Monday, November 10, 2008

Blogging on Peer-Reviewed Research

Archives of Physical Medicine and Rehabilitation recently published a study on the benefits of physical therapy for lower extremity trauma. The abstract is as follows:

OBJECTIVE: To examine the effect of physical therapy (PT) use on a range of measures of physical impairment in a cohort of patients with lower-extremity trauma.

DESIGN: Longitudinal, observational study of patients with severe lower-extremity trauma. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission and at 3, 6, 12, and 24 months postdischarge.

SETTING: Eight level I trauma centers.

PARTICIPANTS: Patients (N=382) whose legs were salvaged after limb-threatening trauma to the lower limb.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Unmet need for PT was assessed from 2 perspectives: an orthopedic surgeon and a physical therapist independently evaluated each patient and were asked whether the patient would benefit from PT. Patients classified by these health professionals as needing PT services over a given period and who reported receiving no PT at the end of that period were classified as having unmet need as evaluated by the orthopedic surgeon or physical therapist for that follow-up period. Multiple variable regression techniques were used to compare improvement in 5 measures of physical impairment and functional limitation between the met and unmet need groups over the periods of 3 to 6, 6 to 12, and 12 to 24 months: percentage of impairment in knee and ankle range of motion (ROM), reciprocal stair climbing pattern, gait deviations when walking, self-selected walking speed greater than 1.2 m/s (4 ft/s), and the mobility subscores of the FIM instrument.

RESULTS: Patients with unmet need for PT as assessed by a physical therapist were statistically significantly less likely to improve in all 5 of the selected domains of physical impairment and functional limitation than patients whose PT need was met. These results remained constant after adjustment for patient sociodemographic, personality, and social resources, as well as injury and treatment characteristics, reported pain intensity, and impairment level at the beginning of the study period. Patients with unmet need for PT as evaluated by an orthopedic surgeon were significantly worse off than patients with met need in only 1 of the 5 selected measures (ROM).

CONCLUSIONS: The results are consistent with a beneficial effect of PT after lower-extremity trauma. The results point to a need for improved standards for the prescription of PT services, and highlight the importance of involving a PT professional in the prescribing process.

I think the conclusion is relatively strong worded in regards to not just the importance of physical therapy intervention, but that outcomes were affected by whether the PT was involved in the decision making for rehabilitation. While it would be a stretch to generalize these conclusion to other lower extremity conditions seen in PT (elective post-op, sprains/strains, neuromuscular) it's important that MD's (the gate keepers in the health care world) begin to shift their view of PT's as less of an adjunct of THEIR treatment to micromanage, and instead begin allowing themselves to work with PT's as health care professionals that bring a different body of knowledge to help in the conservative treatment of neuromusculoskeletal conditions.

Jason L. Harris

Article Reference

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