Establishing appropriate and realistic goals and expected
outcomes for patients with a declining functional status can be challenging –
knowing that the ultimate trajectory of function is expected to be downward. A
new APTA podcast series addresses the challenges
of and suggests solutions for managing the care of these patients, who may have
conditions such as Parkinson disease, muscular sclerosis, cystic fibrosis, or
late-stage congestive heart failure.
The first podcast
begins with general functional status and safety examples. In upcoming podcasts
physical therapists will share their experiences in applying these principles
to specific patients with conditions that are characterized by a declining
interventions are widely recommended for patients with low back pain (LBP), but
a meta-analysis by Australian researchers suggests that its effects on pain and
disability are likely to be small and are supported by only moderate-quality
evidence, says a Medscape Medical News article.
The researchers included randomized controlled trials evaluating
self-management for nonspecific LBP and assessing pain and disability in their
review. They pooled data when studies were similar enough and divided analyses
into short-term (less than 6 months after randomization) and long-term (at
least 12 months after randomization) outcomes.
They found 13 original trials that met inclusion criteria. Efficacy of
self-management (including shared responsibility for a plan of care,
self-monitoring, and management of signs and symptoms) was compared with
efficacy of minimal intervention and with other interventions such as massage,
acupuncture, yoga, and exercise.
"The improvement [in pain and disability] was less than what is
generally considered worthwhile by patients," said lead author Vincinius
C. Oliveira. Specifically, the short-term improvement was -3.2 points on a
100-point scale for pain and -2.3 points for disability. According to the
authors, effect sizes of 20% to 30% are needed for patients to consider
Dawn Carnes, DO, director of the National Council for Osteopathic Research
and senior research fellow at the London School of Medicine and Dentistry in
the United Kingdom, told Medscape that
she was surprised by the strength of the authors' conclusion because small
changes in large populations (such as LBP) do make a difference at a population
Carnes also voiced concerned about the review's inclusion criteria. She
said, "[The authors] included all types of [LBP], including chronic. Why
would you expect pain to improve in a chronic pain population, where drugs
don't even work for these people? Similarly, disability is unlikely to change
in chronic patients, especially those with permanent bony or physiological
The researchers told Medscape that
they "were surprised by lack of definition criteria for self-management.
The study raised questions that our group is currently working on such as
consensus on what self-management for [LBP] is among experts, including
clinicians and researchers."
In comparing self-management with minimal intervention, the authors found
"moderate-quality evidence that self-management interventions have small
but statistically significant effects, compared to minimal interventions, on
pain and disability for LBP."
In addition, they found only low-quality evidence that self-management is
not better than massage, acupuncture, yoga, and exercise in reducing pain or
disability in LBP.
The study was published online October 27
and in the November print issue of Arthritis Care & Research.
activity, including walking on a treadmill and stretching and resistance
exercise, appears to improve gait speed, muscle strength, and fitness for
patients with Parkinson disease, say researchers at the University of Maryland. Their article is published online in Archives of Neurology.
researchers compared 67 people with Parkinson disease who were randomly
assigned to 1 of 3 exercise groups: walking on a treadmill at low intensity for
50 minutes, higher-intensity treadmill training to improve cardiovascular
fitness for 30 minutes, and using weights (leg presses, extensions and curls)
and stretching exercises to improve muscle strength and range of motion.
Participants exercised 3 times a week for 3 months under the supervision of
exercise physiologists at the Baltimore VA Medical Center.
investigators found improved cardiovascular fitness in both the higher- and
lower-intensity treadmill exercise groups. However, only the stretching and
resistance exercises improved muscle strength (16% increase) during the study.
measurement was distance covered during a 6-minute walk, where all 3 types of
exercisers showed improvement compared with their baseline measurement:
lower-intensity treadmill exercise (12% increase), stretching and resistance
exercises (9% increase), and higher-intensity treadmill exercises (6%
are encouraged to see that the lower-intensity treadmill exercise, which is
feasible for most Parkinson patients, proved to have the greatest benefit for
mobility while also improving cardiovascular fitness," said Lisa Shulman,
MD, the study's principle investigator.
E. Ray Dorsey, MD, coauthor of an accompanying journal editorial,
told HealthDay News, "I hope this study adds to the
evidence that exercise should be the standard of care."
In order to continue to provide states that are pursuing
state-based exchanges with appropriate technical support, the Department of
Health and Human Services (HHS) is extending the deadline for blueprint
applications to Friday, December 14. Originally states had to provide federal
regulators a blueprint by November 16, as outlined in HHS' final rule. The deadline for a declaration letter for a state-based exchange
remains Friday, November 16, 2012. In a November 9 letter sent to governors, HHS says it will approve or conditionally
approve the state-based exchanges for 2014 by the statutory deadline of January
HHS will accept declaration letters and blueprint applications for
states that are pursuing state partnership exchanges and make approval
determinations on a rolling basis. The final deadline for both the declaration letter
and blueprint that would be effective for 2014 has been extended to Friday,
February 15, 2013, says the letter. States will be able to apply to run these exchanges
in subsequent years.
qualified health plans offered in exchanges must include the 10 categories of essential health benefits
(EHB) mandated by the Affordable Care Act, which include rehabilitative and
habilitative services. HHS is expected to release the final rule on EHB in the
study reveals that black Americans display lower levels of vitamin D and greater
pain sensitivity than do white Americans. A Vitamin D deficiency may be a risk
factor for increased knee osteoarthritic pain in black Americans, the authors conclude.
Clinical practice guidelines state that vitamin D
levels less than 20 ng/mL represent deficiency, and levels between 21 and 29
ng/mL represent insufficiency. Given that low levels of vitamin D are linked to
chronic pain and other health conditions, especially in black Americans, the
research team set out to investigate if variations in vitamin D levels
contribute to racial differences in patients with knee pain caused by
Researchers at the University of Florida and the University
of Alabama at Birmingham recruited 94 participants—45 black and 49 white
patients with symptomatic knee OA—to complete questionnaires regarding their
symptoms. The study group was 75% female and an average 56 years old.
In addition, study participants underwent testing that
included sensitivity to heat and mechanical pain on the affected knee and the
forearm. Researchers measured heat pain threshold as the point when patients
indicate the sensation "first becomes painful" and pain tolerance
when patients "no longer feel able to tolerate the pain." Mechanical
pain measures were determined by the patients' response to pressure in the knee
that despite living in a southern sunny climate, 84% of black participants had
vitamin D levels less than 30 ng/mL compared with 51% of white subjects.
Furthermore, the average vitamin D level for black Americans was 19.9 ng/mL
(deficiency), compared with white Americans who averaged 28.2 ng/mL
(insufficiency). Black participants reported greater overall knee
osteoarthritis pain, and those with lower vitamin D levels displayed greater
sensitivity to heat and mechanical pain (experimental pain).
"Our data demonstrate that differences in
experimental pain sensitivity between the 2 races are mediated at least in part
by variations in vitamin D levels," said lead author Toni Glover, MSN, ARNP. "However, further studies are needed to fully
understand the link between low vitamin D levels and racial disparities in
Healthcare 411, a new podcast series produced by the Agency for Healthcare
Research and Quality (AHRQ), shares news and information about current research
on important health care topics to help consumers with health care decision
Content provided by the Healthcare 411 Web site includes interviews that
range from 60 seconds to 15 minutes on a variety of health topics. Programs
remain available and searchable on the Healthcare 411 site. The site
also hosts audio and video public service announcements produced by AHRQ and
provides links to related consumer publications and other studies and guides
funded by AHRQ.