Continuing Physical Therapy Education

Interventions Associated With an Increased or Decreased Likelihood of Pain Reduction and Improved Function in Patients With Adhesive Capsulitis:

2009-05-18T13:46:00.001-07:00

Dianne V Jewell, Daniel L Riddle and Leroy R Thacker

DV Jewell, PT, DPT, PhD, CCS, is Assistant Professor, Department of Physical Therapy, Virginia Commonwealth University, 1200 E Broad St, Suite 100, PO Box 980224, Richmond, VA 23298-0224 (USA).
DL Riddle, PT, PhD, FAPTA, is Otto D. Payton Professor, Department of Physical Therapy, Virginia Commonwealth University.
LR Thacker, PhD, is Assistant Professor, Department of Biostatistics, Virginia Commonwealth University.

Address all correspondence to Dr Jewell at: dvjewell@vcu.edu

Background and Purpose: The purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health, pain, and function for patients diagnosed with adhesive capsulitis.

Participants: Data were examined from 2,370 patients (mean age=55.3 years, SD=12.4; 65% female, 35% male) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy.

Methods: Principal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care. A nested logistic regression model was used to identify intervention categories that predicted a 50% or greater change in Physical Component Summary-12 (PCS-12), physical function (PF), bodily pain (BP), and hybrid function (HF) scores.

Results: None of the patients achieved a 50% or greater improvement in PCS-12 scores. Improvement in BP scores was more likely in patients who received joint mobility interventions (odds ratio=1.35, 95% confidence interval=1.10–1.65). Improvement in HF scores was more likely in patients who received exercise interventions (odds ratio=1.50, 95% confidence interval=1.03–2.17). Use of iontophoresis, phonophoresis, ultrasound, or massage reduced the likelihood of improvement in these 3 outcome measures by 19% to 32%.

Limitations: The authors relied on clinician-identified ICD-9 coding for the diagnosis. Impairment measures were not available to support the diagnosis, and some interventions were excluded because of infrequent use by participating therapists.

Discussion and Conclusions: These results are consistent with findings from randomized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis. Ultrasound, massage, iontophoresis, and phonophoresis reduced the likelihood of a favorable outcome, which suggests that use of these modalities should be discouraged.

Surplus Value of Hip Adduction in Leg-Press Exercise in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial

2009-05-18T13:45:00.001-07:00

Surplus Value of Hip Adduction in Leg-Press Exercise in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial
Chen-Yi Song, Yeong-Fwu Lin, Tung-Ching Wei, Da-Hon Lin, Tzu-Yu Yen and Mei-Hwa Jan

CY Song, PT, MS, is a PhD student, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
YF Lin, MD, PhD, is Orthopedic Surgeon, Department of Orthopedics, West Garden Hospital, Taipei, Taiwan.
TC Wei, PT, MS, is Physical Therapist, Yeong-An Clinic, Taipei, Taiwan.
DH Lin, MD, is Orthopedic Surgeon, Department of Orthopedics, En Chu Kong Hospital, Taipei, Taiwan.
TY Yen, PT, MS, is Physical Therapist, Yeong-An Clinic.
MH Jan, PT, MS, is Associate Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F, No. 17, Xuzhou Rd, Zhongzheng District, Taipei 100, Taiwan, Republic of China.

Address all correspondence to Ms Jan at: mhjan@ntu.edu.tw

Background: A common treatment for patients with patellofemoral pain syndrome (PFPS) is strength (force-generating capacity) training of the vastus medialis oblique muscle (VMO). Hip adduction in conjunction with knee extension is commonly used in clinical practice; however, evidence supporting the efficacy of this exercise is lacking.

Objective: The objective of this study was to determine the surplus effect of hip adduction on the VMO.

Design: This study was a randomized controlled trial.

Setting: The study was conducted in a kinesiology laboratory.

Participants: Eighty-nine patients with PFPS participated.

Intervention: Participants were randomly assigned to 1 of 3 groups: hip adduction combined with leg-press exercise (LPHA group), leg-press exercise only (LP group), or no exercise (control group). Training consisted of 3 weekly sessions for 8 weeks.

Measurements: Ratings of worst pain as measured with a 100-mm visual analog scale (VAS-W), Lysholm scale scores, and measurements of VMO morphology (including cross-sectional area [CSA] and volume) were obtained before and after the intervention.

Results: Significant improvements in VAS-W ratings, Lysholm scale scores, and VMO CSA and volume were observed after the intervention in both exercise groups, but not in the control group. Significantly greater improvements for VAS-W ratings, Lysholm scale scores, and VMO volume were apparent in the LP group compared with the control group. There were no differences between the LP and LPHA groups for any measures.

Limitations: Only the VMO was examined by ultrasonography. The resistance level for hip adduction and the length of intervention period may have been inadequate to induce a training effect.

Conclusions: Similar changes in pain reduction, functional improvement, and VMO hypertrophy were observed in both exercise groups. Incorporating hip adduction with leg-press exercise had no impact on outcome in patients with PFPS.

Research shows physical therapy as effective as arthroscopic knee surgery ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery

2008-09-17T23:16:00.000-07:00

ALEXANDRIA: A new study questioning the usefulness of arthroscopic surgery for osteoarthritis of the knee should encourage patients to consider physical therapy as an effective non-surgical option, according to the American Physical Therapy Association (APTA). The study was published in the September 11 issue of the New England Journal of Medicine (NEJM).

According to Eurekalert, the news service of the American Association for the Advancement of Science, the study found that physical therapy, combined with comprehensive medical management, is just as effective at relieving the pain and stiffness of moderate to severe osteoarthritis of the knee as surgery.

"This study offers hope and encouragement to persons with osteoarthritis who would like to avoid the pain and emotional toll of surgery," said APTA President R. Scott Ward, PT, PhD. "Too often, the first line of defense is surgery when it need not always be. Physical therapy can be equally effective and should be considered by not only patients themselves, but also the primary care doctors and orthopedists who are treating them."

