Evidence Based Rehab

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

Web-based academic discussions could well be the way forward for cost-effective and tailored continuing education for health professionals. China’s interactive Orthochina.org wiki project for orthopaedic surgeons is an example of the potential of such internet training for continuing medical education. Zhen-Sheng Ma of the Fourth Military Medical University in Xi’an, China, and his colleagues thoroughly evaluated this online tool and will publish their results¹ in the October issue of Springer’s journal Clinical Orthopaedics and Related Research.

Until recently, the primary vehicle for continuing medical education has been the more traditional conferences and training courses. However, the content of these sorts of courses is not necessarily tailored to meet the individual or immediate needs of professionals and their cost-effectiveness has yet to be established. Created in 1998, Orthochina.org uses an interactive case-based format and is structured using the wiki concept, where the content of the website is created collaboratively by users through an Internet browser. Information in Chinese and English is posted, edited, deleted and updated by carefully screened participants and is academically monitored by its orthopaedic users. Ten years on, the site boasts nearly 34,000 users and counts over 6,000 visits and over 2,000 posts every month.

Real patient cases are submitted for discussion by orthopaedic surgeons. They include the patient’s complaint, findings from physical examinations and relevant images. Professional discussions between participants take place anywhere, anytime, giving suggestions for diagnosis and treatment. Multiple opinions can help the surgeon who has posted his complex case, and is seeking advice on how to treat it, to make an informed decision about his treatment plan.

The authors firmly believe that “surgeon-to-surgeon communication is the most important, the easiest, most closely related to clinical practice, and cost-effective method of patient-problem-orientated continuing medical education.” By using the Internet, orthopaedic surgeons from different backgrounds and geographic locations can work together to enhance their quality of care, something workshops and meetings cannot provide in such a tailored and timely manner.

As a profession that is hampered by practice variation and difficulty adapting (changing) to more evidence based treatemt, I feel physical therapy could really fourish with a similar approach. While we do have great sites to share ideas (EIM, Rehabedge, SomaSimple), often time the forum type format can be disonjointed and hard to follow or return to in the future.

Jason L. Harris

Labels: EBM, physical therapy, Wiki

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LEXANDRIA, VA — The American Physical Therapy Association (APTA) is urging female athletes — particularly soccer players — to consider a new warm-up program to help lower their growing risk of anterior cruciate ligament (ACL) injuries. The announcement comes as APTA celebrates National Physical Therapy Month this October, an annual observance designed to educate the public about the important role physical therapists and physical therapist assistants play in the health care system.

Concurring with a new study published in the American Journal of Sports Medicine (August 2008), APTA says specialized stretching, strengthening, agility and jumping exercises could lower the overall ACL injury rate among female athletes.

The study evaluated outcomes of NCAA Division 1 female soccer players who performed the Prevent Injury, Enhance Performance (PEP) program, designed by physical therapists at Santa Monica (CA) Orthopedic and Sports Medicine Group. Those who performed the PEP program had an overall ACL injury rate 41 percent lower than a group of female athletes who did their regular warm-up. This was one of the largest studies conducted in the NCAA with 1,435 athletes participating.

The PEP program, one example of the many physical therapy-based programs that have demonstrated an equal ability to reduce ACL injuries among female athletes, consists of sport-specific agility exercises and addresses potential deficits in the strength and neuromuscular coordination of the stabilizing muscles around the knee joint. Physical therapist and APTA spokesperson Holly Silvers, MPT, who helped develop PEP, says, "The program was created to address the deficits that are seen in female athletes, particularly weakness in the lateral hip muscles, gluteal, and core muscles." These deficits can contribute to ACL injuries, notes Silvers.

According to physical therapist and APTA spokesperson Mark Paterno, PT, MS, MBA, SCS, ATC, coordinator of orthopedic and sports physical therapy at Cincinnati Children's Hospital Medical Center, recent research published in the British Journal of Sports Medicine found that ACL tears occur four times more frequently in females than in males involved in the same amount of sports participation. He says the difference in neuromuscular control, or the way our muscles contract and react, is one of four primary factors contributing to why women are more susceptible to knee injuries than men. Other discrepancies are anatomical (men and women are structurally differently), hormonal (women's hormonal makeup affects the integrity of the ligament, making it more lax), and bio-mechanical (the positions our knees get in during athletic activities).

Sample exercises athletes can perform to avoid ACL injuries can be found on the APTA Web site, www.apta.org/consumer.

"Women perform athletic tasks in a more upright position, putting added stress on parts of the knee such as the ACL, resulting in less controlled rotation of the joint," said Paterno. "While men use their hamstring muscles more often, women rely more on their quadriceps, which puts the knee at constant risk. To combat these natural tendencies, physical therapists may develop a treatment program to improve strength, flexibility, and coordination, as well as to counteract incorrect existing patterns of movement that may be damaging to joints," he added.

Silvers notes that physical therapist-designed programs can teach athletes how to avoid abnormal movement patterns and lessen stress on the knee, which may include exercises to strengthen hamstring and core muscles.

"Whether patients are athletes or not, physical therapist expertise includes not only rehabilitation and restoration of normal levels of function, but also education regarding how to prevent further injury," says Silvers.

Labels: APTA, Direct access, evidence based medicine, exercise

The fine folks over at NursingDegree.net have worked to post a list of their thoughts on important websites and resources for Physical Therapists.   They have entitled it: "100 Essential Sites and Resources for Physical Therapists".  Check it out and leave a note on your thoughts on what was included and maybe what you think should be included that maybe wasn't.

Jason Harris

Labels: blogs, physical therapist, physical therapy

Physical Therapists in MainE are fighting for their livelihood against the ever-growing bravado in procuring profits by denying more on more services to subscribers and cutting reimbursements to providers. AFTER PT's in MainE signed on to be providers for Anthem BC/BS, Anthem UNILATERALLY cut reimbursement to those same PT's by 20%. Although that is bad in-of-itself, strong-arming providers into reimbursement agreements that are barely at a level (and sometimes below the level) allowing for a consistent profit margin, it is not new. There are two other developments from this action that I find interesting.

The first is what happened when Anthem forced this rate cut on the PT's in MainE. Unlike our long history of passivity, the PT's stiffened up and said "no!" and now have a lawsuit against Anthem that is moving through the courts. I see this as analogous to the terrorized finally pushing the bully back. We may get our asses kicked in the end, but it's finally a step towards standing up for ourselves and our profession.

The second event related to this is the response by our professional organization the APTA. It appears from my vantage point that the APTA is keeping to itself on this issue. In my opinion, this is the perfect opportunity for the APTA to help by flexing some muscle and stand up for what we know is right. It seems we are taking the stance that we don't want to "offend" anyone so we'll just make like Switzerland and play neutral.

We need to support our fellow PT's if not for anything but to avoid becoming bullied just as they are.

Jason Harris

Labels: Anthem, BC/BS, Healthcare, Lawsuit, Maine, physical therapist