Emergency treatment guidelines improve survival of people with severe head injury

A large study of more than 21,000 people finds that training emergency medical services (EMS) agencies to implement prehospital guidelines for traumatic brain injury (TBI) may help improve survival in patients with severe head trauma. The findings were published in JAMA Surgery, and the study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

“This demonstrates the significance of conducting studies in real-world settings and brings a strong evidence base to the guidelines,” said Patrick Bellgowan, Ph.D., program director at NINDS. “It suggests we can systematically increase the chances of saving lives of thousands of people who suffer severe traumatic brain injuries.”

Based on scores of observational studies, guidelines for prehospital management of TBI that were developed in 2000, and updated in 2007, focused on preventing low oxygen, low blood pressure, and hyperventilation in people with head injury. Collectively, the studies suggested that controlling those factors before patients arrived at the hospital could improve survival, but actual adherence to the guidelines had not been examined.

Full story at nih.gov

Hands-On Test Predicts Worsening Knee OA

Physical exam findings of patellofemoral grind may help predict which patients with knee osteoarthritis (OA) are likely to experience significant worsening of their disease, analysis of data from the Osteoarthritis Initiative showed.

Individuals with persistent patellofemoral grind had a greater annual loss of cartilage volume compared with those without this clinical finding (1.30% vs 0.90%, P<0.001), according to Yuanyuan Wang, MD, PhD, of Monash University in Melbourne, Australia, and colleagues.

They also had twice the risk of having a total knee replacement by 6 years (OR 2.10, 95% CI 1.30-3.38, P=0.002), the researchers reported online in Arthritis Care & Research.

The natural history of knee OA can vary notably among patients, and because of the increasing numbers of affected patients worldwide it has become critical to identify those who are most likely to progress, so as to better target healthcare resources.

Full story at MedPage Today

 

Time to Standardize Acute Care Rehab for Patients Poststroke, Say Researchers

Not all rehabilitation is equal for acute care hospital patients with ischemic stroke, say researchers in an article published in the May issue of PTJ (Physical Therapy). Authors found “significant variation” in the use of hospital-based rehabilitation services that “suggest a timely opportunity to standardize rehabilitation service delivery in acute settings for patients with ischemic stroke.”

While current guidelines recommend early mobilization during hospitalization for ischemic stroke, authors write, they do not “provide clear recommendations on the optimal dosage of therapy.” This, combined with no incentive for hospitals to report on functional status to the US Centers for Medicare and Medicaid Services (CMS), led researchers to examine Medicare claims data from 104,295 patients in 2010 to identify what factors were associated with the type and amount of rehabilitation services patients received while in acute care settings.

Full story at APTA

Study finds different amounts of physical therapy for stroke patients

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.”

Full story at news-medical.net

Researchers create smart fabric that aids in athletic coaching and physical therapy

A computer science research team at Dartmouth College has produced a smart fabric that can help athletes and physical therapy patients correct arm angles to optimize performance, reduce injury and accelerate recovery.

The proposed fabric-sensing system is a flexible, motion-capture textile that monitors joint rotation. The wearable is lightweight, low-cost, washable and comfortable, making it ideal for participants of all levels of sport or patients recuperating from injuries.

The study, published in Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies, will be presented later this year at the UbiComp 2019 conference in London in September.

Full story at news-medical.net

New Pilot Study Opportunities Available From CoHSTAR

The Center on Health Services Training and Research (CoHSTAR) has opened a call for the development of multiple pilot studies that would help set the stage for larger efforts to advance a wide range of health services research. APTA was a major financial contributor to the development of CoHSTAR, having donated $1 million toward the center’s startup in 2015.

The selected pilot studies would address research questions in CoHSTAR’s 4 areas of specialization—analysis of large data sets, rehabilitation outcome measurement, cost-effectiveness, and implementation of science and quality improvement research—and the CoHSTAR Pilot Study Program webpage lists examples of specific types of studies that would qualify for funding. Each pilot study will receive $25,000 in funding for direct costs.

