Evidence Based Rehab

Winner to the 2009 EIM Elevator Pitch Contest

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 16 Dec 2009 02:02:00 +0000

By: Christopher Robl from Rockhurst University

More information on Evidence in Motion found here.

More information on Physical Therapy found here.

Again, Satirist Get it Right

noreply@blogger.com (Jason L. Harris, PT, DPT) — Tue, 10 Nov 2009 05:18:00 +0000

Protect Insurance Companies PSA from Will Ferrell

Rehab Haikus

noreply@blogger.com (Jason L. Harris, PT, DPT) — Fri, 09 Oct 2009 11:24:00 +0000

My colleague presented a wonderful collection of rehab Haikus at our last staff meeting. I work at a Planetree hospital and the start of our staff meetings always have a reminder of how we can help beyond PT/OT/ST and treat the person as a whole. My colleague has generously allowed be to reprint these for you all here. They are about - in order - OT, ancillary staff, PT, and ST.

OT with sock aid
ADLs begin the day
Patient dressed,
refreshed

Crisp morn, charts askew
Efficient fingers, phone
shrill
Calm restored . . . coffee

PT smiles, enters
Strenuous
protests occur
Patient ambulates

Teary eyes, cough,
gag
Silent aspiration beware
Mechanical soft

Sad News from the APTA

noreply@blogger.com (Jason L. Harris, PT, DPT) — Thu, 08 Oct 2009 21:06:00 +0000

Dear Orthopaedic Section Member,

The Orthopaedic Section mourns the loss of Richard Erhard, PT, DC, who
passed away Sunday, October 3, 2009 after a long battle with cancer. Dr.
Erhard was a colleague, a teacher, a researcher, a mentor, and a friend to many
in the Orthopaedic Section. Dr. Erhard was a world-renown manual physical
therapist and he taught and lectured extensively throughout the United States
and internationally. His work has been instrumental in development
clinical prediction rules and clinical practice guidelines for low back
pain.

Dr. Erhard's contributions to the clinical practice of orthopaedic physical
therapy were recognized by the Orthopaedic Section with the establishment of the
Bowling-Erhard Clinical Practice Award. Dr. Erhard and Richard Bowling
were honored as the first recipients of this award during the 2007 Combined
Sections Meeting in Boston, Massachusetts. Dr. Erhard elevated the
physical therapy profession through his work, his mentorship and his friendship
and he will be greatly missed.

A viewing will be held Thursday, October 8 from 2-4 pm and 6-9 pm and
Friday October 9 at 10:00 AM with funeral to follow at the John S. Maykuth Jr.
Funeral Home, 7 River Ave, Masontown, PA 15461-1959.

A memorial service will also be held at Heinz Chapel at the University of
Pittsburgh on October 16th from 10:00 to 11:00 AM. A reception will follow
at the Holiday Inn in Oakland. Please contact Tina Fuller at tfuller@pitt.edu or call 412-383-6579 to
RSVP.

Cards and condolences may be sent to Natalie Erhard, PO Box 424, 145
Messick Lane, Lottsburg, VA 22511

Friday Fun Redux

noreply@blogger.com (Jason L. Harris, PT, DPT) — Fri, 24 Jul 2009 11:05:00 +0000

Early on for this blog I was doing a "Friday Fun" post on a mostly weekly basis. Usually something humorous in nature. I realized it's been almost 2 years since I've done this and would like to resurrect it for at least this week.

Today Lewis Black brings us some much needed wacking over the head regarding health care reform. It would be even funnier if Lewis Black didn't make so much sense. See for yourself:

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Back in Black - Health Care Reform

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Joke of the Day

Physical Therapists Can Properly Assess and Fit Walking Aids to Prevent Injuries

noreply@blogger.com (Jason L. Harris, PT, DPT) — Mon, 13 Jul 2009 17:11:00 +0000

ALEXANDRIA, VA, July 13, 2009 — The American Physical Therapy Association (APTA) is urging elderly adults who use canes and walkers as walking aids to be properly assessed and fitted by a physical therapist to avoid fall-related injuries. This advice comes in response to a study published in the Journal of the American Geriatrics Society (June 2009), which found that 47,000 senior citizens end up in emergency rooms each year due to falls from improper use and fit of walkers and canes.

The study, conducted by government researchers, examined six years of emergency room records and found that the walker was associated seven times more with injury-related falls than was the cane. Physical therapists advise that these results indicate a strong need for proper fit and assessment.

