Latest / The STA Clinician Podcast / Ep256: 'How To Read A Research Paper' with special guest Ben Cormack

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Ep256: 'How To Read A Research Paper' with special guest Ben Cormack · The STA Clinician Podcast

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You're listening to the Sports Therapy Association podcast, putting evidence
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back into soft tissue therapy.
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Music.
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Hey people, how are you doing? Welcome to episode 256.
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That's 256 weeks since COVID. we were
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allowed out of our cages and back to practice the
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non-allied health professionals so yeah 250 weeks 56
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weeks and that's where we are sports therapy association podcast sorry a
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bit too much reflection there in the first 30 seconds but my name
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is matt phillips creative runchecklife.com and as always this episode
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is being recorded live on the sports therapy association
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youtube channel and on facebook on a tuesday night
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at 8 p.m so if you listen to the podcast and first of
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all thank you but secondly i'd really encourage you to
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come along if you can if that's in your time zone and you can
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make some time there come along and share some time with the other people
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who join us live you can ask questions directly to the guest and you
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know what after a wonderful conference we've just had you really do take a lot
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more in by joining stuff live because you can address questions and concerns
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there on the spot you'll reflect more whilst you're listening to it and you'll
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wake up the next day with more in your brain it's just it's it's fact it's science
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and but obviously if you can't then i appreciate you listen to the podcast.
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So as I just kind of mentioned, last weekend was indeed the STA Southwestern
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Housing Hub Conference in Exmouth in collaboration with the ST School.
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It was an amazing weekend. Obviously, I'm biased, but it was a lovely weekend.
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Of networking, of workshops, great information.
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I mean, the takeaway for most people was, yes, of course, there was great information.
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We had amazing speakers like Dr. Claire Minchell, Serena Williams,
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we had Andy Hosgood, we had James Ells, huge amounts of speakers there.
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But it's not just the information.
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If it was only about the information, then download a PDF or watch a video.
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It wasn't about that, just that at all. What you pay for a conference,
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this is going to be a common theme on the podcast, is you go there to be given
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this information in such a way that's meaningful, where you're going to give time to reflect,
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to network, to talk to friends. So when you do go back to clinic, it's actually there.
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We spent the last hour or so formulating plans of how to turn all this wonderful
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information to reality.
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So it really was as we planned. And I've got to give thanks to Andy Hosgood
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as well, just for helping me along with that.
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It was lovely. It was really cool. And it's given us loads of ideas for the
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future. So if you did miss out on it, don't worry.
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Well, our aim is to take it around the country like Noel Edmonds and the multicolored
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swap shop for those of you who are old enough. I know Ben is.
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And that's our plan because it worked and we are
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working on a follow-up version so stay
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tuned and we're going to do a reflection episode next
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tuesday september the 30th so if you want to join us
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live for that especially if you went to conference and do come along and we'll
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let you know what worked what maybe didn't work so well that won't be very long
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and yeah we'll have a great time it's gonna be me anna maria maccieri gary benson
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founder of the st of the sta and also andy hosker's coming along as well now
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one of the themes of the conference was supporting soft tissue therapists and
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becoming more evidence-informed, as always.
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So an aspect of that is obviously keeping up with the latest research and.
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That's what made me think about this episode tonight. How easy is it to do that?
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How easy to understand a research paper, to be able to judge its quality,
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reliability, its significance in what we are going to do Monday morning in the clinic.
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So therefore, it gives me great pleasure to introduce, to hope that some of
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you don't know him, otherwise this is all a waste of time.
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If you don't know him, I'm jealous because he's a wealth of information who's guided me.
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I've stood on his shoulders more than one time back in the good old days around
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2013 because he was saying stuff before.
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Lots of people around these days are saying it.
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And yeah, a great thinker, great educator in the industry. And that's Ben Cormack,
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founder of Core Kinetic.
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First time I've said it correctly. And co-founder of the Better Clinician Project.
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Ben's a musculoskeletal therapist with a clinical background,
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qualification in sports therapy, rehabilitation, exercise, stretching back,
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like I say, over 20 years with a special interest in pain and its relation to movement.
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His Core Kinetic courses have run in over 25 countries globally,
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working with individual healthcare professionals, health services,
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hospitals, elite sports teams and pain services and organisations.
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So very excited to have him here tonight. If you have joined us live and then
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do feel free to ask questions and leave comments in the section.
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Let me just have a quick check before I do bring them up. For example,
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Cecily Hislop says, listening whilst hanging the washing out. That's how I roll.
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Multitasking, Cecily. Very good. I like it. And do feel free to ask questions.
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It's a wonderful opportunity, people, if you've joined us live.
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Right then, I've left down there for long enough so let's bring
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up man of the hour how to read a research paper episode
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256 of the sports therapy association video podcast with
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special guest ben cormack of call kinetic and the
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better clinician project you're listening.
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Music.
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To the sports therapy association podcast putting
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evidence back to soft tissue therapy hey
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ben how are you very well
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mate how are you look so relaxed now
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look like i've got a worry in the world you're brilliant i
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like that too many worries i've got too many worries for them to be on my place
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there i like the plant in the background as well it's very relaxing i think
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that's what it's all about so good to see you man like i said we haven't met
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up in person for years but do you look back at like 2010 with fond memories
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was life simpler back then do you think,
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Well, I don't know if it was simpler. Four kids? Less kids?
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Six kids now, but no. No. Yes, of course.
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I remember you coming up to Canary Wharf and helping me out one time,
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and that must have been a good 12. Over a decade, yeah.
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Yeah, over a decade. How did that happen? So, good times.
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It's always good to look back and think about the journey and
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reminisce on how that's been isn't it so yeah my pleasure to be to be here with
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you sir i do wonder and this is just information coming into my head from listening
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to you is it difficult for i'm not gonna say old timers that makes you sound
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old but you were coming up with some you were talking about biopsychosocial before.
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Biopsychosocial was even a thing on social media you were
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talking about neuromatrix you were talking about
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smudging you were talking about everything before and now it's like people
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jumping on the soapboxes going oh don't you know it's this and you're
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thinking yeah i vote about that about 12 13 years ago
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do you let it go off your shoulders or is
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it frustrating of course i mean look in the
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same way that the people that were talking about it 10 years
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before and years before that and so you
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know i think there's a saying isn't there some everything that's
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been said has been said before by someone smarter long
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ago so you know that's it's the circle
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of life matt this is you see so
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humble people this is what i just wanted you to realize um what a great way
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to be educated by someone who's so humble anyway so yeah thank you very much
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for joining us really appreciate it so we're talking about research papers do
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you remember again just drawing on your experiences when you're a younger therapist
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do you remember kind of thinking a bit daunting looking at research paper thinking,
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oh my God, how am I going to make head or tail of this? Or maybe is it sometimes still daunting?
