I recently updated my cable television to receive the MSNBC and CNN channels and a less-expensive digital phone service. As a result, I now get approximately 300 channels and I have one of the most confusing remote controls that I've ever had. I am gradually perusing through the channels and anticipate that I'll get to the 300th by the time I'm 85 years old. What I am discovering as I watch the additional programming is that I am very glad that I have a day job. I have been introduced to a whole new world of "reality" shows that has resulted in my being very content that I apparently lead a boring, overly quiet, unglamorous, and nonglittered existence. However, what I also am seeing is how influential these "reality" shows can be to viewers' beliefs and lifestyles. I am told that some people are actually quite attentive to the conversations these show participants have with each other and what they do when they are voluntarily and willingly being filmed. It brought to my mind the fact that my mother was captivated each day by soap operas and one day she told me that I was acting just like 1 of the actresses (I won't tell you which one). My reply was something like, "mom ... those are actresses portraying fake characters ... so I am just a good actress." She was not amused.

I am reminded by what I see and hear how important word of mouth can be, and how some of what is said is grounded by facts, and some is not grounded by facts. People often pass on their experience to another and the receiver of information decides the credibility of the information based on the type of relationship they have with the presenter of the information. There is a Latin phrase, "Viva Voce," which, according to the online Merriam-Webster Dictionary, is interpreted as meaning "by word of mouth."1 This "word of mouth" sometimes reaches nationally as individuals choose to document their experiences in various venues. For example, on January 7, 2010, there was an article in the New York Times titled, "Treat Me, But No Tricks Please."2 The author wrote about her experience with physical therapy by stating, "When I've gone to physical therapy, the treatments I've had-ice and heat, massage, ultrasound-always seemed like a waste of time. I usually went once or twice before stopping." She relayed that her doctor expressed similar beliefs. The author continued to quote Dr Irrgang, the president of the Orthopedic Section of the American Physical Therapy Association, who stated, "There is a growing body of evidence that supports what physical therapists do, but there is a lot of voodoo out there, too. ... You can waste a lot of time and money on things that aren't very helpful." The author queried Dr Irrgang about why a person should go to a physical therapist for up to 20 sessions. He answered that they may only have to go for 1 or 2 sessions to learn the exercises and later to follow-up. Regarding a person's ability to discriminate between "voodoo physical therapy" and worthwhile treatment, Dr Irrgang stated that2 "You just have to be very inquisitive. ... The physical therapist should be able to explain the various treatment options. You should ask about the benefits and risks, and ask what is the evidence that it will work." The article ended with the author quoting Dr Irrgang as saying, "And if the therapist can't give you good answers ... you might want to rethink your choice of therapist." As evidence of the importance of word of mouth, I offer that on the electronic version that was published on January 6, 2010, there were 183 posted comments from readers.2 They were interesting to read and are still available on the Web site. Just last week a person wrote a letter to the editor in my hometown weekly newspaper about a positive experience she had with a Doctor of Osteopathic Medicine.3 I had a conversation with this doctor and early the next week she had already received several calls from potential patients. I live in a town of approximately 5000 people (30 000 in the summer) and word of mouth is a major source of referrals.

I believe that the days of double-digit numbers of treatment days for most episodes of physical therapy are soon to be-and should be-almost nonexistent. I offer that even if patients don't ask, we, as physical therapists, should be the ones to initiate proof of evidence for what we are proposing as a plan of care. I am currently asking the therapists in my department to give patients a handout describing their condition, as well as their exercises on the day of their evaluation. My goal is to give patients reader-friendly articles that support the proposed plan of care. I would like patients to understand, for example, that they have a problem with their rotator cuff muscles, versus their rotor cup muscles. (They are so cute when they say that!) Our electronic evaluation forms also require that we certify that we have reviewed this plan of care with the patient and that they have had the chance to approve or disapprove with each component of their plan of care. I have recently had 2 patients come to me with review articles about their conditions (postpolio and pelvic pain) and they wanted to discuss the content with me. Patients are becoming empowered by the content they read on the Internet.

So, whether "Viva Voce" is spoken, twittered, tweeted, or posted on Facebook, YouTube, MySpace, or any other space, it has the potential to be a determinant of a medical professional's reputation and, it follows, of patient referrals. I am somewhat proud that I have not done any tweeting or twittering and I don't have anything on any spaces. I am very happy with my boring, overly quiet, and unglamorous life. I do, however, think I'll add a little glitter.

This issue of the Journal of Women's Health Physical Therapy provides information that, I anticipate, will be very useful to clinicians. Drs Rodgers and Abraham provide a case that emphasizes the importance of a working relationship between physical therapists and medical practitioners to afford patients the best plan of care for when there might be a lack of progress with a plan of care. Dr Olszewski has provided a valuable case report that outlines a plan of care for a postpartum woman with dyspareunia and vestibulodynia. Renard and Dr Abraham-Justice present a case report that involved the treatment of a postpartum patient with anterolateral sensory loss and posterior pelvic pain. Underwood and her colleagues document the importance of hip muscle strength in women with and without stress urinary incontinence. Vandyken and Hilton complete their second article in the series of manuscripts on the topic of the treatment of pelvic pain. I propose that we throw a little celebratory glitter to them for the information with which they provide us in this issue of our journal.

Nancy C. Donovan, PhD, PT

Editor-in-Chief

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