A specific exercise strategy that focuses on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome, say authors of an article published online in BMJ. By extension, they add, this exercise strategy reduced the need for arthroscopic subacromial decompression within the 3-month timeframe used in the study.

This randomized, participant and single assessor blinded controlled study was conducted in an orthopedic department in a Swedish university hospital. Orthopedic specialists recruited 102 patients with longstanding (more than 6 months) persistent subacromial impingement syndrome that did not respond to earlier conservative treatment. 

The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers in combination with manual mobilization. The control exercise program consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received 5 to 6 individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks.

The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery.

Most (97, 95%) participants completed the 12-week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points vs 9 points). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment— 69% (35/51) vs 24% (11/46); odds ratio 7.6 (95% confidence interval 3.1 to 18.9). A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery—20% (10/51) vs 63% (29/46); odds ratio 7.7 (95% confidence interval 3.1 to 19.4).

Yesterday, APTA testified on the use of functional mobility and self-management measures at the Department of Health and Human Services' (HHS) National Committee on Vital and Health Statistics Quality Subcommittee on Patient Quality Measures.

Nearly 20 quality experts spoke on understanding patient/consumer health and health care decision-making needs and the measures and data to support health and decision making, using patient experience and satisfaction measures in assessing whether consumers/patients achieve their goals and expectations, and using patient preference measures in selection of insurance coverage, health providers, and treatment options. 

APTA's testimony, delivered by Heather L. Smith, PT, MPH, program director of quality, included information about functional mobility measures that are currently being used. The association described barriers to adopting certain quality measures, such as practitioners' resistance to change, the time needed to administer and interpret results, and access and cost issues related to technology, as well as presented strategies that could be employed to overcome these barriers.    

In addition to APTA, other panelists who presented on measures of functional mobility and self-management included John Hough, DrPH, MPH, MBA, from the National Center on Health Statistics, and Matt Stiefel, MPA, of Kaiser Permanente.

Last week, South Dakota became the latest state to improve consumer protections from excessively high physical therapy copays when Gov Dennis Daugaard signed House Bill 1183, legislation promoted by the South Dakota Chapter.

HB 1183 limits the amount a health insurer may charge a patient for an out-of-pocket copayment or coinsurance amount when he or she visits a physical therapist or occupational therapist. After the bill takes effect July 1, those copayment and coinsurance amounts cannot be higher than those charged when a patient visits a primary care physician or practitioner.

Health insurers often categorize physical therapy as a "specialty" service, and typically require higher copays than primary care services—sometimes as high as $60 or more for a single visit. 

"Legislators saw that this bill was all about patient access and affordability," said Ronald Van Dyke, PT, OCS, president of the South Dakota Chapter. "They wanted to make sure the people of South Dakota could access the physical therapy and occupational therapy care they need at a fair cost."

Read more about House Bill 1183 in this APTA press release.   

Last year, Kentucky enacted a similar copay protection law.

US News & World Report yesterday issued its list of "best jobs"—ranking physical therapist as the fourth best job in health care and the eighth best overall job in 2012. The annual list includes jobs that are "hiring in droves, paying well, and providing room to grow." APTA Deputy Executive Director Janet Bezner, PT, PhD, is quoted in the article about how students can use internship opportunities to "to pay attention to what they like or don't like" and determine the type of patients and the size and style of practice that will best suit them.     

Children given video games that simulate activities such as boxing and dancing are no more physically active overall than children who play nonactive video games, says a HealthDay article based on a study published this month in Pediatrics.

Researchers followed 78 children ages 9-12 who had never owned a Wii video game console. Half of the children choose from a selection of 5 active fitness-focused games. The other half chose from inactive games. After 6 weeks they were given an opportunity to choose another game. The children received needed accessories including balance boards, remote controllers, and resistance bands. Each child wore an accelerometer to measure physical activity. The belt could be taken off only when swimming or bathing, and the children kept a journal of when they removed it.

Lead author Tom Baranowski, PhD, told HealthDay that the investigators expected to see a "substantial increase in physical activity in the group that played the active games, but not in the inactive game group" starting in the first week. They expected another surge when the children chose their second game.

"But we found there was no difference in the level of the activity between the treatment and control groups. What we detected at baseline, before playing active video games, was exactly the same in weeks 1, 6, 7, and 12," Baranowski said.

Pediatrician Christina Suh, MD, who was not part of the research team, said, "The take-home message is that on a population basis, it looks like using active video games is not an effective way of getting kids to be more active. In other words, if someone thinks of passing out Wii fitness consoles to kids in a public school district, for example, it probably wouldn't be effective in terms of its impact on public health."

Exercise prescription for children needs to individualized, Suh added. "The key is figuring out what's really fun for that child." 

Full text of the article is available through Pediatrics. 

You now can order images and downloads from CSM 2012 from David Braun Photography Inc. To order, go to www.davidbraun.photoreflect.com and click on APTA CSM 2012. Enter the password windy12, click the GO button, select any day or event gallery link, and click on thumbnails to view larger images. Use the drop-down menu on the upper right to change between daily galleries. Prices for prints appear on the right when viewing an image. To order file downloads, click on the Digital Products link below the print prices.