evaluate physical therapy interventions for adults with knee osteoarthritis
(OA), investigators from the University of
Minnesota School of Public Health, University of Minnesota Medical School, and
Minnesota Evidence-based Practice Center searched MEDLINE, the Cochrane
Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary
Medicine, and the Health and Psychosocial Instruments bibliography database
from 1970 to February 2012.
A total of 193 randomized, controlled trials (RCTs)
published in English were included in the review. Means of outcomes, physical
therapy interventions, and risk of bias were extracted to pool standardized
mean differences. Disagreements between reviewers abstracting and checking data
were resolved through discussion.
Meta-analyses of 84 RCTs provided evidence for 13 physical
therapy interventions on pain (58 RCTs), physical function (36 RCTs), and
disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic
(11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic
exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6
RCTs) reduced pain and improved function. Several individual RCTs demonstrated
clinically important improvements in pain and disability with aerobic exercise.
Other physical therapy interventions demonstrated no sustained benefit.
Individual RCTs showed similar benefits with aerobic, aquatic, and
strengthening exercise. Adverse events were uncommon and did not deter
participants from continuing treatment.
Free full text of the article is available in Annals of Internal Medicine. A report on the review also is available
from the Agency for Healthcare Research and Quality.
member Becky Jo Olson-Kellogg, PT, DPT,
GCS, coauthored the article.
will host its next Move Forward radio show November 19 at noon ET on Holiday Shopping for Children
With Special Needs.
mommy bloggers, Ellen Seidman of Love that Max and Jennifer
Byde Myers, a founder and editor of The
Thinking Person's Guide to Autism and blogger at www.jennyalice.com, will share their personal
experiences raising children with special needs and tips for holiday shopping.
They also will discuss the role of physical therapy in their children's
Bohmert, PT, MS,will share her expertise as a physical
therapist and discuss the impact that physical therapy can have on children
with communication disabilities and developmental delays. For more information
about the show and this initiative, click here. APTA's press release on the
show is available at www.apta.org/.
report from the Institute of Medicine (IOM) proposes a framework to
assess the value of community-based, nonclinical prevention policies and
wellness strategies, especially those targeting the prevention of long-term,
report's authors conclude that a comprehensive framework for valuing
community-based prevention programs and policies should meet 3 major criteria. First, the framework should
account for benefits and harms in physical and mental health, community
well-being, and community process. The physical and mental health domain
includes reductions in the incidence and prevalence of disease, declines in
mortality, and increases in health-related quality of life.
the framework should consider the resources used and compare the benefits and
harms associated with those resources. To effectively compare interventions,
it is essential to quantify the magnitude of benefits in relation to the
associated cost for each intervention.
the framework must take into account differences among communities that can
affect the link between interventions and outcomes.
selecting 1 community-based prevention policy or program over another can be
difficult, the report recommends that decision
makers weigh the benefits and harms to health, community well-being, and
community process as they assign value to specific interventions.
The authors caution that although a community-based prevention
action may improve the overall health of a community, it may achieve more
strikingly positive results among citizens with a certain income level or
occupation, exacerbating health disparities. If achieving health equity is at
odds with improving overall community health, priorities will have to be
determined, they say.
The 25th annual Marquette Challenge
officially launched at NSC 2012 and participating schools are holding various
fundraising events around the country.
This year's goal is to raise
$200,000 to help reach a total of $2.5 million raised in 25 years of the
Make a Difference! Take the
Challenge! Get started by learning more with the interactive Challenge kit.
to see the schools that have already pledged this year.
you're not receiving the Foundation for Physical Therapy's monthly News & Events e-newsletter, sign up today and
stay current with the latest information on research supported by the
Foundation, funding and awards, and events.
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."