Persistence of symptoms results from both physical and psychological factors

Approximately 50% of people with whiplash-associated disorders (WADs) continue to report neck pain one year after injury, yet despite this prevalence, there is no clear evidence regarding the most effective treatment. Though exercise is considered safe and effective for neck pain, it’s efficacy for WADs specifically is unclear, and the same is true for prescribed physical activity (PPA). In addition, since the persistence of symptoms in WAD patients is due to both physical and psychological factors, a behavioral approach may also be beneficial, but this is not clear either. Based on these shortcomings, a randomized-controlled trial (RCT) was conducted to evaluate the long-term effects of neck-specific exercise on WADs.

Two-year follow-up performed on earlier RCT

The current study was a one- and two-year follow-up on a 2014 RCT. Initially, 216 individuals with grade 2 or 3 whiplash injury were recruited and randomized to the neck-specific exercise (NSE) group, the neck-specific exercise with behavioral approach (NSEB) group or the PPA group, and all interventions spanned 12 weeks. Patients in the NSE group followed a supervised neck-specific exercise program twice a week. At first, this focused on deep cervical muscles, and eventually, more progressive head resistance training was incorporated gradually. The NSEB group received the same treatments plus physical therapist-led behavioral interventions. The PPA group was prescribed general physical activity to be performed independently without any neck-specific exercises. Patients were assessed for pain, disability, functioning and other variables at baseline and then one and two years later.

Positive long-term outcomes reached with neck-specific exercises

In total, 170 patients (79%) completed the one-year follow-up and 123 (57%) completed the two-year-follow-up. At one year, both neck-specific groups displayed more clinically important improvements in pain, disability, and functioning than the PPA group. At two years, the same was true for disability, and there were also clear trends towards greater improvements in all other outcomes as well. The addition of the behavioral approach did not produce any significant differences. This follow-up RCT suggests that neck-specific exercises can lead to improvements in patients with WADs for one or two years, but additional research is needed to confirm these findings with a different study population, longer follow-up and higher retention rates.

-As reported in the March ’16 issue of the Journal of Rehabilitation Medicine

Understanding these costs may help patients spend less on treatment

Low back pain (LBP) is one of the most common of all painful conditions, as up to 36% of the population will experience it at least once every year. For most of these individuals, the first episode of LBP is not the last, and in some cases, the pain can become a long-term problem. This shows just how important it is to utilize effective treatments for LBP. There are numerous treatments available for patients with LBP, but not all lead to the same benefits and some will cost significantly more than others. This means that some patients can be instructed to receive treatments for their LBP that aren’t necessarily the best for them and cost more, simply because that’s what their doctor recommended. In some cases, this could even wind up costing patients more in the process. To develop a clearer idea of the general costs associated with physical therapy and other treatments for LBP, a study was conducted using Medicare data.

Researchers analyze Medicare data over three years

To conduct the study, researchers gathered Medicare data on patients who were diagnosed with LBP for the first time from 2013-2015. They labeled these patients “beneficiaries” and tracked the treatments they received for their first episode of LBP over this period of time, especially focusing on physical therapy, injections, back-related surgery and no treatment. The Medicare costs associated with the treatments these beneficiaries received was then analyzed and compared to determine how expensive each of them was overall.

Medicare spending for patients who received physical therapy is significantly less than it is for surgery

The data showed that in the three years analyzed, 472,000 patients were diagnosed with LBP. Of these beneficiaries, 60,000 (12.7%) received physical therapy as their first line of treatment, while 53,000 (11.3%) were treated with injections, 8,000 (1.6%) had surgery and 351,000 (74.4%) did not receive any of these treatments in the one year following their diagnosis. The analysis revealed that for the beneficiaries that received physical therapy first, the total Medicare spending was about 19% less than it was for injections and about 75% less than spending for patients who had surgery. In addition, within one year after the LBP diagnosis, the difference in average spending was 18% between the therapy first group and injection first group and about 54% between the therapy first group and surgery first group. Finally, beneficiaries who received physical therapy within the first 15 days after being diagnosed with LBP had costs that were about 27% lower down the line than those who received therapy 45-90 days after their diagnosis.

