WEBVTT 00:00:03.509 --> 00:00:04.490 Well, hi, everybody. 00:00:04.770 --> 00:00:06.011 I'm Dr. Skip Gill, 00:00:06.192 --> 00:00:07.633 and I'm one of the trustees 00:00:07.713 --> 00:00:09.654 on the Foundation for OMPT. 00:00:10.294 --> 00:00:11.135 And today I have the 00:00:11.156 --> 00:00:12.836 pleasure to introduce our guest, 00:00:12.977 --> 00:00:15.259 Dr. Jason Benecek. 00:00:15.339 --> 00:00:16.559 Jason is a research 00:00:16.600 --> 00:00:18.361 associate professor at the 00:00:18.402 --> 00:00:19.963 Doctor of Physical Therapy 00:00:19.983 --> 00:00:22.204 program at the University of Florida, 00:00:22.765 --> 00:00:23.765 and also a clinical 00:00:23.826 --> 00:00:25.426 research scientist at 00:00:25.588 --> 00:00:26.788 Brooks Rehabilitation. 00:00:27.609 --> 00:00:28.891 He's been supported by the 00:00:28.931 --> 00:00:30.353 National Institutes of Health, 00:00:30.875 --> 00:00:31.716 the Patient-Centered 00:00:31.836 --> 00:00:33.640 Outcome Research Institute, 00:00:34.301 --> 00:00:35.023 the Center for Health 00:00:35.042 --> 00:00:36.765 Services Training and Research, 00:00:37.226 --> 00:00:38.469 and the Foundation for 00:00:38.509 --> 00:00:39.712 Physical Therapy Research. 00:00:40.731 --> 00:00:42.171 His research interests focus 00:00:42.212 --> 00:00:43.792 on musculoskeletal pain, 00:00:44.273 --> 00:00:46.454 psychologically informed physical therapy, 00:00:47.234 --> 00:00:48.534 implementation science, 00:00:48.674 --> 00:00:50.015 and health services research. 00:00:50.735 --> 00:00:51.735 He currently teaches 00:00:51.795 --> 00:00:53.197 evidence-based practice in 00:00:53.237 --> 00:00:53.996 the Doctor of Physical 00:00:54.036 --> 00:00:55.478 Therapy program at the 00:00:55.537 --> 00:00:56.497 University of Florida. 00:00:57.539 --> 00:00:58.459 He also serves as an 00:00:58.499 --> 00:00:59.520 associate editor for 00:00:59.560 --> 00:01:01.159 physical therapy and an 00:01:01.259 --> 00:01:03.240 editorial review board 00:01:03.280 --> 00:01:04.721 member for the Journal of 00:01:04.841 --> 00:01:06.683 Orthopedic and Sports Physical Therapy. 00:01:07.625 --> 00:01:09.186 Dr. Benachek was also the 00:01:09.225 --> 00:01:10.787 recipient of the Eugene 00:01:10.807 --> 00:01:12.268 Michaels New Investigator 00:01:12.328 --> 00:01:13.789 Award by the American 00:01:13.808 --> 00:01:14.489 Physical Therapy 00:01:14.509 --> 00:01:16.631 Association in twenty twenty one. 00:01:17.411 --> 00:01:18.531 Jason, welcome. 00:01:18.912 --> 00:01:20.673 And it's great to have you on the show. 00:01:21.593 --> 00:01:21.993 Hi, Skip. 00:01:22.153 --> 00:01:23.674 And thanks for the opportunity. 00:01:23.775 --> 00:01:26.296 I always enjoy these podcasts, 00:01:26.316 --> 00:01:27.897 so I'm looking forward to it. 00:01:28.617 --> 00:01:29.438 OK, awesome. 00:01:29.478 --> 00:01:30.640 Well, you know, 00:01:31.359 --> 00:01:32.460 you're very well known in 00:01:32.501 --> 00:01:34.341 this area of mechanistic research, 00:01:34.542 --> 00:01:35.882 amongst other endeavors. 00:01:36.587 --> 00:01:37.308 But I wanted to hear a 00:01:37.427 --> 00:01:39.009 little bit about what your 00:01:39.069 --> 00:01:40.890 clinical and your research 00:01:40.930 --> 00:01:43.290 pathway was that led you to 00:01:43.391 --> 00:01:45.932 develop your expertise in this area. 00:01:46.272 --> 00:01:47.111 What was it that sort of 00:01:47.191 --> 00:01:48.311 sparked your interest? 00:01:49.173 --> 00:01:49.293 Yeah, 00:01:49.313 --> 00:01:50.712 I'm always kind of surprised when 00:01:50.753 --> 00:01:52.674 people say that I'm quote 00:01:52.754 --> 00:01:54.174 unquote known in the area 00:01:54.194 --> 00:01:55.495 of mechanistic research for 00:01:55.534 --> 00:01:56.314 manual therapy. 00:01:57.596 --> 00:01:58.695 But I guess that's where it 00:01:58.736 --> 00:01:59.996 kind of all started, right? 00:02:00.076 --> 00:02:01.417 And I think the group that I 00:02:01.456 --> 00:02:02.138 worked with at the 00:02:02.158 --> 00:02:03.177 University of Florida 00:02:03.757 --> 00:02:04.879 during my PhD training 00:02:06.055 --> 00:02:08.437 We did some pretty, I guess, novel, 00:02:08.557 --> 00:02:09.419 innovative studies 00:02:10.592 --> 00:02:12.052 back then. 00:02:12.073 --> 00:02:14.155 So that's where I think it 00:02:14.194 --> 00:02:15.194 probably all started. 00:02:15.536 --> 00:02:18.137 And my interest in mechanisms, 00:02:18.217 --> 00:02:19.557 manual therapy specifically, 00:02:19.639 --> 00:02:20.658 I think really stemmed back 00:02:20.699 --> 00:02:22.561 to my clinical practice. 00:02:23.441 --> 00:02:24.382 My clinical practice, 00:02:24.421 --> 00:02:25.622 and then obviously as I 00:02:25.663 --> 00:02:26.903 kind of transitioned back 00:02:26.963 --> 00:02:28.344 into a fellowship program, 00:02:29.085 --> 00:02:30.626 that's really where I 00:02:30.645 --> 00:02:32.867 started having questions about, 00:02:33.048 --> 00:02:34.808 we're seeing good outcomes 00:02:34.848 --> 00:02:36.450 with some of these patients, we're seeing 00:02:37.350 --> 00:02:39.073 so-so outcomes with other patients. 