The pain and stiffness of arthritis can be miserable for those that suffer from it and currently there is no cure for it. Fortunately, the lack of a cure does not mean that there is no solution for arthritis sufferers. There may be as many as 100 different reasons that arthritis symptoms appear so proper treatment must start with a proper diagnosis. A physician will often prescribe medications for arthritis symptoms that only offer short-term relief. For long-term relief, patients are increasingly starting to rely on physical therapy.
THE TYPES OF ARTHRITIS
Osteoarthritis is the most common type of arthritis. It is characterized by the breakdown of cartilage around the joints. This can develop from overuse, poor mechanics during activity, or injury. The primary rolls of cartilage are to lubricate joints and distribute forces. Without enough cartilage to carry out these roles, bones rub together creating pain. In severe cases, bone fragments can chip off and bone spurs can develop contributing to even more pain. The most common areas for osteoarthritis are the hands, hips, knees, and spine. Osteoarthritis sufferers often notice a decrease in flexibility, uncomfortable grinding sensation of bones rubbing together, unusual stiffness, and tenderness.
Rheumatoid Arthritis is an autoimmune disease (meaning the body attacks itself) in which the linings of the joint (synovial membrane) become inflamed. This inflammation is not only painful, but can lead deformities in the joints and even bone loss. Common characteristics of rheumatoid arthritis are swelling, tenderness, stiffness, and warmth of joint. Pain often worsens after rest. It generally impacts the hands, wrists, and feet. If untreated, it may progress to other areas of the body including the hips, knees, and shoulder area. The most common symptoms of rheumatoid arthritis are chronic exhaustion, continual fever, decreased appetite, and weight loss. Pain is often sporadic, occurring in flares. While the primary treatment is pharmacological intervention, physical therapy can help.
WHAT DOES A PHYSICAL THERAPIST DO?
Exercise: A tailored therapeutic exercise program can assist with strength and mobility. Research repeatedly shows improvements in short and long term pain and function with specific, high-intensity exercise. Weight-bearing activity and strengthening can improve joint lubrication resulting in reduction of pain. Your physical therapist will design a program addressing all areas of the body affecting your pain. If you suffer from knee pain, an exercise plan will address impairments at the ankle, hip, and low back which all contribute to proper knee mechanics and control. Exercise also focuses on proper mechanics and control during functional movements such as squatting, lifting, and carrying objects with minimal to no pain or difficulty
Manual therapy: PT Solutions’ physical therapists train in various manual therapy techniques that are utilized to decrease your pain and increase your mobility. Research states that joint and soft tissue mobilization are beneficial for patients suffering from arthritis.
Looking for relief from joint pain and stiffness? Our physical therapists can help. We use research-driven and holistic treatments to help you get fast relief, and to help you get your life back. Request an appointment today or visit us online and schedule your appointment 24/7 , 365 days a year .
In physical therapy, trained professionals evaluate and treat abnormal physical function related to, for example, an injury, disability, disease or condition.According to the American Physical Therapy Association (APTA), a physical therapist is a trained and licensed medical professional with experience in diagnosing physical abnormalities, restoring physical function and mobility, maintaining physical function, and promoting physical activity and proper function.
Licensed physical therapists can be found in a range of healthcare settings including outpatient offices, private practices, hospitals, rehab centers, nursing homes, home health, sports and fitness settings, schools, hospices, occupational settings, government agencies, and research centers.
What to expectPhysical therapy can help people of all ages with a range of conditions.A physical therapist helps take care of patients in all phases of healing, from initial diagnosis through the restorative and preventive stages of recovery. Physical therapy may be a standalone option, or it may support other treatments.
Some patients are referred to a physical therapist by their doctor, but other seek therapy themselves.
Whichever way a patient come to a physical therapist, they can expect to:
Common conditionsPhysical therapists can treat a wide variety of medical conditions, depending on their specialty.
Some conditions that can benefit from this type of treatment are:
Benefits of physical therapyDepending on the reason for treatment, the benefits of physical therapy include:
A healthcare provider or physical therapist can advise individuals about the benefits specific to their personal medical history and their need for treatment.
TypesPhysical therapy can help a patient regain movement or strength after an injury or illness.As with any medical practice, a variety of therapies can be applied to treat a range of conditions.
