Interview with Dr. Stacie Fruth, PT, DHSc, OCS

I had the chance to interview Dr. Stacie Fruth, PT, DHSc, OCS recently. Stacie (2009’s Teacher of the Year at Univ of Indianapolis!) is currently the Director of the DPT Program at The University of Indianapolis. You can read more about her here.

The interview is informative & entertaining! We covered something I’ve been very curious about, and it is a special interest of Stacie’s: Physical Therapy in the Emergency Room.

Enjoy!


You’re involved in a field that I think is incredibly interesting and we’ll dig into that later, but first tell us your story. How did you end up where you are today?

I’ll assume you prefer I skip the fun stories of my childhood… 🙂 The brief tale of the journey is that I attended the University of Michigan on a swimming scholarship. I started off pursuing a degree in engineering and two years in decided it wasn’t for me, so switched to Kinesiology. I was infinitely more happy in that program, but realized there’s not much that can be done with that degree. So, I headed to grad school at the University of Massachusetts where I earned a master’s in exercise science. I wasn’t jazzed about my career options with that degree either so started exploring, and stumbled across physical therapy. I landed at the University of Indianapolis because, of all the places I interviewed during the admissions process, I felt the most “at home” there, even though the school was dramatically smaller than Michigan or UMass (which I thought would be a negative – and it wasn’t). I fell in love with the profession and the UIndy program and upon graduating, I told the dean that I would be back and I would somehow find a way to teach in the program. I went out into the world and practiced PT (mainly ortho) – truly loving it – but nine years later headed back to UIndy to start my doctoral degree. Two years into that, a faculty position opened up, and I jumped at the opportunity. I’m now in my 11th year of teaching in the Krannert School of Physical Therapy, and recently assumed the positions of Chair of the School as well as Director of the DPT program.

Check out this Podcast interview on Stacie’s book “Fundamentals of the Physical Therapy Examination: Patient Interview and Tests & Measures“. How was the writing process? What were your biggest challenges in writing & publishing the book?

Ahhh…the Purple Book (as it’s affectionately known)! Labor of love? Arduous? Painstaking? I can’t deny that it was a huge undertaking, but I’m very happy with the outcome. I applied for and was granted a sabbatical from UIndy for a semester and that’s really what allowed me to make the most headway. I secluded myself in a cottage in Michigan in the middle of winter for a month and that really helped to get it off the ground. My publisher (Jones & Bartlett Learning) was wonderful from start to finish. They strongly supported this project and put a ton of resources into it. As an untested author, I was absolutely thrilled to get a full color textbook with professionally made videos (and LOTS of them). What helped immensely is that I had taught this foundational material for 6 or so years and had progressively created a prototype of the book along the way. I was actually shocked that there wasn’t a textbook out there that covered these fundamental but essential skills needed to conduct a solid initial patient exam. So eventually, I just decided to fill that gap myself.

I really wanted the book to be useful to both instructors and students, so the biggest challenge was trying to conform to all the different DPT curricular models out there. For some programs (those that teach the basics of the patient exam first, then branch off into more advanced musculo, neuro, etc.), this textbook fits beautifully. For those with different curricular models (e.g. those that teach methods of doing a musculo exam separate from how to conduct a neuro exam), this text isn’t an obvious fit. Regardless, it does cover all aspects of conducting the initial patient interview (and I don’t think that exists elsewhere) and includes nearly every basic test and measure. The more advanced stuff – such as special tests – is left out on purpose. Plenty of textbooks cover that material quite well…no need for me to repackage that information.

I’m currently in the early stages of revising the book for the next edition and would absolutely LOVE to get as much constructive feedback as possible. I’ve got some reviewer comments, and of course the feedback from my own students, but I welcome anyone’s suggestions as I dive into this in the next few months.

Tanzania! Tell us about one of your unique experiences in Tanzania.

