Posts tagged general physical therapy
What matters most to patients during their Physical Therapy sessions?

At our Physical Therapy practice in Boulder we place an emphasis on allowing each patient an interrupted, one on one, 60 minute session to tell their story. We feel this patient centered approach is critical to gaining a thorough understanding of the patient’s symptoms and their impact on the patient’s life This method is associated with patient’s receiving the care they need compared to the care clinicians think they require.

Throughout the medical research clear communication delivered in an uninterrupted environment initiates the therapeutic alliance between patient and provider. The therapeutic alliance has been shown to impact treatment adherence and health care outcomes across a wide range of medical disciplines including Physical Therapy. A recent research study examines what aspects of the Physical Therapy initial encounter and therapeutic alliance are most important to the patient.

Stenner and colleagues investigated 15 pairs of patients and Physical Therapists to determine which aspects of the Physical Therapy treatment are most important to the patient (Musculoskelet Sci Pract. 2018). Authors reported patients focused on three themes including clear examination and treatment plans, information and understanding, and a collaborative relationship (therapeutic alliance). Researchers emphasized the importance of communication to both elicit and address issues important to the patient. In turn, uninterrupted, effective communication facilitated positive patient experiences and outcomes.

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Cuing for Optimal Spine and Hip Motion During Lifting Tasks

In our Boulder Physical Therapy practice, individualized, progressive exercise is an essential part of each patient’s recovery.   Teaching correct exercise technique often requires both tactile and verbal cues.   Specifically in the lower body we cue to both improve the relative motions at the spine and hips to optimize movements for pain reduction, strength development, and improving sports or task performance.  Commonly, in patients with lower quarter pain we see an increase in spinal contributions and a decrease in hip contributions during lifting tasks. 

A recent study examined the best cuing method for optimizing these movement contributors during a lifting task.  Beach and colleagues analyzed the biomechanical movements of 24 volunteers during a lifting task (Electromyography and Kinesiology. 2017).  During subsequent lifting tasks participants were instructed to lift "without using your lower back" or "with your legs instead of your lower back".  Biomechanical data was collected and compared during the 3 movement tasks.  The authors concluded spine focused cuing, without your lower back, was more effective at reducing spinal contributions to the task compared with leg focused cuing.  


Choosing Physical Therapy First For Low Back Pain Saves $1500 Per Episode Of Care
boulder-low back-pain-treatment

In previous blog posts, we have described the clinical and financial benefits of seeing a Physical Therapist first for treatment of neck or low back pain.  Patients who choose Physical Therapy first experience accelerated recoveries with decreased pain and recurrence rates compared to other providers.  In addition to the clinical benefits, this patient group is also less likely to undergo unnecessary, expensive, and risky interventions such as imaging, injections, and opioid medications.  Taken together patients seen by Physical Therapists first spend significantly less for the same or better recovery compared to other providers.

A recent article in the Journal of Orthopedic and Sports Physical Therapy followed 600 patients with either neck or low back pain to determine the cost and clinical effectiveness of seeing a Physical Therapist or Primary Care Physician for their care  (Denninger et al. 2017).  Authors reported patients see by direct access or patient self referral to Physical Therapy services spend on average $1543 less than those seen by a primary care physician.  Importantly, both groups demonstrated similar improvements in pain and disability.  This study highlights, the cost savings patients can experience if they choose Physical Therapy first for both their neck and low back pain.

Patients Who Seek Care from Physical Therapists Are Less Likely To Use Opiates

Some of the highest quality Physical Therapy research details the effectiveness of our profession treating patients with neck pain.  Patients can expect an accelerated recovery with less short and long term pain if they see a Physical Therapist for their neck symptoms.  In addition, Physical Therapy interventions including manual therapy and exercise are about 1/3 the cost of seeing a primary care physician first for neck pain.  Recent research is also highlighting other important benefits of seeing a Physical Therapist first for neck pain.

Researchers from Duke University analyzed 1700 patients with neck pain to determine which interventions and providers they utilized during their course of care (Horn et al. Proceedings: Innovations, Quality, and Outcomes).  The authors reported patients chose to see either their Physical Therapist, primary care physician, specialist, or chiropractor as the first provider in their care.  Patients seen by a Physical Therapist first were less likely to receive opioid medication in the first year after the onset of their symptoms.  In addition, these patients were less likely to use more expensive, risky, and invasive procedures for their neck pain including injections compared to patients seen by physicians.

This study highlights the importance of patient self referral to Physical Therapy for neck pain symptoms. 

Are Patients and Clinicians Following The Evidence Before Back Surgery

We have written previously on the limitations of back surgery to reduce pain, disability, and improve function in patients with back pain.  The mismanagement of low back pain, including unnecessary surgery, can often be traced back to a clinician practicing outside of evidence based clinical guidelines.  This unwarranted practice variation leads to higher health care costs due to unnecessary imaging, medication use (opiates), and medical procedures.

A recent article in The Spine Journal examined which activities and treatments are performed by patients and clinicians before consultation with a spinal surgeon and if these activities and treatments are consistent with the most up to date practice guidelines (Layne et al. 2017).  Authors studied 229 patients who were referred for an initial surgical consult for their spinal condition.  Not surprising, 74% of patients received medication with close to half of these patients receiving opiates for their low back pain.  Interestingly, patients who had the highest pain, disability, and lowest function utilized the greatest amount of medications while the patients with the lowest pain and disability performed the recommended amounts of exercise. 

The authors concluded many evidence based treatments for low back pain, including Physical Therapy, were not taken advantage of prior to a spinal surgery consultation.  Early, evidence based treatments for low back pain may prevent the need for surgical intervention and limit the amount of patient deterioration occurring while waiting for a surgical consultation.

Early Improvements in Low Back Pain Predict Long Term Improvements

In our Boulder Physical Therapy practice we aim to help accelerate a patient's recovery by optimizing outcomes in fewer visits.  Consistent with the medical evidence, manual therapy in our practice rapidly reduces a patient's pain allowing them to resume normal activities and exercise often in 1-2 visits.  As clinicians, we know this rapid improvement is important not only because it positively impacts a patient's symptoms but also because it strengths the clinician's reasoning process on the appropriateness of a given treatment intervention.  Previous research has highlighted the importance of these early changes and a new article sheds light on how early changes in symptoms can help predict future change.

Cook and colleagues retrospectively examined patients with low back pain who received two weeks of Physical Therapist directed manual therapy (Physiother Theory Pract. 2017).  Patients were followed up to 6 months to determine if early changes in a patient's pain helped predict who improved the most at 6 months.  The authors reported patients whose pain dropped by 1/3 at 2 weeks were 5-7 times more likely to have reduce pain and disability at 6 months.  Patients whose pain dropped by greater than 50% in first two weeks had similar success at 6 months.  This study supports the re assessment of low back pain patients to help predict long term reductions in pain and disability.