Food for Thought…
The latest in physical therapy research
Brought to you by Bragg Creek Physiotherapy
From: A Primary Health Approach to Treating Soft Tissue Injuries: The New NS-WCB Physiotherapy Treatment Model
“Although well established in parts of Europe and the United States, direct and early access to physiotherapy is only slowly being established in Canada in private and public institutions and in the military. Regardless of where physiotherapists play their primary care roles, there is evidence that direct access and early treatment of musculoskeletal soft tissue injuries (STIs) by physiotherapists produces favorable outcomes in three ways:
The first is therapeutic effectiveness. Here, research shows that primary care physiotherapists are as effective as doctors and surgical residents at diagnosing musculoskeletal STIs and are more effective than non-primary care physiotherapists at improving functional outcomes- particularly where physiotherapy treatment is delayed beyond three days after injury. This suggests that timing of a physiotherapy intervention is critical.
The second improved outcome, cost effectiveness, is centered on time loss-from-work, since it accounts for up to two-fifths of the cost of managing musculoskeletal injuries. When a physiotherapist treated patients within 5 days of injury, they had significantly less time loss-from-work, as compared to patients who received treatment beyond the five-day mark. This is a strong financial case for early physiotherapy intervention in soft tissue injuries.
Finally, the literature shows evidence of patient satisfaction with treatment outcomes, and physician satisfaction with primary care physiotherapists’ proposed management plans and patients’ functional outcomes.”
Three brief summaries are provided below outlining the effectiveness of physiotherapy treatment for shoulder, knee and neck injuries.
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From: Effectiveness of Rehabilitation for Patients with Subacromial Impingement Syndrome, by Eric L Sauers
[The] data indicate[s] that exercise, joint mobilization, and laser therapy are effective physical interventions for decreasing pain and functional loss or disability for patients with SAIS. The current evidence does not support the use of ultrasound, and studies evaluating the effectiveness of acupuncture were equivocal.
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From: Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Deyle, et al.
OBJECTIVE: To evaluate the effectiveness of physical therapy for osteoarthritis of the knee, applied by experienced physical therapists with formal training in manual therapy.
INTERVENTION: The treatment group received manual therapy, applied to the knee as well as to the lumbar spine, hip, and ankle as required, and performed a standardized knee exercise program in the clinic and at home. The placebo group had sub therapeutic ultrasound to the knee at an intensity of 0.1 W/cm2 with a 10% pulsed mode. Both groups were treated at the clinic twice weekly for 4 weeks.
RESULTS: Clinically and statistically significant improvements in 6-minute walk distance and WOMAC score at 4 weeks and 8 weeks were seen in the treatment group but not the placebo group. By 8 weeks, average 6-minute walk distances had improved by 13.1% and WOMAC scores had improved by 55.8% over baseline values in the treatment group (P < 0.05). After controlling for potential confounding variables, the average distance walked in 6 minutes at 8 weeks among patients in the treatment group was 170 m (95% CI, 71 to 270 m) more than that in the placebo group and the average WOMAC scores were 599 mm higher (95% CI, 197 to 1002 mm). At 1 year, patients in the treatment group had clinically and statistically significant gains over baseline WOMAC scores and walking distance; 20% of patients in the placebo group and 5% of patients in the treatment group had undergone knee arthroplasty.
CONCLUSIONS: A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.
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From: The Effectiveness of Physical Therapy in the Treatment of Chronic Daily Headaches. Gary W. Jay, M.D., Janel Brunson, BS, RPT, and Suzanne Jeffers Branson, RN
We investigated the adjunctive use of physical therapy, with the more standard modalities of medication and/or biofeedback-enhanced neuromuscular re-education, in patients with chronic daily headaches who had palpable muscle spasm in the neck and shoulder regions.
Patients in group one received medication detoxification (when necessary), amitriptyline and (in some cases), biofeedback. Patients in group two received detoxification (when necessary), amitriptyline (in some cases) and physical therapy, including TENS (trans-cutaneous electrical nerve stimulation). Patients in group three received detoxification (when necessary), amitriptyline in (some cases), and TENS without other modalities of physical therapy.
Patients in groups two and three, as judged by changes in Headache Index, showed a significantly faster and greater decline in headaches than patients in group one, and maintained this excellent relief through the six month follow-up period. From a biochemical perspective, this improvement may be related to the demonstrable increase in serotonin levels that attends TENS. From a behavioral perspective, improvement may be related to the change in "locus of control" from the headache to the patient that attends the more "active" modalities of TENS and physical therapy, as opposed to the more "passive" modality of medication alone.
We hope you found this information useful. If you have any questions or concerns, or would like to know more about physical therapy research, please feel free to contact us at 403-949-4008.
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