Study Finds Tennis Elbow Treatments Provide Little to No Benefit

BOSTON – The painful condition known as “tennis elbow” results from overuse of the tendons in the forearm, typically in a patient’s dominant arm. A repetitive stress injury, tennis elbow affects not just athletes, but also tradesmen, food industry workers, manufacturers and office workers – anyone who uses the hands and wrists for hours each day. Numerous treatments are available to the 200,000 new patients diagnosed with tennis elbow in the United States each year, but few high quality trials have compared these approaches.

In the largest analysis to date, researchers and clinicians at Beth Israel Deaconess Medical Center(BIDMC) have compared the efficacy and safety of non-surgical treatment options for tennis elbow – also called enthesopathy of the extensor carpi radialis brevis (eECRB). Published today in the American Journal of Sports Medicine, the meta-analysis reveals that none of the 11 non-surgical treatment options – including physical therapy, acupuncture, oral anti-inflammatory medications, local botulinum toxin injection therapy, ultrasound, laser therapy and more – performed significantly better than placebo in addressing patients’ pain and that all increased patients’ odds of adverse events.

Full story at bidmc.org

What are the best stretches for tight hamstrings?

The hamstrings are very susceptible to injury, and people who participate in sports that involve running or sprinting are prone to developing tightness or injury in these muscles.

The hamstrings refer to three different muscles in the back of the thigh that run from the hip to the knee. This muscle group helps us walk, run, and jump.

Because people use their hamstrings in everyday movements such as walking, it is important to keep these muscles loose. Stretching will help people avoid strains and muscle tears.

This article will discuss seven of the best hamstring stretches, when to use them, how often to use them, and the benefits of hamstring stretches.

Full story at Medical News Today

Functional regeneration of tendons using scaffolds developed via microarchitectural engineering

The underlying structure-function relationship of living tissues depends on structural and hierarchical anisotropy. Clinical exploitation of the interplay between cells and their immediate microenvironment has rarely used macroscale, three-dimensional (3-D) constructs. Biomechanical robustness is an important biomimetic factor that is compromised during biofabrication, limiting the relevance of such scaffolds in translational medicine.

In a recent study, Zu-Yong Wang and co-workers have detailed a polymeric three-dimensional scaffold engineered with tendon-like mechanical properties and controlled anisotropic microarchitectures. The construct is composed of two distinct portions for high porosity while retaining tendon-like mechanical properties. When tendon cells (tenocytes) were cultured on the scaffold in vitro, phenotypic markers of tenogenesis such as type-1 collagen, decorin, and tenascin were expressed more significantly than in non-anisotropic controls. Now published in Science Advances, the results demonstrated a highly aligned intracellular cytoskeletal network with high nuclear alignment efficiencies. The study also suggests that microstructural anisotropy may play the role of epigenetic mechanotransduction. The work further included an in vivo study where the biomaterial was implanted in a micropig model, with resulting neotissue formed on the scaffold to resemble native tendon tissue in both composition and structure.

Full story at Medical Xpress

Paralysis breakthrough: Electrical implant helps man walk again

A recent case study could overturn existing beliefs about certain paralysis types. An approach combining spinal cord stimulation and physical therapy has now helped a man living for years with lower-body paralysis to stand and walk.

Paraplegia is a condition wherein an individual’s lower body is paralyzed.

A 29-year-old man left with the condition after a snowmobile accident in 2013 has recently been able to stand and walk with some assistance.

This is all thanks to an electrical implant that can stimulate nerves in the spinal cord.

Full story at Medical News Today

Could singing relieve the symptoms of Parkinson’s?

According to a recent pilot study, singing therapy might reduce some of the difficult-to-treat motor and mood symptoms associated with Parkinson’s disease.

Parkinson’s disease is a progressive neurodegenerative condition that affects more than 10 million people worldwide.

Because Parkinson’s predominantly affects older adults, as the population of the United States ages, its prevalence is increasing.

Symptoms include tremor and difficulty coordinating movements. Also, mood changes can occur, with anxiety and depression being relatively common.

Full story at Medical News Today

New study in STEM CELLS could lead to therapy that does away with joint replacement surgery

Durham, NC (October 31, 2018)– A study released today in STEM CELLS moves scientists a step closer to finding how to help the body regenerate joint cartilage ravaged by disease. Their work reveals a new method to quickly and efficiently produce virtually unlimited numbers of chondrocytes, the cells that form cartilage, from human skin cells converted to induced pluripotent stem cells (iPSCs). For the 54 million Americans suffering from arthritis – the nation’s Number One disability – this could be great news.

While a May 2018 report by Modern Healthcare says that currently over 1 million joint replacement surgeries occur every year in the United States alone — and that number is expected to exceed 4 million by 2030 — many medical researchers believe that the future of arthritis therapeutics lies in the application of stem cells to grow new joint cartilage (a process called “chondrogenesis”). Human iPSCs (hiPSCs) are a promising cell source for cartilage regenerative therapies and in vitro disease-modeling systems due to their pluripotency and unlimited proliferation capacity. Furthermore, iPSCs provide a means of developing patient-specific or genetically engineered cartilage to screen for osteoarthritis drugs.