00:02:40.274 --> 00:02:42.175 What are the potential mechanisms? 00:02:42.216 --> 00:02:43.457 Why some people do better 00:02:43.497 --> 00:02:44.959 than others and vice versa? 00:02:46.480 --> 00:02:47.320 I think that's really where 00:02:47.360 --> 00:02:48.002 it all started. 00:02:48.081 --> 00:02:50.525 If you go back to my PhD training, 00:02:51.252 --> 00:02:52.432 My first project really 00:02:52.473 --> 00:02:53.712 focused on manual therapy 00:02:53.772 --> 00:02:55.213 mechanisms where we looked 00:02:55.234 --> 00:02:56.455 at mechanisms associated 00:02:56.474 --> 00:02:58.975 with neuromobilization techniques. 00:02:59.336 --> 00:03:01.897 So we used different 00:03:01.918 --> 00:03:02.937 assessment tools like 00:03:02.978 --> 00:03:03.899 quantitative sensory 00:03:03.938 --> 00:03:06.520 testing and to kind of fill 00:03:06.560 --> 00:03:08.801 in some of the gaps for one 00:03:08.842 --> 00:03:09.921 specific type of manual 00:03:09.961 --> 00:03:12.663 therapy technique. 00:03:12.704 --> 00:03:16.006 I think one thing that was, I think, 00:03:17.539 --> 00:03:18.281 kind of an important 00:03:18.300 --> 00:03:19.662 transition in my journey 00:03:19.701 --> 00:03:21.584 along the way was the shift 00:03:21.604 --> 00:03:23.425 that happened in my research direction. 00:03:24.206 --> 00:03:24.828 And, you know, 00:03:25.388 --> 00:03:26.430 I think going back to even 00:03:26.469 --> 00:03:29.733 when I said I wanted to do a PhD, 00:03:30.274 --> 00:03:31.055 and I think everybody 00:03:31.074 --> 00:03:31.996 probably goes through this 00:03:32.036 --> 00:03:32.997 before they get started, 00:03:33.236 --> 00:03:34.057 like they already 00:03:34.806 --> 00:03:35.706 think they know what their 00:03:35.747 --> 00:03:38.188 dissertation project's going to involve. 00:03:38.808 --> 00:03:40.650 And I honestly always 00:03:40.689 --> 00:03:41.789 thought my dissertation 00:03:41.830 --> 00:03:43.831 project would focus on slump testing, 00:03:44.532 --> 00:03:45.592 slump stretching, I'm sorry, 00:03:45.973 --> 00:03:46.712 because that was like a 00:03:46.752 --> 00:03:47.673 real interest of mine in 00:03:47.693 --> 00:03:48.533 clinical practice. 00:03:48.854 --> 00:03:50.235 And that shift in research 00:03:50.294 --> 00:03:51.715 really happened probably 00:03:51.754 --> 00:03:53.036 after the first two years. 00:03:53.276 --> 00:03:54.616 And at first it was a little, 00:03:55.076 --> 00:03:55.978 I was a little worried, 00:03:56.318 --> 00:03:58.479 but I think ultimately in the end, 00:03:58.538 --> 00:03:59.239 it was a really good 00:03:59.278 --> 00:04:00.539 decision that my mentor 00:04:00.599 --> 00:04:01.659 kind of put on the table 00:04:01.699 --> 00:04:02.540 for me to think about. 00:04:04.308 --> 00:04:05.371 Now a lot of my work is 00:04:05.450 --> 00:04:08.033 really focusing on contextual factors, 00:04:08.114 --> 00:04:09.055 which could, 00:04:09.235 --> 00:04:10.456 and we might get into this 00:04:10.497 --> 00:04:11.639 discussion in a little bit, 00:04:11.739 --> 00:04:13.681 could be mechanisms in and of themselves. 00:04:13.741 --> 00:04:15.402 So long-winded answer, 00:04:16.163 --> 00:04:17.245 but I think an important question. 00:04:17.935 --> 00:04:19.076 Yeah, yeah, thank you. 00:04:19.396 --> 00:04:22.819 So I wanted to talk about 00:04:22.879 --> 00:04:24.220 some of your ongoing research. 00:04:24.259 --> 00:04:26.622 So you received the Clinical 00:04:26.641 --> 00:04:28.303 Science and Manual Therapy 00:04:28.343 --> 00:04:31.245 Grant Award in twenty twenty three. 00:04:32.067 --> 00:04:33.088 And that's a new grant 00:04:33.108 --> 00:04:34.988 that's offered by the Paris 00:04:35.009 --> 00:04:37.870 Family Foundation through our foundation, 00:04:37.891 --> 00:04:39.173 the Foundation for OMPT. 00:04:40.012 --> 00:04:41.134 I wonder if you could give 00:04:41.194 --> 00:04:42.793 us a little overview of 00:04:42.834 --> 00:04:44.954 maybe the study's aims and 00:04:45.175 --> 00:04:46.255 the gaps you were looking 00:04:46.295 --> 00:04:49.797 to fill with this ongoing study. 00:04:49.817 --> 00:04:50.398 Sure. 00:04:50.617 --> 00:04:50.718 Yeah, 00:04:50.737 --> 00:04:53.819 so the title of the study is Patient 00:04:53.858 --> 00:04:54.899 and Physical Therapist 00:04:54.980 --> 00:04:56.779 Perspectives on Spinal 00:04:56.800 --> 00:04:57.841 Manipulative Therapy 00:04:58.288 --> 00:04:59.369 for low back pain and 00:04:59.389 --> 00:05:00.850 associated clinical outcomes. 00:05:01.370 --> 00:05:01.971 Long title, 00:05:02.211 --> 00:05:03.632 but most of our studies do have 00:05:03.853 --> 00:05:04.814 fairly long titles. 00:05:05.875 --> 00:05:06.915 We also included in the 00:05:06.956 --> 00:05:08.197 title that this is a single 00:05:08.317 --> 00:05:09.538 arm intervention study, 00:05:09.639 --> 00:05:10.579 which is important. 00:05:10.839 --> 00:05:11.761 And I think we'll kind of 00:05:11.860 --> 00:05:13.822 maybe take a little deeper 00:05:13.862 --> 00:05:14.923 dive into kind of the 00:05:14.963 --> 00:05:17.367 limitations of such a design. 