Consumer Reports and The Washington Post are helping to spread the word: physical therapy, not surgery, can be the best first-option treatment when it comes to meniscus tears and spinal stenosis.
The July 24 online edition of the Post includes a feature from Consumer Reports titled “If your doctor says you need surgery, you may want to explore other options.” The article lists 4 common surgeries—arthroscopic surgery for a torn meniscus, carotid artery surgery, laminectomy and fusion for stenosis, and hysterectomy—that it describes as “procedures to question if your doctor pushes for them.”
The article states that “research shows that [arthroscopic surgery is] often no better than physical therapy at easing symptoms” of a torn meniscus and points to a study, reported in PT in Motion News in early 2014, that found no differences in outcomes for patients who underwent actual vs sham arthroscopic surgery.
When it comes to rehabilitative therapy poststroke, a new study reinforces the idea that the higher the intensity of the therapy, the less likely it is that a patient will be readmitted to the hospital 30 or 90 days after discharge.
Researchers examined medical records from 64,065 patients admitted to hospitals in Florida and Arkansas for an incident stroke between 2009 and 2010 and linked 30- and 90-day readmissions with the level of physical therapy, occupational therapy, and speech therapy they received while in acute care. Those levels were defined as none, low, medium-low, medium-high, or high, relative to the sum and distributions of charges within each hospital.
When the US Women’s National Soccer Team clinched the World Cup this summer, forward Amy Rodriguez celebrated an additional victory—her successful (and physical therapy-aided) return to the team after having a baby not quite 2 years earlier.
Rodriguez shares her story on the most recent episode of Move Forward Radio—how she approached her pregnancy and return to sport, and the role that physical therapy played in that journey. Although told through the eyes of a world-class athlete, Rodriguez’s story will resonate with moms of any athletic ability who want to regain a physically active lifestyle after childbirth.
Other recent Move Forward Radio episodes include:
Total Knee Replacement: A Storybook Approach Louise Chegwidden, PT, FT, has watched patients and families struggle to cope with the information overload that accompanies total knee replacement surgery, and decided there had to be a better way to prepare families and improve expectations. To fill that void, she wrote a guidebook for families called “Granny Gets a New Knee: and a Whole Lot More.” Chegwidden discusses some of the things patients and family caregivers should know about total replacement surgery, including the benefits of seeing a physical therapist before the procedure. (You can read more about Chegwidden and other physical therapist book authors in PT in Motion’s July feature story “Physical Therapist Authors.”)
When it comes to choosing surgery or physical therapy for carpal tunnel syndrome (CTS), studies have found most people would rather pursue a conservative approach. Now new research from Spain is providing more support for that preference, concluding that in terms of pain and function, physical therapy is equal to surgery at 6 and 12 months after baseline, and actually produces greater improvements earlier on.
In a study e-published ahead of print in the Journal of Pain researchers compared pain and function reports from 111 women who underwent either surgery (56 participants) or physical therapy (55 participants) for CTS. Using the Numerical Pain Rating Scale (NPRS), Boston Carpal Tunnel Questionnaire (BCTQ), and the Global Rating of Change assessment, they analyzed reports at 1, 3, 6, and 12 months after surgery or therapy.
The volume vs value debate, long-familiar to physical therapists (PTs) and physical therapist assistants (PTAs), is now getting wider exposure by way of a recent Wall Street Journal (WSJ), article on the “copious” use of ultrahigh therapy hours billed to Medicare by skilled nursing facilities (SNFs).
In a story published on August 16, WSJ describes results of an analysis it conducted on SNF billing patterns between 2001 and 2013, which found that the use of the ultrahigh category of rehabilitative therapy reimbursement—720 minutes or more a week per patient—has increased from 7% of patient days in 2002 to 54% of patient days in 2013.
While the story acknowledges the benefits of rehabilitative therapy, describing physical therapy, occupational therapy, and speech therapy as often “crucial to recovery,” it also cites interviews with “more than two dozen current and former therapists, rehabilitation directors, and others” who told WSJ reporters that “managers often pressure caregivers to reach the 720-minute threshold.”