What an amazing trip! It was such a privilege to lead that group of 10 DPT students half-way across the globe and observe so many transformational experiences while we were there. I think a personal experience that was very meaningful for me involves a young girl I worked with during my first trip to the same village (Pommern) 10 years prior. She was a very small 4 year old at the time who had CP. Mind you, I’m no peds therapist, but I worked with this girl for several weeks and she took her first steps while I was there. Beyond rewarding. However, knowing that individuals with disabilities often don’t fare well in remote African villages, I always wondered if she would live a meaningful life. When I went back with my DPT students 10 years later, I was able to find this young lady, who was then 15 years old. Her mother (whom I’d spent a lot of time with during my first trip) had died of malaria, so the girl was living with extended family. I was beyond thrilled to find out that she was (generally) ambulatory and had a job doing laundry for her neighbors to help support herself. I have no idea if my work with her made “the” difference, but I’m pretty sure it made some difference, and that’s all that matters. While this was a very meaningful personal experience, it was so cool to share it with the students who came with me when we finally found this girl – to show them that the work they were doing with some of their own “patients” in the village (almost all were very young children) might have a true lasting impact.

A big interest of yours is Physical Therapy in the Emergency Department. How did this start? And, how has it grown?

That’s a long story, but the compact version is that I was hit by a car in 1997 while riding my bike home from work. I landed in an emergency department where I was misdiagnosed (and I knew it, but wasn’t listened to) and handed a pair of crutches still in their plastic wrapping. I remember lying on the bed thinking, “why aren’t PTs here?” I kept asking that question until 2002 when I ran into Michael Brickens, PT who had just started working in the Methodist Hospital (a Level 1 trauma center in Indy). At the time I was nearing the end of my doctoral program and was searching for my final research project. Many years and 6-7 studies later, we’re still going strong. When I met Michael, he was the only PT working in that ED, and the only other ED PTs in the country were in Arizona. Now, the Methodist ED has 2 full-time PTs and 4 per diems (I’m one of them). Indy also has another Level 1 trauma center with 2 full-time PTs (one of whom is one of my UIndy grads), so Indy actually offers the most ED PT coverage hours in the country (pretty sure about that…). Thus, it’s an ED PT research mecca, considering there are only a handful of US-generated published studies out there. I just got one back from PT journal with provisional acceptance for publication so I’m working on that revision now. Stay tuned!

Why is it called PT in the “ED”? ED sounds like something you don’t want to talk about in public… ER sounds exciting. Why “ED” instead of “ER”?

Okay, funny story about that. I was in Starbucks trying to prep for the education session my colleagues and I did at CSM last year. I had a binder of articles and the front of the binder was labeled “ED research.” A guy walked up to me and asked if I could tell him if there were any new treatments out there because “that pill” just wasn’t cutting it for him any more. I kid you not. That was a short but interesting conversation, and I went home and changed the label on the binder! Actually, the answer to your question is simple – the emergency department is just that, a department of most hospitals (with its own specialization, culture, resources, staff, etc.) and much more than just a “room.” So, the terminology has shifted to “ED” in all formal writing/publications. That said, “ER” and “ED” seem to be interchangeable in conversations (even with EM docs).

Let’s say I wanted to work in the ED. How do I prepare for it?

You need broad knowledge in just about every aspect of of PT practice (acute and chronic ortho, neuro, cardiopulmonary, wounds, fracture splinting, multi-trauma, and medically complex/multi-comorbidity). You also need strong differential diagnosis skills. The ability to multitask like crazy comes in handy and you need to be highly independent (ED PTs tend to work completely solo). Something else that’s important is having a high level of confidence in your professional opinions/impressions about patient intervention plans in conversations with the MDs. That said, the collaboration with the ED docs is amazing, and they have come to highly respect PT knowledge and skills. My schedule only allows me to work in the ED about once a month (have done so for 7-8 years) but I’ve worked with patients ranging from 2 to 101 years old, and conditions have covered the spectrum. There is no lack of variety in this setting!