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Yeah, well, if I'm being honest, I find it more boring because,
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you know, not in a horrible way, but in the sense that, you know,
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you maybe I don't read as much that is exciting.
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You know, I think when you first start reading a lot of research and you're
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picking up on new themes and these type of things, you know,
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there's some things that again change. You know, you talk about things like,
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you know, the whole kind of Melzap's neuromatrix theory.
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And I think there was early work by Lorimer coming out. And,
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you know, and it was all very fresh and it was all very new.
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And I maybe feel that, you know, as you read more papers and,
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you know, it might be there's less that is groundbreaking for you potentially.
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But, you know, certainly the papers are a challenge to read.
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It could be really, really boring. they could be really
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really badly written some are some are
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topped in a funny you know like the formatting can
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be you know not conducive to a good read you
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know and are just overly complex so yeah
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so I think it can be daunting in different ways for
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me maybe potentially it's exciting and
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I think that you know if you're getting into reading more evidence
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then that's a really exciting time and you should feel excited
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about that that's good yeah it does and i
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think with like you mentioned there's some like great papers which you
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know are good quality even papers that might
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not hold as much truth as they did but back in the day when
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they were using the information they had they were great and it kind of really
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opens my eyes i think a lot of people's eyes to things like about i don't know
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symmetry for example and asymmetry and the links with pain all the classic kind
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of papers so i think once people do i think once people do kind of take that
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challenge and get to not be fearful of a few papers,
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then it kind of makes you think, okay, I might look at a couple more now.
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But then comes the problem of telling the difference between a poor quality
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research paper, which there's a few out there, and good quality,
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which is where you're going to come today, yeah?
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You're going to help us understand where the limitations might be,
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where maybe the biases might be.
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Is that something which you can do for us?
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I can go, let's see what happens.
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I don't think, I think it's a question I get asked quite a lot,
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like what is a bad research paper?
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And I don't know if there's a really binary answer to that, if that makes sense.
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I think it's probably an explanation of a few different factors.
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So we can kind of chat about that, I think.
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I do like that. I'll just let people know tonight, a lot of Ben's answers will be,
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i don't think it's a binary answer because that's we're talking
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about health care so it's not a case of it depends but
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it does and i love that because your posts on instagram and everything there's always
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that non-certainty you you're you use the
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language like i like to use it where you never totally commit because we don't
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know you know and that's such a healthy way to therapist to have i think take
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away the definites yeah i always say when i teach whatever you expect to have
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probably won't you know when you when you think you've nailed it when you think
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you know what it is when you think you're going to get a certain result,
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something completely off the wall happens.
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But I have a little saying that pain is predictably unpredictable.
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And that's the way that I see it. That's quite liberating though,
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isn't it, for a therapist when they realize that it isn't black and white and
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you could well be wrong and things won't turn out rather than just being these
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fixers and kind of directors. It's much more chilled out than that maybe.
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It makes you a bit more relaxing or not. I think it depends on who people are.
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I think some people like the world in a very, you know, black and white boxes type of way.
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And some other people thrive in the messy and the chaos and,
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you know, sorting through the bits and the pieces.
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And, you know, again, I think it comes back to that diversity of human beings,
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doesn't it? That spectrum of tolerance of uncertainty.
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Love it. Okay. Well, look, let's get into the nitty gritty of it.
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Maybe I want, we're going to remember that if you're listening live and do feel
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free to chuck questions in and the comments and stuff, but I'm thinking of a
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lot of people who download this later on.
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Let's imagine that they've got, let's imagine they've never seen a paper before,
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but they've reached that stage where they've got the confidence now to go,
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you know what? I understand. I've got to be a bit more evidence-based.
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I'm ready now. I'm not scared about tweaking it. I don't care if I've got to
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tell my clients that things are a bit different. Let's have a look at this paper.
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Can you take us through it and what they're going to see and where they should give attention?
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Well, I think the first thing is what type of paper is it?
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You know, is it a randomized controlled trial?
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Is it something where they're, you know, controlling a lot of variables and
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they're randomizing, you know, these type of things, which is designed to show
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a bit more of a causal relationship?
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Is it observational? Are we just watching what happens to a group over a period
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of time or at one point in time?
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So we could have longitudinal data or you have like cross-sectional,
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which is just a singular point in time. Or is it something narrative?
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Is it just someone saying, I want to write a subject and, you know,
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I'm going to get into the science and this type of thing.
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So I think the first thing is what type of paper is it? you know and then I
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think you can go from there to say what does it tell me.
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I like it. Okay. So pick one if you like. Let's go where someone might be looking for the evidence.
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I mean, we're talking about soft tissue therapy, massage therapists,
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but manual therapy, which is always full of claims and the need to move on.
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So what type of papers should people be looking for in that case?
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Well, I suppose, you know, the classic would be randomized controlled trial.
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So the point of the randomized controlled trial is to compare different groups.
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So what you'll do, you're going to take an intervention group,
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you're going to take, you know, potentially two kind of groups.
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So one may be the intervention you like, one might be a comparator.
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And then if it's a really well done trial, we might get a control group as well.
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So, you know, the point of an RCT is, I suppose, two or three things.
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So first one would be that you are trying to find some form of all's-all relationship,
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you know, where you can actually say we've controlled the variables and to kind
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of, you know, say that rather than an observational trial, an observational
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piece of research where you have lots of confounding variables.
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Then the other point of an RCT is to reduce bias.
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So the point of an RCT really is
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to reduce bias and you do that by randomization and
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you do that by binding as well and those are
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the two real key tools i think that you'd
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be kind of looking for to say you know this is
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an rct that's done reasonably well that
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they are you know making sure they are offering spaces
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to reduce bias but one of the big things about rcts is you know essentially
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reduce bias and then find a relationship that we could say is reasonably direct
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and causal because we know that we've controlled the variables,
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as I said, the optional stuff.
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So many different confounders, it's quite hard to make a causal kind of inference on that type of thing.
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So your RCT would be kind of that classic one.
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So let's go, what you might find is you could look at, you know,
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there was a recent RCT interspinal, was it a systematic review? I can't remember.
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But a systematic review would often be a bunch of papers all on the same topic.
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So what you're doing is you're getting a bunch of papers all together and you
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are kind of making sure they're similar and then doing that and you kind of
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make sure that you can then compare and contrast the finding of these papers.
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All right. So I see someone's come in there straight away and come into the
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technicalities of the, uh, Oh really? My gosh, Tim. Okay. He's.
