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