Physical therapists (PTs) can be particularly effective at helping dancers recover from injury thanks to the unique matrix of evaluation, intervention, and communication skills they bring to their approaches, according to a recent study in the Journal of Dance Medicine & Science.

The study, conducted by Megin Sabo, PT, DPT, LMT, OCS, describes the challenge of treating an injured dancer, whose rehearsal and training time is extensive, and who typically wants to return to full function as soon as possible with a minimum of missed practice. Treatment that fails to recognize these elements will tend to be less successful than approaches that are based in an understanding of the dancer's world, a willingness to incorporate modified dance techniques to encourage adherence to "relative rest," and sensitivity to the importance of communicating in ways relevant to the performer.

Sabo's qualitative study incorporated interviews from PTs who had provided care to dancers and dancers who had received rehabilitation after a dance-related injury. Dancers were asked to recount their experiences and share the positives and negatives of their rehabilitation, while the PTs were surveyed on the range of approaches used.

The results showed a high level of agreement among PTs and dancers that the most successful interventions involved in-depth reviews of technique—not just to correct potentially damaging habits but to identify ways for the dancer to incorporate periods of relative rest while minimizing missed rehearsal. Equally important, according to the study, is the PT's ability to understand dance vocabulary and to communicate with dancers in ways that demonstrate this understanding.

APTA members can find the full text of this article in Open Door—choose Open Door's OneSearch Feature, go to Advanced Search, change Keyword to Title in the first field, and type in the article title, "Physical therapy rehabilitation strategies for dancers: a qualitative study."

A new study suggests that older adults without osteoporosis can wait longer between screenings. The study concluded that when an initial bone-mineral-density (BMD) screening showed no osteoporosis, repeating the test 4 years later didn't necessarily help to predict the risk for bone fracture.

Medicare pays for BMD screening every 2 years, and on average beneficiaries' screenings are 2.2 years apart. The researchers concluded, among other things, that while a small proportion of the subjects were reclassified upon the second test as high risk for fracture, it was "unclear whether the reclassification justifies the current US practice of performing serial BMD tests at 2.2-year intervals."

They added, however, that detecting BMD loss would have been "paramount for the … individuals reclassified by a second BMD test who went on to experience a fracture."

The study, published Tuesday in JAMA and free in full text, included more than 800 men and women with an average age of 75. A summary of the study in MedlinePlus includes interview quotes from study author Sarah Berry, MD, MPH, and National Osteoporosis Foundation President Robert Recker, MD.

Physical therapy improved short-term functional ability or minimized secondary complications for patients with Parkinson disease (PD), based on a systematic review of randomized controlled trials (RCTs) of intervention versus no intervention in patients with PD.

Researchers for the study, published ahead of print this week by Cochrane Database System Review, reported that the benefit was significant for speed, 2- or 6-minute walk test, Freezing of Gait questionnaire, Timed Up & Go test, Functional Reach test, Berg Balance Scale, and clinician-rated UPDRS.

Most of any observed differences between treatments were small, the researchers said, noting that these conclusions were based on indirect comparisons of the studies chosen for the review. A consensus menu of "best practice" physical therapy is needed, they concluded, as are large RCTs to demonstrate longer-term efficacy and cost-effectiveness of physical therapy interventions for PD.

The review identified 39 trials with 1827 participants, published up to the end of January 2012. Trials were classified into the following intervention comparisons: general physiotherapy, exercise, treadmill training, cueing, dance, and martial arts. The researchers used tests for heterogeneity to assess for differences in treatment effect across the different interventions.

Look for the full text of this study in APTA's Open Door and PTNow in about 6-8 weeks.

Manual therapy or exercise therapy programs provided by a physical therapist is a cost-effective way to relieve pain in people with osteoarthritis (OA) in the knee and hip joints, new research from New Zealand’s University of Otago shows.

The randomized clinical trial involved 206 patients with hip or knee OA over 1 year and used 3 protocols of treatment provided by physical therapists in addition to usual care by their family practice physician.