According to physical therapist Christopher M Powers, PhD, PT, director of the Biokinesiology program and co-director of the Musculoskeletal Biomechanics Research Lab at the University of Southern California Division of Biokinesiology & Physical Therapy, "Many times knee pain is associated with abnormal movement patterns that cause increased stress on the joint. Arthroscopic surgery does little to correct the dynamic factors that may be contributing to knee pain and pathology. These findings reinforce the need for a comprehensive treatment approach for such patients."

The NEJM study adds to a growing body of evidence supporting physical therapy for treatment of osteoarthritis of the knee, including:

A report published in the January 2008 issue of the journal Physical Therapy that reviewed research on osteoarthritis of the knee from 2000 to 2007 and found "high-quality evidence that exercise and weight reduction reduce pain and improve physical function."

A study published in the Feb 1, 2000 issue of the Annals of Internal Medicine that concluded "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."

A physical therapist will perform a thorough examination and design a plan of care that may include:

A series of exercises designed to help improve motion. Activities in this phase might include water walking, swimming, and flexibility exercises.

An exercise sequence to restore strength including a functional progression, that is, a gradual return to normal activities using exercises that simulate the knee stresses of your normal activities.

A knee's tolerance for stressful activities often decreases with age and loss of conditioning. As a result, stresses that would not have caused pain or injury to the knee last year could today. A decrease in levels of activity over a period of time may also contribute to the vulnerability of knees.

But there are steps one can take to help prevent injury in order to continue enjoying sports and exercise. Pursuing an exercise program designed by a physical therapist can be one of the best protections from injury.

The first step in designing your exercise program is an evaluation by your physical therapist. He or she can identify your predisposing factors, those body traits that may make you more or less vulnerable to a knee injury. Based on this evaluation, your physical therapist can design a program that will help you gain your optimum levels of function, strength and conditioning.

Source: http://www.hindu.com/thehindu/holnus/099200809140921.htm

Therapy program draws Olympic inspiration

2008-08-19T10:23:00.000-07:00

By MARCELLA PEYRE-FERRY, Special to the Local News

08/17/2008

WEST BRADFORD — The Olympic games have inspired some young riders with disabilities to strive for extra accomplishments last week during their therapy sessions at Quest Therapeutic Services.

Quest uses horseback riding as a tool for physical therapy and therapeutic riding for young people ages 2 to 21. This week, the center has adapted its hippotherapy program to include exercises that the children can compare to what they see at the Olympics.

The therapy sessions have adapted to include mounted and unmounted games kicking off with a torch relay, using a simulated torch with tissue paper flames. Gold medals are given out daily to riders for executing swimming strokes with their arms while mounted, playing equestrian games and doing gymnastics.

Other mounted games on the horses include relays, basketball toss and jumps. There are also children's games on the ground, including softball, soccer, tennis, and track-and-field activities.

The addition of the games is intended to encourage children with special needs to meet goals on their individual treatment plans and bring excitement to their therapy.

"We use the horse as a tool as part of the therapy program," said founder and President Sandra McCloskey.

The program anticipates 160 young people will participate in the special events over two weeks.

"It helps to motivate them to reach their goals," McCloskey said. "They're getting really into the spirit of this. This is their day to be in the Olympics."

Hippotherapy at Quest Therapeutic Services is designed to enhance the development of children with special needs. Licensed pediatric physical, occupational and speech therapists serve children with diagnoses such as cerebral palsy, spina bifida, autism and developmental delays. Many volunteers also work to make the program possible, because it takes three people on the ground to assist every student on horseback.

Parents were enthusiastic about the program and how Quest has helped their children. "After less than six months, he's doing much better. He's very happy," said Seema Nayak of Malvern, whose son, Aashay, is benefiting from his sessions at Quest.

Aashay is weaker on one side of his body. But since he started the hippotherapy, he has begun to use his weaker arm and leg more.

"It's a big change for him," said Seema Nayak.

Lee Law of West Chester is a pediatric physical therapist who brings her 10-year-old son, Ryan, to Quest. "It's made a tremendous difference in his head control and support in his trunk," she said. "He gets excited about this as opposed to other therapies."

Parents Lee and Steve Law, along with Ryan's sister and aunt, watched from the lounge area while Ryan turned in different directions in the saddle, road over rails on the ground that simulates jumps and tossed nerf balls and bean bags at targets from the back of the patient pony.

One of the big benefits of hippotherapy is that the motion of the horse helps work muscles that do not otherwise get any stimulation.

"I think you get a lot out of a session because it works him all over," Law said. "It's something different from conventional therapy that you can work on all the things at the same time."

http://www.dailylocal.com/site/news.cfm?newsid=20021281&BRD=1671&PAG=461&dept_id=635398&rfi=6

Physical therapist identifies future pain with new exam

2008-08-11T02:47:00.000-07:00

COURTNEY CRAUTHERS
The Edmond Sun

EDMOND — People looking to prevent weakness and pain later on in life don’t really have a way to educate themselves on how to do it. Until now.

Eric Browning, physical therapist at Keith Physical Therapy, 13301 N. Meridian, created the Musculoskeletal Exam to predict the likely places an individual might develop pain and identify muscles that already might be causing episodic pain.

“Nobody else has done anything like this as far as I know,” Browning said. “It’s just using the knowledge we already have in a systematic way.”

Browning does an assessment of strength and flexibility of the main muscles through 140 to 160 tests during the exam, which costs $120. He said he takes patients through at least six tests per every area of the body and so feels confident in his predictions. Tested muscle areas include wrist, biceps, triceps and feet. He then enters the data into an Excel program, which graphs the strength of each muscle, identifying low- to high-risk areas.

His exams are unique in that he uses a manual muscle tester to measure strength, Browning said. He then compares that to what studies have shown an individual’s strength should be based on their age and body weight. Most doctors and physical therapists measure strength on a one to five scale. Browning said typically when people go to the doctor strength analysis is determined by squeezing the doctor’s hand.

After the MSE exam, Browning gives the individual a report of their exam and educates them on exercises they can complete for muscles that have been determined to be at high risk for pain. He said he also can refer an individual to the appropriate doctor if any problems are found.

“It allows me to help them learn how to fix something before it’s broken,” Browning said. “Most of what we do is empower people to do therapy with minimal equipment.”

He said people can come in for an MSE, work on strengthening their weak muscles and then come back for another exam.