These results show that physical therapy has the lowest Medicare costs of the three treatments analyzed for LBP and that these costs are even lower if patients begin treatment within the first 15 days of being diagnosed. In some cases, this can wind up saving patients money in the long run if they are treated with physical therapy instead of a much more expensive option like surgery. Patients should, therefore, keep this information in mind when deciding if they should seek out treatment for LBP and when considering surgery if a doctor recommends it.

-Summarized from an April ’17 study published by theAlliance for Physical Therapy Quality and Innovation

This particular treatment is commonly used to address a prevalent condition

Joints are the area where two bones come together, and the end of each joint is surrounded by a protective layer called articular cartilage, which cushions your bones and protects them from rubbing against one another. When this cartilage diminishes, the condition that results is called osteoarthritis. Osteoarthritis is the most common form of arthritis and the leading cause of disability and pain in middle-aged and elderly people throughout the world. It can occur in any joint in the body, but it is most common in the knees and hips. Of the many treatments available for knee osteoarthritis, manual therapy is one of the more popular used today. Manual therapy means that the therapist uses only their hands to apply various movements and techniques to the joint in order to reduce pain and other symptoms. Although manual therapy is a frequently used treatment for knee osteoarthritis, it’s not completely clear just how effective it is for reducing patients’ symptoms. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted on all the available research on this topic.

14 studies are accepted for the review

To conduct the study, researchers performed a search of seven medical databases using terms related to manual therapy and knee osteoarthritis. They only accepted randomized-controlled trials (RCTs), which are high-quality studies considered to be the gold standard for evaluating whether a treatment is effective or not. This search led to 99 studies being screened to determine if they were eligible, and of these, 14 RCTs fit the necessary criteria and were accepted for the systematic review and meta-analysis. The findings of each of these RCTs were compared to one another and researchers also assessed their quality.

Manual therapy found to significantly reduce pain, alleviate stiffness and improve function

Results showed that manual therapy was found to significantly reduce pain, alleviate stiffness and improve the physical function in patients with knee osteoarthritis. These positive effects of manual therapy occurred with less than four weeks of treatment, but a treatment course lasting longer than four weeks led to even greater benefits. In addition, only one patient experienced increased discomfort from manual therapy, while no other negative effects were found in any of the other studies. Unfortunately, the quality of the studies included in this systematic review and meta-analysis was not very high due to certain flaws in their design. Nonetheless, these findings indicate that manual therapy is a beneficial treatment for knee osteoarthritis and should be used in treatment programs for patients with this condition. Due to the poor quality of the studies included, additional high-quality RCTs are needed with better design and a longer follow-up to further confirm these findings.

-As reported in the May ’17 issue of Pain Physician

Results from previous studies are inconsistent on effectiveness of treatment

Temporamindibular joint disorder (TMJ) is an umbrella term used to describe several conditions that involve a dysfunction of the jaw. The most common symptoms of TMJs are pain and decreased mobility of the jaw, both of which have a negative impact on patients’ quality of life. There are a number of conservative (non-surgical) treatments available for TMJs, including physical therapy interventions such as exercise-based therapy, massage, stretching and a combination of these techniques. Exercise therapy programs are commonly used to treat TMJs and may include aerobic, stretching, balance and strengthening exercises, but the available studies on this intervention have produced results that are inconsistent. For this reason a powerful pair of studies called a systematic review and meta-analysis was conducted on the effectiveness of exercise therapy for patients with a TMJ. A systematic review collects all the available evidence on a topic, and in the meta-analysis, researchers pool the data from these studies to tease out common trends.

Two medical databases are searched for relevant studies

Researchers performed a search of two major medical databases for high-quality studies that evaluated exercise therapies for TMJ. They only accepted randomized-controlled trials (RCTs), which are considered the gold standard of individual studies used to determine if a treatment is effective. The search identified 37 studies to be screened, and of these, six RCTs fit the necessary criteria and were used for the systematic review and meta-analysis. All included studies were then analyzed and their findings were compared to one another to determine if exercise therapy was in fact effective for TMJs, and their quality was also ranked to gauge their reliability.

