• Friday, May 29, 2015RSS Feed

    Study: Resistance as Effective as Eccentric Training for Achilles Tendinopathy

    The effectiveness of a loading regimen for treatment of Achilles tendinopathy is well-established, and when it comes to what kind of regimen to use—eccentric training (ECC) or heavy resistance training (HSR)—researchers were surprised to find that both work equally well.

    In a study published in the May 27 issue of The American Journal of Sports Medicine (abstract only available for free) researchers from Denmark compared ECC and HSR interventions among 58 patients with chronic Achilles tendinopathy and found that both approaches "yield positive, equally good, lasting clinical results." Authors had hypothesized that the HSR group would yield better outcomes, based on similar studies conducted on patients with patellar tendinopathy.

    For the Achilles study, patients were divided into 2 groups, with 30 receiving HSR and the remaining 28 receiving ECC. Evaluations were conducted at baseline, 12 weeks, and 52 weeks, and included the Victorian Institute of Sports Assessment for Achilles (VISA-A), pain level assessments, ultrasonography, color Doppler scans, and patient satisfaction ratings.

    The ECC group was assigned a regimen of 3 sets of 15 slow repetitions of eccentric unilateral loading while standing on the step of a staircase, 1 exercise performed with straight knees and 1 with bent knees twice a day, 7 days a week, for 12 consecutive weeks. The HSR regimen was performed 3 times a week using resistance equipment at a fitness center, and consisted of 3 2-legged exercises: heel rises with bended knee in a seated calf raise machine, heel rises with straight knee in the leg press machine, and heel rises with straight knee standing on a disc weight with the forefoot with barbells on shoulders. HSR participants completed "3 or 4" sets in each exercise, with reps decreasing and loads increasing over time. Physical therapists instructed both sets of patients on how to perform the exercises.

    "The main difference between the 2 exercises regimens is the total loading time 'seen' by the tendon and the calculated session," authors write. "The time of tendon loading was estimated to be approximately 63 min/wk for ECC and 41 min/wk for HSR."

    What researchers found was that both approaches resulted in "robust clinical and structural improvements" for patients, with average VISA-A improvements of 10 points or more (on a 100-point scale) and reductions of 30 points or more in pain while running. These improvements remained equal at the 12-week and 52-week marks.

    Researchers did identify a few minor differences between the groups: HSR participants reported higher patient satisfaction at 12 weeks (though that dropped off at 52 weeks), and compliance rates were lower for ECC (78%) compared with HSR (92%). Authors are unsure of the exact reason for the difference in compliance, but they speculate that the longer time commitments required by ECC could explain at least part of the differences—"one aspect that may be considered when loading regimens are offered to patients," they write.

    "Eccentric loading regimens for tendinopathy have been widely accepted as the treatment of choice," authors write. "Although the present study was not designed to answer the effect of [contraction regimens such as HSR] per se, it appears that HSR, which includes a concentric as well as eccentric component, produced similar results to the traditional ECC regimen."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    Thursday, May 28, 2015RSS Feed

    Study: Mobilization With Movement Can Make a Difference in Shoulder Impingement

    A new study that attempts to isolate the effectiveness of mobilization with movement (MWM) for unilateral shoulder impingement concludes that the intervention can result in significant reduction in pain compared with a sham intervention. Authors believe that the more realistic use of MWM—not in isolation but as part of a multimodal physical therapy plan—could point to even better results for patients with shoulder impingement syndrome (SIS).

    For the study, recently published in the Journal of Manipulative and Physiological Therapeutics (abstract only available for free), researchers analyzed pain and range of motion results for 42 patients with SIS, half of whom received 4 10-minute sessions of a specific MWM application, and half who received a sham MWM-like intervention. Joshua A. Cleland, PT, DPT, OCS, FAAOMPT, was among the authors of the study.

    The actual MWM was performed by a physical therapist (PT) "with more than 10 years of experience in manual therapy," according to authors, who described the MWM technique as a process whereby "one hand was placed over the scapula posteriorly while the thenar eminence of the other hand was placed over the anterior aspect of the head of the humera." The patient is then asked to move his or her shoulder in flexion while the PT maintains a posterior-lateral manual glide on the humeral head. In each session, 3 sets of 10 repetitions were attempted, but the application was stopped if patients experienced pain.

    The sham MWM involved the PT placing one hand over the belly of the pectoralis major muscle and the other over the scapula without applying pressure. The patient was then asked to move his or her shoulder in the same way as the real MWM.

    Researchers measured pain free and maximum (painful) range of motion (ROM) in shoulder flexion, and pain-free ROM in shoulder extension, abduction, external rotation, and medial rotation at the start of the interventions and after 2 weeks.

    Their findings: patients who received the MWM experienced greater ROM in flexion and external rotation, and achieved a reduction in pain intensity during flexion—"significantly better outcomes" than the sham group, according to authors.

