- Your Bridge to Health -

Non-surgical treatment lead to similar outcomes for back pain
October 20, 2017

Interpretation of study’s findings is misleading

Low back pain is one of the most common painful conditions in the world. Although many individuals who experience low back pain will improve either with or without treatment, some go on to deal with long-term issues. Chronic low back pain (CLBP) is defined as any situation in which pain lasts for more than three months, and it is a major problem for physical therapists and other doctors. In general, it’s recommended that non-surgical treatment that includes various types of exercises should be used first and that surgery should only be considered if these treatments are not available or don’t lead to improvements. Lots of research has supported this type of approach, such as three recent high-quality studies that found no evidence that surgery was any better than non-surgical treatment after 11 years. Unfortunately, one recent study performed in Sweden tried to make the claim that surgery led to superior outcomes compared to non-surgical treatment; however, there were some issues with this analysis. Surgeons performed the study, who may have interpreted information in favor of surgery, even if it actually suggested otherwise. For this reason, a team put forth a commentary that explained the true nature of these findings to better guide patients and medical professionals.

Large sample of patients randomly assigned to different treatments

In the original study, patients with CLBP for at least two years were recruited to participate. This led to a sample of 294 individuals who were randomly assigned to either physical therapy or a surgical procedure called lumbar fusion. All patients were evaluated before these treatments and then monitored for between 9-22 years afterward for pain, disability, and other measures. According to the researchers who conducted the study, patients who had surgery reported better scores in most of the measurements taken, and they recommend that this surgical procedure is a valid treatment option for patients with CLBP. When looking into these results a bit more deeply, though, a different story emerges.

Long-term results really show that there is no difference between treatments

Researchers first pointed out that although patients were randomly assigned to have either surgery or physical therapy, they had a 3-to-1 chance of having surgery. This means that many more patients went on to have surgery versus physical therapy, and makes the results skewed in that direction. In addition to this, the patients that did receive physical therapy were not provided with quality treatments that were based on evidence, which is the norm for reputable physical therapists. Another major difficulty is the fact that although it’s easy to track patients who move from non-surgical treatment to surgical treatment, this is very difficult for patients who do the opposite. Once again, this favors those who have surgery rather than physical therapy. Finally, the long-term results showed that while the surgical group of patients remained stable, the non-surgical group actually continued to improve after two years. Based on these important shortcomings, the original study was biased in its conclusion that surgery was superior to physical therapy. In actuality, it only performed better in certain measures, and non-surgical treatment actually had some advantages of its own. Therefore, the results from that study should be taken with caution, and patients should understand that what it truly shows is that surgery and non-surgical treatment like physical therapy lead to very similar results. The choice is theirs and should be made by evaluating the costs and long-term outcomes of both treatments.

-As reported in the May ’16 issue of The Spine Journal

Specific exercises are beneficial for neck pain
October 12, 2017

This specific combination of treatments has not yet been studied

Neck pain is a major problem that regularly affects millions of Americans. It’s estimated that between 30-50% of the population experiences neck pain each year, and about 11% of people are limited by it when performing daily activities. Although most cases of neck pain improve on their own within a reasonable amount of time, for some individuals it becomes a long-term problem. When pain lasts for more than three months, it’s called chronic neck pain, and it can lead to additional problems like stress, anxiety, reduced quality of life and a tendency to avoid certain behaviors. There are many treatments available for chronic neck pain, but it’s generally accepted that physical therapy and some other treatments are effective for reducing pain and improving function in patients. In particular, doing specific exercises for the neck, increasing physical activity levels and educating patients on their pain and how to cope with it have all been supported by literature as beneficial treatments for patients with chronic neck pain. Despite the fact that all of these treatments are known to be effective, the result of them being using in combination has not been studied. Therefore, a study called a randomized-controlled trial (RCT) was conducted, which is the most powerful type of individual study that can be performed.

