Study: Progressive Strengthening Program Shows Promise Over ‘Standard of Care’ Rehab for Patients Post-TKA

Adults 50 and older who undergo TKA may never fully achieve the same function as older adults without knee pain, but a progressive strengthening exercise program may bring them closer to those levels than would the variable approaches considered “standard-of-care,” according to authors of a recent study.

The study compared self-reported function and test performance for 3 groups: 88 adults aged 50 and older without knee or joint pain (and no TKA); 40 adults aged 50 and older who underwent TKA and participated in “standard-of-care” rehabilitation; and 165 adults aged 50 and over who underwent TKA and participated in what authors describe as an outpatient clinic program that “included progressive strengthening exercises that targeted muscle groups in the lower extremity.” Results were published in Physiotherapy Theory and Practice.

The strengthening program was conducted at a University of Delaware physical therapy clinic beginning 3 weeks after TKA, and consisted of at least 12 outpatient visits 2–3 times a week. The visits themselves focused on strengthening exercises that were progressively adjusted to maintain maximal effort for 3 sets of 10 repetitions for all exercises. The “standard of care” group participated in outpatient rehabilitation elsewhere for an average of 23 sessions that mostly focused on range of motion (ROM), stationary cycling, and “various straight-leg raising exercises without weights,” according to the study’s authors.

Full story at APTA

Results support physical therapy or arthroscopic partial meniscectomy in degenerative knees

Arthroscopic partial meniscectomy was as effective as physical therapy in patients with degenerative knees and a confirmed meniscal tear that was non-obstructive, according to results of a multicenter study presented at the EFORT Annual Congress.

At the meeting, Victor A. van de Graaf, MD, Rudolf W. Poolman, MD, PhD, and colleagues at OLVG Ziekenhuis in Amsterdam received the EFORT Gold Orthopedics Free Paper Award, which designated their paper as the best one in the orthopedic category at the congress.

Participants in the study, which was conducted at six hospitals in the Netherlands, were consented and then randomized 1:1 to either arthroscopic partial meniscectomy (APM) or physical therapy (PT). They were also stratified by age into a group of patients aged 45 to 57 years and a group aged 58 to 70 years.

The mean improvement in the IKDC score from baseline to the 24-month follow-up was the primary outcome, results of which were more favorable for the APM group.

Full story at Healio

Collaborative Stop the Cap Efforts from APTA, AOTA, ASHA Receive National Award

APTA has earned another national award—this time for collaborative efforts to push for an end to the Medicare outpatient therapy cap.

The American Society of Association Executives (ASAE) announced that APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA) were the joint winners of a 2018 Power of A Gold Award for their combined “Stop the Cap” efforts. The work of the 3 associations was instrumental in a congressional decision to permanently end the flawed cap process.

ASAE’s Power of A (the A stands for “association”) Awards, are the industry’s highest honor, recognizing the association community’s valuable contributions on local, national, and global levels. The award will be presented to APTA, AOTA, and ASHA at an ASAE awards dinner on October 3. As a Gold Award winner, the Stop the Cap program is 1 of 6 campaigns under consideration for ASAE’s Summit Award, which will be announced later this summer.

Full story at APTA

10 Common Misconceptions About Pelvic Physical Therapy | Pelvic Guru

Have you ever heard of pelvic physical therapy before? Many have not, but this specialty can be a crucial part of someone’s complete medical care – for women, men, and even children. As one my patients recently said,  “I had no idea this sort of thing exists, but I’m sure glad I found it because it has been THE missing treatment I have needed for years!”.

I had never heard of pelvic physical therapy prior to beginning my doctoral program at Duke University. I remember very clearly when I first learned that some physical therapists did “that.” One of my fellow students had completed a small half-day observation at a local clinic, and excitedly told us all about his day watching the “Pelvic PTs.” We were blown away. We had always assumed physical therapists treated back pain, helped patients after surgery, worked with people who had strokes…but pelvic pain? Urinary incontinence? Sexual dysfunction? This was shocking and new.

Full story at Austin Surgical Institute

Pitcher injuries increase as pitch count rises

More than half of high school baseball pitchers report experiencing pain in their throwing arms during the season. To better understand the cause of these injuries, researchers at The Ohio State University Wexner Medical Center conducted a new study to determine when and why overuse injuries are occurring.

“We found that the number of injuries peaked early — only about four weeks in — and then slowly declined until the end of the season,” said James Onate, associate professor of health and rehabilitation sciences at the Jameson Crane Sports Medicine Institute. “We see a lot of kids who didn’t prepare in the off-season and, when their workload goes through the roof, they’re not prepared for the demand of throwing.”

