Is practicing Evidence based Physiotherapy in this system possible?

Practicing evidence-based physiotherapy in India can be challenging due to the prevalent top-down model where medical officers prescribe treatment plans and physiotherapists simply follow them. This approach is common in both private and government hospitals. However, despite these constraints, there are ways to incorporate evidence-based practice into our work:  
I believe we should be “ready” so these are the mind set a novice PT should have. Experts, seniors, PhDs, people who attended workshop with a white person teaching NDT, rubbing, sticker boys, fascia pullers and professors are beyond redemption. This is not for you.    

1. Treat every patient like a VIP: Adopt the mindset that you are providing care to someone as important as your own mother. This perspective will motivate you to find ways to deliver high-value care within the existing system.
2. Embrace the evolving nature of knowledge: Recognize that knowledge in healthcare is constantly evolving, and new research findings emerge over time. Make a habit of reading scientific literature and staying updated with the latest research in your field. This will enable you to stay abreast of current best practices and gradually incorporate new evidence into your treatments. 
3. Understand what constitutes high-value care: Many healthcare professionals complain about a lack of autonomy, but when asked about high-value care for specific conditions like low back pain or osteoarthritis of the knee, Stroke rehabilitation, they often lack awareness beyond what they were taught in school. Educate yourself about the latest evidence-based interventions and techniques for different conditions to provide the best possible care to your patients.
4. A good starting point for high value care is to assume what you learnt in college like special test, IFT, traction, do and don't, dosage, and much more are complete bullocks 
5. Remember you are in home-based rehabilitation- you have lots of autonomy. Don’t be afraid to through away passive low value care. Don’t listen to “seniors” who keep on telling patients “Want” passive treatment. Not really. Everyone wants to achieve something and patients will be happy if you make them achieve goals they want. If you are so afraid to change your whole practice- start small. Spend some time in passive care and majority of the time in high value care 
6. If you have a clinic, continue to incorporate the prescribed treatments, but supplement them with high-value care interventions. Spending more time with patients and providing additional therapy will likely be appreciated. To embrace high-value care, start with small changes while dedicating the majority of your time to interventions that deliver meaningful outcomes. 
7. Learning high value care for around 10 conditions should not be difficult.  So, take some time to learn. Don’t complicate. Clinical medicine is learning some exercise and a ton of common sense. Sadly, our common sense is ruined by college- so unlearn what you learnt- starting with assuming what you learnt in school is bullocks.   
8. Avoid falling into the trap of blaming the system for its shortcomings. While the system may not readily support change, focus on the positive impact you can have on your patients. Celebrate the small changes you make, as they can prevent cynicism from creeping in. Remember that delivering high-value care is challenging but essential. Embrace the difficulty as an opportunity to apply scientific knowledge and make a real difference for your patients.  
9. Change is a marathon. Results take time. Be patient.   
   
   I would like to have a round 10 points- well seems i ran out of ideas or got bored.
   PS- probably you should also not listen to me and not follow these.
   Love
   K Hariom
   
   
   
   

1. 
   I would like to have a round 10 points- well seems i ran out of ideas or got bored.
   PS- probably you should also not listen to me and not follow these.
   Love
   K Hariom
   
   
   
   
   
   
   

Sitzfleisch

 Do I need a “proper chair” or an ergonomically designed chair for my workspace? The short answer is of course not, and even shorter answer is NO 

If you read about the history of chairs, you will see like most things the Egyptian aristocracy used chairs not stools (that is stools with back rest. And most of us, the mere mortals who don’t workshop cats as gods- sat on ground, squatted in the ground (on which we even published a research article) or on something without back rest. In the 19th century, Michael Thonet, a carpenter, played a significant role in popularizing chairs among the masses through his innovative bentwood technique. However, it's worth noting that chairs remained relatively uncommon in many regions until more recent times. For example, when I was growing up (in the 0s and 80s), chairs were not commonly found in places like cinemas, marriage halls, or rural households. My next-door Neighbours – who had the biggest house in the block had one easy chair and everyone else sat on the floor.  

The proliferation of chairs can be attributed to various factors, including the advent of plastic materials, socio-economic advancements, and changing cultural norms. These factors have contributed to chairs becoming a ubiquitous piece of furniture in modern households and workplaces. 

The advent of comfortable, ergonomically designed chairs brought with it a new set of concerns and fearmongering. Fearmongering plays a significant role in capitalism, including in the field of medicine. As a result, we witnessed headlines proclaiming that "sitting is the new smoking," creating a sense of exaggerated risk. While it is true that prolonged sitting is not ideal for our health, the severity of its negative effects may have been overstated by fear-mongers. 