00:05:18.206 --> 00:05:23.507 But I think the precedence for this study, 00:05:23.588 --> 00:05:24.968 really when we kind of 00:05:25.009 --> 00:05:25.689 talked about even 00:05:25.728 --> 00:05:28.690 developing a grant for this mechanism, 00:05:29.290 --> 00:05:30.411 is that we're obviously, 00:05:31.172 --> 00:05:34.112 we know as practitioners, as clinicians, 00:05:34.293 --> 00:05:37.514 our clinical partners that we talk to, 00:05:38.254 --> 00:05:40.115 we know that the responses 00:05:40.136 --> 00:05:41.276 to spinal manipulative 00:05:41.315 --> 00:05:42.096 therapy are really 00:05:42.177 --> 00:05:43.877 influenced by a multitude 00:05:43.918 --> 00:05:45.577 of interactions between the 00:05:45.637 --> 00:05:46.939 patient and the provider. 00:05:48.482 --> 00:05:49.783 particularly related to 00:05:49.822 --> 00:05:51.504 these contextual factors, 00:05:52.425 --> 00:05:53.406 but it's not that easy. 00:05:53.685 --> 00:05:54.966 Those contextual factors 00:05:55.007 --> 00:05:56.547 could be specific to the patient. 00:05:57.028 --> 00:05:59.048 They could be specific to the provider, 00:05:59.249 --> 00:06:00.550 in this case, the physical therapist, 00:06:01.170 --> 00:06:02.350 or really the interaction 00:06:02.391 --> 00:06:03.632 between the patient and the 00:06:03.692 --> 00:06:05.012 provider's relationship. 00:06:05.673 --> 00:06:07.853 So that's what really kind of, you know, 00:06:08.214 --> 00:06:10.435 I think, you know, 00:06:10.456 --> 00:06:11.377 that was really our main 00:06:11.437 --> 00:06:12.576 interest in kind of going 00:06:12.596 --> 00:06:14.177 for this type of mechanism. 00:06:15.199 --> 00:06:16.259 And we also kind of, 00:06:17.016 --> 00:06:18.497 we use our prior model. 00:06:18.759 --> 00:06:21.040 So I think in the manual therapy world, 00:06:21.540 --> 00:06:22.901 most folks refer to this as 00:06:22.942 --> 00:06:24.142 the Biolosky model, 00:06:25.204 --> 00:06:26.685 mechanisms of manual therapy. 00:06:26.725 --> 00:06:28.927 And we first published that in, I think, 00:06:28.947 --> 00:06:29.827 two thousand nine. 00:06:29.968 --> 00:06:31.288 And we had an updated an 00:06:31.350 --> 00:06:33.391 updated model in two thousand eighteen. 00:06:34.211 --> 00:06:35.473 And that model was really 00:06:35.533 --> 00:06:37.355 important for us in terms 00:06:37.454 --> 00:06:39.836 of developing the idea for this study. 00:06:40.925 --> 00:06:41.906 So we can talk about that a 00:06:41.925 --> 00:06:42.886 little bit more too, 00:06:42.946 --> 00:06:43.786 if that's of interest. 00:06:43.826 --> 00:06:44.887 But overall, 00:06:44.927 --> 00:06:46.809 the goal is to really gain a 00:06:46.848 --> 00:06:48.550 deeper understanding about 00:06:48.589 --> 00:06:49.730 contextual factors 00:06:50.011 --> 00:06:51.250 associated with manual 00:06:51.271 --> 00:06:52.672 therapy utilization, 00:06:53.273 --> 00:06:54.593 the perception from both 00:06:54.634 --> 00:06:56.975 the provider and the patient perspectives, 00:06:57.334 --> 00:06:58.016 and then the clinical 00:06:58.096 --> 00:06:59.516 outcomes associated with 00:06:59.596 --> 00:07:00.716 patients after that 00:07:01.038 --> 00:07:02.458 experience with manual therapy, 00:07:02.999 --> 00:07:04.839 spinal manipulation specifically. 00:07:05.793 --> 00:07:06.053 Sure. 00:07:06.853 --> 00:07:07.014 I mean, 00:07:07.055 --> 00:07:08.314 it would be great if you wanted to 00:07:08.355 --> 00:07:09.235 give us just a quick 00:07:09.295 --> 00:07:10.656 overview of the model. 00:07:10.975 --> 00:07:14.317 And then I was just thinking, 00:07:15.016 --> 00:07:16.317 was there anything maybe 00:07:16.358 --> 00:07:17.798 within this study in terms 00:07:17.879 --> 00:07:19.418 of either the methodology 00:07:19.459 --> 00:07:22.420 or the design that was unique, 00:07:23.161 --> 00:07:24.161 allowing you to get at 00:07:24.201 --> 00:07:25.480 questions maybe you weren't 00:07:25.802 --> 00:07:27.041 able to answer before? 00:07:28.105 --> 00:07:28.665 Yeah, 00:07:28.786 --> 00:07:30.288 so I think the one thing that we're 00:07:30.307 --> 00:07:32.449 really excited about is that, you know, 00:07:32.488 --> 00:07:34.509 the conceptual model for this project, 00:07:34.550 --> 00:07:35.531 like I mentioned earlier, 00:07:36.011 --> 00:07:37.932 is based on our mechanistic model. 00:07:38.913 --> 00:07:40.033 And that model really 00:07:40.074 --> 00:07:41.475 describes potential 00:07:41.514 --> 00:07:42.956 mediators of manual therapy 00:07:43.016 --> 00:07:44.336 related pain inhibition. 00:07:45.502 --> 00:07:47.502 And if you refer back to the 00:07:47.543 --> 00:07:50.625 most recent edition of the 00:07:50.665 --> 00:07:52.346 model back in two thousand eighteen, 00:07:53.245 --> 00:07:54.125 it's a little different 00:07:54.165 --> 00:07:55.646 than the initial model in 00:07:55.687 --> 00:07:57.108 that we are really focusing 00:07:57.187 --> 00:07:59.088 on just one component of the model. 