“It’s a tracking system,” Browning said.

Browning said the exam also is good to help people identify what muscle is causing the episodic pain.

For example, a baseball player kept coming in for therapy because of pain in the middle of his back. However, the pain actually was coming from a weakness in his hip and was being absorbed in his back.

People who are planning to train with a personal trainer or people with hypermobility or flexibility are good candidates for an MSE, Browning said.

“People that train at extremely high levels are likely to have pain at some point,” he said.

Browning created the exam about a year ago and began implementing it about five months ago.

“Everyone that has come has been extremely pleased with the information I’ve given them,” he said.

All patients have been motivated to reverse effects, Browning said.

“The response he got is excellent and his predictability is excellent,” said Thomas Keith, Browning’s partner. “I think it’s an outstanding idea.”

Browning earned a bachelor’s degree in biology at Oklahoma State University and a master’s degree in physical therapy at the University of Oklahoma Health Sciences Center.

FOR MORE information about MSE, visit www.keithpt.com.

http://www.edmondsun.com/business/local_story_221222728.html

Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations

2008-07-28T22:06:00.000-07:00

Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations

Patricia A Miller, Peggy Goddard and Heather K Spence Laschinger

PA Miller, PT, MHSc, is Assistant Clinical Professor, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. At the time of the study, she was Profession Leader, Physiotherapy, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada. Address all correspondence to Ms Miller at 5 Undercliffe Ave, Hamilton, Ontario, Canada L8P 3G9 (pmiller@mcmaster.ca)
P Goddard, MScN, RN, is Assistant Clinical Professor, School of Nursing, McMaster University. At the time of the study, she was Chief of Professional Practice and Chief Nursing Officer, Hamilton Health Sciences Corporation
HK Spence Laschinger, PhD, RN, is Associate Director, Research, and Professor, School of Nursing, University of Western Ontario, London, Ontario, Canada

Background and Purpose. Little is known about physical therapists'perceptions of empowerment. In this study, Kanter's theory ofstructural power in organizations was used to examine physicaltherapists' perceptions of empowerment in a large Canadian urbanteaching hospital. Kanter's theory, which has been studied extensivelyin the nursing profession, proposes that power in organizationsis derived from access to information, support, resources, opportunity,and proportions. Subjects and Methods. A convenience sampleof physical therapists who had been working in the hospitallonger than 3 months was used to determine the scores for thephysical therapists' ratings of empowerment using the Conditionsof Work Effectiveness Questionnaire. Results. Physical therapists'scores were similar to reported staff nurses' scores for accessto support, information, resources, and opportunity (=2.89, 2.91, 2.62, 3.25, respectively). Physicaltherapists' scores were higher than the majority of reportedstaff nurses' and nurse managers' scores for access to sourcesof informal and formal power structures (=2.81 and 3.29, respectively). There was a relationship between theempowerment score and the physical therapists' global ratingof empowerment. Unlike studies of nurses, there were no relationshipswhen demographic attributes and empowerment scores were examined.Discussion and Conclusion. Evidence for the validity of Kanter'stheory of empowerment was found. Kanter's theory can providephysical therapists and their managers with a useful frameworkfor examining critical organizational factors (access to information,support, opportunity, and resources) that contribute to employees'perceptions of empowerment. A baseline measure for comparingfuture empowerment scores of this sample is available. Furtherwork to examine the application of Kanter's theory to othersamples of physical therapists appears to be warranted.

Key Words: Empowerment • Kanter's theory of structural power in organizations • Organizational restructuring • Program management

Staten Island firefighter accused of physical therapy scam

2008-07-23T11:11:00.001-07:00

by Staten Island Advance
Monday July 21, 2008, 4:14 PM

From Bravest to busted?

A firefighter from Staten Island is accused of falsely claiming to be at physical therapy sessions and collecting approximately $7,500 in pay.

John Dimino, 45, a Prince's Bay resident, allegedly signed the Fire Department's command log on multiple occasions between August 2007 and February 2008 indicating he was leaving work to attend physical therapy sessions. The Department of Investigation says it found Dimino did not attend physical therapy on those occasions.

For most of his 18-year career, Dimino has been assigned to Engine 157 in Port Richmond. The alleged fraud happened at the Concord firehouse that houses Rescue Co. 5. Fire officials said that was most likely where he was performing light duty stemming from his injury.

Officials couldn't immediately say exactly how Dimino was injured or when, but said it was an on-duty injury.

He was charged today with third-degree grand larceny, first-degree falsifying business records and second-degree falsifying business records. The top charge of grand larceny carries a maximum penalty of seven years in prison if Dimino is convicted at trial.

The accused firefighter earns an annual salary of $68,470, according to officials.

His attorney, Rob Gallo, declined to discuss the case. Dimino fled from a photographer outside court today.

http://www.silive.com/news/index.ssf/2008/07/staten_island_firefighter_accu.html

Therapists help Iraqi patients gain independence

2008-07-23T11:10:00.000-07:00

by Staff Sgt. Don Branum
332nd Air Expeditionary Wing Public Affairs

7/23/2008 - JOINT BASE BALAD, Iraq -- An Iraqi man whose leg was shattered two months ago can walk again thanks in part to a team of physical and occupational therapists at Joint Base Balad's Air Force Theater Hospital.

Moqdad lay on a raised bed in the middle of the Occupational Therapy and Physical Therapy clinic July 22. Nearby, a pair of crutches leaned against a wall, waiting for the Iraqi Marketplace employee to use them for the first time since he left the hospital. He smiled and chatted with medical technicians as they wove bandages around the pins of a large metal brace -- known as an external fixator -- attached to his right ankle.

The physical therapists first saw Moqdad as an inpatient here, said Lt. Col. Lisa Smith, element chief of occupational and physical therapy for the 332nd Expeditionary Medical Operations Squadron here.

"We started therapy with him, trying to get him to walk again," said Colonel Smith, who is deployed from Wilford Hall Medical Center at Lackland Air Force Base, Texas. "That was the big challenge for us."