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That's going to be a slightly different question so
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p-value is a slightly different thing
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that you know is trying to find kind of
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is you know what's the judgment of the difference between um
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whether that's statistical and then if it's big
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enough is it we'll put a pin in that one minute then maybe that'll come later
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on when we look at the results and that's there's one thing i just wanted
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to say ben because there's one thing i wanted to say thanks tim we
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will come back to that but ben i wanted to kind of point out because i
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think it's useful for everyone to realize this
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is essentially what science is supposed to be and people go oh i
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don't trust science not everybody but a lot of people going oh science isn't everything
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science doesn't know everything and i think it was dara
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brian who said yeah science doesn't know everything that's why
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it exists because the idea of science is
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make a hypothesis and then try and
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prove it wrong and that's the whole idea of a
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paper really a quality research paper so have a hypothesis and
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they do everything they can to see if that's not true
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that's the idea isn't it well and that's
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the point of whether a
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trial is well done yeah because if you do a trial it's off some of the bits
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then actually you're not doing it as well as you could do and you introduce
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things like bias right so you know i think that's the important part well done
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science is about you know trying to do what you just said,
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but there is also a very famous quote that says.
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People use statistics like a drunk man uses Olympos.
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It's very good to support the illumination. And I think that's the great example.
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So this is why we need replication. So I see a lot of the pain in the great example of that.
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When the original research came out, they were talking about some really great
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numbers and, you know, some really kind of big clinical effects and numbers
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needed to treat that were pretty good.
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And then actually when it replicated by people who were not involved in the
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treatment or the system as a kind of business, we saw big results.
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So replication, I think, is often where science becomes very,
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very unbiased, you know, unless you're trying to prove nothing wrong.
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But I think that's the point of replication sometimes, is it,
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you know, maybe allows it to take one step away from people who really want to prove it.
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And hopefully they don't want to disprove it.
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But that element of equipoise and, you know, what humans love to do is always here.
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So the design of the RCT is trying to say humans are biased.
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We love to have a hypothesis and a good paper should report the hypothesis.
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So there's something called the consult guidelines, which means what it really
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is, is a template for writing up a randomized trial.
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Within that, at the bottom of the introduction, it should be,
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what is your hypothesis?
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So rather than actually saying, rather than being a bit woolly about it,
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a good paper should study what the research question is and what their emphasis
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on that question is as well.
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And in that way, you get a sense of what is there by a straightaway.
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So I really like that kind of thing. So what is the research question?
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You know, we're going to compare spinal manipulative therapy against exercise,
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against a control group. We believe that spinal manipulative therapy will be superior.
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That would be the kind of thing. And then you go, okay, I understand where they're.
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But it means they're open and honest about their bias, rather than sometimes
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people don't report it and you don't really know what they think is going to happen or what have you.
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So I think that's an important thing within an RCPT right now.
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Is that a bit of a red flag then?
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They might have just forgotten, and it's annoying that it gets through because
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it's supposed to be peer-reviewed and people are supposed to say,
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yeah, it's ready now for publication.
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But if they miss it out, it's that straightaway thinking, hmm,
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why do they miss that out then?
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Well, I suppose, you know, it depends on the age of the paper.
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So a lot of older papers might not conform to those guidelines,
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whereas a newer paper probably would.
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Certainly, you know, peer-review varies. I peer-review papers.
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And, you know, some people might say that's a very variable thing as well.
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So you know so i think
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that it depends on what journal it's published in what kind of
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these type of things as well um but a good paper should say what are they trying
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to find out you know what is the actual question that they're trying to answer
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and then what is their hypothesis on what they think is going to happen and
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i think even though there's bias within that there's clarity in that bias.
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It's honest bias, isn't it?
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You know, and I don't mind that. You see people, you know, maybe not being as
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transparent with some of the things that could be reported that, you know,
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then maybe it's a little bit sketchy.
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But I don't like to ever think people are being nefarious and whatever.
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So sometimes things are written better. Sometimes things are written by people
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who are English isn't their first language.
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You know, if I had to write, if I was acting something, I might not do a great job, you know.
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So I think I like to give the benefit of the doubt, but with anything, there is variation.
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And hence why you do have reporting guidelines, because it does help to have
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a checklist to say this tick, tick, tick, tick.
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And you are, the one who here reviews that should go tick, tick, tick, tick.
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That's great. No, I don't want to interrupt your frame of thought now.
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You go for it. Keep going. So that was the title.
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And then also, yeah, down the bottom, you say it might even say something about
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the hypothesis. That's great.
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Let's do it more systematically then. So firstly, you like to look at a paper
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and you need to say, what type of paper is it? What is the actual type?
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As we said, it could be a trial. It could be observational. It could be a systematic
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review. could be a narrative review, blah, blah, blah.
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And we're going to look at the introduction. The introduction tells me why are they doing this?
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Really, really simply, the whole point of introduction is to say,
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what is the point of this?
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Where is the gap in the market? You know, that's a good reason to do something
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because there is a question that hasn't been answered.
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So the gap in the market and, you know, every lower back pain paper starts off
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the same way. It says lower back pain is the biggest problem in the world.
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Eight percent of people suffer from it in their life.
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Right. So we'll go past that. But it could also be a minefield of good information
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to educate patients with because it gives us epidemiology.
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It gives us prevalence. It gives us age ranges. And that's really good,
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you know, identifying a problem and also educating about that problem as well.
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So actually, the introduction is quite narrative.
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All should have some good stuff in there that helps us as well.
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But at the bottom of that introduction, we are going to get what is the study
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question, hopefully what is the hypothesis as well, if it's an RCT and it's
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within the consult guidelines as well.
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That's good. So don't skip the introduction then. Have a little look. Well, people do those.
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So, you know, so if you, if any piece of research is only as good as the methods that are used.
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So a really good example, there's a question about a p-value, right?
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And so a p-value is about, you know, is it hypothesis or the null hypothesis,
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right? And so how likely is that to be the case?
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And there's so many different interpretations of what a P value actually means,
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right? And I don't even want to go there because it might get hurt.
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But the guy to read is a guy called Sander Greenland. And he goes a lot into
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the kind of philosophy of statistics and frequentism.
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And, you know, it goes back to, you know, Fisher and Nyman and all these guys.
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And they're called frequent statisticians. We also have what's called Bayesian
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statistics, which is a bit more probability-based rather than a p-value,
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which is a kind of a cutoff.
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But a p-value doesn't mean anything if the experiment is rubbish.
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So statistics matter if the experiment is not done well.
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Because what's the point of having statistics or a p-value or an MCID if you
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want to get a little bit of a bigger effect size?
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There is no point if the methods are not
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done very well so for
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me the methods is probably the most important part of
24:37
reading a paper and you want to know you know
24:40
who they who are they researching so if you had some if let's say you were looking
24:45
at a potential tendinopathy and the age range was 15 60 sedentary people what
24:53
wouldn't be relevant because we know the age range of teletendinopathy, 18 to 35,
24:59
people who jump and do active stuff.
25:02
You know, that's why it's called jumpers need, right? So we know the age range it is.
25:07
We know that there are certain things that you have to do to identify that as a specific pathology.
25:14
So you want to know, is it the right group of people?
25:19
Am I identifying it in the right way?
