- Your Bridge to Health -

Older PT patients treated before hip surgery show better outcomes
May 31, 2018

Delaying surgery can lead to complications after the procedure

Hip fractures are the most common fractures in older adults, and their frequency is growing as a result of an aging population. Rehabilitation methods like physical therapy are recommended after hip fractures to prevent the loss of patients’ independence, but many patients also require surgery to help them recover. Occasionally, surgery for these patients needs to be delayed, mainly because of acute medical problems and lack of operating room availability. Delayed surgery can lead to complications like pneumonia, a decline in physical function, and delayed discharge from the hospital, which is why it’s important to identify ways to reduce these complications. One possible solution is to provide physical therapy before surgery-or preoperative physical therapy-but research on this topic is limited. For this reason, a study was conducted to determine if preoperative physical therapy is effective for improving outcomes and reducing complications in older adults who have hip surgery.

Data on 681 older patients analyzed

To conduct the study, researchers sought out data on older patients who had underwent surgery for a hip fracture from 34 hospitals. A total of 681 patients fit the necessary criteria to be included in the study, half of which were treated with preoperative physical therapy. The preoperative physical therapy program consisted of muscle-strengthening exercises that targeted the lower limbs and trunk, stretching exercises, sitting exercises and ankle movements intended to prevent a condition called deep vein thrombosis. Most programs consisted of about 20-30 minutes of physical therapy every weekday prior to surgery, and whether or not patients received it was determined based on the doctor’s personal opinion. Once these patients were identified, data regarding their outcomes after surgery was collected and analyzed. In particular, researchers were interested in patients’ Functional Independence Measure (FIM) scores, which assessed their independence in common daily activities.

Preoperative physical therapy leads to a number of benefits for patients

Results indicated that patients who underwent preoperative physical therapy experienced a number of benefits and better outcomes compared to those who did not. In particular, preoperative physical therapy patients reported significantly greater gains in motor FIM scores, motor FIM effectiveness and motor FIM score at discharge than the other patients. This means that these patients became significantly more independent while functioning in their daily lives due to the treatment they received. These patients were also discharged from the hospital at a faster rate compared to those who did not receive the therapy. Based on these findings, it appears that preoperative physical therapy can lead to better overall outcomes for older patients who have surgery for a hip fracture. Patients who need hip surgery should therefore be aware that physical therapy before their procedure is an option that will likely help them recover faster, and they should ask their doctor about what is available to them during this time.

– As reported in the March ’18 issue of Geriatrics & Gerontology International

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May 25, 2018

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PT Referral is Down While Opioid Use is Up?
May 24, 2018

Physical therapy is consistently supported as an effective treatment for low back pain

Low back pain (LBP) is estimated to affect up to 80% of all Americans at some point in their lives, and it is one of the leading causes of disability and reasons for visiting a doctor throughout the world. On top of this, studies suggest that this problem will only continue to grow in the future as more people become affected by the condition. National and international guidelines recommend a number of treatments for LBP, which include education, exercise, massage and manual therapy, particularly because they have been deemed effective and safe. Physical therapy for LBP typically includes these and many other commonly recommended interventions, which are brought together in a personalized way for each patient. Studies have consistently shown that physical therapy is an effective treatment for LBP, and the earlier a patient is referred to a physical therapist, the sooner they return to work and the better their outcomes are. This is why many national guidelines specifically recommend physical therapy for LBP. Yet despite this evidence and support, it doesn’t appear that the referral rates for physical therapy have actually increased over the years. To get a clearer idea of how the referral rates of physical therapy to treat LBP have changed in recent times, a study was conducted.

National surveys used to establish patterns in referral rates

To perform the study, researchers collected data from two national surveys on medical care services and another survey from emergency departments from 1997 to 2010. They focused only on visits for patients between 16-90 years of age, and classified patients into four groups based on their age: 16-39, 30-44, 45-59 and 60-90. In addition to data on physical therapy referral rates, researchers also analyzed data on the rates for opioid prescriptions over the same period of time.