Furthermore, the fearmongering around sitting gave rise to a cottage industry focused on educating people about the "proper" way to sit. This included guidelines on sitting posture and warnings against sitting on the floor due to supposed risks of developing osteoarthritis ("OA knee cooties"). The entire field of ergonomics thrived as a result, with an abundance of products and advice on finding the best chair. 

It is important to maintain a balanced perspective and consider individual comfort and needs when choosing seating options. While ergonomic considerations can be beneficial for some, it is essential to separate genuine health concerns from fear-driven marketing tactics. 

The real issues related to sitting for extended periods stem from the fact that humans have evolved to engage in various activities, including extended periods of sitting. Studies conducted on hunter-gatherer communities have revealed that humans historically spent many hours sitting. Even before the rise of office work, individuals engaged in physically demanding tasks such as farming, followed by periods of rest and sitting. 

Therefore, sitting itself is not the problem. The issue arises from our modern lifestyle, where we often lack physical activity and prolonged sedentary behavior becomes the norm. Our bodies are designed to be active and engage in a range of movements. When we don't have enough physical work or movement in our daily lives, it can negatively impact our overall well-being. 

The key is to strike a balance between sitting and physical activity. Incorporating regular exercise, movement breaks, and maintaining an active lifestyle can help counteract the potential negative effects of prolonged sitting. It is important to recognize the importance of overall physical engagement rather than solely focusing on the act of sitting itself. 
 

1. While the following suggestions are not evidence-based, they can be considered as practical ideas to incorporate more movement and avoid prolonged sitting during office work: 

• Consider using a stool instead of a traditional chair for your office work. This can help improve your sitting endurance by providing less comfort and encouraging you to get up and move after some time. 
• Take regular standing breaks and incorporate squats into your routine. Standing up and doing some squats can help break up long periods of sitting and engage your muscles. 
• Opt for a non-comfy chair that doesn't promote extended sitting. A chair that lacks excessive comfort can discourage prolonged sitting and prompt you to stand up and move around more frequently. 
• Avoid keeping everything you need within easy reach on your desk. By placing items like a water bottle or physical files slightly farther away, you are more likely to get up and move occasionally to retrieve them. 
• Make a pact with your colleagues to motivate each other to move every hour or so. Establish a system where you remind each other to take short breaks, stretch, or go for a quick walk to break up sedentary periods. 
• Remember that taking breaks is essential for your well-being. Remind yourself that the tasks at hand are not life-or-death situations, and taking a break won't significantly impact your work. Step away from your laptop and give yourself the opportunity to recharge and rejuvenate. 
• It's important to note that while these suggestions may help promote movement and reduce prolonged sitting, they are not scientifically proven approaches. It's always advisable to consult with healthcare professionals or ergonomic experts for evidence-based recommendations on improving your work environment and overall well-being. 
• if you are in-charge type- throw away that ergonomic expert and get a stick (read the previous suggestion also)

 

Much more- but this blog has become long so.. enough 

 

So where did i get these information and ideas: evolutionary psychology books like- how the mind works by steven pinker,

Exercised: Why Something We Never Evolved to Do Is Healthy and Rewarding- Lieberman  

and my crazy ideas from reading

 

Death of music

  

Richard and I were sitting in Jenny residence around 10.00 Pm. He has just finished his first workshop in GCP on EBM based Low back pain. Richard had 3 loves in his life- Beer, music and Food. He was on his 3 rd beer. He was regaling me with stories about his training in oxford, his travels to Egypt and Paris. When the talk turned towards music- we had found out we both liked some similar music from Jazz to run of the mill hip hop.  

He opened his slick Mac book and played me Bara Bara by Rachid Taha. That was the first time I have heard French Algerian rock song and the next song was Down by the river. Throughout the next 20 years we shared songs from Lead Belly to the last song I sent him “ I hated the day I was born”. Sometimes he will say that’s not my cup of tea hari (the last song he sent me that was “ wrist band” . He sent me a CD disc of american folk songs- i dont know what he thought when i said i dont like them. The one genre i hate is americal folk songs from the lyrics to the accent- i do hate them

I also shared my favorite Tamil songs with Richard, from "Sithadai Kattikittu" to "Ninaithu Ninaithu" (primarily for the beautiful voice of Shreya). We shared everything from Welsh folk songs to Mongolian rock music, and it was a joy to explore our shared love for music. 

However, it saddens me to say that Richard passed away last Saturday. This is my tribute to a dear friend who was a Liberal at heart, leaning towards the left to center on the political spectrum, and a proud father who loved to drink beer. I can relate to his values and beliefs, though not so much his love for beer. Despite his passing, I cherish the memories we shared, especially our discussions about music, and will always remember Richard with fondness. 

I dont know who i am going to share my music with?