25:22
So you know and that's the challenges of say
25:25
subacromial pain or non-specific lower back pain
25:28
because people then turn around and say well how do we know who we were studying
25:32
because the tests are so rubbish and vague right so so the group is not as specific
25:38
as we would like you know and that by definition is reductionist isn't it because
25:44
it has to be to control all of those variables,
25:48
you are, you know, controlling things.
25:50
You are reducing the article that you are looking at. And that's the point, isn't it?
25:56
So, you know, what you'd want to see in the methods are, is it like people have,
26:01
are they testing the problem in the right way?
26:04
Where are they recruiting them from?
26:07
You know, again, things like how are they blinding? So, you know,
26:11
people talk a lot about things like double blind and you must have heard that kind of terminology.
26:16
But actually you don't need to double blind
26:19
if you look at reporting only the outcome
26:22
assessor actually needs to be blind blind it
26:25
you know the participants don't need to be blinded per se and the interventionist
26:29
doesn't particularly need to be blind but the people that are viewing the uh
26:34
the outcome they do need to be blind they need to be separate from the experiment
26:39
and that's one of the big problem with, you know, physical therapy, if you like,
26:44
because if I have someone receiving exercise and manual therapy,
26:47
well, it's very difficult to find that.
26:50
Yeah, tricky. It's almost impossible to blind that, you know.
26:54
If I give you a pill, you know, a sugar pill and, for sake of argument, topical one, Tylenol.
27:02
Oh, well, they can't get that anymore, apparently. It causes autism, didn't you hear?
27:06
Let's not go down that road. Let's not go down that road. That would be mega
27:09
embarrassing if we started talking about that.
27:11
That's easy, isn't it? Because I can have two pills that look very similar and
27:16
you don't need to know which one you're getting.
27:19
And it's one of the reasons why when we talk about having a sham for exercise,
27:24
that's really difficult.
27:25
Because, you know, we kind of, how do you sham exercise? How do you pretend to exercise?
27:31
You know, so what they end up doing is they end up like exercising your arm
27:35
instead of your leg or something like that.
27:37
You know so you know exercise you don't sham
27:40
the exercise you kind of exercise a different body part but then you'll have
27:43
systemic effects which is problematic anyway but it's about the methods is about
27:49
how did you do the experiment so who is it what am i trying to identify how
27:54
did i go about you know setting up the experiment in terms of blinding and.
28:00
And randomization and then also the interventions as
28:04
well so if you are doing manual therapy versus
28:07
exercise which exercise how did you
28:10
standardize the application of that right so
28:13
it's just going into all of those things and ticking all
28:16
of those boxes and then you know like look things like have you pre-specified
28:21
the size of click that you think you're gonna get have you have you kind of
28:26
done a sample size calculation so did you just guess how many people you wanted
28:30
or did you actually calculate how many people you wanted,
28:34
including how many people might drop out, et cetera, right?
28:38
Because if you need, if your power calculations is that you need 50 people per
28:42
group, then you need 50 people, but 20 in each group to the power.
28:46
Actually, you've only got 30 in each group. So the statistics and the P value
28:51
are going to be solid as if you were able to have, you know, what you pre-specify.
28:58
And there's also you know people talk about registration
29:01
where actually what you're meant to do is put
29:04
all of this stuff as a pre-registered thing
29:07
so that people can go back and say you actually
29:10
did it before the experiment not after the
29:13
experiment yeah you know you're not trying to mess about.
29:16
And change things and you know actually you did
29:19
or specified can you go so could
29:22
you go a little bit into sample size because i know it's tempting i
29:25
think for people to think for example they look through and i
29:28
do it if i'm kind of doing a presentation or workshop and i'm
29:31
giving a study and it's like sample size 30 runners and
29:34
inside i kind of feel my heart drop a little bit thinking are they going
29:37
to say only 30 people but it's not a case that sample
29:40
size has to be big for it to be valid because some it's
29:42
all to do with the size effect isn't it and and what you're looking at
29:45
well that's the point of the power calculation yeah
29:48
the power calculation is what a series of checks isn't
29:51
it where they look at all these individual kind of criteria to see
29:54
what size effect you've got what sample size you need to be
29:57
relevant to that sort of stuff yeah because a lot of people won't know what that is
30:00
what you want to i'm just going
30:02
to point out i am not a statistician and oh you know more
30:05
than us joined together so just keep going so i think there's a big difference
30:10
between you know being capable of reading a research paper you know quite slowly
30:18
and methodically and then actually being super hot on the stats quite often
30:23
that i They will, you know,
30:25
I've built up a few connections in my years in this game.
30:28
And then there's, you know, a few people that I trust that are pretty special around this stuff.
30:32
So if I have any issues, then I will just, you know, write off and say,
30:37
you know, what do you think about this, et cetera.
30:40
Palculation is telling us you pre-specify what you're looking for.
30:45
So what is your P-value you're looking for?
30:47
You know, the type of things. We're going to type it in and it's going to spit
30:51
out and say, to find that size of effect, you know, you're going to be different with people.
30:58
So a power calculation, you know, is going to give you the kind of – and remember
31:03
that a sample size can be big as well.
31:06
Tell me about that. Okay. So if your sample size is really big,
31:12
it actually can give false positives, if I remember.
31:15
So it will actually find, you know, the calculations can find some answers within the – you know.
31:21
And again, if you wanted to talk about peak value, then you should probably
31:25
get a statistician in. There's a difference between reading a paper and doing
31:30
the stats of a paper. I think that's really important.
31:33
You know, checking methodology, checking are they looking at the right clinical
31:38
groups, have they gone through certain things is very different to the intimacies of the stats.
31:43
And I'm, you know, very pseudo stats, if I'm being really honest.
31:48
But a sample calculation at least tells us that it's not just random.
31:55
This has been and you can get a sample
31:58
size like and on on the internet there are
32:01
websites that will give you a calculation so if you
32:04
typed in sample size calculator into google it will
32:07
give you a calculator to ask you what's the
32:09
size of the effect you're looking for what's your p-value and
32:13
then it will spit you out you know a number to that
32:16
but you know so a calculation at
32:19
least shows they've done that and that would be
32:22
a big thing that i would be looking for so but what
32:25
you've got to remember is different types of research is going
32:29
to have different sample sizes if you're doing the fmri research
32:33
it's deeply expensive deeply time consuming you are not going to get 100 people
32:39
in your sample it's just not going to work but i think they talk about really
32:44
what what i think we mostly see let's say we have two or three groups generally
32:49
it will be somewhere between 30 to 50 in a group.
32:52
You generally won't get many more than that, if I'm being honest.
32:55
And that would be with a sample size calculation.
32:58
And that's the first critical thinking ever.
33:01
Al, the sample was small. Well, what is a big enough sample size?
33:06
Again, that is dependent on the type of calculation.
33:09
You see, it's not a generic answer. Oh, you need 3,000 people per group.
33:15
It doesn't work like that. Yeah.
