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.
By 2030, several million more people will suffer from heart failure, and related total treatment costs will more than double, from 2012 levels, says the American Heart Association (AHA) in a policy statement published online April 24 ahead of print in Circulation: Heart Failure.
AHA estimated future costs of heart failure (HF) using a methodology that it developed to "project the epidemiology and future costs of HF from 2012 to 2030." The model did not double-count costs associated with comorbid conditions and assumed that heart failure rates based on sex, age, and race/ethnicity will not vary, and increasing costs and technological innovation will not vary. AHA projected that by 2030, more than 8 million people will suffer from heart failure; real total direct medical costs related to heart failure will increase from $21 billion to $53 billion; and total treatment costs will increase from $31 billion to $70 billion.
The statement authors concluded, "The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed."
In December 2012, APTA discussed how physical therapists can help patients manage chronic heart failure in this podcast.
A tailored physiotherapy program improved self-reported functional outcomes and hip range of motion in patients undergoing hip resurfacing, say authors of a study published electronically ahead of print in April by the Clinical Rehabilitation journal.
The study was a randomized controlled trial with 6-, 16-, and 52-week follow-ups. It included 80 men with a median age of 56 who were listed for primary hip resurfacing surgery between 2009 and 2010. The authors, from the Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK, compared tailored postoperative physiotherapy programs with standard physiotherapy. They found that at 1 year, the mean (SD) Oxford Hip Score of the group using the tailored program was higher than the control group at 45 versus 39.6, respectively. In addition, 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group.
The authors concluded that the "study confirms that a tailored rehabilitation programme following Metal On Metal Hip Resurfacing Arthroplasty (MOMHRA) improves self-reported functional outcomes and quality of life compared with a traditional rehabilitation programme."
A specific nonoperative physical therapy program was effective for treating atraumatic full-thickness rotator cuff tears in nearly 75% of patients, say authors of a multicenter prospective cohort study published by the Journal of Shoulder and Elbow Surgery in March.
For this study, the authors enrolled patients with atraumatic full-thickness rotator cuff tears. Using questionnaires, the patients provided data on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments, including Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale.
The authors designed a physical therapy program based on a systematic review of extant literature and evaluated patients at 6 and 12 weeks. During these evaluations, patients chose from 3 courses of action: cured with no formal follow-up scheduled; improved with subsequent therapy and a scheduled evaluation in 6 weeks; and unimproved/optional surgery. At 1 and 2 years, patients were called and asked whether they underwent surgery after their last evaluation. The authors used a Wilcoxon signed rank test with continuity correction to compare initial, 6-week, and 12-week outcome scores.
Among the 452 patients included in the study, patient-reported outcomes improved significantly at 6 and 12 weeks, say the authors. Patients had surgery less than 25% of the time and elected to do so between 6 and 12 weeks, with few undergoing surgery between 3 and 24 weeks.
Physicians who follow preventive health measures are more likely to have patients who follow preventive health measures, according to a Canadian Medical Association Journalstudy cited in the April 8 Medscape News Today.
The study included 1,488 physicians and their 1,886,791 adult patients. The authors examined 8 indicators, such as flu vaccination and mammograms, and found that for all indicators, patients were more likely to undergo preventive practices if their physicians had undergone the same practices (P < .05). The authors found a stronger relationship between similar preventive practices than dissimilar ones; for example, patients of physicians who did and physicians who did not receive the flu vaccine had identical mammography rates.
In their conclusion, the authors state, "Our findings suggest that there is room for improvement in some physicians' preventive practices (particularly around screening and vaccination) and that improving the health of physicians could improve outcomes for their patients as well. We believe that programs for physician health promotion should be developed and studied to determine how best to actively encourage the healthy doctor–healthy patient association."
Physical therapists who set healthy examples for their patients are featured in the March 2013 issue of PT in Motion—read about them in "Endurance Tested."
According to a new systematic review of the evidence base for exercise in critically ill patients, physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, and peripheral and respiratory muscle strength; increasing ventilator-free days; and decreasing hospital and ICU stay.
"It is apparent that survivors of critical illness experience poor physical, functional, and cognitive outcomes often lasting for years," said the authors of a paper published in Critical Care Medicine, noting that this condition, "post intensive care syndrome," and the related "intensive care unit acquired weakness" can result in major impacts on the health and productivity of survivors and caregivers, availability of hospital beds, and health care costs.
"Early physical therapy in intensive care in increasingly recommended, and this review has found preliminary evidence that there are beneficial effects," the study said.
