Measuring the Effects of various Manual Therapy Interventions

Here's my response to a reader who is interested in "Measuring the Effects of various Manual Therapy Interventions".

People typically get Manual Therapy to 

*  Increase mobility/flexibility and/or to
*  Reduce Pain.

The reader pointed out - The Effects of various Manual Therapy Interventions typically cannot be tested/measured using cadavers or computer modeling, and often there is no valid “sham” therapy to measure against.

Let's look into this....

First let's start with a few references....

* Standardized Outcome Measures in Manual Therapy

* Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial - Commentary: Bootstrapping simplifies appreciation of statistical inferences

* Assessment tools for OT

* Guide to Outcomes Measurement for Patients With Low Back

*  The effectiveness of manual therapy, physiotherapy and treatment by the general practitioner for chronic non-specific back and neck complaints

*  Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial

*  Patient-Reported Outcome (PRO) questionnaires for people with pain in any spine region. A systematic review

*  Patients' treatment beliefs in low back pain: development and validation of a questionnaire in primary care

*  Physical Therapy Evaluation and Management of the Shoulder Complex

*  Effectiveness of Manual Physical Therapy for Painful Shoulder Conditions: A Systematic Review

*  Efficacy of Manual Therapy

*  The Science and Practice of Manual Therapy - body language

*  Immediate Changes Following Manual Therapy in Resting State Functional Connectivity As Measured By Magnetic Resonance Imaging (fMRI) In Subjects With Induced Low Back Pain

 * Placebo response to manual therapy: something out of nothing?

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Based on the above...."Measuring the Effects of various Manual Therapy Interventions" might be accomplished by....

*   Ask the patient whether the manual therapy is effective or not.  Listen to their story/narrative.  Observe body language.  Perhaps, use questionnaires.  

*  You can use more sophisticated efficacy measurement tools like fMRI, but these are usually out of the reach of most practitioners.  Stress/Pain Measurement Tools like those used in Biofeedback can be used to test relaxation level (skin conductance and/or heart rate variability).  Since stress/tension increases muscle tightness and increases pain, probably anything to reduce stress/anxiety will help therapy effectiveness

*  The Therapist could increase the perceived effectiveness of the therapy by words/actions.  This is due to enhancing the inherent Placebo Effect, which is a part of any health intervention. 

*  Lastly, if the perceived or measured effectiveness is slow going or non-existant, please consider psychological/emotional reasons for the chronic patient - "Are You “Sick and Tired” of Being “Sick and Tired”?" - Especially see questions therein.

*  I'm sure there are more ways to measure efficacy of Manual Therapy.  Perhaps the Measurement/Testing Modalities of related Health/Medical Interventions might be useful to measure the efficacy of Manual Therapy, too.  Please add your comments to add to this discussion.

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Article is for information only and is not medical advice.  See full disclaimers at TG Ideas LLC.

Four Powerful Concepts to Maximize Healing

Doctors, Please Consider Combining These Four Powerful Concepts to Maximize Your Patient’s Healing

Patients, Are You Getting the Best Treatment from Your Healthcare Professional?

Whether doctors and patients like it or not, there is a mind-body interaction. Healthcare professionals can leverage this interaction for enhanced healing.

As a healthcare professional, please consider these concepts to improve total diagnosis and treatment: 

1. Knowledge and Medical Skills
2. Bedside Manner
3. Maximize the Placebo Effect
4. Minimize the Nocebo Effect 

Knowledge and Medical Skills are taught very well in medical schools. Little need be said on this concept. It is the basis of many medical practices. 

Bedside Manner is becoming more important as many practices are becoming consumer driven. Perhaps some healthcare professional have inherited good bedside manner. Others might want to learn. Some medical schools are combining "people skills" along with the usual curriculum. For those who want to learn more, some references are listed at the end of this article. In addition, here are good Internet search strings for even more information:

1.  listening-skills (patient OR doctor OR nurse)
2.  body-language (patient OR doctor OR nurse)
3.  (listening-skills OR body-language) tutorial
4.  (listening-skills body-language) tutorial

Most healthcare professionals do not consider Placebo/Nocebo Effects, though these effects are as powerful in many cases as medicine and treatment. Again, good techniques can be learned. General references are at the end of this article. To find more information on the Internet, use these search strings:

1.  placebo-(effect OR response) (words OR wording OR ritual OR enhance OR maximize) (patient OR doctor OR nurse OR physician)
2.  nocebo-(effect OR response) (words OR wording OR ritual OR minimize OR diminish) (patient OR doctor OR nurse OR physician)

Use of these four concepts is somewhat of a judgment call by the practitioner. Some patients want only the facts and expertise. Some patients respond more to Bedside Manner. Some respond to Placebo/Nocebo whereas some do not.

