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Latest & greatest articles for Physical Medicine
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PhysicalTherapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. Both physicaltherapy and intraarticular injections of glucocorticoids have been shown to confer clinical benefit with respect to osteoarthritis of the knee. Whether the short-term and long-term effectiveness for relieving pain and improving physical function differ between these two therapies is uncertain.We conducted a randomized trial to compare physicaltherapy with glucocorticoid injection in the primary care (...) setting in the U.S. Military Health System. Patients with osteoarthritis in one or both knees were randomly assigned in a 1:1 ratio to receive a glucocorticoid injection or to undergo physicaltherapy. The primary outcome was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1 year (scores range from 0 to 240, with higher scores indicating worse pain, function, and stiffness). The secondary outcomes were the time needed to complete the Alternate Step Test
have ex- perienced a concussive event for mental health, cognitive impairment, and other potential coinciding diagnoses and refer for additional evaluation and services as indicated. F For patients not deemed appropriate for a comprehen- sive physicaltherapy examination (ie, those who present with severe mental health concerns or health conditions that re- quire medical clearance prior to comprehensive physical exam- ination), physical therapists should provide education regarding concussion (...) , of the practice of physical therapists • Provide information for payers and claims reviewers re- garding the practice of physicaltherapy for common neu- rologic and musculoskeletal conditions • Create a reference publication for physicaltherapy clini- cians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of physicaltherapy STATEMENT OF INTENT This CPG is not intended to be construed or to serve as a standard of medical care
Effect of a Multicomponent Home-Based PhysicalTherapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial. Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community.To compare a multicomponent home-based physicaltherapy intervention (training) with an active control on ability to walk in the community.Parallel, 2-group randomized clinical trial conducted at 3 US (...) , control: 0), urinary tract infection (training: 2, control: 0), dehydration (training: 0, control: 2), and dyspnea (training: 0, control: 2).Among older adults with a hip fracture, a multicomponent home-based physicaltherapy intervention compared with an active control that included transcutaneous electrical nerve stimulation and active range-of-motion exercises did not result in a statistically significant improvement in the ability to walk 300 m or more in 6 minutes after 16
The dose of physical activity to minimise functional decline in older general medical patients receiving 24-hr acute care: A systematic scoping review To identify evidence for a recommended and feasible activity dose to minimise functional decline in older hospitalised general medical patients.Quality 24-hr care of older patients involves balancing activity to minimise functional decline, with rest to aid recovery. However, there is limited guidance regarding an optimal type and dose (...) were included. Study contexts were general medical wards (n = 11, 73.3%), Acute care of the elderly unit (n = 3, 20%) and a nursing unit (n = 1, 6.7%) located in tertiary referral acute hospitals. Most participants were aged 75-84 years (n = 10, 66%), had variable medical diagnoses and samples were either physically capable (n = 4, 26.7%) of limited physical capability (n = 1, 6.7%) or of mixed capability to mobilise independently (n = 10, 66.7%). Walking at least twice a day for approximately 20
PhysicalTherapy on Postoperative Day Zero Following Total Knee Arthroplasty: A Randomized, Controlled Trial of 394 Patients Surgeons have increasingly emphasized early mobilization as a way to facilitate discharge following total knee arthroplasty (TKA). The purpose of this study was to determine whether starting formal physicaltherapy (PT) the afternoon of postoperative day (POD) 0, instead of starting PT the morning of POD 1, could shorten hospital length of stay (LOS).Patients undergoing
2018 John N. Insall Award: Recovery of Knee Flexion With Unsupervised Home Exercise Is Not Inferior to Outpatient PhysicalTherapy After TKA: A Randomized Trial Concerns about the cost and convenience of postsurgical physicaltherapy (PT) have sparked interest in unsupervised, home-based rehabilitation. However, the effectiveness of unsupervised home exercise after primary TKA has not been previously evaluated.(1) Can unsupervised home exercise after surgery provide noninferior recovery
programs after TKR and to explore heterogeneity of treatment effects.Three-arm single-blind randomized clinical trial (January 7, 2015, to November 9, 2017) using an intent-to-treat approach with follow-ups at 3 months and 6 months. The setting was Allegheny County, Pennsylvania (an outpatient physicaltherapy clinic and 4 community centers). Participants had primary TKR performed more than 2 months previously, were 60 years or older, experienced moderate functional limitations, and were medically (...) Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited.To compare the effectiveness of later-stage exercise
The comparative efficacy of theta burst stimulation or functional electrical stimulation when combined with physicaltherapy after stroke: a randomized controlled trial To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physicaltherapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.Single blind randomized controlled trial.Outpatient clinics and inpatient wards at tertiary care (...) neurology center.Adult patients with acute middle cerebral artery territory ischemic stroke.60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physicaltherapy for four weeks followed by home physiotherapy for one year.Fugl Meyer Assessment upper limb score (FMA
General medicine: Erenumab is effective in reducing migraine frequency and improving physical functioning Erenumab is effective in reducing migraine frequency and improving physical functioning | BMJ Evidence-Based Medicine Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts (...) OR managers of institutional accounts Username * Password * your user name or password? You are here Erenumab is effective in reducing migraine frequency and improving physical functioning Article Text Commentary General medicine Erenumab is effective in reducing migraine frequency and improving physical functioning Paolo Martelletti Statistics from Altmetric.com Commentary on : Goadsby PJ, Reuter U, Hallström YA, et al. A Controlled Trial of Erenumab for Episodic Migraine. N Engl J Med . 2017;377:2123
