Thursday, October 09, 2008

Guest entry and debate on what constitutes occupational therapy practice

I received an email from Michele Karnes who wrote the following in the interest of advancing the debate on recent postings and comments regarding interventions that I consider quackery. Michele writes:

This offers a different view in response to your continuing competency column, OT's should be made aware of treatments that are offered to clients/patients, whether it is traditional or non-traditional, a long existing treatment or new one. This enables our OT profession and professionals to better educate the people they treat and interact with.

Instead of taking anyone's word that a particular treatment is 'mysticism' (as you put it) or the best thing since sliced bread, the OT who attends a 2-3 hour session can be introduced to the history and theory, what the treatment or program consists of, indications/contraindications, etc.

In response to Quantum Touch, it is based on the chi concept much like Tai Chi but focuses on therapeutic touch, a long standing principle used in OT. From the Quantum Touch website: “In principal the Quantum-Touch practitioner learns to focus and amplify life-force energy ("Chi" or "Prana") by combining various breathing and body awareness exercises” (I fail to see the problem with this). Additionally, “Over the past eight years, …have taught QT to well over 4000 people. Without exception, professional practitioners of the various modalities have told me that this work can be seamlessly combined with what they know, and in most cases it has transformed their practice. This list includes chiropractors, osteopaths, physical therapists, acupuncturists, cranial sacral therapists, chi gung instructors, and reiki masters, to name but a few”.

Notice the absence of OT, whether we buy into it or not is our own personal preference, however when talking to another health professional, it seems you would rather OT be clueless about what it is, who does it and what the theories behind it are. Tai chi has only become more evidence based recently and early practitioners were pooh-poohed!

Your comment "Undoubtedly, continuing education organizers and providers reap reasonable financial dividends through their offerings" couldn't be further from the truth, if fact one of the reasons this company was formed was to provide accessible, affordable, quality continuing education to our local health providers. The fees are low, food is often provided as well as current information offered by quality speakers who have vast experience in the content area. While Evidence Based Practice is on all of our minds, and ultimately the best to utilize with our patients, if we only used treatments for all of these years we would have missed out on the many treatments that OT’s have historically (and still) use.

Additionally, IACET is the gold standard of continuing education, AOTA CEUs have fewer standards and the standards they have are in line with IACET. IACET enables OT/PT/ST/Athletic trainers and others to learn in an interdisciplinary manner which is highly encouraged by the Institute of Medicine in “Crossing the Quality Chasm: A New Health System for the 21st Century”.

I would also like to urge those that question a practice or program to at least attend an event and look for yourself, much like the therapists who have found this to be a valuable resource!

Thanks for having an open mind!

Michele Karnes




I still believe that Quantum Touch has absolutely no value and should never be accepted as continuing education for occupational therapists. In my opinion it has absolutely nothing to do with the occupational therapy scope of practice as defined by our state law and I believe you would be hard-pressed to find an ACOTE standard that demands the inclusion of this intervention into any curriculum.

If Quantum Touch was only about "breathing and body awareness exercises" than I might not object - but in fact the Quantum Touch website makes claims that this technique can cause remissions of breast and liver cancer, cure scoliosis and other orthopedic misalignments, reduce deformities from rheumatoid arthritis and eliminate panic attacks, reshape bunions and heal deformed or broken bones... the list goes on. It can also apparently be done through 'telephone healing' and even children can do it. It also prevents flowers from wilting and can cause people to smile broadly. All these claims are made on the website at http://www.quantumtouch.com/index.php?option=com_content&%20%20;view=article&id=3&Itemid=58. This does not constitute responsible occupational therapy practice in my opinion.

So actually I don't believe that professionals should be "clueless." People can go read the New York State law governing occupational therapy practice, they can read the ACOTE standards, and then they can read the outrageous claims on the Quantum Touch website. Then they can go read the evidence:

As you are undoubtedly aware, this is not my opinion alone. There are many studies that completely discredit energy healing and it is not accepted by the medical community at large. In fact, if I were to attempt to use a form of energy healing in my practice for a patient who had an acute hand injury I would not improve the patient's condition, the doctor would never refer to occupational therapy again, and I would open myself up to a significant lawsuit for professional malpractice. The premise that this is somehow an acceptable intervention and something that we should be educating occupational therapists on is almost beyond my comprehension.

Michele states that Quantum Touch is based on the concept of Therapeutic Touch. Perhaps the most famous evidence that we have to date that undoubtedly proves that this is a sham is from the article published in JAMA on the inspiration of the 11 year old's fourth grade science fair project - where people who were energy healers only identified an 'energy field' 44% of the time - less than by chance! So much for Therapeutic Touch.

Just because people seek out alternative energy healing interventions doesn't mean that it constitutes appropriate or ethical practice. In an article published in the Journal of the American Medical Association on this topic an author writes: "Given the extensive use of CAM services and the relative paucity of data concerning safety, patients may be putting themselves at risk by their use of these treatments. Only fully competent and licensed practitioners can help patients avoid such inappropriate use... Physicians can also ensure that patients do not abandon effective care and alert them to signs of possible fraud or danger."

When I was much younger and less skilled in researching evidence I went to a course because I wanted to 'see for myself' what it was about. The course was on pediatric myofascial release - and there is no shortage of controversy on whether or not this is a sham intervention. In the course they wanted us to "feel" craniosacral rhythm - and the "instructional technique" was to have us place one hand on our partner's sacrum and the other on their occiput while they were lying supine. Then they dimmed the lights, played background music with the sound of ocean waves crashing on the shore, and the course instructors walked to each set of participants and placed their hands on top of the 'therapist's hands' using alternating gentle pressure and stating "Can't you feel that?" What a joke. Since that time I have learned that I don't always need to go to a course to find out for myself - because the courses invariably have more to do with suggestion and indoctrination and very little to do with real science.

Over time I have come to understand that I don't need to step into a cowpie just because I want to experience it for myself. Sometimes the smell of it from a distance is enough for me. But I am just a street level practitioner with a computer and an opinion. People can decide for themselves.

References:

Jonas W. (1998) Alternative medicine and the conventional practitioner. JAMA, 279, 708-709.

Rosa L, Rosa E, Sarner L, Barrett S. (1998). A close look at Therapeutic Touch. JAMA, 279:1005-1010.

1 comment:

healthskills said...

I am so very in agreement with your post regarding refuting non-evidence-based practice. Being informed about 'alternative' health care practice in no way should constitute an occupational therapist (or any evidence-based health provider) endorsing such practice. I am not going to enter into the debate about what constitutes occupational therapy vs non-occupational therapy, but I am ready to enter into debate about what treatments have empirical evidence to support them. I don't just query 'alternative' health care either, I query ALL health care to either allow itself to be verified using good research practice, or admit that it does not want to be subject to such critique. Then hopefully the dollars that go into advertising will not be able to persuade less scientifically literate consumers to use ineffective treatments.