Evidence Based Rehab

Acupuncture (sticking needles at specific points to a certain depth in the skin) is not an effective treatment for chronic low back pain. This may sound surprising as the media has jumped all over a new study that supposedly shows that acupuncture is more effective than "usual care". Unfortunately - as the media usually does - they've misinterpreted the results of the study. In fact the study showed that there is no difference in the effectiveness between "fake" and "real" acupuncture. Meaning, there is no effect of acupuncture.

Steven Novella over at Science-based Medicine does a masterful job of explaining this in detail. Please visit his post on this study to become enlightened by logical and scientifically based thoughts and discussion - as opposed to hype.

Jason L. Harris

Labels: acupuncture, back pain, evidence based medicine

E vidence Base Rehab has recently been named one of the top 51 physical therapy resources on the web. I appreciate the recognition Ownward Healthcare has given this blog. You can find the full list on their website here.

Surprisingly absent from the "Blog" list is Mike Reinold's great blog. Make sure you visit his blog. He has currently begun a series on Patellofemoral Pain Syndrome.

Jason L. Harris

Labels: award, blogs

The Insurance Journal released an article discussing how a "surprising" share of work comp case costs come from unanticipated costs or, as they term it, "Adverse Surprise Costs." The study reported on was said to find:

Adverse surprise cases were disproportionately chronic conditions with multiple surgeries. They were also disproportionately back pain cases.

That's no surprise to me, however, and should really not be a surprise to anyone dealing with chronic pain and low back injuries. While back pain is not the only musculoskeletal condition being over-treated with narcotics, expensive imaging, and surgery, it certainly is the most costly of all. In fact, most of my recent posts have centered around this subject (you can find them here, here, and here).

What is surprising is that, despite all this research showing all this imaging, surgery, and narcotic prescription make things worse often, we are still using that recipe to treat most folks with LBP. In fact, those doing it are being the ones rewarded with reimbursement for doing so.

Jason L. Harris

Labels: evidence based medicine, insurance, LBP, Low back pain, over-use

David Straight of E-rehab has put together a website called PT's Unite to help bring about a grass-roots effort for California PT's and their push for direct access. Please consider helping in the cause. Remember, success for PT's in one state can help lead to success for you and a failure can make it harder to bring about change in your state.

Good luck to those PT's in California and thank you to David for grabbing the tourch and attempting to lead the way to change.

Jason L. Harris

Labels: Direct access, legislation, physical therapist

A pair of article from the April 1st issue of Spine remind us of what real reform in health care we need. While President Obama is at least attempting to get the ball rolling with changes in health care, Electronic Medical Records (EMR), expanded coverage, and "investing" in prevention and wellness aren't going to change today's problems at the root of rocketing health care costs.

One piece at the root of these rocketing costs is excessive use of imaging, surgery, and drugs. Low back pain treatment often gets the full brunt of these high cost, low efficacy procedures. Now, the new issue of Spine shines some light on the harm this approach can cause.

In the first article by Timothy Carey, MD - Practice patterns and evidence in chronic low back pain care - it was found that (surprise) there is an overuse of narcotics and imaging and little use of established beneficial treatment of exercise. The figures quoted in the article report fewer than 30% of LBP suffers had seen a physical therapist in the past year and, worse yet, only 3% had gone through a structured rehabilitation program.

The second article by Sham Maghout Juratli, MD - Mortality After Lumbar Fusion Surgery - there was a finding of alarmingly high percentage of deaths after fusion surgery related to Analgesic overdose. The author comments that:

Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause.

So, instead of treating LBP primarly with research-proven exercise prescription there is an overuse of narcotics and surgery that are leading to increased loss of life!

Maybe rewarding those attempting to use what research shows as effective for LBP instead of shelling out billions for imaging, drugs, and surgery might not only lead to lessening costs but decreased mortality.

Labels: evidence based medicine, Fusions, Low back pain, physical therapy