One group was given 7 manual physical therapy sessions in addition to usual care, for 40-50 minutes over 9 weeks, followed by 2 boosters after a further 7 weeks. The second group involved a program of exercise both in the clinic and at home, involving stationary cycling, muscle strengthening, stretching and balance, and agility exercises. The third group was treated with a combination of manual and exercise therapy. A control group received only usual medical care from their family practice doctor or other health care providers.

Researchers say the results showed that individually supervised exercise therapy or manual therapy provided by a physical therapist, in addition to usual care, improved pain and physical function for at least 1 year. Given the time limits of the therapy sessions, the researchers added that there doesn’t appear to be additional benefit gained from providing both manual and exercise therapy on top of usual care for OA.

A further study, also published in the journal Osteoarthritis and Cartilage, looked at the economics of the additional treatment in this trial. It found that both additional exercise therapy and manual therapy are more cost effective for the health system and for individuals than applying only the usual OA care management.

"Exercise therapy provided the best cost-effectiveness from a health system perspective, while manual therapy was best, and was actually cost-saving, from a societal perspective," said lead author Haxby Abbott.

"On our main measure, we found that additional manual therapy provided the best symptom relief of the 3 treatments we studied. On the other hand, the exercise program also produced very good results on physical tests and on quality of life gains. So each has its strengths; there is no clear best choice for everyone. What’s clear is that either is better than usual care only."

"These results suggest that family practice doctors should refer patients with hip or knee arthritis for individually supervised exercise or manual therapy provided by a physical therapist, in addition to continuing to provide usual medical care."

In a small clinical study, researchers administered a new method for treating chronic wounds using a novel ultrasound applicator that can be worn like a band-aid, the National Institutes of Health (NIH) reported last week. The applicator delivers low-frequency, low-intensity ultrasound directly to wounds, and was found to significantly accelerate healing in 5 patients with venous ulcers. The technology was developed with funding from NIH's National Institute of Biomedical Imaging and Bioengineering (NIBIB).

In an article to be published in the Journal of the Acoustical Society of America, researchers at Drexel University report that patients who received low-frequency, low-intensity ultrasound treatment during their weekly check-up, in addition to standard compression therapy, showed a net reduction in wound size after 4 weeks. Patients who didn't receive ultrasound treatment had an average increase in wound size during the same time period.

The team's clinical findings were corroborated by their in vitro studies in which mouse fibroblasts—cells that play an active role in wound healing—experienced on average a 32% increase in cell metabolism and a 40% increase in cell proliferation compared with control cells 24 hours after receiving 20 kHz ultrasound for 15 minutes.

The researchers noted that studies with larger numbers of patients are needed to confirm that the technology is both effective and safe to use. If it is deemed so, patients with other types of chronic wounds such as diabetic or pressure ulcers may also benefit from therapeutic ultrasound.

Venous ulcers account for 80% of all chronic wounds found on lower extremities, NIH said, and affect approximately 500,000 US patients annually, a number that's expected to increase as obesity rates climb. It's estimated that treatment for venous ulcers costs the US health care system over $1 billion dollars per year. Standard treatment for venous ulcers involves controlling swelling, taking care of the wound by keeping it moist, preventing infection, and compression therapy.

Despite published guidelines that call for physical therapy or medications such as ibuprofen or acetaminophen for first-line management of most back pain, other treatments such as imaging, narcotics, and referrals to other physicians have increased, according to a study published online yesterday in JAMA Internal Medicine.

Because more than 10% of visits to primary care physicians relate to back and neck pain, and the treatments recommended by guidelines generally are less costly than those being used increasingly, the financial implications in the health care market are significant. "With health care costs soaring, improvements in the management of back pain represent an area of potential cost savings for the health care system while also improving the quality of care," the study concludes.

The study identified 23,918 visits to primary care physicians for spine problems. Average age of the patients increased from 49 to 53 years during the study period, January 1999 through December 2010, and 58% of the patients were female.

According to the results, physical therapy referrals remained unchanged at about 20%, but physician referrals increased from 6.8% to 14%. Nonsteroidal anti-inflammatory drug or acetaminophen use per visit decreased from 36.9% to 24.5%, while narcotic use increased from 19.3% to 29.1%t. The number of radiographs remained at about 17%, but the number of computed tomograms or magnetic resonance images increased from 7.2% to 11.3% during the study period.

