Blog roundup

I’m taking a break from tradition today, and linking to several blog posts that caught my eye for a number of reasons.
The first is from the excellent Science-based Medicine, written by David Gorsky (don’t you like how he uses his own name – no pseudonyms here! BTW you can get my details on the About page).
The whole blog is about examining the evidence for pseudoscientific claims about treatments for various health ailments, and the post I want to highlight is There must be a reason – or how we support our own false beliefs.

I echo his frustration at how ‘…being a skeptic and championing science-based medicine is just how unyielding belief in pseudscience is. Whatever realm of science in which there is pseudoscience I wander into, I find beliefs that simply will not yield to science or reason…It takes a lot of tenacity to keep going back to the well to argue the same points over and over again and refute the same nonsense you’ve refuted over and over again.’

Gorsky discusses a sociological study that uses the concept of cognitive dissonance which, as he puts it, is ‘derive[d] from the observation that people do not like to be aware when they hold contradictory beliefs’. As a result of this dissonance, people discount evidence to the contrary – in fact, actively look for evidence to support their beliefs while at the same time trying to resolve the discomfort of having contradictory evidence brought to their attention. We can call this ‘rationalisation’ and if you think you don’t do it, ask yourself how you justify any unhealthy habit, or any time you’ve failed to maintain a New Year’s Resolution!

The authors of the study Gorsky quotes describe a process called ‘Inferred justification’ that they say ‘operates as a backward chain of reasoning that justifies the favored opinion by assuming the causal evidence that would support it.’ You can see this demonstrated when you read articles where information is ‘cherry picked’ from positive, supportive publications while at the same time discounting any studies that don’t show these findings. I’m reminded of the way one colleague flourishes any paper that supports the use of interventions for low back pain while dismissing (usually on obscure methodological grounds) any research that doesn’t show positive effects.

What seems to happen is that people hold a belief, then spend energy finding reasons to support this belief. He quotes ‘motivated reasoning may be strongest when the stakes are highest.’

Food for thought when using self-reflection to review our own practice.
If we hold a belief, we’re more than likely to look for confirmation than questioning our findings, which is one reason I think it’s so important not to simply self reflect, or to look within our own profession for opinion and evidence, but to look beyond and into the literature from other fields.

One of the best blogs for pointing out selective use of the literature in health has to be Bad Science, written by Ben Goldacre. As a self-confessed exercise-free zone, I jumped (well, not exactly, jumping is exercise!) for joy when I saw the headline ‘Warning: Exercise Makes You Fat’. Woohoo! I can stop feeling guilty for hating the gym! Bugger – Ben does a good job of critiquing the article published in the UK’s Sunday Telegraph, and once again shows that many pieces written by journalists are ‘cherry picked’ (or selectively quote from the literature) and more frighteningly, that people read and act on what they read in the newspaper – and why?

Well a survey quoted by Goldacre (conducted by the World Cancer Research Fund and carried out by YouGov – and available for review) concluded that half of all respondents said they thought scientists and doctors were constantly changing their minds about healthy living advice, although in reality, healthy living advice hasn’t changed at all for at least a decade (don’t smoke, do some exercise, eat more fruit and veg). And a quarter of all respondents said that because scientists keep changing their minds, you might as well eat whatever you want, because it won’t make any difference anyway.’ I’ll bet you’ve heard that before!

BTW bellydance practice and walking the dog count as exercise – so does mowing the lawns, vacuuming the house, making the bed, dancing at a nightclub but not jumping to conclusions. And beware the calories in the alcohol consumed while dancing at the nightclub.

And the final blog for today – the ever-excellent MindHacks reviews why Aaron Beck should be celebrated as an influential psychological therapist. On my theme of science being vital for health treatments, this post links to an article in The American Scholar describing how Aaron Beck applied science to the previously ‘woo’ psychotherapies of Freud and others. As the Vaughan from MindHacks says ‘changes in psychotherapy were largely driven by the persuasiveness and personalities of the leading lights rather than systematic evidence for effectiveness. – Sound familiar? Popular and persuasive people ‘selling’ their successes rather than being clear about the effect. I love the quote attributed to Freud ‘…a theory they didn’t like was bad because it was tainted by the unresolved conflicts of the author…’ In other words, the problem was with the person rather than the ideas they were putting forward.

