- Split View
-
Views
-
Cite
Cite
Alan M Jette, Scientific Journals Are Not Advocacy Organizations, Physical Therapy, Volume 98, Issue 9, September 2018, Pages 731–732, https://doi.org/10.1093/ptj/pzy073
- Share Icon Share
I thank Dr Olaoye Akinyemi for his thoughtful letter to the editor that is being published in this issue of PTJ.1 For me, his letter highlighted an important point about the role of PTJ.
I am in total agreement with Dr Akinyemi, who states in his letter that there is a great societal need for therapeutic approaches that foster a paradigm shift from prescribing opioid substances toward safer nonpharmacological interventions to manage neuromusculoskeletal pain. Not only did I explicitly express this view in my March editorial,2 but this concern was the reason we chose to devote an entire special issue in May to this critical topic.
However, I take issue with Dr Akinyemi's apparent expectation that the special issue should have been formulated to make the argument for physical therapy as the profession of choice—and the physical therapist as the practitioner of choice—for the management of neuromusculoskeletal pain. As a scientific journal, PTJ does not have a mission to advocate for the profession of physical therapy or for physical therapists as the practitioners of choice for any condition. The stated mission of PTJ is to “engage and inspire an international readership on topics related to physical therapy… PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the express purpose of improving patient care.” PTJ is not an advocacy organization; it is a scientific enterprise.
Dr Akinyemi also seems to suggest that APTA would use PTJ to advocate for the profession of physical therapy or for other worthy causes. Although PTJ is the official flagship journal of APTA, and APTA certainly may choose to use research published in PTJ to support policies or arguments, it is critical that the readership understand that APTA has absolutely no editorial control over what is published in PTJ. Editorial judgments are made by the editor in chief in consultation with the PTJ editorial team, not by APTA staff or the APTA Board of Directors. The APTA Board of Directors hires the editor in chief; the editor in chief provides an annual report to the APTA Board of Directors and meets annually with the board to discuss this report; and APTA staff allocate and oversee the journal's budget in consultation with the editor in chief. APTA’s noninvolvement in PTJ editorial decision making and content is critical to maintaining the integrity of PTJ as a scientific journal and our ability to meet our stated mission.
As editor in chief of PTJ, I disagree with the assertion that publishing the special issue was a disservice to the public and profession. In their guest editorship of the special issue, Drs George and Greenspan were true to PTJ’s mission as they organized an outstanding special issue to bring attention to some of the latest research and perspectives on understanding chronic pain, using nonpharmacological strategies for managing chronic pain, and promoting the implementation of evidence-based management of chronic pain among rehabilitation scientists and clinicians. The intent was to be “forward thinking” and highlight innovation and practice opportunities—not to merely summarize existing evidence for interventions commonly used by physical therapists. To note just 3 important evidence-based contributions made in the special issue that have important clinical and policy relevance:
Lead author Daniel Rhon, PT, DPT, a board-certified clinical specialist in orthopedic physical therapy, and his colleagues3 published a study that examined 4 groups of patients who had arthroscopic hip surgery. The findings revealed that patients who were treated by a physical therapist immediately following hip surgery, and prior to being given opioids, were associated with lower downstream costs and lower opioid use compared with patients who received opioids alone for pain management. Patients in the opioid-first group had an average of a 90-day supply of opioids, which was more than double the average supply for the physical therapy-first group (44 days). The authors believe the findings showed that downstream opioid use over the 2-year period after surgery was significantly higher in those who had opioid prescriptions prior to physical therapy compared with those who had physical therapy first. This study provides further evidence in support of early referrals to physical therapy following surgery for musculoskeletal conditions.
Lead author Xinliang Liu, PhD, and colleagues4 reported that immediate physical therapy initiation in patients with acute low back pain was associated with a reduction in opioid use and in downstream health care utilization and costs. In this study, patients receiving physical therapy within 3 days of the onset of low back pain were consistently associated with the lowest opioid medication use and total low back pain–related costs. The finding suggests that when referral to physical therapy is warranted, immediate referral and initiation—within 3 days—may lead to lower health care utilization and lower low back pain–related costs than delayed treatment.
Lead author Jason M. Beneciuk, PT, DPT, PhD, MPH, and colleagues5 noted that musculoskeletal (MSK) pain is highly prevalent and that it is important to identify early which patients may be at risk for persistent symptoms. This study identified several important risk factors for persistent MSK pain after a physical therapy care episode, including higher initial pain, more reports of systemic involvement, and higher distress. Having 2 or fewer comorbidities decreased the chance of patients having persistent MSK pain 12 months after treatment by a physical therapist. According to Beneciuk et al, the early prediction of developing longstanding MSK pain is important because it will allow for better use of nonpharmacological treatment options, such as physical therapy. These findings may help physical therapists identify individuals at higher risk for longstanding pain and may help them deliver preventive interventions.
I urge the PTJ readership to take a careful look at the 14 excellent articles published in the May 2018 special issue. For those who are interested in learning more, take the opportunity to listen to PTJ podcasts that feature interviews with 4 of the authors: Drs Xinkiang Liu, Anneleen Malfliet, Peter O’Sullivan, and Daniel Rhon. PTJ podcasts can be downloaded from our website (https://academic.oup.com/ptj/pages/podcasts) and are available through iTunes.
References
Comments