Priorities for funding will be given to applications that align with 1 of the 4 areas of CoHSTAR specialization, have a strong likelihood of leading to broader research with major external funding, and have good potential to result in future research with high societal or policy impact for physical therapy. Principal investigators must include at least 1 physical therapist (PT) who is a US citizen or a certified permanent resident of the United States.

Full story at APTA

JAMA Oncology: Telerehab Makes a Difference in Patients With Advanced-Stage Cancer

“Collaborative telerehabilitation” isn’t a regular part of care for patients with advanced-stage cancer, but maybe it should be, say authors of a study recently published in JAMA Oncology.They found that the approach, which combines remotely delivered rehabilitation instruction with outpatient physical therapy and regular communication, can reduce pain, improve function, shorten hospital says, and decrease the use of postacute care facilities.

The findings are based on results from the Collaborative Care to Preserve Performance in Cancer (COPE) program, a randomized clinical trial designed to address what the JAMA authors describe as a “knowledge gap” in the application of collaborative care models (CCMs) focused on patient function. The COPE trial includes patients with stage III or IV solid or hematologic cancer with a life expectancy of more than 6 months, and who reported moderate functional impairment (a score of 53-60 on the Activity Measure for Postacute Care assessment, or AM-PAC).

Full story at APTA

3D-PRINTED TISSUE COULD FIX ATHLETES’ DAMAGED JOINTS

Scientists engineered scaffolds that replicate the physical characteristics of osteochondral tissue—basically, hard bone beneath a compressible layer of cartilage that appears as the smooth surface on the ends of long bones.

Injuries to these bones, from small cracks to pieces that break off, are painful and often stop an athlete’s career in its tracks. Osteochondral injuries can also lead to disabling arthritis.

The gradient nature of cartilage-into-bone and its porosity have made it difficult to reproduce in the lab, but Antonios Mikos, a bioengineer at Rice University and graduate student Sean Bittner used 3D printing to fabricate what they believe will eventually offer a suitable material for implantation.

Full story at futurity.org

Osteoporosis: New tools help pinpoint potential risk genes

A combination of powerful tools has helped scientists identify two new genes that could contribute to osteoporosis through their effect on bone density. The finding could lead to better treatments for the bone-weakening disease.

The study, by researchers at the Children’s Hospital of Philadelphia (CHOP) in Pennsylvania, highlights the importance of understanding the 3D geography of the genome in locating genes that cause disease.

The team points out that identifying DNA variants, or differences, behind diseases, is not necessarily enough to locate the genes that cause the disease. The variants, for example, could be triggers of genes in other parts of the genome.

Full story at Medical News Today

Caterpillars could hold the secret to new treatment for osteoarthritis

A substance from a fungus that infects caterpillars could offer new treatment hope for sufferers of osteoarthritis according to new research.

Cordycepin is an active compound isolated from the caterpillar fungus Cordyceps militaris and has proved to be effective in treating osteoarthritis by blocking inflammation in a new way, through reducing a process called polyadenylation. The research was undertaken by scientists from the University of Nottingham and supported by funding from Versus Arthritis. The findings have been published today in Scientific Reports.

Dr. Cornelia De Moor from the University of Nottingham’s School of Pharmacy led the study and said: “The natural compound cordycepin is derived from a caterpillar fungus which is famous in the Far East for its medicinal properties. In this paper we show that orally administrated cordycepin reduces pain and halts disease progression in animal models of osteoarthritis. Intriguingly, it does this by a different mechanism than any other known anti-inflammatory painkiller, through affecting the last step of making a messenger RNA, polyadenylation. This means that medicines derived from cordycepin may help patients for whom other treatments have failed. We hope that cordycepin will prove to be the founder of a new class of pain killer, the polyadenylation inhibitors. There is a long way to go before a cordycepin derived medicine reaches patients, but our work is very promising we are very excited about the prospects.”

Full story at Medical Xpress