00:07:59.675 --> 00:08:00.456 And that's really, 00:08:01.639 --> 00:08:02.800 if you refer to the paper, 00:08:02.880 --> 00:08:04.622 it would be considered zone one. 00:08:05.303 --> 00:08:06.545 And that would be contextual 00:08:06.586 --> 00:08:08.067 factors related to both the 00:08:08.108 --> 00:08:09.831 patient and the provider. 00:08:10.572 --> 00:08:11.372 And one of the things that 00:08:11.413 --> 00:08:12.213 we really tried to 00:08:12.353 --> 00:08:13.475 incorporate in the design 00:08:13.516 --> 00:08:15.879 of this study is to collect data 00:08:16.560 --> 00:08:18.261 specific to the patient and 00:08:18.300 --> 00:08:19.742 specific to the provider, 00:08:20.182 --> 00:08:22.963 but specifically using 00:08:23.023 --> 00:08:24.863 measures that were very similar. 00:08:25.384 --> 00:08:26.245 So that in essence, 00:08:26.264 --> 00:08:27.505 it gives us the potential 00:08:27.625 --> 00:08:28.886 opportunity to really 00:08:28.947 --> 00:08:32.307 compare a provider's perspective about, 00:08:32.408 --> 00:08:32.849 let's say, 00:08:32.948 --> 00:08:35.389 expectations and beliefs to a 00:08:35.450 --> 00:08:36.850 patient's perspectives 00:08:36.971 --> 00:08:39.672 about pain beliefs and 00:08:39.792 --> 00:08:40.852 expectations as well. 00:08:41.692 --> 00:08:42.854 and also linking that 00:08:42.894 --> 00:08:44.394 specific provider to that 00:08:44.434 --> 00:08:45.414 specific patient, 00:08:45.634 --> 00:08:46.956 as opposed to looking at it 00:08:47.635 --> 00:08:49.836 on more of a group level, if you will. 00:08:49.856 --> 00:08:53.139 So, you know, I think very, very, 00:08:53.318 --> 00:08:55.580 very complex in terms of, you know, 00:08:55.780 --> 00:08:56.760 how we're going to collect 00:08:56.801 --> 00:08:58.302 this and match up patients 00:08:58.322 --> 00:08:59.663 with specific providers. 00:08:59.702 --> 00:09:01.383 And I will tell you up front, 00:09:01.583 --> 00:09:02.703 it took a lot of time to 00:09:02.744 --> 00:09:03.884 kind of set up the data 00:09:03.904 --> 00:09:05.265 collection system with this. 00:09:05.365 --> 00:09:05.485 But 00:09:06.433 --> 00:09:07.414 We're beyond that now, 00:09:07.595 --> 00:09:08.495 and that was a nice 00:09:08.576 --> 00:09:11.357 exercise in really making this work. 00:09:11.518 --> 00:09:14.341 So I think that's something 00:09:14.380 --> 00:09:16.582 that we're probably most excited about. 00:09:17.421 --> 00:09:17.660 Yeah, 00:09:17.760 --> 00:09:19.542 and I know you're kind of in the 00:09:19.601 --> 00:09:20.201 midst of it, 00:09:20.221 --> 00:09:21.763 so it would be kind of too 00:09:21.883 --> 00:09:24.624 early to probably talk about results, 00:09:24.683 --> 00:09:26.524 but in terms of kind of 00:09:26.544 --> 00:09:29.225 your recruiting and your data collection, 00:09:29.985 --> 00:09:31.027 can you give us an idea of 00:09:31.067 --> 00:09:32.246 maybe where you're at and 00:09:32.267 --> 00:09:33.206 then maybe what the 00:09:33.268 --> 00:09:35.008 timeline looks for 00:09:35.207 --> 00:09:36.589 finishing up this project? 00:09:37.225 --> 00:09:37.485 Sure. 00:09:38.765 --> 00:09:41.248 So at this point in late 00:09:41.268 --> 00:09:43.068 February of twenty twenty five, 00:09:43.529 --> 00:09:44.931 we have twelve physical 00:09:44.971 --> 00:09:45.831 therapists enrolled. 00:09:46.331 --> 00:09:49.673 We also wanted to we were 00:09:49.714 --> 00:09:51.134 intentional in that the 00:09:51.154 --> 00:09:52.436 physical therapist that we 00:09:52.495 --> 00:09:54.258 approached for this study, 00:09:54.697 --> 00:09:55.979 we wanted to have a fairly 00:09:57.419 --> 00:09:59.000 a fairly equal distribution 00:09:59.081 --> 00:10:00.381 amongst those who have 00:10:00.422 --> 00:10:02.003 received or experienced or 00:10:02.062 --> 00:10:02.923 went through a manual 00:10:02.943 --> 00:10:04.225 therapy fellowship program. 00:10:05.519 --> 00:10:06.321 and another group that 00:10:06.360 --> 00:10:08.485 haven't because that 00:10:08.544 --> 00:10:10.950 potential experience could 00:10:11.129 --> 00:10:12.493 influence the outcomes and 00:10:12.513 --> 00:10:13.615 it could influence a lot of 00:10:13.634 --> 00:10:14.517 the outcomes that we're 00:10:14.537 --> 00:10:16.240 looking for in this study particularly. 00:10:17.263 --> 00:10:18.244 So we have, like I said, 00:10:18.283 --> 00:10:19.784 twelve physical therapists involved. 00:10:20.524 --> 00:10:22.725 The goal, the plan, the expectations, 00:10:22.785 --> 00:10:23.346 if you will, 00:10:23.706 --> 00:10:24.547 is that each of those 00:10:24.586 --> 00:10:26.187 physical therapists recruit 00:10:26.307 --> 00:10:28.549 and enroll eight patients 00:10:29.070 --> 00:10:30.311 over the course of the study. 00:10:30.890 --> 00:10:31.451 And right now, 00:10:31.510 --> 00:10:33.312 I think we have I think we 00:10:33.331 --> 00:10:34.273 have approximately eight 00:10:34.312 --> 00:10:35.614 patients that are enrolled 00:10:36.073 --> 00:10:37.754 across the twelve different 00:10:37.794 --> 00:10:38.654 physical therapists. 00:10:38.674 --> 00:10:41.476 So that's where we are right now. 00:10:41.496 --> 00:10:42.437 And I think it's too early 00:10:42.476 --> 00:10:43.278 to kind of do any 00:10:43.337 --> 00:10:44.719 preliminary analysis of anything. 