So, you’re headed to a conference in the UK next month (Look here & here for info). What are you going to talk to the Brits about?

PT in the ED, of course! I’ve got one platform (influence of PT intervention on falls and return visits to the ED) and one poster (comparison of number of evidence-based interventions provided by PTs versus MDs in the ED for select musculoskeletal conditions). This will be interesting stuff to present because the Brits are way ahead of us in terms of allowing PTs to function autonomously in the ED setting. PTs in the UK can see patients with MSK conditions in the emergency setting independently, including the ability to order diagnostic tests and prescribe simple analgesics. This is exactly where we want to go with ED PT in the US, but we’re not there yet….

How much fun was this??

That was definitely a fun study! My colleague, Anne Mejia-Downs, and I had been looking for ways to get the faculty/staff at UIndy to be more active (and have fun doing so) right about the time that Dance Dance Revolution was hot. So, we designed a study and pulled in 6 of our DPT students to coordinate it. We actually got a nice-sized group to participate and the feedback we got from our participants was great! I presented that study at a conference in South Africa in 2008 and also at CSM in 2009. We then did a follow-up study to this one, looking at changes in balance and mood states following 6 weeks of DDR and also got some nice results (presented at APTA Annual Conference in 2010).

Favorite books & authors?

My favorite “fun” books might be a little on the odd side. I have a strange fascination psychopathology and what influences individuals toward some pretty dark/disturbing behavior. I prefer non-fiction in that realm, but fiction based on real events will do the trick too. So recently, the Gillian Flynn books (Gone Girl, Dark Places, etc), but also stuff like the Hannibal series, Patricia Cornwell’s non-fiction books, Peter Vronsky, etc. On a much less gruesome note, I very much appreciate Clarissa Estes’ Women Who Run with the Wolves. And, although seemingly less intriguing, I really like quality leadership books (The Leadership Challenge, Start with Why, etc.) and find they apply to life both from the professional aspect as well as the personal. That’s the nerd/geek side of me coming out!

What are some of the most challenging aspects of conducting & publishing research?

There is not room on 20 pages to list them all! Research is time consuming beyond belief – simply getting through an IRB can take many months. And the last paper I submitted took 2 days just to get the info into the submission portal. Speaking about the research itself, it is so challenging to find the balance between “high quality” and “clinically meaningful” studies. The higher the quality, the more sterile it is (e.g. by the time you exclude all participants with potential confounding conditions, you’ve excluded the typical clinical patient population). So many studies that do get published have such narrow inclusion criteria that it’s quite difficult to apply the results to any of my patients (my folks have lots of comorbidities and biopsychosoical issues). So, it can be incredibly frustrating to create a study that tries to capture typical clinical populations. I think this is why so many studies that were once considered gold standards now can’t be reproduced – that fascinating variable called “the human being” is awfully tough to control.

What’s the best gift you’ve ever received?

I’ll go with the first answer that popped into my head when I read this question. A pony! That was a VERY long time ago – I was 10 at the time – but the absolute blessing that horses have brought to my life since then is indescribable and it all started with that stubborn little pony. The purpose of horses in my life has changed through the years, but what it centers on is the peace in my soul when I’m with them. My relentless focus on work goes out the window and I can simply “be.” A gift beyond words.

Stacie, thank you for this fantastic interview!

Follow Stacie on Twitter: @StacieFruth

Find me: @CinemaAir

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An “Anecdote” on Dry Needling by Dr. Justin Dunaway, DPT

Want to do something that you’ll feel good about forever?? Then donate RIGHT NOW to Justin’s fantastic Kickstarter project@StandHaiti is very close to meeting their goal, and you can make it happen.

Physio Twitter is getting it’s panties in a bunch over Dry Needling. Take a chill-pill & soak in this much-needed Point Of View by Dr. Justin Dunaway. In case you aren’t already familiar with him (who isn’t??), then check out my interview with Justin here & here.