Beck, from the very beginning of his therapy, systematically reviewed outcome, and as a result there is a large body of empirical evidence supporting CBT for the treatment of many problems. And yet there are still critics of CBT who maybe apply the sort of inferred justification I mentioned at the beginning of this post – the mix of supportive and unsupportive findings for CBT approach in chronic pain is used as justification for pursuing a cure-seeking approach. And this is despite the large body of evidence showing that using passive, cure-seeking strategies to manage a chronic problem, or even worse, failing to address the psychosocial aspects of treatment-seeking, the pain experience and disability, maintains and perpetuates distress and suffering.

Today is a 6-month follow-up day at work. It will be interesting to see the lives being lived by the people who have been participants in our three-week pain management programme. After all, the reason we do pain management (and look for the best evidence for what we do) is so that people move from being patients to being people again.

Cool ‘diseasome’ graphic!

Thanks to Dr Deb for pointing me in the direction of this cool graphic showing the common genetic links between a range of disorders…here’s the link to the full article, from The New York Times.

You can find out so many teeny tiny bits of news on Twitter!
Oh and you can blame Manly Jack for passing on this bit of humour…

Sorry ’bout that. Normal transmission resumes shortly.

Pain Blog Carnival!

Every month the best of pain blogging is gathered together and published by How to Cope with Pain. This month is a little different – instead of us sending in posts, the best posts have been selected and included in the carnival.  Take a look here for this month’s round-up. In the mix is a post on mirror therapy from Neurotopian, and for a little more, you can go here to view a video of mirror box treatment for stroke – the principles are the same for complex regional pain syndrome (CRPS).

My post about using attention management for coping with chronic pain is included – yay!

And my personal favourite is this one by Kerrie from The Daily Headache – scheduling in an ‘off’ day, or pushing yourself to do something knowing that a ‘bad day’ will ensue – but it’s worth it every now and then.

Pain management is all about choices really – and the power of pain management to me is helping people who have chronic pain recognise that they do have choices available, that pain does not need to dictate everything.

Occupational therapy blog carnival #2

It’s like a virus – the number of occupational therapy bloggers is growing, and the online community of occupational therapists is becoming more connected.  Join in if you want to be challenged and enthused!

I’m passionate about people knowing why they make the decisions they do in therapy, so this month I set the topic of ‘clinical reasoning’ to find out what other occupational therapists do when they are working their way through a therapeutic decision.

Clinical reasoning is ‘the ability to select and use information effectively in solving problems…a teachable cognitive skill independent of specific clinical knowledge.’ (Elstein, 1995). Another way of looking at it is the ‘process of making sense of a clinical encounter.’ Clinical reasoning ‘is a dynamic process that occurs before, during, and after the collection of data through history, physical examination, clinical testing and observation.’ (Weiner, 1996).

Occupational therapists have been called the ‘problem solving’ profession, and one clear strength in occupational therapy is the ability to work out ‘what to do’ in a given clinical situation. It can also be a limiting factor because the ability to intuitively work out what to do is influenced by cognitive biases and errors that therapists may not be aware of or accommodate.

The first time a therapist attempts a new assessment or intervention is often the time he or she examines exactly what factors will influence the clinical decision. Cheryl presents Jobsite Analysis posted at Occupational Therapy Notes. In this post she explores the process she used to prepare for her first jobsite analysis. (As a quick aside, Cheryl apologises for the length of her posts – if you take a look at mine, I think we’re about equal!) What Cheryl illustrates to me is the iterative process that is an integral part of clinical reasoning – back and forth from the literature to the clinical situation to the literature and back again.

You can pretty much bet that Chris will have something to interest a curious mind – Chris Alterio presents Monday morning spaghetti posted at ABC Therapeutics Occupational Therapy Weblog. This post especially highlights the way a therapist needs to consider the question: who has the problem? If occupational therapy is a key problem solving profession, it’s important to decide whether the person thought to have the problem actually has one, or whether it might be about the cultural context in which the person is living. Remember that in a ‘medical model’, hormone changes at mid-life can be called ‘hormonal insufficiency’ – or we might call it simply menopause!

Now this next post is not an occupational therapy one, and it’s not even about clinical reasoning – but I did like it, it was submitted to the carnival and for my own perverse reasons I’m going to include it. I am not, however, including the couple of entries on skin care products, nor the adverts for computer services or training! Anna Farmery presents 10 Reasons Why Your Relationship with You Matters posted at The Engaging Brand. I liked this because Anna makes some good points about being true to yourself especially when being involved in an on-line community.

The Salford University Occupational Therapy Blog discussed whether occupational therapists have core values or core skills. This is probably one of the things I have come to acknowledge in my practice in occupational therapy. While some of what an occupational therapists does is ‘unique’ to occupational therapy, there are an awful lot of areas that are common to many health professions – some of them are skills such as being able to establish rapport, being able to ask open-ended questions; others are values such as respect, empathy, honesty and valuing the individual’s perspective.

