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Physical therapy [journal]
- The American Physical Therapy Association's Top 5 Choosing Wisely Recommendations. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 15.
Improving health care in our country requires simultaneous pursuit of three aims: improving the effectiveness of care, improving the health of our population, and reducing the per capita costs of health care.(1) As our nation focuses on ways to achieve this triple aim, the unwarranted overuse of health care resources is a significant concern. The continuing rise in health care costs, estimated at $2.8 trillion or 17.2% of gross domestic product in 2012, puts financial pressure on our national economy and on individuals who are impacted by rising insurance premiums, deductibles, and co-payments or by lost wage increases due to rising costs of premiums incurred by employers.(2) Proponents of the triple aim have suggested there is ample capacity in our health care system to achieve these goals by reducing unnecessary tests, measures and procedures.(1) In fact, the Institute of Medicine estimates that in 2009 alone more than $750 billion (or 1 in 3 dollars spent on health care) was spent on unnecessary medical tests, procedures, and missed prevention opportunities(3). Implementing strategies that reduce unnecessary tests and procedures becomes a challenge, particularly when considering that many of these tests and procedures are reimbursable by insurance. Attempts by the federal government and by private payers to control health care expenditures and utilization have led to an increase in the number and complexity of regulations that govern the provision of care. While the intention may be to improve patient care, these frequently changing and increasingly intricate regulations have led to a burdensome practice environment that challenges the ability of clinicians and administrators to remain in compliance with regulations and laws. Additionally, attempts to control utilization and costs have led to a significant increase in audits and investigations.(4) Because of the complexity of the regulatory environment, even the most diligent physical therapists may find themselves the subject of a costly investigation or audit.(5.)
- Emergence of Virtual Reality as a Tool for Upper Limb Rehabilitation. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 11.
The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality-based simulations, can be used to provide meaningful, repetitive practice together with salient feedback thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control and sensory feedback-based learning mechanisms. The objectives of this paper are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments and to provide evidence concerning current applications for upper limb motor recovery. We also discuss the limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks.
- Patients' Use of a Home-Based Virtual Reality System to Provide Rehabilitation of the Upper Limb Following Stroke. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 11.
A low cost, virtual reality system that translates movements of the hand, fingers and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home based rehabilitation.Effectiveness depends on adherence, so did patients use the intervention to the recommended level. If not, what reasons did they give?Prospective cohort study plus qualitative analysis of interviews.17 patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for eight weeks and were advised to use it three times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way.Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak (p=0.053) positive correlation between duration and baseline reported activities of daily living. Participants reported familiarity with technology and competing commitments as barriers to use although appreciated the flexibility of the intervention and found it motivating.The small sample size limits the conclusions that can be drawn.Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment but participants reported that the intervention was flexible and motivating. It will not suit everyone but some participants recorded high levels of use. Implications for practice are discussed.
- Transcutaneous Electrical Nerve Stimulation Attenuates Postsurgical Allodynia and Suppresses Spinal Substance P and Proinflammatory Cytokine Release in Rats. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 11.
Transcutaneous electrical nerve stimulation (TENS) was used for management of chronic pain.We investigated whether TENS altered postincisional allodynia, substance P, and proinflammatory cytokines in a rat model of skin-muscle incision retraction (SMIR).This was an experimental study.High-frequency (100Hz) TENS therapy began on postoperative day 3 (POD3) and then daily for 20 min to SMIR rats by self-adhesive electrodes delivered to skin innervated via the ipsilateral dorsal rami of lumbar spinal nerves L1-L6 and for the next 27 days. The expressions of substance P, tumor necrosis factor-α(TNF -α), interleukin-6 (IL-6), and IL-1βin the spinal cord and mechanical sensitivity to von Frey stimuli (10g and 4g) were evaluated.SMIR rats displayed a marked hypersensitivity to von Frey stimuli on POD3. In contrast with SMIR rats, SMIR-operated rats after TENS administration showed a quick recovery of mechanical hypersensitivity. On PODs 3, 16 and 30, SMIR-operated rats exhibited an up-regulation of substance P and cytokines (TNF-α, IL-6, and IL-1β) in the spinal cord, whereas SMIR -operated rats after TENS therapy inhibited that up-regulation. By contrast, the placebo-TENS following SMIR surgery did not alter mechanical hypersensitivity and the levels of spinal substance P, TNF-α, IL-6, and IL-1β.The experimental data are limited to animal models and cannot be generalized to postoperative pain in humans.Our results reveal that TENS attenuates prolonged postoperative allodynia following SMIR operation. Increased levels of spinal substance P and proinflammatory cytokines, activated after SMIR surgery, are important in the processing of persistent post-surgical allodynia. The protective effect by TENS may be relating to the suppression of spinal substance P and proinflammatory cytokines in SMIR rats.
- Massage-Induced Brachial Plexus Injury. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 11.
There are few reports in the literature of adverse effects resulting from massage therapy (MT), and no reports of brachial plexus injury (BPI) associated with MT. Here, we report an uncommon case of BPI that developed after a session of MT and review previously published reports of peripheral nerve injury following MT in the literature.A 58-year-old Asian woman developed sudden unilateral paralysis of her left shoulder girdle after a session of MT. A diagnosis of acute BPI was suspected, due to her recent history and the results of several examinations. The results of electrodiagnostic studies indicated a possible location for the lesion, and ultimately led to a different diagnosis.The patient regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. The program included supervised passive range of motion (ROM) exercises, strengthening, and stretching exercises, and a home exercise program as well. At a 12-month follow-up, the patient had gradually recovery shoulder strength, resolution of limitations of ROM, and relief of shoulder pain.To the best of our knowledge, this is the first report of BPI associated with MT. This case serves as a reminder to massage therapists and physical therapists that MT of the neck should be carefully performed, to avoid injury. Further studies will help design safer and more effective MT for the future.