Large sample of patients randomly assigned to two separate groups

Individuals with chronic neck pain for at least six months were recruited for the RCT and screened to determine if they were eligible to participate. Of the individuals screened, 200 were accepted and randomly assigned to either the exercise group or the control group. Participants in both groups attended four education sessions, which lasted for 1.5 hours and took place once a month. The sessions focused on explaining ways that patients could understand and accept their pain, and on how to set goals to work towards. In addition to this, the exercise group also received eight 30-minute sessions, which consisted of instructions for specific neck exercises and a physical activity program. The neck exercises were customized to each patient and were to be performed twice a day for four months. The physical activity program was performed three times a week for four months and consisted of either walking or cycling, and increasing the intensity over this span of time. All participants were evaluated before and immediately after the study for a variety of both physical and mental outcomes related to their chronic neck pain.

Patients who perform exercises and physical activity improve much more

After four months, patients in the exercise group reported significantly better scores than the control group in most/many of the outcomes that were measured. In particular, they were found to have better muscle function, neck flexibility, and pain threshold, as well as improved mood and both mental and physical quality of life. In addition, the participants in the exercise group adhered to their program slightly more than the control group, which may have increased the effect of the treatment even more in their favor. Based on these findings, it appears that a treatment program that combines education, specific neck exercises, and a physical training program is rather beneficial for chronic neck pain patients and can lead to a variety of improvements. Patients who have been plagued by neck pain for a long while should, therefore, seek out the services of physical therapists that provide these types of treatments in order to achieve notable benefits.

-As reported in the August ’16 issue of Manual Therapy

Specific exercises and hands-on therapy is helpful for ankle sprains
October 6, 2017

Many patients who experience one ankle sprain go on to have long-term issues

Ankle sprains are the most common injury in athletes and those who are physically active. These injuries can occur anywhere in the ankle, but sprains to the outside of the ankle (lateral ankle sprains) are most typical and account for about 85% of sprains. In addition to the initial pain and disability that these injuries cause, up to 40% of patients who sprain their ankle once will go on to develop a condition called chronic ankle instability. Individuals with chronic ankle instability tend to experience continual pain and soreness, and a sensation that the ankle is “giving way.” As a result, they are more likely to sprain their ankle again, which can lead to serious long-term issues. Two strategies used by physical therapists for treating these patients are manual therapy and exercise therapy. Manual therapy consists of different types of mobilizations being applied to the patient’s ankle by the therapist, while exercise therapy involves various exercises designed to improve balance and increase strength. Both treatments have been found to lead to benefits, but it’s not completely clear what effect they have when used together. Therefore, a randomized-controlled trial (RCT) was conducted to investigate the combination of these treatments for patients with chronic ankle instability. An RCT randomly places participants in different treatment groups to see which is more effective and is considered the most powerful type of individual study.

Sample of patients randomly assigned to one of two groups

Individuals who reported having recurring ankle sprains were recruited for the study and screened to determine if they were eligible. Out of 68 people screened, 56 fit the necessary criteria and were randomly assigned to one of two treatment groups. Both treatment groups 1 and 2 followed an exercise therapy treatment program that was given during two sessions per week for four weeks. Sessions consisted of six different exercises that were designed to increase strength and improve proprioception, which is the body’s ability to sense its position in space during movements. These exercises were supervised by two physical therapists and progressed each week based on patients’ abilities. In addition to exercise therapy, treatment group 2 also received manual therapy over the course of four weeks. This consisted of therapists performing a series of mobilizations of the ankle joint with the goal of improving patients’ ankle mobility. Each technique lasted 20-30 seconds and was repeated 10 times each by the therapists. All patients were evaluated for pain, ankle stability, pain threshold, strength and flexibility before the study, immediately after treatment and then again one month later.

