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.
After having surgery, many older adults develop delirium, the medical term for sudden and severe confusion. In fact, between 10 and 67 percent of older adults experience delirium after surgery for non-heart-related issues, while 5 to 61 percent experience delirium after orthopedic surgery (surgery dealing with the bones and muscles).
Delirium can lead to problems with thinking and decision-making. It can also make it difficult to be mobile and perform daily functions and can increase the risk for illness and death. Because adults over age 65 undergo more than 18 million surgeries each year, delirium can have a huge impact personally, as well as for families and our communities.
Healthcare providers can use several tools to reduce the chances older adults will develop delirium. Providers can meet with a geriatrician before surgery, review prescribed medications, and make sure glasses and hearing aids are made available after surgery (since difficulty seeing or hearing can contribute to confusion). However, preventing delirium prior to surgery may be the best way to help older adults avoid it.
A person may sustain a traumatic brain injury due to a blow or jolt to the head. Vehicular accidents, sports, assaults and falls are the most common causes of sudden damage to the brain.
However, common consumer products found at home can also cause such injury, particularly in young people. A new study found that 72 percent of reported injuries among children and teens in the U.S. were linked to materials found indoors.
Researchers analyzed nearly 4.1 million non-fatal traumatic brain injuries in children and adolescents, aged up to 19 years, recorded between 2010 and 2013. Data came from 66 hospitals across the country.
The study, published in the journal Brain Injury, shows that American football, beds and floors caused the highest number of injuries in young people.
When it comes to using social media to promote the profession, physical therapy may be missing out: that’s the conclusion of a recent study that analyzed physical therapy-related tweets and found that, for the most part, Twitter discussions about the profession are occurring in an “echo chamber”—if they even rise to the level of a discussion in the first place.
The study, published in APTA’s journal PTJ (Physical Therapy), looked at a random sample of 1,000 tweets from a collection of 30,000 tweets gathered over a 12-week period. Researchers sorted out each message according to its author, intended audience, tone, and theme, and—when it occurred—the “pattern” of the twitter conversation, which includes shares as well as actual online exchanges. The collection was based on 9 search terms: physical therapy, physiotherapy, physical therapist, physiotherapist, #physicaltherapy, #physiotherapy, #physical therapist, #physiotherapist, and #physio. Hashtags associated with “known physical therapy campaigns,” such as APTA’s #ChoosePT, were not included in the searches.
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.
Physical activity in early childhood may have an impact on cardiovascular health later in life, according to new research from McMaster University, where scientists followed the activity levels of hundreds of preschoolers over a period of years.
They found that physical activity in children as young as three years old benefits blood vessel health, cardiovascular fitness and is key to the prevention of early risk indicators that can lead to adult heart disease.
The study, named “Health Outcomes and Physical activity in Preschoolers”, published today in the journal Pediatrics, is the first to demonstrate the benefits of physical activity on blood vessel health in preschoolers.
The final report from a US Department Health and Human Services (HHS) inter-agency task force on pain management best practices is out, and its call for greater collaborative care and improved access to physical therapy comes through loud and clear. It’s a report that in many ways echoes APTA’s white paper on opioids and pain management published nearly 1 year ago.
The “Report on Pain Management Best Practices” changed little from its draft version released in January [Editor’s note: this PT in Motion News article covered the draft in depth]. Like its predecessor, the report identifies gaps and inconsistencies in pain management that can contribute to opioid misuse.
While the task force acknowledges that opioids may be appropriate when carefully prescribed in some instances, it also argues that other approaches—including “restorative therapies” furnished by physical therapists and other health care professionals—should be on equal footing with pharmacological alternatives, particularly when it comes to reimbursement and patient access.
Research led by a UCLA scientist found that a new nerve stimulation therapy to increase blood flow could help patients with the most common type of stroke up to 24 hours after onset.
A study of 1,000 patients found evidence that the technique, called active nerve cell cluster stimulation, reduced the patients’ degree of disability three months after they suffered an acute cortical ischemic stroke, which affects the surface of the brain.
Dr. Jeffrey Saver, director of the UCLA Comprehensive Stroke Center, was the co-principal investigator of the study, which was conducted at 73 medical centers in 18 countries.