I understand that mental health is an important topic, but what can I do as a physiotherapist?
As health care professionals we are dedicated to improving a person’s well-being. As physiotherapists, we are comfortable within the realm of physical signs and symptoms, while sometimes neglecting the intimate connection between the physical and mental bodily spheres. It is undeniable that the two are mutually influenced, but how proficient are we as clinicians in recognizing and addressing this importance within a clinical setting?
Do you know what outcome measures are available to you for quantifying suspected mental health disturbances? Are you confident with who you should be referring your patients to, for the appropriate type of care? How equipped do you feel as a physiotherapist, with addressing a suspected underlying mental health imbalance with your patient? If you felt uncertain with any of your answers to these questions, you are certainly not alone.
A person may have knee surgery to treat pain in the joint due to an injury, such as torn cartilage or a torn ligament. It can also treat other conditions, such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
This article will look at the different types of knee surgery, the rehabilitation timelines, and what people can do to help speed up the recovery process.
Types of knee surgery
There are various types of knee surgery. The type that a person has will depend on the particular injury to the knee joint.
A large study has produced strong evidence that a drug commonly used to treat the bone-thinning disease osteoporosis could safely prevent fractures in elderly women who have bones that aren’t as weak.
The study of 2,000 women age 65 and older at earlier stages of bone loss — a condition known as osteopenia — found the drug zoledronatereduced by about one-third the risk they would suffer a break.
“This is an extremely important paper,” says Dr. Ethel Siris, a Columbia University medical professor who specializes in thinning bones and wasn’t involved in the study. “We now know that we have a therapy that has been shown to be highly effective.”
Patellofemoral Pain (PFP) is an umbrella term that describes peripatella or retropatella pain in the absence of other pathologies. Other descriptions for PFP include patellofemoral pain syndrome, anterior knee pain and chondromalacia patellae (Brukner et al, 2017) and is common in loading activities such as squatting, running and stair ambulation (Crossley et al, 2016).
Although numerous intra and extra articulating structures could be responsible for the production of PFP, the actual cause is not entirely understood (Collado and Fredericson, 2010). One consideration is that PFP is a result of an increased loading through the knee, causing peripatella synovitis or damaging the articulating patellofemoral cartilage which, although avascular and aneural could result in an inflammatory cascade that produces synovial irritation (Brukner et al, 2017).
PFP has shown to affect adolescents, young adults, elite athletes as well as members of the general population with incidence rates varying between 15%-45% and is considered one of the most common types of knee pain (Smith et al, 2018).
APTA-supported legislation that protects physical therapists (PTs) and other health care providers who travel across state lines with a sports team is now just a presidential signature away from becoming law. Known as the Sports Medicine Licensure Clarity Act, the bill met with overwhelming bipartisan support in both the US House of Representatives and the Senate, and is on track to receive approval from President Donald Trump.
When it becomes law the legislation will provide added legal protections for sports medicine professionals when they’re traveling with professional, high school, college, or national sports teams by extending the provider’s “home state” professional liability insurance to any other state the team may visit. The law would apply to licensed health care professionals who travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. The bill was introduced in the House by Reps Brett Guthrie (R-KY) and Cedric Richmond (D-LA), and in the Senate by Sens John Thune (R-SD) and Amy Klobuchar (D-MN).
“This is a big win for PTs, but an even bigger step forward in safeguarding the health of athletes,” said Michael Matlack, APTA director of congressional affairs. “Once enacted, this law will help to support the realities of health care among teams that travel across state lines.”
Spinal cord stimulation and physical therapy have helped a man paralyzed since 2013 regain his ability to stand and walk with assistance. The results, achieved in a research collaboration between Mayo Clinic and UCLA, are reported in Nature Medicine.