Orthopedic physical therapy treats musculoskeletal injuries, involving the muscles, bones, ligaments, fascias, and tendons. It is suitable for medical conditions such as fractures, sprains, tendonitis, bursitis, chronic medical problems, and rehabilitation or recovery from orthopedic surgery. Patients may undergo treatment with joint mobilizations, manual therapy, strength training, mobility training, and other modalities.
Geriatric physical therapy can help older patients who develop conditions that affect their mobility and physical function, including arthritis, osteoporosis, Alzheimer's disease, hip and joint replacement, balance disorders, and incontinence. This type of intervention aims to restore mobility, reduce pain and increase physical fitness levels.
Neurological physical therapy can help people with neurological disorders and conditions such as Alzheimer's disease, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Treatment may aim to increase limb responsiveness, treat paralysis, and reverse increase muscles strength by reducing muscle atrophy.
Cardiovascular and pulmonary rehabilitation can benefit people affected by some cardiopulmonary conditions and surgical procedures. Treatment can increase physical endurance and stamina.
Pediatric physical therapy aims to diagnose, treat, and manage conditions that affect infants, children, and adolescents, including developmental delays, cerebral palsy, spina bifida, torticollis and other conditions that impact the musculoskeletal system.
Wound care therapy can help to ensure that a healing wound is receiving adequate oxygen and blood by way of improved circulation. Physical therapy may include the use of manual therapies, electric stimulation, compression therapy and wound care.
Vestibular therapy aims to treat balance problems that can result from inner ear conditions. Vestibular physical therapy involves a number of exercises and manual techniques that can help patients regain their normal balance and coordination.
Decongestive therapy can help to drain accumulated fluid in patients with lymphedema and other conditions that involve fluid accumulation.
Pelvic floor rehabilitation can help treat urinary or fecal incontinence, urinary urgency and pelvic pain in men and women as a result of injuries or surgery, or because of certain conditions.
Apart from physical manipulation, physical therapy treatment may involve:
By Lori Smith BSN MSN CRNP
Reviewed by Gregory Minnis, DPT
For seniors recovering from injury or illness and for those experiencing chronic pain, physical therapy can help relieve pain and restore physical functions such as flexibility, strength, balance and coordination.
Elderly physical therapy combines a combination of approaches including stretching, walking, massage, hydrotherapy, and electrical stimulation among others.
The goal of physical therapy for seniors is to make daily tasks and activities easier. And to make seniors as independent as possible.
Among the circumstances where physical therapy can be valuable are for those:
The first goal is to reduce pain and swelling if there is any. Then, a PT will apply various techniques to increase flexibility, strength, coordination and balance. These techniques usually involve exercise such as stretching, lifting weights and walking. For more senior exercise ideas, see Active Senior Living.
PTs can also combine an assortment of other therapies, some that may help, and others that may not. It's often a trial and error process.
Types of Physical Therapy
Manual Therapy is therapy performed by the hands of the therapist with the goal of relaxing the patient, reducing pain, and providing more flexibility. It includes:
Cold Therapy is used to relieve pain, swelling and inflammation from conditions such as arthritis. Treatment involves ice packs (15 to 20 minute sessions), ice massage, and rest, ice, compression and elevation (RICE).
Heat Therapy relaxes muscles and improves blood circulation, which is useful for loosening stiff joints from osteoarthritis or other conditions where you've been immobilized. Heat is also used to loosen muscles before exercise.
Electrical stimulation uses electrical current to create a desired effect in the body. For instance, electrical current can scramble pain signals to cover feelings of pain. Electrical stimulation is used to contract muscles in stroke victims and those with arthritis.
Electrical stimulation is the general term that describes the use of electrical current to create an effect in the body. There are several uses for electrical stimulation.
Physical Therapists educate patients in every session. Patients are taught how to perform daily tasks, protect their body from re-injury, perform exercises at home, and how to make their homes a safer place.
Treating Specific Conditions with Physical Therapy The medical community is finding that physical therapy can be used to help patients with a variety of diseases and medical conditions—some obvious, some less so.
Most people 65 and over have some arthritis in their spine, even if they don't have the symptoms. Physical therapy can help offset future symptoms by using aquatic exercises, hot packs, electrical stimulation and other techniques.
As you can see, physical therapy can help seniors in about every area of health care imaginable. If you're recovering from surgery or an illness or living with a disease, ask your doctor about physical therapy. PT can give you back your independence by increasing your mobility and making daily tasks easier.
If you have a question for yourself or a loved one , please contact us at Zenergy physical therapy.