Moqdad was accidentally shot in the lower leg, splintering both his tibia and fibula, said Emad, an Iraqi translator and the eldest of Moqdad's six brothers. Air Force surgeons repaired what damage they could and attached the fixator to Moqdad's limb to help the bones heal properly. Then, they released him.

When the hospital discharges a patient, staff members determine what follow-up treatment the patient may need, Colonel Smith said. In Moqdad's case, the follow ups included regular visits to physical therapy.

The OT/PT clinic sees about 300 inpatients per month, nearly 90 percent of whom are Iraqi patients like Moqdad, Colonel Smith said. Physical therapists focus on treatment of spinal and extremity movement dysfunctions, while occupational therapists work primarily with patients' hands.

Colonel Smith's staff works closely with the Orthopedic Clinic, which installed Moqdad's fixator, so the orthopedic doctors can focus primarily on surgeries.

"Because this is a trauma hospital, we see a lot of patients who would ordinarily go straight to the Orthopedic Clinic," Colonel Smith said. The OT/PT clinic assumes many of the duties of an orthopedic clinic stateside, including screening patients and treating injuries that don't require surgery.

While patients at a hospital in the United States get continuing treatment and advice on how to modify their environment to accommodate their disabilities, patients here don't have that luxury, said Maj. James Ronyak, an occupational therapist deployed from the 88th Surgical Operations Squadron at Wright-Patterson AFB, Ohio.

"We don't see our patients on an extended basis like we would back in the United States," Major Ronyak said, "but as much as we can, we try to help them get back to full function."

The therapists do as much as they can while their patients are in the clinic. The physical therapy team pulled a set of horizontal bars next to the bed's edge for Moqdad and helped him stand on his uninjured left foot. As he hopped gingerly along the bars, Airmen eased him onto the waiting set of crutches.

Moqdad carefully navigated the room, with Colonel Smith following close behind to make sure he didn't fall backward. Finally, he made it back to his bed and lay down as Airmen took the crutches and examined his injured leg.

Once Moqdad leaves the clinic, however, his continued rehabilitation is up to him.
"Continuity of care is important," said Tech. Sgt. Dan Wilson, a physical medicine technician deployed here from the 75th Medical Operations Squadron at Hill AFB, Utah. "We can't go out to the community, so we have to make sure we're giving him the resources to take care of himself."

"We give them whatever they need when they leave the hospital, including illustrated exercises, translated into Arabic," Colonel Smith said. "We go over the exercises ad nauseam with the translators and patients and tell them how important it is to do it."

Most Iraqi patients are grateful for the treatment they receive from Air Force therapists, Colonel Smith said. Moqdad was no exception, as he frequently thanked the medical team in Arabic during his therapy.

Moqdad's family also appreciated the hospital's medical care, Emad said.

"They're the best," Emad said. "Moqdad's very lucky. This is the best hospital in Iraq."

http://www.balad.afnews.af.mil/news/story.asp?id=123107737

How new Medicare legislation can help Physical Therapists

2008-07-23T11:08:00.000-07:00

THERAPY CAPS. Medicare patients can spend no more $1,810 a year on speech and physical therapy and $1,810 on occupational therapy each year while recovering from an illness. But there are exceptions to these so-called "therapy caps."

If you’ve had a stroke and you need more therapy, for instance, Medicare has had a process for side-stepping the caps and getting extra services. That was due to expire at the beginning of this month.

The new legislation reinstates the exceptions process for speech, physical, and occupational therapy for another 18 months, making it possible for patients with serious illnesses to get needed help regaining essential functions.

PROTECTING SENIORS FROM MARKETING ABUSES. I wrote earlier this year about new regulations proposed by federal officials for private plans that operate under Medicare. Here’s a link to that post.

The new Medicare legislation requires the Centers for Medicare and Medicaid Services to make good on its promise and come out with new regulations for so-called Medicare Advantage plans this fall.

Among the practices that will be prohibited, according to the legislation: cold calling, door-to-door sales in apartment buildings and senior living facilities, sales pitches in doctors’ offices or at educational events, and cross-selling of non-health care products, according to materials from the chairman’s office of the Senate Finance Committee.

http://newsblogs.chicagotribune.com/triage/2008/07/how-the-new-med.html

Therapist Caught In The Act Stealing From Patients

2007-10-01T12:54:00.001-07:00

Police in Utah County say they caught a physical therapist - who has a history of drug problems - stealing medication from a client's car while she was inside getting treatment.
Detectives arrested James C. Nackos, 35, on suspicion of burglary, theft and illegal possession of prescription drugs. On Thursday he remained in the Utah County jail without bail.
Nackos is a physical therapist at a Provo clinic. One of Nackos' clients had noticed when she finished her appointments and returned to her car it appeared someone rummaged her purse, said Lt. Rich Ferguson of the Utah County major crimes task force.
The woman's family, armed with a video camera, decided to watch her car while she attended her next appointment, he said. The family members recorded a man who appeared to be Nackos using her keys to enter the car and going through her purse, Ferguson said.
The family reported the burglary to police, and Detective Dan Forster planned a similar sting. On Tuesday, the woman arrived for an appointment again.
Ferguson said the client was inside about 20 minutes when Nackos came outside with her keys and entered the car, taking prescription medication from her purse.
"He's pretty hasty about it," Ferguson said. "He's out of the car pretty quick and we took him down at that time."
It appears Nackos
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would occupy the client by having her operate a therapy machine, then he would take her car keys, he said.
"We're pretty curious if there's other victims," Ferguson said.
Nackos pleaded in abeyance in October 2005 to two felony counts of altering a prescription. The convictions were to be voided after 24 months if Nackos did not violate laws. Failing to meet that term puts Nackos at risk of going to prison for as much as five years on each count, but there was no indication Thursday of whether prosecutors or 4th District Court in Provo were planning to take action.
Nackos has had a license to practice physical therapy since 2002, according to the Utah Division of Professional Licensing. State laws list felony convictions or drug crimes as grounds for discipline against professional license holders. Professional Licensing said it has no record of any enforcement proceedings against Nackos, though it's not clear if Professional Licensing was aware of the convictions.
"It certainly is grounds for investigation," said Scott Ward, physical therapy division chairman at the University of Utah and the president of the American Physical Therapy Association. Ward said he was not familiar with the Nackos case.

