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  • Researchers Find 'Only Positive Effects' From PTs in Primary Care Role

    Get thee to a physical therapist (PT): according to a new study from Sweden, patients seeking primary care for musculoskeletal disorders (MSDs) who are triaged to a PT fare just as well—and in some respects, better—than those who are seen by a physician general practitioner (GP). It's a finding consistent with APTA's own investigations into the PT's role in primary care settings.

    Authors of the study, published in Therapeutic Advances in Musculoskeletal Disease, concede that, at 55 participants, their study was small. But they assert that their findings indicate that directing patients to PTs for primary assessment in primary care results in slightly better patient-reported outcomes related to pain, disability, and health-related quality of life (HRQoL) at follow-up, from 2 weeks to a year after initial visit. "Only positive effects were notable, and no adverse events regarding the triaging process were reported," they write.

    Researchers worked with 3 primary care health centers (PHCCs) in Gothenberg, Sweden, each serving a slightly different socioeconomic population (one serving patients experiencing generally lower socioeconomic conditions; one in a more affluent area; and one serving a more mixed population). PHCCs are the usual route taken by patients in Sweden seeking primary care, where patients are first assessed by a nurse, who determines a treatment pathway—including which provider the patient sees next.

    [Editor's note: want to learn more about how PTs are deepening their footprint in primary care? This 2018 article from PT in Motion magazine explores how the landscape is changing and offers links to APTA resources on issues related to primary care.]

    For the study, it wasn't a question of whether PTs should be delivering primary care—they were already doing that at the 3 participating PHCCs—but of how PT primary care affected outcomes. To make this assessment, researchers worked with nurses to randomly assign patients who normally would be referred to a PT to a control group that received "treatment as usual" (TAU) from a GP. The researchers then compared patient-reported outcomes from the PT and TAU groups at various points.

    Patients participating in the study were "working age" (16-67 years old) individuals seeking help for a new musculoskeletal condition; patients were excluded from the study if they required home visits, were receiving ongoing treatment for the current MSD, were seeking help for a chronic condition unchanged for 3 months or more, or possessed insufficient English or Swedish language skills to complete patient questionnaires.

    Both groups were asked to complete patient questionnaires on pain (0-10 rating scale), disability (Disability Rating Index), HRQoL (EuroQol 5), and risk for developing chronic musculoskeletal pain (Orebro Musculoskeletal Pain Questionnaire). Researchers also sought to determine whether the PT patient group developed different attitudes about responsibility for their MSDs, shifting more of that sense of responsibility to the patient and away from employers and/or medical professionals. Researchers asked patients to complete the questionnaires at initial consultation and 2, 12, 26, and 52 weeks later.

    Analysis revealed that while all patients improved at roughly similar rates, the PT group reported consistently better—albeit just slightly better—outcomes. The exception to that trend was in HRQoL scores, which improved for the PT group over the TAU group by a statistically significant margin.

    As for patient attitudes about responsibility for MSDs, the PT group tended to reduce what authors call "externalization" of the condition to health care providers, but a slight drift to greater externalization focused on employers after 1 year. However, researchers found that the changes in attitudes were slight.

    "This study indicates that early contact with both GPs and [PTs] can reduce the risk for patients developing chronic conditions with subsequent need for more comprehensive treatment," authors write. "As the effects of [PT] treatment were at least as good as TAU, it is clearly feasible to impose management modifications which can free medical competence for other patient groups. It is important to take care of even the group of patients with short-term or low-intensive musculoskeletal conditions to prevent development of chronic disorders."

    The researchers acknowledge that besides the small study population, the project also experienced patient dropout over time—particularly among younger patients in the PT group. Still, they contend, the findings support the role of PTs in primary care.

    "While it cannot be irrevocably concluded that initiation treatment by a [PT] is better for all patients with [MSDs] than [is] medical advice and treatment by a GP, there is nothing to indicate that this triage model for managing patients with [MSDs] in primary care is, in any way, detrimental to the patient health or worse than standard care," they write. "Triaging to [PTs] for primary assessment in primary care seems to lead to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with MSDs."