Measures are needed to educate doctors and patients about the benefits of physical therapy

Based on the surveys analyzed, approximately 170 million patients visited a doctor for complaints related to LBP. From these visits, 17.1 million patients were referred to physical therapy, which equated to a referral rate of 10.1%. From 1997 to 2010, this referral rate for physical therapy remained stable at this low percentage, while the rate for opioid prescriptions increased in these patients over the same time period. Further analysis showed that patients who were not referred to physical therapy were more likely to receive an opioid prescription. This highlights a major problem occurring in the country today, as rising rates of opioid prescriptions are largely to blame for addiction and abuse of these drugs. Physical therapy, on the other hand, is a safe and effective method for treating LBP that is not associated with any of these types of problems. This is why patients with LBP must be educated on the importance of seeking out the services of a physical therapist for their condition, and doctors must also recognize its value and make the appropriate decision of referring patients to physical therapy to improve the chances of a positive outcome.

-As reported in the May ’17 issue of Spine

Patients with a particular type of knee pain are more overweight
May 18, 2018

Association between the two has not been clearly evaluated

Knee osteoarthritis (OA) is a condition in which cartilage that normally protects the knee gradually wears down over the course of time. It is one of the leading causes of pain and disability throughout the world, affecting about 10% of men and 13% of women over the age of 60 in the U.S. The patellofemoral joint connects the kneecap (patella) with the upper leg bone (femur), and symptoms of knee OA frequently occur in this area. This joint also plays a critical role in the function of the knee, as it allows individuals to complete many daily activities like squatting and climbing or descending stairs. Due to its role, though, the patellofemoral joint may be negatively affected by forces that are too strong, such as excessive weight. Overweight or obese individuals with a high body mass index (BMI) put lots of stress on their knees, which may increase the risk for pain in the patellofemoral joint and knee OA, but this association has not yet been clearly evaluated. For this reason, a powerful pairing of studies called a systematic review and meta-analysis were conducted to determine if high BMI is a risk factor for patellofemoral pain and knee OA.

52 studies are accepted into the review

Researchers performed a search of six major medical databases for studies that included information on the associated between BMI and patellofemoral pain or knee OA. This search led to a total of 7,894 studies being evaluated, and from these, 52 met the necessary criteria and were accepted into the review. The findings of each of these studies were then evaluated and compared to one another, and the quality was ranked to determine how reliable their data was. Studies were given a rating from 1 (strong evidence) to 5 (conflicting evidence).

Adults—but not adolescents—with patellofemoral pain and knee OA have a higher BMI

The results of this systematic review and meta-analysis showed that the BMI of adults with patellofemoral pain and knee OA was generally higher than the BMI of healthy individuals without knee pain that they were compared to. When it came to adolescents with patellofemoral pain, however, the same type of association was not found. As for why this association was found it, adults, it likely has to do with the fact that individuals with a higher BMI generally reduce their activity levels due to the persistent pain that is brought on by their condition. In turn, reduced activity levels can actually lead to more weight gain and more stress on the knees, which can create a vicious cycle that makes their condition even worse. This study, therefore, shows how important it is for those with a high BMI to reduce their weight, as doing so may also lower their chances of developing knee pain due to the involvement of the kneecap. Physical therapists can help in their pursuit by prescribing specific exercises and offering advice on how to increase physical activity levels, and those with patellofemoral pain are encouraged to seek out their services for additional guidance.

-As reported in the May ’17 issue of the British Journal of Sports Medicine

Patients who undergo therapy before surgery spend less on care after
May 17, 2018

Surgery has become the treatment of choice for patients with severe hip or knee arthritis

Arthritis is one of the most common causes of disability in the U.S. Approximately 50 million Americans have been diagnosed with some form of arthritis, and about one of every three of these patients has reported being physically limited due to their condition. Osteoarthritis-often referred to as wear-and-tear arthritis is the most common form of the disease, and it can be especially troubling. In this type of arthritis, protective cartilage at the ends of bones gradually wears away, sometimes to the point where the bones begin rubbing against one another. Osteoarthritis that progresses to this point is referred to as end-stage arthritis, which often requires aggressive treatment. Total joint replacement surgery has now become the treatment of choice for end-stage arthritis of the hip or knee, and the rate of this surgery is only expected to increase in the future. To improve the outcomes and reduce the costs for patients who undergo surgery, physical therapy is commonly recommended before the procedure. Preoperative physical therapy, or “prehabilitation,” prepares patients’ bodies for the procedure and teaches them what to expect; however, research is limited on its effectiveness. For this reason, a study was conducted to investigate the association between prehabilitation and the use of care after surgery, as well as the associated costs of this treatment.