Patient-Doctor communication is bilateral. As people-skills are learned and practiced, doctors can pick up the patient's body language combined with listening to them. From that, the doctor or nurse can decide how to adjust his or her own words, body language, and actions. Maybe someday, there will be "Emotional Stress Indicators" on patients to help the doctor decide whether they are helping or hurting the patient.

Medical practice is evolving. As much as there is hope for patients, there is hope for doctors and nurses willing to consider and learn new concepts and skills.

Takeaways: 

1.  Patient-Doctor communication is becoming more and more important, as healthcare becomes more consumer-driven.
2.  Bedside Manner, Placebo Effect, and Nocebo Effect can all be leveraged for enhanced and sustained healing. The progressive and caring healthcare professionals can learn all these.As a patient, find a practitioner that fits you as a person. Ask around, explaining what is important to you, as a health care consumer. Give each practitioner a fair chance, but do your part to communicate your needs and wants. Healthcare professionals are not "Mind-Readers".

For more information: 

1.  Bedside Manner 
2.  Can Better Bedside Manner Be Taught? 
3.  Bedside Manner: Concept Analysis and Impact on Advanced Nursing Practice 
4.  Patient-Physician Communication: Why and How 
5.  Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer by David Watts, M.D., Random House Digital, Inc., 2006
6.  Listening to Patients: A Phenomenological Approach to Nursing Research and Practice by Sandra P. Thomas, PhD, RN, FAAN, et al., Springer Publishing Company, 2004
7.  The Power of Hope: A Doctor`s Perspective by Howard Spiro, Yale University Press, 1998
8.  The Placebo Effect: An Interdisciplinary Exploration by Anne Harrington, Harvard University Press, 1999
9.  Program in Placebo Studies and the Therapeutic Encounter hosted at Beth Israel Deaconess Medical Center 
10.  Specific Components of Bedside Manner in the General Hospital Psychiatric Consultation: 12 Concrete Suggestions 
11.  As a Healthcare Professional, Are You Checking All the Vital Signs to Evaluate Total Patient Condition?
12.  Medical Monitor with an Emotional Stress And/or Pain Indicator

Disclaimer - Article is for information only and is not medical advice.

You Can Make Your Medicine or Medical Treatment Work Better

You Can Make Your Medicine or Medical Treatment Work Better

A New Look at the Placebo Effect

How are you? Did the new medicine help? These are some typical questions from your doctor. Think about it. Your doctor depends on you to tell them whether a treatment or medicine is working or not. 

If you say a treatment is working, your doctor says great and considers you to be healing. If you say it is not working, your doctor will probably prescribe something else.

Your response to your doctor depends on the amount of time, money, or effort you put into your treatment.  

The more you participate in your own health care, the more effective a medicine or treatment will be. 

This natural phenomenon is called the "Effort Justification" or "Justification of Effort Effect".

If you are working hard on your therapy, you probably want to say it is working. If you have spent a lot of money on a prescription, you probably will say it is working. If you have stuck with a therapy for a long time, you probably will say it is still working. 

"If you think you can do a thing or think you can't do a thing, you're right." - Henry Ford

 

This thinking can sometimes get you into trouble when you ignore the facts of your health recovery. On the other hand, this thinking can benefit you. Keep a balance of what you want to think and what is reality. 

To make your treatment most effective, you might consider the following.

 

1. Give the treatment a reasonable time to work. Give it a deadline. If there is no or little benefit, tell your doctor.

2. Own your health. Own your health conditions and deal with them. You are the boss of your own health care. Work with and manage your health care team. Your health care team is working for you.

