New research from the Netherlands shows that older patients with chronic obstructive pulmonary disease (COPD) are at increased risk for carotid artery plaque formation and for the presence of vulnerable plaques with a lipid core, according to the American Thoracic Society. 

The cross-sectional study, part of the Rotterdam Study, an ongoing population-based cohort study examining the occurrence of and risk factors for chronic diseases in subjects aged 55 years and older, involved 253 patients with COPD and 920 patients without the condition. COPD was confirmed by spirometry. Participations with carotid wall thickening (intima-media thickness ≥ 2.5 mm) on ultrasonography underwent high-resolution MRI to characterize carotid plaques.

Participants with COPD had a twofold increased risk of carotid wall thickening on ultrasonography compared with controls. This risk increased significantly with the severity of airflow limitation. On MRI, vulnerable lipid core plaques were significantly more frequent in participants with COPD compared with those without COPD.

"Clinicians should be aware that COPD patients are at increased risk for asymptomatic carotid atherosclerosis and that COPD might lead to vulnerable plaques by inducing or aggravating the presence of plaques with a lipid core," said researcher Bruno H.C. Stricker, MD, PhD.

 "Understanding the underlying risk factors for stroke in COPD patients can help identify those at high risk and lead to the development of more personalized preventive treatment strategies targeting this devastating complication," he added.

The findings were published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

The Foundation of Haitian Rehabilitation (FONHARE) is a grassroots Haitian organization providing rehabilitation services to the citizens of Ouanaminthe. It is the only organization providing rehab services in the northeast of Haiti to 13 cities with almost 500,000 citizens. Ivens Louius, the founder and director, is a physical therapist and an occupational therapist. FONHARE currently is providing services in a medical clinic owned and run by Louius's  brother, who is a physician. A foundation has been laid for a large onsite rehabilitation clinic adjacent to the medical clinic. There is a genuine need for volunteers to be part of establishing rehabilitation and physical therapy as a specialized service in a country that had virtually none before the 2010 earthquake. For more information about volunteer opportunities, as well as opportunities to provide financial support, visit FONHARE at www.fonhare.org.   

Self-reported function, hip range of motion (HROM), and patient-perceived improvement occurred after an 8-week program of exercise therapy (ET) for patients with hip osteoarthritis (OA), say authors of an article published in Archives of Physical Medicine and Rehabilitation. Manual therapy (MT) as an adjunct provided no further benefit, except for achieving higher patient satisfaction, they add.

For this investigation, 131 patients with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants in Dublin, Ireland, were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and wait-list control (n=43).

Participants in both ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either the ET or ET+MT group after the 9 week follow-up. Their data were pooled with original treatment group data—ET (n=66) and ET+MT (n=65).

The primary outcome was the WOMAC physical function (PF) subscale. Secondary outcomes included physical performance, pain, HROM, anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction.

There was no significant difference in WOMAC PF between ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference 0.09) or at 18 weeks (mean difference 0.42), or other outcomes, except "patient satisfaction with outcome," which was higher in the ET+MT group. Improvements in WOMAC, HROM, and patient-perceived change occurred in both treatment groups compared with the control group.

Physical therapists (PTs) should consider a number of details before contracting with payers, whether private or public. View APTA's new Managed Care Contracting Toolkit today to learn valuable information about joining a managed care plan, and securing and tracking contracts. A chapter on "doing the math" can help you decide which fee schedules, patient populations, and payment methodologies are best suited to your practice. The toolkit also breaks down the pros and cons of common methodologies that third-party payers use to pay for physical therapy services and offers information on negotiating contracts.   

APTA's Payment and Practice Management Department created the member-only toolkit to help PTs make informed decisions about joining a provider network.

An analysis of clinical practice guidelines archived on the National Guideline Clearinghouse (NGC) website as of June 2011 demonstrated poor compliance with Institute of Medicine (IOM) standards, with little if any improvement over the past 2 decades, say authors of an article published this month in Archives of Medicine. 

For the study, 2 reviewers independently screened 130 guidelines selected at random from NGC's website for compliance with 18 of 25 IOM standards.

The overall median number of IOM standards satisfied (out of 18) was 8 (44.4%). Fewer than half of the guidelines surveyed met more than 50% of IOM standards. Barely a third of the guidelines produced by subspecialty societies satisfied more than 50% of the IOM standards surveyed.

Information on conflicts of interest was given in fewer than half of the guidelines surveyed. Non-English literature, unpublished data, and/or abstracts were rarely considered in developing guidelines. Differences of opinion among committee members generally were not aired in guidelines. Benefits of recommendations were enumerated more often than potential harms. Guidelines published from 2006 through 2011 varied little with regard to average number of IOM standards satisfied.

"Everybody everywhere is developing guidelines and there is no real quality control," lead author Philip A. Mackowiak, MD, told Reuters News. "There is no good oversight of who actually develops the guidelines or what criteria need to be met in order for them to be published."

IOM's standards were not published until 2011. Mackowiak acknowledges that the experts who developed the guidelines reviewed by his team would not have been able to use IOM's standards.  However, he added that similar standards have been published before and that they were basic enough that they should have been followed, says Reuters.

E-mail photos and brief descriptions of your events to public-relations@apta.org and we will consider them for our NPTM Celebrations webpage.

Nominate a deserving APTA member who is 50 years or older, committed to being active and fit, and encourages others to be the same. Go to www.apta.org/FitAfter50/ to learn more about the campaign and to nominate yourself or another deserving 50+ year old.