According to physical therapist and APTA member Cathy Ciolek, PT, DPT, GCS, many patients often borrow walking aids from friends and family, which can result in injuries. "We see many patients use borrowed canes, walkers, and crutches without adjusting the fit and height appropriately, which can cause discomfort and result in further injury," she said.

In addition to providing a proper fit, your physical therapist can assess your individual needs to ensure you are using the proper walking aid and that it is in proper working condition. "In some instances a cane may not be the safest option, and it would be best to use a walker. Your physical therapist can help make that decision," says Ciolek. She provides some general tips for those using a cane or walker as a walking aid:

The walker or cane should be about the height of your wrists when your arms are at your sides.
When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

As experts in restoring motion and mobility in people's lives, physical therapists work collaboratively with physicians to ensure safe recoveries from illness or injury. Ciolek recommends seeing a physical therapist for an assessment and proper fit or asking for a referral to a physical therapist from your physician. Visit www.moveforwardpt.com to find a physical therapist near you.

noreply@blogger.com (Jason L. Harris, PT, DPT) — Mon, 13 Jul 2009 15:51:00 +0000

Often times it is the obvious that is the most difficult to grasp or realize:

Jason L. Harris

What is a PT? Watch and See...

noreply@blogger.com (Jason L. Harris, PT, DPT) — Fri, 19 Jun 2009 12:44:00 +0000

LOAN REPAYMENT LEGISLATION INCLUDES PHYSICAL THERAPISTS AS FRONTLINE PROVIDERS

noreply@blogger.com (Jason L. Harris, PT, DPT) — Thu, 18 Jun 2009 02:17:00 +0000

ALEXANDRIA, VA, June 17, 2009 — Legislation to establish a Frontline Providers Loan Repayment Program that includes physical therapists was introduced Tuesday by Representative Bruce Braley (D-IA). The Access to Frontline Health Care Act of 2009 (HR 2891) would encourage physical therapists to practice in underserved areas, says the American Physical Therapy Association (APTA).

HR 2891, which would amend the Public Health Service Act, creates a process that is similar to the National Health Services Corp (NHSC) in which a provider signs a commitment to practice in an area for at least 2 years in exchange for student loan repayment. Currently, physical therapists are not included in the NHSC's Loan Repayment Program. This legislation would complement the Physical Therapist Student Loan Repayment Eligibility Act of 2009 (HR 988), which would allow physical therapists to participate in the NHSC's program.

Under HR 2891, providers pledge to practice in a "Frontline Scarcity Area." Scarcity areas include a Health Professional Shortage Area as defined by the Health Resources and Services Administration Shortage Designation Branch of the US Department of Health and Human Services (HHS), or an area designated by a state as having a shortage of frontline care services. HHS' Secretary can give preference to a scarcity area in which an entity has demonstrated that it has an interdisciplinary program, or pledges to initiate such a program. The Secretary also determines the amount of the loan repayment.

"APTA applauds Representative Braley for introducing this much needed legislation and including physical therapists in it," said APTA President R. Scott Ward, PT, PhD. "With health care reform legislation on the horizon, it's imperative that our leaders address workforce issues as a part of overall reform. The Frontline Providers Loan Repayment Program would bring physical therapists to areas in the country where their services are greatly needed."

In addition to physical therapy, the following qualify as frontline services: general surgery, chiropractic, optometry, ophthalmology, audiology, speech language pathology, pharmacy, public health, podiatric medicine, dietetics, occupational therapy, general pediatrics, respiratory therapy, medical technology, and radiologic technology. All services must be performed by a health care provider with the appropriate education.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 72,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.

Who Is Surprised By This??

noreply@blogger.com (Jason L. Harris, PT, DPT) — Thu, 11 Jun 2009 03:05:00 +0000

News out of the National Center for Complementary and Alternative Medicine reports the not so unexpected findings of $2.5 billion (yes, that is a "B" for billion) spent on testing "alternative" methods for treating everyday ailments. And, of corse, when a treatment is based upon what is counter to known human anatomy and physiology, they were found to be no better than placebo.

"You expect scientific thinking" at a federal science agency, said R. Barker Bausell, author of "Snake Oil Science" and a research methods expert at the University of Maryland, one of the agency's top-funded research sites. "It's become politically correct to investigate nonsense."

