Occasionally I will take the time to watch the final quarter of a basketball game, as I have found that is usually the most exciting part of a game. Although I do enjoy a well-run play that results in scoring a basket, I often find that I have outbursts of verbal appreciation when a player successfully executes what has become known as a “slam dunk.” The Merriam-Webster Online Dictionary defines slam dunk as “something that is sure to happen or be successful.”1
I was surprised to find that the very first slam dunk performed by a woman occurred in 1984. The player was a 6′7″ center named Georgeann Wells from West Virginia University. A Wall Street Journal reporter, Reed Albergotte, wrote about the event when video proof became available after the opposing coach's son found a videotaping of the game in 2009.2 The first high schooler to slam dunk a basketball was Candace Parker when she participated in a slam dunk contest for the McDonald's All-America Game in 2004 and beat out 5 male competitors to take home the trophy. This is the same contest that was won by LeBron James in 2003.3 Candace was also the first woman to slam dunk in a NCAA tournament game in 2006 when she played for the University of Tennessee Lady Vols.4 The first woman to slam dunk a basketball in the WNBA was Lisa Leslie when she played for the Los Angeles Sparks in 2003.5
Because of the fact that I am only 5′6″ tall, I have only been able to imagine how it feels to be able to slam dunk a basketball. Indeed, when I played in college, I was ecstatic when I could jump and barely touch the bottom of the net. Unfortunately, there were no trophies for that. However, I have now come to realize that there is another way I am going to be able to participate in a slam dunk event. This summer, I, along with Susan Clinton and Alaina Newell, was invited to participate in a Clinical Practice Guideline (CPG) Workshop that was held at the headquarters of the APTA. During the workshop, we were guided through the process of writing and publishing a CPG. Susan and Alaina have already done the most difficult and most time- and energy-consuming part of a guideline on the topic of pelvic girdle pain in the antepartum population. I am now entering the process at what is equivalent to the final quarter of the game.
For those who are unsure of the game plan of CPGs, I think that a very brief explanation might be helpful. In 2011, the Institute of Medicine defined clinical practice guidelines as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence.”6 The Institute of Medicine report instructs that:
To be trustworthy, clinical practice guidelines should:
- Be based on a systematic review of the existing evidence;
- Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups;
- Consider important patient subgroups and patient preferences, as appropriate;
- Be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest;
- Provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of recommendations; and
- Be reconsidered and revised as appropriate when important new evidence warrants modifications of recommendations.6
For the first part of the process, all the available research identified through a systematic review of the topic of choice is carefully read and reviewed and appraised for quality. This is an arduous process. An excellent review of the process was provided by Drs Susan Kaplan, Colleen Coulter, and Linda Fetters in 2013.7 The final product is a written CPG that summarizes the research to guide clinical practitioners in deciding what should be the most effective and efficient interventions. The guideline is akin to a coach's playbook that is generated after watching hours and hours of tapes from previous competitors’ games. And, just as players on a team trust that their coach has put in the time to determine how they might best win the game, our patients rely on us to spend the time to determine what the most efficient and effective intervention would be that would ensure that their copays are good investments. Having trustworthy guidelines allows clinicians to choose interventions that should have a slam dunk result for their patients.
I'll close with one final analogy. If a coach develops a playbook plan for a specific game based on the other team playing a 1-3-1 defense, but the other team uncharacteristically presents with a 2-1-2 defense, she must be able to revise that plan based on what is presented. I offer that physical therapists function as movement coaches. We must not only develop a plan on the basis of trustworthy guidelines, but also be ready to revise on the basis of how a patient presents. Please note that I am not intimating that clinicians can go from research-based to “oh ... I heard about this intervention from a friend of a friend of a former basketball player who had physical therapy once.” We must become a profession that relies solely on research evidence or we might find ourselves out of the game (profession).
Although the Section on Women's Health is just now in the “warm-up” phase of CPGs, the Orthopedics Section has completed several guidelines that can be found on their Web site, and the Pediatrics Section is just about to publish their first guideline on the topic of Torticollis. If you are wondering about the utility of well-written guidelines, please take a look at these guidelines.
By employing the information from CPGs, as well as the most current peer-reviewed published research, even we height disadvantaged people can experience the joy of slam dunking (although we will have to imagine the crowd roaring with excitement).
This issue of JWHPT includes research that may well be included in a future CPG. Dr Peterson and her colleagues articulate the anatomical differences in the shape of female and male carpal tunnels. Drs John and Kristin Greany outline the fitness benefits from pushing a baby stroller. Dr Alappattu takes us through her interventions for a woman diagnosed with stage III cervical cancer who was experiencing chronic pain. Dr Thompson describes the results of her pilot study for women with urge and stress incontinence with the use of exercise and electrical stimulation.
I do want to remind each reader about the effort that is expended by many dedicated individuals who volunteer their time to ensure that each issue of this publication presents trustworthy information. Dr Diane Borello-France spends countless hours ensuring that each manuscript goes through a peer-review process. She and I depend on reviewers who have a strong commitment to the discipline of women's health physical therapy and are willing to spend some of their valuable time providing feedback to authors. I am so very appreciative of the work that each of the reviewers does for JWHPT. I also want to extend “high-fives” to each member of the editorial staff (Dr Diane Borello-France, Dr Karen Abraham, Dr Elaine Wilder, Darija Scepanovic, and Dr Wenting Wu).
Because of the fact that we are receiving an increased number of manuscripts submitted to the journal, I am hoping to add to the lineup of reviewers. Please, if you would be willing to review manuscripts, or know of someone who might be willing to join this team, please alert me by sending an e-mail to me at firstname.lastname@example.org. I do want each potential reviewer to understand that although we do require that each reviewer have 1 or more areas of content expertise, we have a statistician on the editorial staff whom we call on to review the statistical content.
Nancy C. Donovan, PT, PhD
7. Kaplan SL, Coulter C, Fetters L. Developing evidence-based physical therapy clinical practice guidelines. Pediatr Phys Ther. 2013;25:257–270.