    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.

    Researchers: Aquatic Exercise Offers Similar Results With Less Pain for Patients With Chronic LBP

    Aquatic exercise, a common physical therapist intervention for patients with chronic low back pain (CLBP), shouldn't be viewed as "less strenuous or less effective" than land-based exercise, according to authors of a recent study in PTJ (Physical Therapy). In fact, they write, water-based exercise can be beneficial for people whose movement is limited by pain.

    Researchers recruited 40 men aged 18 to 45 with a healthy body mass index. Half of participants had experienced CLBP for greater than 12 weeks; the control group experienced no back pain. Both groups performed 15 aquatic exercises and 15 land-based exercises with movement patterns similar to the aquatic exercises. Fourteen of the exercises included upper extremity dynamic movements, and 16 focused on the lower extremities.

    The authors measured heart rate, rate of perceived exertion, and pain. They also used video motion analysis and wireless, waterproof EMG sensors to measure bilateral activation of the erector spinae, multifidus, gluteus maximus, gluteus medius, rectus abdominis, external oblique, and internal oblique muscles.

    Among their findings:

    There were few significant differences between the CLBP and control groups. Heart rate (HR), rate of perceived exertion (RPE), pain, and muscle activation for both land and water-based exercises were similar for both groups. Patients with CLBP had greater mean left erector spinae activations in one exercise and higher RPE in another.

    Differences were seen when comparing results for exercises performed in water versus land. Muscle activation was greater on land in 29% of cases and in water in 5% of cases. Heart rate was higher on land with all exercises, but RPE was not consistently higher or lower in either environment.

    Pain was reported more than twice as frequently when subjects exercised on land. However, pain levels were generally low in both environments.

    While the study was small, and the researchers say it was the first to examine this data set for aquatic exercises, the fact that results were similar for both groups suggested to them that "exercising in the water can be beneficial for rehabilitation and strengthening by allowing people with CLBP to perform the exercises and activate muscles without their condition adversely affecting them."

    [Editor's note: interested in aquatic physical therapy? Check out the APTA Academy of Aquatic Physical Therapy.]

    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.

    Can Cognitive and Physical Activity in Midlife Reduce the Risk of Dementia in Later Years? Researchers Say Yes

    Staying intellectually engaged and physically active is an important part of a healthy lifestyle at any age, but now authors of a new study from Sweden say that cognitive and physical activity in midlife can pay off years later by reducing the risk of some forms of dementia. The results of the study showed that individuals who were cognitively active in midlife reduced their risk for Alzheimer's disease (AD) by as much as 46%, while those who were physically active reduced the risk of later dementia and stroke by 53%.

    The study, e-published ahead of print in Neurology, followed 800 women from 1968 to 2012, noting levels of cognitive and physical activity at baseline, and analyzing rates of various types of dementia as the women aged. Baseline activity ratings were taken when the women were 38-54 years old (average age, 47) as part of the Prospective Population Study of Women.

    Cognitive activity was assessed on 0-2 point scale based on each woman's level of involvement in 5 areas of activity: intellectual, artistic, manual, club, and religious. Activity in each category could range from no/low (0) to high (2). Information was obtained via "semi-structured psychiatric interviews."

    Physical activity (PA) was assessed using the Saltin-Grimb Physical Activity Level Scale, which assigns PA levels on a 4-point scale: 1 - completely inactive; 2 - light PA for at least 4 hours a week; 3 - regular physical training such as running or swimming for at least 2-3 hours a week; and 4 - regular intense physical training such as running or swimming several times a week or participating in competitive sports.

    After the initial assessments in 1968-69, participants were reexamined for cognitive and neurophysiologic function in 1974-75, 1980-81, 1992-93, 2000-03, 2005-06, and 2009-10. The last 4 follow-ups included "close informant interviews" that provided additional, third-party information on behavioral changes, activities of daily living, and, if it had occurred, the participant's age at onset of dementia. Information on potential confounders—education, socioeconomic status, hypertension, smoking, diabetes, angina, psychological stress, and depression—was also gathered.