Data collected on nearly 5,000 patients

To conduct the study, researchers looked for medical records of patients who received treatment after having surgery for hip or knee osteoarthritis. This search led to a total of 4,733 patients being identified who fit the necessary criteria, and data related to their treatment was collected and analyzed. Researchers were particularly concerned with the care these patients received within 90 days after being discharged from the hospital, and the impact that pre-habilitation had on their use of care and its costs.

Pre-habilitation associated with a reduced use of care after surgery

Results showed that overall, 77% of the patients studied used some type of care services after having surgery. In patients who did not receive prehabilitation, 79.7% used these services, compared to only 54.2% of those who received prehabilitation. With further analysis, it was found that the prehabilitation was associated with a 29% reduction in after-surgery care. This reduced use of care resulted in a total savings of $1,215 per patient, which was mainly the result of fewer payments to skilled nursing facilities and home health care.

These findings support the use of preoperative physical therapy-or prehabilitation-in patients preparing for hip or knee replacement surgery, as it can reduce the need for patient care and its associated costs following the procedure. Individuals who are scheduled to have this type of surgery should therefore consider having a short course of physical therapy prior to their surgery date, in order to increase their chances of a successful outcome and quicker recovery.

– As reported in the October ’14 issue of The Journal of Bone and Joint Surgery

Hands- on therapy is beneficial for carpal tunnel and reduces pain
May 14, 2018

Individuals with this condition may have to miss work due to symptoms

Carpal tunnel syndrome (CTS) is a condition that results from pressure being placed on a nerve in the wrist. This compression of the median nerve can come from swelling or anything else that makes the carpal tunnel smaller, and it leads to numbness, weakness, tingling and other problems in the hand. CTS affects up to 3.8% of the population, and its symptoms often make it difficult for working individuals to complete their jobs. This may lead to absence from work and a decline in work performance. Effective treatment is therefore needed to address CTS, and there are many options available. One option that may be used is physical therapy, especially if it includes manual therapy, an intervention in which the therapist performs various manipulations with their hands. Unfortunately, evidence to support physical and manual therapy is lacking, and these treatments are often ignored in reviews. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted that compared manual therapy to another type of treatment called electrophysical therapy for CTS.

Patients randomly assigned to one of two groups

Patients diagnosed with CTS were invited to participate in the study and screened to determine if they were eligible. This process led to a total of 140 patients being accepted to the RCT, who were then randomly assigned to either the manual therapy group or the electrophysical group. Patients in both groups underwent a 10-week physical therapy treatment program, but the specific parts of the program were different in each group. In the manual therapy group, the physical therapist performed a massage and various mobilizations of the median nerve, which was carried out during two weekly sessions for 20 sessions total. The electrophysical therapy group also consisted of 20 sessions total, but patients were treated with a red laser that was pointed at their wrist for two minutes and 40 seconds. The goal of this intervention is to stimulate the immune system to release chemicals that will heal the area and restore balance to the wrist, and was followed by another similar treatment called ultrasound. All patients were evaluated using a number of outcome measures at the beginning of the study and after the treatment was completed.

Both groups improve, but manual therapy brings about greater changes

Results showed that both treatments led to improvements, as patients experienced less pain, greater function, and fewer symptoms after completing the interventions. Patients in the manual therapy group, however, reported even greater improvements than those in the electrophysical therapy group in all three of these measurements. Another finding showed that the average reduction in pain was 290% in the manual therapy group and only 47% in the electrophysical therapy group. Based on these results, it appears that manual therapy is more beneficial for patients with CTS than electrophysical therapy. Patients dealing with CTS should, therefore, seek out the services of a physical therapist that offers this type of intervention in order to experience similar outcomes as the participants of this current study.