Scientific study demands that we need to be open to change and paradigm shifts. However, some sort of plausibility needs to exist in order for us tax-payers to be throwing or money at it.

"There's been a deliberate policy of never saying something doesn't work. It's as though you can only speak in one direction," and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.

As said by many smarter people than me, many times, the point of scientific thought is the ability to critique and understand that just throwing more money at a treatment until you get the answer you'd like (eg acupuncture can help in some cases - but, of course, so does sham acupuncture).

Jason L. Harris

MSNBC.COM Story

If We Know We Shouldn't...Why Do We Still Do?

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 03 Jun 2009 15:25:00 +0000

Ihave posted several articles on the overuse of imaging in musculoskeletal care (find them here, here, here, and here). Now we have another study from the Archives of Internal Medicine making not only that statement but going as far as speculating that this is related to financial gain, improved patient satisfaction, and potential for more harm that good.

In a news release from Musculoskeletal Report, the study found:

Patients were more likely to undergo imaging tests if their primary care physician worked in large practices and if the doctor was offered patient satisfaction-based financial incentives. Practices with clinical quality-based incentives, however, were less likely to order advanced imaging tests for low back pain patients in the absence of clinical red flags.

Additionally, the article reports on the potential harm of advanced imaging stating:

...advanced imaging of the spine has a low yield of unexpected findings and an “alarmingly high” yield of irrelevant findings.

I'm sure, as physical therapists, we see the fallout from this. More and more patients are presenting in the clinic with simple low back pain (simple meaning no neurologic, systemic, or lytic component - not low in pain) with no treatment beyond narcotics and muscle relaxants and MRI in hand. Now we not only have to try to get them better after 4-6 weeks of prior ineffective treatments, we also have to convince them that all the irrelevant findings (disc bulge, DDD, foraminal stenosis in now way associated with their complaints, etc) are not the problem and will not result in death, or worse, disability.

It seems everyone knows we shouldn't be doing this. Now we just need to convince the gate keepers with their own imaging labs to not perform these unnecessary, revenue generating, insurance companies turn a blind eye to, procedures. I'm sure there will be no difficulty in that.

Jason L. Harris

Hoangmai H. Pham, Bruce E. Landon, James D. Reschovsky, Beny Wu, & Deborah Schrag (2009). Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients Archives of Internal Medicine, 169 (10), 972-981

Massage Not Helpful Post-workout

noreply@blogger.com (Jason L. Harris, PT, DPT) — Thu, 21 May 2009 20:57:00 +0000

Irecieved an interesting study in my in box this morning. It finds that massage after exercise not only does NOT increase blood flow and, therefore, improve lactic acid removal, it decreases both blood flow and lactic acid removal.

It is reported:

Dr. Tschakovsky said that massage may act by decreasing inflammation, or it may produce a placebo effect. “There is so much inconclusive work out there, that we really don’t understand massage in the context of exercise,” he said.

Interesting study that seems to punch a hole in a long accepted belief on how to minimize pain after exercise.

Jason L. Harris

References

1. Wiltshire V, Poitras V, Pak M, et al. Massage impairs rather than enhances lactic acid removal from muscle after strenuous exercise. Presented at: annual American College of Sports Medicine conference; May 27-30, 2009; Seattle, Wash. Presentation Number: 09-SA-4065-ACSM.

More Evidence of Acupunctures Lack of Effectiveness

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 20 May 2009 16:13:00 +0000

Acupuncture (sticking needles at specific points to a certain depth in the skin) is not an effective treatment for chronic low back pain. This may sound surprising as the media has jumped all over a new study that supposedly shows that acupuncture is more effective than "usual care". Unfortunately - as the media usually does - they've misinterpreted the results of the study. In fact the study showed that there is no difference in the effectiveness between "fake" and "real" acupuncture. Meaning, there is no effect of acupuncture.

Steven Novella over at Science-based Medicine does a masterful job of explaining this in detail. Please visit his post on this study to become enlightened by logical and scientifically based thoughts and discussion - as opposed to hype.

Jason L. Harris

Evidence Based Rehab Named in List of Top Online PT resources

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 13 May 2009 01:27:00 +0000

E vidence Base Rehab has recently been named one of the top 51 physical therapy resources on the web. I appreciate the recognition Ownward Healthcare has given this blog. You can find the full list on their website here.

Surprisingly absent from the "Blog" list is Mike Reinold's great blog. Make sure you visit his blog. He has currently begun a series on Patellofemoral Pain Syndrome.