    Between 1998 and 2012, 194 women—nearly 25%--developed dementia over an average 31.5-year timespan. Average age of dementia onset in the group was 79.8 years, and the overall average age at death was 80 years. In addition to total dementia rates, researchers looked at rates of AD, vascular dementia (VaD), "mixed dementia" (both AD and cerebrovascular disease [CVD]), and "dementia with CVD,” which encompassed individuals with any type of dementia and stroke.

    When researchers began analyzing rates of dementia in terms of baseline levels of cognitive and physical activity, they discovered a connection between that activity and lower risk of dementia, albeit in different areas: cognitive activity was associated with a 46% risk reduction for Alzheimer's disease, while PA was associated with a 37% risk reduction for mixed dementia and a 53% drop in risk for dementia with CVD. Both types of activity reduced overall dementia risk by about 33%. The reduced risk rates remained even when researchers factored in the potential confounders. Neither type of activity seemed to reduce the risk for VaD alone.

    Authors write that a possible explanation for the reduced risk has to do with the ways in which cognitive and physical activity increase "cognitive reserve," or "how flexible and efficiently one can make use of available brain reserve," even when measurable factors such as brain size and neuronal count are lower. It's a concept echoed in a study that appeared in Neurology earlier this year, in which researchers reported that higher levels of PA and motor skills not only lowered the odds of dementia, but seemed to buffer its severity if it did occur.

    Authors of the Swedish study acknowledge some significant limitations in their study, including its focus on a fairly demographically homogenous group, and the lack of any data on whether the women active in midlife remained so as they aged. Also "impossible to rule out," according to the researchers: the possibility that the lower cognitive and physical activity levels reported by some of the women were "manifestations of very early pathologic processes in dementia disorders."

    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.

    CPG: Avoid Surgery for Atraumatic Shoulder Pain

    Authors of a new clinical practice guideline (CPG) on treatment of shoulder pain took a hard look at the advisability of surgery and came to a conclusion that can be boiled down to 3 words: don't do it.

    Published in BMJ, the CPG focuses on adults with atraumatic shoulder pain lasting for 3 months or more (diagnosed as subacromial pain syndrome, or SAPS), and zeroes in on the effectiveness of arthroscopic decompression surgery versus nonsurgical approaches including exercise therapy, analgesics, and injections. The CPG development group, which included patients who had experienced SAPS, analyzed results of 2 systematic reviews—one on what constitutes a "minimally critically important difference" (MCID) in patient-reported outcomes, and another on the benefits and harms of decompression surgery. The systematic reviews included 7 trials involving 1, 014 patients.

    In reviewing the systematic review of MCIDs for SAPS, the CPG group identified, with confidence, 2 changes that patients value: a difference in pain of at least 1.5 points on a visual 1-10 scale, and a difference in function of at least 8.3 units on a 100-point scale. In both areas, decompression surgery resulted in no significant differences from other approaches—including placebo surgery. The lack of difference remained at 6-month, 2-year, and 5-year follow ups.

    Authors of the CPG also looked at 6 trials that compared surgery with exercise therapy, and although all were at high risk of bias due to lack of blinding, the results indicated that surgery demonstrated no advantages over exercise therapy in terms of pain, function, quality of life, perceived effect, and return to work.

    Armed with the conclusion that decompression surgery isn't any more effective than sham surgery or other treatment approaches, the CPG authors next analyzed the benefits and harms of the procedure. Again, surgery didn't fare well.

    After the guideline panel found that "potential harms from surgery were incompletely reported in the trials," the group requested that the systematic review be expanded to include observational studies that evaluated harm after the procedure. They found 4 sets of results from a large US study that found a roughly 0.55% risk of complications after 30 days. The harms included bleeding, infections, peripheral nerve injury, anesthetic complications, and venous thromboembolism.

    Given the procedure's risks and apparent lack of superiority in terms of effectiveness, "the panel concluded that almost all well informed patients would decline surgery and therefore made a strong recommendation against subacromial decompression surgery," authors write. "Clinicians should not offer patients subacromial decompression surgery unprompted, and others should make efforts to educate the public regarding the ineffectiveness of surgery."

