A pilot study has found that exercise can be an effective way to reduce depression symptoms among individuals with Parkinson disease (PD), particularly if the exercise program is implemented as soon as possible after diagnosis.
The project followed 31 patients who were randomized into an early start group or a delayed start group. While researchers found no substantial differences in scores on the Unified Parkinson Disease Rating Scale among the groups, the patients in the early start group scored "significantly better" on the Beck Depression Inventory. The research was published in Parkinsonism & Related Disorders (abstract only available for free).
Early exercise is an important component in managing the symptoms and side effects of PD. APTA offers several resources on the role physical therapy can play in treatment, including a PT's Guide to Parkinson Disease, a Move Forward radio broadcast on the topic, and evidence-based practice research that can be accessed through PTNow.
If there is a single best way to dress and treat venous leg ulcers, it can't be confirmed through existing research. That's the conclusion reached by a research group from the federal Agency for Healthcare Research and Quality (AHRQ) after a systematic review that found "little evidence exists" for the effectiveness of one approach over another.
The AHRQ study (.pdf) conducted by the Johns Hopkins University Evidence-Based Practice Center (EPC) focused on advanced wound dressings, systemic antibiotics, and venous surgery to evaluate which approach best facilitated healing. The EPC reviewed more than 10,000 research articles and narrowed its analysis to 60 studies that met research criteria. Methods reviewed included simple wound dressings, advanced wound dressings, dressings that incorporated biological elements such as human skin cells, use of systemic antibiotics, and venous surgery.
In the end, researchers found research lacking and were unable to point to any approach as preferable. "We found a paucity of well-designed well-controlled studies, as well as a lack of standard case definitions or approaches to managing confounders and interactions," the report stated. "Most studies were not blinded, and the results are therefore subject to reporting and ascertainment bias."
Absent from the report is any mention of the role movement can play in the management of venous ulcers. No physical therapists (PTs) were included in the key informant, technical expert, or peer reviewer groups that participated in the creation of the report; however, APTA did provide comments on a draft version of the report just released as well as a separate draft report on future research. In those comments, APTA representatives pointed out that the report on future research needs contained no discussion of exercise and gait training to optimize venous pump as a treatment option, and suggested that exercise prescription or walking to manage venous ulcers be included.
The EPC group will release a "disposition of comments" document 3 months after the online publication of its initial report. APTA will review the current report, disposition information, and report on future research needs to determine the best way to communicate with AHRQ on the benefits of physical activity in treatment.
APTA's Section on Electrophysiology and Wound Management offers resources for PTs interested in the latest developments in this area.
According to a recent analysis, the pressures of an aging US population should cause emergency departments (EDs) to rethink delivery of care based on cooperative interdisciplinary decision-making, including comprehensive discharge planning involving physical therapists (PTs) when appropriate.
The report, "Transforming Emergency Care for Older Adults," (abstract only available free) appears in the December 2013 issue of the health care policy journal Health Affairs and describes how EDs can respond to the "silver tsunami" affecting nearly all areas of health care. The article's authors assert that success will require EDs to seize "opportunities to transform the emergency department's … role as the 'front door' of the hospital to becoming the 'front porch,'" where treatment is provided with attention to what happens after the patient leaves the ED.
Among the recommendations included in the analysis are the use of evaluative measures of cognitive function and discharge risk assessments, and the creation of "comprehensive discharge planning that includes shared decision-making." The plan should also include a high level of involvement with care transitions and "appropriate specialty consultation, such as physical therapy or home services, or both," authors write.
The article warns that these new models of care for EDs that employ "much needed care-coordination" could, in the short term, increase ED lengths-of-stay and costs. However, authors assert that the changes create an opportunity for "pivotally improving patient health outcomes and facilitating optimal shared decision making while reducing admissions, ED revisits, and overall care costs."
Health Affairs recently held a briefing on the latest thoughts on EDs, and has made video and other materials available online for free. PTs can find out more about the integral role of physical therapists in emergency care at APTA's webpage devoted to physical therapy practice in EDs.
High school athletes at higher elevations experience 31% fewer concussions than athletes closer to sea level, and the difference may have something to do with the "tight fit" created inside the skull when altitude increases intracranial pressure.
A recent study published in the Orthopaedic Journal of Sports Medicine looked at nearly 6,000 high school athlete concussions from across the US by examining data collected between 2005–2006 and 2011–2012 through the National High School Sports-Related Injury Surveillance System. After dividing incidents by the altitude at which they occurred, researchers found a strong correlation between lower concussion rates and higher elevations, with athletes playing at over 600 feet experiencing fewer concussions in both competition and practice settings.
Researchers pointed to several factors that could contribute to the differences, but stated that what seems to happen is that higher altitudes reduce intracranial compliance—essentially, the amount of give that allows the slosh effect associated with concussions—and create a situation "similar to having an airbag deploy or 'bubble wrap' inflate and thus prevent damage to structures within a container."
The study's authors call for more research in the relationship between altitude, intracranial pressure, and concussion, and point to recent studies that reduced brain injury in rats by as much as 83% through altering brain fluid dynamics. They wrote that "future research is warranted to test the hypothesis that mitigating slosh in the human cranium via mild jugular vein compression will reduce or diminish severity of concussion."
APTA believes that concussion should be managed and evaluated by a multidisciplinary team of licensed health care providers that includes a PT. The association has developed policy resources at both state and federal levels, while practice-focused online concussion resources include a series of podcasts, a PT's guide to concussions, and online learning opportunities on when to return to sport and managing concussions with an interprofessional team. Members can also access evidence-based practice research through the PTNow webpage.
Today's mothers are spending an average of 12.5 hours less per week on physical activity (PA) than mothers in the 1960s—a difference that researchers are describing as a "significant reallocation" of time to sedentary activities that could contribute to a potential public health crisis.
The findings, published in the December Mayo Clinic Proceedings, examined data contained in the American Heritage Time and Use Study, an activity log program that has captured more than 50,000 diary days and 90 behavioral categories from mothers beginning in 1965.
Researchers divided the mothers into 2 groups—those with children between the ages of 5 and 18 (mothers with older children or MOC), and those with children younger than 5 (mothers with younger children, MYC)—and reviewed activity logs over a 45-year period, 1965–2010.What they found, according to the authors, was alarming:
Researchers attributed most of the difference to a significant rise in "screen-based media use" and wrote that "with each passing generation, mothers have become increasingly physically inactive, sedentary, and obese, thereby potentially predisposing children to an increased risk of inactivity, adiposity, and chronic [non-communicable diseases]."
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.
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