Tuesday, March 8, 2016

Faith and Patience in Science and Data

Oh the joys of protocol and milestone based therapy!

I wanted to write a little disclaimer on my website about my ACL repair. Very briefly that would be: My injury and recovery may be totally different from anyone else's injury and recovery as my "data input" is likely different than yours. You might be a young athlete or you might be an old couch potato. If you are reading this two years from know because you have a torn ACL, please note that the data--the research based protocols and milestones--may have changed. For example: a few years ago, continuous motion machines were in. Now they are not. Things change. Things perpetually change, and sometimes you will get caught in the middle of those changes, as I am stuck today.

But first, let me tell you a story. I graduated from college in 1991, and the job market was terrible. The US was at the tail end of a recession, and many of my friends didn't have jobs. In my final quarter before graduation, I didn't have a job. Instead of going on a full court press of looking for a job, I decided I'd enjoy my last few weeks of being a college student and worry about getting a job after graduation. I was in the Mathematical Methods in the Social Sciences (MMSS) program at NU. One day about three weeks before graduation, I got a call from a strategic marketing consulting firm asking if I would like to interview. They had called the MMSS program and asked which students they should call about a job.

In the interview, my future boss asked me what I thought about data.

"Data tells you more about what you don't know that what you do know," I said.

"What do you mean?" he said.

"You can have data that says 75% of women like a product and 25% of men like it, but that is just an estimate. What the data is saying is that than men are less favorable towards to the product than women, not at that 'women like it' or 'men hate it.' The data in this case is a guideline that helps you understand something in a relative context."

He leaned back in his chair, and that was when I knew I had the job.

Fast forward almost twenty five years, and I am thinking about that conversation.

Today, I was faced with three different interpretations of the same data from three people I respect and admire. I had my stitches removed today and I had a PT appointment. I talked to Dr. Tex, Evan my physical therapist and Claire, Dr. Tex's physician assistant. In addition to my medical team, I am also getting insights and information from friends who have gone through an ACL repair. I talked to Kim yesterday whose had two ACL repairs, and Jack has a colleague who had his ACL repaired a few years ago. I have another friend who had her ACL repaired a week before me.

At my appointments, we discussed unlocking the brace so I can walk with a bended knee. We also talked about taking the brace off to sleep. All three people on my medical team agree with the milestone based approach, or as Dr. Tex says, "Earning my way out of the brace." If I can do certain number of exercises, then I can sleep without it, unlock the straight leg, and then get rid of it completely.

Where they disagree (and they do) is on which milestones I should meet for each reward, i.e., sleeping without the brace or unlocking the brace. I could be frustrated with the different opinions. I could say they are using a protocol based approach, so what is up with all of the differences of opinions? How can there be differences of opinions when there is a protocol? I can see that Jack's friends and my friends might all get different treatments because we are different inputs into the protocol machine.

Instead, I have faith and patience. I know that data tells us more about what we don't know than what we do know. We know that protocol A might be less effective than protocol B, but that doesn't mean the protocol B is the best protocol ever. And every few months, there are new studies showing this exercise is somewhat more effective than another. But overall, I know they are steering the ship is heading in the right direction. I know even if they disagree, the data and research shows that physical therapy and wearing a brace is significantly better than not doing physical therapy and not wearing a brace.


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