The next generation of doctors will start their careers at a time when physicians are feeling pressure to limit prescriptions for opioid painkillers.
Yet every day, they’ll face patients who are hurting from injuries, surgical procedures or disease. Around 20% of adults in the U.S. live with chronic pain.
That’s why some medical students felt a little apprehensive as they gathered recently for a mandatory, four-day course at Johns Hopkins University in Baltimore — home to one of the top medical schools in the country.
Exercise prescription is at the heart of every rehab professional’s arsenal. Whether you are prescribing a simple one such as a straight leg raise or something much more complex involving coordination of proprioception and plyometrics, you are intending to help your patients. There’s a key component that is often missed during rehab however, and when it is, it can limit your effectiveness. It may even drive your patients to report increased pain with treatment and in the worst cases, it prevents your patient from achieving their goals.
I don’t believe this is intentionally missed in rehab, but it’s something you will rarely see in research and a component rarely focused on in school. Is your intervention aimed at the wrong impairment?
Let’s start with this example that’s easier to see and then we’ll move onto one that may be a bit less obvious.
In a final rule from the US Centers for Medicare and Medicaid (CMS), inpatient rehabilitation facilities (IRFs) will see a 2.5% payment increase in the 2020 fiscal year (FY), which begins October 1, 2019—an approximate boost of $210 million. But they’ll also need to prepare for some expanded reporting measures in the years to come—including a requirement to report data on social determinants of health.
Reporting requirements won’t change much in FY 2020. However, beginning with the FY 2022 IRF Quality Reporting Program (QRP), IRFs will be required to provide certain standardized patient assessment data (SPADE) to CMS. The additional SPADE requirements are aimed at bringing IRFs up to speed with provisions of the 2014 IMPACT Act, a law that mandated more uniformity in reporting across postacute care (PAC) settings. In a fact sheet on the final rule, CMS writes that the addition of these SPADES “will improve coordination of care and enable communication.”
Specifically, CMS will adopt the SPADES on pain interference on sleep, therapy, and day-to-day activities, provisions being added in light of the opioid crisis. CMS is considering adding future SPADEs including dementia, bladder and bowel continence, care preferences, advance care directives and goals of care, caregiver status, veteran status, health disparities and risk factors, and sexual orientation. Also on CMS’ radar: assessments related to opioid use, and frequency, exchange of electronic health data, and interoperability.
Medicare-covered stroke patients receive vastly different amounts of physical and occupational therapy during hospital stays despite evidence that such care is strongly associated with positive health outcomes, a new study by Brown University researchers found.
The research team, led by Amit Kumar, an adjunct assistant professor at Brown’s School of Public Health, analyzed Medicare claims data from 2010 for approximately 104,000 stroke patients. They found that 15 percent of patients received no physical therapy (PT) or occupational therapy (OT), while on average stroke patients received 2 hours of therapy during their hospital stay. Some patients received almost 4 hours of therapy, but these tended to be patients with the longest hospital stays, Kumar added.
“For stroke patients, rehabilitation services are one of the most important components in providing treatment after they are stabilized in the acute setting,”said Kumar, who is also an assistant professor of physical therapy at Northern Arizona University. “This is the only treatment that helps patients regain activities for daily living, such as walking or using the restroom independently. So it’s really important to start physical therapy and occupational therapy as early as possible.”
Thousands of people worldwide suffer severe spinal cord injuries each year, but little is known about why these injuries often continue to deteriorate long after the initial damage occurs.
Yi Ren, a professor of biomedical sciences at the Florida State University College of Medicine, is making progress in understanding why such significant harm is inflicted in the weeks and months after a spinal injury. In a study published today in the journal Nature Neuroscience, Ren explained how a natural immune system response may contribute to additional injury.
When spinal cord damage occurs, the endothelial cells that line blood vessels are activated to remove potentially harmful material, like myelin debris, from the site of the injury. However, Ren and her team discovered that this process may be responsible for causing further harm.
“The consequences of the effort of endothelial cells to clear myelin debris is often severe, contributing to post-traumatic degeneration of the spinal cord and to the functional disabilities often associated with spinal cord injuries,” said Ren, whose team conducted the study over a period of five years.
An initiative adopted by Lancaster University to embed physical activity into the training for medical students has been showcased at a national and international level.
Lancaster Medical School was the firstschool in the UK to fully embed the Movement For Movement physical activity resources into the undergraduate programme and all medical schools and schools of health now have access to the resources, reaching a potential 120,000 students across the UK.
This Movement For Movement initiative, led by Ann Gates has been shared with all medical schools and visits to a sample of schools was funded by Public Health England and Sport England.
Patients who underwent physical therapy soon after being diagnosed with pain in the shoulder, neck, low back or knee were approximately 7 to 16 percent less likely to use opioids in the subsequent months, according to a new study by researchers at the Stanford University School of Medicine and the Duke University School of Medicine.
For patients with shoulder, back or knee pain who did use opioids, early physical therapy was associated with a 5 to 10 percent reduction in how much of the drug they used, the study found.
Amid national concern about the overuse of opioids and encouragement from the Centers for Disease Control and Prevention and other groups to deploy alternatives when possible, the findings provide evidence that physical therapy can be a useful, nonpharmacologic approach for managing severe musculoskeletal pain.
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).