FLEX CEUs: New CEU Courses

LOW BACK PAIN: THE ROLE OF FEAR

Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, and evidence suggests that psychosocial factors, especially fear-avoidance beliefs are important in predicting patients who will progress from an acute to a chronic stage, as well as failure of interventions.  The goals of this CEU course are to evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP, determine whether balance response of LBP patients is different from healthy controls under various conditions, and find out whether body sway is related to the fear of fall in LBP individuals.  Fear and psychological distress in regards to pain and disability is also discussed.

LOW LEVEL LASER THERAPY EFFECTS ON INFLAMMATION

Inflammation of the synovial membrane plays an important role in the pathophysiology of osteoarthritis (OA).  The goal of this CEU course is to evaluate the effects of low-level laser therapy (LLLT) on joint inflammation.

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Early physical therapy benefits low-back pain patients

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit—but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

Full story at Medical Xpress

Patients with low-back pain benefit from early physical therapy

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit – but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

Full story at news-medical.net

Rocker bottom shoes help reduce chronic low back pain

A new study confirms that rocker bottom shoes helps strengthen back muscles, improving the spine’s curvature and thus reducing low back pain.

Researchers of the Sports Physiotherapy master’s degree at Valencia’s CEU Cardenal Herrera university have confirmed, in a new study of their research work into back pain, that unstable shoes improve the strength of back muscles in order to maintain balance and stability when walking. This muscular strengthening contributes to reducing low-intensity chronic low back pain, which can be disabling for those who suffer it. The results of this new study, headed by CEU UCH teachers Juan Francisco Lisón and Pablo Salvador, co-authors of the first international study on this matter, have been published in the Q1 edition of scientific magazine Clinical Rehabilitation.

As the coordinator of the CEU UCH master’s degree, Pablo Salvador, explains, “patients with chronic low back pain are usually advised to perform exercises to strengthen the muscles in their back, which improve stability of the spine in the lower back area, although it is always hard to make sure they comply with this type of exercises. What this new study shows is that the use of unstable shoes for several hours during a patient’s day-to-day life, without any other specific exercises, effectively contributes to the muscular strengthening of their back and improves the degree of curvature of the spine in the lumbar area, thus helping to reduce chronic pain.”

Full story at Science Daily

How should you sleep if you have lower back pain?

Lower back pain not only affects a person’s daily life but can also disturb their sleep. Furthermore, poor bed posture can worsen or even cause backache. So, what are the best sleeping positions for lower back pain?

This article provides a guide to the six best sleeping positions for lower back pain, as well as offering advice on pillows and mattresses, sleep hygiene, and when to see a doctor.

The best sleeping positions

Not only can lower back pain get in the way of a good night’s rest, but poor sleeping posture may make the existing pain worse.

A poor sleeping position may even be the underlying cause of lower back pain. This is because certain positions can place unnecessary pressure on the neck, hips, and back.

Full story at Medical News Today

Study: Referral to Physical Therapy for LBP Reduces Odds of Later Opioid Prescription—Even When Patients Don’t Follow Up on the Referral

There’s solid evidence that physical therapy as a first-line approach for low back pain (LBP) improves outcomes, but not many studies have focused on the factors that are associated with referral to physical therapy in the first place, regardless of later participation in treatment. Now authors of a recent study believe they’ve found associations indicating that the very act of referral for physical therapy may point to the ways a primary care provider’s approach to LBP can affect patient perceptions and reduce odds of later opioid use, even when the patient doesn’t follow through with the referral.

The study, published in the Journal of the American Board of Family Medicine looked at data from 454 Medicaid enrollees who were initially treated by a primary care provider for LBP, of which 215 received a referral for physical therapy. While researchers were interested in differences between the referral and nonreferral groups, the target of their study was something they believe is missing in current research: an examination of the entire referral population, regardless of whether those patients followed up with actual physical therapy.

Full story at APTA

JAMA: Equipment Ownership, Prior Imaging Behavior Predict High Rates of Low-Value Imaging for LBP, Headache

Despite evidence showing that imaging for low back pain (LBP) and uncomplicated headache is not necessary, too many health care providers still order these services for their patients, who incur greater financial costs. In a new study published in JAMA Internal Medicine, researchers identified several factors associated with higher rates of low-value imaging—including whether the providers owned the imaging equipment.

Using 4 years’ worth of claims data from 1 insurer, authors analyzed clinician characteristics as predictors for imaging for uncomplicated back pain and headache—2 low-value services identified by the Choosing Wisely campaign guidelines as inappropriate for imaging.

Full story at APTA

Study Says Cost Savings of Physical Therapy for LBP Are Significant

When it comes to physical therapy for treatment of low back pain (LBP), Medicare is getting a bargain, according to authors of a new study. Researchers say that not only is physical therapy cheaper than injections or surgery in the short-term, it’s an approach that is likely to save on treatment costs for at least a year after initial diagnosis, with average savings of 18% over treatments that begin with injections and 50% over treatments that begin with surgery.

The study, commissioned by the Alliance for Physical Therapy Quality and Innovation (APTQI), focused on Medicare A and B claims data from 472,000 beneficiaries who received a diagnosis of LBP and began treatment between February and October of 2014. Researchers from the Moran Company tracked 3 treatment paths—physical therapy, injections, and surgery—and compared total costs of initial treatment as well as total costs for 12 months after diagnosis. The study also included an analysis of cost differences associated with how soon physical therapy was initiated after diagnosis, the physical therapist interventions used, and relationships between the use of physical therapy and the referring health care provider.

Full story at APTA

Spinal manipulation treatment for low back pain associated with modest improvement in pain, function

Among patients with acute low back pain, spinal manipulation therapy was associated with modest improvements in pain and function at up to 6 weeks, with temporary minor musculoskeletal harms, according to a study published by JAMA.

Back pain is among the most common symptoms prompting patients to seek care. Lifetime prevalence estimates of low back pain exceed 50 percent. Treatments for acute back pain include analgesics, muscle relaxants, exercises, physical therapy, heat, spinal manipulative therapy (SMT) and others, with none established as superior to others. Paul G. Shekelle, M.D., Ph.D., of the West Los Angeles Veterans Affairs Medical Center, Los Angeles, and colleagues conducted a review and meta-analysis of previous studies to assess the effectiveness and harms associated with spinal manipulation compared with other nonmanipulative therapies for adults with acute (six weeks or less) low back pain.

Full story of spinal manipulation therapy for LBP at Science Daily

Revised Physician Guidelines Shift to Non-Drug Approaches as First-Line Treatment for LBP

In brief:

  • In a revision of clinical guidelines, the American College of Physicians is recommending nonpharmacologic approaches over the use of medications as first-line treatment for acute, subacute, and chronic LBP.
  • Changes are based in part on new evidence showing that acetaminophen and antidepressants were no better than placebos.
  • Guidelines recommend that physicians advise patients that pain is likely to diminish through exercise and maintenance of as many daily activities as possible.

The latest advice on low back pain (LBP) from the American College of Physicians (ACP) makes it clear: patients with acute LBP will generally improve over time regardless of treatment, and that when treatments are necessary, nondrug approaches including exercise are preferred for all but the most stubbornly chronic manifestations of the condition. The new guidelines represent a shift from ACP’s previous position, which called for the use of medication as part of first-line treatment.

Full story on use of medication as first-line treatment for LBP at APTA