Research Roundup! Dr. Emilio “Louie” Puentedur

 

Dr. Puentedura was born in Madrid, Spain and raised in Melbourne, Australia.  He received his B.App.Sc. in Physiotherapy from La Trobe University in 1980.  In 1983, he completed a graduate diploma in Manipulative Therapy (GDMT) from the same University.  After practicing for approximately 15 years in outpatient physical therapy, he moved to the USA. He completed a post-professional Doctorate in Physical Therapy at Northern Arizona University in Flagstaff, AZ in 2005, and a PhD in Physical Therapy at Nova Southeastern University in Fort Lauderdale, FL in 2011. He joined the UNLV Department of Physical Therapy in 2007.  He is an ABPTS Certified Specialist in Orthopedics and a Fellow of the American Academy of Orthopedic Manual Physical Therapists.

Dr. Puentedura is senior faculty with International Spine Pain Institute (ISPI) and Evidence in Motion (EIM) and teaches many weekend seminar courses for practicing physical therapists.

Faculty Position

Associate Professor, Graduate Coordinator

Coordinator for PhD in Interdisciplinary Health Sciences

Education

PhD in Physical Therapy – Nova Southeastern University, Fort Lauderdale, FL – 2011

DPT, Northern Arizona University, Flagstaff, AZ  – 2005

GDMT – La Trobe University, Melbourne, Australia – 1983

BAppSc PT – La Trobe University, Melbourne, Australia – 1980

Research Interests

Dr. Puentedura’s primary research interests are in clinical effectiveness and mechanisms of spinal manipulation, neurodynamic interventions, and neuroscience education for chronic pain.

PubMed Bibliography: click here
ResearchGate: click here

What inspired you to go into research?

After almost 30 years in clinical practice, and having been an avid consumer of research, I felt there were many gaps in the evidence that I could try to fill. One of my biggest beefs was that research into spinal manipulation often did not actually provide ‘manipulation’ because the interventions were often poorly defined and mixed in with non-thrust mobilization interventions. Another thing that I knew from my clinical experience was that manipulation was not something to be used on “all patients with neck or back pain” and yet, much of the research included “all patients” in their study samples. The push for sub-grouping and the classification-based approach advocated by researchers in the early 2000’s was another impetus for me to move away from full-time clinical work to research and teaching. I guess the other thing that inspired me was when I discovered statistics was not as bad as I remembered it from my undergrad days!

Is there anything you wish you would have known before you became a researcher?

Research is a learning process and while it is nice to think we could get statistically significant findings for all our studies, it actually helps to make mistakes and learn from them. My earliest lesson was that I could not be a sole researcher. You have to join a research team and work with others to develop and conduct good research designs. I have been very lucky to join some excellent people on these team efforts, and the work is much more fun when you share in the joys and frustrations with others.

I guess the main thing I wish I would have known before becoming a researcher was that I really wanted to be one. Because I would have left clinical practice sooner and have a lot more research completed by now.  But, on the flip side, I think my clinical experience is extremely valuable because I want my research to have clinical application and meaning.

What area of study has your recent research been on?  

My focus over recent years has been on the safety and effectiveness of cervical spine manipulation.  Over the last 15 years that I have been teaching thrust joint manipulation skills to physical therapists, it has never ceased to amaze me how fearful therapists are of using manipulation in the C spine, and how cavalier an attitude they have about doing it in the thoracic spine. Through my research, I have tried to point this out and urge greater caution when using manipulation in the thoracic spine, and a more realistic attitude about the dangers of it in the c-spine.  At the same time, I have been heavily involved in Pain Neuroscience Education (teaching people about pain) and the value of such an approach in patients with chronic pain.

I have always felt that manual therapy and pain science should go together, and I’m very glad to see many therapists and researchers are seeing that it is not an “or” situation – manual therapy OR pain science education, but an “and” thing. There is emerging evidence that they go together well with the right patient.

Can you describe how your research has evolved over the years, bringing you to where you are today?

I think that my research approach has gone full circle over the years. By that, I mean that initially, I was very clinically oriented and wanted to focus on real-life clinical situations. I soon discovered that rigorous research means controlling for as many extraneous variables as possible and my research moved in that direction. So much so that I soon realized what I was studying was a little too far removed from real-life clinical experience, and I had to circle back again.

It has been a matter of trying to balance the pendulum so it doesn’t swing too far in one direction. I want my research to pass the test of scientific rigor, but I also want clinicians to see it as useful for their day-to-day decision-making. It’s pretty difficult getting the right mix.  My focus today is more on clinical application.

What do you feel is the biggest hurdle between researchers and clinicians?  What are some solutions you see in overcoming these barriers?

I think the greatest hurdle is that they don’t speak the same language. Many clinicians don’t understand the difference between statistical significance and clinical significance. Terms like minimal detectable change, minimal clinically importance difference, 95% confidence intervals, odds ratios and numbers needed to treat may be hard for clinicians to grasp. On the flip side, there are many researchers out there who wouldn’t know the first thing about actually treating a patient from initial evaluation to discharge. This creates a gulf between researchers and clinicians. As a clinician, I was always a bit annoyed when researchers seemed to be telling me what I should be doing with my patients based on their research findings. I’d read that research and discover that my patient didn’t actually fit the study criteria, and there was no way I could get away with the minimal interventions provided in the study. So, it had little impact. I think that the only way to bridge that gulf or overcome that barrier is for better dialog between the two groups.

We need more clinicians to become involved in research and we need researchers to get out there and get their hands dirty and actually see some patients. It’s all about perspective.

Can you give advice to students/practitioners, who may be considering a career in research, on how to how to find a school and researcher to work under?

The best advice I can give someone considering a career in research is to get at least 10 years of clinical experience under your belt before looking for a school to get a PhD and a researcher to work with. We have far too many who graduate with their DPT, work less than 2 years in clinical practice (decide it’s not for them) and move quickly into teaching and research. Who would you rather learn from, a teacher/ researcher with minimal to no clinical experience or someone with at least 10 years under their belt?

Our profession needs less academic researchers and more clinician researchers.

So, once you’ve practiced PT for a decade, you’ll know which area really interests you and you’ll have a much better idea of the gaps in the research and how to fill them. Learning all the research material is much easier later in life when you have experience to draw from. Also, I can tell you that you’ll be much more attractive as a faculty hire if you have a decent amount of clinical experience in your resume versus someone who went straight into PhD work after graduating PT school.

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