33:18
But I think it is important to report a sample size calculation because otherwise,
33:24
what are they aiming for?
33:25
You know, I think that is something that you need to look at.
33:29
At least they have done it.
33:31
You know, you might not understand it, but they have done it and reported it.
33:34
That's great. And that would be in the methodology, yeah? It would be mentioned
33:37
there? Yeah, yeah, yeah.
33:39
Yeah, it's going to be in the methodology, yeah. Perfect.
33:43
Methodology, method section is usually the biggest.
33:46
That should usually take up the most, especially a randomized controlled trial
33:51
because that's the meat in the two-bed child that I hate for instance.
33:56
You know i like yeah i think it's useful as well for i mean i was very lucky because i was.
34:06
My education twitter actually helped my
34:09
education probably with you as well back in the good old days where you could ask a
34:12
question you wouldn't be jumped on or cancelled or anything and there was some really
34:15
useful conversations which happened it was lovely you know
34:18
it's great nowadays social media we've done an episode about this
34:21
it's probably the last place you want to ask a question anyway because it's just
34:24
people just jump in even good meaning people we've forgotten we've
34:27
forgotten the way just to be nice to each other
34:30
i was thinking i mean it's just because you're on the show and we go
34:33
back a few years but you remember when like on twitter there used
34:36
to be like weekly kind of we used
34:39
to kind of do like follow friday follow friday these days it's like hang friday
34:46
there's a list of people who to cancel it's like what happened to just recommending
34:49
people and sharing stuff and just records yeah i think there i i you know was
34:55
obviously destroyed by, you know,
34:57
the platform itself.
35:00
But then I also think some of the characters we did became very prevalent and toxic.
35:06
And they just weren't around when that was the good, you know,
35:09
the 2010, probably to around, you know, 2015 maybe, where people on a Friday
35:15
used to say, these are great guys, go and follow them.
35:18
And you could put up a blog and people would share them.
35:21
You know, it became a little bit, yeah, not not not my cup of tea not my cup
35:26
of char that's a shame but i mean if you're in a group.
35:30
I mean i'm obviously i'm biased but stf weekly chats
35:33
but if you're if you're any group association where you know no one's there to
35:36
make a point or to make you feel bad or to kind of judge you so
35:39
i think it's really useful if you are going through a research paper with the
35:42
knowledge you're getting from ben now just to have the confidence to
35:45
type or say if it's a zoom call just i'm
35:48
a bit they haven't got a power calculation going
35:51
on here is that something which we should kind of raise or talk about just
35:54
if that's what you're thinking or that or the sample size here is that
35:57
correct because that's how you learn isn't it you've got to ask questions when you
36:01
say things like does is it a good paper or is it a bad paper you know i i would
36:07
say if it doesn't have something like that in it i probably would trust it a
36:12
bit less it's fair enough unless
36:14
it's an old paper when not everything is reported as well as it is now.
36:21
But certainly, you would expect to see that in there.
36:24
And I do a research review most weeks, whether that's for the Better Clinician
36:29
Project, for my own stuff, or for Physio Network or something like that.
36:33
And these are just my mental checklists that I'm going to go down.
36:37
And if they're not there, I'm a bit like, you know how they get these numbers
36:42
that makes me trust it a little bit less that's great exactly what we wanted
36:47
what we wanted to hear that's great okay so methodology and then i guess we
36:51
get to probably the most complicated part of the paper the results yeah.
36:56
Yeah, so results are actually some of the things that I like the best because
37:03
what you've got to remember about results, they have a commentary.
37:07
It is just raw data. Well, it's not raw data, you know, you can still mess about
37:11
with it, but it's just the numbers reported.
37:14
So, you know, what you'd want to do is you'd want to go and see,
37:17
if it's an RCT and you are comparing two groups, are they reporting the between-group exercise, right?
37:25
So what you want to see is what is the whole point of an RCT is comparison.
37:31
So one of the big things we talk about is does it tell you about your patient?
37:37
Does a paper tell you about your patient?
37:39
Not individually because you
37:41
cannot compare individual against individual against individual against.
37:46
It's an impossibility. So that's why you have an average of two groups.
37:51
So you have an average for each group and then you compare those two averages.
37:55
And that's the only, it does a brilliant thing imperfectly, if that makes sense.
38:01
Because it gives us population level information and we're looking for individual
38:06
level information about our paper, really. But we can't get that. That's impossible.
38:11
So the next best thing is who has done an experiment on this and looked at this
38:16
population data. And so it is imperfect.
38:20
But the whole point here is that we're going to take two groups and we are going
38:23
to look at the difference of those numbers between two groups.
38:28
And you could report that as a statistical significant difference,
38:32
which would be your p-value. You know, is it 0.06?
38:36
Is it 0.04?
38:38
You know, actually, if you think about that, that dichotomous p0.05,
38:44
how much difference is there between 0.06 and 0.04?
38:48
Well, not a lot. You know, that's why we look at that and think,
38:51
you know, some like a Bayesian statistic, statistical kind of person would look
38:57
at that and say, you know, it's dichotomous, isn't it?
38:59
It's this kind of, you know, why is this been stuck here?
39:03
Whereas someone, you know, a Bayesian approach might be a bit more,
39:07
is there that much difference between 0.6 and 0.4?
39:11
But that's where you're going to see those in the result. You're going to see
39:14
the actual real number, hopefully, or you might see what's called a calculated effect size.
39:21
And a calculated effect size is when they look at things like Cohen.
39:24
You must have seen Cohen's, Cohen's D.
39:28
And you might see 0.2 or 0.5 or 0.8.
39:32
And that's what you call a calculated effect size where they,
39:35
you know, play with the numbers a little versus an effect size that might be, you know, on a VAS of 1.4.
39:43
That would be the real number not a
39:46
calculated effect size you know and
39:49
that's what you're looking for are they reporting you know
39:52
if you know if you're highest and you
39:55
wanted your intervention to show something positive you
39:59
might show what's called the within group change so
40:03
we know that all groups will change over time you
40:06
know we could call that natural history or you know regression to
40:09
the mean or whatever and one is
40:12
more the the nature of the problem one is
40:15
more repeated measurement and so what you'll
40:18
see with any group generally is change the time and
40:22
but if both groups change over time the
40:25
same there's no between group difference
40:28
you might report the within
40:32
group not the between group you know
40:35
so again the result allowed to look at that
40:38
raw data and if someone said there's a
40:40
difference we could go to the results and say how big
40:43
is it and that's the famous oh no gene glass
40:46
quote and i think he says and it's you got me here really late my bedtime was
40:52
about an hour ago sorry i'm an old boy aren't i you forget this i've got gray.
40:57
In my beard big boy so jim glass says it's not is there a difference It's the.
41:02
Size of the difference that's important.
41:05
And this is an example of where size matters, Matt.
41:09
Whatever your wife may tell you, this is where size matters.
41:14
Ben Cormack, ladies and gentlemen.
