you look at 00:08:33.052 --> 00:08:34.331 the report and you sort of 00:08:34.371 --> 00:08:35.452 brief over the report, 00:08:35.913 --> 00:08:36.573 it could be viewed as 00:08:36.594 --> 00:08:38.596 something that seems relatively positive, 00:08:38.635 --> 00:08:38.836 right? 00:08:38.895 --> 00:08:40.216 I mean, obviously we get a lot of our 00:08:42.048 --> 00:08:43.429 information and some of us 00:08:43.730 --> 00:08:45.312 actually probably use app 00:08:45.351 --> 00:08:46.953 technology to help us with 00:08:47.134 --> 00:08:48.154 various aspects that we 00:08:48.174 --> 00:08:49.496 have in our life but 00:08:50.197 --> 00:08:51.740 understanding our role and 00:08:51.779 --> 00:08:52.740 our importance I think is 00:08:52.780 --> 00:08:54.121 really key there so I 00:08:54.142 --> 00:08:56.004 appreciate that answer there 00:08:57.030 --> 00:08:58.472 So Jake, 00:08:58.493 --> 00:08:59.113 you're going to get on the 00:08:59.153 --> 00:09:00.375 question board here pretty soon, 00:09:00.394 --> 00:09:01.856 but Megan, I've got another one for you. 00:09:02.717 --> 00:09:05.640 So could you kind of, you know, 00:09:05.660 --> 00:09:06.442 we've been talking about 00:09:06.481 --> 00:09:07.864 this report and I think a 00:09:07.903 --> 00:09:09.004 lot of our listeners are probably like, 00:09:09.085 --> 00:09:09.404 wait, wait, 00:09:09.424 --> 00:09:10.186 tell me a little bit more 00:09:10.206 --> 00:09:10.746 about this report. 00:09:10.767 --> 00:09:11.467 What are you talking about 00:09:11.488 --> 00:09:12.107 with this report? 00:09:12.589 --> 00:09:12.769 So 00:09:13.490 --> 00:09:16.313 A little bit of the cart in 00:09:16.333 --> 00:09:17.215 front of the horse there, Sam. 00:09:17.254 --> 00:09:17.975 But tell us, 00:09:18.035 --> 00:09:19.979 give us an overview of this report. 00:09:20.058 --> 00:09:21.500 And if you can, 00:09:21.541 --> 00:09:22.763 can you outline some of 00:09:22.783 --> 00:09:24.485 those options that they 00:09:24.565 --> 00:09:26.147 highlighted in this report 00:09:26.167 --> 00:09:27.269 for treatments and such? 00:09:27.739 --> 00:09:29.441 Yeah, that's a great question. 00:09:29.520 --> 00:09:31.363 So what I would first say is 00:09:31.403 --> 00:09:32.504 that you have to appreciate 00:09:32.524 --> 00:09:33.985 they kind of categorized 00:09:34.426 --> 00:09:35.966 the types of digital health 00:09:36.008 --> 00:09:36.827 technologies that they 00:09:36.868 --> 00:09:37.869 wanted to focus on. 00:09:38.429 --> 00:09:40.351 So the technologies that 00:09:40.371 --> 00:09:41.994 they put three different categories, 00:09:42.014 --> 00:09:44.076 so PT guided solutions, 00:09:44.596 --> 00:09:46.557 app-based exercise solutions, 00:09:46.618 --> 00:09:48.639 and then remote monitoring. 00:09:48.760 --> 00:09:49.100 And so 00:09:49.594 --> 00:09:50.836 Each one has, I would say, 00:09:50.916 --> 00:09:53.379 different levels of PT interaction. 00:09:53.458 --> 00:09:54.559 And so, again, when you read that, 00:09:54.600 --> 00:09:55.321 I think that's a really 00:09:55.360 --> 00:09:56.322 important piece because 00:09:56.342 --> 00:09:58.024 they do some direct comparisons. 00:09:58.686 --> 00:10:00.868 And maybe even I would say 00:10:00.927 --> 00:10:02.110 this will dive into some of 00:10:02.149 --> 00:10:03.932 Jake's conversation pieces, but about, 00:10:04.273 --> 00:10:04.633 you know, 00:10:05.094 --> 00:10:06.534 what the findings actually mean 00:10:06.554 --> 00:10:08.538 from a clinical practice perspective. 00:10:09.062 --> 00:10:10.623 But PT-guided solutions may 00:10:10.643 --> 00:10:11.783 have moderate level 00:10:11.942 --> 00:10:13.563 involvement from a PT. 00:10:14.345 --> 00:10:16.446 So again, definitely they are, I would say, 00:10:16.466 --> 00:10:18.265 a little bit more simulated 00:10:18.326 --> 00:10:20.807 or similar to in-person PT. 00:10:20.847 --> 00:10:21.807 And so they did a lot of 00:10:21.847 --> 00:10:24.028 comparisons to in-person PT 00:10:24.048 --> 00:10:25.850 with these PT-guided solutions. 00:10:27.390 --> 00:10:29.772 The app-based therapy 00:10:29.812 --> 00:10:33.634 solutions used some app monitoring, 00:10:33.693 --> 00:10:34.333 some ACT 00:10:34.889 --> 00:10:36.071 some activity engagement, 00:10:36.091 --> 00:10:37.753 such as adherence tracking. 00:10:38.774 --> 00:10:40.695 But typically the PT set up 00:10:40.735 --> 00:10:41.676 the treatment plan. 00:10:42.197 --> 00:10:43.057 But then after that, 00:10:43.077 --> 00:10:44.839 it was like a little bit more hands off. 00:10:45.460 --> 00:10:45.940 So again, 00:10:46.000 --> 00:10:47.081 I think you can appreciate that 00:10:47.100 --> 00:10:48.261 the app base may not have 00:10:48.302 --> 00:10:49.442 as much interaction. 00:10:50.625 --> 00:10:52.225 It would typically set them 00:10:52.285 --> 00:10:55.308 up and then kind of go to minimal to no. 00:10:55.802 --> 00:10:56.543 interaction at all. 00:10:56.623 --> 00:10:58.864 And then remote monitoring 00:10:58.903 --> 00:10:59.424 were actually 00:10:59.585 --> 00:11:01.946 supplementations used in 00:11:02.005 --> 00:11:03.807 addition to in-person PT. 00:11:04.248 --> 00:11:05.308 And this one is what would 00:11:05.328 --> 00:11:08.551 they use is billing codes, is RTM, 00:11:08.591 --> 00:11:10.451 so remote therapeutic monitoring. 00:11:10.993 --> 00:11:12.693 So that would be in addition 00:11:12.774 --> 00:11:14.215 to in-person PT, 00:11:14.235 --> 00:11:15.576 this would be the augmented piece. 00:11:15.596 --> 00:11:16.035 This would be some 00:11:16.076 --> 00:11:17.636 additional things that they were doing. 00:11:18.337 --> 00:11:19.197 So those are the three 00:11:19.238 --> 00:11:21.820 categories that this report 00:11:21.899 --> 00:11:24.341 generated around those types. 00:11:25.506 --> 00:11:25.647 Um, 00:11:25.667 --> 00:11:27.067 they did talk a little bit about rural 00:11:27.087 --> 00:11:28.989 health as being one of the aims, 00:11:29.048 --> 00:11:30.129 but really their studies 00:11:30.188 --> 00:11:32.149 didn't focus on rural health access. 00:11:32.169 --> 00:11:33.490 So remember those who live 00:11:33.530 --> 00:11:34.772 in rural health may not 00:11:34.871 --> 00:11:36.192 actually have great wifi. 00:11:36.533 --> 00:11:37.253 And so some of these 00:11:37.293 --> 00:11:39.053 technologies and barriers 00:11:39.094 --> 00:11:39.913 and challenges weren't 00:11:39.953 --> 00:11:41.115 really detailed out. 00:11:41.154 --> 00:11:41.855 So I think we have to 00:11:41.894 --> 00:11:43.255 appreciate that report piece. 00:11:44.024 --> 00:11:45.166 But then the last thing I 00:11:45.206 --> 00:11:46.307 feel like you want to know 00:11:46.366 --> 00:11:47.567 just before we get into the 00:11:47.628 --> 00:11:49.850 studies more is that they 00:11:50.211 --> 00:11:52.371 prioritize some assessment pieces, 00:11:52.432 --> 00:11:53.933 which if you think about it, 00:11:53.953 --> 00:11:55.195 there were two pieces that 00:11:55.215 --> 00:11:55.774 they looked at. 00:11:55.836 --> 00:11:57.856 They looked at in-person PT 00:11:58.298 --> 00:11:59.138 and usual care. 00:11:59.558 --> 00:12:02.081 And so heterogeneity is 00:12:02.140 --> 00:12:03.322 pretty large when you think 00:12:03.361 --> 00:12:05.004 about in-person PT and all 00:12:05.043 --> 00:12:06.924 of these conditions and diagnoses. 00:12:07.346 --> 00:12:08.145 But really with that, 00:12:08.386 --> 00:12:09.788 it didn't prioritize it. 00:12:09.807 --> 00:12:10.849 It had to be hands-on. 00:12:11.575 --> 00:12:12.897 It didn't prioritize what 00:12:12.956 --> 00:12:14.759 those interventions specifically were. 00:12:14.820 --> 00:12:15.179 And again, 00:12:15.259 --> 00:12:16.722 I think we have to appreciate 00:12:17.283 --> 00:12:18.264 in-person PT, 00:12:18.905 --> 00:12:21.910 a lot of range of interventions. 