Hydroxyapatite-Coated Tibial Implants Compared with Cemented Tibial Fixation in Primary Total Knee Arthroplasty

2007-10-01T12:51:00.000-07:00

A Randomized Trial of Outcomes at Five Years

L.A. Beaupré, PhD, PT¹, M. al-Yamani, MD¹, J.R. Huckell, BSc, MDCM, FRCS(C)¹ and D.W.C. Johnston, MD, FRCS(C)¹

¹ University of Alberta, Capital Health, 1F1.52 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada. E-mail address for L.A. Beaupré: lauren.beaupre@capitalhealth.ca

Investigation performed at Capital Health, Edmonton, Alberta, Canada

Disclosure: In support of their research for or preparationof this work, one or more of the authors received, in any oneyear, outside funding or grants in excess of $10,000 from StrykerCanada, Inc. Neither they nor a member of their immediate familiesreceived payments or other benefits or a commitment or agreementto provide such benefits from a commercial entity. No commercialentity paid or directed, or agreed to pay or direct, any benefits toany research fund, foundation, division, center, clinical practice,or other charitable or nonprofit organization with which theauthors, or a member of their immediate families, are affiliatedor associated.

Background: Although excellent long-term results have been reported withcemented tibial fixation, cementless fixation as a means toimprove the longevity of total knee prostheses continues tobe of interest to clinicians. The purpose of this study wasto compare outcomes between cementless tibial fixation withhydroxyapatite and cemented tibial fixation in the first five yearsfollowing primary total knee arthroplasty.

Methods: We performed a prospective, randomized clinical trialthat included eighty-one patients with noninflammatory kneearthritis who underwent primary total knee arthroplasty whenthey were less than seventy years of age. The subjects wererandomized at the time of surgery to be treated with either cementlesstibial fixation with hydroxyapatite or cemented tibial fixation. Evaluationswere performed preoperatively and at six months, one year, and fiveyears postoperatively by a physical therapist who was blindedto group allocation. Self-reported pain and function, the primaryoutcomes, were measured with the Western Ontario and McMasterUniversities Osteoarthritis Index (WOMAC) and the RAND 36-ItemHealth Survey (RAND-36). Complications and revision rates weredetermined through a review of hospital records and at eachpatient evaluation. The Knee Society radiographic score wasused to evaluate plain radiographs at each assessment.

Results: Seventy subjects (86%) completed the five-year assessment. Slightlymore pain was reported in the hydroxyapatite group at six monthsas measured with both the WOMAC and the RAND-36, a differencethat disappeared by one year postoperatively. No differenceswere seen in function, radiographic findings, or complications.No subject required revision of the tibial prosthesis duringthe study.

Conclusions: At five years postoperatively, there is no difference betweencementless tibial fixation with hydroxyapatite and cementedtibial fixation in terms of self-reported pain, function, health-relatedquality of life, postoperative complications, or radiographicscores.

Level of Evidence: Therapeutic Level I. See Instructions toAuthors for a complete description of levels of evidence.

Helping Patients Walk Again

2007-10-01T12:48:00.000-07:00

Hamburg, Penn. -- For stroke patients or people living with multiple sclerosis or cerebral palsy, one of the most difficult, but very common, side effects of their condition is paralysis of part of the body. But now, a new device is giving some patients their life back.

For Lorrie Hemerly, a short walk with her husband, Jeff, is reason to celebrate. Just a few months ago, it was impossible to keep up. Multiple sclerosis had rendered her right leg nearly useless.

"It was one of my first questions when they told me I had MS. Was I going to wind up in a wheelchair?" Hemerly says.

But now, physical therapists are using a new wireless, computer-controlled device to help people with central nervous system disorders. Hemerly suffers from what is known as "Foot Drop." She's not able to raise her toes while she's walking.

That's where the "NESS" L-300 comes in. "NESS" stands for neuromuscular-electrical-stimulation-system. The NESS has three parts -- a sensor inside the user's shoe with a transmitter that is clipped onto the heel, the brace at the knee, and a small, hand-held control unit.

When Hemerly steps down on her heel, the transmitter sends a wireless signal to her brace. Then, two electrodes send a timed, electrical pulse to the nerves that control the paralyzed foot.

"That is the one that you're stimulating during what's called the 'swing phase,' when you want the leg to be able to go up and through without issue," says Kathy Slezak, physical therapist at Good Shepherd Rehabilitation Network in Allentown, Penn.

Hemerly can control the "NESS." When she's tired, her foot starts to drag, so she can increase the electrical stimulation.

But the biggest benefit? Hemerly says the device has greatly increased her stability. This first-time grandma said she couldn't hold little McKenzie and walk at the same time. Now, that's changed.

"It gives you a little bit more confidence now. You can do a bit more," Hemerly says.

Patients say they can feel the electrical charge going into their leg, but it's not painful, and they get used to it quickly. Physical therapists say they've had the most success with patients who have paralysis on only one side of the body. Good Shepherd Rehabilitation Network is the only in-patient Beta testing site for the technology in the United States.

What Ails You: Role of physical therapist more complicated than some understand

2007-08-07T11:04:00.000-07:00

By Jackie Randa

It was a very nice lady who, when she overheard me talking one day, came up and excitedly told me that her granddaughter, who had recently graduated from high school, was now doing physical therapy.

“Is that so? Where?” I asked trying hard not to knit my brow too tightly at her. Her granddaughter, it turns out, had gone to work in a chiropractor’s office. The “physical therapy” she was doing was applying various hot packs and electrical modalities to patients before or after the chiropractor performed his adjustments.

There is often confusion between chiropractic and physical therapy. Chiropractic treatment is a philosophy of health that asserts pain and dysfunction, regardless of where it presents itself, stems from misalignment of the spine; therefore, chiropractic treatment must include manipulation. You may receive other modalities during your treatment with the chiropractor, but the massage, heat and electrotherapy are only adjuncts to the chiropractic manipulation.

