Ep46: When Physios Can Order Imaging: Smarter Imaging, Better Care with Jack Miller and Rob Werstine

In this episode, we discussed:

The principal use of diagnostic imaging and laboratory testing: When it should be used and when it shouldn't be used The limitations of diagnostics and ramifications of overuse on psychological, behavioural, and systemic levels Improving providers' literacy and patient education around diagnostics The impact of physiotherapists having the scope expansion and the current state of advocacy on this topic

Resources

The Canadian C-spine Rule The Ottawa Ankle Rule The Ottawa Knee Rule Canadian Association of Radiologists Utilization Guideline American College of Radiologist Appropriateness Criteria Brinjikji, W., et al. (2015). MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. American Journal of Neuroradiology, 36(12), 2394-2399. Flynn, T. W., et al. (2011). Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good. journal of orthopaedic & sports physical therapy, 41(11), 838-846. Sajid, I. M., Parkunan, A., & Frost, K. (2021). Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care. BMJ open quality, 10(3). Scott, I. A., Slavotinek, J., & Glasziou, P. P. (2024). First do no harm in responding to incidental imaging findings. Medical Journal of Australia, 220(1), 7-9. Sharma, S., et al. (2021). “I would not go to him”: Focus groups exploring community responses to a public health campaign aimed at reducing unnecessary diagnostic imaging of low back pain. Health Expectations, 24(2), 648-658. VOMIT (Victim Of Medical Imaging Technology) Poster: https://www.aptei.ca/product/vomit-radiology-facts-wall-poster/

Rob Werstine BA, BSc, MSc, DPT, FCAMPT, Dip Sport, MBA Rob Werstine is a Physiotherapist who holds an Advanced Practice Provider position in the Rapid Access Clinic for Low Back Pain at LHSC in London and holds an adjunct teaching appointment in the School of Graduate Studies at Western University. Rob has spent his career opening access to health care for Canadians through the development of non-physician specialists. He helped create the first and only degree granting Clinical Master’s program for Physiotherapists in Orthopaedics at Western University in 2007 and helped create a National Clinical Specialists Program in 2012. He chaired the IFOMPT Conference in 2012 and has been an expert consultant for health care associations and regulatory bodies across North America. Rob has continued to help improve the ability of hundreds of non-physician health care professionals to take on Advanced Practice roles through the creation of Key Clinical Skills Inc., a continuing education provider for health care professionals across Canada and around the world, which has been providing education opportunities since 2016.

Dr. Jack Miller BSc(PT), Dip MT(NZ), MClSc, DPT, FCAMP Dr. Miller completed his BSc in Physical Therapy at the University of Toronto in 1980. He then spent six years in New Zealand where he completed the New Zealand Manipulative Therapy Association’s Graduate Diploma of Manipulative Therapy in 1984. During this program he had the opportunity to be directly mentored by both Robin McKenzie and Brian Mulligan. On returning to Canada, he went on to complete a Masters of Clinical Science at Western University in London and a Post-Professional Doctor of Physical Therapy Degree from the University of St. Augustine in the USA. Jack has been the senior editor of the Canadian Physiotherapy Association’s Orthopaedic Journal, an executive member of the Orthopaedic Division of CPA, the President of the Canadian Academy of Manipulative Physical Therapy, a member of the CPA Specialization accreditation committee, the conference chair for IFOMPT 2012, and was a founding member of the Mulligan Concept Teacher’s Association. He has