00:12:22.864 --> 00:12:25.144 The usual care is actually 00:12:25.686 --> 00:12:26.645 what we would see in some 00:12:26.686 --> 00:12:28.927 other studies is, again, 00:12:29.067 --> 00:12:30.649 where it's not PT, 00:12:31.308 --> 00:12:33.451 that actually usual care is medications, 00:12:33.490 --> 00:12:34.571 which is over the counter, 00:12:35.511 --> 00:12:36.591 application of ice. 00:12:36.692 --> 00:12:38.953 They may actually get some education, 00:12:39.894 --> 00:12:41.235 but most of it was like PT 00:12:41.254 --> 00:12:43.116 visits or no care at all. 00:12:43.856 --> 00:12:44.236 So, again, 00:12:44.356 --> 00:12:45.577 each individual study kind of 00:12:45.618 --> 00:12:47.239 reset their own standard. 00:12:47.438 --> 00:12:49.880 And this study that was 00:12:49.941 --> 00:12:50.681 included in the virtual 00:12:50.701 --> 00:12:51.961 health kind of categorized those. 00:12:52.303 --> 00:12:55.285 are those in-person PT 00:12:55.385 --> 00:12:57.226 interventions or are those 00:12:57.366 --> 00:12:58.628 usual care interventions? 00:12:58.668 --> 00:12:59.509 And that's kind of how they 00:12:59.548 --> 00:13:00.568 dichotomize them, 00:13:00.990 --> 00:13:03.510 but a ton of heterogeneity 00:13:03.530 --> 00:13:05.533 within each of those studies. 00:13:05.613 --> 00:13:06.013 So again, 00:13:06.033 --> 00:13:07.313 just to kind of give you a high 00:13:07.354 --> 00:13:08.333 level overview of the way 00:13:08.354 --> 00:13:09.014 it was organized. 00:13:10.066 --> 00:13:10.385 Yeah. 00:13:10.405 --> 00:13:11.706 So basically comparing 00:13:11.767 --> 00:13:12.826 something highly variable 00:13:12.866 --> 00:13:14.388 to something that's highly variable. 00:13:15.489 --> 00:13:16.629 We know where that can go, right? 00:13:17.028 --> 00:13:18.830 And so, all right. 00:13:19.110 --> 00:13:19.730 Good to hear. 00:13:20.471 --> 00:13:21.711 Jake, you've been quiet here now. 00:13:21.731 --> 00:13:23.592 We've got to get you, 00:13:23.712 --> 00:13:25.432 I feel like you're ready to 00:13:25.494 --> 00:13:26.754 roll into this as well too. 00:13:26.813 --> 00:13:28.294 But I wanted to get, 00:13:29.315 --> 00:13:30.875 obviously as a background 00:13:30.916 --> 00:13:32.136 and research and 00:13:32.756 --> 00:13:35.577 NIH funding and somebody who 00:13:35.597 --> 00:13:38.018 has contributed a lot to our profession. 00:13:39.018 --> 00:13:40.077 I remember you've been on a 00:13:40.118 --> 00:13:40.658 lot of studies that 00:13:40.697 --> 00:13:42.658 actually probably do compare usual care, 00:13:42.739 --> 00:13:43.259 PT, 00:13:43.298 --> 00:13:45.139 those kinds of things in the infancy 00:13:45.578 --> 00:13:46.500 of when we were looking at 00:13:46.539 --> 00:13:47.679 those kinds of questions, 00:13:47.700 --> 00:13:49.299 specifically with hands-on care. 00:13:49.320 --> 00:13:50.179 So I think having you on 00:13:50.220 --> 00:13:52.020 here as a guest is really, 00:13:52.061 --> 00:13:54.061 really key and important. 00:13:54.081 --> 00:13:55.461 I think it really validates 00:13:55.480 --> 00:13:56.441 some of this conversation 00:13:56.461 --> 00:13:57.682 that we're going to have here. 00:13:57.761 --> 00:13:59.081 So appreciate you being on here. 00:13:59.682 --> 00:14:00.744 So we're going to go in a 00:14:00.783 --> 00:14:01.524 little bit into this 00:14:01.544 --> 00:14:03.989 because this is sort of a yes, it is a 00:14:05.509 --> 00:14:07.048 sort of a marketing kind of a thing, 00:14:07.068 --> 00:14:08.610 but it's also set up to 00:14:08.789 --> 00:14:11.110 look like it was a research being done. 00:14:11.171 --> 00:14:12.091 And so I think it needs to 00:14:12.130 --> 00:14:13.971 have some of that criticism there. 00:14:14.032 --> 00:14:15.851 So I wanted to ask you, 00:14:15.932 --> 00:14:17.753 why is it important to then 00:14:17.812 --> 00:14:19.753 critique this document? 00:14:20.774 --> 00:14:21.774 And especially that it's not 00:14:21.813 --> 00:14:24.375 a peer reviewed paper and 00:14:24.414 --> 00:14:25.414 it's not necessarily maybe 00:14:25.475 --> 00:14:27.096 intended to be a peer reviewed paper, 00:14:27.676 --> 00:14:29.657 but I think it warrants that critique. 00:14:29.677 --> 00:14:31.017 So why is that important? 00:14:31.976 --> 00:14:34.457 Yeah, great question, Derek. 00:14:34.477 --> 00:14:34.899 Thanks. 00:14:35.219 --> 00:14:38.441 And I think it's important 00:14:38.480 --> 00:14:40.922 just to retouch on the fact that, yes, 00:14:40.961 --> 00:14:43.243 this is really a report to 00:14:43.322 --> 00:14:44.764 industry and investors. 00:14:45.244 --> 00:14:46.825 And as a part of this report, 00:14:47.046 --> 00:14:48.125 kind of the foundation of 00:14:48.166 --> 00:14:49.647 it was a systematic review. 00:14:50.486 --> 00:14:52.589 And a systematic review is 00:14:52.729 --> 00:14:54.769 used to synthesize data and 00:14:54.970 --> 00:14:56.331 to help us understand a lot 00:14:56.410 --> 00:14:57.571 about a particular topic. 00:14:57.591 --> 00:14:58.152 And in this case, 00:14:58.172 --> 00:14:59.932 it was virtual musculoskeletal solutions. 00:15:00.836 --> 00:15:03.739 And when you do a systematic review, 00:15:03.798 --> 00:15:06.600 you register the review 00:15:06.922 --> 00:15:09.803 with an organization and 00:15:09.964 --> 00:15:12.284 which basically you 00:15:12.304 --> 00:15:13.365 basically tell an 00:15:13.426 --> 00:15:15.126 organization what it is 00:15:15.147 --> 00:15:16.107 that you're going to do in 00:15:16.148 --> 00:15:17.369 the systematic review so 00:15:17.408 --> 00:15:18.429 that people can come back 00:15:18.450 --> 00:15:20.091 and then and then check 00:15:20.130 --> 00:15:21.011 your work and make sure 00:15:21.032 --> 00:15:21.871 that you did what you said 00:15:21.892 --> 00:15:23.013 you were going to do in the 00:15:23.052 --> 00:15:23.793 systematic review. 00:15:23.833 --> 00:15:24.894 So they actually did that. 00:15:25.654 --> 00:15:27.056 But then, as you mentioned, 00:15:27.416 --> 00:15:28.956 it didn't the the actual 00:15:28.996 --> 00:15:30.157 systematic review itself 00:15:30.297 --> 00:15:31.217 and anything else in the 00:15:31.238 --> 00:15:33.458 report did not go through a 00:15:33.558 --> 00:15:35.080 normal peer review process, 00:15:35.120 --> 00:15:36.279 which would typically be 00:15:36.640 --> 00:15:37.561 which would be common and 00:15:37.620 --> 00:15:38.562 which would be standard 00:15:38.601 --> 00:15:40.322 practice if the report were 00:15:40.341 --> 00:15:41.562 to be published in the in 00:15:41.582 --> 00:15:42.583 the scientific journal. 00:15:43.024 --> 00:15:46.184 And so it really subverted 00:15:46.225 --> 00:15:47.025 might not be the right. 00:15:47.955 --> 00:15:48.754 term to use, 00:15:49.315 --> 00:15:50.936 but the fact that it did not 00:15:51.015 --> 00:15:52.076 go through a peer review 00:15:52.135 --> 00:15:54.496 process basically allows 00:15:54.537 --> 00:15:55.317 whoever's writing the 00:15:55.356 --> 00:15:57.998 report to frame the 00:15:58.038 --> 00:15:59.138 findings in whichever way 00:15:59.158 --> 00:16:00.198 that they feel like they 00:16:00.219 --> 00:16:01.379 want to frame them. 00:16:01.458 --> 00:16:05.299 And so some of the things 00:16:05.320 --> 00:16:07.880 that to me that were a bit concerning, 00:16:09.361 --> 00:16:09.461 well, 00:16:09.481 --> 00:16:10.542 let me just first say that the 00:16:10.581 --> 00:16:12.283 report included both 00:16:14.110 --> 00:16:15.951 randomized trials and 00:16:16.152 --> 00:16:17.312 observational studies. 