Adding manual therapy leads to even greater outcomes

Results showed that although both groups reported better overall scores in all the measurements taken, those in treatment group 2 experienced greater improvements than treatment group 1. This was based on lower levels of pain, better ankle stability and greater flexibility, pain threshold and strength in participants who had the treatment combination. These findings suggest that exercises for strength and proprioception can be very effective on their own for helping patients with chronic ankle instability, but adding manual therapy to the treatment program may likely lead to even greater outcomes for them. Therefore, patients with chronic ankle instability who continue to sprain their ankle should seek out physical therapy services to address their condition. By combining exercise therapy for strength and proprioception and manual therapy, physical therapists can produce noticeable improvements in these patients and help them to function better with a reduced risk for additional ankle sprains.

-As reported in the August ’16 issue of Manual Therapy

Seeing physical therapists early for neck pain is better than waiting
September 28, 2017

New strategies are needed to improve healthcare system

Under the current system, the majority of healthcare in the U.S. is delivered in a fee for service, volume-based model. This means that healthcare providers like doctors have an incentive to handle a large number of patients since they will receive payment for their services regardless of each patient’s outcome. Using this type of system is one of the main reasons that healthcare costs continue to increase in the country. Clearly, new strategies are needed to improve the system so that patients can receive the best and most appropriate care possible at a reasonable cost. One way to do this is by identifying treatments that are effective for the patient, priced reasonably and given at the appropriate time. The use of physical therapy early on is one treatment that is studied in this regard.

The benefits of early treatment for neck pain have not been studied

Recent studies have shown that early physical therapy for lower back pain is recommended to improve the outcomes of patients better than prescription medications and other treatments. It has also been found associated with less use of healthcare resources and lower costs overall. Neck pain is the second most common disorder that affects the body’s movements behind lower back pain, and physical therapy is commonly used to treat it; however, the effects of early physical therapy for neck pain have not been studied. For this reason, a study was conducted that compared patients with neck pain who received physical therapy at an earlier date with those that waiting a period of time before beginning physical therapy.

Information from a large database used to compare both patient groups

A large database with detailed information about patients who received physical therapy for neck pain was used to conduct the comparison of early and delayed users. Patients were categorized as using early physical therapy if they reported their pain in less than four weeks, while those who waited longer than four weeks were classified as delaying physical therapy. A total of 1,531 patients were identified from the database and fit the necessary criteria. This included 451 patients who received early physical therapy and 1,080 who received delayed physical therapy.

Early physical therapy leads to several benefits over delaying

After comparing both groups of patients, it was found that those who received early physical therapy experienced better outcomes with less disability and pain than those who delayed it. This was found to be the case not only in their actual outcomes but in their value as well since patients got more out of each dollar they spent with early physical therapy over delayed physical therapy. Since patients improved more and required less treatment, there was also a benefit in cost for the physical therapists and insurance companies. Finally, the overall efficiency of treatment was found to be superior in the group that received early rather than delayed physical therapy. These findings clearly show that seeing a physical therapist for neck pain within four weeks will lead to much better outcomes than waiting longer to do so. More research is needed to confirm these findings and eventually make policy changes to reflect them, but in the meantime, patients who have neck pain are encouraged to see a physical therapist early instead of delaying treatment in order to experience the best possible benefits.

-As reported in the July ’16 issue of BMC Health Services Research

Getting physical activity significantly reduces the risk of arthritis
September 21, 2017

The specific benefits of different amounts of physical activity are not completely clear