The shoulder is one of the most used and mobile joints in the body, which is why it can be so difficult when you are experiencing pain or an injury in that area. A complex ball and socket joint, essentially, the shoulder is made of the humerus (arm bone), the scapula (shoulder blade), and clavicle (collarbone). Due in large part to how much we use our shoulders, this joint is incredibly susceptible to injury. There are many different types of shoulder pain and injuries, but two of the most common causes of pain are overuse and poor posture. In today’s society many people spend the entire day typing on a computer, hunched over and full of concentration. We often don’t realize just how hard this is on our bodies overall, especially our shoulders.
There are many different symptoms and types of shoulder pain that people can experience – including an aching, burning pain right between the shoulder and the neck. Others complain of a sharp pain at the tip of the shoulder when reaching their arms overhead. Regardless of the type of pain, it is a good idea to take action as soon as possible. The longer you ignore it and don’t seek treatment, the worse it will get.
When it comes to shoulder pain or injuries, there are numerous different treatment options, from surgery and medication to physical therapy. In recent years alternative forms of medicine have become more widely used to treat a host of injuries and ailments, including shoulder injuries. In order to better understand how you may benefit from physical therapy for your shoulder injury, we thought it would be helpful to go over some of the most common shoulder problems people experience. If you are living with any of the following, we encourage you to consult a Grand Prairie physical therapist to see if this is a viable option for you.
Some Common Shoulder Injuries and Problems
Some of the most common shoulder problems and injuries that can be treated with physical therapy include:
Why pay cash or out of pocket from insurance for Physical Therapy? Every year more and more of our patients are paying cash out of their own pockets for our physical therapy services. Like most health care providers, we bill insurance companies as a service of convenience for our patients. In recent years, deductibles have climbed to $5000 or more, copays have become higher, and scrutiny by insurance companies over what is covered has increased. We are now at a point where many of our patients/clients have lower out-of-pocket expenses if they simply pay for our services without going through their insurance carrier.
Government regulators allow us to provide discounts if sessions are paid for by the patient on the day of service, with further discounts if they pay for multiple sessions. We can afford to offer these discounts because we significantly reduce our administrative expense if we are not billing your insurance company and then waiting for 30-90 days or more to get paid (unfortunately that is not unusual). As the patient you have less cost, however your payment to us does not apply to your deductible. If you have a flex spending account or health savings account, your payments to us may be reimbursed.
Often spending two to three sessions focusing on your issue is very productive and can actually save you time and money in the long run. This is especially true if you have a high deductible plan.
Some physical therapy practitioners and clinics will accept a “fee for service” reimbursement or “capitation”. In the last few years insurance companies have cut back on physical therapy insurance reimbursement 30-50%. Physical Therapy clinics that accept a capitated rate may have to reduce time spent directly with a Physical Therapist. Often a co-pay of $30.00-$40.00 is required for a 30 minute treatment. That combined with meeting your deductible, and now you are paying more for PT, than if you paid cash.
If you have a high deductible plan, $2000.00 or greater, you are essentially paying out of pocket. Why not make the choice where you want to go? NOT where your insurance or your health network dictates?
With overuse of opioids for the treatment of chronic pain becoming a national public health epidemic, the Centers for Disease Control and Prevention (CDC) released guidelines that recommend nondrug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.
"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," the guidelines state ("CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016" - March 15, 2016). "Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate."
While there are certain conditions - including cancer treatment, palliative care, and end-of-life care - where opioid prescription for chronic pain may be appropriate, the CDC cited numerous cases where opioid use could be significantly reduced or avoided altogether.
"The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain," the guidelines state. "There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months. Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip. Exercise therapy also can help reduce pain and improve function in low back pain and can improve global well-being and physical function in fibromyalgia."
Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing or eliminating the need for opioids. Research has shown that a simple education session with a physical therapist can lead to improved function, range of motion, and decreased pain.
Before you agree to a prescription for opioids, ask if physical therapy might be right for you.
Working With Combat AthletesSports that involve fighting are among the most challenging and stressful—not to mention dangerous—competitions.Combat athletes compete in many different sports. While some—such as wrestling, boxing, and karate—have been practiced for hundreds or even thousands of years, others, such as mixed martial arts (MMA) and Brazilian jiu jitsu (BJJ), are new to the scene. (The term "combat sports" describes a competition whose essence consists of direct combat between 2 competing athletes.