00:16:17.894 --> 00:16:21.356 And the great majority of 00:16:21.417 --> 00:16:23.119 the studies in the 00:16:24.080 --> 00:16:25.240 systematic review were 00:16:25.360 --> 00:16:26.422 observational studies. 00:16:28.291 --> 00:16:30.211 It's important to know that 00:16:30.613 --> 00:16:31.874 kind of the gold standard 00:16:31.933 --> 00:16:34.215 for determining 00:16:34.315 --> 00:16:35.296 effectiveness of an 00:16:35.336 --> 00:16:37.476 intervention is a randomized trial. 00:16:38.278 --> 00:16:40.198 And observational studies 00:16:41.000 --> 00:16:42.640 are subject to lots of 00:16:42.701 --> 00:16:44.682 different types of bias 00:16:44.903 --> 00:16:49.044 that typically are not 00:16:49.085 --> 00:16:50.927 present or present in 00:16:51.067 --> 00:16:53.788 lesser amounts in randomized trials. 00:16:54.809 --> 00:16:56.750 And so it's just important 00:16:56.770 --> 00:16:57.652 to realize that when we're 00:16:57.692 --> 00:16:58.572 talking about making 00:16:58.611 --> 00:16:59.952 recommendations about the 00:16:59.972 --> 00:17:01.293 effectiveness of an intervention, 00:17:01.333 --> 00:17:03.254 when we have the great 00:17:03.274 --> 00:17:04.435 majority of studies in a 00:17:04.516 --> 00:17:06.856 systematic review are 00:17:06.896 --> 00:17:10.798 studies that are really subject to bias, 00:17:10.838 --> 00:17:12.259 then that should just give 00:17:12.299 --> 00:17:14.280 the reader some concern. 00:17:15.162 --> 00:17:20.025 And I think that in the report, they did, 00:17:21.092 --> 00:17:24.993 report the level of bias and 00:17:25.555 --> 00:17:29.517 they evaluated bias using 00:17:29.596 --> 00:17:33.259 standardized methods of evaluating bias, 00:17:33.298 --> 00:17:34.900 both for systematic reviews 00:17:35.099 --> 00:17:36.540 and for observational studies. 00:17:37.361 --> 00:17:39.863 And they found that about 00:17:39.942 --> 00:17:41.304 seventy five percent of the 00:17:41.324 --> 00:17:43.144 studies that were reported 00:17:43.285 --> 00:17:44.325 in the systematic review 00:17:44.806 --> 00:17:46.626 had high levels of bias, 00:17:46.747 --> 00:17:48.548 were rated as having high levels of bias. 00:17:49.587 --> 00:17:49.929 And so 00:17:52.486 --> 00:17:53.987 When you put that together 00:17:54.727 --> 00:17:57.828 with their strong 00:17:57.888 --> 00:17:59.089 recommendations for 00:17:59.210 --> 00:18:01.851 immediate adoptions of 00:18:03.031 --> 00:18:04.633 these musculoskeletal solutions, 00:18:05.413 --> 00:18:06.574 I think it should just give 00:18:06.634 --> 00:18:09.634 us pause to make that leap 00:18:10.776 --> 00:18:13.116 to immediate adoption of 00:18:13.136 --> 00:18:14.678 these solutions in the 00:18:14.738 --> 00:18:17.460 presence of high levels of bias. 00:18:18.327 --> 00:18:21.570 And I'm not sure that a peer 00:18:21.611 --> 00:18:23.172 reviewed manuscript of the 00:18:23.211 --> 00:18:24.472 same systematic review 00:18:24.553 --> 00:18:28.737 would allow such a strong recommendation. 00:18:29.636 --> 00:18:31.598 And so to me, 00:18:31.679 --> 00:18:33.420 I think that that's important 00:18:33.440 --> 00:18:34.000 to point out here. 00:18:35.501 --> 00:18:36.301 I appreciate that. 00:18:37.022 --> 00:18:37.782 As somebody that just 00:18:38.063 --> 00:18:39.084 published a systematic 00:18:39.304 --> 00:18:40.663 review and has had some 00:18:40.884 --> 00:18:41.744 history with publishing 00:18:41.785 --> 00:18:42.704 systematic reviews, yeah, 00:18:43.664 --> 00:18:44.385 I think one of the things 00:18:44.405 --> 00:18:45.925 that we're looking for, and maybe, 00:18:46.165 --> 00:18:47.207 you know, twenty years ago, 00:18:48.106 --> 00:18:49.008 we could just say, OK, 00:18:49.268 --> 00:18:50.107 the studies were bad, 00:18:50.167 --> 00:18:51.449 but here's the results and 00:18:52.028 --> 00:18:52.909 take with it what you may. 00:18:52.949 --> 00:18:54.170 But we're a little bit more 00:18:54.190 --> 00:18:56.330 of an advancing research profession now. 00:18:56.391 --> 00:18:57.830 And I've noticed that even 00:18:57.871 --> 00:19:00.592 when I've tried to, you know, 00:19:00.612 --> 00:19:02.472 get published systematic reviews, 00:19:02.512 --> 00:19:04.854 appropriately so, where we actually half 00:19:05.054 --> 00:19:07.935 to factor that bias into our 00:19:07.976 --> 00:19:08.757 recommendations, 00:19:08.797 --> 00:19:09.636 just not basically saying 00:19:09.676 --> 00:19:10.577 these studies were terrible 00:19:10.617 --> 00:19:12.179 and then here's our recommendations. 00:19:12.898 --> 00:19:13.660 And that would definitely go 00:19:13.720 --> 00:19:15.280 through that peer review process. 00:19:15.800 --> 00:19:18.083 And so appreciate that lens 00:19:18.143 --> 00:19:18.782 on looking at that, 00:19:18.803 --> 00:19:19.384 because I think a lot of 00:19:19.403 --> 00:19:20.044 times people don't 00:19:20.163 --> 00:19:22.826 understand how that can 00:19:22.905 --> 00:19:25.688 sometimes impact the 00:19:25.728 --> 00:19:26.929 results and the research 00:19:27.128 --> 00:19:28.009 and those sorts of things. 00:19:28.068 --> 00:19:29.230 And the peer review process 00:19:29.269 --> 00:19:30.971 certainly takes away some 00:19:31.010 --> 00:19:31.872 of that layering there. 00:19:31.892 --> 00:19:33.452 So, yeah, that's great. 00:19:34.286 --> 00:19:34.445 Well, 00:19:34.605 --> 00:19:35.826 if I could also point out something 00:19:35.886 --> 00:19:37.207 else is that there's 00:19:37.426 --> 00:19:39.288 something called the grade, 00:19:39.827 --> 00:19:44.848 which is a way of basically 00:19:44.888 --> 00:19:47.390 assessing risk of bias or, you know, 00:19:48.931 --> 00:19:49.851 I have to cut this out for 00:19:49.871 --> 00:19:50.550 a second because I want to 00:19:50.570 --> 00:19:51.491 figure out how I want to say this. 00:19:51.511 --> 00:19:58.114 It's not really, let's see. 00:20:07.742 --> 00:20:08.763 It's more determining the 00:20:08.804 --> 00:20:11.366 evaluation of the, yeah, 00:20:11.767 --> 00:20:13.249 it's used to be applicable. 00:20:13.328 --> 00:20:14.230 It's a quality rating, 00:20:14.250 --> 00:20:15.530 an overall quality rating. 00:20:16.471 --> 00:20:17.373 Yeah. 00:20:17.432 --> 00:20:18.894 But it's an evaluation piece. 00:20:18.933 --> 00:20:20.695 So you step back and do that. 00:20:20.997 --> 00:20:21.136 Yeah. 00:20:21.156 --> 00:20:22.357 Okay. 00:20:26.481 --> 00:20:28.123 Ready? 00:20:28.163 --> 00:20:29.163 I'd also like to point out 00:20:29.223 --> 00:20:32.066 that it's recommended that 00:20:32.105 --> 00:20:33.126 systematic reviews and 00:20:33.968 --> 00:20:35.788 other types of publications 00:20:35.848 --> 00:20:38.030 like guidelines use an 00:20:38.191 --> 00:20:39.811 overall evaluation for 00:20:40.452 --> 00:20:42.875 evaluating the quality of the evidence. 00:20:43.234 --> 00:20:44.395 And that is called, 00:20:45.156 --> 00:20:46.257 one thing that's recommended, 00:20:46.637 --> 00:20:48.880 one version of this is called the grade. 00:20:49.759 --> 00:20:51.901 And grade is a quality 00:20:51.941 --> 00:20:55.241 rating that can be applied 00:20:55.261 --> 00:20:56.303 to the evidence essentially. 00:20:56.942 --> 00:20:59.544 And really what it does is 00:21:00.565 --> 00:21:02.325 the researchers then use 00:21:02.365 --> 00:21:03.586 this grade to say that 00:21:03.645 --> 00:21:08.788 their level of certainty 00:21:09.288 --> 00:21:12.148 regarding the findings of 00:21:12.169 --> 00:21:13.890 the studies is very high or very low. 00:21:17.409 --> 00:21:18.549 Although this is recommended 00:21:18.589 --> 00:21:20.211 for systematic reviews to use the grade, 00:21:20.230 --> 00:21:21.372 it wasn't in this case. 00:21:21.451 --> 00:21:22.492 And so again, 00:21:22.553 --> 00:21:24.494 I think that we just need to 00:21:24.515 --> 00:21:25.736 be aware of these, 00:21:25.996 --> 00:21:26.836 what I feel like are 00:21:26.855 --> 00:21:28.917 shortcomings in the conduct 00:21:28.938 --> 00:21:29.959 of the systematic review. 