Musculoskeletal Treatment Pathways

As we’ve interviewed expert clinicians on the podcast, clear trends have emerged. These clinicians have two things in common:

1. They have a pretty set arc to their treatment sessions.

2. They tend to work from “menus” of intervention options.

I’m pretty sure they do this—because this is what they’ve discovered works. But, I’ve never really seen this approach studied or discussed in research…until now.

I was honestly flabbergasted to hear one of the most prominent rehab researchers in the world, talking about these two things, in his paper  Many Paths to Recovery: The Case for Treatment Pluralism. From what I understand, Dr. Cook gives these concepts some formal names: he calls those intervention menus ‘treatment pluralism‘—and he calls the components of the arc of a session ‘therapeutic ritual‘… driven by what researchers call contextual factors

In today’s episode, I can’t wait to dig deeper into this paper—and how our guest Dr. Chad Cook currently understands the factors that make therapy effective.

This is an episode that could fundamentally change how you think about each patient encounter.

1. You will be able to identify the importance of therapeutic ritual in structuring your approach to treatment.

2. You will be able to recognize ways to determine a treatment approach, when there is no superior intervention per the research.

1. Tell me the story of how you became interested in treatment pluralism & what it is?

2. Tell me about the experience of writing this paper. & What stands out to you as you look at it now.

3. Have you experienced treatment pluralism in your research studies?

4. You use the term “shared mechanisms” in the paper. What are shared mechanisms?

5. In your mind, why are there no superior interventions? Do you think it has anything to do with poor treatment fidelity or what?

6. If there are no superior interventions, why does it matter what treatments we give our patients?

7. You’ve used a term called “therapeutic ritual” before. What is this?

8. Is it bad thing & Is this the same thing as placebo?

9. How much do you think we can manipulate an outcome using a therapeutic ritual?

10. I want to tell you my mental model of practice – and the resources we are building and get your critique in light of this discussion.

• Many Paths to Recovery: The Case for Treatment Pluralism

• Manual therapy treatment mechanisms are complex: Challenges and a call to action

• An International Consensus Definition for Contextual Factors: Findings from a Nominal Group Technique

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

OT Potential pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in this topic.

Speaker interests: Chad E. Cook is the author of the primary journal article explored in this course. He has no financial interest in this topic to disclose.