Nearly 1 in 3 reproductive-aged women may be experiencing chronic or cyclic pelvic pain, with many cases going unreported and untreated, according to a new report from the National Institutes of Health (NIH).
In a study designed to assess the connection between pelvic pain and endometriosis, researchers from NIH and the University of Utah School of Medicine surveyed 473 18- to 44-year-old women scheduled to undergo surgery or imaging. The reasons for the surgery or imaging included infertility, menstrual irregularities, tubal sterilization, masses or lumps in the pelvic region, or pelvic pain.
Prior to surgery, the women answered questions about the location and severity of any pain they had experienced in the past 6 months. The survey included questions about 17 specific types of pain related to sexual intercourse, menstrual period, urination or bowel elimination, or other pain, such as muscle or joint pain or migraine headaches.
Patients who receive care from self-referring physicians for the treatment of low back pain (LBP) are more likely to be referred for some form of physical therapy, but that’s just part of the story. According to newly published research, LBP patients who are self-referred receive fewer physical therapy visits and more ineffective passive modalities than patients who aren’t self-referred—and all at a higher overall cost.
In the study, researchers analyzed 158,151 LBP episodes in private health insurance claims records for nonelderly individuals enrolled in plans offered by Blue Cross Blue Shield of Texas. They found that physicians who “self-referred”—that is, referred their patients to a business with which they have a financial relationship—referred 26% of their patients to physical therapy. That rate was 16 percentage points higher than among non-self-referrals. Overall physical therapy was referred at a rate of 14%.
But the higher rate of referrals doesn’t tell the whole story, according to the study’s authors, who analyzed what happened next—and how much it wound up costing.
Even though cardiac rehabilitation (CR) is strongly supported as an intervention for patients who have suffered a heart attack, too few people are getting referrals for CR programs, and an even smaller number is actually following through once they get a referral, according to a research letter recently published in JAMA.
Authors looked at CR enrollment and participation rates by comparing Medicare records of 58,269 acute myocardial infarction (AMI) patients with a national registry of coronary treatment intervention outcomes (National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Registry). They found that between 2007 and 2010, only 64.2% of AMI patients were referred to CR at the time of hospital discharge, and only 12,000 of those patients attended at least 1 CR session during the following year.
Broken down in another way, the rates of CR referral and engagement are even more disappointing: according to the researchers, among all patients included in the study, only 23.1% attended at least 1 CR session. Just 5.4% completed 36 sessions or more—the number of sessions typically covered by health insurance.
Researchers have known for a while that insulin resistance (IR), a condition that can lead to diabetes, tends to peak in mid-adolescence, and they were aware that physical activity (PA) can have a positive effect on those IR levels. Now, they have a better understanding of just how significantly IR levels can be knocked back by PA—and how those effects are limited to a certain age-related window.
A study of 300 children in England aged 9-16 (evenly divided between males and females) found that during the average peak in IR, at ages 12-13, adolescents who were physically active reported IR levels 17% lower than their less-active cohorts, independent of body fat percentage and their pubertal status. Interestingly, those positive effects taper off fairly rapidly with age, moving to a 14% difference by age 14, an 8% difference by 15, and a negligible 1% difference at 16.
Researchers have known for some time that vertebrae diameters in adult women are smaller than in men, but now a new study says that those differences occur in the fetal stage and are present at birth—a variation believed to be an evolutionary adaptation that allows females the increased flexibility needed to maintain mobility during pregnancy.
In a study published in the August issue of the Journal of Pediatrics, authors used magnetic resonance imaging (MRI) to look at the spines of 35 newborn males and 35 newborn females, all healthy full-term babies aged 2-7 days. What they found is that while other factors were equal among the groups—such as spine length, vertebrae height, intervertebral disc height, and even femur length and diameter—the cross-sectional area (CSA) of the vertebrae of the females was on average 10.6% smaller than the males.
Authors theorize that the difference is related to human evolution as bipedal animals.