00:21:30.519 --> 00:21:31.119 Yeah, no, great. 00:21:31.140 --> 00:21:32.181 Probably brought that up there. 00:21:32.820 --> 00:21:34.663 So you've kind of mentioned 00:21:34.682 --> 00:21:35.103 this a little bit, 00:21:35.123 --> 00:21:35.823 but can you tell us a 00:21:35.863 --> 00:21:37.023 little bit about the 00:21:37.124 --> 00:21:38.566 studies and why the 00:21:38.605 --> 00:21:41.147 listeners may need to read 00:21:41.167 --> 00:21:43.048 the report cautiously? 00:21:43.630 --> 00:21:44.730 You've mentioned a little bit of that, 00:21:44.789 --> 00:21:45.730 but maybe you can expand on 00:21:45.750 --> 00:21:46.432 that a little bit too. 00:21:48.547 --> 00:21:49.612 Okay, pause for a second. 00:21:49.632 --> 00:21:50.454 I'm not sure what I want to 00:21:50.494 --> 00:21:51.598 say here because I think that... 00:21:59.537 --> 00:21:59.916 I don't know. 00:22:00.156 --> 00:22:01.718 I mean, how should we frame this? 00:22:01.758 --> 00:22:03.159 Because I think that the, the main, 00:22:03.719 --> 00:22:05.519 the main issues there are 00:22:05.819 --> 00:22:06.500 the fact that it's 00:22:06.579 --> 00:22:07.921 observational studies and, 00:22:08.181 --> 00:22:09.260 and they're more subject to 00:22:09.361 --> 00:22:11.281 bias and randomized trials are, 00:22:11.362 --> 00:22:12.163 I think I've kind of said. 00:22:12.182 --> 00:22:12.262 Yeah. 00:22:13.063 --> 00:22:14.104 You might've said that when you, 00:22:14.124 --> 00:22:15.084 when I asked the question, 00:22:15.324 --> 00:22:16.644 it was in my list of questions to ask. 00:22:16.664 --> 00:22:17.424 So that's why I did it. 00:22:17.464 --> 00:22:19.766 But I would just, 00:22:19.905 --> 00:22:21.987 I would just restate like, so, I mean, 00:22:22.086 --> 00:22:23.248 in that study, right. 00:22:23.327 --> 00:22:23.847 I mean, 00:22:23.948 --> 00:22:25.848 and I've got to just pull it back up, but, 00:22:26.009 --> 00:22:26.048 um, 00:22:26.585 --> 00:22:29.527 majority of these were high risk of bias. 00:22:29.567 --> 00:22:29.827 I mean, 00:22:29.867 --> 00:22:31.189 and you could even state what that 00:22:31.229 --> 00:22:31.429 number. 00:22:31.449 --> 00:22:32.569 So just so we know, 00:22:32.630 --> 00:22:33.790 like there's twenty seven. 00:22:33.891 --> 00:22:34.550 I just have it right here. 00:22:34.931 --> 00:22:36.732 Exhibit seventeen or exhibit thirteen. 00:22:37.012 --> 00:22:38.473 So nine studies were 00:22:38.534 --> 00:22:40.234 moderate risk of bias and 00:22:40.556 --> 00:22:45.239 twenty seven were high risk of bias. 00:22:45.278 --> 00:22:46.240 And I think you just state 00:22:46.279 --> 00:22:47.361 that and then maybe what 00:22:47.381 --> 00:22:48.602 that means for people. 00:22:49.440 --> 00:22:50.121 You know, remember, 00:22:50.181 --> 00:22:51.060 clinicians don't always 00:22:51.101 --> 00:22:52.542 understand risk of bias. 00:22:52.722 --> 00:22:53.564 I would even say, like, 00:22:53.884 --> 00:22:55.765 what does that mean in the 00:22:55.785 --> 00:22:56.905 way that they should interpret it? 00:22:56.925 --> 00:22:57.006 Okay. 00:22:57.026 --> 00:22:59.127 Yeah, I think that's a great idea. 00:22:59.188 --> 00:22:59.347 Okay. 00:22:59.689 --> 00:23:01.789 Get ready. 00:23:01.830 --> 00:23:02.371 Let me mark. 00:23:02.391 --> 00:23:02.471 Yep. 00:23:02.550 --> 00:23:03.571 Go for it. 00:23:05.605 --> 00:23:07.906 So I think that just to 00:23:07.967 --> 00:23:10.928 reiterate that we had nine 00:23:11.587 --> 00:23:12.469 clinical trials, 00:23:12.528 --> 00:23:13.709 randomized clinical trials 00:23:13.868 --> 00:23:15.890 in this systematic review 00:23:16.130 --> 00:23:18.790 and twenty seven observational studies. 00:23:19.730 --> 00:23:22.935 And among the clinical trials, 00:23:24.438 --> 00:23:25.900 six of the nine were 00:23:25.940 --> 00:23:28.683 reported as having high risk for bias. 00:23:29.424 --> 00:23:32.028 And among the observational studies, 00:23:32.490 --> 00:23:33.631 twenty one of the twenty 00:23:33.671 --> 00:23:34.992 seven were reported to have 00:23:35.032 --> 00:23:35.934 high risk of bias. 00:23:36.624 --> 00:23:38.484 And so why we need to be 00:23:38.525 --> 00:23:39.465 concerned about this is 00:23:39.506 --> 00:23:40.625 when you have risk of bias 00:23:40.645 --> 00:23:42.106 in a clinical trial or 00:23:42.166 --> 00:23:43.728 observational study is that 00:23:44.107 --> 00:23:45.509 essentially it can impact 00:23:45.548 --> 00:23:46.930 the results and you can get 00:23:48.411 --> 00:23:50.172 potentially a misleading result. 00:23:50.872 --> 00:23:53.834 And so that's the big 00:23:53.913 --> 00:23:55.095 picture of why we need to 00:23:55.134 --> 00:23:56.496 be concerned about risk of 00:23:56.516 --> 00:23:58.096 bias and these high levels, 00:23:58.155 --> 00:24:00.438 particularly high levels of risk of bias. 00:24:00.617 --> 00:24:01.278 Remember, that's it. 00:24:01.337 --> 00:24:02.338 Seventy five percent of the 00:24:02.358 --> 00:24:03.799 studies in the systematic 00:24:03.819 --> 00:24:05.441 review had high risk of bias. 00:24:06.080 --> 00:24:08.502 yet the reports suggested 00:24:08.542 --> 00:24:09.163 that we ought to 00:24:09.263 --> 00:24:12.705 immediately adopt these 00:24:12.746 --> 00:24:13.787 musculoskeletal solutions 00:24:14.248 --> 00:24:15.509 when the risk for 00:24:15.648 --> 00:24:16.990 misleading results is high. 00:24:18.836 --> 00:24:19.057 You know, 00:24:19.076 --> 00:24:21.218 and I guess one of the things 00:24:21.238 --> 00:24:21.939 that I'm just thinking 00:24:21.959 --> 00:24:23.980 about here right now is, you know, 00:24:24.039 --> 00:24:24.700 I think a lot of our 00:24:24.759 --> 00:24:25.661 listeners might be looking 00:24:25.701 --> 00:24:26.461 at this and saying, 00:24:26.580 --> 00:24:27.382 especially if they look at 00:24:27.422 --> 00:24:28.622 the report and you just 00:24:28.662 --> 00:24:30.502 read it kind of quickly and 00:24:30.522 --> 00:24:31.203 you forget about some of 00:24:31.223 --> 00:24:32.523 the things that we talked about here, 00:24:32.984 --> 00:24:33.704 you might say, wow, 00:24:33.724 --> 00:24:34.965 this is pretty interesting, 00:24:35.086 --> 00:24:36.526 maybe even alarming, right? 00:24:36.546 --> 00:24:38.007 Like, wow, holy cow, 00:24:38.027 --> 00:24:40.689 we've got ways that we can 00:24:41.009 --> 00:24:42.710 or things that might even, you know, 00:24:43.757 --> 00:24:44.096 oh no, 00:24:44.478 --> 00:24:46.038 we could be replaced in a certain way, 00:24:46.098 --> 00:24:46.239 right? 00:24:46.259 --> 00:24:47.058 I think that that's some of 00:24:47.239 --> 00:24:48.579 the fears and the concerns 00:24:48.619 --> 00:24:49.621 that a lot of industries 00:24:49.641 --> 00:24:50.161 are going through. 00:24:50.181 --> 00:24:51.021 And maybe we've always felt 00:24:51.102 --> 00:24:52.001 a little bit protected 00:24:52.442 --> 00:24:53.482 around that in physical 00:24:53.522 --> 00:24:55.124 therapy because of that. 00:24:55.144 --> 00:24:55.924 But now we're seeing that 00:24:56.025 --> 00:24:58.286 infiltrate into what we are doing. 