Evidence Based Rehab

Stumbled upon a nice article written about physical therapy from a patient's perspective. Nice view as it starts out with the patient expressing his hesitation in trying treatment from a PT and his desire for a quick fix.

Oh great!" I remember thinking. "Voodoo medicine! Why can't they just give me a pill to make this go away?

Nice to see a physical therapist was able to get one of our countries finest back up and running! You can read the rest of the article by clicking HERE.

Jason L. Harris

Labels: physical therapist, physical therapy, treatment

A new study from Spine concludes that there are muscle changes that, they conclude, are common in those with true low back pain. Here is the abstract:

Study Design. Prospective longitudinal study.

Objective. To investigate, using magnetic resonance imaging (MRI), the influence of bed rest on the lumbopelvic musculature.

Summary of Background Data. Reduced gravitational loading and inactivity (bed rest) are known to result in significant change in musculoskeletal function, although little is known about its effects on specific muscles of the lumbopelvic region.

Methods. Ten healthy male subjects underwent 8 weeks of bed rest with 6 months of follow-up. MRI of the lumbopelvic region was conducted at regular time-points during and after bed rest. Using uniplanar images at L4, cross-sectional areas (CSAs) of the multifidus, lumbar erector spinae, quadratus lumborum, psoas, anterolateral abdominal, and rectus abdominis muscles were measured.

Results. Multifidus CSA decreased by day 14 of bed rest (F = 7.4, P = 0.04). The lumbar erector spinae and quadratus lumborum CSA showed no statistically significant difference to baseline across the time of bed rest (P > 0.05). The anterolateral abdominal, rectus abdominis, and psoas CSA all increased over this time. Psoas CSA increased by day 14 (F = 6.9, P = 0.047) and remained so until day 56, whereas the anterolateral abdominal CSA (F = 29.4, P = 0.003) and rectus abdominis CSA (F = 8.9, P = 0.03) were not statistically larger than baseline until day 56. On reambulation after completion of the bed rest phase, multifidus, anterolateral abdominal, and rectus abdominis CSA returned to baseline levels (P > 0.05) by day 4 of follow-up, whereas psoas CSA returned to baseline level after day 28 of the follow-up period.

Conclusions. Bed rest resulted in selective atrophy of the multifidus muscle. An increased CSA of the trunk flexor musculature (increases in psoas, anterolateral abdominal, and rectus abdominis muscles) may reflect muscle shortening or possible overactivity during bed rest. Some of the changes resemble those seen in low back pain and may in part explain the negative effects of bed rest seen in low back pain sufferers.

This adds to the growing mountain of evidence against bed rest for LBP. One would hope that the current first line practitioners that LBP patients encounter (GP's and, sadly, PA's and NP's) know this; but, as Ellen Degeneres showed us even "stars" are given advice contradictory to the mounting evidence. What's worse is her large audience may also believe that bed rest is the best treatment for their low back pain.

Educate, educate, educate. Tell everyone you know about the harm of bed rest!

Labels: bed rest, EBM, Low back pain, treatment

Our friends over at Evidence in Motion posted in their blog about a gentleman that swears he has invented a machine that automates physical therapy. Called the HYDROT-pt5™, this machine:

..delivers automated alternating Hot, Neutral Zone, Cold, Intermittent Compression, and Directional Massage… back to back, through a single pad automatically.

Wow, isn't that how PT was practiced in 1980 before we realized all it did was make the patient feel better for 1 hour? Here's the machine itself:

The "inventor's" website is totally devoid, obviously, of any literature to back up his claims from a Cleburne Times-Review article that the machine is:

...capable of speeding up healing and reducing pain in less than a third of the time it normally takes...

The website does have a "Peer Review" link. However, this presents us only with testimonials. A few have "Dr." before their names, so this must warrant the "Peer" aspect of Peer Review.

As Physical Therapists, we must watch our backyards for snake oil salesman like this and educate the public and the medical community as to what real physical therapy is, and maybe more important, what it is not.

Labels: Fraud, physical therapy, treatment