Similar to athletes in other pro sports—as well as to tactical athletes, including military personnel, police, and firefighters—combat sports athletes' continued employment relies on their physical performance and, ideally, avoiding injury. However, the physical demands of combat sports mean that injuries occur more frequently than in other sports. In MMA, for example, a number of studies have found an injury rate of 24-29 per 100 fight participations.
Both women and men compete in combat athletics. Women compete in judo in the Olympics as well as at other levels; MMA fighter Ronda Rousey was an Olympic judo bronze medalist before transitioning to MMA, where she won the UFC (Ultimate Fighting Championship) women's bantamweight championship. Holly Holm was a professional boxer and kickboxer before defeating Rousey to win the UFC bantamweight championship. Amanda Nunes, the current MMA bantamweight champion, started training in karate at age 7 and pursued training in boxing at the age of 16. She holds a black belt in BJJ and a brown belt in judo. In fact, many women combat athletes have practiced multiple martial arts.
Physical therapists work with these athletes focus on minimizing injuries, addressing those that do occur, and extending the careers of the athletes.
We analyze technique and identify the sources of the movement problem from the individual, then complete manual therapy, stretches, strengthening, and neuromuscular reeducation, and build back up into reintegrating appropriate movement into the specific problem area to maximize performance.
While conditions and injuries for combat sports athletes can vary, the most common injuries are rib injuries, thoracic restrictions, lower back pain, knee pain (frequently meniscal or at the iliotibial band or medial region), hip impingement and pain, ankle sprains, elbow hyperextension (often among "newbies" to their sport, she says), postconcussion headaches, and chronic whiplash.
We can also see a lot of shoulder impingement syndrome (SIS), which frequently occurs because the athletes have been taught to protect their chin while throwing jabs by "putting on a hoodie"—bringing their shoulders up and forward, as if shrugging into a jacket.
Many of these patients stay in 'fight stance,' continuing to cover their chin as they go to their [daytime or salaried] jobs, and the anterior tipping of the scapula will frequently, over time, cause partial supraspinatus tears if not addressed, For these patients, my first goal is to fully normalize thoracic mobility, costal mobility, and cervical mobility through manual interventions. Ribs 1-4 are very frequently restricted in these patients. Soft tissue work and stretching instruction usually is needed."
It's also important to assess lumbar and hip mobility and lumbopelvic stability, as many of these patients are using their upper body to power their punches instead of rotating through their hips and pelvic girdle, and incorporating their whole body in delivering the strike.
Regarding chronic injuries, Lou sees a lot of low back and shoulder pain. Each fighter is different, but a large contributing factor I've seen is from the fighter's posture—rounded shoulders, pitched forward—compounded by the dominant patterns in specific types of combat sports such as wrestling, judo, and jiu jitsu.
In the realm of MMA, the most common injury location is the head and face—predominately the nose, eyes, and jaw regions. This is followed by the lower extremities and then upper extremities.
The upper and lower extremities tend to follow distal to proximal locations with regard to higher injury rate,The hand typically suffers a higher injury rate, followed by the elbow and then the shoulder. The lower extremity follows the same pattern, with the toes having the highest injury rate, followed by the ankle and then the knee. The research shows this across multiple studies.
Combat Sports & Terminology in BriefHere are brief summaries of some of the sports and terms mentioned in this blog .
Boxing, both amateur and professional, involves attack and defense with the fists. Boxers wear padded gloves and generally observe the code set forth in the Marquess of Queensberry rules. Matched in weight and ability, boxing contestants try to land blows while attempting to avoid the blows of the opponent. A boxer wins a match either by outscoring the opponent—points can be tallied in several ways—or by rendering the opponent incapable of continuing the match. Bouts range from 3 to 12 rounds, with each round normally lasting 3 minutes.1
Brazilian Jiu-Jitsu (BJJ) is a martial art and combat sport that teaches a smaller person how to defend himself or herself against a larger adversary by using leverage and proper technique. The Gracie family, founders of BJJ, modified judo and traditional Japanese jujutsu to create the art. It contains stand-up maneuvers but is most known for its ground-fighting techniques. Gaining superior positioning—so one can apply the style's numerous chokes, holds, locks, and joint manipulations to an opponent—is the key in BJJ.2 Fights may be won by submission or by points awarded by the referee.
Chokes are submission moves that apply pressure to the neck, cutting off blood to the brain. A player who does not "tap," or submit, will lose consciousness.3
Joint Locks are moves that apply pressure to a joint and push it in an "unnatural" direction (ie, locking an arm and forcing an elbow backward). This restricts an opponent's movement and/or causes him or her to submit due to pain and/or potential for a hyperextension injury or broken bone.