Exercise therapy leads to several benefits for patients

After completing the systematic review and meta-analysis, researchers found that exercise therapy reduced pain and improved the range of motion (flexibility) of patients with TMJs. The improvements in flexibility came primarily from programs that emphasized mobility exercises and a mixed treatment programs, and it appeared that twice weekly was the most effective treatment method for reducing pain. However, it’s not clear what the most appropriate type, intensity and duration of exercise therapy should be for the best results. Therefore, more research is needed to investigate these factors in more detail. Nonetheless, these studies clearly show that exercise therapy is an effective treatment for reducing pain and improving flexibility in patients with a TMJ. Individuals with this condition should therefore be encouraged to seek out the treatment of a physical therapist for an appropriate treatment program that will help them improve.

-As reported in the October ’16 issue of Clinical Rehabilitation

Delaying surgery can lead to complications after the procedure

Hip fractures are the most common fractures in older adults, and their frequency is growing as a result of an aging population. Rehabilitation methods like physical therapy are recommended after hip fractures to prevent the loss of patients’ independence, but many patients also require surgery to help them recover. Occasionally, surgery for these patients needs to be delayed, mainly because of acute medical problems and lack of operating room availability. Delayed surgery can lead to complications like pneumonia, a decline in physical function, and delayed discharge from the hospital, which is why it’s important to identify ways to reduce these complications. One possible solution is to provide physical therapy before surgery-or preoperative physical therapy-but research on this topic is limited. For this reason, a study was conducted to determine if preoperative physical therapy is effective for improving outcomes and reducing complications in older adults who have hip surgery.

Data on 681 older patients analyzed

To conduct the study, researchers sought out data on older patients who had underwent surgery for a hip fracture from 34 hospitals. A total of 681 patients fit the necessary criteria to be included in the study, half of which were treated with preoperative physical therapy. The preoperative physical therapy program consisted of muscle-strengthening exercises that targeted the lower limbs and trunk, stretching exercises, sitting exercises and ankle movements intended to prevent a condition called deep vein thrombosis. Most programs consisted of about 20-30 minutes of physical therapy every weekday prior to surgery, and whether or not patients received it was determined based on the doctor’s personal opinion. Once these patients were identified, data regarding their outcomes after surgery was collected and analyzed. In particular, researchers were interested in patients’ Functional Independence Measure (FIM) scores, which assessed their independence in common daily activities.

Preoperative physical therapy leads to a number of benefits for patients

Results indicated that patients who underwent preoperative physical therapy experienced a number of benefits and better outcomes compared to those who did not. In particular, preoperative physical therapy patients reported significantly greater gains in motor FIM scores, motor FIM effectiveness and motor FIM score at discharge than the other patients. This means that these patients became significantly more independent while functioning in their daily lives due to the treatment they received. These patients were also discharged from the hospital at a faster rate compared to those who did not receive the therapy. Based on these findings, it appears that preoperative physical therapy can lead to better overall outcomes for older patients who have surgery for a hip fracture. Patients who need hip surgery should therefore be aware that physical therapy before their procedure is an option that will likely help them recover faster, and they should ask their doctor about what is available to them during this time.

– As reported in the March ’18 issue of Geriatrics & Gerontology International

Physical therapy is consistently supported as an effective treatment for low back pain

Low back pain (LBP) is estimated to affect up to 80% of all Americans at some point in their lives, and it is one of the leading causes of disability and reasons for visiting a doctor throughout the world. On top of this, studies suggest that this problem will only continue to grow in the future as more people become affected by the condition. National and international guidelines recommend a number of treatments for LBP, which include education, exercise, massage and manual therapy, particularly because they have been deemed effective and safe. Physical therapy for LBP typically includes these and many other commonly recommended interventions, which are brought together in a personalized way for each patient. Studies have consistently shown that physical therapy is an effective treatment for LBP, and the earlier a patient is referred to a physical therapist, the sooner they return to work and the better their outcomes are. This is why many national guidelines specifically recommend physical therapy for LBP. Yet despite this evidence and support, it doesn’t appear that the referral rates for physical therapy have actually increased over the years. To get a clearer idea of how the referral rates of physical therapy to treat LBP have changed in recent times, a study was conducted.