Physical therapists, by way of contrast, believe that a vast majority of pain and dysfunction results from problems in the soft tissues (muscles, ligaments, tendons, nerves, etc.). Apart from the philosophical differences, from my experience, the biggest difference between chiropractic and physical therapy is in the effort to guide you to a point when you will become independent of the physical therapist. Especially early in your treatment, I may do treatments to you, but by the time we are nearly done, you will be independent in various movements and practices which will allow you to manage your condition on your own.

Just as I, a physical therapist, cannot advertise chiropractic services, a chiropractor may not say or advertise that he offers physical therapy unless he either is dually licensed or employs a physical therapist who would then perform physical therapy for his clients. A chiropractor may use any of the modalities to help relieve your symptoms. The modalities — which include ultrasound, heat, ice and electrotherapy — can be used by a variety of health professionals and others. They are not tightly regulated and are not, in and of themselves, considered physical therapy. Your dentist may have ultrasound and electrotherapy available. When you go to a spa, they may have the same machines available to use as an adjunct to your massage.

While hot packs and electrotherapy can be a soothing adjunct to any treatment, they should never constitute the treatment in entirety. If that is the only service you are receiving, you need to have a lengthy discussion with your healthcare professional.

Massage, in and of itself, is not physical therapy. If the professional care you are receiving — whether chiropractic or physical therapy — only includes the modalities and massage by an unlicensed aide, you are being shortchanged. Massage is a wonderful way to maintain your health, reduce your stress, care for and nurture your self. It is not, however, an effective treatment for most of the conditions you would seek professional help with.

Physical therapists perform soft tissue mobilization, which is sometimes confused with massage by those who have not had their soft tissue mobilized. Massage may include scented oils, fragrant candles and soothing music while a massage technician smoothes and soothes your muscles. It may be a gross understatement to say that soft tissue mobilization can be uncomfortable. A physical therapist performing soft tissue mobilization is actually reorganizing the tissues so that, once you recover from the treatment, you will find that your pain and dysfunction is greatly reduced. Soft tissue mobilization must be performed by a licensed therapist; either a physical therapist or physical therapist assistant.

Some of our friends and neighbors are being required by their doctor to go to the doctor’s office for physical therapy. “Surely,” you think, “the doctor can perform physical therapy.” Actually? No. physical therapy is performed solely by physical therapists. Your physician may employ a physical therapist who will treat you, but you would have to ask yourself why the doctor is requiring you to travel such long distances to receive your therapy when there are qualified therapists here in your home town. Your doctor is obligated to tell you that he profits from your treatment through the physical therapist he employs.

Personally, I have concerns about physical therapists working for other professionals. It is not that I expect all physical therapists to be self-employed like I am. That is a hard road; a path not for the timid. When a physical therapist works for a doctor or for a chiropractor, I believe — and research on the topic supports my conviction — the patient suffers. Research shows that when the physician profits from the patient’s referral to therapy, treatment is less effective and includes significantly more visits than when the patient is seen by an independent physical therapist.

If you are being treated in a physician-owned physical therapy clinic, be sure you are, in fact, being treated by a physical therapist. A physician cannot direct the activity of a physical therapist assistant. Although assistants are licensed, they must be directly supervised by a physical therapist. When your physician bills your insurance for physical medicine (what physicians sometimes call physical therapy), the doctor must perform the treatment himself. He cannot relegate your care to an unlicensed aide.

A physical therapist has a graduate degree and may even have board certification in their area of expertise. Those diplomas and licenses should be proudly displayed. When you are receiving physical therapy, you should be receiving the focused attention and skills of a licensed professional and not, with all due respect to my friend’s granddaughter, a high school graduate working her first real job. You come to us with pain and dysfunction and we help you through various means to regain as much movement and function as possible. When some restriction persists or when the condition you have is chronic, we help you learn to manage that condition and maximize your abilities in spite of it. A physical therapist helps you reclaim your life from the enemy: pain and immobility.

http://www.desertdispatch.com/news/physical_1126___article.html/therapist_therapy.html

Your Salary as a Physical Therapist

2007-07-30T20:09:00.000-07:00

There were 5,107 respondents who listed physical therapy as their profession. This total number of respondents included both PTs and PTAs.

When combining these two job titles under the overall heading of physical therapy professionals, the most common salary range was actually the highest, "More than $75,001," which included 13.5 percent of respondents. However, the lowest salary range option, "Less than $30,000," also registered a high percentage (11.7 percent). Other common salary ranges included $55,001 to $60,000 (12.5 percent), $50,001-$55,000 (11.6 percent) and $45,001-$50,000 (11.3 percent). There were at least 219 respondents for all 11 salary range options, with the least common range being $30,001-$35,000 (4.3 percent).

When the physical therapy professional population was broken down by nine geographical regions, some interesting statistics became clear. West South Central was the most lucrative region for PT professionals (average salary: $55,729) by a slim margin over the East South Central region ($55,560).

Substantially behind these two regions were the third and fourth most lucrative, Pacific, with an average salary of $53,394 for PT professionals, and Middle Atlantic at $53,261. The fifth-most lucrative region was Mountain/Southwest ($51,090), while the final four were West North Central ($50,583), South Atlantic ($50,247), East North Central ($49,423) and New England at $47,648.

PTs by Region

Of the more than 5,000 survey respondents who selected physical therapy as their profession, approximately 4,400 indicated they were physical therapists, as opposed to PTAs. Among that population, the most common salary range was also the highest option, "More than $75,001," including 15.9 percent of respondents. Other high-ranking ranges were $55,001-$60,000, (13.7 percent of respondents), $50,0001-$55,000 (12.2 percent), $45,001-$50,000 (11.5 percent) and $60,0001-$65,000 (10.4 percent). There were at least 44 respondents for all 13 salary range options, with 6.2 percent of respondents representing the lowest category, "Less than $20,000." The category registering the fewest respondents was $20,001-$25,000, which included just one percent of PTs who filled out the survey.

Within the entire physical therapist population, the highest average salary was registered by the East South Central Region at $60,128. Right behind it were the West South Central region ($58,700) and the Middle Atlantic ($56,809). Representing the statistical middle were the Pacific ($56,438), South Atlantic ($54,989) and East North Central regions ($54,106). The lowest three regions in terms of average salary were Mountain/Southwest ($53,582), West North Central ($52,889) and New England ($52,832).