00:10:45.850 --> 00:10:46.370 You know, 00:10:46.390 --> 00:10:47.491 that's really our main effort 00:10:47.532 --> 00:10:49.173 right now is to really 00:10:49.192 --> 00:10:50.254 focus on the recruitment 00:10:50.313 --> 00:10:52.274 and enrollment parts of the study. 00:10:52.394 --> 00:10:53.235 Yeah, that's great. 00:10:53.296 --> 00:10:54.517 And I mean, 00:10:54.537 --> 00:10:55.538 I like that you're looking at 00:10:55.658 --> 00:10:56.938 both angles of this. 00:10:57.038 --> 00:10:57.938 Do you, 00:10:58.539 --> 00:11:00.400 either from your own kind of 00:11:00.561 --> 00:11:01.522 research or clinical 00:11:01.581 --> 00:11:05.063 intuition or from other 00:11:05.104 --> 00:11:06.705 things maybe that are published, 00:11:06.745 --> 00:11:08.025 do you have a sense of, 00:11:09.287 --> 00:11:11.488 by parsing out maybe how much of this is 00:11:12.708 --> 00:11:13.910 How much of the effect might 00:11:13.951 --> 00:11:15.273 be related to the patient's 00:11:15.393 --> 00:11:17.014 contextual factors versus 00:11:17.054 --> 00:11:18.677 how much might be related 00:11:18.756 --> 00:11:19.778 to the clinician? 00:11:19.798 --> 00:11:19.918 I mean, 00:11:20.799 --> 00:11:21.961 are you thinking it might be a 00:11:22.020 --> 00:11:23.663 fifty fifty or do you think 00:11:23.943 --> 00:11:25.865 that maybe even like the 00:11:26.246 --> 00:11:28.009 provider's influence might 00:11:28.028 --> 00:11:29.350 be a lot higher than we thought? 00:11:29.951 --> 00:11:32.013 Yeah, so that's another great question, 00:11:32.253 --> 00:11:33.033 and that's something we 00:11:33.073 --> 00:11:34.595 considered when we kind of 00:11:34.855 --> 00:11:36.056 developed this grant. 00:11:36.556 --> 00:11:36.735 You know, 00:11:36.775 --> 00:11:37.797 if you look at the literature in 00:11:37.836 --> 00:11:38.476 this area, 00:11:38.777 --> 00:11:40.719 there's been quite a few 00:11:40.778 --> 00:11:42.078 studies that really focus 00:11:42.139 --> 00:11:43.580 on one or the other, right? 00:11:43.620 --> 00:11:45.461 The patient's perspective or 00:11:45.520 --> 00:11:46.861 the clinician's slash 00:11:46.881 --> 00:11:47.942 provider's perspective. 00:11:48.302 --> 00:11:49.203 And there's been a few 00:11:49.264 --> 00:11:50.464 studies that have actually 00:11:50.563 --> 00:11:52.326 looked at both and really 00:11:52.365 --> 00:11:54.027 looked at relationships 00:11:54.427 --> 00:11:56.008 amongst patients and providers. 00:11:57.508 --> 00:11:59.149 So that's kind of like our 00:11:59.168 --> 00:12:00.668 approach to this is that we 00:12:00.708 --> 00:12:03.370 wanted to look at both, 00:12:03.409 --> 00:12:04.889 but we also wanted to link 00:12:05.429 --> 00:12:07.551 specific patients with therapists, 00:12:08.051 --> 00:12:09.890 not as a therapist group as a whole. 00:12:10.811 --> 00:12:13.392 The question about what's my hypothesis, 00:12:13.451 --> 00:12:14.731 what do I think is stronger? 00:12:16.192 --> 00:12:18.153 I think in a perfect world, 00:12:18.192 --> 00:12:19.972 you might say that it's fifty-fifty, 00:12:20.013 --> 00:12:22.433 but I don't think that will be the case 00:12:24.022 --> 00:12:25.424 I think my gut instinct is 00:12:25.485 --> 00:12:27.970 probably telling me that a 00:12:28.009 --> 00:12:29.714 lot of this is probably 00:12:30.014 --> 00:12:33.302 more heavily driven by the provider. 00:12:34.756 --> 00:12:35.817 And again, I think, you know, 00:12:36.138 --> 00:12:37.198 a follow up question to 00:12:37.219 --> 00:12:39.740 this study would be, you know, 00:12:40.081 --> 00:12:41.623 wouldn't it be great if we 00:12:41.663 --> 00:12:42.823 had a better understanding 00:12:42.903 --> 00:12:44.066 of the influence of 00:12:44.145 --> 00:12:46.147 provider perspectives and 00:12:46.187 --> 00:12:47.908 how that can influence outcomes? 00:12:48.409 --> 00:12:49.090 And I had a really 00:12:49.129 --> 00:12:50.711 interesting talk with some 00:12:50.751 --> 00:12:51.712 of the leadership in our 00:12:51.732 --> 00:12:53.354 health system just to kind 00:12:53.374 --> 00:12:54.796 of get an idea like, you know, 00:12:55.784 --> 00:12:56.806 in a few years from now, 00:12:56.846 --> 00:12:57.726 would this be something 00:12:57.746 --> 00:12:59.087 that we would even consider? 00:12:59.248 --> 00:13:01.068 And the topic of really 00:13:01.168 --> 00:13:03.431 matching patients with 00:13:03.471 --> 00:13:06.092 providers that have similar attitudes, 00:13:06.153 --> 00:13:07.714 beliefs, what have you about, 00:13:07.995 --> 00:13:09.395 in this case, spinal manipulation. 00:13:10.572 --> 00:13:11.572 and you know I've talked to 00:13:11.633 --> 00:13:12.975 others about that and you 00:13:12.995 --> 00:13:14.136 know well that sounds like 00:13:14.157 --> 00:13:15.557 a great idea but you know 00:13:15.938 --> 00:13:16.820 that's that's not going to 00:13:16.840 --> 00:13:18.442 happen you know leadership 00:13:18.501 --> 00:13:19.903 in my system said that 00:13:19.923 --> 00:13:21.085 would be great if we could 00:13:21.125 --> 00:13:22.586 do that and are we there 00:13:23.207 --> 00:13:24.308 are we to the position that 00:13:24.328 --> 00:13:25.431 we can do that right now 00:13:26.691 --> 00:13:27.030 No, 00:13:27.270 --> 00:13:28.751 but just to hear that there's 00:13:28.812 --> 00:13:30.371 enthusiasm and interest and 00:13:30.451 --> 00:13:31.773 excitement from leadership 00:13:31.832 --> 00:13:33.232 on our system that, you know, 00:13:33.332 --> 00:13:34.493 this is maybe something we 00:13:34.513 --> 00:13:35.533 could look at in the future. 