Alece Kaplan presents Death With Dignity Act Implemented on March 4th posted at OT Advocacy, saying, “A blog post about the ways that Washington State’s new Death With Dignity Act impacts occupational therapists.”  I don’t come from the US, but I think everyone who works in health will at some point need to take time to think about death and dying.

Venthan Mailoo presents Occupational Therapy First – It is time for our profession to lead; not follow. | meta-ot posted at Venth’s Blog. I do agree – time for occupational therapists to be proud of what we do, and that doesn’t mean laying claim to do everything, simply recognising what occupational therapy can contribute to a team.

Alvaro Fernandez presents Michael Merzenich: Brain Plasticity offers Hope for Everyone posted at SharpBrains: Your Window into the Brain Fitness Revolution, saying, “”Whatever you struggle with in a sense as it stems from your neurology, the inherent plasticity of the brain gives you a basis for improvement. This is a way underutilized and under-appreciated resource that well all have.””

If there is one word that is being well-used in pain management, it is neuroplasticity – we can and do learn all our lives, and this has to involve brains!

Mike Reinold presents What Exactly Is a SLAP Lesion? Top 5 Things You Need to Know About a Superior Labral Tear ~ posted at

Ouch! Not something I’ve experienced, thankfully, but some of the people I see have had one, and proceeded to experience chronic pain – so it’s good to learn how to identify and manage this pretty common injury.

One of the most enthusiastic members of the international occupational therapy e-community is Claire. Claire Hayward presents I don’t want to make people independant: occupational heresy? posted at E-nableOT. Do you think she’s being a heretic by not always wanting to ‘make people independent’? My own reflection is this: we need to be guided by a balance between what is culturally appropriate in terms of independence, what the person within his or her own context wants, and what the literature suggests is the most appropriate approach in the long term for the individual-in-context. Do you notice that ‘contextual’ part of my definition? Context isn’t just about the person and his or her beliefs, but also about the family, the neighbourhood, the local community – and the larger community at both the societal and political levels.

I think occupational therapy can benefit from going outside the occupational therapy literature to see what other scientists have found out about factors that influence human behaviour.  For that reason I am probably just as heretical as Claire in that I often adopt therapeutic methods and models from other fields of learning in order to help the people I work with achieve their occupational performance goals.

My own contribution to this carnival involves several musings on the way we as clinicians might be tripped up by our cognitive errors.  I posted these three posts last year, but I think they’re both relevant and practical.  Go here, here and here for my take on decision-making and what we can learn from cognitive psychology.

If you’ve enjoyed this carnival, and want to read more – you can visit each of the blogs mentioned in today’s post, and you’ll be sure to find out some interesting things.

That concludes this edition. Submit your blog article to the next edition of
occupational therapy
using our
carnival submission form.
Past posts and future hosts can be found on our

blog carnival index page

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Grand Rounds – medical/health blog carnival

While I’m on a roll and linking to good carnivals, grand rounds has been published for a long time now – it’s a roundup of fabulous posts of a medical or health-related nature. It’s often hosted at different sites, so to keep up with it I find I need to remember to go to the current one and put a reminder on my Google Calendar (not advertising OK, NOT!!!) to where the next carnival is being hosted.

In browsing Better Health, I just found the Grand Rounds calendar – the limitations of WordPress strike again, and I can’t load the widget here (I think), but there is a calendar and you can always find the Grand Rounds location at Better Health.

Pain blog carnival is up!

This month’s pain blog carnival is up now. Go here to read some of the internet’s finest blog posts on managing pain, hosted by How to Cope with Pain every month.

If you’re unfamiliar with what a ‘carnival’ is, it’s where several (read: many) blog authors link to a single site to post on a theme on a certain date. Here’s the wikipedia entry for it. It’s often a chance to link to some new writers, find out something across a broad range of views on a topic, and a bit like having a magazine to read on your favourite subject.

I hope you take the time to head over to read this month’s pain blog carnival – and if you’ve enjoyed that, come back here for the occupational therapy blog carnival at the beginning of May.

Occupational Blog Carnival #2 – Call for submissions

This months the carnival is hosted by me!

The topic is ‘clinical reasoning and occupational therapy’

The closing date for posts is the 3rd April so get going now!
The carnival will be published on the 6th April.

Click here to submit a post

Don’t forget to subscribe to the carnival – visit its permanent home here.

