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Edelle (Edee) Field-Fote, PT, PhD, FAPTA, was not talking about a side gig as a stage magician or CGI tech for a Harry Potter spin-off movie. In delivering the 54th Mary McMillan Lecture on Feb. 22, Field-Fote discussed the very real results that patients experience with physical therapy — results, in fact, that led her as a middle school candy-striper to the profession — as well as the workings of the human body that while steeped in science can take on an air of wizardry.

Field-Fote is director of spinal cord injury research and the Hulse Spinal Injury Laboratory; professor, Emory University School of Medicine, Division of Physical Therapy; and professor of the practice, Georgia Institute of Technology, School of Biological Sciences.

With the title of her lecture "Mastering our Own Magic in the Evolution Toward Precision Practice," Field-Fote focused on three areas that she said the profession must concentrate on to "propel the evolution of physical therapy toward precision practice."

First, she said, is to focus our energies on excellence in our own core knowledge and skills. "While we would all love to be excellent in everything we do," she said, "excellence requires that we make choices … about where we will focus our limited time and energies." This includes resisting the urge to reach beyond our mission as a profession or to add “shiny new practices" that take time away from building expertise on our core skills, she said.

One such skill area is measurement, Field-Fote said. PTs may believe they "know" when patients are improving, but the profession can't rely on that type of intuition. "How can you have precision practice without precision measurement? She asked. "Only by measuring change can we really know if our interventions are effective."

Field-Fote said her second area of concentration is championing movement measures as biomarkers of health-related conditions and outcomes. Looking specifically at prognostic biomarkers, she pointed to numerous movement-related measures that can identify the likelihood of a clinical event or of recurrence or progression of a condition. For example, walking speed and grip strength are biomarkers for future frailty in older adults, and the 6-Minute Walk Test is a proxy biomarker of exercise tolerance. "These movement-related biomarkers inform clinical decision making," she said, "and they don't require high-tech equipment and resources the way many other biomarkers do."

Finally, Field-Fote said the third area of concentration for moving toward precision practice is to decipher the mechanisms of movement-related change in the human body. While there is abundant evidence for the preventive and restorative effects of exercise, understanding why this is so — how movement, practice, and training change the physiology and structure of the body — is imperative. "Understanding the 'how' is the basis for refining our interventions and fitting them to the patient," she said.

Her own research on how physical therapist interventions change the nervous system in ways that support improved function even for people with spinal cord injury was one example of studies being done, "but I certainly am not alone," Field-Fote said. She called out other studies that provide evidence of the power of movement to change body systems in fundamental ways. Notably, she pointed out, of the 13 articles she identified, 10 had at least one author who received funding from the Foundation for Physical Therapy Research. "Every one of you who has ever contributed to the Foundation has helped our profession to lead the way in adapting to the dawning world of precision medicine," she said.

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