Ride 'Em Cowboy

Article Outline

• Copyright

That is exactly what Dorit Aaron and Scott Kozin, Chairmen of the combined annual meetings of the ASHT and ASSH, did in San Antonio. Right there on the floor of the massive convention center meeting these two dudes came riding in on horseback, much to the delight of the near one thousand in the audience. The wild-west cowboy theme of the meeting was carried out brilliantly, not only by Dorit and Scott, but also by other star players, not the least of which were Donna Breger and Terry Light, Presidents of the ASHT and ASSH, respectively.

With such a spectacular show from start to finish, it is difficult for me to put a finger on the number one segment of the entire event. Yet, I did find one of the less-hyped features especially to my liking. A panel of a half-dozen high-profile surgeons presented a 15–20 minute segment called the JOURNAL of RETRACTION. The format of the presentations was to have each surgeon retract a position they had publicly taken in the past about a particular approach or surgical procedure that they no longer felt was the answer to a specific clinical problem. For example, Lee Osterman retracted his one time strongly held position that STT fusion was the solution to scapholunate dissociation. I was impressed by the courage and candor these well-known surgeons displayed by standing up, one by one in front of their peers, and admitting with grace and charm, that they had been wrong.

But it is not my intent to focus on the noble confessions of the surgeons, rather it is to ask the question if we ought not to take a similarly critical look at many of the techniques that we have been using clinically day in and day out without ever questioning their validity. For example, I earned my early reputation in hand therapy for teaching joint mobilization, but in later years have shied away from teaching joint mobs because I am no longer enamored of its application to the problem of joint stiffness. How strong is the basis or rationale for so many of our clinical techniques? What is the level of evidence, to borrow a term from the gurus of evidence-based practice? The HTCC test committee each year sits down in some nondescript hotel conference room and reviews every single question on the CHT exam. One of the details that Chairman Patti Taylor insists the committee do is to try to find a primary reference source to support the validity of each question/answer. The troubling reality is that so many of the questions/answers, which address the heart and soul of our hand therapy practice, still are referenced to Rehab of the Hand and not supported by primary references. Clearly I am not criticizing the editors of Rehab of the Hand; it remains our professional Bible. Nor am I criticizing the HTCC for not finding primary sources. I am saying that we do not have primary sources for so much of our basic practices. That is to say the evidence supporting the validity of our work is often pretty thin. My view is that we need to produce more evidence to validate our work … not a new theme from the editor's desk.

Not only should we seek to validate our practices, but also we need to have the stuff to speak up when we find evidence that challenges the traditional wisdom. The JHT is always pleased to publish evidence that either supports or renounces the traditional wisdom. Afterall, Veritas Vos Liberabit. What techniques do you use every day that perhaps belong in the JOURNAL of RETRACTION?—KF