3. Be an active participant. Know what each pill does. Think about each pill you take, how it is helping you.

4. Put some effort into your treatment. Do your part, whether it is therapy or taking medications on time.

5. Believe that what you and your health team are doing is working. Believe it with all your heart.

6. Be willing to spend some money on your health. Good health is the greatest wealth you can have.

Some people might say negatively that this is the Placebo Effect working. Let them say what they want. It is working for you. Believe in that. Do not let your self or anyone else get you down. You have a right to be as healthy and happy as you can be. 

Takeaways:

• A patient's health outcome can be influenced by the amount of effort, time, or money invested by the patient.
• The Placebo Effect is a good thing and can be enhanced by you and your health care team.
• We are just beginning to understand how the mind can affect the health of the body.

For more information:

• Effort Justification
• Placebo Effect
• Cognitive dissonance and psychotherapy: The role of effort justification in inducing weight loss
• Good Internet Search String - effort justification (response OR effect) (health OR healing OR placebo)

Disclaimer - Article is for information only and is not medical advice.

Do You Really Need All Those Medications? Could the Dosage Be Reduced?

15+ Ways to Increase the Effective Potency of Your Medicines and Therefore Decrease Your Dosage

Do You Really Need All Those Medications? Could the Dosage Be Reduced?

For those people who want to decrease medicine usage, there is hope. Recently, it has been found that hypnosis, suggestion, and/or the Placebo Effect can amplify the effect of medicines or treatments. This probably has been known for a long time but only becoming known now, for whatever reason. 

Be sure to work with a healthcare professional to evaluate your medicine usage. Then, inform your doctor you would like to use the power of your mind to increase the potency of each medicine. By increasing the effective potency, you can probably decrease the dosage of many prescriptions. Listen to your doctor but decide what is best for you. 

You might have to find a new doctor, since many doctors are only physicians and do not consider the mind-body connection. The choice is up to you. You are in charge of your own health care. 

Are your medicines or treatments not working very well, are troublesome, or are unaffordable? Maybe it is time to try something new and enlist the power of your mind. 

If you are ready, below are some suggestions on how medications or treatments could be enhanced, amplified, or generally made more effective.

 

First, it is important to relax. Stress aggravates any illness and hinders any medicine or treatment from being effective. Find a stress management routine that works for you on a long-term basis. Consider this part of your medicine or treatment. Your life or at least your good health might very well depend on it. 

1. Put your pills in a brightly colored large container, labeled "Pill Potency Increaser". Subconsciously, you think the pills inside are actually increasing potency.

2. Ask a clergy person to bless the pills or treatment with extra healing power.

3. Wrap a devotional object, e.g. rosary, around the pill container and pray for a potency increase.

4. Make your own healing machine to amplify the pills, salve, etc. Keep your medications in your healing machine until use to maximize potency.

5. It is important to find a health care professional to encourage you in your efforts. Doctors have great power over us, since they are seen as authority figures. If the doctor says something will work, the medicine or treatment will probably work better. If the doctor is not confident of the medicine or treatment offered, it will not work as well. This also applies for a doctor discarding your mind-body concepts. Adverse effects from negative comments or actions of a doctor are called the Nocebo Effect.

6. Ask family members or friends to hold the pill bottles for a while to infuse extra healing power. Love and caring is a powerful healer in itself.

7. Buy or make yourself a small special light. Decorate and locate the light just the way you want. Keep the light on all the time to remind you of the healing power of your medication. Maybe let the light shine on your pill bottles to direct healing rays into the medication.

8. Pause briefly before you take your dose of medicine. Think how effective your potency-increased dosage is going to be. Look at the medicine as you take it. Feel it going into your body. Imagine a warm feeling inside that results from internal healing beyond the potency of the medicine. Your body is now working with the medicine. You are healing from the inside out and you know it. You can feel it.

9. Listen to guided imagery recordings that suggest or encourage your internal healing power. You can even make your own healing recordings. Put in suggestions such as "My wonderful mind is increasing the potency of each of my medications. Therefore, I will need less medication as time goes on. I am working with supportive health care professionals who are cheering me on. I am so lucky." Consider wrapping the headphone cord around your pill bottles to infuse healing audio energy into the medicine.

10. Consider a hypnotherapist to suggest to your mind that the medicines or treatments are more powerful than they technically are. You can also learn self-hypnosis to help you relax and add effective potency to your medicines. Some say hypnosis can increase the placebo effect for better results.

