Evidence Based Rehab

Labels: education, physical therapist

ALEXANDRIA, VA, June 17, 2009 — Legislation to establish a Frontline Providers Loan Repayment Program that includes physical therapists was introduced Tuesday by Representative Bruce Braley (D-IA). The Access to Frontline Health Care Act of 2009 (HR 2891) would encourage physical therapists to practice in underserved areas, says the American Physical Therapy Association (APTA).

HR 2891, which would amend the Public Health Service Act, creates a process that is similar to the National Health Services Corp (NHSC) in which a provider signs a commitment to practice in an area for at least 2 years in exchange for student loan repayment. Currently, physical therapists are not included in the NHSC's Loan Repayment Program. This legislation would complement the Physical Therapist Student Loan Repayment Eligibility Act of 2009 (HR 988), which would allow physical therapists to participate in the NHSC's program.

Under HR 2891, providers pledge to practice in a "Frontline Scarcity Area." Scarcity areas include a Health Professional Shortage Area as defined by the Health Resources and Services Administration Shortage Designation Branch of the US Department of Health and Human Services (HHS), or an area designated by a state as having a shortage of frontline care services. HHS' Secretary can give preference to a scarcity area in which an entity has demonstrated that it has an interdisciplinary program, or pledges to initiate such a program. The Secretary also determines the amount of the loan repayment.

"APTA applauds Representative Braley for introducing this much needed legislation and including physical therapists in it," said APTA President R. Scott Ward, PT, PhD. "With health care reform legislation on the horizon, it's imperative that our leaders address workforce issues as a part of overall reform. The Frontline Providers Loan Repayment Program would bring physical therapists to areas in the country where their services are greatly needed."

In addition to physical therapy, the following qualify as frontline services: general surgery, chiropractic, optometry, ophthalmology, audiology, speech language pathology, pharmacy, public health, podiatric medicine, dietetics, occupational therapy, general pediatrics, respiratory therapy, medical technology, and radiologic technology. All services must be performed by a health care provider with the appropriate education.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 72,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.

Labels: APTA, Press Release

News out of the National Center for Complementary and Alternative Medicine reports the not so unexpected findings of $2.5 billion (yes, that is a "B" for billion) spent on testing "alternative" methods for treating everyday ailments. And, of corse, when a treatment is based upon what is counter to known human anatomy and physiology, they were found to be no better than placebo.

"You expect scientific thinking" at a federal science agency, said R. Barker Bausell, author of "Snake Oil Science" and a research methods expert at the University of Maryland, one of the agency's top-funded research sites. "It's become politically correct to investigate nonsense."

Scientific study demands that we need to be open to change and paradigm shifts. However, some sort of plausibility needs to exist in order for us tax-payers to be throwing or money at it.

"There's been a deliberate policy of never saying something doesn't work. It's as though you can only speak in one direction," and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.

As said by many smarter people than me, many times, the point of scientific thought is the ability to critique and understand that just throwing more money at a treatment until you get the answer you'd like (eg acupuncture can help in some cases - but, of course, so does sham acupuncture).

Jason L. Harris

MSNBC.COM Story

Labels: alternative medicine, sham

Ihave posted several articles on the overuse of imaging in musculoskeletal care (find them here, here, here, and here). Now we have another study from the Archives of Internal Medicine making not only that statement but going as far as speculating that this is related to financial gain, improved patient satisfaction, and potential for more harm that good.

In a news release from Musculoskeletal Report, the study found:

Patients were more likely to undergo imaging tests if their primary care physician worked in large practices and if the doctor was offered patient satisfaction-based financial incentives. Practices with clinical quality-based incentives, however, were less likely to order advanced imaging tests for low back pain patients in the absence of clinical red flags.

Additionally, the article reports on the potential harm of advanced imaging stating:

...advanced imaging of the spine has a low yield of unexpected findings and an “alarmingly high” yield of irrelevant findings.

I'm sure, as physical therapists, we see the fallout from this. More and more patients are presenting in the clinic with simple low back pain (simple meaning no neurologic, systemic, or lytic component - not low in pain) with no treatment beyond narcotics and muscle relaxants and MRI in hand. Now we not only have to try to get them better after 4-6 weeks of prior ineffective treatments, we also have to convince them that all the irrelevant findings (disc bulge, DDD, foraminal stenosis in now way associated with their complaints, etc) are not the problem and will not result in death, or worse, disability.

It seems everyone knows we shouldn't be doing this. Now we just need to convince the gate keepers with their own imaging labs to not perform these unnecessary, revenue generating, insurance companies turn a blind eye to, procedures. I'm sure there will be no difficulty in that.

Jason L. Harris


Hoangmai H. Pham, Bruce E. Landon, James D. Reschovsky, Beny Wu, & Deborah Schrag (2009). Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients Archives of Internal Medicine, 169 (10), 972-981

Labels: evidence based medicine, Imaging, Low back pain