Fibromyalgia and resistance exercise have often been considered an impossible combination. But with proper support and individually adjusted exercises, female patients achieved considerable health improvements, according to research carried out at Sahlgrenska Academy, Sweden.
“If the goal for these women is to improve their strength, then they shouldn’t be afraid to exercise, but they need to exercise the right way. It has long been said that they will only experience more pain as a result of resistance exercise, that it doesn’t work. But in fact, it does,” says Anette Larsson, whose dissertation was in physical therapy and who is an active physical therapist.
As part of her dissertation, she studied 130 women aged between 20-65 years with fibromyalgia, a disease in which nine of ten cases are women. It is characterized by widespread muscle pain and increased pain sensitivity, often combined with fatigue, reduced physical capacity and limitation of activities in daily life.
One of the nation’s foremost sports orthopedic surgeons said Wednesday night in Orlando that the best medicine to help prevent youth sports injuries is to avoid playing year-round and not to specialize in one sport.
And don’t approach a child’s athletic pursuits like he is a miniature version of Tom Brady or LeBron James.
“Don’t treat 6- and 7-year-old kids like they’re professional athletes,” Dr. James Andrews told an audience of about 100 at Florida Hospital Orlando. “They’re not ready for that level of high-intensity training.”
Andrews, 73, has operated on many top professional athletes and is the team doctor for several franchises, including the Tampa Bay Rays. He was in Central Florida as part of the hospital’s Distinguished Lecture Series and in support of his book, “Any Given Monday,” about how to avoid injuries in youth athletes.
For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare.
Services have been terminated for some seniors, such as those with severe cases of multiple sclerosis or Parkinson’s disease, because therapists said they weren’t making sufficient progress. Others, including individuals recovering from strokes or traumatic brain injuries, have been told that they reached an annual limit on services and didn’t qualify for further care.
Neither explanation stands up to scrutiny. Medicare does not require that older adults demonstrate improvement in order to receive ongoing therapy. Nor does it limit the amount of medically necessary therapy, for the most part.
The end of the hard cap on payment for therapy services under Medicare was big news for patients and the profession—a fact that hasn’t escaped the notice of The Washington Post.
The March 1 edition of the Post featured a story from Kaiser Health News on the elimination of the cap, which is described as a change “buried” in the federal spending plan approved by Congress in February, albeit one that “reveals much about how health care financing often gets done—or undone—in Washington.”
The article recounts the birth of the cap in 1997, efforts to repeal it, and the regular scrambles to apply temporary exceptions to the policy. And to help illustrate the long slog that finally led to repeal, Kaiser reporter Shefali Luthra retells the story of an ambitious physical therapist who left his practice in Michigan and headed to Washington, DC, nearly 20 years ago to help advocate for an end to the cap. His name: Justin Moore, PT, DPT—as it happens, the same Justin Moore who’s now CEO of APTA.
Some form of direct access to physical therapist (PT) services has been a reality in all 50 states since early 2015. But just how much of a reality is it? That’s another question.
A recent report from APTA analyzed data from a 2015 survey of nearly 6,000 PTs from all states and the District of Columbia to get a sense of how direct access was being implemented—or not implemented—and what might be standing in the way of broadest possible use. Analyses found that while direct access is happening to some degree across the country, a combination of institutional barriers, state-level restrictions, and varying levels of understanding of the concept among PTs may be hindering its growth.
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.
Physical therapy cannot move forward as a profession until those who practice it resolve the issue of unwarranted variation in practice. Tara Jo Manal, PT, DPT, FAPTA, in her delivery of the 22nd John H. P. Maley Lecture, was unequivocal in sending this message to the profession. “The greatest challenge to the value of physical therapy is unwarranted variation—situations in which wide variation of care is not explained by the type or severity of the condition or by patient preferences,” she said to a capacity audience on June 23 as part of APTA’s NEXT Conference and Exposition.
Physical therapy is not the only health care discipline with this problem; unwarranted variation is a challenge within all of health care in meeting the triple aim of improving societal health, enhancing the individual patient experience, and reducing costs. But even if physical therapy has not yet been in the “center of the crosshairs,” Manal said, our profession increasingly has been identified as an area of interest as payment moves toward value-based systems in order to reduce waste in spending. The lack of standardization in physical therapist practice “puts all physical therapists at risk for reductions in covered rehabilitation services,” she said.
Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined.
When it comes to injury, lifters and athletes will do just about anything to get back into the gym. They’re desperate to get under the bar again without feeling like a knife is being driven deep into their sciatic nerve.
Shoulder, lower back, and knee injuries are reaching epidemiologic levels. But not all therapy and rehabilitation are equal. There are gold standard methods and practitioners that can return you to the iron and reduce your likelihood of reinjury, but there also are fluffy methods and non-lifting healthcare professionals who will waste your time and money.
If you’re hurt, know which therapy methods to prioritize and which ones to avoid even if they “feel good” at the time. And please, go out of your way to find a rehab pro that actually knows a thing or two about training, and maybe even looks like he lifts.
Although awareness of the severity of the nation’s opioid crisis is growing and the number of practice guidelines recommending nondrug approaches to pain treatment is increasing, the problem itself continues to take its toll on Americans across the country. That toll is well-documented by the media, with an increasing amount of attention also being paid to how the country found itself in this situation and what we do to make our way out of it.
Here’s a brief roundup of recent reports.
Despite guidelines, Americans are still receiving lots of opioids for low back pain.
A National Public Radio – Truven survey reveals that more than half of respondents experienced low back pain in the last year; among those who sought help from a physician, a surprisingly high number received prescriptions for painkillers. “We have a serious problem with our health care delivery system where physicians are highly incentivized to prescribe pills and perform procedures because that’s what pays,” Stanford University psychiatrist Anna Lembke tells NPR. “They’re also motivated to please patients but don’t have much time to manage complex medical conditions.”