41:16
Yes. You know what you were getting, buddy. But it's cool because people who
41:21
are kind of thinking, oh, there's a lot of acronyms here and Cohen's D and all that.
41:25
Just look it up. This is where Google can be your friend. It's like,
41:28
if you go to Cohen's D, then it'll tell you like 0.5 is a medium effect,
41:31
0.8 is, you know, and then 0. And it's, you can look these things up.
41:35
They've always got complicated things with Greek symbols, because that's just
41:38
the way the language is used.
41:39
But the significance of them is fairly easy to, to look up and suss out and
41:43
write down a bit of paper.
41:44
So don't be put off by the acronyms and the different methods they're using.
41:47
So, sorry, I just wanted to say that.
41:50
Yeah, of course. And again, it's like reading a paper.
41:53
If you find a word or something, you don't recognize
41:56
well you know some people throw
41:59
their toys out of the pram i'm stupid they're you
42:02
know and other people might do well let's just google it
42:05
and you know or or you know
42:08
and and it's just about slowly edging forward
42:11
isn't it and building your knowledge and the problem
42:14
is people want knowledge given to them in the sense of
42:17
day one here's all the knowledge download it you know
42:20
like a flash drive and unfortunately knowledge is something that's
42:23
built over a lifetime time isn't it you know
42:26
and whether that's pathology
42:29
whether it's assessment or it's research whether it's
42:32
exercise prescription whether it's techniques you know
42:36
all of it is just a you know a life
42:39
but we'll be bought if you had everything at the fingertips i
42:42
think well that's what this current generation is discussing and finding
42:45
out and look at the problems they've got yeah we
42:49
won't go down that road it's true discussion but your result
42:52
yeah but your discussion is opinion isn't it it's like
42:54
yeah that all depends isn't it on the methodology and
42:57
introduction everything and the biases because otherwise yeah what
43:01
they say in the discussion is what they're trying to do they're trying to do
43:04
two things so they're trying to say why they think they saw the results and
43:10
then the other thing that they often do is compare and contrast to other research
43:14
that's So it got similar results to UKEO 2017.
43:21
Why did we get similar results? If it's a contrast, why do we see a contrast?
43:27
So it's trying to explain what we see and what else has been done in the field
43:33
that might be similar as well.
43:35
You know but essentially it's an opinion piece isn't
43:37
it and you may look at a piece of research and say
43:41
i don't actually agree with much in the discussion if i
43:44
look at the methodology and i look at the
43:47
results how much do i actually agree with
43:50
their discussion and i think that's you know uh yeah but that's the point of
43:54
the discussion it's you know it's not meant to be factual well it is you know
43:58
it is factual but not meant to be just raw data it is meant to be a bit of an
44:04
opinion on what we saw and how that may compare and contrast to some other stuff as well.
44:10
Of stuff this is cool i'm hoping people are benefiting from this there's a little
44:15
bit of jargon in there but really it's just a nice methodological it's challenging
44:19
that word isn't it methodological methodological methodological easy for you
44:25
to say and yeah you just work your way through it it's like you say learning
44:27
it bit by bit but it's interesting how those early,
44:31
kind of foundational things are important if you
44:34
to be able to interpret have a look at the discussion everything otherwise
44:37
it's just all falls out so so for
44:40
me both of my degrees i did some form of
44:43
research in them right but doing
44:47
research i think is different as to being a
44:49
clinician interpreting research i think they're two different skills so i think
44:55
that reading a paper from it from being a clinician didn't so much about the
45:00
stats and knowing you know t tests and whatever else is going on within that,
45:08
linear regressions, et cetera, right?
45:11
What it's really understanding is what are the basics of these sections.
45:16
That effort is really key. What are the basics that I'm seeing?
45:20
And I think sometimes people want to understand too much too quickly.
45:24
It's not like reading a book. It's not a novel. I wouldn't sit in the bath and
45:29
read this. You know, it's a grind.
45:31
You have that, haven't you? But you have, though, Ben, haven't you?
45:37
But it is a grind. It's not meant to be Jackie, you know, the one who wrote
45:43
all the soft pawns. Collins?
45:47
Jackie Collins. There you go. Careful, mate, because that's careful,
45:50
because that's actually my cousin. So just leave it there, mate.
45:52
That's actually, yeah, related there.
45:54
Yeah. I wanted to... You know what I mean? It's not meant to be that.
45:58
It's not meant to be that type of throwaway literature that you read chilled out.
46:05
It is meant to be a little analytical and difficult to read.
46:10
Something that I like to see...
46:13
And maybe they're just putting it in there to make me feel comfortable with them and like them.
46:17
But I'd love to see limitations. I like it when an author will automatically
46:19
kind of mention at the bottom, hold on.
46:22
Yeah, we're excited by this, but let's have a look at what could be the limitations
46:25
of what we've found. So that's maybe a good sign if they mention limitations
46:28
or strengthen limitations.
46:30
Well, let's say that dropouts is a great example.
46:34
So let's say they had a huge amount of dropouts and they didn't mention that in the limitations.
46:40
You know, that would be a limitation, wouldn't it?
46:43
Right? So, yes, you'd look at it and they might say, well, we had problems recruiting
46:48
or we had people drop out or, you know, one of the tests that we use aren't
46:54
as accurate as we would like or, you know, some other type of thing.
46:58
Or that they may say the strengths might be it's a
47:01
unique question no one has asked this before you
47:04
know or we did it in a new way or something like
47:07
all this a strength was the large sample size or
47:10
the accuracy of using mri over a clinical test right so there are all things
47:16
where you might see those strengths and limitations that oh that you may agree
47:21
with or or disagree with depending on how well you've read the research,
47:26
you know, how much you've taken in.
47:28
And if I read an RCT, there's no way I get everything the first time I read it.
47:33
I often go back to papers and read them again, and I'm like,
47:36
oh, I didn't really see that the first time.
47:38
Right? Because it's not easy to read. It's not a Jackie Collins novel.
47:42
It is a piece of scientific literature.
47:45
It said to me, Steve Kamper, and if you ever want to look at some good research
47:52
breakdown, He did a JOSPT series.
47:55
He's an Aussie. And Steve Kamper said to me many years ago, research is not for clinicians.
48:02
It's for researchers. And that's really important to understand.
48:06
This is not written for your average clinician to read on holiday or on the bus or whatever.
48:12
It's written in a certain academic language. And you could say there's an element
48:16
of elitism within that because of the way that it's written.
48:20
And for most people, I can totally understand why they're not going to engage
48:25
massively with it, because it's not very exciting. It is quite boring and difficult.
48:31
But I suppose the more you do it, the more efficient you become,
48:35
the more stuck you can read, you can read it.
48:39
Again, that might become boring, you know, because it does. But at the same
48:42
point, you do get the information that you need from it quite a lot.
48:47
But I think that's a common theme amongst the great educators I've surrounded myself with.