Please publicize the carnival on your own blog or through other channels such as Twitter, Facebook. – megalist of the top healthcare blogs

Healthcare 100 -

Take a look at the list and see where your favourite blog is ranked!
I’m actually about #339 currently (I often get ranked between #250 and #350) of the 1027 blogs that are rated on the site. Not that it’s about the numbers (yeah, right!)
For some of the FAQ’s especially about the features of this site, go here .
Some of my favourites are ranked on this site including Bad Science, PsychCentral, BrainBlogger, Musings of a Distractible Mind, and Dr Deb.

I’m definitely NOT in this business to be ranked or rated or for awards. If I was, I’d spend a lot more time writing on popular topics, for patients instead of therapists, and I’d post shorter posts! I write because I enjoy sorting things out in my own mind, exploring things I’ve pondered about, and because I can’t see anything else quite like this on the net.

I originally started posting as part of my rehabilitation for postconcussion syndrome (it really helped me learn to paraphrase and integrate new information!), and it’s become a place where I encounter people working in the field of pain management, can file (for free!) lots of the resources I use each day in clinical work, and it’s been an incredible way to document my own learning and values.

Some of you might have seen the survey to the left of this post – it’s about what you might like to see me write about. At the moment it looks like writing about how I apply theory to clinical cases is something you’d like me to cover. I want to do this, but I also want to link in to specific papers to make sure you have something to refer back to (don’t take my word without checking the original study).

Does this all take time? Well, yes. I blog often early in the morning, or in the evenings when everyone sane is watching TV. I could be watching TV or I could be processing some photography, reading, painting or sewing or even dancing – but for me, pain management is something that is incredibly fascinating, rewarding and stimulating. No I don’t really have a boundary between my ‘work’ and my ‘life’! One day maybe I can make a living out of writing this blog – until then, I’ll just do it for the reasons I’ve given above.

I love comments, I love debate and I would love you to make comments. I usually respond to comments (except the ones that lead me to a spam site, OK? I don’t need silicon implants, herbal remedies or a bigger… you know what I mean?!). So, if you’ve enjoyed something, or maybe you’re irritated, or curious, or have another site to share – let me know!

Occupational Therapy Blog Carnival!

If you are an occupational therapist, or you have never really taken occupational therapy seriously, now is the time to take a look at the international Occupational Therapy Blog Carnival #1.

Thanks to one of the most energetic Web 2.0 protagonists I’ve ever met, ‘Buckeyebrit’ (AKA Claire Hayward from UK!) organised this inaugural occupational therapy carnival. Go here to her blog ‘E-nableOT’ for the blog roundup.

Next month I’m up for hosting it – be prepared for some stimulating, enlightening and rewarding reading.
If you’re an occupational therapist, or have something related to occupational therapy in your blog, think about contributing. Next month’s topic is ‘clinical reasoning and occupational therapy’ (my choice!) so I invite you all to contribute. Maybe an example of the reasoning behind an intervention you’ve used. Maybe a description of how you’ve applied a model of practice into a treatment. Perhaps it’s a thought about how your clinical reasoning has developed over your practice – or maybe, if you’re not an occupational therapist, how your reasoning differs from occupational therapists you’ve worked with.

I’ll give you more details about what to do – and I won’t let anyone forget either! – in the next couple of weeks.

Pre-Christmas gratitude – 5 things I’m grateful for

In these couple of days before Christmas, it’s traditional to review some of the ‘best of’ 2008. It’s been just over a year since I started this blog, and the topic list and readership has grown a whole lot!

What am I grateful for in 2008?

  1. Teamwork – the people I work with are fantastic. You can’t work alone in pain management IMHO,  a team of like-minded people to support you both professionally and personally just can’t be beaten.  I take my hat off to the team at Burwood Pain Management Centre who keep me honest, deflate my ego (gently), cushion my falls, keep me standing and give me inspiration to keep on caring about what I do.
  2. Motivation – using motivational approaches like motivational interviewing to help people make their own choices rather than remaining ambivalent.  Whatever the choice, it’s easier to make changes once you’re moving than remain stuck.  I’m grateful for the sense of freedom that using motivational approaches has given me, and that I’ve been able to apply it in my work.  Now if only it could work with my kids?!
  3. The magic of the interweb – and so many dedicated bloggers. I find it unbelievable that there are so many people who spend time writing intelligent, interesting, provoking and inspiring posts on topics dear to my heart – and it’s all free (provided you can get on the internet).  There are so many topics to choose from, and the quality can be stunning.  I’m not a ‘Web 2.0’ kind of person, and I’m not about to rave about the wonders of interactivity, I’m simply awed at how many people spend time putting up resources so the rest of us can find them. (more…)