The researchers analyzed 10 randomized control trials and 5 systematic reviews after identifying 3,126 abstracts (1980 through January 2012) from a keyword search using "critical care" and "physical therapy" and related synonyms. Overall there was a significant positive effect favoring physical therapy to improve quality of life (g = 0.40, 95% confidence interval 0.08, 0.71), physical function (g = 0.46, 95% confidence interval 0.13, 0.78), peripheral muscle strength (g = 0.27, 95% confidence interval 0.02, 0.52), and respiratory muscle strength (g = 0.51, 95% confidence interval 0.12, 0.89). Length of hospital stay (g = -0.34, 95% confidence interval -0.53, -0.15) and ICU stay (g = -0.34, 95% confidence interval -0.51, -0.18) significantly decreased, and ventilator-free days increased (g = 0.38, 95% confidence interval 0.16, 0.59) following physical therapy in the ICU, the study says.
rehabilitation for long‐term care residents may be effective,
reducing disability with few adverse events, but effects appear quite small and
may not be applicable to all residents, say authors of an updated Cochrane review
first published in 2009. There is insufficient evidence to reach conclusions
about improvement sustainability, cost‐effectiveness,
or which interventions are most appropriate, they add. Future large‐scale
trials are justified.
For this update, the authors
searched the trials registers of Cochrane entities, trials and research
registers, and conference proceedings; checked reference lists; contacted
authors, researchers, and other relevant Cochrane entities; and updated
searches of electronic databases in 2011 and listed relevant studies as
awaiting assessment. They selected randomized studies comparing a
rehabilitation intervention designed to maintain or improve physical function
with either no intervention or an alternative intervention in older people
(over 60 years) who have permanent long-term care residency.
Two review authors independently
assessed risk of bias and extracted data. The primary outcome was function in
activities of daily living. Secondary outcomes included exercise tolerance,
strength, flexibility, balance, perceived health status, mood, cognitive
status, fear of falling, and economic analyses. The authors investigated
adverse effects, including death, morbidity, and other events. They synthesized
estimates of the primary outcome with the mean difference; mortality data with
the risk ratio; and secondary outcomes, using vote-counting.
The authors included 67 trials
involving 6,300 participants. Fifty-one trials reported the primary outcome, a
measure of activities of daily living. The estimated effects of physical
rehabilitation at the end of the intervention were an improvement in Barthel
Index (0 to 100) scores of 6 points (7 studies), Functional Independence
Measure (0 to 126) scores of 5 points (4 studies), Rivermead Mobility Index (0
to 15) scores of 0.7 points (3 studies), Timed Up and Go Test of 5 seconds (7
studies), and walking speed of 0.03 m/s (9 studies). Synthesis of
secondary outcomes suggested there is a beneficial effect on strength,
flexibility, and balance, and possibly on mood, although the size of any such
effect is unknown. There was insufficient evidence of the effect on other
secondary outcomes. Based on 25 studies (3,721 participants), rehabilitation
does not increase risk of mortality in this population (risk ratio 0.95).
However, it is possible bias has resulted in overestimation of the positive
effects of physical rehabilitation, say the authors.
Patients with stroke may make more
functional gains if their postacute care includes treatment received at an inpatient
rehabilitation facility (IRF), say authors of an article published this month in Archives
of Physical Medicine and Rehabilitation. This finding may have important
implications as postacute care delivery is reshaped through health care reform,
Researchers conducted this prospective
cohort study at 4 northern California hospitals that are part of a single
health maintenance organization. They enrolled patients with stroke (N=222)
between February 2008 and July 2010.
Baseline and 6-month assessments
were performed using the Activity Measure for Post Acute Care (AM-PAC), a test
of self-reported function in 3 domains: basic mobility, daily activities, and applied
Of the 222 patients analyzed, 36%
went home with no treatment, 22% received home health/outpatient care, 30%
included an IRF in their care trajectory, and 13% included a skilled nursing
facility (but not IRF) in their care trajectory. At 6 months, after controlling
for variables such as age, functional status at acute care discharge, and total
hours of rehabilitation, patients who went to an IRF had functional scores that
were at least 8 points higher (twice the minimally detectable change for the
AM-PAC) than those who went to a skilled nursing facility in all 3 domains and
in 2 of 3 functional domains compared with those who received home
APTA members Alan Jette, PT, PhD,
FAPTA, Diane E. Brandt, PT, PhD, and Elizabeth K. Rasch, PT, PhD, coauthored