Older adults are at significant risk of developing vision differences between their eyes that, if undetected, could increase the likelihood of falls.
A new longitudinal study (abstract) in Optometry and Vision Science found that nearly 1 in 3 adults develop significant vision differences in each eye (called anisometropia) by their late 70s, an incidence rate that "needs to be clearly emphasized to clinicians" to ensure appropriate correction, according to the study's authors. If left uncorrected, the condition can interfere with depth perception and other visual skills necessary to prevent falls.
APTA identifies visual impairments as a significant contributor to falls and recommends interventions that address multiple risk factors.
Need more information on falls prevention? Get evidence-based practice information through PTNow and Open Door, and download APTA's education on exercise prescriptions for balance and falls prevention and pocket guide on falls risk reduction (.pdf). Share falls prevention information and experiences with APTA's online community dedicated to the issue.
The standard 2-hour patient repositioning schedule to minimize pressure ulcers could be stretched to 3 or 4 hours with the use of high-density foam mattresses, according to a recent study funded in part by the National Institutes of Health (NIH).
The study as reported in the October 2013 issue of the Journal of the American Geriatrics Society involved 942 consenting residents aged 65 and older at 27 nursing homes in the United States and Canada. All subjects were rated as having moderate to high risk of pressure ulcers based on the Braden Scale.
Subjects were divided into groups that received repositioning every 2, 3, or 4 hours for 3 weeks while lying on high-density foam mattresses. In addition to normal care and prevention measures (heel protector boots, barrier creams, incontinence briefs, etc), participants engaged in their normal activities including standing, bathing, and going to therapy "as usual."
At the end of the study, researchers determined that "there was no difference in [pressure ulcer] incidence over 3 weeks of observations between those turned at 2, 3, or 4-hour intervals," a finding that authors attribute to the use of the newer high-density foam mattresses. Researchers believe that the foam mattresses "effectively redistribute pressure" better than typical spring mattresses.
Management of wounds, including pressure ulcers, is the focus of an APTA online course for physical therapists (PTs). The association's Move Forward patient-focused resources include a PT's guide to pressure ulcers, and PTs interested in evidence-based practice research on the topic can access articles through APTA's PT Now online resource service.
A new study has reaffirmed a link between stroke reduction and walking in older men—but the link has more to do with time spent walking than intensity of the activity.
In an article published in the November 14 issue ofStroke, British researchers report on data involving 3,357 ambulatory men who took part in a 10-year study related to heart health. The men ranged in age from 60 to 80 and were grouped according to time spent walking, among other factors.
Researchers found that over the 10-year period, the men who spent more time walking every week (8 to 14 hours) reduced risk of stroke by about 33% over those who spent minimal time walking (0 to 3 hours a week). That finding wasn't surprising in itself, but when researchers compared distance/speed data among time cohorts, they found no significant association between distance and risk reduction. In other words, time spent walking mattered more than pace.
"Among community-dwelling older men we observed … a strong inverse dose-response association between time spent walking and risk of stroke, independent of walking pace, vigorous physical activity, established, and novel risk factors," authors wrote. "Results suggest that total volume of walking rather than the intensity is important for stroke prevention."
APTA cites the role of physical activity in stroke reduction in resources aimed at patients, physical therapists, and policymakers. Members can provide their patients with a handout on stroke prevention (.pdf, listed under "Neurology"), and can share information on this topic with others by downloading resources at APTA's Issue Briefs webpage.
A study of more than 1 million adult hospital admissions has revealed a high rate of opioid prescriptions for nonsurgical patients, with over 43% receiving the medications during their stay, and over half of that population receiving opioids on the day of discharge. Researchers also identified a pattern of high-dosage prescription and significant regional variations.
In the study, researchers reviewed records of nonsurgical admissions between 2009 and 2010 from 286 nonfederal acute care hospitals. Authors found that 43% of the 1.14 million nonsurgical patients received opioids, with the average dose equivalent to about 68 milligrams of oral morphine per day. Additionally, researchers identified spikes in use: of the patients receiving opioids, 23% received dosages of 100 milligrams or more on at least 1 day of hospitalization. The research was conducted by a team from Beth Israel Deaconess Medical Center and published online November 13 in the Journal of Hospital Medicine.
The use of opioids was not confined to the days of hospitalization, according to the research, which found that 26% of patients were also administered opioids on the day of discharge. Authors believe that the common practice of tapering patients off these drugs means that as many of half of these patients also received a prescription for opioid medication to be taken after discharge.