    Authors of the study write that the reasons for the improvement through MWM are "speculative" but offer the possibility that the force applied by the PT "diminished the abnormal translation of the humerus, which has been identified in individuals with shoulder problems."

    Researchers cited the fact that the study focused on MWM as a sole intervention as a limitation to their work. "In typical physical therapy practice, a multimodal treatment approach is often used," they write. "It is possible that combining MWM with other commonly used interventions including exercise and taping may result in greater improvements."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    Wednesday, May 27, 2015RSS Feed

    Postpartum Exercise, Concussion, Stroke, and More: Catch Up With Move Forward Radio

    The transformative power of physical therapy to treat diverse conditions is at the heart of recent Move Forward Radio episodes.

    A twice-monthly podcast, available for free download from iTunes or at MoveForwardPT.com, Move Forward Radio is a terrific resource to share with your patients. Recent episodes include:

    Pregnant and postpartum exercise
    During pregnancy and childbirth a woman’s body goes through profound changes in a relatively brief period of time. For women who exercise during or after pregnancy, failure to respect those changes has the potential to lead to problems. Christy Martin, PT, DPT, SCS, who specializes in sports physical therapy, and Vicki Lukert, PT, PRPC, who specializes in pelvic health, outline how pregnant and postpartum women can exercise safely and how to spot warning signs for problems that might require medical attention.

    Concussion and mild traumatic brain injury
    At Brooke Army Medical Center in Texas, Miriam Hammerle, PT, Cert SMT, often sees patients who have suffered a mild traumatic brain injury or concussion in the line of duty. One of her recent patients, Lt Col Tony Cromer Jr, suffered a concussion when his head was slammed by an opening door. The effects of that workplace accident, including headaches and dizziness, were the same as they often are for soldiers on the battlefield. Hammerle and Cromer discuss his injury and treatment.

    Autism spectrum disorder (ASD)
    ASD can be treated by a range of therapists who have individual specialties but overlapping goals. Christine Baksi talks about her 4-year-old son Sam, who was diagnosed with ASD at the age of 2, and is benefitting from a variety of therapies including physical therapy. Joining the discussion is Sam's physical therapist Lori Glumac, PT, DSc, PCS, who is a member of a collaborative care team that helps children with ASD develop physically and socially.

    Avoiding golf injuries
    Having a repeatable swing is key to having a good golf game. But with that repetition comes a risk for injury to backs, elbows, shoulders, and more. Michael Mulcahy, PT, discusses treatment for injured golfers, outlines typical golf-related injuries, and offers prevention tips that can help golfers strengthen themselves and their game.

    Stroke awareness, prevention, and recovery
    Those fortunate enough to survive a stroke often face problems with mobility, speech, balance, weakness, and memory loss, among other symptoms. Fortunately, depending on the severity of the stroke and the health of the individual, a physical therapist can effectively treat many of these side effects. Julia M. O. Castleberry, PT, DPT, MS, CLT, GCS, NCS, addresses all aspects of stroke, including describing what stroke rehabilitation looks like, how to spot a stroke, identifying who is at risk, and how to lower that risk.

    Spinal stenosis
    Spinal stenosis is a degenerative disease that causes a narrowing within vertebrae of the spinal column, resulting in pressure on the spinal cord. While it may sound like a serious problem in need of an invasive medical procedure (such as surgery), a recently published study in the Annals of Internal Medicine suggests that surgery should be considered only when other more conservative treatments, such as physical therapy, fail. Lead author Anthony Delitto, PT, PhD, FAPTA, discusses the study, treatment for lumbar spinal stenosis, and what patients need to know about options to avoid going under the knife.

    Move Forward Radio is featured and archived at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online via Blog Talk Radio or downloaded as a podcast via iTunes.

    APTA members are encouraged to alert their patients to the radio series and other MoveForwardPT.com resources to help educate the public about the benefits of treatment by a physical therapist. Ideas for future episodes and other feedback can be e-mailed to consumer@apta.org.


    Wednesday, May 27, 2015RSS Feed

    David Sackett, 'Father of EBM,' Dies

    David Sackett, MD, regarded as the "father of evidence-based medicine," died on May 13. He was 80.

    In a career—or as Sackett described, a series of careers—that included many achievements, Sackett is most often recognized by the public as the researcher who confirmed that aspirin helps to prevent heart attacks. Among health professionals, however, Sackett is recognized as the person who applied research evidence to clinical practice—an approach that may seem obvious today, but was radical in the late 1950s, when he first decided to consult clinical trials to determine treatment approaches.

    A lengthy obituary in the Globe and Mail states that Sackett's "methods and philosophy, now standard practice, have helped determine everything from what surgery is best after a heart attack to what type of hospital administration provides the best bang for the buck," and cites a BMJ article that ranks evidence-based medicine (EBM) as one of the most significant medical advancements in the past 150 years, "alongside the discovery of vaccines and antibiotics."