-As reported in the April ’17 issue of the Journal of Manipulative and Physiological Therapeutics

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May 11, 2018

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PT after knee surgery leads to improvements in function & flexibility
May 10, 2018

Many patients who have surgery go on to experience lingering issues

The meniscus is a piece of cartilage shaped like a wedge that rests between the thighbone and the shinbone. There are two of these in each of your knees, and the job of each meniscus is to stabilize the knee joint and absorb shock. Meniscus tears are very common, and surgery to repair these injuries is currently one of the most frequently performed procedures. In most cases, knee arthroscopy procedures are used to treat these tears, and it’s estimated that 636,000 of these are performed each year. Arthroscopy is minimally invasive, which means that only small incisions and instruments are used in order to reduce the risk of complications. But many patients who undergo arthroscopic surgery to remove the damaged meniscus still experience issues like pain, loss of range of motion (ROM) and strength, and reduced quality of life (QoL) after the procedure. This is why physical therapy is commonly recommended after surgery to help patients recover more quickly and avoid these complications. But even though it is popularly used, evidence is lacking on the overall effectiveness of physical therapy and which treatments should be recommended. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted.

18 high-quality studies are included

To conduct the review and analysis, researchers performed a search of 11 major medical databases for relevant studies on the topic. Only randomized-controlled trials (RCTs) were accepted, which are considered the gold standard of individual studies for determining if a treatment is beneficial. From this search, 1,028 articles were identified, and 18 of these fit the necessary criteria to be included in the systematic review. Due to certain inconsistencies in these studies, only six were included in the meta-analysis. Once collected, the findings of the included studies were evaluated and compared to one another to determine if physical therapy was indeed effective after arthroscopic meniscectomy and which treatments were best.

Physical therapy benefits patients, especially when a home-exercise program is involved

Results of the systematic review and meta-analysis were generally supportive of the use of physical therapy after meniscus surgery. This was based on several studies that found a positive effect of various types of physical therapy treatments utilized during the recovery period. But the most effective intervention appeared to be combining an outpatient physical therapy program-meaning it was performed at a designated clinic-with a home-exercise program. When this type of combination was used, patients experienced notable improvements in their knee function, ROM, as well as reduced swelling. Based on these findings, it appears that sending patients to physical therapy after meniscus surgery can help them to improve more rapidly, and this process can be improved further by including a home-exercise program. Individuals who are considering or preparing for this type of surgery should therefore ask their doctors about treatment following their procedure and ensure that physical therapy is included in their recovery process.

– As reported in the Aug. ’13 edition of JOSPT

PT after shoulder surgery responsible for a faster recovery
May 4, 2018

Surgery only recommended if other treatments don’t lead to improvements

Subacromial impingement syndrome (SIS), sometimes referred to as shoulder tendinitis, is a painful condition in which certain structures in the shoulder become compressed by bones in that region. Patients with SIS are usually managed with of a number of nonsurgical treatments, including rest, injections and physical therapy. In most cases, surgery is only considered for patients that do not improve after attempting several nonsurgical treatments. After surgery, physical therapy is typically recommended to help patients regain shoulder function. Although this approach is commonly utilized, there is no consensus about the most appropriate strategy, and little is known about the effectiveness of different types of exercise programs. It’s also possible that patients who have trouble returning to normal activities may require additional efforts to help in their recovery. For this reason, a high-quality study called a randomized-controlled trial (RCT) was conducted. In this RCT, patients with SIS who had surgery were randomly assigned to one of two treatments to determine which was more effective for helping them recover.