Enjoy!


 

An “Anecdote” on Dry Needling

With all this talk about RTCs, efficacy and effectiveness, and the necessity or futility of clinical experience… I’d like to share an experience, one that I feel matters more than the research, more than opinions or my clinical experience: a patient experience.  While I am very well read on the needling literature, have a strong foundation in physiology and a deep understanding of placebos, nocebos, and non-specific effects, as well as very strong opinions on all of these things…I’m going to leave them out of this discussion. I feel as we delve deeper and deeper into this rabbit hole of which research is better, who has a stronger understanding of its nuances, and the over reaching value of the research, we are forgetting about why we do it all. Each year of schooling, the piles of research, and the endless debates… aren’t about the stats or publications, and certainly are not about the paycheck. It was, is, and always should be about the patient first.  I want to share this single anecdote, keeping in mind the current debate between Dunning et al and Ridgeway/Venere et al in regards to the effectiveness and efficacy of dry needling.

This is the story of Sandy. Sandy is a person, not a statistic or a subject in a well powered RTC that wound up in a systematic review with a metanalysis showing strong evidence in support of my treatment choice, but a human in a very debilitating amount of chronic pain.  A human with loads of bias, confounding variables, and expectations.

Sandy (who is now 70 years old) was in a car accident 20 years ago, leaving her with chronic neck pain and headaches. Like many patients, she received radiographs, medical interventions, medications, shots, and legitimately good PT. As all these interventions failed and her condition worsened, she became depressed, decreased her activity due to pain, took increasing amounts of pain meds, and her condition ultimately deteriorated. She ended up having a cervical fusion (which was unsuccessful) that launched her into an even more pain and deeper depression and was prescribed methadone 3x/day. At this point, she was spending 90% of her time crying in bed, her medical team had given up on her and she on herself. Sadly, we’ve all known these patients.

When I first met Sandy, I just let her talk. A quick objective revealed neck joints and musculature that had clearly not moved in over a decade and a human feeling hopeless about her situation, just as you’d expect. After talking about treatment, she agreed to give dry needling a shot. I placed 10-15 needles in her neck, upper traps, back of her head, and a few points in her hands and applied electric to the needles for 20 min.

The next day she called to tell me that she had had her first good night’s sleep in longer than she could remember. I saw her twice a week for a few weeks and primarily performed DN. Within a month, she was going to the store, having family dinners, and playing cards with friends. Within two months, she was hiking the grand canyon with her new boyfriend pain free.  All from an intervention with no therapeutic value.

I realize this is anecdotal, Level 5 evidence, clinical experience, or whatever you want to call it. I understand that it is full of bias, confounding variables, “placebo”, “non-specific effects”, and other terms we use to discredit the things we don’t understand. But really, this is a human, a person who lost her life and then got it back through physical therapy. Sandy has regained her life because of an intervention. The choice of this specifically was guided by clinical experience, which may or may not be backed solidly in the literature. No RCTs have been written about the Sandys or the countless others with similar stories and certainly, if I practiced “Evidence Blinding Medicine,” Sandy would still be in bed, lonely and miserable.

I am not writing this to stoke the fires of the current debate on needling, what it means to be evidence based, or where clinical experience falls into the mix. I write this as a reminder that we treat humans, not statistics, and we should not forget that. We cannot be so focused on the PDF on our laptop that we forget about the human on our table.  Let the evidence guide you, but not blind you. Clinical experience, while full of bias and confounding variables, is absolutely paramount in treating the Sandys of the world. As promised, I will not cite any literature, nor will I reference any gurus or experts in the field. But I will leave you with this quote, one that we continue to get further and further from as we “advance” our knowledge, education, and research skills…one that speaks to the human element of what we do and the need for clinical experience and expertise.

“I would rather know the person who has the disease than the disease the person has.” 

–Hippocrates 460 BCE – 375 BCE

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