Jason L. Harris

Back Pain, Surgery, Drugs, Imagaing, Excessive Costs....Again

noreply@blogger.com (Jason L. Harris, PT, DPT) — Tue, 12 May 2009 04:38:00 +0000

The Insurance Journal released an article discussing how a "surprising" share of work comp case costs come from unanticipated costs or, as they term it, "Adverse Surprise Costs." The study reported on was said to find:

Adverse surprise cases were disproportionately chronic conditions with multiple surgeries. They were also disproportionately back pain cases.

That's no surprise to me, however, and should really not be a surprise to anyone dealing with chronic pain and low back injuries. While back pain is not the only musculoskeletal condition being over-treated with narcotics, expensive imaging, and surgery, it certainly is the most costly of all. In fact, most of my recent posts have centered around this subject (you can find them here, here, and here).

What is surprising is that, despite all this research showing all this imaging, surgery, and narcotic prescription make things worse often, we are still using that recipe to treat most folks with LBP. In fact, those doing it are being the ones rewarded with reimbursement for doing so.

Jason L. Harris

California PT's Need Your Help

noreply@blogger.com (Jason L. Harris, PT, DPT) — Mon, 13 Apr 2009 23:25:00 +0000

David Straight of E-rehab has put together a website called PT's Unite to help bring about a grass-roots effort for California PT's and their push for direct access. Please consider helping in the cause. Remember, success for PT's in one state can help lead to success for you and a failure can make it harder to bring about change in your state.

Good luck to those PT's in California and thank you to David for grabbing the tourch and attempting to lead the way to change.

Jason L. Harris

Back Pain & the Need for Real Health Care Reform

noreply@blogger.com (Jason L. Harris, PT, DPT) — Sun, 05 Apr 2009 04:05:00 +0000

A pair of article from the April 1st issue of Spine remind us of what real reform in health care we need. While President Obama is at least attempting to get the ball rolling with changes in health care, Electronic Medical Records (EMR), expanded coverage, and "investing" in prevention and wellness aren't going to change today's problems at the root of rocketing health care costs.

One piece at the root of these rocketing costs is excessive use of imaging, surgery, and drugs. Low back pain treatment often gets the full brunt of these high cost, low efficacy procedures. Now, the new issue of Spine shines some light on the harm this approach can cause.

In the first article by Timothy Carey, MD - Practice patterns and evidence in chronic low back pain care - it was found that (surprise) there is an overuse of narcotics and imaging and little use of established beneficial treatment of exercise. The figures quoted in the article report fewer than 30% of LBP suffers had seen a physical therapist in the past year and, worse yet, only 3% had gone through a structured rehabilitation program.

The second article by Sham Maghout Juratli, MD - Mortality After Lumbar Fusion Surgery - there was a finding of alarmingly high percentage of deaths after fusion surgery related to Analgesic overdose. The author comments that:

Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause.

So, instead of treating LBP primarly with research-proven exercise prescription there is an overuse of narcotics and surgery that are leading to increased loss of life!

Maybe rewarding those attempting to use what research shows as effective for LBP instead of shelling out billions for imaging, drugs, and surgery might not only lead to lessening costs but decreased mortality.

Physiopedia - A Wikipedia for Physical Therapists

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 18 Feb 2009 14:25:00 +0000

Announced today is the formation of the first wiki-based collaborative online educational resource for the global physiotherapy community. Physiopedia is an ambitious project which aims to eventually offer an evidence-based knowledge resource for physiotherapy professionals throughout the world. Through utilising collaborative wiki technology Physiopedia is a place where all physiotherapists can participate by contributing, sharing and building knowledge to develop a global understanding. For educators Physiopedia offers an opportunity to involve their students in this knowledge creation process as part of an educational program.

Individuals and educational institutions around the world are contributing to Physiopedia in various ways. Educational institutions are engaging their students to contribute content as part of their educational program, expert clinicians are contributing seed content free of copyright restrictions and individuals are contributing content out of their own personal interest and as part of their professional development.

Making high quality information for physiotherapy professionals freely available via a collaborative, open and constantly evolving website has the potential to promote the physiotherapy profession and improve patient care. Over the next few years, there will be a growing community of contributors who will create pages in different clinical areas covering anatomy, physiology, conditions, assessment and interventions. Other professional resources that will be created include evidence based practice, outcome measures and research methods. These pages will be constructed using the latest evidence and will be constantly evolving with updated information.