National surveys used to establish patterns in referral rates

To perform the study, researchers collected data from two national surveys on medical care services and another survey from emergency departments from 1997 to 2010. They focused only on visits for patients between 16-90 years of age, and classified patients into four groups based on their age: 16-39, 30-44, 45-59 and 60-90. In addition to data on physical therapy referral rates, researchers also analyzed data on the rates for opioid prescriptions over the same period of time.

Measures are needed to educate doctors and patients about the benefits of physical therapy

Based on the surveys analyzed, approximately 170 million patients visited a doctor for complaints related to LBP. From these visits, 17.1 million patients were referred to physical therapy, which equated to a referral rate of 10.1%. From 1997 to 2010, this referral rate for physical therapy remained stable at this low percentage, while the rate for opioid prescriptions increased in these patients over the same time period. Further analysis showed that patients who were not referred to physical therapy were more likely to receive an opioid prescription. This highlights a major problem occurring in the country today, as rising rates of opioid prescriptions are largely to blame for addiction and abuse of these drugs. Physical therapy, on the other hand, is a safe and effective method for treating LBP that is not associated with any of these types of problems. This is why patients with LBP must be educated on the importance of seeking out the services of a physical therapist for their condition, and doctors must also recognize its value and make the appropriate decision of referring patients to physical therapy to improve the chances of a positive outcome.

-As reported in the May ’17 issue of Spine

Association between the two has not been clearly evaluated

Knee osteoarthritis (OA) is a condition in which cartilage that normally protects the knee gradually wears down over the course of time. It is one of the leading causes of pain and disability throughout the world, affecting about 10% of men and 13% of women over the age of 60 in the U.S. The patellofemoral joint connects the kneecap (patella) with the upper leg bone (femur), and symptoms of knee OA frequently occur in this area. This joint also plays a critical role in the function of the knee, as it allows individuals to complete many daily activities like squatting and climbing or descending stairs. Due to its role, though, the patellofemoral joint may be negatively affected by forces that are too strong, such as excessive weight. Overweight or obese individuals with a high body mass index (BMI) put lots of stress on their knees, which may increase the risk for pain in the patellofemoral joint and knee OA, but this association has not yet been clearly evaluated. For this reason, a powerful pairing of studies called a systematic review and meta-analysis were conducted to determine if high BMI is a risk factor for patellofemoral pain and knee OA.

52 studies are accepted into the review

Researchers performed a search of six major medical databases for studies that included information on the associated between BMI and patellofemoral pain or knee OA. This search led to a total of 7,894 studies being evaluated, and from these, 52 met the necessary criteria and were accepted into the review. The findings of each of these studies were then evaluated and compared to one another, and the quality was ranked to determine how reliable their data was. Studies were given a rating from 1 (strong evidence) to 5 (conflicting evidence).

Adults—but not adolescents—with patellofemoral pain and knee OA have a higher BMI

The results of this systematic review and meta-analysis showed that the BMI of adults with patellofemoral pain and knee OA was generally higher than the BMI of healthy individuals without knee pain that they were compared to. When it came to adolescents with patellofemoral pain, however, the same type of association was not found. As for why this association was found it, adults, it likely has to do with the fact that individuals with a higher BMI generally reduce their activity levels due to the persistent pain that is brought on by their condition. In turn, reduced activity levels can actually lead to more weight gain and more stress on the knees, which can create a vicious cycle that makes their condition even worse. This study, therefore, shows how important it is for those with a high BMI to reduce their weight, as doing so may also lower their chances of developing knee pain due to the involvement of the kneecap. Physical therapists can help in their pursuit by prescribing specific exercises and offering advice on how to increase physical activity levels, and those with patellofemoral pain are encouraged to seek out their services for additional guidance.

-As reported in the May ’17 issue of the British Journal of Sports Medicine

Surgery has become the treatment of choice for patients with severe hip or knee arthritis

Arthritis is one of the most common causes of disability in the U.S. Approximately 50 million Americans have been diagnosed with some form of arthritis, and about one of every three of these patients has reported being physically limited due to their condition. Osteoarthritis-often referred to as wear-and-tear arthritis is the most common form of the disease, and it can be especially troubling. In this type of arthritis, protective cartilage at the ends of bones gradually wears away, sometimes to the point where the bones begin rubbing against one another. Osteoarthritis that progresses to this point is referred to as end-stage arthritis, which often requires aggressive treatment. Total joint replacement surgery has now become the treatment of choice for end-stage arthritis of the hip or knee, and the rate of this surgery is only expected to increase in the future. To improve the outcomes and reduce the costs for patients who undergo surgery, physical therapy is commonly recommended before the procedure. Preoperative physical therapy, or “prehabilitation,” prepares patients’ bodies for the procedure and teaches them what to expect; however, research is limited on its effectiveness. For this reason, a study was conducted to investigate the association between prehabilitation and the use of care after surgery, as well as the associated costs of this treatment.

