Evidence Based Rehab

Richard Deyo MD, the keynote speaker at the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) National Conference in October 2008, has again published data indicting the US approach to chronic back pain dramatically increases costs without improved outcomes. Deyo and colleagues reported in the January 2009 issue of the Journal of American Board of Family Practice the following staggering statistics:

• A 629% increase in Medicare expenditures for epidural steroid injections;
• A 423% increase in expenditures for opioids for back pain;
• A 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;
• A 220% increase in spinal fusion surgery rates.

The incidence of chronic and acute Low Back Pain, as documented by office visits, has not changed during the last 12 years. The application of these technologies is not without consequences Deyo et al noted, ‘Innovation has often outpaced clinical science, leaving uncertainty about the efficacy and safety of many common treatments. Complications and even deaths related to pain management are increasing.’ Indeed, the reoperation rates for low back pain have increased, not improved. The authors conclude that the ‘Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.’ They note that these approaches often are applying an acute care model to chronic pain and not acknowledging the current evidence that chronic pain requires a different approach and that there are ‘no magic bullets.’ In a “chronic care model” chronic back pain, like diabetes or asthma, ‘is a condition we can treat but rarely cure.’ Deyo et al suggest the solution that ‘chronic back pain may benefit from sustained commitment from health care providers; involvement of patients as partners in their care; education in self-care strategies; coordination of care; and involvement of community resources to promote exercise, provide social support, and facilitate a return to work.’

Tim Flynn, PT, PhD, president of the AAOMPT states, ‘The manual physical therapist is the health care provider uniquely trained to manage individuals with chronic low back pain. We utilize low risk, state-of-the-art care incorporating exercise, manual physical therapy, patient education and the application of the biopsychosocial model in managing this chronic condition. The Academy is dedicated to the application of current models for chronic pain management.’ The recent AAOMPT conference in Seattle focused on current theories and practice of chronic pain management with international experts on pain management.

Labels: AAOMPT, CPR, Direct access, evidence based medicine, health care, LBP, Low back pain, physical therapist, physical therapy

Seattle, Washington, October 30, 2008- Physical therapists from around the world are converging on Seattle this week for the annual conference of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Pain: From Science to Solutions, the conference theme, speaks to the unique role physical therapists have in combating pain. Pain from musculoskeletal problems such as back and neck pain is a leading cause of healthcare utilization. Manual physical therapy techniques such as spinal manipulation play an important role in pain relief for patients throughout the United States. Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization designed to restore motion and reduce pain. AAOMPT members will be discussing emerging research suggesting that spinal manipulation has the ability to positively affect the brain’s processing of pain signals. Keynote speaker and distinguished researcher, Richard Deyo, MD, MPH, will open the conference. Dr. Deyo is the Kaiser-Permanente Endowed Professor in Evidence-Based Medicine, Oregon Health Science University Department of Family Medicine.

AAOMPT president, Tim Flynn, PT, PhD, said about the conference, “This is an exciting time for physical therapy and for health care. On one side, we have a tremendous amount of research emerging in support of manual physical therapy for pain relief, and on the other side we see the stars aligning for great change in the health care industry.” Flynn continued, “As a patient, your choices come down to drugs, surgery, or physical therapists. Physical therapists can offer a low-cost solution for patients with pain and high-quality research supports what we do.”

For more on the benefits physical therapists can provide in the management of back and neck problems, contact your nearest physical therapist or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org. AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research.