It should be commonly known by now that being physically active on a regular basis is beneficial and has a protective effect against many diseases and health conditions. Despite this, it’s not completely clear how this protective effect differs based on the exact amount of physical activity an individual gets. In other words, what amount of physical activity is necessary to experience specific effects, and how does this change with greater amounts of activity? The World Health Organization (WHO) currently recommends getting 600 metabolic equivalents (MET) minutes of total activity each week in order to obtain health benefits. A MET is a unit of measurement used to describe the amount of energy exerted when performing physical tasks or activities, and 600 MET minutes in a week is approximately equal to walking (4 METs) for 150 minutes or running (8 METs) for 75 minutes total. Totals for MET-minutes are calculated by multiplying the METS for the activity by the number of minutes it’s performed, so five hours of gardening (4 METs) in a week equates to 4 x 300 = 1,200 MET minutes. Though these values are commonly used for physical activity recommendations, it’s not completely understood to what degree they reduce the risk for certain health conditions and if greater amounts reduce this risk even more. Therefore, a powerful pair of studies called a systematic review and meta-analysis was conducted. The systematic review gathered all of the highest-quality evidence on the topic available, and the meta-analysis compared the findings of these studies to one another to establish a conclusion.

Researchers identify 174 studies for the systematic review and meta-analysis

Researchers searched through two databases for studies that examined the connection between physical activity and the risk of any of the following five health conditions: breast cancer, colon cancer, diabetes, heart disease and stroke. In particular, they were interested in the total MET-minutes per week of individuals and how that affected their risk for any of those five conditions. After screening 6,965 studies, researchers identified 174 that fit the necessary criteria and were used for the meta-analysis.

Risk for disease is lowered with more physical activity, but only to a certain point

Results from the meta-analysis showed that higher levels of total physical activity were associated with a lower risk for all five of the health conditions that were looked into. The health benefits that individuals experienced were found to be the greatest once achieving a certain amount of physical activity, but after that point, the decrease in risk for the conditions studied was minimal. One of the main examples to illustrate this point is the following: individuals who got 600 MET-minutes per week of physical activity had a 2% lower risk of diabetes compared with those who did not get any physical activity. When the amount of physical activity increased from 600 to 3,600 MET minutes/week, this risk was reduced by an additional 19%. After this, however, similar increases in physical activity only led to small reductions in the risk for diabetes. Similar trends were found with the other health conditions examined as well.

Individuals should get more physical activity than what is recommended

Based on this, researchers said that getting 3,000-4,000 MET-minutes per week appears to be the ideal range for obtaining the most health benefits and the greatest reduction of risk for the five health conditions. More physical activity than this may not necessarily lead to more benefits or a lower risk. The researchers, therefore, suggest that the physical activity levels of individuals should be significantly higher than what is currently recommended (600 MET-minutes/week) in order experience the greatest reduction in risks for breast cancer, colon cancer, diabetes, heart disease and stroke. Since it may take some time before any recommendations are actually changed, individuals can take matters into their own hands and work towards getting more physical activity for their overall health and risk for a disease.

-As reported in the August ’16 issue of The BMJ

Exercise and physical therapy help patients with knee arthritis
September 15, 2017

Unclear if additional sessions make therapy any more effective

Osteoarthritis (OA) is a common disorder in which cartilage that normally surrounds and protects joints wears away gradually over time. Overweight or obese individuals and those over the age of 65 are also more likely to develop it. There are many treatments available for knee OA, including exercise that may be combined with manual therapy. In this type of therapy, a physical therapist performs manipulations and mobilizations with their hands to reduce pain and improve function. Unfortunately, it’s not clear if the use of manual therapy adds any extra benefits to exercise alone. Some patients may also struggle to retain their improvements in the long term. One suggestion is to include “booster sessions,” in which patients meet with their physical therapist regularly for weeks or months after their initial sessions to discuss their progress and help them with recommendations to keep improving. Once again, research is lacking on whether these booster sessions are actually beneficial for patients. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare the effects of manual therapy, booster sessions and exercise therapy for patients with knee OA.

