Category: medical

Virtual PT after knee replacement provides good outcomes with lower costs

A virtual system for in-home physical therapy (PT) provides good outcomes for patients undergoing rehabilitation following total knee arthroplasty (TKA) – with lower costs than traditional in-person PT, reports a study in the January 15, 2020 issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

“Relative to traditional home or clinic PT, virtual PT with telerehabilitation for skilled clinical oversight significantly lowered three-month health-care costs after TKA while providing similar effectiveness,” according to the clinical trial report by Janet Prvu Bettger, ScD, of Duke University, Durham, N.C., and colleagues.

Ready full article at News-Medical.net

Study finds dopamine, biological clock link to snacking, overeating and obesity

Coinciding with this increase in weight are ever-rising rates of heart disease, diabetes, cancer and health complications caused by obesity, such as hypertension. Even Alzheimer’s disease may be partly attributable to obesity and physical inactivity.

“The diet in the U.S. and other nations has changed dramatically in the last 50 years or so, with highly processed foods readily and cheaply available at any time of the day or night,” Ali Güler, a professor of biology at the University of Virginia, said. “Many of these foods are high in sugars, carbohydrates and calories, which makes for an unhealthy diet when consumed regularly over many years.”

In a study published Thursday in the journal Current Biology, Güler and his colleagues demonstrate that the pleasure center of the brain that produces the chemical dopamine, and the brain’s separate biological clock that regulates daily physiological rhythms, are linked, and that high-calorie foods — which bring pleasure — disrupt normal feeding schedules, resulting in overconsumption. Using mice as study models, the researchers mimicked the 24/7 availability of a high-fat diet, and showed that anytime snacking eventually results in obesity and related health problems.

Read full article at Science Daily

Separate Studies, Similar Conclusions: Bundling for Knee, Hip Replacement Seems to be Working

Has all the bundling been worth it? Two new studies of bundled care models used by the Centers for Medicare and Medicaid Services (CMS) conclude that, at least for lower extremity joint replacement (LEJR), the answer is yes. Taken as a whole, the studies make the case that while the savings achieved through some bundled care models may not be dramatic, they do exist — and aren’t associated with a drop in quality.

The studies, published in Health Affairs, take different approaches to answering questions about the effectiveness of bundling programs mostly associated with CMS’ voluntary Bundled Payments for Care Improvement (BPCI) initiative: one was a systematic review that analyzed existing research on the programs, while the other focused on data from hospitals that did and did not participate in BCPI over a three-year period. Their conclusions, however, had much in common.

Full article at APTA

Telemedicine may be as effective as in-person visit for people with many neurologic disorders

For people with many neurologic disorders, seeing the neurologist by video may be as effective as an in-person visit, according to a review of the evidence conducted by the American Academy of Neurology (AAN). The evidence review examined all available studies on use of telemedicine for several neurologic conditions – stroke being one of the conditions that is well-validated and highly utilizes telemedicine – and is published in the December 4, 2019, online issue of Neurology®, the medical journal of the AAN. The results indicate that a diagnosis from a neurologist by video for certain neurologic conditions is likely to be as accurate as an in-person visit.

Telemedicine is the use of video conferencing or other technology for doctor visits from another location. The patient could be at home or at a local doctor’s office.

Full story at News-Medical

UnitedHealthcare to Expand Program Waiving Copays, Deductibles for Physical Therapy for LBP

Momentum around better insurer coverage of physical therapy continues to build at UnitedHealthcare (UHC), which announced that it’s moving ahead to expand a pilot project that waives copays and deductibles for 3 physical therapy sessions for patients with new-onset low back pain (LBP). The pilot follows a multiyear collaboration between APTA, OptumLabs®, and UHC.

The program is targeted at UHC enrollees in employer-sponsored plans who experience new-onset LBP and seek care from an outpatient in-network provider. The program fully covers up to 3 visits to a physical therapist (PT) or chiropractor in addition to visits normally covered. When the program was rolled out in June, it was limited to plans sponsored by employers of more than 50 employees in Florida, George, Connecticut, North Carolina, and New York. The expanded pilot, which begins January 1, 2020, will extend to self-funded plans with 2 to 50 employees in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia.