---

Jason L. Harris

Labels: AAOMPT, evidence based medicine, manipulation, physical therapy

Seattle, Washington, October 29, 2008- Washington is one of only two states in the nation that prohibits physical therapists from performing spinal manipulation. Back and neck pain are two of the most common reasons patients seek medical care. The ability of physical therapists to perform spinal manipulation is supported by numerous high quality randomized clinical trials. This body of research, much of it developed by physical therapists, has demonstrated the proven efficacy of manual physical therapy interventions, to include mobilization AND manipulation, for patients with back and neck pain. Physical therapists have produced landmark research in the area of low back and neck pain which is recognized by national and international physician groups. This month’s issue of Spine, reports on the results of a randomized clinical trial, which demonstrated that patients with neck pain who received a physical therapy program of spinal manipulation and exercise had twice the improvement in symptoms compared to the current guideline group (Walker, 2008). Unfortunately, the current law prevents the citizens of the state of Washington from receiving physical therapy treatment that is evidence based, proven to be effective, and recommended in clinical practice guidelines.

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapists, expressed confidence that, "Given the overwhelming evidence of the benefits of physical therapy I would expect that this limitation will soon change. It is time to bring health care in Washington into the 21st century.” Flynn continues, “The American Medical Association, the Department of Defense, the American Physical Therapy Association’s Scope of Practice, as well as 48 other states in our nation recognizes physical therapists’ ability to perform spinal manipulation. Furthermore, the American College of Physicians and the American Pain Society (Chou, 2007) have published clinical practice guidelines recommending manipulation by physical therapists as the only proven treatment for patients suffering with acute low back pain.“

---

It is my opinion that the chiropractic associations continue to push and agenda portraying "patient safety" as a reason to continue to prevent PT's in the state of Washington to manipulate. However, manipulation is taught to all PT's in our training, just as examination, evaluation, therapeutic exercise, and physical modalities skills are taught. "Safety" is a red herring covering-up for the real reason which is profits. Legislators in Washington need to hear from patients in particular about how this law is negatively affecting their health care potentially leading to chronic conditions and significantly increased costs.

Jason L. Harris

Labels: AAOMPT, evidence based medicine, legislation, physical therapy

Tallahassee, Florida, October 20, 2008 – Neck pain is one of the top 10 reasons for a patient to visit a doctor. The lead article in the most recent issue Spine reports on the results of a randomized clinical trial which demonstrated that patients who received manual physical therapy and exercise had twice the improvement in symptoms compared to the current guideline group. The subjects in the study experienced both short and long term improvements in their neck pain. The study compared the use of manual therapy and exercise compared to the current guidelines of advice, rest, and range of motion. The results of this study are comparable to those reported by Hoving et al in 2002, which also demonstrated that manual physical therapy and exercise resulted in excellent clinical results in the treatment of neck pain while also providing a significant cost savings compared to usual physician care (Kothals-de Bos et al 2003). Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization, designed to restore motion and reduce pain. Hurwitz et al (2008) concluded in a systematic review on neck pain also in the journal Spine, “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.”

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, “This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain.” He continued, “Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain.” If you have neck or back pain or the aches and pains of musculoskeletal problems contact your local physical therapist today.

Jason L. Harris

Labels: AAOMPT, Direct access, evidence based medicine, manipulation, Mobilization

More surgery, more drugs, and more injections are not what the doctor ordered.

Tallahassee, Florida, May 20, 2008 – When it comes to chronic back pain management patients should know that “less is more.” The American Pain Society at their annual meeting unveiled a current review on invasive procedures for the treatment of chronic low back. The scientific review concluded that most invasive interventions, including spinal joint injections, radiofrequency denervation, intradiscal electrothermal therapy demonstrated no evidence of effectiveness. Furthermore, surgical procedures for chronic low back pain demonstrated only small improvement in pain and disability but were accompanied by considerable risk.

"The expert panel reaffirms its previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou."

“The American Pain Society panel has acknowledged the central role of an active physical therapy program in managing low back pain patients,” noted Timothy W. Flynn PT, PhD, President of the American Academy of Orthopaedic Manual Physical Therapists. “The key in chronic low back pain is avoiding too much medicine. There is no magic bullet but a combination of hands on care and an active exercise approach is the best solution.”

Labels: AAOMPT, evidence based medicine, Healthcare, LBP, Low back pain, physical therapy, public relations