Large sample of patients randomly divided into four even groups

Individuals with knee OA were recruited to participate in the RCT and screened to determine if they fit the necessary criteria. A total of 300 patients were accepted for the study and randomly assigned to one of the following four groups: 1) exercise with no booster sessions, 2) exercise with booster sessions, 3) manual therapy with exercise (no booster sessions), and 4) manual therapy with exercise and booster sessions. The exercise program, which all four groups performed, consisted of various strengthening, stretching, agility and balance exercises. In some cases, additional exercises were added for the hip and ankle if patients seemed to need them. For manual therapy, different maneuvers were applied with manual force from the therapist to increase the flexibility of the knee and surrounding muscles. This all took place during 12 sessions, with those who didn’t receive boosters doing all of them in nine weeks, and those with boosters spreading them out more evenly over 11 months. All patients also followed a home-exercise program twice a week or more that included the same exercises that were performed during the program. Participants were evaluated for pain, function and other measures before treatment, and then nine weeks and one year later.

All patients improve, but role of booster sessions and manual therapy not clear

After nine weeks, patients in all four treatment groups experienced significant improvements in all the outcomes measured. By one year, some of these effects had reduced, but for the most part, the improvements lasted. Despite this, the addition of booster sessions or manual therapy was not found to result in any greater benefits for patients after one year. Some positive effects were noticed, but they did not remain in the long term. Based on these findings, it appears that exercise is clearly effective for reducing pain and improving the function of patients with knee OA. Although booster sessions and manual therapy may help patients improve even more, it was not found to be the case in this study. Additional research is needed to investigate the role of booster sessions in more detail, but for now, patients with knee OA should feel confident that a physical therapist can effectively treat their condition with various exercises and help them achieve improvements that last in the long term.

-As reported in the August ’16 issue of Osteoarthritis and Cartilage

Adding movement to stretching is more beneficial
September 7, 2017

No studies have evaluated the combination of these two types of treatment before

Adhesive capsulitis, or frozen shoulder, is a condition that causes stiffness and pain in the shoulder joint. It restricts the function and motion of the shoulder, which makes it difficult to perform many activities normally. Frozen shoulder is most common in adults between the ages of 40-65 and those who have had the condition in the past, and its cause is still not well understood. Treating frozen shoulder is a long and difficult process, and there are several different strategies that may be used. One of them is called joint mobilization, in which a physical therapist moves the shoulder in different directions to increase its flexibility and reduce pain. Another is manual stretching exercises, which are stretches that are also performed by a physical therapist for the same purpose. Although these techniques have been supported by medical literature as to be effective, combining the two of them has not yet been studied. Therefore, a study called a randomized-controlled trial (RCT) was conducted on the topic. RCTs are the most powerful type of individual studies available, and they compare two groups of patients that are randomly assigned to different treatments.

Two small groups of patients undergo treatments for six weeks

Individuals with frozen shoulder were recruited to participate in the RCT and evaluated to determine if they fit the necessary criteria. Of the 42 patients that were screened, 26 fit the criteria and were then randomly assigned to either the joint mobilization and stretching group or the stretching exercise alone group. Treatment took place during three sessions each week for six weeks, with patients in the combination group receiving both treatments, while the others only received stretching exercises. The joint mobilization exercises were applied by the physical therapist at a lower rate at first, and their intensity increased further into the treatment sessions. This was dependent on the tolerance and pain of each patient. The therapist completed stretching exercises while the patient lay on the bed in 20-minute sessions of 20 seconds of stretching followed by 10 seconds of rest. In addition, patients in both groups followed a home-exercise program twice a day for the duration of treatment. These consisted of 10 repetitions of stretching and strengthening exercises, and patients were told to continue these for at least one year after treatment. All patients were assessed for pain, disability, and flexibility before treatment, immediately afterward, and then one year later.

Combining both treatments is more effective than stretching exercises alone

Results showed that the patients who received the combination of joint mobilization and stretching exercises experienced better outcomes than those who only had stretching exercises. This was seen in measurements for flexibility, pain, shoulder function and the ability to perform daily activities, and the improvements were present up to one year later. These findings suggest that the addition of joint mobilizations to manual stretching exercises leads to the best possible outcomes for patients with frozen shoulder. All physical therapists are capable of performing both of these techniques, and patients with frozen shoulder are therefore encouraged to seek out their services when deciding what type of doctor to visit for treatment.