Patients treated with either physical therapy or usual care

Patients with SIS who had a surgical procedure called arthroscopic subacromial decompression were recruited for the study between 8-12 weeks after surgery. A total of 126 patients fit the necessary criteria and were randomly placed into either the physical therapy group or the usual care group. Patients in the physical therapy group followed a program that consisted of a combination of both supervised training sessions and home-exercise training. They received between 8-15 training sessions during the first eight weeks. Over the next four weeks, the frequency of these sessions varied depending on how patients responded, and they were told to perform their home exercises more regularly. Sessions lasted up to one hour each which consisted of aerobic exercise on a stationary bicycle, manual therapy performed by the physical therapist, and seven exercises that specifically targeted the shoulder. Patients were also instructed to become physically active at a moderate or high intensity for at least 30 minutes three times a week. Patients in the usual care group did not receive any specific treatments, but were told to continue the postoperative treatments recommended by the hospital. All patients were assessed before being assigned to their groups, and then again three and 12 months later for a variety of outcomes, including strength, range of motion and quality of life.

Following a course of physical therapy should be the norm after surgery

Results showed that after 12 months, patients in the physical therapy group improved significantly more than those who received usual care. This was based on better questionnaire scores showing that patients who had physical therapy had improved shoulder function and less fear about their condition than the other group. They were also found to be more physically active and had a better overall impression of the changes they experienced from treatment. This RCT, which is the largest study that’s ever been performed on the topic, clearly shows that physical therapy leads to numerous improvements for patients with SIS after having surgery. Based on these findings, physical therapy should be considered a necessary component of recovery following surgery, and it’s recommended that a treatment program similar to the one used here is followed to increase the chances of a positive outcome.

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

Home exercise and physical therapy beneficial for hand fractures
May 3, 2018

Completing treatment at home has certain advantages

Fractures of the hand are very common, and about one-third of these fractures involve the metacarpals, which are the bones between the wrist and the fingers. These injuries are particularly common in young adults, and they typically prevent patients from being able to carry out many basic tasks that involve the affected hand. The treatment for metacarpal fractures varies depending on how badly the bone is broken, and some patients choose to have surgery with the hopes of restoring their hand function more quickly. After surgery, physical therapy is typically recommended to help patients achieve these goals, and treatment can be given either within a clinic or through a home-exercise program. There are pros and cons of both approaches to treatment, but the main advantage of a home-exercise program is the fact that less time is needed and it can be performed at the patient’s leisure without needing an appointment. Unfortunately, there is not much research to support the use of home-exercise programs for metacarpal fractures. For this reason, a powerful study called a randomized-controlled trial was conducted to compare the two treatments.

Patients are randomly assigned to two groups and evaluated for 12 weeks

Individuals who fractured their metacarpal bone scheduled to have surgery were recruited for the study, and 60 fit the necessary criteria and were invited to participate. These participants were then randomly assigned to either the traditional physical therapy group or the home exercise group. Both treatments started two weeks after surgery, and the physical therapy treatment consisted of 12 30-minute sessions over the course of six weeks. Each physical therapist chose which exercises were to be performed, and they also instructed patients on how to perform these exercises at home. In the home-exercise group, patients were given a booklet with a set of specific exercises, which were to be performed for six weeks. Each day consisted of three exercise cycles, and each cycle consisted of 4-6 exercises and lasted 20-30 minutes. Exercises gradually progressed in terms of intensity as patients improved, and strengthening exercises were performed in the final two weeks. All patients were then evaluated for the flexibility, or range of motion (ROM) of their hand joints, as well as hand function and grip strength at weeks two, six and 12.

Both groups improve to a similar extent

After 12 weeks, results showed that both groups improved in all of the measurements taken. In particular, both the physical therapy and home-exercise group experienced similar improvements in grip strength and hand function, with no major differences found between them. The only significant difference between groups was for ROM of the fingers, as the home-exercise group scored significantly better than the physical therapy group after 12 weeks. These findings suggest that a home-exercise program may be just as effective as a traditional physical therapy program in helping patients recover from surgery for hand fractures. Patients who have fractured their hand preparing to have surgery may, therefore, consider both options after the procedure—and realize the importance of home exercise—to assist them with the recovery process and bring them back to full function as quickly as possible.

-As reported in the April ’17 issue of the Journal of Hand Surgery