    As for the alternatives to surgery, authors state that "the whole area of best management of SAPS is uncertain," including exercise therapy, manual therapy, and electrotherapies. Current evidence on these approaches show "uncertain benefit to patients compared with watchful waiting, and guidelines vary in their recommendations," they write.

    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.

    From PTJ: PT, PTA Injuries Related to Patient Handling Still Common in LTC Settings

    Despite efforts by APTA and others to emphasize safety and the use of lifting devices, physical therapists (PTs) and physical therapist assistants (PTAs) working in long-term care (LTC) facilities continue to experience musculoskeletal disorders (MSDs) linked to patient handling incidents, say authors of a new study. Areas of injury most frequently cited by PTs, PTAs, and other "therapy personnel"—occupational therapists (OTs) and occupational therapy assistants (OTAs)—were the lower back, shoulder, and neck.

    For the study, published in the February issue of PTJ (Physical Therapy), researchers looked at a year's worth of workers compensation claims (WCCs) from a long-term care company with 202 skilled nursing facilities and 20 assisted living facilities, and compared those data with the results of confidential surveys completed by 2,642 employees of the company. While the primary aim of the study was to get a sense of the magnitude of musculoskeletal injuries experienced by employees, authors also were interested in how those injuries correlate to workers' perceptions of their job demands and whether they routinely used resident-lifting equipment.

    For the analysis, the authors divided the WCC claims into 4 categories related to the cause of injury: ergonomic (manual or patient handling, bodily reaction, repetition), workplace violence, acute incident (fall, slips, trips, being struck by an object), and other. The nature of the injury—acute, subacute, nonspecific, nonmusculoskeletal—and body region affected also were grouped into major areas. Employees were grouped into larger categories: therapy personnel, nursing aide, licensed practical nurse (LPN), registered nurse (RN), social/speech/respiratory service, technician, housekeeping/dietary maintenance, and office/administrative service.

    Among the findings:

    • According to WCC data, the most commonly injured body regions among all employees were upper extremities (37%), lower back/back and trunk (20%), and lower extremities (17%).
    • Therapy personnel had the lowest rate of claims for acute injury, at 2 claims per 1,000, but their average per-claim cost were the highest.
    • In terms of ergonomic injury among clinical staff, nursing aides reported the highest rate of injury, at 36 claims per 1,000. Therapy personnel were next, at 16 per 1,000—a rate similar to those of LPNs and RNs.
    • About 43% of subacute injuries (defined by the authors as "sprains, spasms, muscle contusions, carpal tunnel, tendinitis, disc hernias, and similar injuries") were related to patient handling incidents across all jobs, with nursing aides once again reporting the highest claims rate, at 58 per 1,000. Therapy personnel were next highest at 15 per 1,000.
    • Therapy personnel, RNs, and nursing aides reported low back pain at a similar rate—48.1%, 44%, and 47.5%, respectively. Therapy personnel registered higher rates of neck pain (24.4%) and shoulder pain (34.6%) than nursing personnel (14%-22% for neck pain and 25%-30% for shoulder pain).
    • In analyzing survey results among employee categories, researchers found that therapy personnel recorded the third highest "psychological demand score" (5.87 on a 2- to 8-point scale, behind RNs and LPNs), and the highest "physical demand score"(14.6 on a 5- to 20-point scale), followed by nursing aides (12.6).
    • Just over half of therapy personnel—53%—reported that they "never" or "rarely" use resident-lifting equipment. When asked to explain the use rates, "a majority of therapy personnel stated that treatment did not involve lifting because the goal was to make residents independent," authors write.

    "It is concerning that MSD symptoms and costs…for therapy personnel were higher than for nurses," the authors write. "Our finding on the low use of resident-handling equipment by therapy staff, and the rationale that equipment use interferes with therapy goals, are consistent with prior studies." This use pattern is common despite evidence of similar patient outcomes with and without the use of patient-handling equipment and safe patient-handling protocols, they add.

