To 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.  

APTA member Becky Jo Olson-Kellogg, PT, DPT, GCS, coauthored the article.

APTA will host its next Move Forward radio show November 19 at noon ET on Holiday Shopping for Children With Special Needs. Two popular 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 development. Joan 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/.       

A new 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, chronic diseases.

The 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.

Second, 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.

Third, the framework must take into account differ­ences among communities that can affect the link between interventions and outcomes.

Because 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 Marquette Challenge.

Make a Difference! Take the Challenge! Get started by learning more with the interactive Challenge kit.

Click here to see the schools that have already pledged this year.

If 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 functional status.

Self-management 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 interventions worthwhile.

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 level. 

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 change."

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.

Physical 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.

The 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.

The 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.

One key 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% increase).

"We 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."