physical therapy

According to research presented earlier this month, physician-diagnosed symptomatic knee osteoarthritis (OA) is occurring on average 16 years earlier in life than what was previously found in the 1990′s. The research performed at Brigham and Women’s Hospital and was presented at the American College of Rheumatology Annual Scientific Meeting in Chicago.

If the trend continues, the amount of healthcare utilization and especially the number of total knee replacement surgeries may need to be performed in the near future may dramatically increase. One result of such an increase was stated to be a significant increase in health care costs in the United States.

You can read more at the American College or Rheumatology or in the press release at PR Web.

Photo by mikebaird

 

An Epub ahead of print at the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) describes a study done comparing outcomes following Total Knee Arthroplasty (TKA; also sometimes known as TKR for ‘Total Knee Replacement’). Two rehabilitation protocols were followed by the two different groups in the study.

The two groups 8 were age and sex-matched. One group followed a standard, lower intensity rehabilitation program while the second group followed a higher intensity program that progressed as tolerated. The high intensity (HI) group had an additional month of treatments but there were already significant differences between the two groups at the 3.5 weeks post TKA. The HI group also utilized machine-based strengthening while the lower intensity group only progressed to ankle weights or resistive bands.

The study found that those in the higher intensity group had superior strength and functional outcomes while not experiencing any increase in pain or decrease in range of motion (ROM). The HI group showed significantly greater short-term and long-term strength and function as measured at 3.5 weeks, 12weeks and 52 weeks .

It’s worth noting that the study only involved a small sample size and lacked randomization and blinding. However, the researchers believe that this illustrates that larger similar studies are warranted.

J Orthop Sports Phys Ther. 2011 Sep 30;

Authors: Bade MJ, Stevens-Lapsley JE

Please see the Journal of Orthopaedic & Sport Physical Therapy (JOSPT) site for more topics.

The University of West Indies, School of Physical Therapy, recently conducted a study on the use of the Wii as a adjunct to physical therapy treatment for children with cerebral palsy. The study was a small one, only involving six children, but the results they found were very positive.

The Wii was chosen largely because of it’s affordability compared to other gaming consoles, making it a much more likely candidate to be purchased by the families of children requiring treatment. Compared to standard physical therapy treatment costs the Wii is very affordable.

One of the primary reasons cited for the success of using video games as therapy is because of the much greater likelyhood that the children will actually take part in the therapy. The video games, while being physically challenging, are also engaging and make the children what to do their therapy.

It is believed that the neurological connections in the brain are strengthened by the new activities offered by the ‘virtual reality’ game play and that the plasticity of the brain allows it to do some ‘re-wiring’ as a result of the mental and physical stimulation.

Although this study involved children with cerebral palsy, the researchers are excited to explore the possibilities of using the Wii with people with cardiovascular impairments as well.

You can read more about the study in the Jamaica Observer here: http://www.jamaicaobserver.com/news/-Wii–care_8980080

The Wellnes Blog at TIME.com recently posted a story describing a study done that showed the significant benefits a of Physical Therapy program on the reduction of postpartum depression in new moms. The study was conducted by the University of Melbourne’s Physiotherapy Department and was published in the journal Physical Therapy. In it the researchers found that women in the study showed a 50% less chance of experiencing postpartum depression.

The researchers state that more studies are necessary to confirm the benefits beyond the initial month that the study followed up.

The full text can be found here. A PDF version is also available.

Physical therapy may reduce postpartum risk for some new mothers – Wellness – TIME.com.

Clinical Orthopaedics and Related Research recently published an article entitled “Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty.” The article discusses a study of dysfunction in the quadriceps and hamstring muscles following Total Knee Arthroplasty (TKA).

Using bilateral isometric strength tests and EMG measures of quads / hams co-activation the study found that the difference in loss of strength between the muscle groups was not significant; both were weakened equally.

The authors claim that in post TKA rehab the hamstrings are often neglected  relative to the emphasis placed on quadricep strengthening and retraining. Their conclusion from this study is that the hamstrings should be included with the quadriceps as the primary focus in post total knee arthroplasty rehabilitation.

View the official abstract here.

Knee Arthroplasty - side view

The Journal of Bone and Joint Surgery has a new review article titled ‘What’s New in Adult Reconstructive Knee Surgery.’ The review primarily discusses articles that appeared in The Journal of Bone and Joint Surgery (American Volume), The Journal of Arthroplasty, and select articles from Clinical Orthopaedics and Related Research in 2008.