    In addition to his direct clinical practice, Sackett founded the journal Evidence-Based Medicine, and became the first chair of the Cochrane Collaboration. A self-published autobiography (.pdf) in question-and-answer form is available online, as well as an oral history of EBM that features Sackett and other leaders.

    Look for a tribute to Sackett and his impact on physical therapy and rehabilitation in an upcoming issue of PTJ.


    Tuesday, May 26, 2015RSS Feed

    Legislation Would Expand PT Workforce in Underserved Areas, Extend Student Loan Repayment Program to PTs

    Legislation that would include physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in underserved areas was introduced in both the US House of Representatives and Senate, just in time to be included in the grassroots advocacy efforts taking place during PT Day on Capitol Hill June 3-4.

    The Physical Therapist Workforce and Patient Access Act (H.R. 2342/S. 1426) was reintroduced late last week and, if passed, would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA).

    The bill was introduced in the House by John Shimkus (R-IL) and Diana DeGette (D-CO), and in the US Senate by John Tester (D-MT) and Roger Wicker (R-MS). The timing of the reintroduction couldn't be better, as an estimated 1,000 PTs, physical therapist assistants (PTAs), and students from PT and PTA programs descend on Washington, DC, to join in PT Day on Capitol Hill on June 4. Events will begin with a rally before participants fan out across the halls of Congress to advocate for increased patient access to PTs, loan forgiveness, the Medicare therapy cap, and other issues.

    APTA is a strong supporter of legislation that extends student loan forgiveness to PTs, particularly as a way to improve access to physical therapist services in areas already experiencing shortages.

    "Based on current trends in the physical therapist workforce, the shortage of physical therapists could potentially reach over 27,000 in the United States by 2020, greater than other primary care disciplines recognized by the [NHSC]," APTA notes in a position paper on the legislation (.pdf). "The inclusion of physical therapists in the NHSC Loan Repayment Program will help to ensure that rehabilitation services are available to underserved communities."

    Find out more about PT workforce legislation—including details about the NHSC loan repayment program and what you can do to advocate for the profession—at APTA's Education and Workforce Legislation webpage.


    Tuesday, May 26, 2015RSS Feed

    Foundation Opens Call for Scientific Review Committee Members

    The Foundation for Physical Therapy (Foundation) is accepting nominations and CVs from physical therapists (PTs) interested in serving on the Foundation's Scientific Review Committee (SRC). This elite group of professionals is the peer review arm of the Foundation’s scholarship, fellowship, and grants programs.

    Members selected to serve on the SRC have significant practice in training pre- and postdoctoral students and mentoring emerging investigators, as well as a strong track record of extramural funding and peer review experience at the federal level. Terms are for 3 years beginning January, 2016.

    For more information, including a full list of qualifications to serve on the SRC and instructions on submitting a CV, please visit the SRC webpage or email rachaelcrockett@apta.org.

    CVs must be received by August 1, 2015.


    Friday, May 22, 2015RSS Feed

    Meniscus Surgery All in Your Head, Says One Psychiatrist

    Apparently, even psychiatrists have issues—and sometimes these issues include feelings about the validity of arthroscopic surgery for meniscus tears.

    In an opinion piece for Psychiatric Times titled "Knee Surgery? Think Twice," psychiatrist Allen Frances, MD, explores not just the power of the placebo effect, but the role of exercise and physical therapy to lessen the pain associated with meniscus tears.

    To make his point, Frances mostly turns over the commentary to Teppo Jarvinen, the orthopedic surgeon who was the lead author a study that compared outcomes of patients who received arthroscopic surgery for a meniscus tear with patients who were provided sham surgery. The results showed that the sham surgery patients reported outcomes just as good as or better than their real-surgery counterparts. Findings of the study were reported in a January 2014 PT in Motion News article.

    In the Psychiatric Times article, Jarvinen says that knee surgery is sometimes recommended but that "without a true traumatic event … resulting in your knee filling up with blood ... if you're able to move your knee freely (even with some possible pain), there is no urgent need to have your knee 'scoped.'"

    "Rather, go and see your physiotherapist, start a good rehab program, and give it some 3-4 months to let nature take its course," Jarvinen says.

    Allen writes that Jarvinen's research "is one of those landmark studies that should change the world."

    "Patients beware before accepting the knife," Allen writes. "Insurance companies take note in establishing standards for reimbursement. Guideline makers insert watchful waiting and rehab before recommending surgery."


    Thursday, May 21, 2015RSS Feed

    New Postacute Care Webpage Makes an IMPACT

    Work in a postacute care setting? Brace yourself for IMPACT.

