The Monday Memo
February 24th, 2020 PITT DPT STUDENTS
Where Research Can Make an Impact in Patient Care – A Case Study
As we continue reviewing journal articles and learning about research methods through our Evidence Based Practice curriculum, I am sure plenty of my fellow students are left wondering, “What current research is being done, what are the implications, and is any of it more interesting than comparing the effect of receiving physical therapy vs. not?” I have been a research assistant in the Ferguson Laboratory through the department of Orthopedic Surgery for just over a year now and would like to share my insights from the Head and Neck Cancer project I have been working on.
Over at the Otolaryngology clinic in the Eye and Ear Institute, every Thursday there is a survivorship clinic during which head and neck cancer survivors are seen for their annual visits (including physical therapy, swallowing, and dental screens) and can participate in research studies if they so choose. One of those being the project I am working on, which is a study that aims to understand the relationship between Neck Disability Index, patient reported scores related to beliefs about pain and pain recovery (FABQ and TSK), and objective measurements of function (ROM scores). At the end of the day we are observing and understanding neck function in this population, however, when these patients are seen by the physical therapist there are plenty more things to consider. Shoulder function is observed and tested (scored via PENN-ASES/DASH) as well as eating and swallowing (EAT-10); deconditioning, lymphedema, trismus, and radiation fibrosis are all considered.
Cancer is a disease that affects the whole person, and frankly its quite silly that the NDI is the driving score to determine whether a patient needs physical therapy or not. As well, it does not make sense to use it as a measure of recovery since in my experience I have seen both very good and very bad ROM for a range of NDI scores from low to high. Ultimately, this is a very complex patient population with many factors that affect decision making, however, we as students and practicing physical therapists can do more to advance the profession through research. Some of my lessons and observations thus far: quality of life is as good a score as any other to understand patient outcomes, we can look at specific NDI items instead of using the survey in its whole, as well the NDI could just not be specific enough to capture the problem for this population, and that some patients tolerate losses of ROM in certain directions better than others.
Sebastian Murati, SPT