Today Physiopedia is calling for students, clinicians and educational institutions to contribute content. Professionals around the world who contribute to Physiopedia will have the opportunity to make a difference by promoting our profession and in improving the health of our patients. Physiopedia will also serve as an important place for professionals to create a presence on the Web and become known for their specialties.

Physiopedia’s founder is Rachael Lowe from the UK, a physiotherapist and e-learning specialist who combines these skills with the specific aim of utilising web technology for physiotherapy education. She has developed this site with the global community in mind in consultation with Eric Robertson, Assistant Professor at the Medical College of Georgia in the USA.

Educational institutions and clinicians have begun to contribute content to Physiopedia and the site will continually develop to provide a valuable promotional and educational resource to the global physiotherapy community. This free public site will officially launch later in 2009 but this preview site becomes available today at www.physio-pedia.com.

Stop the Madness!! - Low Back Pain and Routine Imaging

noreply@blogger.com (Jason L. Harris, PT, DPT) — Mon, 09 Feb 2009 12:00:00 +0000

Lancet recently published a systemic review looking at routine imaging for Low Back Pain (LBP) without "red flags" that would suggest serious underlying conditions (eg, myelopathy, cancer, fracture, etc). While the results aren't surprising to the majority of conservative musculoskeletal practitioners, they do need to be publicized to the general public just as much as the silly studies that show "acupuncture" being effective treatment fot LBP. The authors conclude:

Lumbar imaging for low back pain without indications of serious underlying conditions does not improve clinical outcomes," they conclude. "Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low back pain and without features suggesting a serious underlying condition

However, despite studies that show MRI's done for LBP and work related injuries tend to lead to poorer outcomes, and that much of what is foung (DDD, spondylosis, Disc herniations) are "normal" findings, the authors seem pessimistic in MD's changing their behavior.

...there is no compelling reason why more attention should be paid to low back pain than to any other prevalent condition." Other factors include patient expectations about diagnostic testing, reimbursement structures that provide incentives for imaging, and the fear of missing relevant pathology...

Throw in great marketing for spinal surgery, these imaging results are a great stepping stone to push invasive surgery for non-specific low back pain. So, get the word out - stop the excessive imaging and treat LBP initially with what we know has the greatest return for the least potential harm - Physical Therapy, education, and gentle return to activity.

Roger Chou, Rongwei Fu, John A Carrino, Richard A Deyo (2009). Imaging strategies for low-back pain: systematic review and meta-analysis The Lancet, 373 (9662), 463-472 DOI: 10.1016/S0140-6736(09)60172-0

OVER TREATING CHRONIC BACK PAIN: A US HEALTHCARE FAILURE

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 28 Jan 2009 13:00:00 +0000

Richard Deyo MD, the keynote speaker at the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) National Conference in October 2008, has again published data indicting the US approach to chronic back pain dramatically increases costs without improved outcomes. Deyo and colleagues reported in the January 2009 issue of the Journal of American Board of Family Practice the following staggering statistics:

A 629% increase in Medicare expenditures for epidural steroid injections;
A 423% increase in expenditures for opioids for back pain;
A 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;
A 220% increase in spinal fusion surgery rates.

The incidence of chronic and acute Low Back Pain, as documented by office visits, has not changed during the last 12 years. The application of these technologies is not without consequences Deyo et al noted, ‘Innovation has often outpaced clinical science, leaving uncertainty about the efficacy and safety of many common treatments. Complications and even deaths related to pain management are increasing.’ Indeed, the reoperation rates for low back pain have increased, not improved. The authors conclude that the ‘Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.’ They note that these approaches often are applying an acute care model to chronic pain and not acknowledging the current evidence that chronic pain requires a different approach and that there are ‘no magic bullets.’ In a “chronic care model” chronic back pain, like diabetes or asthma, ‘is a condition we can treat but rarely cure.’ Deyo et al suggest the solution that ‘chronic back pain may benefit from sustained commitment from health care providers; involvement of patients as partners in their care; education in self-care strategies; coordination of care; and involvement of community resources to promote exercise, provide social support, and facilitate a return to work.’

Tim Flynn, PT, PhD, president of the AAOMPT states, ‘The manual physical therapist is the health care provider uniquely trained to manage individuals with chronic low back pain. We utilize low risk, state-of-the-art care incorporating exercise, manual physical therapy, patient education and the application of the biopsychosocial model in managing this chronic condition. The Academy is dedicated to the application of current models for chronic pain management.’ The recent AAOMPT conference in Seattle focused on current theories and practice of chronic pain management with international experts on pain management.