    APTA's Safe Patient Handling webpage offers resources for avoiding injury, including links to online courses, US Food and Drug Administration guidelines on proper use of patient lifts, and a bibliography of journal articles from multiple disciplines.

    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.

    Check Your QPP Status (Again)

    Beginning this year, Medicare's Quality Payment Program (QPP) applies to qualifying physical therapists (PTs). Does that mean you?

    The US Centers for Medicare and Medicaid Services (CMS) has recently updated its QPP participation lookup resource to reflect the rules for 2019. APTA recommends that even if you've checked on your participation status before, you should revisit the site to see if anything has changed.

    The QPP and its Merit-based Incentive Payment System (MIPS) represent some of the most sweeping changes to PT reporting and payment in years—and all indications are that the models will likely include more PTs in the future. Get up to speed with this major shift through resources available at APTA's QPP webpage.

    Researchers: Physical Therapy-Related Cochrane Reviews Largely Inconclusive

    The Cochrane Database of Systematic Reviews is widely considered the “gold standard” for health care professionals who want to know what current, high-quality research says about the efficacy of various interventions. But when it comes to physical therapy, a “researcher or clinician would not necessarily be able to turn to [Cochrane reviews] for a definitive answer” on a treatment strategy, write authors of an article in the International Journal of Rehabilitation Research (abstract only available for free).

    Reviewers for the Cochrane Collaboration—an international network of subject-matter groups that produces evidence-based resources—are known for their systematic analysis of evidence obtained from randomized clinical trials and provide recommendations for specific interventions. Like any systematic review, Cochrane reviews (CRs) are based on the existing research, and randomized controlled trials vary in quality.

    For the Rehabilitation Research study, a multidisciplinary group of researchers in Japan turned to physical therapy to find out what CRs had to say about various interventions. They examined 283 CRs to evaluate just how conclusive the evidence is with regard to physical therapy, as well as what factors influence the degree of conclusiveness.

    Authors classified a CR as “conclusive” if it identified a particular intervention as “superior to another” or found that interventions are “equivalent.” Inconclusive reviews concluded that “no decision can be made.”

    While the authors acknowledge that CRs “often show a lack of strong evidence for the efficacy of a particular treatment or strategy,” they found that an overwhelming majority of reviews related to physical therapy—94.3%—were inconclusive and recommended further study, a rate higher than in many other areas of study. Reviews that evaluated a larger number of trials or included greater total numbers of patients were more likely to list conclusive results; still, even among CRs with conclusive results, 68.8% recommended further study.

    According to the authors, many factors were associated with recommendations for further research, including low-quality study design, small sample sizes, too few available studies, and not enough data on participant subgroups or on adverse effects.

    “The low proportion of conclusive studies may be attributable to the poor quality of evidence” in physical therapy, the authors write, noting, however, that, unlike other areas of study, blinded randomized controlled trials are “often hard to achieve” in physical therapy research.

    Authors emphasized that although inconclusive reviews cannot assist in clinical decision making, “high-quality inconclusive reviews…are of great value” to identify gaps in the literature and areas for further study.

    And while there's much work to be done to increase the number of physical therapy-related CRs with conclusive recommendations, authors think the effort is worthwhile—and timely.

    “Trials in physiotherapy are worth conducting, as the field is positioned as a new frontier and is receiving much attention," they write. "Future research in physiotherapy and further development of the [Cochrane Collaboration] are eagerly awaited.”

    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.

    Study: More Evidence for Early Post-TKR Exercise Interventions 'Urgently Needed'

    With the number of total knee replacements (TKRs) on the rise and average hospital lengths-of-stay (LOS) for the procedure dropping, you might naturally assume that the most effective early postoperative exercise interventions for TKR have been pretty well established by now.

    You'd be wrong, say authors of a new systematic review.

    They write that their review, which scoured more than 1,200 potentially useful studies, reveals a "paucity" of research that "makes it challenging for clinicians to deliver high-quality evidence-based exercise programs in the early postoperative period." They add that the prevalence of TKR and ever-decreasing hospital stays underscore the fact that more high-quality randomized clinical trials are "urgently needed."