Effect of Early Surgery vs PhysicalTherapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial. Despite recent studies suggesting arthroscopic partial meniscectomy (APM) is not more effective than physicaltherapy (PT), the procedure is still frequently performed in patients with meniscal tears.To assess whether PT is noninferior to APM for improving patient-reported knee function in patients with meniscal tears.Noninferiority, multicenter (...) to APM (n = 159) or a predefined PT protocol (n = 162). The PT protocol consisted of 16 sessions of exercise therapy over 8 weeks focused on coordination and closed kinetic chain strength exercises.The primary outcome was change in patient-reported knee function on the International Knee Documentation Committee Subjective Knee Form (range, 0 to 100; from worse to best) from baseline over a 24-month follow-up period. The noninferiority margin was defined as a difference between treatment groups of 8
Effectiveness and Downstream Healthcare Utilization for Patients That Received Early PhysicalTherapy Versus Usual Care for Low Back Pain: A Randomized Clinical Trial Randomized controlled trial.The aim of this study was to compare early physicaltherapy versus usual care in patients with low back pain.Early physicaltherapy (PT) has been associated with reduced downstream healthcare utilization in retrospective studies, but not investigated prospectively in the military health system.Military (...) service members seeking care from a general practitioner were recruited. Patients attended a 20-minute self-management class with focus on psychosocial resilience and then randomized to usual care only (UC) versus immediately starting a 3-week physicaltherapy program (PT). Primary outcome was the Oswestry Disability Index at 1 year. Secondary outcomes included Oswestry scores at 4- and 12-week follow-up, numeric pain rating scale, global rating of change, and healthcare utilization at 1 year
Clinical and ultrasound remission after 6 months of treat-to-target therapy in early rheumatoid arthritis: associations to future good radiographic and physical outcomes To explore associations between remission, based on clinical and ultrasound definitions, and future good radiographic and physical outcome in early rheumatoid arthritis (RA).Newly diagnosed patients with RA followed a treat-to-target strategy incorporating ultrasound information in the Aiming for Remission in rheumatoid (...) were defined: no radiographic progression and good outcome (no radiographic progression+physical function≥general population median), both sustained 12-24 months. We calculated the ORs of these outcomes for the remission definitions.Of 103 patients, 42%-82% reached remission at 6 months, dependent on definition. Seventy-one per cent of patients had no radiographic progression and 37% had good outcome. An association between 6-month remission and no radiographic progression was observed for ACR
Cost-effectiveness of internet-based cognitiveâ€“behavioural therapy and physical exercise for depression Both internet-based cognitive-behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care.To determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care.Economic evaluation of a randomised controlled trial (N = 945) in Sweden. Costs were estimated by a service use (...) questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective.The primary analysis showed that incremental cost per QALY gain was €8817 for ICBT and €14 571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of €21 536 (£20 000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76
The impact of implementing a fall prevention educational session for communityâ€dwelling physicaltherapy patients The aim of this study was to evaluate the impact of a fall prevention educational session on fall risk knowledge, use of fall prevention interventions and the number of falls in community-dwelling older persons attending physical therapy.This pilot study used a mixed method design consisting of a quantitative pretest-posttest quasi-experimental design followed by a qualitative (...) and subsequent evaluation. An increase in fall risk knowledge (p = 0.031) and implementation of fall prevention techniques was noted. One fall was sustained 60 days after therapy discharge.
Ethics reporting practices in randomized controlled trials of physicaltherapy interventions after stroke Adequate reporting of ethics-related research methods promotes convergence on best ethics practices. In physicaltherapy, studies on ethics reporting are limited to few aspects, and none focuses on stroke research. Our objectives were to investigate the reporting of multiple ethics-related features and its variation over time, and the characteristics of the studies associated with ethics (...) reporting in Randomized Controlled Trials (RCTs) of physicaltherapy interventions after stroke.A random sample of RCTs published in the years 2004, 2009 and 2014, was extracted from the PubMed database, regardless of the publishing journal. For each trial we investigated year of publication, trial registration, sample size, stroke subtype, phase of the disease, setting, interventions and dosing, outcome measures, outcome of the study, PEDro score and 5-year impact factor of the publishing journal
Caregiver-Provided PhysicalTherapy Home Programs for Children with Motor Delay: A Scoping Review Caregiver-provided physicaltherapy home programs (PTHP) play an important role in enhancing motor outcomes in pediatric patient populations.This scoping review systematically mapped clinical trials of caregiver-provided PTHP that were aimed at enhancing motor outcomes in children who have or who are at risk for motor delay, with the purpose of (1) describing trial characteristics; (2) assessing
Minimally Displaced, Isolated Radial Head and Neck Fractures Do Not Require Formal PhysicalTherapy: Results of a Prospective Randomized Trial Nondisplaced and minimally displaced fractures of the radial head and neck are common injuries, yet the role of physicaltherapy (PT) in their treatment is unclear. The aim of this trial was to assess the need for formal PT following a simple fracture of the radial head or neck.Patients who had a nondisplaced or minimally displaced fracture of the radial