PTAs by Region

Slightly fewer than 800 of the PT professionals responding to the survey indicated they were PTAs. As a group, the most common salary range among the PTA population was actually the lowest option in the survey, "Less than $20,000," with 16.6 percent. Other common ranges included $35,001-$40,000 (16.3 percent), $30,001-$35,000 (15.3 percent) and $40,001-$45,000 (14.7 percent). There were, however, at least a handful of respondents in the highest ranges as well, with 1.1 percent indicating they fell in the $65,001-$70,000 category, 0.4 percent picking the $70,001-$75,000 option, and 0.8 percent selecting the "More than $75,001" category.

Regionally, there was much disparity among PTAs in average salary. The most lucrative region was West South Central, where the average PTA made $38,952 per year. Other high totals included East South Central ($37,500) and Pacific ($34,891). The middle regions included Mountain/Southwest ($33,350), South Atlantic ($32,179) and West North Central ($31,764). Bringing up the rear, meanwhile, were Middle Atlantic ($29,870), New England ($29,581) and East North Central ($27,316).

Regional Conclusions

Taken as a whole, these statistics offer an intriguing look at the regional physical therapy salary situation in the United States. For example, the East South Central and West South Central regions proved to be the two most lucrative for physical therapy professionals as a whole, physical therapists as a specific group, and physical therapist assistants as a specific group. East South Central actually averaged about $1,400 more per year than West South Central for physical therapists, but West South Central's even greater salary advantage in the PTA category gave that region a slight edge for physical therapy professionals as a whole.

On the opposite end of the spectrum, the New England region proved to be consistently less lucrative than other regions in all three categories. Ranking at the bottom for PT professionals as a whole ($47,648), it was also the lowest-ranking region for PTs ($52,832) and second-lowest for PTAs ($29,581).

The East North Central region, on the other hand, demonstrated the greatest disparity in terms of its ranking for PTs compared to PTAs. Ranking in the middle of the pack for physical therapists with an average salary of $54,106, it was last by a margin of more than $2,000 in the PTA category with an average of $27,316. The Middle Atlantic region also offered a significant PT/PTA ranking disparity, placing third in the physical therapist category ($56,809) but just seventh in the physical therapist assistant category ($29,870).

Disparity existed from the opposite perspective as well. For example, PTAs in the Mountain/Southwest region (ranking fourth at $33,350) could expect to earn a decent buck compared to other parts of the country, whereas PTs in the Mountain/Southwest region were paid at a comparatively low rate (ranking seventh at $53,582).

The South Atlantic region, meanwhile, deserves credit for consistency. It ranked exactly in the middle, fifth out of nine regions, for both PTs ($54,989) and PTAs ($32,179). Statistics being a funny thing, however, the disparate numbers registered by other areas actually made South Atlantic rank seventh out of nine regions among PT professionals as a whole ($50,247).

Salary and Education

Based on the results of our salary survey, levels of education have a decided impact on salaries earned in physical therapy—although not in the way some might believe.
Participants in the survey were asked to identify their level of education from four main categories—non-four-year college graduates (high school or GED, some college experience, associate's degree), college graduates (bachelor's degree), master's degree (MA, MBA, MPH, MS) or doctorate degree (DPT, PhD).

Those who fell into the non-four-year college graduate category showed the lowest salaries, with the three categories reporting an average annual salary of $32,261. The surprising results came from the other three categories, where the discrepancies between salaries were minimal.
College graduates with bachelor's degrees in the physical therapy field reported an average salary of $62,084, comparing favorably to those PTs with master's degrees (average salary of $64,247 annually) and those with DPT or PhD degrees ($64,192 annually).

Six percent of respondents—about 300 people totalidentified their educational level as something other than the above categories. That group reported an average annual income of $61,337.

Levels of Education

Respondents were split almost 50-50 between those with master's or doctorate degrees and those without. While only 2.2 percent of respondents reported having earned a Master of Business Administration (MBA) degree, these respondents reported the highest average annual salary of any individual educational level at $75,431.

Not surprisingly, the most common level of education reported was a bachelor's degree, comprising 32 percent of respondents. Following closely thereafter was the MSPT degree at 30 percent. Associate's degree was third-most popular, at 14 percent, followed by the DPT at 10 percent. As previously stated, 6 percent of respondents cited another level of education. The other eight percent was comprised of those with master's degrees other than MSPTs, and people who were either high school graduates or had only completed some college.

Along gender lines, male respondents reported an average annual salary of $60,058, while females reported earning $51,106. The good news is that the majority of males and females in similar positions earn comparable paythe difference can likely be attributed to a larger number of males in higher-level positions.

Pay Based on Experience

First-year physical therapists responding to our survey reported an average salary of just under $43,000 per year, which compares quite favorably to salaries in similar fields. Following that first year, our results indicate that therapists can expect an annual increase of about 5 percent, before salaries tend to level off around year eight of their careers with a salary in the high-$50,000 to low-$60,000 range.

Using this information as a composite, the height of a therapist's earning potential seems to be between years 15 to 20 of his career—or right around age 40. Therapists with more than 20 years of experience can expect salaries in the low-to-mid 70s. According to the survey, salaries can again level off after a therapist reaches 35 years of experience—however, as you might imagine, the number of responses from therapists with that level of experience was limited—less than 100 such clinicians.

Eighty-two percent of respondents said they had been practicing PT for 15 years or less, with more than 50 percent of those respondents falling between one and five years experience. Another 12 percent were in years 16 to 25 of their career, with the final 6 percent having upward of 25 years of experience.

Salary and Setting

According to our results, setting also seems to impact the salaries of physical therapists and PTAs. In the case of both PTs and PTAs, outpatient and clinical settings are the most common place to work followed by long-term care facilities, hospitals and private practice.

In the outpatient setting, average salaries range from $46,655 all the way up to $103,000 while inpatient practitioners reported salaries ranging from $30,000 to $73,000.

Location of the setting may have some impact on the salaries, as outpatient practitioners reported far higher numbers working in suburban areas (48.5 percent), followed by urban areas (32.7 percent) and rural areas (18.8 percent). On the other hand, the majority of PTs in inpatient settings (50.3 percent) worked in urban areas followed by suburban practitioners (34.1 percent) and rural practitioners (15.7 percent).