    Authors of the review, published in BMC Musculoskeletal Disorders, had an inkling of what they were up against: they were aware that there were "limited studies" that demonstrated the effectiveness or best approach to early postoperative interventions, and they recognized that "large variations between institutions and individual clinicians exist as to what active inpatient therapy is prescribed." Still, they wanted to evaluate existing research to see if some of those gaps could be filled in.

    Focusing on studies that investigated supervised exercise therapy after TKR in the acute hospital setting, the researchers were able to find 1,296 possibly useful articles, of which 77 were reviewed in full text. Of those, only 4 articles were considered eligible for systematic review, and just 3 of the 4 met the criteria for meta-analysis. Reviewers excluded studies that used electrical stimulation, acupuncture, cryotherapy, and "electrical modalities" such as continuous passive motion, "as these were considered...an adjunct to physiotherapist-led exercise-based interventions."

    In the end, the 4 studies included in the review involved 323 participants and 373 individual knees (1 study with 50 participants studied both knees of each individual). Total study-versus-control group sizes were roughly equal, and, overall, most participants (78.5%) were female. The review focused on outcomes from 4 interventions: modified quadriceps setting, flexion splinting, passive flexion ranging, and a drop-and-dangle flexion protocol. As for assessment of outcomes, those varied depending on the study—not only did baselines differ, but follow-up times ranged from 4 weeks postsurgery to as much as 1 year afterward.

    Though not conclusive, researchers noted a few characteristics related to the various interventions: patients receiving the drop-and-dangle protocol had better flexion in the first 2 days after TKR and at discharge; flexion splint patients tended to be discharged earlier and had greater flexion at 6 weeks after TKR; and the modified quadriceps-setting patients tended to have greater hamstring and gluteal muscle strength. However, a meta-analysis of 3 of the 4 studies found no differences in flexion or knee society scores at 6 weeks' post-TKR.

    The real bottom line to be gleaned from the analysis, according to authors, is that the lack of solid evidence "precludes the formulation of clinical guidelines as to the optimum type, frequency, or duration of early exercise therapy after TKR."

    "Given the cost of providing these inpatient services, it is surprising that such a large deficit exists in the literature," authors write. "There is a need for further studies of high-quality design into supervised exercise therapy programs to provide greater functional outcomes and patient-reported satisfaction following TKR surgery, particularly in the early post-operative period."

    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.

    Systematic Review: LBP Studies Make the Case for Early Physical Therapy

    Authors of a new systematic review of 11 studies on low back pain (LBP) have found that despite sometimes-wide variation in research design, a picture of the value of early physical therapy for the condition is emerging—and the results are encouraging.

    According to the review, e-published ahead of print in the Archives of Physical Medicine and Rehabilitation (abstract only available for free), evidence supports the cost-effectiveness and better patient outcomes of early physical therapy over later physical therapy for LBP, and even points to a correlation between early physical therapy and lower rates of opioid prescription overall. As for utilization and costs associated with early physical therapy versus so-called "usual care" (UC)? Early treatment by a physical therapist (PT) adhering to APTA guidelines could make a positive difference there as well, authors say, but that's a harder question to answer definitively until studies become more uniform in terminology and design.

    The review synthesized data from 11 studies narrowed down from an initial pool of 1,146 articles. Authors aimed not only to compare early versus late physical therapy for LBP, but also to assess early physical therapy against UC that didn't include physical therapy (at least not initially, for some of the studies). Four of the studies were randomized controlled trials (RCTs), 6 were retrospective cohort studies, and 1 was a prospective cohort study. Study sizes ranged from 60 to 753,450 individuals. The studies were focused on new episodes of LBP, and did not address physical therapy as prevention.

    It didn't take long for authors of the review to realize they were up against some challenges in synthesizing the studies' results, mostly because of the variation in ways the individual projects were set up and conducted. Variation included the timeframes researchers used to define "early," "delayed," and "late" physical therapy, the inclusion of an option for later physical therapy in UC groups in some studies, and the variability of "education" components that were sometimes included in the UC groups, which in 2 RCTs included advice to remain physically active.