11. Watch healing videos or computer games as you take your medicines. Imagine the medicine focusing on the malady and beating it. Imagine yourself being restored to health. Put your medicines right in front of the computer monitor to show that world that you are serious in getting better. You are "sick and tired of being sick and tired".

12. Heal in groups by combining with others who also want to increase the effective healing power of their medicines. This could be groups in person, over the Internet, on the telephone, etc. Combine the healing power of all of you to help each one of you. Brainstorm new ideas.

13. If you are a parent or caregiver and giving medications or treatments, pause for a moment and you yourself become relaxed. Say an encouraging word or two, like "This will make you feel better". Use your imagination to make up positive, encouraging, uplifting comments instead of absent-mindedly giving pills to others. If you are religious or spiritual, you could "pray" with the person to make the pills work extra-good.

14. Wear some special jewelry or have something in your pocket to remind you that your medicine is working. When symptoms recur, rub the special object. Feel the warmth of the object that has been heated by your own body. Remind yourself that the medicine is still working. Shift your thinking to something else. Maybe think of what you want to do when you feel better. Change your mind, which you can do, from sickness to health. Then go on knowing that the medicine is indeed working.

15. Add some music to your pill taking or treatment. You might consider something like the 1959 song "High Hopes", "Theme from Rocky", or anything else that empowers you and gives you hope.

16. Use scents (aromatherapy) to enhance the medication or treatment and relax you.

17. Thank your medicine for working so well. Thank your body for working with the medicine or treatment. You and your medicine are now working in unison now. Your doctor might think you now need less medicine to achieve the same effect. You are doing it. Congratulate yourself on your progress. Do not expect too much at first. Make small changes. Sometimes forward, sometimes back, but you are indeed improving. Tell others about your success, especially your doctor. Your doctor might very well be amazed and astonished. Maybe your outstanding progress will help others. Enjoy your new healthy happy life.

Yes, some will discard all this mind-body talk. Let them think what they want. If it works, who cares? What do you have to lose?

 

Henry Ford said, "If you think you can do a thing or think you can't do a thing, you're right."

Whether you or doctors like it or not, there is a psychological component with any active medication or treatment. When the psychological component is positive, it is called the Placebo Effect. When the psychological component is negative, it is called the Nocebo Effect. 

Perhaps, Mr. Ford's quote could be revised to say something like "If you think it will work or if you do not think it will work, you're right".

 

Takeaways:

• There is a psychological or placebo/nocebo effect with any active medication or treatment.
• You can make your medicines or treatments more effective by relaxing, maximizing the placebo effect, and minimizing the nocebo effect.
• You are in charge of your own health care and can decide what is best for you.

For more information:

• Hypnobo: Perspectives on Hypnosis and Placebo
• Spanos, N.P., Perlini, A.H., & Robertson, L.A. (1989). Hypnosis, suggestion, and placebo in the reduction of experimental pain Journal of Abnormal Psychology, 98(3), 285-293.
• Together, Placebo and Distraction Increase Pain Relief
• Placebo analgesia
• Utilizing placebo mechanisms for dose reduction in pharmacotherapy
• How to Make Your Own Healing Machine
• Placebo Effect and Nocebo Effect
• Placebo effect works even if patients know they're getting a sham drug

Disclaimer - Article is for information only and is not medical advice. Seek professional help as needed or wanted.

15+ Ideas on How to Make “Healing Cookies” Actually Heal the Sick

15+ Ideas on How to Make “Healing Cookies” Actually Heal the Sick

Many people give treats to sick people to make them feel better. Could these treats also be infused with healing power?

 

This added healing power might very well be possible. Throughout history, there have been instances where a person's mind has changed a food or drink into something magical, mystical, or spiritual. The result was that the person got better, even to the point of curing himself or herself. We know little about healing, especially from the inside out. 

Many of these types of healing activities have been associated with religious activities. You can do your part in helping someone heal, however, even if you are not particularly religious. You can bake healing cookies or bread. You can make a pot of chicken soup. Then you can visit the sick person with your treats. 

In addition to the actual baking or cooking, here are some ideas on how you can infuse healing power within your culinary delights. 

