• News New Blog Banner

  • New Podcast Series Focuses on Managing Patients With a Declining Functional Status

    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.

    Benefits of Self-management for LBP Not Considered 'Worthwhile' by Patients

    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.

    Low-intensity Exercise Shows Greatest Benefit for Patients With Parkinson Disease

    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."