- Effect of Transcutaneous Electrical Nerve Stimulation on Pain, Function, and Quality of Life in Fibromyalgia: A Double-Blind Randomized Clinical Trial. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 11.
Fibromyalgia is a common chronic pain condition that has a significant impact on quality of life and often leads to disability. To date there have been few well controlled trials assessing the utility of non-pharmacological treatment modalities such as transcutaneous electrical stimulation (TENS) in the management of pain and improvement in function in individuals with fibromyalgia. The purpose of this study was to complete a long-term, multi-center study to assess the effects of transcutaneous electrical stimulation in females with fibromyalgia.This is a phase II randomized, double-blind, placebo controlled multi-center clinical trial. 343 participants with fibromyalgia will be recruited for this study and randomly assigned to one of 3 groups, the intervention (TENS), placebo or no treatment. After completing the randomized period, all participants will receive the intervention for one month. The participants will be asked to use TENS at the highest tolerable level for at least 2 hours daily during physical activity. The primary outcome will be pain with movement with secondary outcomes assessing functional abilities, patient reported outcomes and quantitative sensory testing.The results of this study will provide us with some of the first evidence from a large double-blind placebo-controlled trial on the effectiveness of transcutaneous electrical stimulation on pain control and quality of life changes in patients with fibromyalgia.
- Psychometrics of the Wrist Stability and Hand Mobility Subscales of the Fugl-Meyer Assessment in Moderately Impaired Stroke. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 4.
There remains a need for a quickly administered, stroke-specific, bedside measure of active wrist and finger movement for the expanding stroke population. The wrist stability and hand mobility scales of the upper extremity FM (w/h UE FM) constitute a valid, reliable measure of paretic UE impairment in patients with active wrist and finger movement.This study determined the w/h UE FM's in a stable cohort of survivors with only palpable movement in their paretic wrist flexors.Single center cohort study SETTING: Outpatient rehabilitation clinic in the Midwestern United States PATIENTS: 32 subjects exhibiting stable, moderate, UE hemiparesis (15 males; mean age of subjects = 56.6 ± 10.1 years; mean time since stroke = 4.6 years ± 5.8) MEASUREMENTS: The w/h UE FM and Action Research Arm Test (ARAT) were administered twice. Intraclass correlation coefficients (ICCs), Cronbach's alpha, and ordinal alpha were computed to determine reliability, while Spearman's rank correlation coefficient and Bland Altman plots were computed to establish validity.(ICC's for the w/h UE FM and ARAT were 0.95 and 0.99, respectively. w/h UE FM intra-rater reliability and internal consistency were > 0.80, while concurrent validity was also > 0.70. This was also the first stroke rehabilitative study to apply ordinal alpha to examine internal consistency values, revealing w/h UE FM levels >0.85. Concurrent validity findings were corroborated by Bland-Altman plots.It appears that the w/h UE FM is a promising tool to measure distal UE movement in patients with little active paretic wrist and finger movement. This finding widens the segment of patients on whom the w/h UE FM can be effectively used, and addresses a gap, since commonly used measures necessitate active distal UE movement.
- Associations Between Upper Limb Disability on the Different Levels of the International Classification of Functioning, Disability and Health in People With Multiple Sclerosis. [JOURNAL ARTICLE]
- Phys Ther 2014 Sep 4.
It is unknown how impairments caused by MS have impact on the upper limb capacity, performances and community integration.This study aimed to investigate to which extent impairments explained the variance in 'activity' and 'participation' level measures and to which extent upper limb capacity measures explained perceived performance on the 'activity' level in persons with MS (PwMS) with different dexterity levels.A cross-sectional study.One hundred and five PwMS (median EDSS=6.5) were assessed with measures of (a) 'body functions and structures' level: strength, active range of motion of the wrist, tactile sensitivity, tremor, spasticity and pain, (b) 'activity' level: the Nine Hole Peg test (NHPT), Action Research Arm Test (ARAt) and Manual Ability Measure-36 (MAM-36), and (c) 'participation' level: the Community Integration Questionnaire. The sample was split in a low and high dexterity group using the median score of the NHPT.In the total group, muscle strength, tactile sensitivity of the thumb and intention tremor explained 53-64% of the variance in the 'activity' level measures. In the low dexterity subgroup, muscle strength and active range of motion explained 43-71% of the variance in the 'activity' measures. In the high dexterity subgroup, only 35% of the variance in the MAM-36 was explained by muscle strength. Capacity measures (NHPT and ARAT) were moderately to highly associated with perceived performance (MAM-36) in the low dexterity group.Some of the outcome measures showed ceiling effects in PwMS with a high dexterity level.Upper limb muscle strength is the most important impairment affecting capacity and the perceived performance in daily life. Associations between outcome measures differ between PwMS with different dexterity levels.
- Has the italian academia missed an opportunity? [Letter]
- Phys Ther 2014 Sep; 94(9):1358-60.