1. Before you start, try to find out about the sick person. You probably do not need to know a lot about their particular illness. It is important to know about them as a person though. Are they religious or not? What are some of their interests in life? Take into account their ethnicity, age, etc. Make sure your treats do not interfere with their dietary restrictions or preferences. From a very brief personality profile, you can decide what healing treats to make, how to make them, and how to deliver them.

2. Start out with a "healing recipe", some of which are listed below. Sometimes just starting to do something starts the healing process within the universe.

3. If the recipe calls for water, consider using a few drops of potable "holy water" with the regular water. Holy water can be purchased at religious supply stores or on the Internet. Another option is to ask a clergy person to bless some water for you.

4. Do not add "healing herbs" or the like, however, since these might interfere with the person's medications. Stick with the recipe except for inert ingredients, like water.

5. Ask a clergy person to bless you in your healing activities.

6. Imprint the cookies or bread with symbols that have a good meaning to the sick person. These might be religious symbols or even a smiley face.

7. Believe that your cookies, bread, or soup will actually help heal the sick person.

8. As you prepare or deliver the goodies, put a little humor in it. Humor heals just as it is. An example of this is the movie "Patch Adams".

9. If you are religious or spiritual, include your version of God into the preparation and delivery. Some might call this action prayer.

10. Schedule a visit rather than just dropping in. Plan a time when you both will be relaxed. Healing works better when both the visitor and patient are relaxed. Let them know the ingredients of the treats, including holy water, if used. This is important since some ingredients might not agree with them. If the sick person is a child or someone who cannot communicate, check with the guardian, doctor, or other person in charge. Do not be offended if they don't eat the goodies. Hide your disappointment if they do not eat or show great appreciation. They are sick and just doing all they can to get better. You are there for them. Just visit and take the treats back with you, if not eaten. Learn from your experiences for future visits.

11. When you are there with the sick person, ask them what they would do if they felt better. Get them talking on what they like to do most. Find out what their life dreams are. This type of conversation gives them hope and a will to live, all while eating a tasty cookie.

12. Try to gauge your visit according to their body language or words. Ask them before you do things in their room.

13. Listen to them in detail. You are there for them. Your biggest healing gift might just be to listen. Probably stay away from giving advice and "fixing". It is a great gift to give them personalized treats, be friendly and confident, listen to them, then leave so they can rest and heal.

14. Touch their hand or arm a little, if you and they are comfortable doing so. Touch can be healing too.

15. Be confident that your healing cookies will work. Your belief will instill hope in the sick person. Go into some detail how you added holy water, prayed over the treats, and made the imprint just for them. This will personalize the healing action of the treats.

16. As you prepare to leave the sick person, reinforce how the treats were prepared special just for them. Say how you think the treats will provide long-lasting healing. Since the treats are not long lasting, consider giving them a lasting reminder of ongoing healing. This gift might be an inexpensive pendent, ring, or other token. Encourage them that if they feel sick again to touch the token to revive the healing action of the treats they ate. 

It is important not to rely entirely on healing cookies, bread, or even chicken soup. Health care professionals should treat sick people, if possible. Let the professionals be part of the healing team. The decision of how and whether to heal rests with the individual, however.

Yes, some will consider all this "The Placebo Effect". Let them think what they want. If it works, who cares? 

"The psychical method has always played an important, though largely unrecognized, part in therapeutics. It is from faith, which buoys up the spirits, sets the blood flowing more freely, and the nerves playing their parts without disturbance, that a large part of all cures arise. Despondency or lack of faith will often sink the stoutest constitution almost to death's door; faith will enable a bread pill or a spoonful of clear water to do almost miracles of healing, when the best medicines have been given over in despair. The basis of the entire profession of medicine is faith in the doctor and his drugs and his methods." - Quote by Dr. Osler. Bolding added by the author of this article. 

Takeaways:

• Your time and treats might very well help someone get better.
• You can enhance the healing potential of your treats.
• There is probably little to lose and maybe a lot to gain by your efforts.

For More Information:

• My Healing Cookie Recipe
• Healing Cookies - Recipe
• Unleavened Communion Wafers - Recipe
• Faith Healing
• Placebo
• The Faith Factor: Proof of the Healing Power of Prayer by Dale A. Matthews et al., Penguin, 1999 - Please see references on bread, wafer, etc.

Disclaimer - Article is for information only and is not medical or legal advice. Seek professional help, as needed or wanted.