-As reported in the August ’16 issue of Clinical Rehabilitation

Hands-on physical therapy are effective for a shoulder condition
August 30, 2017

Condition lasts at least one year and consists of three phases

Adhesive capsulitis, commonly called frozen shoulder, is a condition that causes pain, stiffness, and loss of motion in the shoulder. It occurs in about 2-5% of the population and is most common in people between the ages of 40-60. Frozen shoulder lasts approximately 12-42 months, and consists of three phases. It starts with a painful phase lasting 2-9 months, which is followed by a stiff phase for 3-12 months in which the shoulder becomes very stiff and difficult to move. The last of these is the healing, or thawing phase, in which patients regain their movement and function over the course of 5-26 months. Physical therapy is commonly used to treat frozen shoulder, and one of the techniques used by physical therapists is called mobilization. This consists of various hands-on movements applied to the shoulder to increase its flexibility and reduce pain. Although mobilizations are frequently used, it’s not clear how effective they are and which techniques are best. For this reason, a powerful type of study called a systematic review was conducted. The review collected all available literature on the topic to determine which mobilization technique was most effective for frozen shoulder.

A total of 12 studies are accepted for the review

Researchers performed a search using two medical databases for any studies that looked into different mobilization techniques to treat frozen shoulder. A total of 12 studies with data on 810 patients fit the necessary criteria and were included in the systematic review. Seven different types of mobilization techniques were evaluated, and the main patient outcomes measured were pain and range of motion, which is a measure of how much they could move their shoulder. The data from all of these studies was evaluated in depth, and their quality was also assessed to determine how reliable their findings were.

A combination of a few types of techniques is most effective for frozen shoulder

On the whole, mobilization techniques were found to be beneficial for patients with frozen shoulder. A combination of one approach called the Maitland technique with the mobilization of the spine and shoulder stretching appears to be best for reducing pain and improving shoulder flexibility. For this reason, this combination of techniques is recommended for patients with frozen shoulder; however, there was not enough information on many of the other mobilization techniques in the review. Therefore, additional research is needed to investigate these other techniques in more detail so it can be more clearly determined which is the best for treating frozen shoulder. While this process takes place, patients with frozen shoulder should acknowledge that mobilization techniques performed by physical therapists are generally helpful for reducing pain and increasing the flexibility of their shoulder.

-As reported in the August ’16 issue of the Archives of Physical Medicine and Rehabilitation

Treatment program with neck exercises leads to more satisfaction
August 16, 2017

Many patients with whiplash injuries go on to have long-term complications

Whiplash is an injury that occurs after the neck experiences a forceful movement that jerks it back and forth. They tend to cause pain and stiffness that can last for a while. In addition, about half of all patients that have a whiplash injury go on to develop symptoms and complications that can persist for more than one year. These are called whiplash-associated disorders (WADs), which often lead to poor mental health and decreased satisfaction with life. Although WADs are common, there is no clear evidence as to which treatment is best for them. Both general physical activity and exercises designed specifically for the neck are often prescribed, and it’s possible that neck-specific exercises are more effective. Sometimes, these neck-specific exercises are also accompanied by a behavioral approach that targets patients’ mental state in the process.

New study conducted to evaluate long-term outcomes of earlier research

A study was conducted to compare these treatments, and it found that neck-specific exercises were generally more effective than a general physical activity for WADs; however, it did not analyze the satisfaction level of patients. Therefore, another study was performed to evaluate these outcomes in the long-term and determine if different types of treatment led to greater overall satisfaction in patients.