Jujutsu is a Japanese martial art and method of close combat for defeating an armed and armored opponent while using no weapon or only a short weapon. Because striking an armored opponent proved ineffective, practitioners learned that the most efficient methods for neutralizing an enemy took the forms of pins, joint locks, and throws. These techniques were developed around the principle of using an attacker's energy against him or her, rather than directly opposing it.4
Karate developed out of martial arts forms practiced on Okinawa, an island now part of Japan. The word karate is Japanese for "open hand" (kara means open and te means hand). Te signifies that the main weapon is the body. Instead of an arsenal of swords or guns, the "karateka" cultivates a personal arsenal of punches, kicks, and deflection techniques. Kara relates to the psychology of karate. Karatekas are open to the world around them, making them better equipped to handle any attack.5 Historically, and in some modern styles, grappling, throws, joint locks, restraints, and vital-point strikes also are taught.
Krav Maga is a tactical mixed-martial art/combative and self-defense system that combines boxing, judo, jujitsu, and aikido. It was developed for the Israel Defense Forces and Israeli security forces. The primary goal, to neutralize a threat as quickly as possible, governs all the other principles of Krav Maga. It consists of strikes, holds, and blocks. The fighter looks to combine an offensive movement with every defensive movement.6
MMA (Mixed Martial Arts) is a full-contact sport that allows a variety of fighting styles to be used (including martial and non-martial arts techniques). Striking and grappling techniques, either standing or on the ground, are permitted. The early years of the sport saw a wide variety of traditional styles, but it is now common for fighters to train in multiple styles, creating a more balanced skill set.7 A competitor may win by submitting his or her opponent (forcing the opponent to concede the match), knocking out the opponent, prompting a referee stoppage (technical knockout), accumulating the most points from the judges, or causing an injury that results in a doctor's stoppage.
Muay Thai or Thai boxing is the Thai national sport. In Muay Thai, competitors fight standing as in Western boxing, but elbows, knees, and kicks strikes are allowed, with the only protection being the gloves. An important part of this fighting style is the clinch (standing wrestle).
Seniors wrestle with a variety of medical issues that can make it more difficult to stay steady on their feet. Each year, more than one-third of people age 65 or older fall. Of those who fall, up to 30 percent suffer moderate to severe injuries, such as hip fractures, and increase their risk of early death, according to the CDC. Falls and related injuries can seriously impact a senior’s life, limiting certain activities or even making it impossible to live independently.
Balance exercises are crucial to help prevent falls by improving a person’s ability to control their body. Frequently doing a few simple, at-home exercises will help seniors enhance their coordination and decrease the risk of falling.
One great thing about exercises to improve balance is that they can be done as often as you wish, anytime, anywhere. Before you begin, make sure you have a sturdy chair, person, railing or countertop nearby to hold on to if you feel unsteady. It’s also a good idea to talk to your doctor about any exercise-related concerns. Don’t engage in anything that feels overly uncomfortable.
Here are four balance exercises for older adults:
1. Stand on one foot. We’ll start off simple. Find a sturdy chair to stand behind and hold on to for balance. Lift one foot up and hold it for 10 seconds. Repeat this 10 to 15 times, then switch and do the same thing with the other leg. It may be easier to stand on one leg than the other – this is totally normal. Once you perfect this move, try reaching your raised foot as far as you can out to the front.
2. Walk heel to toe. Start by putting one heel in front of the toes of your other foot. You want your feet to touch. If they can’t touch, get them as close as you comfortably can. Choose a spot in front of you to focus on. Start walking, putting one heel in front of the toes on your other foot. Walk 20 steps like this, staring at your spot for balance.
3. Rock from side to side. For this exercise, begin by placing your feet hip width apart, pressing into the ground with the same force in each foot. Slowly transfer your weight to one side, lifting the opposite foot. Hold it up for for 20-30 seconds. Transfer the weight back into both feet and repeat on the other side. Repeat this process five times on both legs.
4. Balance walk. Pretend you’re a tightrope walker in the circus. Raise your arms out to your sides, parallel to the floor. Choose a spot ahead to focus on and walk towards. Start walking in a straight line. As you walk, lift your back leg up and hold it for a few seconds. Repeat this while alternating legs, walking 20 steps.
As your balance gets better, you can modify these exercises to make them more difficult. To challenge yourself, try holding onto the chair with only one hand. With time, try holding on with only one finger and, finally, with no hands. Once you’re steady on your feet, try doing the exercise with your eyes closed.