Topics covered in the discussion include:

• Economic Factors and Performance Measures
• Unicompartmental Arthritis
• Surgical Approaches
• Computer Navigation in Total Knee Arthroplasty
• Perioperative Management
• Prophylaxis Against Venous Thromboembolism
• Outcomes After Total Knee Arthroplasty
• Complications
• Evidence-Based Orthopaedics
• Evidence-Based Articles Related

Read the full article here.

A study published in the British Medical Journal BMJ suggests that a semi-hard collar or physiotherapy / physical therapy was found to be more effective than a ‘wait and see’ approach to care for radiating neck pain. The study was a randomized trial of 205 patients with early onset radiculopathy and was held in three Dutch hospitals.

The patients were in one of three groups, all of whom were allowed to use painkillers:
1) wore a semi-hard collar for 3-6 weeks

2) physiotherapy with home exercises for 6 weeks

3) wait and see

Physiotherapy treatment consisted primarily of mobilising and stabilising the cervical spine using ‘hands-off’ methods.

The recommedation coming out of the study was to choose the semi-hard collar over physiotherapy / physical therapy treatment as these two options both offered significantly better results than the wait and see policy for pain reduction but the collar was less expensive than the physiotherapy treatments. The study only looked at short term pain relief; it would be interesting to see what the more long term effects would be. It would also be interesting to see if a ‘hands-on’ physical therapy approach would produce even greater benefits to the patients.

See the fully study here.

Published 7 October 2009, doi:10.1136/bmj.b3883
BMJ 2009;339:b3883

The Wii has been been a top seller in the game console market for years and continues to become more prevalent in homes around the world. Unlike gaming systems such as the Xbox and the PS3, playing games on the Wii often involves more gross motor skills than fine motor skills. Used correctly this makes the Wii potentially effective in improving coordination, balance, range of motion as well as general strength.

Physical therapists are increasingly bringing the Wii into the rehabilitation setting. Patients see it as a great alternative to often boring and repetitive exercises programs. The incorporation of gross limb and body movements into a game setting seems to keep patients much more engaged.

Popular therapy games include tennis and bowling as well as games like ‘Wii Fit’ which directly focused on actual balance and strength training. Not only can these games can be played individually but they can also be played by multiple players at the same time, which can increase engagement even more.

The Wii is being used in many different rehabilitation settings such as basic health maintenance in the elderly, youth physical therapy, stroke rehabilitation, post-surgical rehabilitation and brain injury rehabilitation. Clinicians feel that the benefits are even more broad and may aid in stress reduction as well as offering benefits to the treatment of diabetes, asthma and even heart disease. An early case study in PT Journal found that the rehabilitation program of a of a cerebral palsy when augmented with the Wii resulted in “positive outcomes at the impariment and functional levels”.

The price point on the gaming systems is very appealing as well. In an industry where equipment is usually very expensive, the appeal of the small $250 cost of a console, a cost that includes several games and a controller, is hard to deny. Most equipment in a rehab setting is very specialized for the small rehabilitation market; small in relation the the mass appeal of a commercial product like the Wii.

As the Nintendo Wii becomes more prevalent in the treatment programs for many conditions there is one condition that we may see begin to proliferate; the dreaded ‘Nintendonitis.’

A small trial recently showed that a simple eccentric wrist twist exercise can be very effective in the treatment of ‘tennis elbow’ ( lateral epicondylitis ). Adding these simple exercises to a home program dramatically improved functional scores and pain reduction.

The exercise can be performed anywhere and serves the same purpose as very expensive isokinetic machines. Instead of expensive machines the exercise involves the use of a small rubber bar similar in size and shape to a baton used in running relay races. Using the rubber bar, “twist with the wrist of their uninjured arm and then slowly untwist with eccentric wrist extension of the injured arm over a period of about four seconds. Three sets of 15 repetitions were scheduled each day.”

The trial was reported at the annual meeting of the American Orthopaedic Society for Sports Medicine in Keystone, Colo.

Read more at Medpage Today.

A recent article on Dynamic Chiropractic entitled “Update on Manipulation and Exercise – What the Research Says” discusses research examining the connection and synergistic effects of combining spinal manipulation with exercise. While the article does state that not all research finds a positive synergistic effect between the two, it goes on to state that it is “purely logical” that spinal manipulation will have a positive effect on exercise.

A number of studies are briefly discussed, including studies that involved participation of chiropractors, physical therapists and osteopaths performing the spinal manipulations and/or administering exercises. It is interesting to note that one study of patients with chronic low back pain (CLBP) or chronic neck pain (CNP) found “Sixty-four percent of physical therapy patients were prescribed exercise, compared to 33.1 percent of DCs and only 14.4 percent of MDs/DOs.”

Read the full article