Physical therapists in academic settings reported salaries ranging from an average of $42,000 for first-year educators to $114,000 for an educator with 32 years of experience. The average salary, however, among educators (full and part time) was $61,850.

School PTs, on average, are making a salary of $55,004. The majority of school-based practitioners reported working in suburban areas at 46.5 percent, however, their counterparts in rural and urban areas are almost evenly distributed at 28.2 and 25.4 percent, respectively.

Examining Home Health

Home-health therapists and PTAs, on average, have a higher salary relative to the PT population at large. The median salary among home-health physical therapists is $61,030, while among the general physical therapy population, the average salary was $59,827. While the difference is not great, it becomes more apparent when broken down by subcategories, such as location.

In most regions, home-health practitioners take home an average salary of approximately $4,000 more than the rest of the physical therapy community. However, in the Pacific region of the country, as well as the Middle Atlantic and Mountain/Southwest regions, home health practitioners average approximately $10,000 more in salary than those who are not in home health.

"Home health has a wider range in income, both on the high and low end," explained Roger Herr, PT, MPA, COS-C. "This is a function of both the flexibility in hours and range of commitment of clinicians."

Home health care practitioners also tend to have a greater level of experience, Herr added. "There is an industry bias to having at least one year of related health care experience before entering home care, so the population will be more experienced," he said.

Benefits are also a difference with home-health practitioners compared to clinical and private-practice PTs. According to the survey results, home-health PTs tend to have fewer benefits than the PT community at large does. A smaller percentage of home-health practitioners receive dental insurance, health insurance, vacation/sick time and other common benefits.
However, according to Herr, the setting lends itself to this type of discrepancy. "Wider variety in benefits leads some to choose to work in places with less benefits. Homecare people work both part-time and full-time, so they may have additional supports as in other modes for getting benefits (partner/spouse)," he said.

Brian W. Ferrie, Rob Senior and Stefanie Kurtz are on staff at ADVANCE.
http://physical-therapy.advanceweb.com/common/editorial/Editorial.aspx?CC=70497&CP=2

Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands

2007-07-29T09:04:00.000-07:00

Kelly P Westlake and Elsie G Culham
First published on July 17, 2007
KP Westlake, PT, PhD, MSc, is Post-Doctoral Fellow, Rehabilitation Research and Development Center, VA Palo Alto HCC, 3801 Miranda Ave, Palo Alto, CA 94304 (USA).
EG Culham, PT, PhD, is Professor and Director, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.

westlake@rrd.stanford.edu

Background and Purpose: Age-related changes in the ability to adjust to alterations in sensory information contribute to impaired postural stability. The purpose of this randomized controlled trial was to investigate the effect of sensory-specific balance training on proprioceptive reintegration.

Subjects: The subjects of this study were 36 older participants who were healthy.

Methods: Participants were randomly assigned to a balance exercise group (n=17) or a falls prevention education group (n=19). The primary outcome measure was the center-of-pressure (COP) velocity change score. This score represented the difference between COP velocity over 45 seconds of quiet standing and each of six 5-second intervals following proprioceptive perturbation through vibration with or without a secondary cognitive task. Clinical outcome measures included the Fullerton Advanced Balance (FAB) Scale and the Activities-specific Balance Confidence (ABC) Scale. Assessments were conducted at baseline, postintervention, and at an 8-week follow-up.

Results: Following the exercise intervention, there was less destabilization within the first 5 seconds following vibration with or without a secondary task than there was at baseline or in the falls prevention education group. These training effects were not maintained at the 8-week follow-up. Postintervention improvements also were seen on the FAB Scale and were maintained at follow-up. No changes in ABC Scale scores were identified in the balance exercise group, but ABC Scale scores indicated reduced balance confidence in the falls prevention education group postintervention.

Discussion and Conclusion: The results of this study support short-term enhanced postural responses to proprioceptive reintegration following a sensory-specific balance exercise program.

The Pursuit of Physical Therapy Continuing Education Online

2007-07-29T07:25:00.000-07:00

By Milos Pesic

Continuing education in any field is a great boost to one’s value. To have that same continuing education offered online is a godsend. Not only does online education offer the chance to enhance one’s knowledge, but it offers to have you learn at home. Enter – physical therapy continuing education online. Physical therapists everywhere rejoice! A chance to further their knowledge, at home, with different online institutions to choose from, a godsend indeed for physical therapy.

Physical therapy continuing education online is a growing boon for the industry. What with thousands of physical therapists seeking quality education, but have been hampered by time, money, or simply being too far away, physical therapy continuing education online is proving to be a very good way to further physical therapy studies. One of these online institutions offering continuing education is OnlineCE. One of the industry’s leaders, OnlineCE offers students a variety of courses which include introduction to hand therapy, sports and hand injuries, topics in shoulder rehabilitation, upper extremity anatomy, wound management and a host of other courses for health professionals especially physical therapists. Another accredited corporation that provides physical therapy continuing education online is Care2learn.com. Care2Learn.com is a Florida based corporation and is provided by onlineHealthNow,Inc. Online courses offered include: A Physical Therapist’s Guide to Documenting for Medicare, Assessment And Documentation Of Wounds, On the Frontier With HIPAA-What HealthCare Professionals Need to Know and Do, Contract vs. In House Therapy: Making the Decision under PPS, to name a few.

Depending on your preference of courses, there are a slew of other sites that offer physical therapy continuing education online, giving you the chance to choose. Some sites offer courses not offered by others, so choose carefully which site you would enroll in. Choose the site which best suits your preference. Other sites to check out are CEUWORLD.com, Texas Physical Therapy Association and American Physical Therapy Association. Of course you are not limited to these sites, you can check out other sites to help you find the site for you.

In all, physical therapy continuing education online is a fast growing industry. Choose which site you’d want to join and know the courses offered. Know all you can about the various sites and know what courses you would like to enroll in. Physical therapy continuing education online is here to stay, which is a good thing for physical therapists. Be careful though of bogus sites; be sure the site you choose is accredited. Physical therapists rejoice indeed.

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