The rate of leg and foot amputations among US adults aged 40 and older with diagnosed diabetes declined 65% between 1996 and 2008, according to a study by the Centers for Disease Control and Prevention published Tuesday in Diabetes Care.
For the study, researchers calculated nontraumatic lower-extremity amputation (NLEA) hospitalization rates, by diabetes status, among people aged 40 years and older on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence.
The researchers found that the age-adjusted rate of diabetes-related lower-limb amputations was 3.9 per 1,000 people in 2008 compared with 11.2 per 1,000 in 1996. In addition, among people with diagnosed diabetes in 2008, men had higher age-adjusted rates of leg and foot amputations than women (6 per 1,000 vs 1.9), and blacks had higher rates than whites (4.9 per 1,000 vs 2.9). Adults aged 75 years and older had the highest rate—6.2 per 1,000—compared with other age groups.
"NLEA continues to be substantially higher" in people with diabetes than those without and "disproportionately affects people aged ≥75 years, blacks, and men," the authors write. "Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the US diabetic population that are at higher risk."
For many years, APTA and the Federation of State Boards of Physical Therapy (FSBPT) have discussed and collaborated on continuing competence. Following the publication of a joint paper in 2010 to generate discussion on continuing competence and to move the conversation forward, members of APTA and FSBPT boards of directors met in early in 2011 to discuss several topics, including continuing competence.
On Monday, APTA and FSBPT sent a joint communication to members that provided the 2011 discussion topics and outlined APTA's and FSBPT's preferred approach to developing models of continuing competence. The communication also provides information on voluntary tools that FSBPT has developed for state licensing boards.
For further information or to ask questions, contact Janet Bezner at janetbezner@apta.org or Susan Layton at slayton@fsbpt.org.
The majority of patients with lumbar impairments who are classified based on initial clinical presentation by manipulation and stabilization clinical prediction rules (CPRs) also are classified as derangements whose symptoms centralized, say authors of an article published in Journal of Manual & Manipulative Therapy. Manipulation and stabilization CPRs may not represent a mutually exclusive treatment subgroup, but may include patients who can be initially treated using a different classification method, they add.
Eight physical therapists practicing in 8 diverse clinical settings classified patients typically referred to rehabilitation by McKenzie syndromes (McK) (eg, derangement, dysfunction, and posture, pain pattern classification (eg, centralization [CEN], not centralization [Non CEN], and not classified [NC]), manipulation CPR (positive, negative), and stabilization CPR (positive, negative). Prevalence rates were calculated for each classification category by McK, pain pattern classifications (PPCs), and manipulation and stabilization CPRs. Prevalence rates for McK and PPCs were calculated for each CPR category separately.
Data from 628 adults (mean age: 52±17 years, 56% female) were analyzed. Prevalence rates were:
- McK-- derangement 67%, dysfunction 5%, posture 0%, other 28%
- PPC -- CEN 43%, Non CEN 39%, NC 18%
- manipulation CPR -- positive 13%
- stabilization CPR -- positive 7%
For patients positive for manipulation CPR (n = 79), prevalence rates for derangement were 89% and CEN 68%. For patients positive for stabilization CPR (n = 41), prevalence rates for derangement were 83% and CEN 80%.