00:24:58.326 --> 00:25:00.027 And I think what I wanted to 00:25:00.047 --> 00:25:01.327 get at here was especially 00:25:01.347 --> 00:25:04.109 with the research aspect of this. 00:25:04.170 --> 00:25:05.211 So, you know, 00:25:05.810 --> 00:25:06.750 all three of us are a little 00:25:06.770 --> 00:25:08.270 bit nerdy in our research ways. 00:25:08.432 --> 00:25:12.211 And some of us more than others, Jake, we, 00:25:12.592 --> 00:25:12.832 you know, 00:25:13.092 --> 00:25:15.292 we look at things very differently, 00:25:15.492 --> 00:25:16.432 maybe than, say, 00:25:16.613 --> 00:25:17.992 clinicians might look at 00:25:18.032 --> 00:25:19.794 things or certainly the consumers. 00:25:20.253 --> 00:25:20.413 Right. 00:25:20.453 --> 00:25:21.213 I think that's actually 00:25:21.273 --> 00:25:22.193 probably even a bigger 00:25:22.953 --> 00:25:24.515 population that might see this and say, 00:25:24.535 --> 00:25:24.674 hey, 00:25:24.694 --> 00:25:26.035 this is this is fascinating and 00:25:26.075 --> 00:25:26.414 interesting. 00:25:26.434 --> 00:25:26.734 And actually, 00:25:26.755 --> 00:25:28.154 it was just today that I 00:25:28.694 --> 00:25:30.036 perused my social media and 00:25:30.476 --> 00:25:31.096 I'm on like these 00:25:32.175 --> 00:25:34.263 runner group pages, right? 00:25:34.585 --> 00:25:35.247 And on the runner group 00:25:35.267 --> 00:25:36.130 pages are always like, 00:25:37.348 --> 00:25:39.150 putting a picture of their leg and saying, 00:25:39.210 --> 00:25:39.950 I have pain here. 00:25:39.970 --> 00:25:40.631 What is this? 00:25:41.290 --> 00:25:42.332 And then you have a lot of 00:25:42.372 --> 00:25:45.153 people that provide input and, you know, 00:25:45.313 --> 00:25:46.394 opinions and, you know, 00:25:46.753 --> 00:25:47.914 we ourselves or other 00:25:47.934 --> 00:25:48.575 people are probably doing this. 00:25:48.595 --> 00:25:49.015 It's like, okay, 00:25:49.035 --> 00:25:49.955 I'm not going to type anything. 00:25:49.976 --> 00:25:50.536 I'm not going to type 00:25:50.556 --> 00:25:52.096 anything because you just really can't, 00:25:52.116 --> 00:25:52.856 you know, 00:25:52.876 --> 00:25:53.998 but that's kind of what this is 00:25:54.157 --> 00:25:56.358 a little bit like, but like you said, 00:25:56.759 --> 00:25:59.621 this is such a big stakes thing, you know, 00:25:59.661 --> 00:26:00.781 where it's replacing 00:26:00.842 --> 00:26:03.303 something that is so important. 00:26:03.363 --> 00:26:04.564 Whereas in research, 00:26:05.564 --> 00:26:06.523 what I think is most 00:26:06.564 --> 00:26:07.704 alarming with this is that 00:26:08.305 --> 00:26:09.525 research we know takes what 00:26:09.585 --> 00:26:11.125 five to seven plus years 00:26:11.184 --> 00:26:12.645 for findings to then 00:26:13.205 --> 00:26:14.105 translate into clinical 00:26:14.145 --> 00:26:15.306 practice and that's 00:26:15.365 --> 00:26:16.886 research the unfortunate 00:26:16.906 --> 00:26:18.126 thing with this is that 00:26:18.287 --> 00:26:19.166 it's actually something 00:26:19.207 --> 00:26:21.728 that is put forth by 00:26:21.968 --> 00:26:23.028 industry that actually 00:26:23.067 --> 00:26:24.568 probably has a bigger 00:26:24.669 --> 00:26:26.048 engine in it than even our 00:26:26.108 --> 00:26:28.430 research bodies do and I 00:26:28.470 --> 00:26:29.910 think that's probably one of the more 00:26:30.430 --> 00:26:32.311 alarming features of this is that yes, 00:26:32.352 --> 00:26:33.211 while it didn't follow the 00:26:33.251 --> 00:26:35.513 research process, like we say it should, 00:26:36.174 --> 00:26:40.258 um, the outcome and the, uh, potential, 00:26:41.019 --> 00:26:41.098 uh, 00:26:41.199 --> 00:26:42.680 fallout from that is actually much 00:26:42.720 --> 00:26:44.000 greater than in the research. 00:26:44.221 --> 00:26:45.102 I really think that's really 00:26:45.122 --> 00:26:46.002 important and key for 00:26:46.063 --> 00:26:47.163 listeners to understand 00:26:47.584 --> 00:26:48.484 that process and that 00:26:48.684 --> 00:26:50.605 systematic methodology for 00:26:50.705 --> 00:26:51.886 being able to come up with 00:26:52.086 --> 00:26:53.307 answers and address those things. 00:26:53.327 --> 00:26:54.628 So appreciate that Jake a lot. 00:26:54.648 --> 00:26:55.309 Yeah. 00:26:55.630 --> 00:26:57.551 And if I can just kind of reiterate that, 00:26:57.571 --> 00:26:58.291 that, uh, 00:26:59.246 --> 00:27:00.666 You know, that this is, again, 00:27:01.047 --> 00:27:02.227 being a report to industry, 00:27:04.327 --> 00:27:05.407 the thing that we're really 00:27:06.489 --> 00:27:08.048 concerned here is that 00:27:08.588 --> 00:27:09.930 there was no peer review 00:27:09.970 --> 00:27:13.530 process for this product. 00:27:14.151 --> 00:27:15.432 And as such, 00:27:16.672 --> 00:27:19.393 there's no way to let potential consumers, 00:27:20.093 --> 00:27:22.653 being clinicians, policymakers, and so on, 00:27:24.035 --> 00:27:26.836 any concerns that we might have. 00:27:28.734 --> 00:27:29.959 And I, and I'll add, I mean, 00:27:29.999 --> 00:27:31.143 so it's interesting, right? 00:27:31.202 --> 00:27:32.989 Is when you read in the top, you know, 00:27:33.009 --> 00:27:34.314 the beginning of the document, 00:27:34.763 --> 00:27:36.644 it does have who contributed 00:27:36.683 --> 00:27:37.724 to the writing of this. 00:27:37.765 --> 00:27:41.185 And there was one PT, again, clinician. 00:27:41.806 --> 00:27:43.586 The rest of them were physician-based. 00:27:43.746 --> 00:27:44.506 And so again, 00:27:44.526 --> 00:27:47.287 that's who constructed the study. 00:27:47.426 --> 00:27:49.228 And when they looked at 00:27:49.288 --> 00:27:50.387 getting some additional 00:27:50.448 --> 00:27:52.127 stakeholder involvement, 00:27:52.508 --> 00:27:53.328 they actually looked at 00:27:53.368 --> 00:27:54.388 more of those that were in 00:27:54.429 --> 00:27:55.628 the virtual health side of 00:27:55.689 --> 00:27:58.470 things rather than the PT side of things. 00:27:58.609 --> 00:28:00.650 I think that's a gap that I 00:28:00.670 --> 00:28:01.790 just want to re-highlight. 00:28:01.851 --> 00:28:02.951 And then I want to gap 00:28:03.330 --> 00:28:07.313 that PTs, we're not a dime a dozen. 00:28:08.153 --> 00:28:10.673 There is a wide range of what we do. 00:28:11.013 --> 00:28:11.394 However, 00:28:11.453 --> 00:28:12.875 it's usually patient driven and 00:28:12.894 --> 00:28:14.296 they put a lot of different 00:28:14.395 --> 00:28:16.036 types of patients together. 00:28:16.496 --> 00:28:17.076 And then again, 00:28:17.096 --> 00:28:17.576 there's a lot of 00:28:17.596 --> 00:28:18.896 heterogeneity in the types 00:28:18.936 --> 00:28:20.117 of approaches that we use. 00:28:20.698 --> 00:28:21.258 And again, 00:28:21.838 --> 00:28:24.180 it just adds layers of what I 00:28:24.200 --> 00:28:25.559 would say variables that 00:28:25.579 --> 00:28:27.221 then muddy the waters into 00:28:27.280 --> 00:28:29.122 really the validity of what 00:28:29.142 --> 00:28:30.021 their findings were. 00:28:30.778 --> 00:28:31.678 So stepping back, 00:28:31.718 --> 00:28:32.939 saying maybe we didn't get 00:28:32.959 --> 00:28:33.699 the right input, 00:28:33.858 --> 00:28:35.219 maybe there was some risk of bias, 00:28:35.298 --> 00:28:36.819 it maybe overinflated some 00:28:36.859 --> 00:28:38.279 of the outcomes from those studies, 00:28:38.660 --> 00:28:40.060 but now we're putting it 00:28:40.121 --> 00:28:42.461 out as a marketing product 00:28:42.500 --> 00:28:43.800 without that layer of 00:28:43.842 --> 00:28:45.301 complexity to state. 00:28:45.801 --> 00:28:46.922 It simplifies it, 00:28:47.301 --> 00:28:48.482 like there is more value in 00:28:48.502 --> 00:28:52.064 this maybe than what really may be there. 00:28:52.263 --> 00:28:53.384 It may be an overestimate. 00:28:54.778 --> 00:28:56.638 Yeah, I would agree. 00:28:56.659 --> 00:28:58.140 I think hopefully a lot of 00:28:58.180 --> 00:29:00.501 our listeners do agree as well too, 00:29:00.582 --> 00:29:00.721 right? 