With an implanted stimulator turned on, the man was able to step with a front-wheeled walker while trainers provided occasional assistance. He made 113 rehabilitation visits to Mayo Clinic over a year, and achieved milestones during individual sessions:
Total distance: 111 yards (102 meters) — about the length of a football field
Total number of steps: 331
Total minutes walking with assistance:16 minutes
Step speed: 13 yards per minute (0.20 meters per second)
“What this is teaching us is that those networks of neurons below a spinal cord injury still can function after paralysis,” says Kendall Lee, M.D., Ph.D., co-principal investigator, neurosurgeon and director of Mayo Clinic’s Neural Engineering Laboratories.
Even though the National Institutes of Health’s “Go4Life” month is wrapping up, the initiative will continue to offer resources to providers and the public. And for good reason.
Strongly supported by APTA, Go4Life is an ongoing effort to connect the public and health care providers with information and resources related to healthy aging. In addition to information on how exercise improves health, the Go4Life website includes suggested exercises, workout videos, fitness tracking resources, and access to printed materials including infographics, posters, bookmarks, and postcards, all available for free. The program also offers a free “Speaker’s Toolkit” to help providers develop presentations to target audiences—available by emailing Go4Life@mail.nih.gov.
Of course, staying physically active for healthy aging isn’t just a good idea—it’s a concept supported over and over again by research. A lot of research. To give you an idea of the level of support for the positive effects of physical activity on aging, here’s a quick overview of just some of the research articles that have been published on this topic during the month of September alone.
Fibromyalgia patients who regularly visit their physicians are much less likely to attempt suicide than those who do not, according to a new Vanderbilt University Medical Center study published in Arthritis Care & Research.
Patients who did not attempt suicide were at the doctor an average of 50 hours per year versus less than one hour per year for the group who committed self-harm, according to lead author Lindsey McKernan, PhD, assistant professor of Psychiatry & Behavioral Sciences, Physical Medicine & Rehabilitation.
“Fifty hours versus one hour – that’s a staggering difference,” McKernan said. “They might have been at one appointment in a year and this disorder, fibromyalgia, takes a lot to manage. It takes a lot of engagement.”
APTA has joined with more than 150 other health care organizations to let the US Centers for Medicare and Medicaid Services (CMS) know that while its “Patients Over Paperwork” efforts are appreciated, one CMS attempt to reduce administrative burdens is likely to result in reduced access to care for some of the sickest Medicare beneficiaries.
The concerns center around a provision related to evaluation and management (E/M) visits included in the 2019 physician fee schedule rule proposed by CMS over the summer. The change, ostensibly intended to reduce paperwork, would collapse E/M payment rates currently based on a 5-level complexity system for new and established patients into what would amount to a 2-level system—combining levels 1-3 and levels 2-5. CMS acknowledges that the change would result in higher payments for E/M visits at the 1-3 levels while levels 4 and 5 will see reductions based on the 2019 proposed relative value units. However, CMS argues, the reduced paperwork burden would offset the payment drop.
In a letter sent to CMS last month, APTA and other cosigners praise CMS for its initiative to reduce provider paperwork, but question the wisdom of the E/M plan, arguing that the change would unfairly impact providers who see sicker patients, “ultimately jeopardizing patients’ access to care.”
The Sports Medicine Licensure Clarity Act (S. 808) has successfully passed the U.S. Senate, taking another critical step forward. Introduced by Senators John Thune (R-SD) and Amy Klobuchar (D-MN) in 2017, this legislation clarifies medical liability rules for sports medicine physicians, athletic trainers and other medical professionals to ensure they’re properly covered by their liability insurance while traveling with athletic teams to another state.
The bill previously passed out of the U.S. Senate HELP Committee in June and will now go back to the U.S. House of Representatives to approve language changes made by the Senate. The House approved a slightly different version of the bill in 2017. Once the House approves the changes, it will advance to the President for signature.
“The passage of S. 808 will ensure patients are able to receive quality care from their respective medical teams, no matter where they are competing,” said AMSSM President Chad Asplund, MD, MPH. “This is another decisive step benefiting everyone involved in taking care of athletic teams.”