The study also identified variations in use among hospitals in different parts of the country, with hospitals in the West reporting an opioid use rate about 37% higher than use rates in the Northeast, which reported the lowest rate. In addition, researchers found a correlation between frequency of prescription and risk of opioid-related complications.
A significant portion of nonsurgical hospital admissions are for patients with musculoskeletal injuries, and physical therapists (PTs) must often assess the impact of opioids and other pain medications on early mobility in the hospital as well as on later interventions. APTA offers several resources on this topic, including a 2-part course on the drugs used to treat pain and inflammation, and research on opioids and exercise available via the PT Now portal.
A new report from the federal Agency for Healthcare Research and Quality (AHRQ) assembles the results of 12 grant studies that, combined, show that effective use of health care IT can play a significant role in improving outcomes, increasing patient engagement, and lowering costs—particularly for patients moving to or from ambulatory care settings.
The report, titled "Findings and Lessons From the Improving Management of Individuals With Complex Healthcare Needs Through Health IT Grant Initiative" (.pdf) tracks the work of a dozen projects awarded AHRQ grants in 2007. The grant initiative is 1 in a 5-part series and a component of AHRQ's Ambulatory Safety and Quality Program, which AHRQ states was designed "to improve the safety and quality of ambulatory health care in the United States."
In the document, AHRQ discusses how grant research informs 5 major content areas: novel approaches to providing high-quality care, integration of patient information across transitions, shared decision making and patient-clinician communication, strategies for IT adoption, and the impact of health IT on outcomes. Almost all projects "demonstrated the potential of EHRs [electronic health records] and PHRs [personal health records] to effectively move evidence-based information to the point of care, including the transfer of structured information between clinical data systems," according to the report.
The projects themselves included the implementation of information exchange systems for ambulatory care providers treating patients in rural areas recently discharged from the hospital, the creation of computer-assisted telephone call systems to monitor patient self-care after discharge, and various care coordination projects aimed at using IT to better manage care of patients with multiple comorbidities. AHRQ characterized the results of the projects as "timely and relevant to better serve patients with complex health care needs."
APTA offers several resources on IT and EHRs, including a webpage devoted to the use of EHRs. The association describes the EHR as a system that "puts a complete medical record at providers' fingertips" and a resource that "can be used to help inform the clinician of trends in care delivery or various aspects of care" through access to evidence-based practice data.
The mystery of a 134-year-old anatomical "enigma" has finally been solved with the announcement of a new knee ligament. Described in 1879 only as a "pearly resistant fibrous band," the newly named anterolateral ligament (ALL) could affect tibial rotation and the pivot shift phenomenon, according to researchers.
The presence of the ligament was verified through examination of 41 cadaveric knees, which, with 1 exception, included the ALL. A recounting of the research (abstract only) that led to the discovery was published in the October 2013 issue of the Journal of Anatomy, and word quickly spread to major news organizations such as the Huffington Post and Time.
Researchers describe the ALL as a "well defined structure" that is situated "at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament." It follows an oblique course to the anterolateral aspect of the proximal tibia, with its insertion on the tibia "grossly located between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB)."
While the authors cite the need for more research on the ALL, they hypothesize that the ligament plays the role of a stabilizer for internal rotation, and speculate that the ALL could play a part in "rotary knee instability patterns witnessed in many [anterior cruciate ligament] deficient knees."
A recently published literature review and meta-analysis has determined that there may be a link between patellofemoral pain (PFP) and quadriceps atrophy, and authors believe the findings "support the rationale for use of quadriceps strengthening as part of a rehabilitation program for PFP."
The analysis, published in the November 2013 issue of the Journal of Orthopaedic & Sports Physical Therapy, reviewed 10 studies that focused on patients with PFP and no coexisting pathology. Measurement of quadriceps size was obtained with a tape measure, through ultrasound, or by way of magnetic resonance imaging (MRI), and all studies included baseline data.
The study's authors found that the presence of atrophy was more reliably detected through imaging techniques than with girth measurements but that the atrophy did exist to such an extent that quadriceps-strengthening exercises could be "an important consideration" in rehabilitation. Authors acknowledge that this suggestion differs from research that "has led many clinicians to shift their focus toward more proximal factors in PFP rehabilitation."
PFP is common, particularly among young athletes, and accounts for as much as 25% of all reported knee pain. APTA's guide to PFP recognizes the role that quadriceps-strengthening may play in rehabilitation and provides information on PFP that PTs can share with patients. More broadly focused information on knee pain is also available at the PT's guide to knee pain webpage.
Prevention exercises can help the elderly avoid falls, but can they also reduce injuries when a fall occurs? A recently-published meta-analysis indicates just such a possibility.