00:29:00.741 --> 00:29:02.103 I mean, obviously our product, 00:29:02.123 --> 00:29:03.203 our bulk of our listeners 00:29:03.223 --> 00:29:04.964 are going to be listening 00:29:05.045 --> 00:29:06.246 into this and having some 00:29:06.286 --> 00:29:07.546 concerns and hopefully 00:29:07.566 --> 00:29:08.707 feeling proud about what 00:29:08.747 --> 00:29:10.929 they do from an actual 00:29:11.088 --> 00:29:11.828 physical therapy 00:29:11.848 --> 00:29:12.710 perspective and the 00:29:12.769 --> 00:29:13.410 training that they've 00:29:13.470 --> 00:29:14.691 received and what they 00:29:15.251 --> 00:29:16.251 bring to the table when it 00:29:16.291 --> 00:29:18.334 comes to managing these 00:29:18.834 --> 00:29:20.295 patients and individuals with 00:29:20.515 --> 00:29:21.856 you know, lots and lots of problems. 00:29:21.876 --> 00:29:22.719 And I think the impact that 00:29:22.739 --> 00:29:23.740 we can have on society, 00:29:23.759 --> 00:29:24.480 I think all those things 00:29:24.701 --> 00:29:25.303 should be things that we 00:29:25.323 --> 00:29:26.443 should be very proud about. 00:29:27.025 --> 00:29:28.827 So I guess for both of you, 00:29:30.048 --> 00:29:32.730 what can our said consumers, 00:29:32.750 --> 00:29:33.711 our physical therapists, 00:29:33.751 --> 00:29:34.573 especially those that 00:29:34.792 --> 00:29:35.614 really believe in what 00:29:35.634 --> 00:29:36.974 they're doing in terms of 00:29:37.335 --> 00:29:38.936 either hands-on or being present. 00:29:38.957 --> 00:29:39.517 So it doesn't have to always 00:29:39.537 --> 00:29:41.278 just be hands-on the care, 00:29:41.338 --> 00:29:43.119 but being present in the moment, right, 00:29:43.180 --> 00:29:44.000 is also important. 00:29:44.381 --> 00:29:45.923 What can our consumers do? 00:29:45.962 --> 00:29:46.863 And is there sort of any 00:29:47.003 --> 00:29:48.704 kind of call to action to our, 00:29:49.965 --> 00:29:51.887 especially musculoskeletal practitioners? 00:29:53.290 --> 00:29:53.730 Yeah, 00:29:53.750 --> 00:29:56.032 I'm going to step in a safe space and 00:29:56.053 --> 00:29:57.374 just say advocacy. 00:29:57.733 --> 00:29:59.035 But when I say advocacy, 00:29:59.134 --> 00:30:00.695 I'm actually being very specific. 00:30:01.856 --> 00:30:02.557 We need to actually 00:30:02.597 --> 00:30:03.758 understand the complexity 00:30:03.837 --> 00:30:04.959 around this problem. 00:30:05.839 --> 00:30:07.240 And part of this is just making yourself, 00:30:07.260 --> 00:30:08.821 first of all, a little bit more informed. 00:30:09.342 --> 00:30:10.423 Read this. 00:30:11.464 --> 00:30:12.786 The other part is that you 00:30:12.826 --> 00:30:14.268 also need to look at the landscape. 00:30:14.528 --> 00:30:16.509 I mean, so I need to say, and again, Derek, 00:30:16.548 --> 00:30:17.170 you brought it up in the 00:30:17.210 --> 00:30:18.371 beginning of the conversation, 00:30:18.431 --> 00:30:20.172 but AI is different than 00:30:20.192 --> 00:30:21.272 virtual health technologies 00:30:21.292 --> 00:30:22.753 that were grouped into this study. 00:30:23.213 --> 00:30:25.096 And the reality is AI is 00:30:25.175 --> 00:30:26.977 picking up even faster. 00:30:27.877 --> 00:30:28.958 We need to be prepared for 00:30:28.998 --> 00:30:29.919 that conversation. 00:30:30.138 --> 00:30:31.180 And I'm going to even say 00:30:31.579 --> 00:30:32.800 one of the major virtual 00:30:32.961 --> 00:30:34.803 MSK contributors was Sword 00:30:34.863 --> 00:30:36.304 Health that was in these studies. 00:30:36.703 --> 00:30:38.204 Again, not speaking bad about it, 00:30:38.224 --> 00:30:39.306 but I'm going to give you facts. 00:30:39.673 --> 00:30:40.974 The facts are is that Sword 00:30:41.015 --> 00:30:41.796 Health just laid off 00:30:41.855 --> 00:30:43.577 thirteen PTs in order to 00:30:43.637 --> 00:30:44.599 ramp up their AI 00:30:44.660 --> 00:30:46.721 technologies in their in 00:30:46.761 --> 00:30:48.684 their type of services. 00:30:48.805 --> 00:30:50.106 So, OK, 00:30:50.227 --> 00:30:51.888 so the PT is going to have oversight. 00:30:51.949 --> 00:30:53.111 Who's verifying? 00:30:53.171 --> 00:30:54.613 How do we know that this AI 00:30:55.169 --> 00:30:56.609 isn't taking over maybe into 00:30:56.730 --> 00:30:57.810 areas that are concerning 00:30:57.830 --> 00:30:58.791 I'm going to step into 00:30:58.832 --> 00:31:00.593 another space so united 00:31:00.633 --> 00:31:01.814 healthcare is now under a 00:31:01.874 --> 00:31:03.434 major class action lawsuit 00:31:03.775 --> 00:31:05.135 because they actually have 00:31:05.296 --> 00:31:06.477 algorithms that were used 00:31:06.517 --> 00:31:08.759 by ai to determine cutoff 00:31:08.798 --> 00:31:10.519 points of service and so 00:31:10.599 --> 00:31:11.580 now they've cut off 00:31:11.621 --> 00:31:12.961 essential rehab services 00:31:13.001 --> 00:31:14.202 for those individuals with 00:31:14.303 --> 00:31:15.963 injury or sickness and 00:31:16.023 --> 00:31:16.844 medicare advantage 00:31:16.884 --> 00:31:18.045 beneficiaries and there's 00:31:18.085 --> 00:31:19.886 actually a lawsuit on this so 00:31:20.567 --> 00:31:21.288 Advocacy. 00:31:22.128 --> 00:31:23.951 If you have patients who are 00:31:24.010 --> 00:31:25.132 seeking those technologies, 00:31:25.452 --> 00:31:26.634 they absolutely need to be 00:31:26.713 --> 00:31:27.775 aware that it may not be 00:31:27.815 --> 00:31:28.756 considered the same. 00:31:29.457 --> 00:31:30.999 If they're not getting the type of care, 00:31:31.058 --> 00:31:32.079 we have to think about how 00:31:32.099 --> 00:31:33.201 are our insurance companies 00:31:33.240 --> 00:31:34.663 now using AI and 00:31:34.702 --> 00:31:36.064 technologies to make 00:31:36.104 --> 00:31:37.065 decisions on how they're 00:31:37.085 --> 00:31:37.865 going to provide care 00:31:37.885 --> 00:31:40.348 benefit coverage to our patients. 00:31:40.990 --> 00:31:43.751 So this is really advocacy as in like, 00:31:44.051 --> 00:31:45.532 talk to your legislators, 00:31:45.833 --> 00:31:47.614 get active and talk about 00:31:47.693 --> 00:31:49.075 what these technologies do 00:31:49.115 --> 00:31:51.215 to the patients that we so care to serve, 00:31:51.516 --> 00:31:52.557 not just with our hands on, 00:31:52.616 --> 00:31:53.797 but with our brains that we 00:31:53.897 --> 00:31:55.838 ended up seeking so many years of, 00:31:56.239 --> 00:31:56.499 you know, 00:31:56.558 --> 00:31:58.759 degrees in education to best benefit. 00:31:59.040 --> 00:32:00.201 It's not the same as a coach. 00:32:00.540 --> 00:32:01.922 And I don't know that AI is 00:32:01.981 --> 00:32:03.303 going to do it in the same 00:32:03.323 --> 00:32:05.144 way with personalized care. 00:32:05.544 --> 00:32:06.744 I do think there's formulas, 00:32:07.164 --> 00:32:07.925 but I don't know that 00:32:07.945 --> 00:32:08.645 they're going to ever 00:32:08.685 --> 00:32:10.146 replace the human touch piece 00:32:10.579 --> 00:32:11.660 and the human conversation 00:32:11.680 --> 00:32:14.240 piece that is essential to what we do. 00:32:14.801 --> 00:32:16.961 I really appreciate that answer. 00:32:17.001 --> 00:32:17.561 And I think, 00:32:18.123 --> 00:32:18.883 especially those of us that 00:32:18.903 --> 00:32:20.282 are a little bit involved in advocacy, 00:32:20.323 --> 00:32:21.324 maybe we think about it this way, 00:32:21.344 --> 00:32:22.223 but maybe it's time for all 00:32:22.263 --> 00:32:23.505 of our PTs to start 00:32:23.525 --> 00:32:24.265 thinking about this way a 00:32:24.305 --> 00:32:25.505 little bit more so, 00:32:26.025 --> 00:32:27.685 is being proactive instead 00:32:27.705 --> 00:32:28.826 of being reactive. 