Data collected on nearly 5,000 patients

To conduct the study, researchers looked for medical records of patients who received treatment after having surgery for hip or knee osteoarthritis. This search led to a total of 4,733 patients being identified who fit the necessary criteria, and data related to their treatment was collected and analyzed. Researchers were particularly concerned with the care these patients received within 90 days after being discharged from the hospital, and the impact that pre-habilitation had on their use of care and its costs.

Pre-habilitation associated with a reduced use of care after surgery

Results showed that overall, 77% of the patients studied used some type of care services after having surgery. In patients who did not receive prehabilitation, 79.7% used these services, compared to only 54.2% of those who received prehabilitation. With further analysis, it was found that the prehabilitation was associated with a 29% reduction in after-surgery care. This reduced use of care resulted in a total savings of $1,215 per patient, which was mainly the result of fewer payments to skilled nursing facilities and home health care.

These findings support the use of preoperative physical therapy-or prehabilitation-in patients preparing for hip or knee replacement surgery, as it can reduce the need for patient care and its associated costs following the procedure. Individuals who are scheduled to have this type of surgery should therefore consider having a short course of physical therapy prior to their surgery date, in order to increase their chances of a successful outcome and quicker recovery.

– As reported in the October ’14 issue of The Journal of Bone and Joint Surgery

Individuals with this condition may have to miss work due to symptoms

Carpal tunnel syndrome (CTS) is a condition that results from pressure being placed on a nerve in the wrist. This compression of the median nerve can come from swelling or anything else that makes the carpal tunnel smaller, and it leads to numbness, weakness, tingling and other problems in the hand. CTS affects up to 3.8% of the population, and its symptoms often make it difficult for working individuals to complete their jobs. This may lead to absence from work and a decline in work performance. Effective treatment is therefore needed to address CTS, and there are many options available. One option that may be used is physical therapy, especially if it includes manual therapy, an intervention in which the therapist performs various manipulations with their hands. Unfortunately, evidence to support physical and manual therapy is lacking, and these treatments are often ignored in reviews. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted that compared manual therapy to another type of treatment called electrophysical therapy for CTS.

Patients randomly assigned to one of two groups

Patients diagnosed with CTS were invited to participate in the study and screened to determine if they were eligible. This process led to a total of 140 patients being accepted to the RCT, who were then randomly assigned to either the manual therapy group or the electrophysical group. Patients in both groups underwent a 10-week physical therapy treatment program, but the specific parts of the program were different in each group. In the manual therapy group, the physical therapist performed a massage and various mobilizations of the median nerve, which was carried out during two weekly sessions for 20 sessions total. The electrophysical therapy group also consisted of 20 sessions total, but patients were treated with a red laser that was pointed at their wrist for two minutes and 40 seconds. The goal of this intervention is to stimulate the immune system to release chemicals that will heal the area and restore balance to the wrist, and was followed by another similar treatment called ultrasound. All patients were evaluated using a number of outcome measures at the beginning of the study and after the treatment was completed.

Both groups improve, but manual therapy brings about greater changes

Results showed that both treatments led to improvements, as patients experienced less pain, greater function, and fewer symptoms after completing the interventions. Patients in the manual therapy group, however, reported even greater improvements than those in the electrophysical therapy group in all three of these measurements. Another finding showed that the average reduction in pain was 290% in the manual therapy group and only 47% in the electrophysical therapy group. Based on these results, it appears that manual therapy is more beneficial for patients with CTS than electrophysical therapy. Patients dealing with CTS should, therefore, seek out the services of a physical therapist that offers this type of intervention in order to experience similar outcomes as the participants of this current study.

-As reported in the April ’17 issue of the Journal of Manipulative and Physiological Therapeutics