It's Important to Give Up Sometimes

noreply@blogger.com (Jason L. Harris, PT, DPT) — Mon, 26 Jan 2009 16:11:00 +0000

Reading the newest issue of Orthopaedic Physical Therapy Practice (the magazine of the Orthopaedic Section of the APTA) I found interesting the Editor's Message written by Christopher Hughes, PT, PhD, OCS. The letter titled "When All Else Fails...We Succeed!" relates that an episode of care from a Physical Therapist that does not end with hoped for gaols met, is not a waste. That, in fact, it is a valuable tool to help in the clinical decision making by MD's - especially in the arena of deciding on surgery or other invasive procedure.

I agree with this view, and have educated a number of my clients that at the very least, their episode with me will make them better prepared for surgery and increase their prognosis after surgery. I would like to speak on a subject related to this: Over Utilization.

I will give our fellow professionals the benefit of the doubt and say that the desire to achieve all goals for all clients leads to continuing treatment past maximum medical benefit. We all do this, and looking at my stats from 2008, those who were discharged w/o all goals met averaged about 2-3 more visits than those who where discharged with goals met. Some of that is related to me trying to get that last goal or two, some related to MD referring back to "just try a little more", and more is related to the client wanting to have more PT. Now, what we need to be aware of is "benefit chasing".

We all know of clinics/PTs that do this. If the client has 20 visits per year, that's how many PT sessions they'll get. Regardless if it's a knee sprain or s/p ACL reconstruction. It's this practice behavior that really hurts us, particularly in the eyes of the insurance companies.

I'm sure there are many reasons why this practice occurs. Including desire to maximize profits. What we need to do as a profession is self police and encourage appropriate utilization of our care provided. Steps we (individually) can do are:

Set goals with time frames, and share these with our clients. This will help hold ourselves accountable.
Use outcome surveys. DASH, Oswestry, Neck Disability Inex, etc. Easy to get caught up in the "I feel a little better" trap and keep treating. Use these tools to help measure actual perceived change allowing you to make better continued treatment decisions.
Track your outcomes. This will allow you to evaluate your tendacies in treatment and areas you can improve.
Question your collegues and be open to constructive critisism from your collegues regarding visits.

How do you monitor utlization? Do have anecdotes regarding over use or proper use of PT sessions? Any other suggestions on how to prevent over utilization?

National Groups Unite to Call for Healthcare Reform

noreply@blogger.com (Jason L. Harris, PT, DPT) — Thu, 15 Jan 2009 07:24:00 +0000

Multi-Million Dollar Television Ad Buy Unveiled Today Promotes Health Care Reform as a Top Domestic Priority for the Next President and the New Congress

Washington, D.C. -- January 8, 2009 -- Six organizations representing consumers, physicians, insurers, patients and pharmaceutical research companies are banding together to launch a new multi-million dollar national television advertising buy. Their common message: In order to fix the ailing economy, the nation needs health care reform that addresses the related problems of health care costs and people losing health coverage.

The groups are the American Cancer Society Cancer Action Network (ACS CAN), the American Medical Association (AMA), Families USA, the Pharmaceutical Research and Manufacturers of America (PhRMA), Regence BlueCross BlueShield, and the Service Employees International Union (SEIU).

The ad will air at least until Feb. 5 and focuses visually on the nation’s manufacturing sector, but the organizations all agree that every sector of the economy will benefit from health care reform. The ad opens with: “At a time when American businesses are hurting, why should we worry about fixing health care? Because quality, affordable health care can save money and make businesses more competitive.”

“Cancer patients across the country—including those with insurance—often must dig deep into their savings and risk financial ruin to pay for cancer treatment and care,” said John R. Seffrin, Ph. D., Chief Executive Officer of the American Cancer Society and its advocacy affiliate, ACS CAN. “Elected officials should recognize what American families already know—that fixing the economy requires that we fix the broken health care system.”

“Healing our health care system is a key component to jumpstarting our national economy. As our new ad makes clear—quality, affordable health care is good for families and it's good for businesses,” said AMA President Nancy H. Nielsen, M.D.