"Structured physiotherapy should be tried before surgery is chosen," concluded researchers of a study comparing surgery followed by physical therapy and physical therapy alone for cervical radiculopathy. Even though the results of the 24-month randomized controlled trial, published this week in Spine, showed greater improvement in the first postoperative year, the differences between the groups decreased after the second year. The study compared 2 approaches to cervical radiculopathy: anterior cervical decompression and fusion (ACDF) with a physical therapy program (31 subjects) and the same physical therapy program alone (32 subjects). The physical therapy program included general and specific exercises and pain coping strategies. Outcome measures were disability (Neck Disability Index, NDI), neck- and arm-pain intensity using a visual analog scale (VAS), and the patient's global assessment. At 12 months, there was no significant difference between groups for NDI or VAS for arm-pain intensity. The surgical group scored significantly better on the VAS for neck-pain intensity, and 87% of patients in the surgical group self-rated their symptoms as "better/much better" compared with 62% of those in the physical therapy-only group. However, at 24 months, both groups showed significant reduction in NDI, neck pain, and arm pain.

The use of a foot drop stimulator (FDS) or an ankle foot orthosis (AFO) coupled with initial physical therapy sessions significantly improves gait speed in stroke survivors, say authors of a study published electronically ahead of print in May in the journal Stroke.

The authors, from the Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, conducted a multicenter, randomized, single-blind trial comparing FDS and AFO treatments for stroke survivors with gait speeds ≤0.8 m/s. Study participants consisted of 118 males and 79 females, aged 61-72 who experienced a stroke 4-5 years prior to the trial. Participants were treated using FDS or AFO for 30 weeks and provided 8 physical therapy sessions during the first 6 weeks of the trial.

The authors found significant improvements in gait speed using either FDS or AFO, with a mean change of 0.14 m/s for FDS and 0.15 m/s for AFO. When comparing FDS and AFO treatment groups, they did not find much variance in gait speed between the groups, but concluded that the FDS group expressed significantly greater user satisfaction than the control group. They also found significant improvements in standard measures of body structure and function, activity, and participation in both the FDS and AFO treatment groups and concluded that their "clinical trial provides evidence that FDS or AFO with initial physical therapy sessions can provide a significant and clinically meaningful benefit even years after stroke."

Finnish researchers reported that an intensive, long-term exercise program was beneficial to the physical functioning of patients with Alzheimer disease (AD) without increasing total costs of health and social services or causing any significant adverse effects. The implications are promising, if increased, targeted exercise would allow more patients to remain at home or delay a move to a care facility.

The study included 210 home-dwelling patients with AD living with their spousal caregivers, divided into 3 groups: group-based exercise, tailored home-based exercise, and "usual community care." Both exercise groups were led by physical therapists who tailored the exercise to the patients' needs. The group-based exercise group attended twice-a-week classes, while a physical therapist visited the home-based group for 1 hour twice a week.

After 1 year, the home-exercise and group-exercise subjects had significantly less deterioration in function and significantly fewer falls than the control subjects, with the home-exercise group faring the best. The main outcome measures used included the Functional Independence Measure, Short Physical Performance Battery, and information on the use and costs of social and health care services.

Although emergency medical services (EMS) use can increase stroke evaluation and treatment, more than a third, or 36.3%, of stroke patients fail to use EMS to get to the hospital, say authors of a study published electronically ahead of print in April by the journal Circulation: Cardiovascular Quality and Outcomes.

For this study, the authors analyzed data from 204,591 hemorrhagic and ischemic stroke patients. Those patients were admitted to 1,563 hospitals that use National Institute of Health Stroke Score and insurance status data and participate in the Get With the Guidelines-Stroke program.

The authors concluded that while 63.7% of patients arrived to the hospital via EMS, older patients using Medicaid and Medicare insurance and severe stroke patients were more likely to use EMS services. Race and ethnic minorities and people living in rural areas were less likely to use EMS services. Use of EMS services is associated with earlier arrival, prompter evaluation, more rapid treatment, and greater eligibility for treatment with tissue-type plasminogen activator.

Members can view APTA's issue brief (member login required) on stroke to learn more about a physical therapist’s role in stroke prevention and treatment.