In the study, published October 29 in the British Medical Journal, researchers reviewed results of 17 trials involving 4,305 patients aged 60 and older living in community dwellings. Each of the studies compared patients who received falls prevention exercises with those who did not, and contained data on subsequent falls and the extent of injury sustained. Authors of the meta-analysis then grouped the injuries according to standardized classifications and reviewed seriousness of injuries across the studies.
The research revealed that in addition to lessening the rate of falls, prevention exercises also reduced the severity of injury when falls do occur, with estimated reductions of 37% for all injurious falls, 43% for severe injurious falls, and 61% for falls that produced fractures. Authors of the study write that "it is…thought that exercise prevents injurious falls not only by improving balance and decreasing the risk of falling, but also by improving cognitive functioning, and the speed and effectiveness of protective reflexes (such as quickly extending an arm or grabbing nearby objects) or the energy absorbing capacity of soft tissues (such as muscles), thereby diminishing the force of impact on the body."
APTA provides education on exercise prescriptions for balance and falls prevention, and offers resources for physical therapists on balance and falls prevention, how to develop consumer events on balance, falls and exercise, and information on evidence based falls programs. Members can also access an APTA pocket guide on falls risk reduction (.pdf) as well as take part in an online community where members can share information about falls prevention.
Older women who take aromatase inhibitor (AI) therapy as part of their breast cancer treatment may be able to walk their way to decreased joint pain, according to a recent study from the University of North Carolina at Chapel Hill. Results of the study were announced in a press release issued in conjunction with the annual meeting of the American College of Rheumatology.
The study focused on 30 women aged 65-87 whose treatment included the use of an AI. AI treatment often produces joint pain or stiffness-a side-effect that results in a 20%-32% discontinuation rate. In the study, the women were placed on the Arthritis Foundation's 6-week Walk With Ease physical activity program and interviewed before and after implementation.
Researchers found that in addition to increasing walk frequency and duration, the women reported a 19% drop in fatigue, a 10% decrease in pain, and a 32% reduction in joint stiffness. Of the group, 90% reported increased motivation to increase physical activity and expressed confidence that they would continue to walk.
The findings echo APTA's understanding of the important role that activity should play in the lives of cancer survivors. The association offers continuing education on physical therapy for cancer survivors, and visitors to APTA's website can view a video on collaborative care and breast cancer rehabilitation. Additionally, the role of the physical therapist in cancer survivorship was the focus of an article in the July 2013 edition of PT in Motion magazine.
A new study has reinforced the idea that for total hip and knee replacement patients, rehabilitation that begins in the recovery room can reduce the length of hospital stays. Researchers in the study found that 70% of rapid rehabilitation patients spent less time in the hospital than patients whose first rehabilitation session occurred the day after surgery.
The study (.pdf), published in a recent issue of the Bulletin of the Hospital for Joint Disease, reviewed 900 hip and knee replacement patients divided into 1 group of rapid rehabilitation patients (331) and 1 group of standard rehabilitation patients (569). The 2 groups were comparable for sex, age, ASA class, anesthesia type, comorbidity groups, and time of physical therapy, although procedure length and estimated blood loss did vary somewhat between the groups, with the rapid rehabilitation group recording less of both.
The therapy program for both groups was the same, with the only difference being when and where it began: the rapid rehabilitation patients were mobilized in the recovery room, while the standard rehabilitation patients were mobilized on the morning of postoperative day 1.The results showed that hip replacement patients averaged a 3.9-day stay in the rapid rehabilitation group and a 4.6-day stay in the standard rehabilitation group. Knee replacement patients saw a less dramatic difference, with the rapid rehabilitation group averaging a 3.6-day stay and the standard rehabilitation group recording a 4.1-day average.
Researchers called the differences significant and cited benefits of shorter stays that included decreased patient needs for services such as blood transfusion, reduced risk of postoperative complications, and increased cost savings.
APTA is a strong supporter of rehabilitation research, and APTA members were part of the Blue Ribbon Panel on Medical Rehabilitation Research at the National Institutes of Health (NIH). The panel's findings, which included recommendations for the development of a research plan and elevation of the National Center for Rehabilitation Research within the NIH structure, were recognized in a statement issued by APTA in January 2013.
American Physical Therapy Association | 1111 North Fairfax Street, Alexandria, VA 22314-1488 703/684-APTA (2782) | 800/999-2782 | 703/683-6748 (TDD) | 703/684-7343 (fax)
Contact Us | For Advertisers & Exhibitors | For Media | Follow APTA
All contents © 2013 American Physical Therapy Association. All Rights Reserved.