Three groups of patients are evaluated for one year

Patients with long-term WADs were recruited to participate, and a total of 216 fit the necessary criteria and were accepted to the study. These patients were then randomly divided into three groups: the neck-specific exercise group, the neck-specific with behavioral approach group or the prescribed physical activity group. In the neck-specific exercise group, patients were prescribed an exercise program that focused on the neck. During these sessions, which took place twice a week, patients performed various exercises that targeted muscles deep in the neck. Patients also followed a home-exercise program, and more intense treatment was prescribed later on. Patients in the second group followed the same treatment as the first group. The only difference was the program progressed more slowly and was accompanied by education and instructions from a physical therapist on how to manage their pain. In the physical activity group, a physical therapist instructed patients to get involved in a regular physical activity of their choice on a regular basis, and no exercises for the neck were prescribed. All treatments lasted for three weeks, and patients were told to continue exercising afterward. In this analysis, patients were assessed for treatment satisfaction and other variables for up to one year.

Greater improvements lead to greater overall satisfaction

Results showed that after one year, the satisfaction of all patients with their treatment improved over time, regardless of the type of treatment they received. However, the patients who received neck-specific exercises were found to improve significantly more over time than those who received physical activity. They also reported greater enablement and expectation fulfillment, which are related to satisfaction. This was apparent regardless of whether behavioral therapy was also used. Considering the fact that the earlier study also showed patients who received neck-specific exercises experienced less pain and greater functioning, it appears that these improvements were associated with better satisfaction levels as ell. Patients with WADs can benefit from seeing a physical therapist for a treatment program that focuses heavily on neck-specific exercises in order to experience the best possible outcomes and highest level of satisfaction with their treatment.

-As reported in the August ’16 issue of the Journal of Orthopaedic and Sports Physical Therapy

Physical therapy improves health and is effective for its cost
August 11, 2017

New strategies are needed to address rising health care costs

Health care costs are continuing to rise in many developed countries throughout the world, which is partially due to a growing number of people approaching retirement age. In the U.S., millions of individuals still don’t have health care insurance, and many of those who do are not satisfied with their plan. This highlights the need for new strategies to address rising health care costs and make effective insurance more affordable for individuals. One concept that plays a major role in this process is cost-effectiveness, which essentially determines how much someone is getting out of a treatment based on how much it costs. A treatment that is highly cost-effective will produce good results without costing too much. Physical therapy is one treatment that’s considered by many in the field to be cost-effective since it usually leads to notable improvements and is reasonably priced. To develop a clearer understanding physical therapy’s cost-effectiveness, a powerful study called a systematic review was conducted. This systematic review collected all the available evidence on the cost-effectiveness of physical therapy compared to usual care, which includes appointments with doctors, medications and other services. Its goal was to determine just how cost-effective physical therapy is for patients to better guide treatment decision-making.

18 studies fit the necessary criteria for review

Researchers performed a search of four major medical databases for relevant studies on the cost-effectiveness of physical therapy compared to usual care for various conditions. After screening 367 initial matches and going through additional references, they found 18 studies that fit all the necessary criteria and were used for the review. The findings of these 18 studies were evaluated and compared to one another, and the quality of each study was also assessed to determine the reliability of the information they provided.

Physical therapy leads to improved health and is generally found to be cost-effective

Results from this systematic review showed that physical therapy, either on its own or added to usual care, led to improved health. This was found to be the case in almost all studies included. Regarding cost-effectiveness, six out of eight studies found that physical therapy on its own was cost-effective when compared to usual care. In addition, four out of 11 studies found physical therapy to be cost-effective when combined with usual care. Overall, this amounted to more than half of the studies supporting the cost-effectiveness of physical therapy. One reason this figure is not higher is the fact that different definitions of cost-effectiveness were used in the included studies. This may have made it difficult to determine the true cost-effectiveness of physical therapy. Nonetheless, this review shows that physical therapy is beneficial for leading to improvements in health, and it is generally cost-effective for patients. Additional studies should look into this matter in greater detail and researchers should also work towards establishing a clearer definition for cost-effectiveness, which will make comparing studies easier in the future.

-As reported in the June ’16 issue of Physical Therapy