High Fidelity: From Cicero to the PT Clinic (and a Record Store in Between)
First, a Physical Therapy Haiku…
Vinyl holds moments,
each impression holds memory
songs live faithfully.
Movie Recommendation – High Fidelity (3/31/2000, Touchstone Pictures)
We have a vinyl record player in the clinic, and we have had one for over 10 years. We were ahead of the current vinyl resurgence. It has become quite a conversation piece, and patients bring their own vinyl to play during PT. We recently had a debate amongst Friday morning patients about whether we should put on either Neil Young or Neil Diamond. What amazes me is how much the topic of music or the actual music itself generates a conversation about memories and autobiographical information from a patient. Therapeutic alliance is enhanced by a quick conversation about when someone first saw the Rolling Stones in concert or about how this was the first album they bought in high school.
Vinyl is often said to sound better because it provides a continuous analog signal, capturing the full depth and warmth of the original sound waves without the compression that digital formats use. This can result in a richer listening experience, especially for older recordings mastered initially for vinyl. Like most things human beings have opinions on, it’s a debate that is ultimately just a preference or bias.
Back to why I purchased the record player for the clinic. I had just rewatched the movie High Fidelity and frequented a coffee shop where the owner had a record player on the counter. I was impressed with the depth and breadth of his eclectic collection.
To audiophiles, high fidelity (hi-fi) means high-quality sound reproduction. Yet, while writing this blog post, I wondered what fidelity means to patients and physical therapists.
When you hear the word fidelity, what comes to mind? Maybe you think of loyalty in relationships. Perhaps you think of the U.S. Marines’ motto, Semper Fidelis — “always faithful.” Or maybe, like me, you think of John Cusack in the movie High Fidelity, reorganizing his record collection and wrestling with what it means to stay true. But fidelity has much older roots, stretching back to the Romans. And today, it also has a very practical meaning in physical therapy: treatment fidelity. Oddly enough, Cicero, a Roman orator, and Rob Gordon, a cynical record-store owner, have more in common with PTs than you might expect.
Cicero and the Orators: Fidelity as Loyalty
In the Roman Republic, fides — faithfulness, reliability, loyalty- were among the highest civic virtues. Orators like Cicero often stepped into court cases not because they were paid, but because fides demanded it. These “intervention orators” lent their voices to support friends, clients, or allies.
Cicero opens some of his speeches by saying, in effect: “I’m here not for myself, not for gain, but because loyalty compels me.” That was his way of saying: I am faithful, I am constant, true to this cause.
Physical Therapy: Fidelity as Staying True
Fast-forward 2,000 years, and fidelity reappears in physical therapy clinics instead of courthouses. In PT, intervention, or treatment, fidelity means sticking to the plan: delivering an exercise program or manual therapy protocol as designed, with the correct dose, quality, and consistency.
- Skip half the exercises or underload the tissues? Fidelity drops.
- Swap out proven interventions for something flashy from TikTok, but untested? Fidelity drops.
- Carry out manual therapy interventions like I use spices with my sheet pan meals, sprinkling a dash here, and putting a spoonful there without rhyme, reason, or consistency. Fidelity drops.
- Deliver the program as intended, with skill and engagement? Fidelity holds.
High Fidelity (the movie)
What does John Cusack’s character in High Fidelity have to do with Cicero or physical therapists? Surprisingly, a lot.
- Rob’s Record Collection: He keeps reorganizing his albums — alphabetically, autobiographically, chronologically — searching for the true order. PTs face the same temptation: to tinker with interventions until the original structure is lost. High fidelity means resisting that urge and sticking with what works.
- Top Five Breakups: Rob revisits his old relationships, asking what went wrong. In PT, we can do the same: review “top five” treatment failures and ask if it was the patient or if we drifted from fidelity.
- Semper Fidelis vs. High Fidelity: The Marines’ motto means always faithful. Rob’s “high fidelity” means true-to-sound (and maybe true-to-self). For PTs, fidelity means being faithful to the science and the patient.
Does It Matter?
For Cicero, fidelity gave moral credibility. For Rob Gordon, fidelity was about identity. For physical therapists, fidelity ensures that patient outcomes can be trusted.
High fidelity isn’t just about records or relationships; it’s about staying true to the essence of what works, whether in the Forum, the record store, or the physical therapy clinic.
So next time you’re documenting a treatment session, remember: Cicero would have your back, the Marines would salute you, and John Cusack would probably reorganize your exercise log into his “Top Five Most Faithful Interventions.” Ask yourself, “Was today’s care faithful to plan, evidence, and patient needs?”
If you want to learn more about fidelity in physical therapy and treatment fidelity, I have included some selected references below. Thanks for taking the time to read this blog post. I will see you on the flip side…
More reading
- An M, Dusing SC, Harbourne RT, Sheridan SM, Consortium ST-P. What Really Works in Intervention? Using Fidelity Measures to Support Optimal Outcomes. Phys Ther. 2020;100:757–765.
- Hand BN, Darragh AR, Persch AC. Thoroughness and Psychometrics of Fidelity Measures in Occupational and Physical Therapy: A Systematic Review. Am J Occup Ther. 2018;72:7205205050p7205205051–7205205050p7205205010.
- Hildebrand MW, Host HH, Binder EF, et al. Measuring treatment fidelity in a rehabilitation intervention study. Am J Phys Med Rehabil. 2012;91:715–724.
- Salamh P, Cook C, Reiman MP, Sheets C. Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis. Musculoskeletal Care. 2017;15:238–248.
- Toomey E, Hardeman W. Addressing Intervention Fidelity Within Physical Therapy Research and Clinical Practice. J Orthop Sports Phys Ther. 2017;47:895–898.
- Toomey E, Matthews J, Guerin S, Hurley DA. Development of a Feasible Implementation Fidelity Protocol Within a Complex Physical Therapy-Led Self-Management Intervention. Phys Ther. 2016;96:1287–1298.
About the Author
J.W. Matheson is a physical therapist with 30 years of experience and a growing passion for making science accessible to everyday people. Over the years, he’s learned that physical therapy—and the research behind it—isn’t the neat, airtight world textbooks promise. Musculoskeletal pain science is messy, flawed, and deeply human, just like the people it aims to help.
While many talk about “evidence-based” practice, J.W. leans toward science-based practice—grounded in the best available research, scientific reasoning, healthy skepticism, solid methodology, and an understanding of where the evidence falls short. Once a fiery debater on social media, J.W. found that arguing rarely changes minds. Now, he’s more interested in listening than lecturing, asking better questions than delivering quick answers. He believes the best PTs aren’t the ones who are always “right,” but the ones who stay open, curious, and compassionate in the face of uncertainty. Through his writing, J.W. invites others to explore the gray areas of healthcare, where humility meets science—and where true progress happens.
Featured image is property of J.W. Matheson