48:52
It's like yourself and Dr. Clare Minchel, Jeff Esculia, we've got Melanie Boucher about fascia.
48:59
They're all people who are researchers initially, but they're trying to translate
49:02
that into a language which clinicians can understand.
49:04
I mean, that's lovely to be dipping your toes in both. If you've got the skill
49:07
to do that, then that's kind of a godsend.
49:10
It's quite cool for us. Yeah, but I would call myself as a researcher,
49:14
I would say, you know, if I do have a skill,
49:17
it's probably taking some of this complexity and being able to get it across
49:22
in, you know, I like to think I'm a translator of information.
49:27
I like to do heavy science in hard cockney. And I think that has a certain job, I would hope.
49:34
But yeah, for me, you know, some of the other guys I think you talk about there
49:38
are probably researchers.
49:39
I'm not that. but i haven't learned how
49:42
to do some of that and communicate it
49:45
to people so humble which is a nice segue to a
49:48
hundred citations congratulations not a researcher but you've
49:50
had a hundred people mentioning you and thanking you for
49:53
your for your paper on the biopsychosocial model is lost in translation so well
49:58
done first of all that must feel nice yeah look that you know that that's a
50:01
nice thing i know that there are lots of proper academics that don't believe
50:06
that so you know a scummy Cockney boy like me,
50:12
yeah, look, I'll give myself a little pat on the back for that one, eh?
50:15
Thank you i hope joe gave you a pound of eggs well joe gibson has been on the
50:19
show before that must be fun must mean it was it was it i mean is it fun just
50:22
a quick question off the cuff,
50:24
was this fun was it great was it nice working with these people peer review was not fun okay so,
50:31
when when i peer review papers my main job is to be an arsehole right so i look
50:37
at other people's peer review comments and i just think oh really you know you
50:43
do you think it's a little pedantic And sometimes it's, you know,
50:46
academic kind of showboating, if you like.
50:50
Whereas I always say, you know, I look to some people in my comments,
50:54
whatever I say is about making it more readable, not picking it apart ridiculously.
51:00
Do you know what I mean? So for me, a lot of my peer review is readability.
51:04
But for a lot of other people, it's an opportunity to be as pedantic as possible.
51:09
And yes, we had a lot of pedantry within that. And ultimately,
51:14
though, it's something like the third most cited paper in the journal or something.
51:20
So I must say that that pedantry obviously came out in a good result here.
51:26
I'd have been pissed if that pedantry had four citations.
51:29
So, you know, at least there is a benefit. I've erased that memory.
51:35
I think it's a good example, though, of you just being ahead of the game.
51:38
I've always regarded you as ahead of the game and a great person to follow because
51:40
you challenge yourself, which is always a great sign of, you know, an educator.
51:44
You're very fast to challenge your own biases.
51:47
And, you know, whilst people are still kind of thinking BPS,
51:50
the solution to everything, and it's, you know, as it happens,
51:53
the pendulum swings too far.
51:55
You're the person who goes, well, hold on, just put that Ben Cormack hook out,
51:58
just gently pull it back.
51:59
Not too far, but I'd see you as somebody who just kind of sticks their arm out
52:03
and goes, whoa, whoa, whoa, easy there. Hold on.
52:06
Yeah, I mean, I suppose that's a little bit of pedantry in itself, isn't it? But...
52:11
You know, one of the things that I'm not big on in this world,
52:14
or the game as I like to call it, is fantastic.
52:18
It's really, really difficult working with people with painful problems.
52:21
And I think any time, one thing that I really don't like is the next fantastic thing.
52:27
Because I've seen all of them, whether it's biomechanical, whether it's pain-biased,
52:32
whether it's, you know, motor control.
52:34
I like to say, I'm like Taylor Swift. I've had a lot of eras.
52:39
That's our soundbite for the, thank you for that, Ang. Yeah,
52:42
I did an Insta post on that. Oh, you did, it's true, of course. Yeah.
52:48
The point is that when you've, you know, when you've seen the second coming
52:53
of Christ a number of times, you know, and now seeing, you know,
52:58
other things that, you know, annoy me.
53:01
Maybe I shouldn't get annoyed, I don't know, but I know that it's difficult. I know it's hard.
53:05
I know well-known research often doesn't show fantastical
53:09
results so what really gets me is
53:12
people proclaiming that the next big thing they're going
53:15
to next big thing or they are the next big thing and i
53:18
think that does it goes against the reality of what
53:21
i've seen here you know i've seen
53:24
from other people as well and i've seen some other research and and
53:27
it's just a you know that's that's what drives me a lot of the time is whoa
53:31
whoa whoa you know i you know i've been around i've seen a few things in my
53:35
time and i I can smell that this maybe doesn't align with other research that
53:40
I read or are made that I read or just what I've seen in clinic.
53:45
Or it might just be that I'm a bit rubbish. I do not know. But I think that's often common.
53:50
That like you know reeling things back in you is that
53:53
you know you're probably not better than
53:56
that person or that person if we if you're honest
53:59
with all of us it's a
54:01
great message i listen to you and it's just thinking it's a great message that therapists
54:05
could could help their practice and help their patients
54:08
and everything it's just a an approach isn't it a frame of mind which
54:11
again takes me on to the nice segue of you've got a new
54:14
mentorship starting have you first of all let's do us in order first of all
54:17
people who aren't aware go to corekinetic.co.uk you've
54:21
got courses running at the moment what have you got going
54:23
on yes matt i was with an nhs hospital
54:26
up in manchester last week in germany this weekend
54:29
in czech republic next you know me matt i've been around
54:32
a while i probably you know i i teach i
54:36
teach a fair bit you know it's my teaching's my
54:39
comfort zone much better at talking about it than doing
54:41
both in terms of being a clinician yeah
54:45
you know it's much easier to talk about it than it is to
54:48
actually help people so i think they say people do
54:51
it teach don't they so there there is that but yeah
54:54
so look you know we i'm always that's that that's really
54:57
what i like that's my that's my vibe really teaching i like to think as i said
55:03
you know i'd hopefully take some of these complex things make them a little
55:07
bit easier for people oh you do so if soft tissue therapists manual therapists
55:12
a lot of kind of sports therapists or massage therapists, if they go to the website,
55:15
what sort of courses do you think might be useful for them?
55:19
Well, look, I mean, we've got our mentorship starting on Monday,
55:23
which we go to evidence-based medicine.
55:26
We talk about esophical understanding of looking at how we actually understand
55:32
the body, going from mechanics to biology.
55:35
I like to talk about understanding clinical assessment, those type of things,
55:41
putting it into context, what am I actually looking at?
55:45
What is it telling me? things like pain science, biopsychosocial,
55:49
all of these things I get into all of it.
55:51
And we've got every, we've got chirobs, osteos, physio.
55:56
I was going to say, it's fairly multidisciplinary, yeah? Oh, massively so.