    Still, authors of the review were able to identify at least 1 common pattern: in the 6 studies that compared early physical therapy with late physical therapy for LBP, 5 "demonstrated significant reductions in HSU [health services utilization]." Those reductions ranged from an estimated savings of $1,209 after 24 months to $2,991 after 1 year (for a study that compared late physical therapy with "immediate" physical therapy). Early physical therapy also reduced the likelihood of later opioid use, spine injection, and spine surgery compared with late physical therapy.

    When it came to early physical therapy versus UC for LBP, the results were inconclusive, the authors write—2 out of 3 studies that assessed cost found a higher price tag associated with early physical therapy. What makes these results inconclusive, according to the researchers, is that there are simply too many unexplored variables related to "patient characteristics, care-seeking patterns, and physician decision-making."

    "Patients who participate in early [physical therapy] may also be fundamentally different from patients who follow the usual care pathway," the authors write. "Additionally, not all people with LBP go on to seek medical care. Estimates of the proportion of individuals experiencing LBP who seek care is highly variable…with percentages ranging from 9.19% in some geographic locations to 44.5% in others."

    As for the patients who seek physical therapy versus usual care, authors say the patients are more likely female, have higher educational levels, and have higher income compared with those who seek UC. "Therefore, patients who participate in early PT…may be part of a care-seeking group that is more active in seeking treatment than those who receive usual care, who may take a more passive approach," the authors write. "These traits may lead the early PT group to utilize more health services compared to the usual group."

    Finally, authors write, earlier studies "support the idea that not only does adherence to APTA guidelines for acute LBP decrease risk of later HSU, but nonadherence to APTA guidelines and ineffective [physical therapy] treatments could potentially increase future use of health services." The problem is that most of the studies included in the review were unclear about whether or how often the physical therapy interventions adhered to the guidelines.

    Despite the mixed results, the authors believe their findings "support early access to [physical therapy] as a cost-effective intervention for acute LBP that reduces HSU," adding that "receiving early [physical therapy] for acute LBP could not only reduce health care costs, but it may also help combat the opioid crisis

    "Early [physical therapy] for acute LBP…may prevent the potential for recurrences and chronic pain, leading downstream cost savings and better outcomes for individuals," the authors write. "Even if recurrences do occur, which is fairly likely, early [physical therapy] can give people with new episodes of LBP strategies to manage their condition independently in the future, preventing unnecessary overuse of resources."

    APTA members Elizabeth Arnold, SPT; Janna La Barie, SPT; Lisely Da Silva, SPT; Meagan Patti, SPT; Adam Goode, PT, DPT, PhD; and Derek Clewley, DPT, PhD, co-authored the study.

    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.

    Foundation Has a New Name, Logo, and Website

    What's in a name? For the organization formerly known as The Foundation for Physical Therapy (Foundation), just about everything.

    Earlier this month, the Foundation announced a name change for the organization, from the Foundation for Physical Therapy to the Foundation for Physical Therapy Research. It's a subtle change, but an important one, according to Foundation President Edelle Field-Fote, PT, PhD, FAPTA.

    "After much consideration, the board of trustees concluded that this addition to our name would more clearly define what we do," Field-Fote said in a Foundation news release. "Research has always been the core of our identity. Now it's a part of our name."

    The name change, adopted in the Foundation's 40th anniversary year, was accompanied by a new logo and redesigned website. The shifts were the result of a nearly 2-year communications assessment.

    Rather than an attempt to capture a new direction, the name change is intended to make the Foundation's focus as clear as possible. According to Field-Fote, the work of the Foundation will continue unaltered.

    "Although our name and logo have changed…our everyday work and enduring commitment to the profession remain unwavering," Field-Fote said.

    Since its establishment with the financial support of APTA in 1979, the Foundation has become an independent 501(c)(3) organization that has awarded more than $17 million in grants, scholarships, and fellowships. In addition, the Foundation established the Center on Health Services Training and Research (CoHSTAR), a multi-institutional research and training program. APTA is a Foundation Pinnacle Partner in Research and was a lead donor to the establishment of CoHSTAR.