“That’s why finding methods to rapidly and efficiently differentiate hiPSCs into chondrocytes in a reproducible and robust manner is critical,” said Farshid Guilak, Ph.D., from Washington University’s Center of Regenerative Medicine and Shriners Hospitals for Children (St. Louis, Mo.). He is a co-senior author of the study in STEM CELLS along with Charles A. Gersbach, Ph.D., from the Department of Biomedical Engineering at Duke University (Durham, N.C). Scientists from Cytex Therapeutics (Durham, N.C.) and Stanford University (Stanford, Calif.) also participated.

Full story at Stem Cells Portal

Study reveals no benefit to costly and risky brain cooling after brain injury

The study, published today, in the Journal of the American Medical Association and presented at the same time at the Congress of European Society of Intensive Care Medicine in Paris by lead authors, Professors Jamie Cooper and Alistair Nichol, looked at the outcomes for 511 patients across six countries who had traumatic brain injury (TBI).

An estimated 50-60 million people, worldwide, will suffer a TBI this year and more than half of the world’s population will suffer at least one TBI during their lifetime. There has long been controversy around the benefits of brain cooling in the Intensive Care Unit following a TBI, in the belief the cooling or hypothermia reduces brain inflammation and consequent brain damage.

Professors Cooper, and Nichol, together with Lisa Higgins, and Tony Trapani, Dr. Dashiell Gantner, Profs Michael Bailey, Stephen Bernard, Peter Cameron Jeffrey Rosenfeld and Andrew Forbes all from Monash, together with colleagues in Queensland, Western Australia, New Zealand, France, Qatar, and Saudi Arabia, divided the TBI patients into two groups: those that received hypothermia treatment as soon as possible post-injury, often in the ambulance on the way to an emergency department, and half who did not receive the therapy. The study, called POLAR (Prophylactic hypothermia to lessen traumatic brain injury) ran from seven years from 2010.

Full story at Medical Xpress

Survey Finds ‘Considerable Variation’ in Postsurgery ACL Rehab

Authors of a new study say that while guidelines exist for rehabilitation after anterior cruciate ligament (ACL) reconstruction, there remains “a large degree of variation in rehabilitation progression” among physical therapists (PTs), particularly when it comes to timing of the progression, strength assessment, and use of patient-reported outcome measures

Those conclusions, published in the Journal of Orthopaedic and Sports Physical Therapy were based on results of an online survey of 1, 074 members of APTA’s Academy of Orthopaedic Physical Therapy, American Academy of Sports Physical Therapy, and Private Practice Section. Authors believe that this is the first time PTs’ private practice patterns in this area have been studied.

As for the respondent pool, the majority of PTs treated patients in a private practice or hospital-based outpatient facility. Just over half (52.5%) held American Board of Physical Therapy Specialties certifications in either orthopaedic or sports physical therapy, and 92.5% were APTA members. Authors of the study also classified respondents by the volume of post anterior cruciate ligament repair (ACLR) patients they treated annually, with 32.3% falling into the “low volume” category of 1 to 5 per year, 28.8% grouped into a “medium volume” category of 6 to 10 patients per year, and 37.9% categorized as “high volume,” with 11 or more post-ACLR patients per year. Researchers also tracked respondents by years in practice.

Full story at APTA

CMS Finalizes ‘Site Neutral’ Outpatient Plan; New Approach to DMEPOS Bidding

As it continues to roll out final payment rules for 2019, the US Centers for Medicare and Medicaid Services (CMS) is sticking to its pattern of mostly following through on its original proposals—this time by ending payment rates that favor hospital-owned outpatient facilities over independent physicians’ offices, and adopting a new supplier bidding system for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

Outpatient Prospective Payment System (OPPS)
As it proposed, CMS will expand the use of a “site-neutral” payment model in its reimbursement for the clinic visit service (HCPCS G0463), the most common service billed under the OPPS. Currently, Medicare and beneficiaries often pay more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting. CMS is doing away with the current system that pays so-called “off-campus” hospital-owned facilities an estimated $75 to $85 more than it does independent counterparts for this service. According to a CMS fact sheet, the agency estimates that the change, implemented over a 2-year period, will save an estimated $380 million in 2019 alone. The change does not directly affect physical therapists (PTs) working in outpatient hospital settings, given that outpatient therapy services delivered by PTs are paid under the physician fee schedule, not OPPS.

Full story at APTA

Final Home Health Rule Keeps New Payment Model—With a Few APTA-Supported Changes

Although comments from APTA and other stakeholders helped to spark a few positive changes, the final home health (HH) rule released by the US Centers for Medicare and Medicaid Services (CMS) is nearly the same as what was proposed in July, complete with a major shift to an entirely new payment methodology.

That payment system, known as the Patient Driven Groupings Model (PDGM), moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. However, CMS seems to have listened to APTA and others who called for more detailed clinical care groupings and a clarification that therapists will be permitted to use remote patient monitoring. Mandated by the Balanced Budget Act of 2018, the new system commences in January 2020. Meanwhile, according to a CMS fact sheet, home health providers are on track for a 2.2% payment increase in 2019—the first increase in 10 years.

Full story at APTA