00:13:35.793 --> 00:13:37.793 You know, to me, that was exciting. 00:13:37.894 --> 00:13:38.634 And that really kind of 00:13:38.674 --> 00:13:40.274 pushed me a little further to say, 00:13:40.355 --> 00:13:42.416 you know, hey, this study, this study, 00:13:42.576 --> 00:13:43.895 the outcomes of this study 00:13:43.956 --> 00:13:45.196 could have relevance from a 00:13:45.255 --> 00:13:46.897 clinical practice perspective as well. 00:13:47.856 --> 00:13:49.038 Yeah, yeah, definitely. 00:13:49.057 --> 00:13:50.197 I mean, I think that's great. 00:13:50.278 --> 00:13:51.259 I mean, 00:13:51.278 --> 00:13:53.000 maybe any other future research 00:13:53.039 --> 00:13:54.039 directions that you're 00:13:54.100 --> 00:13:55.760 thinking along these lines? 00:13:55.801 --> 00:13:58.162 I mean, I know like in this area, 00:13:58.282 --> 00:13:59.582 only everyone can take a 00:14:00.123 --> 00:14:02.583 small bite out of the bigger problem. 00:14:02.624 --> 00:14:04.664 So whether for your research 00:14:04.705 --> 00:14:07.807 team or other teams that are out there, 00:14:08.767 --> 00:14:10.748 any other maybe big ideas 00:14:10.788 --> 00:14:11.969 or big questions that 00:14:12.969 --> 00:14:14.549 everyone needs to dissect a bit? 00:14:15.902 --> 00:14:16.022 Yeah, 00:14:16.042 --> 00:14:16.981 so one of the co-principal 00:14:17.001 --> 00:14:18.322 investigators on this study 00:14:18.383 --> 00:14:19.643 is Dr. Joe Bialawski. 00:14:19.702 --> 00:14:21.203 He's one of my colleagues at 00:14:21.224 --> 00:14:22.264 the University of Florida 00:14:22.283 --> 00:14:23.344 and Brooks Rehabilitation. 00:14:23.424 --> 00:14:25.125 And we both have a really 00:14:25.144 --> 00:14:26.466 shared interest in shared 00:14:26.505 --> 00:14:27.245 decision making. 00:14:28.306 --> 00:14:28.865 You know, 00:14:28.905 --> 00:14:31.106 we recently completed a small 00:14:31.147 --> 00:14:33.467 pilot study looking at, you know, 00:14:34.225 --> 00:14:36.246 how we can incorporate or 00:14:36.346 --> 00:14:37.986 integrate clinical practice 00:14:38.027 --> 00:14:40.148 guidelines into clinical 00:14:40.187 --> 00:14:41.607 practice with our patients. 00:14:41.668 --> 00:14:43.609 Because our patient partners tell us, 00:14:44.129 --> 00:14:45.230 although they may be aware 00:14:45.269 --> 00:14:46.049 of the guidelines, 00:14:46.169 --> 00:14:47.409 one of the real struggles 00:14:47.450 --> 00:14:49.831 or barriers is still how to 00:14:49.951 --> 00:14:51.772 implement them in clinical practice. 00:14:52.312 --> 00:14:53.471 So one of the things that we 00:14:53.511 --> 00:14:54.392 kind of looked at and we 00:14:54.432 --> 00:14:56.092 were interested in is, you know, 00:14:56.113 --> 00:14:56.653 this could be an 00:14:56.732 --> 00:14:59.014 opportunity for shared decision making. 00:14:59.994 --> 00:15:01.654 And I say that because, you know, 00:15:02.014 --> 00:15:03.235 shared decision-making in 00:15:03.254 --> 00:15:04.235 the outpatient physical 00:15:04.275 --> 00:15:05.936 therapy arena is a lot 00:15:06.076 --> 00:15:07.917 different than shared decision-making, 00:15:07.956 --> 00:15:09.417 let's say in primary care, 00:15:09.476 --> 00:15:10.557 because let's face it, 00:15:10.998 --> 00:15:12.197 a lot of the options that 00:15:12.238 --> 00:15:13.317 we can provide from an 00:15:13.398 --> 00:15:14.698 intervention perspective, 00:15:15.379 --> 00:15:18.240 all have very similar levels of risk. 00:15:18.639 --> 00:15:21.520 And that risk is probably very low, right? 00:15:21.561 --> 00:15:23.601 So how do we make this work? 00:15:24.042 --> 00:15:25.101 So that's one thing that we 00:15:25.182 --> 00:15:27.163 are interested in is kind of, you know, 00:15:27.643 --> 00:15:29.024 how do we really take the 00:15:29.063 --> 00:15:30.365 preliminary results of that 00:15:30.404 --> 00:15:32.066 small pilot study and kind 00:15:32.106 --> 00:15:33.888 of what we're looking at here and, 00:15:34.327 --> 00:15:35.609 you know, 00:15:35.788 --> 00:15:37.269 maybe look a little further in 00:15:37.309 --> 00:15:38.471 terms of how we can really 00:15:38.630 --> 00:15:39.892 integrate our patient 00:15:39.951 --> 00:15:41.474 preferences and our 00:15:41.514 --> 00:15:44.176 clinicians' experience in 00:15:44.235 --> 00:15:45.115 terms of clinical 00:15:45.155 --> 00:15:47.097 decision-making for our patients. 00:15:47.217 --> 00:15:48.918 Yeah, I like that direction. 00:15:49.799 --> 00:15:51.681 And lots of work needs to be done, I guess, 00:15:51.721 --> 00:15:52.902 by lots of folks on that. 00:15:52.922 --> 00:15:53.562 Definitely. 