    New to the APTA website: a webpage exclusively devoted to providing you with everything you need to know about postacute care reform in Medicare, including information on how the Improving Post-Acute Care Transformation (IMPACT) Act will change the types and quantity of data provided to the Centers for Medicare and Medicaid Services (CMS).

    The new webpage provides a basic outline of the principles behind postacute care reforms, resources from CMS, summaries of proposed rules, and highlights of APTA's involvement in the process.

    The reach of IMPACT and other postacute care reforms extends to skilled nursing facilities, home health, inpatient rehabilitation facilities, and long-term care hospitals. APTA is a strong supporter of the reform initiatives, including the provisions of the IMPACT Act.


    Thursday, May 21, 2015RSS Feed

    BMJ Study Links Regular Physical Activity to Longer Life in Elderly Men

    Older men have yet another incentive to be physically active—they can extend their lifespan. At least this was the case for elderly men in an observational study recently published in the British Medical Journal (BMJ) (free full-text download) that linked regular physical activity to a lower risk of death.

    Boosting physical activity levels in this age group seems to be as good for health as giving up smoking, the findings suggested.

    The 5,738 men under observation had taken part in the Oslo I study of 1972-1973, at which time they would have been aged 40-49, and again in Oslo II 28 years later. In Oslo II they were monitored for almost 12 years to see if physical activity level over time was associated with a lowered risk of death from cardiovascular disease, or from any cause.

    The men were surveyed on, among other things, their weekly leisure time physical activities. Activities were classified as sedentary (watching TV or reading); light (walking or cycling, including to and from work for at least 4 hours a week); moderate (formal exercise, sporting activities, or heavy gardening for at least 4 hours a week); and vigorous (hard training or competitive sports several times a week).

    The analysis indicated that more than an hour of light physical activity was linked to a 32% to 56% lower risk of death from any cause. Less than an hour of vigorous physical activity was linked to a reduction in risk of between 23% and 37% for cardiovascular disease and death from any cause. The more time spent doing vigorous exercise, the lower the risk seemed to be, falling by between 36% and 49%. Men who regularly engaged in moderate to vigorous physical activity during their leisure time lived 5 years longer, on average, than those who were classified as sedentary.

    Factoring in the rising risk with age of death from heart disease and stroke made only a slight difference to the results, researchers said. Overall, these showed that 30 minutes of physical activity—of light or vigorous intensity—6 days a week was associated with a 40% lower risk of death from any cause.

    Being an observational study, no definitive conclusions can be drawn about cause and effect, the researchers pointed out, adding that only the healthiest participants in the first wave of the study took part in the second wave, which may have lowered overall absolute risk. But the differences in risk of death between those who were inactive and active were striking, even at the age of 73, they suggest.

    More effort should go into encouraging elderly men to become more physically active, the researchers concluded, emphasizing the wide range of ill health that could be warded off as a result. PT in Motion News reported in 2014 on 2 other studies touting the benefits of physical activity for older adults: JAMA reported that a physical activity program can reduce the risk of losing the ability to walk without assistance; and the Journal of Physical Activity & Health reported that each hour of sedentary behavior increases the odds of disability in activities of daily living.

    APTA offers educational resources that address the role of the physical therapist in health and wellness in older adults and provide insight into older adults and exercise adherence. Additionally, APTA's consumer-focused MoveForwardPT.com website includes a webpage featuring videos addressing the importance of fitness across the lifespan. The association also offers a prevention and wellness webpage that includes videos, podcasts, and educational resources.


    Wednesday, May 20, 2015RSS Feed

    Last Chance to Test ICD-10 Reporting System

    With no further delays on the horizon, the shift to the new International Classification of Diseases, 10th Revision (ICD-10) is set for October 1. Physical therapists (PTs) have one more chance to capitalize on an opportunity to test the new system before actual implementation, but only if they act quickly.

    The last of 3 ICD-10 test programs that the Centers for Medicare and Medicaid Services (CMS) has conducted for health care providers is scheduled for July 20-24, and the deadline to apply is May 22. APTA is encouraging members to sign up for the program to gauge their own practice's readiness for the change.

    Bonus for any PTs who already participated in the January or April end-to-end tests: you can participate again in July without reapplying.

    The testing program will allow a sample group of providers to work with Medicare administrative contractors (MACs) and Common Electronic Data Interchange (CEDI) contractors to evaluate the system for processing the new codes, from submission to remittance advice. That testing process will include submission of claims with ICD-10 codes to the fee-for-service claims system, adjudication of claims, and the production of accurate remittance advices.

    CMS is targeting a broad cross-section of providers and will select testing participants based on needs for the study. Volunteers can apply through their MAC's website but must do so by May 22. The MACs and CEDI will notify the volunteers selected by June 12 with information needed for the testing.

    More information on the testing process is available online (.pdf).

    Need more information on what the change to ICD-10 means for your practice? Visit the APTA ICD-10 webpage, which includes background and resources.


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