As you age, it’s important that you are able to balance well. Steady balance is essential to avoiding dangerous falls. Start small, doing a few repetitions of these exercises every couple days, gradually allowing your coordination to get better. Staying active will help keep you or your senior loved one’s body and mind healthy and happy.
Start using these balance exercises for fall prevention today.
Questions? Feel free to call us at 858-792-1124 or email us at email@example.com today
If arthritis is limiting your activities, a physical therapist can help.
A physical therapist (PT) can help you get moving safely and effectively. Physical therapists are licensed professionals with graduate degrees and clinical experience who examine, diagnose and treat or help prevent conditions that limit the body's ability to move and function in daily life, according to the American Physical Therapy Association (APTA).
Physical therapy focuses on the body’s ability to engage in movement. Movement can be anything from getting in and out of chairs to climbing stairs, walking in your neighborhood, playing a sport or doing recreational activities.
Goals of physical therapy in arthritis include improving the mobility and restoring the use of affected joints, increasing strength to support the joints, and maintaining fitness and the ability to perform daily activities.
What Can a Physical Therapist Do for You?
Develop an individualized plan of exercises to improve flexibility, strength, coordination and balance to achieve optimal physical function.
The goal of a physical therapy session is to teach you how to do things in your treatment plan – such as performing certain exercises, or how to best use hot/cold compresses – for yourself. The visits are often short and focus on identifying problems with your physical function and giving strategies for care that you can do at home.
The key to a successful outcome is learning the exercises from a physical therapist and practicing them at home over the long term. Improvement is gradual – the body gets stronger and more adept slowly over time – so consistent practice is essential.
When visiting the PT, think clearly about what your complaint is and what you would like to be able to do after physical therapy. Your goal can be getting in and out of your car without pain, raising up on your toes or raising your arms to reach items in your kitchen cabinets, taking a walk or performing your job without pain in the hips, knees and feet. Your PT can then work with you to develop a plan that is right for you to achieve your goals.
Preoperative Physical Therapy Results in 'Significant' Reduction in Postoperative Care Use for Patients Undergoing Hip or Knee Replacement
A new study has found that as few as 1 to 2 sessions of preoperative physical therapy can reduce postoperative care use by 29% for patients undergoing total hip or knee replacement, adding up to health care cost savings of more than $1,000 per individual.
Researchers in Ohio reviewed 4,733 Medicare cases involving total hip or knee replacement from a combination of 169 rural and urban hospitals with wide geographic distribution, and found that 79.7% percent of patients who did not receive preoperative physical therapy required postacute care services. That rate dropped to 54.2% for patients who received even a small number of physical therapy sessions before surgery. The study was e-published ahead of print in the Journal of Bone and Joint Surgery (abstract only available for free).
After adjusting for demographic variables and comorbidities, the study's authors estimated a 29% reduction in postoperative care use among the preoperative physical therapy group, which translated into adjusted cost reductions of $1,215 "driven largely by reduced payments for skilled nursing facility and home health agency care."
Patients with at least 1 billed encounter using CPT codes designating physical therapy evaluation or self-care/home management training were included in the preoperative group, providing they had received the service within 30 days of their surgeries.
Researchers believe that the benefit of preoperative physical therapy was derived mostly from the way it prepared patients for postoperative rehabilitation. In most instances studied, they write, preoperative physical therapy was limited to 1 or 2 sessions, which "suggests that the value of preoperative physical therapy was primarily due to patient training on postoperative assistive walking devices, planning for recovery, and managing patient expectations, and not from multiple intensive training sessions to develop strength and range of motion."
"Our study demonstrates a significant reduction in postacute care use associated with the use of physical therapy during the preoperative period for total joint replacement surgery," authors write, adding that in settings where replacement surgery has been recommended by an orthopedic surgeon, "physical therapy appears to provide value within the structure of a standardized preoperative joint replacement education and planning program in which physical therapists may play an important role."
While researchers acknowledge that more work needs to be done to pinpoint the best way to balance resource allocation between pre- and postoperative activities, they cite the current study's findings as a good first step in refining new models of care.
"As payments in health care move from a fee-for-service basis to more global payments that require some risk sharing by providers," authors write, "the ability to manage populations across the continuum to high-quality outcomes at low cost will be imperative."
Kenneth Mauck, MPT, MS , Manual Therapy Expert