“While businesses and families cope with unaffordable health care costs, many workers are losing their jobs and health coverage,” said Ron Pollack, Executive Director of Families USA. “As a result, it’s clear that America’s economic difficulties require meaningful health care reform. It’s this message that animates our ad campaign.”

“Expanding access to quality and affordable health insurance is good for patients and good for our economy,” Billy Tauzin, President and CEO of PhRMA, said today. “Improved access means we can do more to promote prevention and more to detect and treat conditions at an early stage, when we can do the most to avoid poor health outcomes and costly complications of chronic diseases, which account for seven out of every ten deaths in America.”

“Given the nation’s economic and health care crises, now is the time to bring meaningful, lasting change to our health care system,” said Mark Ganz, President and CEO of Regence. “We urge President-elect Obama and Congressional leaders to bring together stakeholders who are willing to discard outdated concepts and collaborate on practical solutions.”

“As the economy sputters, the need to fix healthcare is becoming more and more urgent. The clock is ticking,” said Andy Stern, President of SEIU, the nation's largest union of healthcare workers. “It will take all of us—individuals, corporate leaders, healthcare providers and the government—working together to solve America's healthcare crisis.”

The ad was unveiled today by all the sponsoring organizations at a news conference in Washington, D.C.

About the sponsors:

ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit http://www.acscan.org/.

The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues. Working together, the AMA's quarter of a million physician and medical student members are playing an active role in shaping the future of medicine. For more information on the AMA, please visit http://www.ama-assn.org/.

Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health care for all Americans. Working at the national, state, and community levels, we have earned a national reputation as an effective voice for health care consumers for 25 years. For more information, visit http://www.familiesusa.org/.

With 2 million members in Canada, the United States and Puerto Rico, SEIU is the fastest-growing union in the Americas. Focused on uniting workers in healthcare, public services and property services, SEIU members are winning better wages, healthcare and more secure jobs for our communities, while uniting their strength with their counterparts around the world to help ensure that workers—not just corporations and CEOs—benefit from today's global economy.

Regence BlueCross BlueShield is a leading health insurer in the Northwest/Mountain State Region, offering health, life and dental insurance. Regence serves nearly three million members as Regence BlueCross BlueShield of Oregon, Regence BlueShield (selected counties in Washington), Regence BlueCross BlueShield of Utah and Regence BlueShield of Idaho. Each plan is a not-for-profit independent licensee of the Blue Cross and Blue Shield Association. Regence is committed to improving the health of our members and our communities, and to transforming our health care system. For more information, please visit regence.com.

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AAOS Knee OA Clinical Treatment Guidelines

noreply@blogger.com (Jason L. Harris, PT, DPT) — Thu, 18 Dec 2008 11:46:00 +0000

The American Academy of Orthopaedic Surgeons (AAOS) recently released their Guidline on the Treatment of Osteoarthritis of the Knee. AAOS' guidlines join those made by the Osteoarthritis Research Society International (OARSI) guidlines released in February of this year. AAOS makes recommendations on topics ranging from lifestyle modifications to, of course, surgical interventions. However, there were a couple of recommendations/statements that stood out to me.

The first was they recommend AGAINST the prescribing of Glucosamine, Chondroitin, or hydrochloride. I would have to say that my observation in the clinic that greater than 50% of my patients over the age of 50 are taking one or all of these. I haven't read any studies that show a strong benefit from any of these. However, they are marketed hard. Will like to know if there are any side effects from long term use of these.

The last issue I wold like to discuss is AAOS', in my opinion, obvious choice to avoid the term/word "PHYSICAL THERAPY". This is in stark contrast to OARSI's recommendation which specifically recommends physical therapy. AAOS recommends many treatments used by physical therapists and education routinely provided by physical therapists. However, at no time does the 265 page document use the terms "physical therapy "or "physical therapist" in reference to it's recommendations. The did have 2 PT's on the review board (one the president of the orthopaedic section of the APTA) and get the nod of acceptance from the APTA. However, I feel this is just a continuation of, specifically, orthopaedic surgeons refusal to aknowldedge the importance of our profession instead of something the own and direct as just a small aspect of their patient's recovery.

Besides the hypocrisy of direct access for PT's (may go to a massage therapist with a certificate for back pain w/o MD ok but not a PT with a doctoral degree), this concerted effort by orthopaedic surgeons in general to make sure PT's stay subservient gives me the most angst in my professional life. In the end, our working together and respecting each others discrete knowledge for orthopaedic patients should be paramount. Instead, it's unilateraly ignored and buried.