Full story at APTA

BU researcher receives NIH grant for clinical research in rheumatology

David Felson, MD, MPH, professor of medicine and epidemiology at Boston University Schools of Medicine (BUSM) and Public Health (BUSPH), was awarded a National Institute of Health (NIH) P30 Center Grant.

The five-year, $3.6 million award will allow for further clinical research in rheumatology at the Boston University Core Center for Clinical Research, and will provide broad clinical research expertise to a large multidisciplinary group of investigators whose research focuses on osteoarthritis and gout with a secondary emphasis on scleroderma, spondyloarthritis, osteoporosis and musculoskeletal pain.

The Center includes researchers from BU, Boston Children’s Hospital, the Beth Israel Deaconess Hospital, Massachusetts Institute of Technology, Northeastern University and different groups at Harvard University. This group is comprised of individuals with backgrounds in rheumatology, physical therapy, engineering, epidemiology, biostatistics, genetics, evolutionary biology and behavioral science, who critically review projects, provide methodologic guidance to research and creates new multidisciplinary collaborations.

Full story at News Medical

Exercise especially important for older people with heart disease

It is well-known that exercise is good for cardiac health, but older adults tend to fall through the cracks when it comes to rehabilitation programs. Now, a study has shown that these individuals have the most to gain.

Heart disease is the leading cause of death for both men and women in the United States, being responsible for 1 in 4 deaths. Every year, approximately 610,000 people in the U.S. die of heart disease, while about 735,000 people have a heart attack.

Adults over the age of 65 years are more likely than younger people to have heart disease because the heart changes with age. Heart disease is a significant cause of disability, according to the National Institute on Aging, who note that it affects the ability of millions of older people to be active and have a good quality of life.

Full story at Medical News Today

Caution urged in reducing opioids for pain

After years and decades in which healthcare providers were freely prescribing opioids for all sorts of painful conditions, the US Centers for Disease Control and Prevention (CDC) published guidelines to help bring down opioid prescription rates and with them, addiction and overdose-related death rates. Though these were not binding, they urged physicians to be cautious in dealing with opioids when prescribing for pain.

The result was predictable: many doctors and patients, as well as advocacy groups, reacted strongly, claiming that many patients with severe chronic pain had been on opioids for years at high doses, yet had not developed addiction. They also claimed that the guidelines had caused many such patients to go without the pain relief they required. Over 300 doctors also formalized their protests in a letter to the CDC in the first part of 2019.

In clarification, the CDC countered by saying that its guidelines were not meant to force patients or healthcare providers to suddenly stop taking opioids or sharply reduce the dosage, and called upon doctors to understand its stance properly before applying the guidelines. The new guide shows potential sources of harm to patients who are abruptly taken off opioids, and describes factors that must be kept in mind when opioid tapering is considered. The CDC has also included several tapering protocols, to reinforce the message that abruptly stopping opioid use patterns could harm the patient.  

Full story at News Medical

Wrist-worn step trackers accurate in predicting patient health outcomes

Determining how far patients with pulmonary disease can walk in six minutes has long been an effective clinical tool to help physicians determine their exercise capacity, as well as to aid in predicting health outcomes and mortality.

Now, in a new study, researchers at Intermountain Healthcare in Salt Lake City found that steps measured through a step tracker worn on the wrist can be used to estimate exercise capacity and determine the health status of patients, rather than the standardized six-minute walk distance test, which is usually conducted in a clinical setting.

Using the wrist-worn step trackers, researcher found data may be used in clinical care at higher intervals to effectively monitor patient progress and disease management. Researchers say the results are another example in how wearable and monitoring devices like Fitbits and Apple Watches can be used in patient care to improve outcomes.

Full story at Medical Xpress

Posture and Movement Coordination, Sensorimotor Integration May Affect Motor Skills in Children With Autism

The message

In children with autism spectrum disorder (ASD), problems with sensorimotor integration and difficulty in coordinating posture and arm motions may result in impaired motor planning and control. These children also exhibited fewer anticipatory postural adjustments and demonstrated more corrective control during arm movements. Compared with typically developing peers, children with ASD were less likely to use visual cues to plan for motions required to catch an item, such as a ball.

The study

To examine the interplay of sensory cues, postural demands, and arm movement during ball-catching, researchers in Taiwan asked children with and without ASD to catch a ball rolling down a ramp toward them. Of the children, 15 had ASD and 15 were typically developing age- and sex-matched peers.

Full story at APTA