00:32:29.006 --> 00:32:30.666 And a lot of things in the world, 00:32:30.686 --> 00:32:32.167 we can be a little bit 00:32:32.228 --> 00:32:34.488 reactive because the wheel 00:32:34.528 --> 00:32:35.568 moves a little slowly. 00:32:36.249 --> 00:32:37.130 But I think, as you said, 00:32:37.210 --> 00:32:39.051 the AI wheel moves a little 00:32:39.092 --> 00:32:40.874 faster in certain spaces 00:32:41.474 --> 00:32:42.615 than we can appreciate. 00:32:42.655 --> 00:32:44.136 So I think, you know, 00:32:44.317 --> 00:32:45.358 not waiting to be reactive 00:32:45.398 --> 00:32:46.200 because by that point, 00:32:46.400 --> 00:32:48.402 maybe far too late. 00:32:48.422 --> 00:32:50.003 We don't know, but very well could be. 00:32:50.044 --> 00:32:51.045 So I appreciate that 00:32:51.285 --> 00:32:54.208 proactive advocacy response. 00:32:54.248 --> 00:32:54.888 Jake, what do you think? 00:32:55.423 --> 00:32:55.683 Yeah, 00:32:55.723 --> 00:32:58.546 I just really agree with everything 00:32:58.726 --> 00:33:00.667 basically Megan said and that you said, 00:33:00.928 --> 00:33:03.388 and doing our best as 00:33:03.429 --> 00:33:04.809 physical therapists to find 00:33:04.829 --> 00:33:06.230 a seat at the table where 00:33:06.290 --> 00:33:07.451 decisions are being made 00:33:07.952 --> 00:33:09.534 about whether or not these 00:33:09.614 --> 00:33:10.914 types of solutions are 00:33:10.954 --> 00:33:13.695 going to be available for consumers. 00:33:14.217 --> 00:33:20.000 And that requires some work, 00:33:21.221 --> 00:33:23.982 but I think that we need to have that 00:33:27.133 --> 00:33:32.137 Cut that out. 00:33:32.218 --> 00:33:33.077 Leave that in. 00:33:33.137 --> 00:33:36.441 Especially the tongue. 00:33:36.942 --> 00:33:39.384 We are going to do outtakes at some point, 00:33:39.403 --> 00:33:39.804 but yeah. 00:33:41.484 --> 00:33:46.529 Love it. 00:33:46.549 --> 00:33:47.450 I think that most of what I 00:33:47.470 --> 00:33:50.053 said was good except the very end. 00:33:50.153 --> 00:33:50.353 Yes. 00:33:50.593 --> 00:33:51.334 It was all good. 00:33:51.354 --> 00:33:53.335 It was all good. 00:33:54.511 --> 00:33:56.314 Do I have to reshoot that or what? 00:33:56.334 --> 00:33:57.755 Because I don't even remember what I said. 00:33:59.175 --> 00:34:00.317 No, do you remember where you were at, 00:34:00.356 --> 00:34:01.018 like thought-wise? 00:34:02.618 --> 00:34:04.079 You were talking about seats at the table. 00:34:04.599 --> 00:34:08.744 Yeah, I think that it's just, yeah, 00:34:09.284 --> 00:34:11.365 if we can stop it at everybody needs to, 00:34:11.385 --> 00:34:14.548 we need to be making 00:34:14.588 --> 00:34:15.710 efforts to make sure that 00:34:15.730 --> 00:34:16.610 we have a seat at the table 00:34:16.630 --> 00:34:17.710 where these decisions are made. 00:34:18.391 --> 00:34:19.932 I'll find that somewhere. 00:34:19.952 --> 00:34:20.032 Okay. 00:34:20.052 --> 00:34:21.594 All right. 00:34:21.695 --> 00:34:23.215 And begin. 00:34:27.300 --> 00:34:28.240 Oh, you just want to stop it there. 00:34:28.581 --> 00:34:28.820 Oh, yeah. 00:34:28.860 --> 00:34:30.922 I think I don't really have anything else. 00:34:30.943 --> 00:34:31.985 I think that's good. 00:34:32.005 --> 00:34:33.726 Then I may fire a question 00:34:33.746 --> 00:34:34.367 back at you then. 00:34:34.387 --> 00:34:35.228 Yeah, fire another one. 00:34:36.769 --> 00:34:37.210 Yeah. 00:34:37.250 --> 00:34:37.851 Well, wait. 00:34:37.871 --> 00:34:38.771 I'm going to get us on the 00:34:38.791 --> 00:34:39.552 right timer here. 00:34:42.371 --> 00:34:42.751 So Jake, 00:34:42.791 --> 00:34:43.853 I think that's really interesting 00:34:43.893 --> 00:34:44.873 that you mentioned getting 00:34:44.893 --> 00:34:46.054 a seat at the table. 00:34:46.894 --> 00:34:48.476 I feel like in this space, 00:34:49.277 --> 00:34:50.757 especially with what we're doing in PT, 00:34:51.518 --> 00:34:53.579 there are a lot of tables in this. 00:34:53.619 --> 00:34:54.181 And I know that this is 00:34:54.221 --> 00:34:56.902 putting you a little bit on the spot, 00:34:56.943 --> 00:34:58.744 but have you any thoughts 00:34:58.804 --> 00:35:00.505 on what that might actually look like? 00:35:00.545 --> 00:35:02.467 Megan's brought up talking 00:35:02.487 --> 00:35:03.788 with your legislators and 00:35:03.827 --> 00:35:04.547 those kinds of things that 00:35:04.608 --> 00:35:06.429 can actually have impact on 00:35:06.449 --> 00:35:07.831 swift policy changes and 00:35:07.990 --> 00:35:08.672 that sort of thing. 00:35:09.411 --> 00:35:11.532 Any other thoughts on how that might look? 00:35:11.873 --> 00:35:12.673 I especially want your 00:35:12.873 --> 00:35:13.554 thoughts and your opinion 00:35:13.594 --> 00:35:13.994 because you've been 00:35:14.014 --> 00:35:14.675 involved in a lot of 00:35:14.715 --> 00:35:15.875 different things like the 00:35:16.615 --> 00:35:19.237 opioid misuse and different 00:35:19.277 --> 00:35:21.018 types of ventures and such. 00:35:21.057 --> 00:35:21.798 And I know that so you've 00:35:21.858 --> 00:35:23.458 had seats at the table. 00:35:23.559 --> 00:35:24.539 And I just would love our 00:35:24.579 --> 00:35:26.141 listeners to hear how you 00:35:26.181 --> 00:35:27.121 get those seats at the table, 00:35:27.141 --> 00:35:28.101 what you've done in the past. 00:35:29.280 --> 00:35:30.842 Well, I think that related to this, 00:35:30.862 --> 00:35:31.844 the seat of the table could 00:35:31.884 --> 00:35:34.146 be making sure that you 00:35:34.206 --> 00:35:35.748 have a good pipeline to 00:35:35.949 --> 00:35:38.932 your health system 00:35:38.952 --> 00:35:40.916 leadership when decisions 00:35:40.956 --> 00:35:42.338 are being made about what 00:35:42.398 --> 00:35:44.721 types of insurance options 00:35:44.760 --> 00:35:45.561 are being provided. 00:35:46.342 --> 00:35:48.483 And that could be, 00:35:50.023 --> 00:35:50.824 and it could also be 00:35:51.003 --> 00:35:53.543 actually banding together 00:35:53.784 --> 00:35:55.204 as local clinics, 00:35:56.784 --> 00:35:58.146 more mom and pop clinics 00:35:58.186 --> 00:36:00.025 banding together to figure 00:36:00.065 --> 00:36:00.927 out how you're going to 00:36:00.967 --> 00:36:02.206 respond to some of these 00:36:03.286 --> 00:36:04.608 potentially virtual 00:36:04.807 --> 00:36:05.748 solutions that might be 00:36:06.688 --> 00:36:09.969 pushed upon us rather than 00:36:12.798 --> 00:36:13.920 being given really an option 00:36:13.940 --> 00:36:16.505 of whether or not to adopt it. 00:36:17.166 --> 00:36:19.251 And so being able to have 00:36:20.693 --> 00:36:22.376 kind of a critical mass in 00:36:22.516 --> 00:36:25.498 order to go to health 00:36:25.518 --> 00:36:27.240 system leadership and 00:36:27.440 --> 00:36:29.103 insurance companies to have 00:36:29.143 --> 00:36:30.963 these conversations and 00:36:31.105 --> 00:36:32.846 advocate for our profession, 00:36:33.266 --> 00:36:35.028 I think will be critical in 00:36:35.048 --> 00:36:35.809 the coming years, 00:36:36.289 --> 00:36:38.311 particularly as Megan mentioned, 00:36:38.391 --> 00:36:39.413 related to AI, 00:36:39.492 --> 00:36:41.375 because that's not going away, 00:36:41.594 --> 00:36:42.936 it's only going to accelerate. 00:36:43.938 --> 00:36:44.159 Yeah, 00:36:44.179 --> 00:36:45.639 the competition changes a little bit 00:36:45.699 --> 00:36:46.579 there instead of being 00:36:46.619 --> 00:36:47.920 competing with the 00:36:47.940 --> 00:36:48.900 clinician down the street, 00:36:48.920 --> 00:36:49.762 we're competing against 00:36:49.981 --> 00:36:50.822 something very different, 00:36:50.902 --> 00:36:51.943 very interesting perspective. 