To accurately assess the timing and severity of their pain, 97 high school pitchers were asked to submit a weekly questionnaire via text message.

Full story at Science Daily

Surgical technique improves sensation, control of prosthetic limb

Humans can accurately sense the position, speed, and torque of their limbs, even with their eyes shut. This sense, known as proprioception, allows humans to precisely control their body movements.

Despite significant improvements to prosthetic devices in recent years, researchers have been unable to provide this essential sensation to people with artificial limbs, limiting their ability to accurately control their movements.

Researchers at the Center for Extreme Bionics at the MIT Media Lab have invented a new neural interface and communication paradigm that is able to send movement commands from the central nervous system to a robotic prosthesis, and relay proprioceptive feedback describing movement of the joint back to the central nervous system in return.

Full story at Medical Xpress

Home-based telehealth therapy program effective for stroke rehabilitation, shows study

In-home rehabilitation, using a telehealth system and supervised by licensed occupational/physical therapists, is an effective means of improving arm motor status in stroke survivors, according to findings presented by University of California, Irvine neurologist Steven C. Cramer, MD, at the recent 2018 European Stroke Organisation Conference in Gothenburg, Sweden.

“Motor deficits are a major contributor to post-stroke disability, and we know that occupational and physical therapy improve patient outcomes in a supervised rehabilitation program,” said Cramer, a professor of neurology in the UCI School of Medicine. “Since many patients receive suboptimal therapy doses for reasons that include cost, availability, and difficulty with travel, we wanted to determine whether a comprehensive in-home telehealth therapy program could be as effective as in-clinic rehabilitation.”

Full story at News Medical

Dry needling vs. acupuncture: What the research says

Dry needling and acupuncture involve puncturing the skin with thin needles for therapeutic purposes. While a shared aim is to provide relief from pain, the practices are otherwise very different.

Practitioners of dry needling attempt to release tension from knots and pressure points in muscles. Acupuncturists insert needles to release endorphins and affect the nervous system. Traditionally, acupuncture was used to align a person’s energy, or chi.

While researchers have studied acupuncture as a complementary treatment for many conditions, dry needling is a newer practice, and the evidence is less comprehensive. Also, strict guidelines are in place for acupuncturists, but dry needling is not regulated.

Full story at Medical News Today

Exercise doesn’t slow cognitive decline

Moderate to high intensity exercise does not slow cognitive (mental) impairment in older people with dementia, according to new research.

The research team found that although exercise improved physical fitness, it cannot be recommended as a treatment option for cognitive impairment in dementia.

Nearly 47.5 million people worldwide have dementia and the view that exercise might slow cognitive decline has widespread popularity.

But recent reviews of trials of exercise training in people with dementia show conflicting results. To try and resolve the uncertainty, researchers decided to estimate the effect of a moderate to high intensity aerobic and strength exercise training program on cognitive impairment and other outcomes in people with dementia.

Full story at futurity.org

Prior TBI Diagnosis Increases Risk of Parkinson’s Disease

Recently, there has been attention on the association of traumatic brain injury (TBI) with progressive neurodegenerative diseases; such as, Parkinson’s disease. However, the association between mild TBI and Parkinson’s remains unclear. Therefore, the authors used 3 nationwide Veterans Health Administration databases (Comprehensive TBI Evaluation, National Patient Care Databases, Vital Status File Database) of inpatients and outpatients seen between 2002-2014 to determine the risk of developing Parkinson’s disease following a TBI. Authors age-matched 162,935 patients (~48 years of age) with TBI diagnosis without dementia, Parkinson’s disease, or secondary parkinsonism at baseline to a random sample of patients without any of the aforementioned conditions. The authors defined TBI exposure as a diagnosis of TBI after a comprehensive neurological assessment or by at least one inpatient or outpatient TBI diagnosis from a list of ICD-9 codes. Parkinson’s disease was defined as any inpatient or outpatient diagnosis of ICD-9 332.0 at least 1 year after TBI. The average follow-up was ~5 years. The authors found that a veteran with a prior TBI (0.6%) is >56% more likely to develop Parkinson’s disease than a veteran without a prior TBI (0.3%). This finding was consistent even after accounting for factors such as medical comorbidities (diabetes, hypertension, cerebrovascular disease) and psychiatric disorders (anxiety, post-traumatic stress, drug/alcohol use). Furthermore, this finding was consistent among people with mild or moderate-severe TBI.

Full story at Sports Medicine Research