Evidence Based Rehab

Osteoarthritis (OA) is no doubt a growing cause of loss of function in our society. MSNBC's Health department recently reported on this growing epidemic related to total joint replacements. They are worth a watch. The first video found here discusses the financial impact on Medicare and the second seems more of a marketing clip for total joint replacements. What caught my ear was in the second video the surgeons comments on why total joints. To paraphrase he states total joints are done when "conservative" treatments don't help. He lists conservative treatments as "medications and drugs..". Wow, is it any surprise that these failed? Not many of us can manage chronic progressive pain with medications.

What is disappointing is the utter lack of mention of what literature shows helps and what is a first line recommendation for pain and dysfunction related to OA. That is Physical Therapy. PT is less expensive, can lead to independence in pain management, has good long term outcomes, and has little to no potential negative effects. These qualities are almost completely opposite of what pills and injections offer.

I've seen total joint replacements completely change a persons function, but if we truly want to decrease costs of conservative management of joint pain, we need to shift away from expensive drugs and injections, eliminate unnecessary imaging, and encourage the return of individuals control over their physical well being.

So, you've got drugs, you've got surgery, or you've got Physical Therapy. Let's let individuals know about their choices.

Jason L. Harris

Labels: Direct access, Medicare, Osteoarthritis, physical therapy

Labels: Direct access, evidence based medicine, Medicare, physical therapy

A press release from the American Association of Oral & Maxillofacial Surgeons discusses a bill that would allow them to refer patients to physical therapy. Currently only osteopathic (DO's) and allopathic (MD's) doctors may "oversee" (read: sign the ok for) physical therapy.

Oral & Maxillofacial surgeons and other dentist make the case that they routinely treat patients that would benefit from PT, therefore having the ability to do so would be beneficial:

As Congressmen Pascrell and Cantor noted in sponsoring the bill, because a dentist or OMS cannot directly refer patients for physical therapy, they must refer patients to an allopathic or osteopathic physician to establish a therapy plan. In his statement of introduction on the floor of the House of Representatives, Pascrell stated, Such consultation has proven to be inefficient, unnecessary and cumbersome, and it ultimately delays patient treatment and the continuum of care.

I agree. But I'll take it one step further. It is just as "inefficient, unnecessary and cumbersome" for patients to have to go to their MD, DO, DDS in the first place for neuromusculoskeletal rehab. True full direct access to physical therapist - the experts in neuromusculoskeletal conservative care - would greatly decrease time to recovery and the extraneous costs of medications and excessive imaging associated with going to multiple physicians before getting to see a physical therapist.

Labels: Direct access, EBM, education, evidence based medicine, Medicare

A Reuters report on MSNBC relates that there has been a 20% increase in hospital and doctor visits since 2002. The article claims

The reason is clear — Americans are getting older. “When you reach 50 things start going wrong, just little by little, and you keep going back to the doctors,” Burt said.

Labels: CMS, legislation, Medicare, physicians