00:15:55.312 --> 00:15:56.352 I wonder if you could just 00:15:56.373 --> 00:15:59.495 share for me a little bit about, you know, 00:15:59.554 --> 00:16:01.395 for folks maybe looking for 00:16:01.436 --> 00:16:02.596 the clinical science and 00:16:02.615 --> 00:16:04.557 manual therapy grant, you know, 00:16:04.576 --> 00:16:07.119 we're in the process right now of that. 00:16:07.158 --> 00:16:08.580 And this is an award that 00:16:08.620 --> 00:16:10.019 we'll be doing every year. 00:16:12.061 --> 00:16:14.383 And at least for the next couple of years. 00:16:14.783 --> 00:16:15.903 So I just wonder if you had 00:16:15.942 --> 00:16:18.124 any advice or maybe just 00:16:18.164 --> 00:16:19.144 you could share a few 00:16:19.184 --> 00:16:20.466 thoughts about the process 00:16:20.525 --> 00:16:22.886 of going through that particular process. 00:16:23.402 --> 00:16:28.006 grant application with our organization. 00:16:28.047 --> 00:16:28.307 Sure. 00:16:28.466 --> 00:16:28.727 Yeah. 00:16:29.207 --> 00:16:33.251 And I'd like to thank the 00:16:33.932 --> 00:16:35.754 Paris Family Foundation for 00:16:35.774 --> 00:16:36.635 the opportunity. 00:16:36.755 --> 00:16:39.538 It was very timely for our 00:16:39.578 --> 00:16:41.179 group to kind of move forward with this. 00:16:41.220 --> 00:16:43.243 And I think the process in general was 00:16:44.399 --> 00:16:47.725 DRI say it was a fairly easy 00:16:47.765 --> 00:16:49.909 process for us to kind of, 00:16:49.950 --> 00:16:51.111 communicating with folks 00:16:51.293 --> 00:16:54.057 along the way was a seamless process. 00:16:54.077 --> 00:16:55.780 So that's the first thing I 00:16:55.821 --> 00:16:56.601 wanted to talk about. 00:16:57.255 --> 00:16:59.197 I think in terms of suggestions is, 00:16:59.496 --> 00:17:00.337 and I think this probably 00:17:00.378 --> 00:17:01.337 applies for a lot of 00:17:01.378 --> 00:17:02.778 different grant opportunities, 00:17:02.818 --> 00:17:03.698 grant mechanisms, 00:17:03.759 --> 00:17:05.339 is make sure your project 00:17:06.201 --> 00:17:07.981 idea is consistent with the 00:17:08.061 --> 00:17:09.942 overall mission and goals 00:17:10.722 --> 00:17:11.883 of the grant application. 00:17:13.743 --> 00:17:15.285 Because even if 00:17:15.345 --> 00:17:16.726 investigators have ideas 00:17:16.766 --> 00:17:19.007 about a novel idea, an innovative idea, 00:17:19.027 --> 00:17:19.907 an interesting idea, 00:17:20.407 --> 00:17:21.508 it needs to be in line and 00:17:21.548 --> 00:17:22.788 consistent with the call 00:17:22.848 --> 00:17:24.230 for the grant itself. 00:17:24.970 --> 00:17:25.730 I think another thing that's 00:17:25.750 --> 00:17:27.010 really important is to 00:17:27.070 --> 00:17:28.892 really develop your team, 00:17:29.432 --> 00:17:30.952 a strong team ahead of time. 00:17:31.353 --> 00:17:33.554 And a really important part of that team, 00:17:33.953 --> 00:17:35.513 at least in our experiences, 00:17:35.714 --> 00:17:37.454 is the clinical partners. 00:17:38.395 --> 00:17:38.576 You know, 00:17:38.596 --> 00:17:39.976 we've communicated with and we 00:17:40.036 --> 00:17:41.176 engaged our clinical 00:17:41.217 --> 00:17:42.676 partners even during the 00:17:42.696 --> 00:17:44.097 grant development stages to 00:17:44.137 --> 00:17:44.877 really get their 00:17:44.917 --> 00:17:46.798 perspective about this idea 00:17:47.378 --> 00:17:49.240 and how might this look in 00:17:49.279 --> 00:17:50.260 clinical practice. 00:17:51.020 --> 00:17:52.121 Conducted the study in 00:17:52.141 --> 00:17:53.281 clinical practice because 00:17:54.001 --> 00:17:54.943 that's where this study is 00:17:54.983 --> 00:17:55.605 being conducted. 00:17:55.664 --> 00:17:56.967 It's not a laboratory setting. 00:17:56.987 --> 00:17:58.469 This is really being done 00:17:58.509 --> 00:17:59.971 during routine clinical practice. 00:17:59.991 --> 00:18:01.133 So I think those are 00:18:01.153 --> 00:18:02.375 probably the most important 00:18:02.816 --> 00:18:05.780 points and comments in 00:18:05.820 --> 00:18:07.143 terms of advice for folks 00:18:07.163 --> 00:18:07.804 that might be thinking 00:18:07.844 --> 00:18:08.704 about this in the future. 00:18:09.385 --> 00:18:09.625 Yeah. 00:18:09.705 --> 00:18:10.146 Okay. 00:18:10.247 --> 00:18:10.386 Yeah. 00:18:10.426 --> 00:18:10.846 Thank you. 00:18:11.587 --> 00:18:11.968 Um, 00:18:12.008 --> 00:18:14.249 so just wondering as we kind of finish up, 00:18:14.328 --> 00:18:14.549 if, uh, 00:18:15.190 --> 00:18:17.211 you have any kind of last thoughts or, uh, 00:18:17.612 --> 00:18:19.153 any little pieces of wisdom, 00:18:19.192 --> 00:18:20.453 maybe you'd like to share 00:18:20.473 --> 00:18:23.336 with our listeners, uh, about, you know, 00:18:23.455 --> 00:18:24.896 building a successful 00:18:25.096 --> 00:18:27.617 academic and research career, uh, 00:18:27.657 --> 00:18:28.318 like you've done. 00:18:28.919 --> 00:18:30.299 Yeah. 00:18:30.319 --> 00:18:33.041 Um, so, you know, a few years ago, 00:18:33.241 --> 00:18:35.243 back in Cleveland at the, uh, 00:18:35.324 --> 00:18:36.183 annual conference, 00:18:36.344 --> 00:18:38.425 I was asked to give a talk on, um, 00:18:40.208 --> 00:18:40.873 on mentorship. 