00:36:51.983 --> 00:36:52.182 Yeah. 00:36:52.302 --> 00:36:54.003 And it's going to be couched as access. 00:36:54.023 --> 00:36:54.304 I mean, 00:36:54.483 --> 00:36:55.344 so I think we really need to 00:36:55.364 --> 00:36:57.326 appreciate that it's couched as access. 00:36:58.385 --> 00:37:00.347 I live in North Carolina or North Canton, 00:37:00.407 --> 00:37:00.867 Ohio. 00:37:01.007 --> 00:37:01.248 Right. 00:37:01.327 --> 00:37:02.847 And so when we think about, you know, 00:37:02.887 --> 00:37:03.849 where you live, Derek, 00:37:03.869 --> 00:37:04.849 and where Jake lives, 00:37:04.929 --> 00:37:06.210 I would say we're not in 00:37:06.369 --> 00:37:08.050 rural areas for the most part. 00:37:08.914 --> 00:37:10.396 I received a solicitation 00:37:10.456 --> 00:37:11.836 from the insurance provider 00:37:11.876 --> 00:37:13.358 of a local hospital systems 00:37:13.398 --> 00:37:15.119 around here that they're 00:37:15.159 --> 00:37:18.661 now offering sword health PT services. 00:37:19.240 --> 00:37:20.402 And I'm thinking about all 00:37:20.422 --> 00:37:22.543 of the access of PT local to him. 00:37:22.583 --> 00:37:23.603 Like there's a ton. 00:37:24.164 --> 00:37:24.985 I was solicited. 00:37:25.565 --> 00:37:27.346 I don't live in rural health areas. 00:37:27.786 --> 00:37:29.067 Access is pretty easy. 00:37:29.568 --> 00:37:31.429 And so is it going to be one 00:37:31.449 --> 00:37:32.369 of these solutions? 00:37:32.568 --> 00:37:33.170 And again, 00:37:33.570 --> 00:37:34.791 it was through sword health and 00:37:34.831 --> 00:37:36.032 now I'm actually more anxious. 00:37:36.092 --> 00:37:37.271 Is it AI generated? 00:37:37.893 --> 00:37:38.193 And so, 00:37:39.110 --> 00:37:40.510 Here's another advocacy tool. 00:37:40.990 --> 00:37:41.871 Go through it yourself. 00:37:42.452 --> 00:37:43.192 That's what I'm going to do. 00:37:43.733 --> 00:37:44.813 I'm actually going to sign 00:37:44.873 --> 00:37:46.293 up for Sword Health PT, 00:37:47.014 --> 00:37:48.414 and I'm going to evaluate it. 00:37:48.635 --> 00:37:49.735 And then I'm going to write 00:37:49.755 --> 00:37:50.876 to the hospital system and 00:37:50.896 --> 00:37:52.197 the insurers if I see 00:37:52.237 --> 00:37:52.958 something that would be a 00:37:53.018 --> 00:37:54.699 high variation of typical practice. 00:37:55.239 --> 00:37:56.800 So start small. 00:37:57.440 --> 00:37:58.280 You can go big, 00:37:58.681 --> 00:38:00.342 you can have big conversations, 00:38:00.942 --> 00:38:01.961 but we can't put our head 00:38:02.001 --> 00:38:02.902 in the sand and pretend 00:38:02.943 --> 00:38:04.983 like this isn't existing in 00:38:05.163 --> 00:38:06.264 a current concern. 00:38:06.744 --> 00:38:08.583 We have to engage in the conversation. 00:38:09.224 --> 00:38:10.644 My bigger concern is how are 00:38:10.664 --> 00:38:11.865 these algorithms going to 00:38:11.905 --> 00:38:13.565 then decide who gets coverage, 00:38:13.606 --> 00:38:14.425 who doesn't get coverage, 00:38:14.445 --> 00:38:16.907 or when does coverage get cut off? 00:38:16.927 --> 00:38:18.228 These are conversations that 00:38:18.248 --> 00:38:19.027 we have to start to 00:38:19.068 --> 00:38:20.788 appreciate in our science. 00:38:21.588 --> 00:38:22.789 We've come a long way. 00:38:23.331 --> 00:38:24.692 But we're not all the way 00:38:24.771 --> 00:38:25.711 where we need to be even 00:38:25.731 --> 00:38:27.213 about dosage in all of the 00:38:27.253 --> 00:38:28.173 research areas that we 00:38:28.213 --> 00:38:29.974 still need to explore what 00:38:30.074 --> 00:38:32.315 is best practice in the various areas. 00:38:32.376 --> 00:38:33.836 So I would continue to 00:38:33.876 --> 00:38:35.538 encourage clinicians in the 00:38:35.637 --> 00:38:36.898 listening areas to make 00:38:36.938 --> 00:38:38.480 sure that they're doing best practice, 00:38:38.500 --> 00:38:39.840 such as the guideline-based cares. 00:38:39.860 --> 00:38:40.300 I mean, 00:38:40.320 --> 00:38:42.222 we really do need to be at the top 00:38:42.262 --> 00:38:44.143 of our game for us all to unite together. 00:38:44.659 --> 00:38:46.139 so that we don't have a low 00:38:46.159 --> 00:38:47.679 variation in our practice 00:38:48.101 --> 00:38:49.221 and that that's who gets 00:38:49.280 --> 00:38:50.081 picked on and then it 00:38:50.121 --> 00:38:51.181 changes the practice 00:38:51.242 --> 00:38:53.043 profession for all of those 00:38:53.063 --> 00:38:54.284 who truly do believe in the 00:38:54.423 --> 00:38:55.443 best hands on care, 00:38:55.563 --> 00:38:58.326 the best solutions for our patients. 00:38:59.246 --> 00:39:00.427 We definitely need to step 00:39:00.487 --> 00:39:02.226 up our game as practitioners, too. 00:39:02.367 --> 00:39:03.668 So there's there's a lot of 00:39:03.748 --> 00:39:04.929 low levels of hanging fruit 00:39:04.949 --> 00:39:05.528 that we can do. 00:39:05.588 --> 00:39:06.268 There's some higher, 00:39:06.349 --> 00:39:07.809 bigger things that we need to target. 00:39:08.951 --> 00:39:10.411 But I think the biggest 00:39:10.431 --> 00:39:11.791 thing I can say is engagement. 00:39:12.371 --> 00:39:13.134 and advocacy. 00:39:13.153 --> 00:39:14.237 Those are the things we have 00:39:14.277 --> 00:39:15.420 to start to believe that we 00:39:15.460 --> 00:39:16.985 can make a difference and 00:39:17.005 --> 00:39:18.027 we have to start somewhere. 00:39:19.052 --> 00:39:20.193 I appreciate that. 00:39:20.213 --> 00:39:21.474 Really good advice. 00:39:21.775 --> 00:39:22.416 This has been great. 00:39:23.295 --> 00:39:24.376 I really do hope that our 00:39:24.436 --> 00:39:26.498 listeners have enjoyed some 00:39:26.518 --> 00:39:28.280 of this conversation, this dialogue. 00:39:28.860 --> 00:39:31.021 It's not doom and gloom, by all means. 00:39:31.061 --> 00:39:32.222 We're a wonderful profession. 00:39:32.282 --> 00:39:32.903 I think that we should all 00:39:32.923 --> 00:39:33.583 be excited about it. 00:39:33.603 --> 00:39:34.184 And that's how we should 00:39:34.224 --> 00:39:35.224 actually walk away from 00:39:35.244 --> 00:39:37.586 this podcast is who we are 00:39:37.626 --> 00:39:39.367 and what we do and what our identity is. 00:39:39.909 --> 00:39:41.329 But realize that there are 00:39:42.451 --> 00:39:43.130 people that are always 00:39:43.170 --> 00:39:44.012 wanting to have a little 00:39:44.032 --> 00:39:45.773 bit more say in this space. 00:39:45.992 --> 00:39:47.514 And we need to just make sure that we are 00:39:48.074 --> 00:39:49.496 for society and for the 00:39:49.516 --> 00:39:50.556 individuals that we serve 00:39:50.597 --> 00:39:51.557 protecting that space. 00:39:51.818 --> 00:39:52.458 So appreciate. 00:39:52.478 --> 00:39:54.039 We're already an economic value. 00:39:54.480 --> 00:39:55.601 We're an economic value. 00:39:55.740 --> 00:39:56.581 I don't need to be cheaper 00:39:56.621 --> 00:39:57.523 to just be cheaper. 00:39:57.842 --> 00:40:00.045 We need to be cheaper with high quality. 00:40:00.324 --> 00:40:01.365 And I think that's the piece 00:40:01.385 --> 00:40:02.547 we just can't lose sight of. 00:40:02.567 --> 00:40:04.108 We are already a great value. 00:40:04.949 --> 00:40:06.110 So we just need to keep the 00:40:06.130 --> 00:40:07.150 message consistent. 00:40:07.791 --> 00:40:08.612 Yeah, there we go. 00:40:08.692 --> 00:40:10.632 Great words to leave on. 00:40:10.733 --> 00:40:11.373 Thank you, Megan. 00:40:11.434 --> 00:40:12.014 Thank you, Jake, 00:40:12.054 --> 00:40:13.255 so much for being on the show. 00:40:13.675 --> 00:40:14.376 Pleasure being here. 00:40:14.416 --> 00:40:14.856 Thanks, Derek. 00:40:15.036 --> 00:40:16.318 Thanks, Derek. 00:40:16.398 --> 00:40:16.677 Bye, Jake. 00:40:17.579 --> 00:40:18.056 Bye Megan.