Good recommendations and good information for us all to read. Hope future editions of these recommendations can include the recommendation skirted through out - the referral to a physical therapist.

Jason Harris

PHYSICAL THERAPY OFFERS EVIDENCE-BASED SOLUTION

noreply@blogger.com (Jason L. Harris, PT, DPT) — Wed, 17 Dec 2008 00:28:00 +0000

New Study Shows Manual Physical Therapy and Exercise ProducesSignificant Improvements in Neck Pain

ALEXANDRIA, VA, December 12, 2008 — The American Physical Therapy Association (APTA) is urging patients with musculoskeletal pain to consider treatment by a physical therapist, in light of a new federal survey showing that more than one-third of American adults and nearly 12 percent of children use alternative medicine - with back and neck pain being the top reasons for treatment. Results of the 2007 survey of more than 32,000 Americans were released December 11 by the National Institutes of Health's National Center for Complementary and Alternative Medicine.

According to APTA, physical therapy offers an evidence-based, time-tested solution to these common conditions in comparison to alternative treatments.
For neck pain, for example, a recent study published in the medical journal Spine found that when patients received up to six treatments of manual physical therapy and exercise, they not only experienced pain relief, but were also less likely to seek additional medical care up to one year following treatment.

"This study, demonstrating the efficacy of physical therapy for a condition as widespread as neck pain, is particularly relevant in today's challenging economic environment," according to the study's lead researcher and APTA spokesman Michael Walker, PT, DSc, OCS, CSCS, FAAOMPT. "The Kaiser Foundation, for instance, recently found that more than half of all Americans are not taking prescribed medication and postponing needed medical care in an effort to save money. It is important for consumers to know that there are effective, conservative solutions such as physical therapy available.1"

Walker's study compared the effectiveness of a three-week program of manual physical therapy and exercise to a minimal intervention treatment approach for patients with neck pain.
Study participants consisted of 94 patients with a primary complaint of neck pain, 58 (62%) of whom also had radiating arm pain. Patients randomized to the manual physical therapy and exercise group received joint and soft-tissue mobilizations and manipulations to restore motion and decrease pain, followed by a standard home exercise program of chin tucks, neck strengthening, and range-of-motion exercises. Patients in the minimal intervention group received treatment consistent with the current guidelines of advice, range-of-motion exercise, and any medication use prescribed by their general practitioner. Patients did not have to complete all six visits if their symptoms were fully resolved.
Sample exercises to relieve neck pain can be found on the APTA Web site, www.apta.org/consumer.

Results show that manual physical therapy and exercise was significantly more effective in reducing mechanical neck pain and disability and increasing patient-perceived improvements during short- and long-term follow-ups. These results are comparable with previous studies that found manual physical therapy and exercise provided greater treatment effectiveness (Hoving et al, 2002)2 and cost effectiveness (Kothals-de Bos et al, 2003)3 than general practitioner care.
"Physical therapist intervention can be an effective, high-value, conservative solution for treatment of musculoskeletal pain," said Walker.

"Physical therapists can help individuals improve mobility and quality of life without expensive surgery or the side effects of pain medication. We give patients the tools they need, such as the home program we used in the study, to help them prevent or manage a condition in order to achieve long-term health benefits."

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility — without expensive surgery or the side effects of medications. APTA represents more than 70,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice. Learn more about conditions physical therapists can treat at www.apta.org/consumer, and find a physical therapist in your area at www.findapt.us.

1 http://www.kff.org/kaiserpolls/h08_posr102108pkg.cfm
2 Hoving JL, Koes BW, de Vet HC, van der Windt DA, et al. Manual Therapy, Physical Therapy, Or Continued Care by a General Practitioner for Patients with Neck Pain. Ann Intern Med 2002;136 (10):713-722
3 Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 2003;326 (7395):911

EIM Announces Winner of Elevator Pitch Contest

noreply@blogger.com (Jason L. Harris, PT, DPT) — Sat, 13 Dec 2008 20:10:00 +0000

The folks over at Evidence In Motion have announce the winners of their "30 Second Elevator Pitch Contest" asking participants to answer the question:

- Why physical therapy is the best first choice in musculoskeletal care.

The grand prize winner was the entry submitted by BJ Lehecka from Wichita State University. You can see BJ's winning entry below. To see the full list of winners and other information, please go to EIM's blog found here.