56:00
S&C coaches, you know. And remember you came up to one that I ran about 10 or
56:06
15 years ago, Matt, and I think you did some game physics with us.
56:10
That's a long time ago. Like a Canary Walk.
56:12
You know, now it's online because obviously it's
56:15
easier to reach people all over the world and we you know
56:18
i think we've probably got 15 countries represented
56:21
so far again this year which is which is
56:24
fantastic fantastic yeah so if
56:27
you listen to the podcast and you want to information about that you
56:29
can go to youtube i'm putting it up on the screen now it's the advantage of
56:32
watching it rather than listening to it but it's totally up to you or you
56:35
can go to the website and you'll see details or instagram and facebook your
56:38
core kinetic on both of those on your instagram and facebook if people
56:41
want to follow you and you're and you're very good with your um it's
56:44
very consistent um you put a lot of information out there
56:47
it's all there for people to have a little look at and normally done in
56:50
a it's not testing ground i
56:53
like to test a few ideas and see what pushback i get from people with the crazy
56:58
stuff that comes out of my brain you know yes the mentorship but if you are
57:03
listening to this and you don't want to go to youtube the mentorship is basically
57:06
and correct me if i'm wrong this is from one of your posts recently it's an
57:09
eight-week program two hours per week time commitment watching reading,
57:12
four meetups, key research texts, case studies.
57:16
Online meetups.
57:17
But live with you kind of chatting and talking people through stuff here. Live online. Yeah.
57:22
And it starts September the 29th. So if you listen to this podcast,
57:25
have you still got gaps on that or...
57:27
Yeah, we've still got a few. It's online, so, you know, there's always a few gaps.
57:31
You know, we've got a nice health cohort, as usual, you know,
57:35
coming through the doors.
57:36
It's always, you know, always nice to have, to know that you're still relevant,
57:41
Matt, even with a few white hairs in the beard.
57:44
No, you're still relevant. I won't be next year, but maybe just one more year.
57:48
You will be, you will be. Let me be relevant.
57:50
No, because that's the other thing. As an educator, you've got longevity,
57:53
because every other word you say is maybe, could be. you know it's the people
57:57
who go yeah this is like this you know everything you yeah.
58:03
Taking the uh taking the easy way out no it's
58:06
the best the safest way and that's what we should be with like with our patients more you
58:09
know just saying this could work if it's not we'll go down another road but let's
58:11
try this that's what we all need to be even though we're trained to be
58:14
kind of like this is going to work and this is going to help you because it
58:17
worked for the last person we we just dig holes for ourselves and
58:20
it gets stressful anyway so yeah mentorship great thing go
58:23
along to call kinetic.co.uk have a look at that
58:26
and a new mentorship starting on the
58:28
29th which is only six days away fantastic monday not
58:32
long now buddy six days very nice good
58:35
fun right well look time it's 9 0 1 i said you'd be
58:37
in bed by 10 past nine so i'm going to be a man of my word thank you
58:40
so much ben for joining us really really appreciate it just quickly
58:43
got the better clinician product project as well
58:46
which is a chance how's that what's the
58:50
who's the best people are going to you know benefit from that
58:53
who's that designed for again we've got we
58:55
have got every type of clinician across the
58:59
board with that you know and trainers and massage people
59:02
and yeah just like really really again multi-disciplinary you know we've got
59:07
a couple of thousand members on there so it uh it's pretty juicy and pretty
59:11
spicy and that i do that with of course with adam and we get to have a bit of
59:15
a banter and you know and have a laugh while hopefully giving a little bit of information as well.
59:21
And that's been really popular over the last five years.
59:24
No, a lot of STA members have said nothing but good things about that.
59:28
It's a really, it's a cool combination, I think. I think it's like, oh, it's classics.
59:33
It's going, and they go down like Morecambe and Wise, Litton and Large.
59:35
It's just you two have got that.
59:38
You two have got that kind of, and that complements each other.
59:41
And the final product by yourselves, well, wouldn't recommend it.
59:44
But the two of you together, fantastic. Balance each other out.
59:48
Yeah. Fantastic, Mike. I've got one neck and one neck. Brilliant.
59:52
Really appreciate it. So yeah, call kinetic.co.uk, people, check it out.
59:56
If you're interested in being an STA member, just putting this in there quickly
59:59
before we finish, then make sure you do use the code podcast25.
1:00:03
It'll get you three months extra if you join for a single year. So that's £75.
1:00:07
Yes, you heard that correctly, £75 for an annual membership.
1:00:11
And if you use the code podcast25, it'll get you 15 months instead of 12,
1:00:15
only value for new members.
1:00:16
And if you're level three and qualified after 2014, then make sure you opt for associate member.
1:00:21
Right then, that's it. We've come to the end. Next week, like I said,
1:00:24
on the 30th, we're going to be reflecting on the recent Hanson Hub and SDA conference
1:00:28
with Anna-Marie Maccieri, director of the SD School, Gary Benson,
1:00:30
founder of the SDA, and Addie Hosgood of Unlock with Andy and the Unbound Project.
1:00:34
That's going to be 8 o'clock on YouTube, Sports Over Association channel or Facebook page.
1:00:38
So do try and join us live if you can because you will take away more from it by doing things live.
1:00:45
Thanks, Ben. Really appreciate your time. 903.
1:00:49
Really nice to catch up with you. I hope you catch up face-to-face one day in
1:00:52
the future before the superpowers just end it.
1:00:57
Was the conference that, I remember you did the online conference in COVID.
1:01:02
Was that meant to be in person at the time when you switched it online?
1:01:06
It was supposed to be a repeat of the Brighton way I did, yeah.
1:01:09
Yeah, yeah, yeah. And we would have bumped into each other then.
1:01:15
It's true. I'll have to try and drag you to Therapy Expo or something,
1:01:18
or that'd be nice. Oh, don't let me a therapy expo.
1:01:22
You're thinking of the old day. The new day are very liberal.
1:01:25
They're very chilled out. Very, yeah, very cool.
1:01:27
We'll see about that. All right, mate. I won't give you any more.
1:01:30
I get conference invites anyway.
1:01:35
Thank you so much. We'll catch up soon. Where's that? Exotic.
1:01:41
Spain is in Europe. Oh, very nice. No, I thought you said, oh,
1:01:44
I see. Spain, yeah, I know the place.
1:01:46
I think I lived there for nine years. Is San Diego pain summit still happening?
1:01:50
Oh the pain summit i did that three times yeah yeah
1:01:53
the pain summit 2017 19
1:01:56
and 20 i i think it ran out of steam unfortunately but it was a great conference
1:02:01
yeah i think americans ran out of steam but anyway right thanks everybody thank
1:02:06
you so much for joining us look after each other look after yourselves maybe
1:02:10
see some of you live next tuesday bye-bye and thanks once again to ben take care.
1:02:16
Music.