Visit Your Physical Therapist Every Six Months
To Tune-Up Your Back
Meet Linda Van Dillen, PT, PhD, Associate Director of
Musculoskeletal Research and Professor of Physical
Therapy and Orthopaedic Surgery at Washington
University in St. Louis. She received a Doctoral Training
Research Grant from the Foundation in 1992 while
pursuing her PhD in Experimental Psychology from
WUSTL. Dr. Van Dillen's research focuses on
musculoskeletal pain problems, particularly low back,
hip, and neck pain. Read on to learn more about Dr. Van
Dillen, how she got her start, and what's going on in her
lab!
FPT: Dr. Van Dillen, how did you become interested in physical therapy
and what led you to research?
Van Dillen: During my undergraduate education I was studying biology but I
had no idea what I was going to do after graduation. And then I met a physical
therapist who opened my eyes to how I could apply the basic science that I
was currently learning. After three years as a biology major, I decided to
change my focus. I started to take some of the background courses that were
needed for physical therapy and I fell in love with the clinical sciences. I
practiced for about eight years. During this time I earned a master's degree in
physical therapy. While I was in the clinic I pretty much did everything you
could do as a PT. As I treated patients, I realized that as a profession we were
really not based in evidence. I saw the importance of research in making
decisions about how you treat patients and the benefit of knowing what the
evidence is in order to give the best treatment. So I made a decision that
research was what I wanted to focus on for the rest of my career.
FPT: Interesting! Evidence based practice is fundamental to the
profession. How did the Foundation for Physical Therapy assist you in
achieving your goals as you made your transition?
Van Dillen: I received Foundation funding to support my PhD in experimental
psychology. I was impressed that I was being supported even though I wasn't
studying in a “physical therapy” program. I had purposefully stepped out of
physical therapy to learn content and research skills that were relevant to
physical therapy but in a discipline that I thought had a strong scientific
foundation. The goal was to use the knowledge I gained during my doctoral
education to ask questions relevant to physical therapy. The money I received
allowed me to focus on my research and helped fund the experiments I was
conducting as part of my dissertation. I am thankful that the Foundation saw
the importance of training people in other sciences so that they could come
back to the profession and apply that knowledge to study questions relevant to
physical therapy. I was also a co-investigator on another Foundation-funded
grant, and without this support, I would never have been able to go on to
obtain funding from the National Institutes of Health (NIH).
FPT: Speaking of funding, what are a few of the research projects you
have been involved with?
Van Dillen: Our lab is focused on understanding mechanisms contributing to
musculoskeletal pain, and most of our funding has been related to low back
pain (LBP) conditions. The largest project we are currently running is an R01
NIH-funded study looking at management strategies for people with longstanding LBP. We're comparing a best evidence treatment for chronic LBP,
which is providing strength and flexibility exercise, to what we are calling
‘motor skills training'. In the motor skills training condition we are targeting
the activities people can't perform due to their pain. We take the information
we have obtained from our standardized examination about movements and
postures associated with the person’s LBP symptoms, and we apply this
information as we train people to change how they perform their activities. The
goal is to reduce their pain and improve their function by getting people to
learn new movement and posture strategies during daily activities.
The basis for this project came from an earlier study. In the earlier study, we
found that when people received treatments for LBP that included exercise as
well as a training program to try to change HOW they perform activities
contributing to their LBP, they adhered more to one aspect of the treatment
than the other. Specifically, they adhered more and for a longer period of time
to the training program focused on changing daily activity performance rather
than the exercise. The current study is separating exercise from the motor
skills training to see what the separate effects are of the two kinds of
treatment. We also are trying to determine to what extent people adhere to
the two different kinds of treatments for LBP and how preference may affect
adherence and outcomes.
Even if both treatments end up being equally effective, it will be important to
know which treatment people adhere to the most and for the longest time. It is
important to know if a particular treatment is an effective stimulus. It is just as
important to find a treatment for LBP that fits people's needs, and to which
they can adhere so that they can manage this chronic problem over prolonged
periods of time.
The other interesting finding from our earlier study was that at 6 months after
the initial active treatment phase, people started to drop off in their adherence
to their home program, and the change in adherence was associated with a
deterioration in outcomes. In our current study, at the 6 month time point we
are randomizing people to either extra treatment in the clinic or no extra
treatment. The goal is to determine if people who get extra treatment at the 6
month time point do better over the long run than people who don't. It's
similar to the model of how a dentist practices; you go in and you get your
treatment and you improve, and then you come back for a checkup to tune
things up, and then you get sent back out again. This really isn't how PT
practices for the most part, so we are hoping that we find something
that's effective, we find something that people adhere to, and that we
find out whether little 'tune-ups' in the long run are going to be better
for the course of the problem, rather than just waiting until somebody gets
into an acute flare-up of pain.
FPT: Wow - considering that millions of Americans suffer from chronic
LBP, this sounds like something from which the population would
benefit! I love the idea of 6-month check-ups with your physical
therapist. What is the potential impact that your research will have on
the clinical population?
Van Dillen: We are hoping we find treatments that are effective for reducing
LBP, but also that people with LBP are able to find a treatment or practice that
they understand how to implement in order to manage their condition. Our
emphasis is on giving the patient the skills to manage their condition. So your
mention of a 6-month check-up with a physical therapist is spot on: this
potentially offers a long term solution to handling LBP in which a
physical therapist can re-visit with the patient periodically for needed
adjustments, while also providing the patient with the skills and tools
he needs to handle the day-to-day management of his LBP.
This model also has implications for healthcare costs. Helping the patient
initially learn how to perform skills and exercises to manage their issues at
home, and providing periodic assistance from a physical therapist to avoid
acute flare-ups could ultimately lower healthcare costs. The model also likely
can be applied to other persistent or recurrent musculoskeletal conditions.
FPT: This is a whole new way to approach the management of LBP and
other chronic musculoskeletal conditions! What advice would you give
to an emerging investigator as they're beginning their career?
Van Dillen: As a research scientist, you don't get a lot of day to day payoff or
feedback as you do with patient care, so it is important to stay focused and to
be very persistent. It is also important to really look at what your data is
telling you and to change given that information. You should test things, not to
prove that physical therapy is the be all and end all, but rather to understand
how physical therapy can provide the best care for a patient. You may
hypothesize something that's not right or that's a little off, but that's ok. That
data tells you where to go in the future. Sticking with what you're doing and
being willing to reconsider what you're examining is important as a new
researcher.
FPT: Great advice. Finally, I have to ask, what is the best part about
being a scientist?
Van Dillen: I like the idea of discovering new information that could impact
the care of people. I've been very lucky because I have good ties within
physical therapy but I also have a lot of relationships with scientists outside
the field who are interested in mechanisms that contribute to musculoskeletal
pain. I have learned a lot from these colleagues. They have perspectives that I
don't have so I think that has been really educational and fun. I also enjoy
mentoring. I like bringing on new students and taking them through the
process and hoping they get as passionate about being a scientist as I am.
FPT: Thank you, Dr. Van Dillen, for taking the time to speak with us.
This has been such an interesting conversation and your research
holds much potential for patient care, especially in the area of
prevention. We look forward to following your research and how it is
implemented into practice to help those individuals suffering from low
back pain.
If you're interested in learning more about Dr. Van Dillen and her
research, check out this video about her study on fox2now.com and
read about her tips to alleviate back pain while standing in a recent
issue of Dr. Oz Magazine!
Help researchers like Dr. Van Dillen make an impact.
To learn more about other Foundation alumni, visit our website!