00:18:41.987 --> 00:18:43.988 And for the first time in 00:18:44.067 --> 00:18:45.067 probably fifteen years, 00:18:45.107 --> 00:18:46.409 it really forced me to sit 00:18:46.429 --> 00:18:49.089 down and think about my mentors. 00:18:49.650 --> 00:18:50.631 They're always on your mind, 00:18:50.651 --> 00:18:51.330 you know who they are, 00:18:51.371 --> 00:18:53.612 but to really talk about 00:18:54.051 --> 00:18:55.633 the influence of the mentors. 00:18:55.853 --> 00:18:57.574 So I think that's really, 00:18:57.993 --> 00:18:59.193 really important is for 00:18:59.213 --> 00:19:00.835 folks to identify strong 00:19:01.295 --> 00:19:03.236 personal and career mentors 00:19:04.096 --> 00:19:05.376 and do it early. 00:19:06.356 --> 00:19:07.738 And sometimes a single 00:19:07.817 --> 00:19:08.978 individual could kind of 00:19:08.998 --> 00:19:10.318 fill both of those, right? 00:19:10.878 --> 00:19:12.621 personal mentor and a career mentor. 00:19:13.540 --> 00:19:14.622 I think that's really important. 00:19:15.482 --> 00:19:16.544 I think developing your 00:19:16.604 --> 00:19:18.286 strong collaborator team 00:19:19.263 --> 00:19:20.903 And when I say collaborator team, 00:19:21.585 --> 00:19:22.404 I think it's important that 00:19:22.424 --> 00:19:23.944 folks think about real 00:19:24.244 --> 00:19:25.785 long-term collaborators and 00:19:25.825 --> 00:19:27.165 not just collaborators that 00:19:27.205 --> 00:19:28.846 want to be involved from a 00:19:28.885 --> 00:19:30.306 data collection perspective. 00:19:31.326 --> 00:19:32.626 The sooner you can develop 00:19:33.106 --> 00:19:34.166 and strengthen your team, 00:19:34.247 --> 00:19:37.347 I think it'll be a benefit to folks. 00:19:38.528 --> 00:19:39.468 I mentioned earlier about 00:19:39.508 --> 00:19:41.348 the collaboration with clinical partners. 00:19:42.368 --> 00:19:44.229 I think that's extremely important. 00:19:44.348 --> 00:19:47.289 And then the final piece of this, 00:19:47.309 --> 00:19:48.130 we did a little work 00:19:48.789 --> 00:19:50.310 several years ago in kind of 00:19:50.371 --> 00:19:51.632 developing partnerships 00:19:51.652 --> 00:19:52.593 with our patients. 00:19:53.253 --> 00:19:54.734 And that's a little bit more challenging. 00:19:54.775 --> 00:19:56.395 It's a little bit more difficult, 00:19:56.516 --> 00:19:58.738 especially sustaining those partnerships. 00:19:58.837 --> 00:20:00.479 But I think it was really 00:20:00.519 --> 00:20:02.180 valuable to me and it 00:20:02.220 --> 00:20:04.481 allowed us to kind of provide 00:20:04.781 --> 00:20:06.383 the patient's perspective in 00:20:06.423 --> 00:20:08.605 terms of ideas that we have 00:20:09.105 --> 00:20:10.846 for our future research projects. 00:20:11.066 --> 00:20:12.406 So I think those are 00:20:12.446 --> 00:20:14.648 probably the easiest things 00:20:14.709 --> 00:20:16.309 to think about in terms of my mind. 00:20:16.650 --> 00:20:19.571 And then finally, you know, reality, 00:20:20.092 --> 00:20:21.432 you know, it's not an easy journey. 00:20:22.286 --> 00:20:23.487 There will be times where 00:20:23.646 --> 00:20:25.367 you decide you want to 00:20:25.407 --> 00:20:27.528 switch your career or position again, 00:20:27.789 --> 00:20:28.829 maybe some folks. 00:20:29.691 --> 00:20:30.851 But I think you have to kind 00:20:30.891 --> 00:20:33.212 of keep the end picture in mind. 00:20:33.333 --> 00:20:35.473 And it's very rewarding, 00:20:35.874 --> 00:20:37.015 especially if your 00:20:37.075 --> 00:20:38.675 overarching goal is to 00:20:38.715 --> 00:20:40.057 improve clinical practice. 00:20:41.438 --> 00:20:42.038 Ultimately, 00:20:42.298 --> 00:20:43.138 it's going to benefit the 00:20:43.179 --> 00:20:44.339 patients that we serve. 00:20:45.241 --> 00:20:46.284 And I think something that 00:20:46.324 --> 00:20:47.506 can't be missed is it's 00:20:47.546 --> 00:20:48.527 also going to benefit the 00:20:48.567 --> 00:20:50.830 providers that care for those patients. 00:20:51.030 --> 00:20:53.575 So I think, you know, 00:20:53.796 --> 00:20:55.117 those are my pieces of wisdom, 00:20:55.417 --> 00:20:55.818 if you will. 00:20:57.051 --> 00:20:57.813 I think that's great. 00:20:58.492 --> 00:21:00.894 I've enjoyed this time with you, Jason. 00:21:01.596 --> 00:21:03.076 Thank you so much for taking 00:21:03.116 --> 00:21:05.499 some time out to talk to us 00:21:05.798 --> 00:21:07.200 about your current study, 00:21:07.259 --> 00:21:09.342 about the grant process, 00:21:09.701 --> 00:21:12.423 and just kind of future 00:21:12.463 --> 00:21:13.846 research directions and 00:21:14.645 --> 00:21:15.846 some great advice there. 00:21:16.387 --> 00:21:18.068 So we'll be looking forward 00:21:18.108 --> 00:21:19.329 to hearing more about your 00:21:19.390 --> 00:21:22.833 study and any future research endeavors. 00:21:23.813 --> 00:21:24.173 So again, 00:21:24.634 --> 00:21:26.444 Thank you and take care, Jason. 00:21:26.686 --> 00:21:27.028 Okay. 00:21:27.048 --> 00:21:27.510 Thank you, Skip.